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Pulmonary sclerosing pneumocytoma (PSP) is a rare, benign tumor. Given the challenges of a bronchoscopic diagnosis, surgery is performed during the early stages of the disease. Therefore, little is known about the growth pattern of PSP. This case of PSP was not diagnosed despite bronchoscopy, resulting in lung resection eight years after the anomaly was first identified on computed tomography (CT). This report compares the long-term follow-up of CT and pathological findings and discusses the difficulty in making a diagnosis using a bronchoscopic forceps biopsy to aid in future PSP diagnoses and treatment planning.
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PURPOSE: To create an equation for identifying post-myopic laser vision correction (M-LVC) eyes by using corneal shape parameters in swept-source optical coherence tomography (SS-OCT) biometer and verify its accuracy. SETTING: Nagoya eye clinic, Nagoya, Japan. DESIGN: Retrospective evaluation of a screening approach. METHODS: The control participants were selected retrospectively from patients who visited our clinic for cataract surgery or refractive surgery. M-LVC patients were selected retrospectively from patients who visited our clinic for cataract surgery or M-LVC postoperative checkups. The control and post-M-LVC patients with keratometric values between 39 diopters (D) and 43 D were included in the final analysis. Patients were randomly assigned to equation-creation and validation groups in a 2:1 ratio. To discriminate post-M-LVC patients from control participants, multiple logistic regression analysis was performed with the corneal shape parameters from the optical biometer as independent variables. RESULTS: The M-LVC and control groups consisted of 90 eyes from 90 patients and 97 eyes from 97 patients, respectively. The average keratometry (Ave-K) values did not differ significantly between the control and M-LVC groups (p=0.187). The multiple logistic analysis identified the asymmetry component (regression coefficient, 5.357; odds ratio, 212.158) and corneal eccentricity index (regression coefficient, -5.088; odds ratio, 0.006) as explanatory variables. The area under the receiver operating characteristic curve in the predictive equation-creation group was 0.946. The sensitivity and specificity in the validation group were 93.3% and 87.5%, respectively. CONCLUSIONS: The M-LVC discriminant prediction equation with the topography-equipped SS-OCT biometer was effective in detecting post-M-LVC eyes with high accuracy.
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We performed a systematic review of studies that compared beta-lactams vs. beta-lactams plus aminoglycosides for the treatment of febrile neutropenia in cancer patients. METHOD: We searched CENTRAL, MEDLINE, and Embase for studies published up to October 2023, and randomized controlled trials (RCTs) that compared anti-Pseudomonas aeruginosa beta-lactam monotherapy with any combination of an anti-Pseudomonas aeruginosa beta-lactam and an aminoglycoside were included. RESULT: The all-cause mortality rate of combination therapy showed no significant differences compared with that of monotherapy (RR 0.99, 95% CI 0.84 to 1.16, high certainty of evidence). Infection-related mortality rates showed that combination therapy had a small positive impact compared with the intervention with monotherapy (RR 0.83, 95% CI 0.66 to 1.05, high certainty of evidence). Regarding treatment failure, combination therapy showed no significant differences compared with monotherapy (RR 0.99, 95% CI 0.94 to 1.03, low certainty of evidence). In the sensitivity analysis, the treatment failure data published between 2010 and 2019 showed better outcomes in the same beta-lactam group (RR 1.10 [95% CI, 1.01-1.19]). Renal failure was more frequent with combination therapy of any daily dosing regimen (RR 0.46, 95% CI 0.36 to 0.60, high certainty of evidence). CONCLUSION: We found combining aminoglycosides with a narrow-spectrum beta-lactam did not spare the use of broad-spectrum antibiotics. Few studies included antibiotic-resistant bacteria and a detailed investigation of aminoglycoside serum levels, and studies that combined the same beta-lactams showed only a minimal impact with the combination therapy. In the future, studies that include the profile of antibiotic-resistant bacteria and the monitoring of serum aminoglycoside levels will be required.
