Community Structure of Aquatic Insects Adapted to Lentic Water Environments, and Fine-Scale Analyses of Local Population Structures and the Genetic Structures of an Endangered Giant Water Bug Appasus japonicus.

Environments such as floodplains and the marshlands of rivers, lakes and ponds, are important habitats for aquatic insects adapted to lentic water conditions. In addition, ponds and paddy fields artificially created for agriculture are also important alternative habitats for lotic water-dependent wildlife. In this study, we focused on aquatic insects in ponds in the Matsumoto Basin, located in the center of Japan. Although this is an urbanized area, aquatic animals adapted to floodplains inhabit it at a relatively high density for Japan. We conducted a multifaceted evaluation of the environments of the 33 ponds in this region and conducted a survey of the aquatic insect fauna inhabiting them. In this study, we conducted quantitative sampling, focusing on two insect orders adapted to large-scale lentic water environments (i.e., Heteroptera and Coleoptera), and observed five species of three families and 16 species of five families from the Matsumoto Basin, respectively. Within these species, eight endangered species were included. Furthermore, we carried out a genetic structure analysis for the giant water bug, Appasus japonicus, inhabiting these ponds in high density, and conducted a comparative evaluation of their genetic diversity between these ponds. A total of 530 specimens of A. japonicus were genetically analyzed for the mitochondrial DNA COI region, and 26 haplotypes were observed. The degree of genetic diversity between the ponds was clearly demonstrated. In addition, we discussed the wintering possibilities for the giant water bugs based on their corresponding surrounding environmental factors, and comprehensively discussed their "source-sink" relationships in this region. Therefore, this is a comprehensive study focused on the relevant environmental factors, diversification of their community structures, their population structures, and their genetic structure at a fine scale.

[A case of esophageal and intestinal tuberculosis that occurred during treatment of rheumatoid arthritis with etanercept].

An 88-year-old woman with rheumatoid arthritis who had started etanercept treatment in July 2011 was referred to our hospital in February 2012 for right-sided pleural effusion. Chest computed tomography showed right pleural effusion, partial swelling of a calcified mediastinal lymph node, and mid-esophageal thickening of the mucosal wall. Gastroendoscopy showed mid-esophageal ulceration. Histological examination of biopsy specimens from this ulceration revealed noncaseating granulomas with Langhans giant cells. Ziehl-Neelsen staining of this section was positive for acid-fast bacilli. Polymerase chain reaction analysis of gastric juice was positive for Mycobacterium tuberculosis; we therefore diagnosed the patient with esophageal tuberculosis. However, since abdominal computed tomography showed swelling of mesenteric lymph nodes, we also suspected intestinal tuberculosis. Colonoscopy showed multiple ileal erosions; histological analyses of biopsied specimens revealed granulomas with Langhans giant cells, similar to the esophageal findings. We finally diagnosed the patient with both esophageal and intestinal tuberculosis. After anti-tuberculosis treatment, the right pleural effusion disappeared and the abdominal lesions improved. Although mycobacterial involvement of both the esophagus and intestine is rare in immunocompromised and immunocompetent hosts, differential diagnosis of these diseases is likely to become more important.

[A case of pulmonary tuberculosis in which diagnosis was delayed because of prior treatment with fluoroquinolone and metronidazole].

We report the case of a patient with pulmonary tuberculosis, whose diagnosis was delayed because of prior treatment with fluoroquinolone and metronidazole. A 35-year-old woman developed productive cough, fever, and back pain, which lasted for 3 weeks before admission to hospital. She had been diagnosed with lower respiratory infection and was treated with garenoxacin mesilate hydrate for 7 days before admission. As her symptoms did not improve, she was referred to our hospital for further evaluation. A chest computed tomography scan revealed confluent consolidation in the right lower lung, predominantly in segment 7, and lung abscess was initially suspected. Since chemotherapy with ceftriaxone and minomycin did not reduce her symptoms, metronidazole was added on day 4. Her symptoms improved dramatically and she was discharged on day 15. Metronidazole was given for a total of 3 weeks, and 2 weeks after discontinuation of metronidazole, she presented with recurrent chest pain and was diagnosed with active pulmonary tuberculosis. In addition to the atypical imaging findings in this patient, the use of chemotherapeutics such as garenoxacin mesilate hydrate and metronidazole, which have anti-tuberculosis effects, meant that the diagnosis of tuberculosis was complicated and hence delayed. We should keep in mind that some general chemotherapy agents, including linezolid, also have anti-tuberculosis effects and may cause similar problems with diagnosis.

