The analysis of lung sounds in infants and children with a history of wheezing/asthma using an automatic procedure.

BACKGROUND: Lung sound analysis parameters have been reported to be useful biomarkers for evaluating airway condition. We developed an automatic lung sound analysis software program for infants and children based on lung sound spectral curves of frequency and power by leveraging machine learning (ML) technology. METHODS: To put this software program into clinical practice, in Study 1, the reliability and reproducibility of the software program using data from younger children were examined. In Study 2, the relationship between lung sound parameters and respiratory flow (L/s) was evaluated using data from older children. In Study 3, we conducted a survey using the ATS-DLD questionnaire to evaluate the clinical usefulness. The survey focused on the history of wheezing and allergies, among healthy 3-year-old infants, and then measured lung sounds. The clinical usefulness was evaluated by comparing the questionnaire results with the results of the new lung sound parameters. RESULTS: In Studies 1 and 2, the parameters of the new software program demonstrated excellent reproducibility and reliability, and were not affected by airflow (L/s). In Study 3, infants with a history of wheezing showed lower FAP0 and RPF75p (p < 0.001 and p = 0.025, respectively) and higher PAP0 (p = 0.001) than healthy infants. Furthermore, infants with asthma/asthma-like bronchitis showed lower FAP0 (p = 0.002) and higher PAP0 (p = 0.001) than healthy infants. CONCLUSIONS: Lung sound parameters obtained using the ML algorithm were able to accurately assess the respiratory condition of infants. These parameters are useful for the early detection and intervention of childhood asthma.

Polarization control by modulated photonic-crystal lasers.

Modulated photonic-crystal lasers can control the output beam direction two-dimensionally by exciting a two-dimensional cavity mode at the non-diffractive photonic band-edge and diffracting the mode upwards with position modulation of each air hole. In these lasers, the position modulation can be introduced one-directionally, where the modulation is given by the distances between the air holes, or two-directionally, where the modulation is given by the rotation angles of the air holes. For one-directional position modulation, we show that the polarization of output beams is perpendicular to the direction of modulation. For two-directional position modulation, we show that circularly polarized beams are obtained. As such, these lasers can control not only the beam direction but also the polarization.

Molecular detection of lymph node metastases in breast cancer patients: results of a multicenter trial using the one-step nucleic acid amplification assay.

PURPOSE: Accurate assessment of metastasis in sentinel lymph nodes (SLN) of breast cancer is important but involves a heavy workload for the pathologist. We conducted a multicenter clinical trial in Japan to evaluate a new automated assay system for cytokeratin 19 mRNA, the one-step nucleic acid amplification (OSNA) assay (Sysmex), to detect lymph node metastasis of breast cancer. EXPERIMENTAL DESIGN: Surgically obtained axillary lymph nodes were sectioned into four pieces, two of which were examined with the OSNA assay. The other two adjacent pieces were examined with H&E and immunohistochemical staining for cytokeratin 19. Serial sections at 0.2-mm intervals were used in trial 1 to determine the specificity of the OSNA assay, and three pairs of sections cut from the sliced surfaces of the pieces were used in trial 2 to compare the accuracy of the OSNA assay with that of a routine pathologic examination for SLNs in Japan. RESULTS: In trial 1, the sensitivity and specificity were 95.0% [95% confidence interval (95% CI), 75.1-99.9%] and 97.1% (95% CI, 91.8-99.4%), respectively, for 124 axillary lymph nodes obtained from 34 patients. In trial 2, the agreement between findings of the assay and of the pathologic examination was 92.9% (95% CI, 90.1-95.1%) for 450 axillary lymph nodes obtained from 164 patients. CONCLUSION: The OSNA assay can detect lymph node metastasis as accurately as can conventional pathology and thus can be an effective addition to or alternative for rapid intraoperative examination of SLNs.

A foreign body granuloma after gastric perforation mimicking peritoneal dissemination of gastric cancer: report of a case.

This report presents the case of a 58-year-old man who was found to have foreign body granulomas (FBGs) that mimicked disseminated gastric cancer. The patient presented with a severe attack of acute upper abdominal pain, was admitted to the hospital, and thereafter underwent an immediate laparotomy due to a diagnosis of an upper gastrointestinal perforation. Follow-up endoscopy revealed an ulcer scar measuring 2 cm in size in the anterior wall of the middle stomach. The pathological examination of biopsy specimens taken around the scar revealed well to poorly differentiated adenocarcinoma. At the time of reoperation performed 2 months after the first operation, many small white granulomas were observed which were thought to be the result of peritoneal dissemination of the gastric cancer. However, both the cytology of the Douglas washing and pathological examination of frozen section specimens were negative for carcinoma, and therefore a distal gastrectomy was performed. The pathological examination revealed the presence of FBGs. In this rare case, the FBGs formed shortly after surgery and were difficult to distinguish from disseminated cancer.

Spread of Intraductal Papillary Neoplasm Arising from the Cystic Duct of the Biliary Tree.

Intraductal papillary neoplasm of the bile duct (IPNB) is a variant type of the bile duct carcinoma characterized by intraductal growth. IPNB is also recognized as a precursor of invasive carcinoma. We describe herein an extremely rare case of IPNB arising from the cystic duct. A 68-year-old man was admitted to our hospital for investigation of epigastralgia and abnormal levels of biliary tract enzyme. Computed tomography and magnetic resonance imaging showed a mass lesion spreading from the cystic duct to the upper-middle bile duct. Endoscopic retrograde cholangiography demonstrated diffuse duct dilation with a grossly visible intraductal mass and amorphous blobs, suggesting the presence of mucobilia or scattered tumors. We performed extrahepatic bile duct resection with lymphadenectomy. Macroscopically, a friable papillary tumor originated from the cystic duct grows intraluminally into the bile duct. Pathologically, the tumor was found to be intramucosal adenocarcinoma spreading to the whole extrahepatic bile duct, which was compatible with IPNB. We should discuss the features and progression processes of IPNB through this precious case.