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BACKGROUND Shewanella spp. are gram-negative facultative anaerobic, oxidase-positive, motile bacilli that are ubiquitous but commonly occur in seawater and can cause opportunistic infection. Reports on the risk factors for Shewanella infection, its severity, antibiotic susceptibility, and prognosis are limited. This report is of a 78-year-old man with alcoholic cirrhosis presenting with bacteremia and empyema due to infection with Shewanella spp. CASE REPORT A 78-year-old man with alcoholic cirrhosis (Child-Pugh B) presented to our emergency room with a high fever. He had eaten raw fish one week prior to admission. Chest computed tomography showed a right unilateral pleural effusion, and he was hospitalized with suspected empyema. Shewanella spp. was detected in the pleural effusion and blood cultures. We initiated piperacillin/tazobactam and vancomycin empirically and switched to ceftriaxone; the effusion was successfully treated using antibiotics and pleural drainage. However, on hospitalization day 53, the patient died of aspiration pneumonia. In our literature review, we extracted 125 reported cases (including our case) and found that men were disproportionately affected (81%); median age was 61.6 (56-75) years; underlying diseases included hepatobiliary disease (33%), malignancy (25%), and cardiac disease (24%); Shewanella spp. infection sites were skin and soft tissue (35%), respiratory system (18%), and hepatobiliary system (11%); and management included antibiotics (100%), drainage (16%), and debridement (16%). The survival rate was 74% with antibiotics alone. CONCLUSIONS Our case highlights that clinicians should recognize Shewanella spp. as a cause of empyema and bacteremia in patients with liver cirrhosis, and that microbiological diagnosis with antibiotic sensitivity testing and treatment should be undertaken urgently to prevent fatal sepsis.
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Bacteriemia , Empiema , Derrame Pleural , Shewanella , Idoso , Animais , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Cirrose Hepática Alcoólica/complicações , Feminino , Microbiologia de Alimentos , Peixes/microbiologiaRESUMO
Refractory pneumothorax associated with interstitial lung disease (ILD) remains a challenging condition due to the patient's tolerability and lung compliance that restrict the feasibility of aggressive interventions. Additionally, many cases recur after improvement with treatment, and reports of successful management for this complicated condition are limited. Herein, we report the case of a 60-year-old man with ILD, utilizing home oxygen therapy, who experienced a successful recovery from a surgical intervention under local anaesthesia for pneumothorax. This case highlights the potential for operative intervention under local anaesthesia as a viable option for patients who do not respond to internal approaches.
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Three thioflavin T (ThT) derivatives, namely ThT/ethylenediaminetetraacetic acid conjugates (E1T, E2T, and E1T1P), were designed and synthesized as sensing components for divalent metal ion detection. Furthermore, these ThT derivatives were used to design lantern-type G-quadruplex (G4) fluorescent sensors. The fluorescence intensities of the ThT derivatives decreased by 1.2- to 5.6-folds in the presence of Ni2+ and Cu2+, respectively, regardless of the topology of the utilized G4. Conversely, when Mn2+ and Zn2+ coexisted in antiparallel G4, the fluorescence intensities of E2T increased to approximately 3.3- and 2.3-folds, respectively, depending on the concentration of the divalent metal ion, allowing for quantitative analyses. The Job plot analysis revealed that the binding ratio of G4 and E2T changed from 2:1 to 1:2 with the increasing concentration of the divalent metal ions. These results indicated that the basic principle of such a lantern-type G4 sensor can be applied to the detection of divalent metal ions and other types of targets, such as proteins, and small molecules via ThT derivatization.