Multiple granulomatous lung lesions in a patient with Epstein-Barr-virus-induced mononucleosis and new-onset systemic lupus erythematosus: a case report.

INTRODUCTION: Granulomatous lesions are commonly encountered abnormalities in pulmonary pathology, and often pose a diagnostic challenge. We report an unusual case of granulomatous lung disease with uncommon characteristics, which developed following Epstein-Barr-virus-induced mononucleosis and new-onset systemic lupus erythematosus. We aim to highlight a diagnostic approach for the condition and to raise awareness of the possibility of it being related to the immunological reaction caused by Epstein-Barr virus infection. CASE PRESENTATION: A 36-year-old Japanese man, who had been diagnosed with Epstein-Barr-virus-induced infectious mononucleosis, new-onset systemic lupus erythematosus, and secondary Sjögren's syndrome three weeks previously, presented to our facility with fever and diffuse pulmonary infiltrates. A computed tomography scan of the chest revealed multiple small nodules in both lungs. Fiberoptic bronchoscopy with bronchoalveolar lavage revealed lymphocytosis with predominance of T lymphocytes. A histological examination of a lung biopsy taken during video-assisted thoracic surgery showed randomly distributed tiny granulomatous lesions with infiltration of eosinophils. The differential diagnoses included hypersensitivity pneumonitis, sarcoidosis, and pulmonary involvement of Crohn's disease, systemic lupus erythematosus, and Sjögren's syndrome, but the clinical and pathological findings were not consistent with any of these. Our patient's condition did not improve; therefore, prednisolone therapy was started because of the possibility of specific immunological reactions associated with Epstein-Barr virus infection. After steroid treatment, our patient showed radiological and clinical improvement. CONCLUSIONS: To the best of our knowledge, this is the first case of a patient developing randomly distributed multiple granulomatous lung lesions with eosinophilic infiltrates after Epstein-Barr virus infection and systemic lupus erythematosus. On the basis of our data, we hypothesize that Epstein-Barr virus infection altered the immune response of our predisposed patient and contributed to the pathogenesis of the lung lesions. Our patient's clinical response to steroid treatment was excellent.

[Analysis of risk factors of drug-induced lung injury in patients receiving gemcitabine treatment].

Gemcitabine hydrochloride is a very safe medicine that even outpatients can be administered, and the bone marrow depression that is the dose limiting factor remains moderate and does not need special treatment, although it is confirmed in most cases. Meanwhile, caution is required because there is a possibility of drug-induced lung injury and death due to high frequency, compared with the appearance rate described in the packaging insertion. We investigated the clinical background of a patient in whom drug-induced lung injury appeared, and clarified the risk factor by administering gemcitabine hydrochloride. Males, people aged 65 or over, those with a smoking history and those undergoing first-line chemotherapy treatment are at risk of drug-induced lung injury. Attention must be paid to the occurrence of drug-induced lung injury, to examining the clinical course, the chest image, and the blood test, and to do earlier detection, the offending medicine discontinuance, and beginning of the treatment.

A case of IgG4-related lung disease associated with multicentric Castleman's disease and lung cancer.

A 67-year-old man with submaxillary lymphadenopathy diagnosed as reactive follicular hyperplasia of the lymph node was referred to us for pulmonary evaluation. Pathological findings of the lung and hilar lymph node biopsies showed the histological feature of Castleman's disease (CD). Interestingly, infiltrated plasma cells had strong immunoreactivity for IgG4. In addition, this patient had coexisting lung cancer. We believe this is the first described case of IgG4-related lung disease associated with multicentric CD (MCD) and lung cancer. To establish a therapeutic strategy for IgG4-related lung disease, the association between IgG4-related disease and MCD needs to be clarified.

[A case of yellow nail syndrome associated with fibrosarcoma of the skin successfully treated with pleurodesis].

A 72-year-old man was referred to our hospital because of bilateral pleural effusion. Although examination of pleural effusion obtained by thoracentesis did not show any specific etiology, we diagnosed yellow nail syndrome due to his yellow nails and lymphedema of both lower limbs. Diuretics were effective for the control of his pleural effusion. Subsequently, fibrosarcoma was found in his abdominal skin and was resected. The pleural effusion gradually increased after the cessation of oral diuretics. Histological examination of a pleural biopsy specimen obtained by thoracoscopy showed chronic lymphocytic inflammation, but no malignancy. His previously intractable right pleural effusion was successfully treated with pleurodesis using OK-432, suggesting that pleurodesis with OK-432 could be an effective method for the control of pleural fluid in this disease.

