Cryptococcal Pleuritis in an Immunocompetent Patient: A Case Report and Literature Review.

Cryptococcosis, primarily an opportunistic infection, often occurs in immunocompromised patients but can also affect immunocompetent individuals. Cryptococcosis typically manifests in the lungs, but pleurisy is rare, particularly in immunocompetent patients. This report details a case of cryptococcal pleuritis in a 74-year-old immunocompetent male with a history of heart failure, presenting initially with pleural effusion. Diagnostic challenges arose due to the initial absence of intrapulmonary lesions. The diagnosis was eventually established through a surgical biopsy and tissue culture, revealing Cryptococcus neoformans. This case underscores the complexity of diagnosing cryptococcal infections, particularly in immunocompetent patients, and highlights the need for considering cryptococcosis in differential diagnoses of lymphocyte-predominant exudative pleural effusions.

Anti-SOX-1 Antibody-Positive Paraneoplastic Limbic Encephalitis Diagnosed During Small Cell Lung Cancer Treatment.

Paraneoplastic neurological syndrome (PNS) mostly presents its symptoms prior to cancer treatment. We present a case of anti-Sry-like high mobility group box 1 (SOX-1) antibody-positive PNS diagnosed during the treatment of small-cell lung cancer (SCLC). A 65-year-old woman with a history of smoking and SCLC (T3N1M0) was hospitalized to receive chemo-radiation therapy. On day 14, the course was complicated by left mastitis associated with febrile neutropenia. Drainage was performed for the left mastitis, and cefepime was initiated. The fever subsided within a few days, but the patient became agitated accompanied by logorrhea. With the exception of mental status, her neurological examination was unremarkable. Due to mildly impaired renal function, cefepime encephalopathy was considered in the differential diagnosis, but the agitation grew worse despite cefepime discontinuation. Further evaluations, including brain magnetic resonance imaging without contrast and cerebrospinal fluid analysis, were unremarkable. Acyclovir and steroid pulse therapy were initiated empirically for herpes simplex virus (HSV) and PNS, respectively. On day 22, acyclovir was discontinued because the HSV polymerase chain reaction test result was negative. On day 26, the serum anti-SOX-1 antibody test was reported to be positive. Other paraneoplastic syndrome-associated antibodies, including anti-amphiphysin, CV2, PNMA2, Ri, Yo, Hu, recoverin, titin, zic 4, GAD 65, Tr, and N-methyl-D-aspartate receptor antibodies, were negative. The agitation improved gradually following the continuation of chemotherapy and steroid treatment. The patient was discharged on day 55 in stable condition. Although PNS mostly presents prior to cancer treatment, it is important to recognize that it may develop during the course of cancer treatment. Evaluation and empirical treatment for PNS should be considered in patients who develop encephalopathy during cancer treatment, as early treatment can lead to a better outcome.

A case of ruptured ovarian metastasis of small cell lung cancer.

A 53-year-old woman with small-cell lung cancer (SCLC) presented at our hospital complaining of abdominal distention. Blood tests revealed rapidly progressive normocytic anemia and elevated lactate dehydrogenase levels. Pelvic magnetic resonance imaging revealed a left ovarian tumor and ascites. As her symptoms rapidly worsened, she underwent emergency surgery, which revealed a ruptured metastatic ovarian tumor of SCLC. Emergency surgery averted a life-threatening situation in this patient, and subsequent chemotherapy facilitated long-term survival. As seen from literature review, in female SCLC patients, ovarian metastasis and rupture is a rare but possible complication that should be considered because of its life-threatening nature.

The Japanese Respiratory Society guidelines may reduce unnecessary chest computed tomography in patients with pneumonia requiring hospitalization: A retrospective study.

BACKGROUND: With the abundance of CT scanners in Japan, doctors can easily order CT scans to diagnose pneumonia. The Japanese Respiratory Society (JRS) guidelines uniquely recommend conditions for which additional CT scans should be considered at the time of diagnosis of pneumonia, a feature not found in other guidelines. In this study, we aimed to evaluate the usefulness of the recommendations in a bid to reduce the number of unnecessary CT examinations. METHODS: We retrospectively reviewed the electronic medical records of consecutive patients with pneumonia hospitalized between April 2016 and March 2017 to extract patients' backgrounds and clinical courses. Conformity with the JRS guideline recommendations was also examined. In the patients who did not meet the recommendations, we investigated the proportion of them for whom an additional CT scan influenced the clinical decisions. Finally, we evaluated whether there was a difference in hospital stay depending on the additional chest CT at the time of admission. RESULTS: We included 363 hospitalized patients with pneumonia. Chest CT scan was performed in 306 patients (84.3%), of whom 186 (60.8%) did not meet the JRS guideline recommendations. Chest CT revealed findings requiring a change in treatment strategy in only 14 (7.5%) of the 186 patients. Among the 240 patients (66.1%) who did not meet the recommendations, no statistically significant difference was observed in the hospital stay or mortality between patients with and without CT scans. CONCLUSIONS: Adherence to the JRS guideline recommendations may reduce the excessive use of CT scans in the diagnosis of pneumonia.

