[A Case of Pyoderma Gangrenosum of the Penis Difficult to Distinguish from Fournier Gangrene].

Here, we report a case of pyoderma gangrenosum of the penis which was difficult to distinguish from Fournier gangrene. The patient was a 54-year-old male who was aware of redness and swelling of the glanspenis for 1 month prior to a consultation at our department. Although he was diagnosed with herpes and treated at a nearby hospital, his symptoms did not improve. Subsequently, the patient visited our department following the onset of pain and fever. During his initial consultation, he had a fever of 39 °C as well as redness and swelling of the glans penis with partial spontaneous purulent discharge. His blood test revealed an elevated white blood cell count (20, 000/µl) and C-reactive protein (19.1 mg/dl). Because Fournier gangrene was suspected, administration of broad-spectrum antimicrobial agents was initiated but proved to be ineffective. An abscess (2 cm in diameter) was also noted in the umbilical region.Enterococcus faecalis was detected by the bacterial culture ; and therefore, Fournier gangrene was diagnosed. A partial penectomy was performed to control the infection. Pathological findings showed only non-specific inflammation ; however, fever persisted postoperatively and blood test results showed no improvement. Furthermore, new abscess lesions emerged on the right heel and back. Because the re-performed abscess bacterial culture test result was negative, pyoderma gangrenosum was suspected, and he was started on oral prednisolone (20 mg/day). On the following day, his fever subsided and his blood test results also showed improvement. A final diagnosis of pyoderma gangrenosum was ultimately made.

Differences in Water Dynamics between the Hydrated Chitin and Hydrated Chitosan Determined by Quasi-Elastic Neutron Scattering.

Recently, it was reported that chitin and chitosan exhibited high-proton conductivity and function as an electrolyte in fuel cells. In particular, it is noteworthy that proton conductivity in the hydrated chitin becomes 30 times higher than that in the hydrated chitosan. Since higher proton conductivity is necessary for the fuel cell electrolyte, it is significantly important to clarify the key factor for the realization of higher proton conduction from a microscopic viewpoint for the future development of fuel cells. Therefore, we have measured proton dynamics in the hydrated chitin using quasi-elastic neutron scattering (QENS) from the microscopic viewpoint and compared the proton conduction mechanism between hydrated chitin and chitosan. QENS results exhibited that a part of hydrogen atoms and hydration water in chitin are mobile even at 238 K, and the mobile hydrogen atoms and their diffusion increase with increasing temperature. It was found that the diffusion constant of mobile protons is two times larger and that the residence time is two times faster in chitin than that in chitosan. In addition, it is revealed from the experimental results that the transition process of dissociable hydrogen atoms between chitin and chitosan is different. To realize proton conduction in the hydrated chitosan, the hydrogen atoms of the hydronium ions (H3O+) should be transferred to another hydration water. By contrast, in hydrated chitin, the hydrogen atoms can transfer directly to the proton acceptors of neighboring chitin. It is deduced that higher proton conductivity in the hydrated chitin compared with that in the hydrated chitosan is yielded by the difference of diffusion constant and the residence time by hydrogen-atom dynamics and the location and number of proton acceptors.

Human T-lymphotropic virus type I (HTLV-I)-specific CD8+ cells accumulate in the lungs of patients infected with HTLV-I with pulmonary involvement.