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BACKGROUND: Empyema necessitans (EN) is a rare condition characterized by pleural infection with pus spreading into adjacent soft tissues. Although Mycobacterium tuberculosis and Actinomyces israelii are common causative agents, methicillin-resistant Staphylococcus aureus (MRSA) is relatively rare, but it is associated with high mortality in empyema cases. We aimed to report a unique case of EN caused by MRSA and present a literature review to better understand this rare condition. CASE PRESENTATION: A 69-year-old man with a history of right ureteral stone presented with fever and left anterior thoracic pain. A physical examination revealed redness and swelling in the left thoracic region. Imaging studies confirmed EN with fluid accumulation around the sternocostal joint of the left first rib. MRSA was identified from blood and pleural fluid cultures. The patient received antimicrobial therapy, and a chest tube was inserted for drainage. Despite initial improvement, vertebral osteomyelitis was diagnosed on day 17. The antimicrobials were subsequently terminated after 6 weeks, but vertebral osteomyelitis recurred, and treatment was resumed and completed on day 215. CONCLUSION: EN caused by MRSA is rare, and the literature review revealed 14 cases from human sources. Positive blood cultures were observed in 40% of cases, and metastatic infections were present in 30% of cases. Osteomyelitis was the most common type of metastatic lesion. All the patients underwent drainage. Patients with MRSA-associated EN frequently develop disseminated lesions and should therefore be carefully examined. Moreover, appropriate treatment with antibiotics and drainage is necessary for a good prognosis. Although the prognosis appeared to be favorable in our review, publication bias and treatment challenges for metastatic infections should be considered.
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Anti-Infecciosos , Empiema , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Infecções Estafilocócicas , Masculino , Humanos , Idoso , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Antibacterianos/uso terapêutico , Empiema/tratamento farmacológico , Osteomielite/microbiologiaRESUMO
In a routine medical check-up, a healthy man in his 20s was found to have an upper left lung abnormality. Subsequent chest CT revealed the cluster sign (CS) and galaxy sign (GS). Although tests such as sputum analysis and interferon-gamma assays reduced the likelihood of tuberculosis, these abnormalities remained unchanged. A lung biopsy indicated non-caseating granuloma unrelated to tuberculosis. Initially suspected of sarcoidosis, the patient later developed fever and malaise. Follow-up CT showed CS progressing to a cavitatory shadow and GS intensification. The detection of Mycobacterium tuberculosis (M. tuberculosis) in a subsequent sputum analysis prompted treatment with antitubercular drugs, leading to symptom relief.CS and GS are usually associated with sarcoidosis but can also occur in tuberculosis, connected to slower pathogen growth and lower isolation rates. Furthermore, pulmonary tuberculosis may ultimately be present even when biopsies show non-caseating granulomas that are not typical of M. tuberculosis and sputum culture results are negative for M. tuberculosis Tuberculosis should not be ruled out lightly, and patients should be carefully followed-up.
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Pneumopatias , Mycobacterium tuberculosis , Sarcoidose , Tuberculose Pulmonar , Masculino , Humanos , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Sarcoidose/diagnóstico , Granuloma , EscarroRESUMO
To investigate sex differences in the titles and lifestyles of Japanese ophthalmologists, we evaluated work places and private lives. Retrospective cross-sectional study. The study included 1721 members (1344 males and 377 females) of the Japanese Society of Cataract and Refractive Surgery. An online, anonymized questionnaire was distributed to the society members. The questionnaire included 40 questions to collect data on profiles, lifestyles, job title, families, spouses, children, household chores, child-rearing, and work satisfaction. In total, 219 members (144 males and 75 females; 53.4â ±â 1.0 and 51.3â ±â 9.9 years old, respectively) completed the questionnaire. The job title, working time, annual income, marriage rate, and the number of children significantly differed between male and female respondents. Female respondents had greater responsibilities toward house chores, child care, and nursing, whereas several male doctors had spouses who did not work or worked for shorter times, earned a lower income, and contributed greater toward family responsibilities. Female respondents changed their job titles after having children more frequently than male respondents. Both males and females had limited time available for community activities and volunteer work. There were no significant differences in daily sleep duration. Both sexes were equally satisfied with their career choice of ophthalmology; however, fewer females recommended ophthalmology as a career for students and children compared to males. There are significant sex differences among ophthalmologists in Japan in terms of family responsibilities; this topic has received insufficient attention.