Varicella-zoster pneumonia with endobronchial lesions.

Varicella-zoster pneumonia with endobronchial lesions is rare. When immunosuppressed patients get skin lesions with systemic symptoms, the possibility of varicella-zoster virus infection of the respiratory tract should be kept in mind. In our case, the pulmonary lesions persisted for 15 months.

Non-standard trajectories found by machine learning for evaporative cooling of 87Rb atoms.

We present a machine-learning experiment involving evaporative cooling of gaseous 87Rb atoms. The evaporation trajectory was optimized to maximize the number of atoms cooled down to a Bose-Einstein condensate using Bayesian optimization. After 300 trials within 3 hours, Bayesian optimization discovered trajectories that achieved atom numbers comparable with those of manual tuning by a human expert. Analysis of the machine-learned trajectories revealed minimum requirements for successful evaporative cooling. We found that the manually obtained curve and the machine-learned trajectories were quite similar in terms of evaporation efficiency, although the manual and machine-learned evaporation ramps were significantly different.

Roles of noradrenergic transmission within the ventral part of the bed nucleus of the stria terminalis in bidirectional brain-intestine interactions.

AIMS: The bed nucleus of the stria terminalis (BNST) is a limbic structure mediating autonomic and neuroendocrine responses and negative affective states such as anxiety and fear. We previously demonstrated that noradrenergic transmission via ß-adrenoceptors within the ventral part of BNST (vBNST) is involved in bidirectional interactions between the brain and the upper gastrointestinal (GI) tract. The present study aimed to examine the roles of intra-vBNST noradrenergic transmission via ß-adrenoceptors in bidirectional interactions between the brain and lower GI tract. METHODS: In vivo microdialysis experiments were performed to examine colorectal distention (CRD)-induced noradrenaline release within the vBNST of freely moving male Sprague-Dawley rats. Colonic transit and abdominal pain perception were examined following intra-vBNST injections of isoproterenol, a ß-adrenoceptor agonist, with and without co-administration of timolol, a ß-adrenoceptor antagonist. RESULTS: CRD increased extracellular noradrenaline levels within the vBNST and evoked abdominal contractions in a pressure-dependent manner (30-60 mm Hg). Bilateral intra-vBNST injections of isoproterenol (30 nmol/side) significantly increased CRD (30 mm Hg)-induced abdominal contractions. Intra-vBNST injections of isoproterenol (30 nmol/side) significantly increased colonic transit, which was reversed by co-administration of timolol (30 nmol/side). CONCLUSION: The results of this study suggest (a) the existence of a positive feedback loop between intra-vBNST noradrenaline release and abdominal pain perception, and (b) the modulation of colonic motility by intra-vBNST noradrenergic transmission via ß-adrenoceptors. Dysfunction of the lower GI tract may increase noradrenaline release within the vBNST, which, in turn, may exacerbate impairment of its motility and pain perception.

Bidirectional brain-gut interactions: Involvement of noradrenergic transmission within the ventral part of the bed nucleus of the stria terminalis.

INTRODUCTION: Although the important roles of bidirectional interactions between the brain and gut in stress and emotional responses have long been recognized, the underlying neuronal mechanisms remain unclear. The bed nucleus of the stria terminalis (BNST) is a limbic structure involved in stress responses and negative affective states, such as anxiety and depression. We have previously demonstrated that noradrenergic transmission within the ventral part of the BNST (vBNST) plays a crucial role in anxiety-like behaviors and pain-induced aversion. OBJECTIVES: This study aimed to examine the involvement of noradrenergic transmission via ß-adrenoceptors within the vBNST in bidirectional brain-gut interactions. METHODS: We measured the gastric distention (GD)-induced noradrenaline release within the vBNST of freely moving rats using an in vivo microdialysis technique. Gastric emptying and intestinal transit were examined following intra-vBNST injections of isoproterenol, a ß-adrenoceptor agonist, in the absence or presence of the coadministration of timolol, a ß-adrenoceptor antagonist. RESULTS: Gastric distention at a higher pressure (45 mm Hg) but not at a lower pressure (25 mm Hg) resulted in a significant increase in extracellular noradrenaline levels within the vBNST. Intra-vBNST injections of isoproterenol (30 nmol/side) induced significant reductions in gastric emptying and small intestinal transit, both of which were reversed by the coadministration of timolol (30 nmol/side). CONCLUSION: Noradrenergic transmission via ß-adrenoceptors within the vBNST was involved in bidirectional brain-gut interactions. These findings suggest that gastric dysfunction may induce negative affective states via the enhanced release of noradrenaline within the vBNST which, in turn, may cause gastrointestinal impairments.