Pulmonary involvement has been identified in human T-lymphotropic virus type I (HTLV-I) carriers and patients with HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). However, the relationship between HTLV-I infection and lung disease is poorly understood. The occurrence of HTLV-I-specific immune responses in the lungs of patients infected with HTLV-I with pulmonary involvement was investigated. The frequency of HTLV-I-specific CD8+ cells and the amount of HTLV-I proviral DNA were determined in bronchoalveolar lavage fluid cells and peripheral blood mononuclear cells (PBMCs) from five patients with HAM/TSP and one HTLV-I carrier who had pulmonary involvement. HTLV-I-specific CD8+ cells were detected by flow cytometry using human leukocyte antigen/antigen complex multimers. The analysis of bronchoalveolar lavage fluid revealed lymphocytosis in five of six patients. HTLV-I provirus was detected in the bronchoalveolar lavage fluid cells of all patients, and the proviral load in these cells was comparable to that in PBMCs. The frequency of HTLV-I-specific CD8+ cells in the bronchoalveolar lavage fluid cells was 5.1 times higher than that in PBMCs. Immunohistochemically, clusters formed by HTLV-I-specific CD8+ cells were detected in lung tissue by in situ tetramer staining. No samples were available from patients infected with HTLV-I without lung disorders. Whether accumulation of CD8+ cells is specific to patients with pulmonary involvement remains unclear. These results indicate that HTLV-I-specific CD8+ cells accumulate and HTLV-I-infected cells exist in the lungs of patients infected with HTLV-I with pulmonary involvement.

Two cases of gastrointestinal perforation after radiotherapy in patients receiving tyrosine kinase inhibitor for advanced renal cell carcinoma.

We report two cases of gastrointestinal perforation (GIP) after radiotherapy in patients receiving tyrosine kinase inhibitor (TKI) for advanced renal cell carcinoma (RCC). Case 1 was a 61-year-old woman with lung metastases after a radical nephrectomy for a right RCC (cT3aN0M0) treated with interferon-alpha (OIF, 5 MIU, three times per week). She developed lytic metastases of the left femur and the left acetabulum. She was treated with palliative radiotherapy to the metastatic portion (3 Gy × 10 fractions), and 400 mg sorafenib twice per day plus continuing interferon alpha. She experienced sudden left lower abdominal pain after four weeks of treatment, and was diagnosed with a perforation of the sigmoid colon with fecal peritonitis. Case 2 was a 48-year-old man with lung, lymph node, and bone metastases after a radical nephrectomy for a right RCC (cT2N0M0), and was treated with 400 mg sorafenib twice per day. He developed lytic bone metastases of the lumbar vertebrae, which was treated with palliative radiotherapy to L2-4 (3 Gy × 10 fractions). He experienced sudden abdominal pain after two months of radiation treatment, and was diagnosed with a perforation of the sigmoid colon with fecal peritonitis. These cases underwent radiotherapy, and therefore this may be related to the radiosensitivity of TKI.

Hydrogen Dynamics in Hydrated Chitosan by Quasi-Elastic Neutron Scattering.

Chitosan, an environmentally friendly and highly bio-producible material, is a potential proton-conducting electrolyte for use in fuel cells. Thus, to microscopically elucidate proton transport in hydrated chitosan, we employed the quasi-elastic neutron scattering (QENS) technique. QENS analysis showed that the hydration water, which was mobile even at 238 K, moved significantly more slowly than the bulk water, in addition to exhibiting jump diffusion. Furthermore, upon increasing the temperature from 238 to 283 K, the diffusion constant of water increased from 1.33 × 10-6 to 1.34 × 10-5 cm2/s. It was also found that a portion of the hydrogen atoms in chitosan undergo a jump-diffusion motion similar to that of the hydrogen present in water. Moreover, QENS analysis revealed that the activation energy for the jump-diffusion of hydrogen in chitosan and in the hydration water was 0.30 eV, which is close to the value of 0.38 eV obtained from the temperature-dependent proton conductivity results. Overall, it was deduced that a portion of the hydrogen atoms in chitosan dissociate and protonate the interacting hydration water, resulting in the chitosan exhibiting proton conductivity.

Lower skin temperature decreases maximal cycling performance.