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Catarata , Oftalmologia , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Japão , Caracteres Sexuais , Estudos Transversais , Estudos Retrospectivos , Inquéritos e Questionários , Estilo de Vida , Satisfação no EmpregoRESUMO
Background: Crizotinib has been approved for C-ros oncogene 1 (ROS1)- and anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) patients. Few studies have examined the differences in crizotinib treatment outcomes between these patients and the progression sites during treatment. We investigated the metastatic spread, crizotinib efficacy, and progression patterns during crizotinib treatment in ROS1- and ALK-rearranged NSCLC patients. Methods: We retrospectively reviewed crizotinib-treated ROS1- and ALK-rearranged NSCLC patients between January 2011 and March 2021. Patient characteristics, clinical outcomes, and progression patterns during treatment were collected from medical records. The metastasis extent, crizotinib response, and progression patterns between the groups were compared. Results: We identified 26 patients with ROS1- and 42 with ALK-positive NSCLC. The baseline proportion of central nervous system (CNS) metastases did not differ between the groups (12% vs. 29%, P=0.10), but the proportion of extrathoracic metastases, including CNS metastases, was significantly higher in ALK-positive than in ROS1-positive NSCLC patients (35% vs. 71%, P=0.003). Regarding the response to crizotinib, the objective response rate (ORR), progression-free survival (PFS), or overall survival (OS) did not significantly differ between the groups (ROS1 vs. ALK, ORR: 69% vs. 69%, P=0.987; PFS: median 10.9 vs. 10.7 months, P=0.232; median OS: not reached vs. 67.7 months, P=0.495). The CNS was the most common metastasis site in both groups [ROS1 vs. ALK, 69% (11/16) vs. 46% (17/37), P=0.127], and the cumulative incidence of CNS metastasis did not differ between the groups (P=0.914). Conclusions: Crizotinib treatment outcomes, including progression patterns, were similar between ROS1- and ALK-positive NSCLC patients.
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Purpose: To evaluate the efficacy of YOUSOFT soft contact lenses in correcting irregular astigmatism and prescription results of patients with keratoconus. Patients and Methods: The retrospective observational study included 55 eyes (mean age, 32.2 ± 10.6 years; 36 men and 6 women) of 42 patients with keratoconus who tried YOUSOFT for rigid gas permeable (RGP) lens intolerance. Average keratometry, corneal astigmatism, and maximum keratometry were 49.4 ± 5.2 diopters (D), 3.7 ± 2.1 D, and 57.3 ± 8.2 D, respectively. Patients were divided into YOUSOFT prescription and non-prescription cases, wherein the prescription rates were calculated. YOUSOFT visual acuity was compared with spectacle-corrected distance visual acuity (CDVA) and RGP lens-CDVA. Results: YOUSOFT was prescribed to 28 out of 42 patients (prescription rate 67%). In the YOUSOFT prescription cases, YOUSOFT-CDVA (logMAR -0.04; 95% confidence interval [CI]: -0.08 to 0.00) was significantly better than spectacle-CDVA (logMAR 0.23; 95% CI: 0.08 to 0.38; P < 0.0001), whereas YOUSOFT-CDVA (logMAR -0.03; 95% CI: -0.08 to 0.03) did not significantly differ from the RGP lens-CDVA (logMAR -0.02; 95% CI: -0.08 to 0.04; P = 0.856). Conclusion: YOUSOFT was effective in correcting irregular corneal astigmatism, suggesting that it is highly effective in patients with RGP lens intolerance.