[A case of primary pulmonary nocardiosis with multiple pulmonary nodules successfully treated with moxifloxacin].

A 18-year-old man was admitted with fever. His chest radiograph and CT scan showed consolidation shadow in the right middle lobe and multiple nodules in both lungs. He was treated with meropenem and minocycline. After this antibiotic therapy, the consolidation shadow disappeared and the multiple nodules were slightly reduced in their size. Since filamentous bacteria suspicious of Nocardia grew transiently in the initial sputum culture, we started to treat him with oral sulfametoxazole-trimethoprim. However, because agranulocytosis was caused by sulfametoxazole-trimethoprim therapy, we had to change the anti-bacterial therapy to minocycline. Minocycline was not effective, and the nodules enlarged. For accurate diagnosis, we employed video-assisted thoracic surgery (VATS) to investigate the histological and bacterial analyses of the pulmonary nodules. Histological findings of the pulmonary nodule obtained by VATS revealed granuloma with central necrosis associated with neutrophilic micro-abscess. Filamentous gram-positive bacteria in pulmonary nodule tissue was stained positively with both Grocott and Ziehl-Neelsen staining. Taking these findings together, we diagnosed primary pulmonary nocardiosis. Three months after initiating moxifloxacin, the size of the multiple pulmonary nodules was markedly reduced. Our experience with this case suggests that moxifloxacin can be recommended for the treatment of pulmonary nocardiosis.

Four-point probe resistance measurements using PtIr-coated carbon nanotube tips.

We performed four-terminal conductivity measurements on a CoSi2 nanowire (NW) at room temperature by using PtIr-coated carbon nanotube (CNT) tips in a four-tip scanning tunneling microscope. The physical stability and high aspect ratio of the CNT tips made it possible to reduce the probe spacing down to ca. 30 nm. The probe-spacing dependence of resistance showed diffusive transport even at 30 nm and no current leakage to the Si substrate.

[Eosinophilic pleural effusion by dirofilariasis].

A 44-year-old man visited our hospital because of right chest pain. Pleural effusion in the right lung was detected on a chest radiograph. A chest CT scan demonstrated no abnormal lesions in either lung field, but passive atelectasis due to the pleural effusion was present. Since many eosinophils were found in the exudative pleural effusion, a parasitic infection was suspected. An enzyme-linked immunosorbent assay test led to a diagnosis of eosinophilic pleural effusion by dirofilariasis. Pleural effusion disappeared spontaneously and the level of anti-Dirofilaria immitis antibody decreased. Continued careful observation is necessary in such cases.

[A case of solitary nodular pulmonary amyloidosis].

A 64-year-old man without respiratory symptoms was introduced to our hospital because of a nodule of 20 mm in diameter found in the left lung in a periodic health examination. The chest radiograph and CT scan showed a well-defined nodule in the middle of the left lung field, and enlarged mediastinal lymph nodes. Lung cancer was suspected, and transbronchial and CT guided biopsies were performed, but did not lead to a definitive diagnosis. Since the patient refused further examinations, we carefully followed up the nodule in the chest radiograph. After a year and a half, the nodule and the lymph nodes became enlarged, and the patient was admitted to the hospital for a surgical biopsy. Video-assisted thoracoscopic surgery followed by thoracotomy was performed for both a biopsy and nodule resection. Histologically, the nodule tissue was rich in amorphous substances positively stained with Congo Red, which was consistent with amyloidosis. No findings of systemic amyloidosis or secondary amyloidosis were demonstrated.

[A case of pleural effusion associated with allergic bronchopulmonary aspergillosis during a relapse of the disease].

A 61-year-old man with history of bronchial asthma since childhood was admitted to our hospital for examination of eosinophilia and of lung infiltration seen in the chest radiograph. Allergic bronchopulmonary aspergillosis (ABPA) was diagnosed on the basis of the following findings: elevated serum IgE level, positive immediate skin reaction to Aspergillus antigen, the presence of precipitating antibodies against Aspergillus antigen, and central bronchiectasis. Oral prednisolone administration (30 mg daily) was started. During the course of reducing the prednisolone dose by up to 5 mg per day, pleural effusion appeared in the right lung. It was speculated that this eosinophilic exudative effusion was associated with a relapse of ABPA. After treatment with the dose of prednisolone increased to 20 mg per day and with oral itraconazole, the pleural effusion disappeared. We report a rare case of pleural effusion associated with ABPB on relapse.