BACKGROUND: It is known that external cooling of body regions involved in exercise, prior to exercise, decreases anaerobic performance. However, there have been no studies reporting the effects of whole body skin surface cooling before exercise on maximal anaerobic capacity. In order to clarify the effects, we compared power output during the Wingate anaerobic test between preconditioning by exposure to temperature 10 degrees C and 25 degrees C. METHODS: Eight healthy males carried out the Wingate test for 30 seconds, after pre-conditioning for 60 minutes using a perfusion suit with water at a temperature of 10 degrees C or 25 degrees C. We evaluated the peak power (PP) and peak power slope (PS) of the power output. RESULTS: Mean skin temperature (T(sk)) at 60 minutes of pre-conditioning in the 10 degrees C trial was significantly lower than in the 25 degrees C trial (p < 0.05). PP and also PS were significantly lower in the 10 degrees C trial than in the 25 degrees C trial. Changes (Δ) in PP between the 10 degrees C trial and the 25 degrees C trial were strongly correlated with ΔT(sk) and Δ in thigh and leg skin temperature (ΔT(thigh) and ΔT(leg), respectively), whereas ΔPS was strongly correlated with ΔT(sk), but not with ΔT(thigh) and ΔT(leg). CONCLUSIONS: Whole body skin surface cooling prior to exercise restricts anaerobic capacity, especially in the initial phase of exercise.

[A case of inflammatory myofibroblastic tumor of the urinary bladder].

A 61 year-old man complaining of asymptomatic gross hematuria was admitted to our hospital in May 2005. Transurethral resection of bladder tumor (TUR-BT) was performed for a bladder tumor (urothelial carcinoma (UC), pTa, G2). The TUR-BT was performed again because cystoscopy revealed a nonpapillary bladder tumor on the posterior bladder wall in September 2007. The pathological findings showed a UC, pTa, G2 and an inflammatory myofibroblastic tumor (IMT), pT1. The TUR-BT was performed two more times for tumor recurrences. We considered a total cystectomy because of the possibility of a pathologically low grade sarcoma and the considerable enlargement of the tumor size for a month after the TUR-BT. Ultimately, a malignant sarcoma was not diagnosed from the pathological findings. We practiced conservative therapy with a steroid and the tumor was reduced.

[A case of tuberculous lateral great adductor muscle abscess during treatment of miliary tuberculosis].

We report a rare case of a thigh abscess which appeared during treatment of miliary tuberculosis. A 72-year-old woman with a history of diabetes mellitus was being treated for systemic sclerosis with prednisolone. She was then admitted to our hospital with fever, and chest computed tomography showed an abnormal shadow. She was given a diagnosis of miliary tuberculosis, and antituberculous therapy was initiated with isoniazid, rifampicin, ethambutol and pyrazinamide. Although this combination of antituberculous drugs was effective, 3 months after the initiation of treatment, a collection of fluid appeared in her left thigh. Further examination revealed the fluid to be positive for Mycobacterium tuberculosis on PCR and negative on mycobacterial culture. We thus diagnosed this phenomenon to be a paradoxical reaction.

Effect of oral administration of GABA on temperature regulation in humans during rest and exercise at high ambient temperature.

BACKGROUND: Centric administration of gamma-aminobutyric acid (GABA) has been implicated to affect temperature regulation in animals during rest or under anesthesia. However, there are few reports concerning the effects of the oral administration of GABA on temperature regulation in humans during rest and exercise. In order to clarify the effects and underlying mechanisms, we measured several parameters related to temperature regulation of humans during rest and exercise at high ambient temperature (35 degrees C). METHODS: On two occasions, eight endurance-trained men rested for 20 min and cycled at 65% VO2peak for 30 min. In control trial (trial-C), subjects drank the sample which was a sports drink of 200 mL (placebo) before the rest period. In another trial (trial-G), subjects drank the sample which was a sports drink containing 1000 mg of GABA (GABA drink) before the rest period. RESULTS: In trial-G, the plasma GABA concentrations were maintained higher than those in trial-C during the experiment. An increase of esophageal temperature during rest and exercise was inhibited in trial-G. Sweat rate, and plasma catecholamine concentrations during exercise were inhibited in trial-G. CONCLUSIONS: Esophageal temperature inhibition is suggested to be induced by the suppression of cold-sensitive neurons during rest, and the inhibition of plasma catecholamine concentrations caused by the GABA-induced attenuation of the sympathetic nervous system during exercise.

[Successful lobectomy in 3 lung cancer cases with severe COPD after treatment with tiotropium bromide].