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PURPOSE: To evaluate the long-term (8-10 years) outcomes of toric implantable collamer lens (TICL) surgery. SETTING: Nagoya Eye Clinic, Nagoya, Aichi, Japan. DESIGN: Retrospective observational study. METHODS: Patients who underwent TICL surgery from 2005 to 2009 to correct myopia and myopic astigmatism were enrolled. The safety, efficacy, predictability, astigmatism correction efficacy, and complications were evaluated using preoperative, 1-year postoperative, and final examination data. RESULTS: 133 eyes of 77 patients were included. At the final visit, the mean uncorrected and corrected visual acuities were -0.01 ± 0.2 and -0.17 ± 0.05, respectively. The mean safety and efficacy indices were 0.91 ± 0.26 and 0.68 ± 0.21, respectively. The manifest astigmatism was -0.45 ± 0.43 diopters (D). The mean corneal astigmatism change from 1 year postoperatively to the final visit was 0.40 ± 0.26 D. Of the 38 eyes with a change in corneal astigmatism ≥0.5 D, 30 eyes (78.9%) changed to against-the-rule (ATR) astigmatism, 1 (2.6%) changed to oblique astigmatism, and 7 (18.4%) changed to with-the-rule (WTR) astigmatism. The mean manifest astigmatism change from 1 year postoperatively to the final visit was 0.43 ± 0.52 D. Of the 60 eyes with a change in manifest astigmatism ≥0.5 D, 25 (41.7%) changed to ATR astigmatism, 18 (30.0%) changed to oblique astigmatism, and 17 (28.3%) changed to WTR astigmatism. During follow-up, 8 (6.0%) of 133 eyes developed anterior subcapsular cataracts, among which 4 (3.0%) underwent TICL removal and phacoemulsification and aspiration. No vision-threatening complications occurred. CONCLUSIONS: TICL surgery showed good long-term astigmatism-correcting effects, although the long-term uncorrected visual acuity decreased. The procedure was effective in correcting myopia and astigmatism.
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Astigmatismo , Doenças da Córnea , Miopia , Lentes Intraoculares Fácicas , Humanos , Refração Ocular , Astigmatismo/cirurgia , Astigmatismo/complicações , Implante de Lente Intraocular , Miopia/cirurgia , Miopia/complicações , Doenças da Córnea/cirurgia , Resultado do TratamentoRESUMO
Introduction Reports are rare on the usefulness of the FilmArray Respiratory Panel 2.1 (FARP) using lower respiratory tract specimens. This retrospective study assessed its use, as part of a comprehensive infectious disease panel, to detect the viral causes of pneumonia using bronchoalveolar lavage samples from immunosuppressed patients. Methods This study included immunocompromised patients who underwent bronchoalveolar lavage or bronchial washing by bronchoscopy between April 1, 2021, and April 30, 2022. The collected samples were submitted for comprehensive testing, including FARP test; reverse transcription polymerase chain reaction (RT-PCR) for cytomegalovirus, varicella-zoster virus DNA, and herpes simplex virus; PCR for Pneumocystis jirovecii DNA; antigen testing for Aspergillus and Cryptococcus neoformans; and loop-mediated isothermal amplification method for Legionella. Results Out of 23 patients, 16 (70%) showed bilateral infiltrative shadows on computed tomography and three (13%) were intubated. The most common causes of immunosuppression were anticancer drug use (n=12, 52%) and hematologic tumors (n=11, 48%). Only two (9%) patients tested positive for severe acute respiratory syndrome coronavirus 2 and adenovirus by FARP. Four patients (17%) tested positive for cytomegalovirus by RT-PCR, but no inclusion bodies were identified cytologically. Nine (39%) patients tested positive for Pneumocystis jirovecii by PCR, but cytology confirmed the organism in only one case. Conclusions Comprehensive infectious disease testing, performed using bronchoalveolar lavage samples collected from lung lesions in immunosuppressed patients, showed low positive detection by FARP. The viruses currently detectable by FARP may be less involved in viral pneumonia diagnosed in immunocompromised patients.
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A 52-year-old man developed a right pneumothorax during treatment for COVID-19. In a previous case report concerning this patient, his recovery was achieved through implanting four endobronchial Watanabe spigots (EWS) in the right B1 and B3 in two phases and spraying N-butyl-2-cyanoacrylate (NBCA). One year later, EWS removal was planned. He was intubated under bronchoscopic guidance, and the right upper lobe was observed. The right B1 and B3 inlets were found to be covered with granuloma. Despite the presence of a nylon thread for easy retrieval and partial debridement of the granulation, removal of the implanted EWS in the right B1 and B3 using grasping forceps, basket forceps, and two types of balloons under fluoroscopic guidance was challenging. NBCA spraying is a possible cause of foreign body granuloma formation. Therefore, careful consideration of the indications for the combined EWS-NBCA procedure is necessary.