Decrease in PSCA expression caused by Helicobacter pylori infection may promote progression to severe gastritis.

SNP rs2294008 in Prostate Stem Cell Antigen (PSCA) and decreased PSCA expression are associated with gastric cancer. The objective of this study is to investigate the role of rs2294008 and PSCA expression in the gastritis-gastric cancer carcinogenic pathway. We conducted a case-control association study of H. pylori-infected gastritis and gastric cancer. rs2294008 was associated with the progression to chronic active gastritis (P = 9.4 × 10-5; odds ratio = 3.88, TT + TC vs CC genotype), but not with H. pylori infection per se nor with the progression from active gastritis to gastric cancer. We also assessed the association of rs2294008 with PSCA mRNA expression in the gastric mucosa at various disease stages and found that rs2294008 was associated with PSCA expression (P = 1.3 × 10-12). H. pylori infection (P = 5.1 × 10-8) and eradication therapy (P < 1 × 10-11) resulted in the reduced and increased PSCA expression, respectively, indicating negative regulation of PSCA expression by H. pylori infection. PSCA expression was decreased in severe gastritis compared with mild gastritis only among T allele carriers. Our findings revealed the regulation of PSCA expression by host genetic variation and bacterial infection might contribute to gastritis progression after H. pylori infection.

The Transcriptional Landscape of p53 Signalling Pathway.

Although recent cancer genomics studies have identified a large number of genes that were mutated in human cancers, p53 remains as the most frequently mutated gene. To further elucidate the p53-signalling network, we performed transcriptome analysis on 24 tissues in p53+/+ or p53-/- mice after whole-body X-ray irradiation. Here we found transactivation of a total of 3551 genes in one or more of the 24 tissues only in p53+/+ mice, while 2576 genes were downregulated. p53 mRNA expression level in each tissue was significantly associated with the number of genes upregulated by irradiation. Annotation using TCGA (The Cancer Genome Atlas) database revealed that p53 negatively regulated mRNA expression of several cancer therapeutic targets or pathways such as BTK, SYK, and CTLA4 in breast cancer tissues. In addition, stomach exhibited the induction of Krt6, Krt16, and Krt17 as well as loricrin, an epidermal differentiation marker, after the X-ray irradiation only in p53+/+ mice, implying a mechanism to protect damaged tissues by rapid induction of differentiation. Our comprehensive transcriptome analysis elucidated tissue specific roles of p53 and its signalling networks in DNA-damage response that will enhance our understanding of cancer biology.

Laser spectroscopic probing of coexisting superfluid and insulating states of an atomic Bose-Hubbard system.

A system of ultracold atoms in an optical lattice has been regarded as an ideal quantum simulator for a Hubbard model with extremely high controllability of the system parameters. While making use of the controllability, a comprehensive measurement across the weakly to strongly interacting regimes in the Hubbard model to discuss the quantum many-body state is still limited. Here we observe a great change in the excitation energy spectra across the two regimes in an atomic Bose-Hubbard system by using a spectroscopic technique, which can resolve the site occupancy in the lattice. By quantitatively comparing the observed spectra and numerical simulations based on sum rule relations and a binary fluid treatment under a finite temperature Gutzwiller approximation, we show that the spectra reflect the coexistence of a delocalized superfluid state and a localized insulating state across the two regimes.

An approach of estimating individual growth curves for young thoroughbred horses based on their birthdays.

We propose an approach of estimating individual growth curves based on the birthday information of Japanese Thoroughbred horses, with considerations of the seasonal compensatory growth that is a typical characteristic of seasonal breeding animals. The compensatory growth patterns appear during only the winter and spring seasons in the life of growing horses, and the meeting point between winter and spring depends on the birthday of each horse. We previously developed new growth curve equations for Japanese Thoroughbreds adjusting for compensatory growth. Based on the equations, a parameter denoting the birthday information was added for the modeling of the individual growth curves for each horse by shifting the meeting points in the compensatory growth periods. A total of 5,594 and 5,680 body weight and age measurements of Thoroughbred colts and fillies, respectively, and 3,770 withers height and age measurements of both sexes were used in the analyses. The results of predicted error difference and Akaike Information Criterion showed that the individual growth curves using birthday information better fit to the body weight and withers height data than not using them. The individual growth curve for each horse would be a useful tool for the feeding managements of young Japanese Thoroughbreds in compensatory growth periods.

