A Novel Type of Aspiration Presenting With Acute Respiratory Failure Caused by Upper Airway Obstruction Due to Diaper Pica.

We herein report an extremely rare case of acute respiratory failure due to pica of the high-molecular-weight polymers in a diaper (HMWPD). An 81-year-old woman was admitted to our hospital because of dyspnea. Several hours earlier, the facility staff saw her tearing the diaper and eating it. And several hours later, the staff found her complaining of dyspnea. Her chest computed tomography revealed airway foreign bodies. Immediately, flexible bronchoscopy was performed. The trachea and the bilateral bronchi were filled with the HMWPD. We tried to grasp the HMWPD with various common instruments, but the HMWPD could not be grasped. Finally, we performed direct bronchoscopic suction. All the HMWPD were removed successfully. The HMWPD have hygroscopic property resulting in volume expansion and the fatal consequence of upper airway obstruction. Physicians working in an emergency department should be aware of this acute respiratory failure due to diaper pica and its effective treatment.

Successful Treatment of Antifungal Combination Therapy with Inhaled Liposomal Amphotericin B and Oral Voriconazole for Intractable Chronic Progressive Pulmonary Aspergillosis.

We experienced a case of the successful treatment of intractable pulmonary aspergillosis with inhaled liposomal amphotericin B (L-AMB) and oral voriconazole (VRCZ). A 52-year-old man was admitted to our hospital with a fever. Chest computed tomography (CT) revealed an infiltrative shadow. Two separate sputum cultures detected Aspergillus niger. Although we treated the patient with single and combined antifungal agents, the infiltrative shadow worsened. After obtaining sufficient informed consent from the patient, we switched him to an inhaled L-AMB. The infiltrative shadow subsequently improved. The patient has remained well for one year without exacerbation. We herein report the usefulness of inhaled L-AMB and oral VRCZ.

Spatial and temporal requirement of defective proventriculus activity during Drosophila midgut development.

The Drosophila middle midgut cells derived from the endoderm develop into four distinct types of cell. Of these cells, copper cells have invaginated microvillar membranes on their apical surface, and they are involved in two distinct functions, i.e., copper absorption and acid secretion. The homeobox gene defective proventriculus (dve) is expressed in the midgut, and two transcripts, type A (∼4.9kb) and type B (∼3.5kb), have been identified. We isolated the deletion allele dve(E181) that completely removes the first exon for type-A (dve-A) transcript. Dve expression pattern in dve-A mutant background indicates that isoform switching is dynamically regulated in a cell-type specific manner. Using RNAi for dve-A, we examined spatial and temporal requirement of the Dve-A activity. Early Dve-A activity is required to repress isoform switching in copper cells, and for establishment of two gut functions. Late Dve-A activity in copper cells, but not in adjacent interstitial cells, is required for acid secretion, while the activity is redundantly required in both cells for the copper absorptive function. Furthermore, ectopic type-B expression in larval copper cells specifically impaired the copper absorptive function. These results provide insight into molecular mechanisms to establish functional specificity.