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PURPOSE: To evaluate the implantable collamer lens (ICL)-sizing method using the partial regression coefficient of the implanted ICL size to review the conventional horizontal compression coefficient and match the results of clinical observation. SETTING: Nagoya Eye Clinic, Nagoya, Japan. DESIGN: Interventional case series. METHODS: Patients who underwent ICL V4c implantation to correct myopia and myopic astigmatism were enrolled. The stepwise multiple regression analysis used achieved vault as a dependent variable and preoperative biometric parameters as explanatory variables. The partial regression coefficient of the implanted ICL size was obtained to develop the optimal ICL-sizing formula, the Nakamura-Kojima formula version 3 (NK-formula V3). 85 eyes of 45 patients were implanted with an ICL size recommended by the NK-formula V3. At 3 months postoperatively, the achieved vault was measured using anterior segment optical coherence tomography to validate the NK-formula V3. RESULTS: The study enrolled 174 patients (174 eyes). The partial regression coefficient of the implanted ICL size adopted as the compression-vault coefficient in the multiple regression equation predicting the vault was 0.729. To validate the NK-formula V3, 77 (90.6%), 7 (8.2%), and 1 (1.2%) eyes were in the moderate-vault, low-vault, and high-vault categories, respectively. The mean difference between the achieved and predicted vaults was 0.064 ± 0.190 (range: -0.264 to 0.742) mm for the NK-formula V3 and 0.176 ± 0.217 (range: -0.254 to 0.907) mm for the NK-formula V2. CONCLUSIONS: As in vivo coefficient measurement experiments are not possible, the partial regression coefficient is the best option for developing a formula to predict the optimal ICL size.
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Miopia , Lentes Intraoculares Fácicas , Humanos , Acuidade Visual , Implante de Lente Intraocular/métodos , Olho , Miopia/cirurgia , Estudos RetrospectivosRESUMO
In this study, HcVGH, a method that learns spatio-temporal categories by segmenting first-person-view (FPV) videos captured by mobile robots, is proposed. Humans perceive continuous high-dimensional information by dividing and categorizing it into significant segments. This unsupervised segmentation capability is considered important for mobile robots to learn spatial knowledge. The proposed HcVGH combines a convolutional variational autoencoder (cVAE) with HVGH, a past method, which follows the hierarchical Dirichlet process-variational autoencoder-Gaussian process-hidden semi-Markov model comprising deep generative and statistical models. In the experiment, FPV videos of an agent were used in a simulated maze environment. FPV videos contain spatial information, and spatial knowledge can be learned by segmenting them. Using the FPV-video dataset, the segmentation performance of the proposed model was compared with previous models: HVGH and hierarchical recurrent state space model. The average segmentation F-measure achieved by HcVGH was 0.77; therefore, HcVGH outperformed the baseline methods. Furthermore, the experimental results showed that the parameters that represent the movability of the maze environment can be learned.
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A 49-year-old man diagnosed with metastatic non-small cell lung cancer was treated with immune checkpoint inhibitor (ICI) combination therapy (nivolumab + ipilimumab) as first-line therapy. During the treatment course, the patient developed ICI-associated diabetes mellitus and adrenal insufficiency, and insulin and hydrocortisone replacement therapy (10 mg/day) were initiated for endocrine toxicity. Despite systemic treatment, the disease progressed. Near the end of the patient's life, he was repeatedly hospitalized for diabetic ketoacidosis and adrenal crisis because he could not physically administer insulin subcutaneously or self-administer oral hydrocortisone due to the deterioration of his general condition as a result of disease progression. This case report demonstrates that it is necessary to evaluate not only the impact of immune-related adverse events on short-term quality of life during ICI treatment but also on the patient's end-of-life care.