It is well known that lung cancer patients with severe chronic obstructive pulmonary disease (COPD) have a higher risk of postoperative complications than patients without COPD. However, the information regarding preoperative treatment to improve pulmonary function of the lung cancer patients with severe COPD is limited. Here, we report 3 lung cancer cases with severe COPD. Although all patients received medication without tiotropium bromide in combination with pulmonary rehabilitation for 1 or 2 months, their pulmonary function did not improve and the predicted postoperative FEV1/predicted FEV1 was below 40% in all cases. After the approval in Japan for use of tiotropium bromide in the treatment of COPD, all patients were treated with tiotropium bromide. The pulmonary function in all patients improved 2-4 weeks after the start of tiotropium bromide, and we performed lobectomy safely. Currently all patients maintain good pulmonary function without recurrence of lung cancer. We propose that treatment of tiotropium bromide might be one of the effective preoperative methods to improve pulmonary function of lung cancer patients with severe COPD.

VO2 estimation using 6-axis motion sensor with sports activity classification.

In this paper, we focus on oxygen consumption (VO2) estimation using 6-axis motion sensor (3-axis accelerometer and 3-axis gyroscope) for people playing sports with diverse intensities. The VO2 estimated with a small motion sensor can be used to calculate the energy expenditure, however, its accuracy depends on the intensities of various types of activities. In order to achieve high accuracy over a wide range of intensities, we employ an estimation framework that first classifies activities with a simple machine-learning based classification algorithm. We prepare different coefficients of linear regression model for different types of activities, which are determined with training data obtained by experiments. The best-suited model is used for each type of activity when VO2 is estimated. The accuracy of the employed framework depends on the trade-off between the degradation due to classification errors and improvement brought by applying separate, optimum model to VO2 estimation. Taking this trade-off into account, we evaluate the accuracy of the employed estimation framework by using a set of experimental data consisting of VO2 and motion data of people with a wide range of intensities of exercises, which were measured by a VO2 meter and motion sensor, respectively. Our numerical results show that the employed framework can improve the estimation accuracy in comparison to a reference method that uses a common regression model for all types of activities.

Applying neural network to VO2 estimation using 6-axis motion sensing data.

This paper focuses on oxygen consumption (VO2) estimation using 6-axis motion data (3-axis acceleration and 3-axis angular velocity) that are obtained from small motion sensors attached to people playing sports with different intensities. In order to achieve high estimation accuracy over a wide range of intensities of exercises, we apply neural network that is trained by experimental data consisting of the measured VO2 and motion sensing data of people with a wide range of intensities of exercises. We first investigate the gain brought by applying neural network by comparing its accuracy with an approach based on the linear regression model. Then, we analyze how much improvement the information on angular velocity can bring as compared with the estimation with the acceleration data alone. Our numerical results show that the employed framework exploiting neural network can improve the estimation accuracy in comparison to the linear regression model and the exploitation of information on the angular velocity plays an important role to improve the accuracy over higher intensities of exercises.

Real-time sensing, transmission and analysis for vital signs of persons during exercises.

Real-time monitoring of vital signs from persons during exercises is useful from the medical, healthcare and sports physiological points of view. In professional team sports, physical trainers or technical coaches want to manage the physical conditions of athletes during exercise training in the grounds, on the other hand, in elementary and junior high schools, teachers want to take care of schoolchildren during physical training. In realization of the vital signs monitoring, there are three technical problems to be solved. The first is how to accurately sense vital signs, the second is how to reliably transmit them by wireless, and the third is how to identify factors effective for disease screening, injury prevention, performance analysis and talent identification. In this paper, we present the necessity of real-time monitoring of vital signs from persons during exercises, introduce solutions for the problems which we have so far worked out, and point out remaining technical problems.

Motion artifact cancellation and outlier rejection for clip-type ppg-based heart rate sensor.