High-resolution music with inaudible high-frequency components produces a lagged effect on human electroencephalographic activities.

High-quality digital sound sources with inaudible high-frequency components (above 20 kHz) have become available because of recent advances in information technology. Listening to such sounds has been shown to increase the α-band power of an electroencephalogram (EEG). The present study scrutinized the time course of this effect by recording EEG along with autonomic measures (skin conductance level and heart rate) and facial electromyograms (corrugator supercilii and zygomaticus major). Twenty university students (19-24 years old) listened to two types of a 200-s musical excerpt (J. S. Bach's French Suite No. 5) with or without inaudible high-frequency components using a double-blind method. They were asked to rate the sound quality and to judge which excerpt contained high-frequency components. High-α EEG power (10.5-13 Hz) was larger for the excerpt with high-frequency components than for the excerpt without them. This effect was statistically significant only in the last quarter of the period (150-200 s). Participants were not able to distinguish between the excerpts, which did not produce any discernible differences in subjective, autonomic, and facial muscle measures. This study shows that inaudible high-frequency components have an impact on human brain activity without conscious awareness. Unlike a standard test for sound quality, at least 150 s of exposure is required to examine this effect in future research.

Control of resonant interaction between electronic ground and excited states.

We observe magnetic Feshbach resonances in a collision between the ground and metastable states of two-electron atoms of ytterbium (Yb). We measure the on-site interaction of doubly occupied sites of an atomic Mott-insulator state in a three-dimensional optical lattice as a collisional frequency shift in a high-resolution laser spectroscopy. The observed spectra are well fitted by a simple theoretical formula, in which two particles with an s-wave contact interaction are confined in a harmonic trap. This analysis reveals a wide variation of the interaction with a resonance behavior around a magnetic field of about 1.1 G for the energetically lowest magnetic sublevel of 170Yb, as well as around 360 mG for the energetically highest magnetic sublevel of 174Yb. The observed Feshbach resonance can only be induced by an anisotropic interatomic interaction. This scheme will open the door to a variety of studies using two-electron atoms with tunable interaction.

Empirical Percentile Growth Curves with Z-scores Considering Seasonal Compensatory Growths for Japanese Thoroughbred Horses.

Percentile growth curves are often used as a clinical indicator to evaluate variations of children's growth status. In this study, we propose empirical percentile growth curves using Z-scores adapted for Japanese Thoroughbred horses, with considerations of the seasonal compensatory growth that is a typical characteristic of seasonal breeding animals. We previously developed new growth curve equations for Japanese Thoroughbreds adjusting for compensatory growth. Individual horses and residual effects were included as random effects in the growth curve equation model and their variance components were estimated. Based on the Z-scores of the estimated variance components, empirical percentile growth curves were constructed. A total of 5,594 and 5,680 body weight and age measurements of male and female Thoroughbreds, respectively, and 3,770 withers height and age measurements were used in the analyses. The developed empirical percentile growth curves using Z-scores are computationally feasible and useful for monitoring individual growth parameters of body weight and withers height of young Thoroughbred horses, especially during compensatory growth periods.

Empirical Growth Curve Estimation Using Sigmoid Sub-functions that Adjust Seasonal Compensatory Growth for Male Body Weight of Thoroughbred Horses.

Thoroughbred horses are seasonal mating animals, raised in northern regions or countries. Foals born yearly in spring generally show a typical seasonal compensatory growth pattern, in which their growth rate declines in the first winter and increases in the next spring. In this study, a new empirical adjustment approach is proposed to adjust for this compensatory growth when growth curve equations are estimated, by using 1,633 male body weights of Thoroughbreds as an illustrating example. Based on general Richards growth curve equation, a new growth curve equation was developed and fit to the weight-age data. The new growth curve equation had a sigmoid sub-function that can adjust the compensatory growth, combined with the Richards biological parameter responsible for the maturity of animals. The unknown parameters included in the equations were estimated by SAS NLMIXED procedure. The goodness of fit was examined by using Akaike's Information Criterion (AIC). The AIC values decreased from 13,053 (general Richards equation) to 12,794 (the newly developed equation), indicating the better fit of the new equation to the weight-age data. The shape of the growth curve was improved during the period of compensatory growth. The proposed method is one of the useful approaches for adjusting seasonal compensatory growth in growth curve estimations for Thoroughbreds, and for their management during the compensatory period. Based on this approach, the optimal growth curve equations can be estimated also for female body weight of Thoroughbreds or other growth traits affected by seasonal compensatory growth.