Heart rate sensing can be used to not only understand exercise intensity but also detect life-critical condition during sports activities. To reduce stress during exercise and attach heart rate sensor easily, we developed a clip-type photoplethysmography (PPG)-based heart rate sensor. The sensor can be attached just by hanging it to the waist part of undershorts, and furthermore, it employs the motion artifact (MA) cancellation technique. However, due to its low contact pressure, sudden jumps and drops, which are called "outliers," are often observed in the sensed heart rate, so we also developed a simple outlier rejection technique. By an experiment using five male subjects (4 sets per subject), we confirmed the MA cancellation and outlier rejection capabilities.

Pleural cryptococcosis with idiopathic CD4 positive T-lymphocytopenia.

A 19-year-old man was admitted to our hospital because of chest pain. He was diagnosed as having pleural cryptococcosis by pleural biopsy. His CD4 positive T-lymphocyte count was low (< 300 microl) and there was no evidence of human immunodeficiency virus infection. He was successfully treated with fluconazole. However, his CD4 positive lymphocyte counts remained low after the recovery and he was diagnosed as idiopathic CD4 positive T-lymphocytopenia. Pleural cryptococcosis is rare and its predisposing condition is still controversial. To our knowledge, this is the first case of pleural cryptococcosis associated with idiopathic CD4 positive T lymphocytopenia.

Cancellation of motion artifact induced by exercise for PPG-based heart rate sensing.

Heart rate (HR) sensing during exercise is essential for medical, healthcare and sport physiological purposes. Photo-Plethysmo-Graphy (PPG) is a simple and non-invasive technique for HR sensing, but it is highly sensitive to motion artifact. This paper proposes a cancellation technique of motion artifact in PPG-based HR sensing for a man during exercise. The canceller is equipped with two sensors; one is a normal PPG sensor where an LED/Photo-Detector (PD) contacts the skin to detect Blood Volume Pulse (BVP) (+motion artifact) and the other is a motion artifact sensor where an LED/PD does not contact the skin to detect only motion artifact. Experimental results show that the proposed technique, which is implemented in adaptive algorithms, can sense HR correctly by cancelling motion artifact induced by exercises such as running and jumping.

Oral administration of γ-aminobutyric acid affects heat production in a hot environment in resting humans.

BACKGROUND: Central administration of γ-amino butyric acid (GABA) induces lower body temperature in animals in hot ambient air. However, it is still unknown whether oral GABA administration affects temperature regulation at rest in a hot environment in humans. Therefore, in the present study, we specifically hypothesized that systemic administration of GABA in humans would induce hypothermia in a hot environment and that this response would be observed in association with decreased heat production. METHODS: Eight male participants drank a 200-ml sports drink with 1 g of GABA (trial G) or without GABA (trial C), then rested for 30 minutes in a sitting position in a hot environment (ambient air temperature 33°C, relative humidity 50%). RESULTS: We found that changes in esophageal temperature from before drinking the sports drink were lower in trial G than in trial C (-0.046 ± 0.079°C vs 0.001 ± 0.063°C; P < 0.05), with lower heat production calculated by oxygen consumption (41 ± 5 W/m2 vs 47 ± 8 W/m2; P < 0.05). CONCLUSIONS: In this study, we have demonstrated that a single oral administration of GABA induced a larger decrease in body core temperature compared to a control condition during rest in a hot environment and that this response was concomitant with a decrease in total heat production.

Vessel wall temperature estimation for novel short term thermal balloon angioplasty: study of thermal environment.

We have been proposing novel thermal balloon angioplasty, photo-thermo dynamic balloon angioplasty (PT-DBA). PTDBA realized <10s short term heating that can prevent surrounding tissue thermal injury and low pressure dilatation that can prevent restenosis in chronic phase. We aim to determine the most efficient heating condition suit to individual symptom with pre-operation thermal simulation. We analyzed the flow dynamics and heat convection inside the balloon, and investigated heat conduction of balloon film to establish the temperature estimation method among vessel wall. Compared with ex vivo temperature measurement experiment, we concluded that the factors need to be considered for the establishment would be the heat conduction of the flow inside PTDB, heat conduction at the balloon film, and contact thermal resistance between the balloon film and vessel wall.