Thoracic empyema caused by Alloscardovia omnicolens and Bifidobacteriumdentium.

A 62-year-old man was admitted to our emergency department with the complaint of worsening dyspnea after initiating anti-tuberculous therapy (isoniazid [300 mg/day], rifampicin [600 mg/day], ethambutol [750 mg/day], and pyrazinamide [1,500 mg/day]) for tuberculous pleuritis. His oral hygiene status was poor. The patient had no significant past medical history. However, he had a history of smoking (10 cigarettes per day for 45 years) and was a social drinker. Chest radiography revealed increased right pleural effusion and pneumothorax. The pleural fluid was purulent, and the culture grew Alloscardovia omnicolens, Bifidobacterium dentium, and Prevotella loescheii. He was treated with antibiotics (3 g of intravenous ampicillin/sulbactam every 6 h, which was changed to oral amoxicillin/clavulanate potassium on day 34) in addition to anti-tuberculous therapy, he underwent chest tube insertion, and subsequently improved. Bifidobacteriaceae are commensal flora of the mouth and pulmonary infections caused by these organisms are extremely rare. Nevertheless, clinicians should consider these organisms as a possible cause of pulmonary infections, and consider that respiratory infections caused by commensal flora of the mouth may occur during the treatment of other diseases in patients with poor oral hygiene.

Targeting brain regions of interest in functional near-infrared spectroscopy-Scalp-cortex correlation using subject-specific light propagation models.

Targeting specific brain regions of interest by the accurate positioning of optodes (emission and detection probes) on the scalp remains a challenge for functional near-infrared spectroscopy (fNIRS). Since fNIRS data does not provide any anatomical information on the brain cortex, establishing the scalp-cortex correlation (SCC) between emission-detection probe pairs on the scalp and the underlying brain regions in fNIRS measurements is extremely important. A conventional SCC is obtained by a geometrical point-to-point manner and ignores the effect of light scattering in the head tissue that occurs in actual fNIRS measurements. Here, we developed a sensitivity-based matching (SBM) method that incorporated the broad spatial sensitivity of the probe pair due to light scattering into the SCC for fNIRS. The SCC was analyzed between head surface fiducial points determined by the international 10-10 system and automated anatomical labeling brain regions for 45 subject-specific head models. The performance of the SBM method was compared with that of three conventional geometrical matching (GM) methods. We reveal that the light scattering and individual anatomical differences in the head affect the SCC, which indicates that the SBM method is compulsory to obtain the precise SCC. The SBM method enables us to evaluate the activity of cortical regions that are overlooked in the SCC obtained by conventional GM methods. Together, the SBM method could be a promising approach to guide fNIRS users in designing their probe arrangements and in explaining their measurement data.

[Autopsy case of light chain deposition disease presented by nephrotic syndrome].

An eighty-one-year-old male with lower leg edema and proteinuria was diagnosed as having nephrotic syndrome and was hospitalized for a detailed examination. Kidney biopsy and immunostaining revealed nodular glomerulosclerosis and deposition of lambda chains, respectively. Because these findings indicate the occurrence of light chain deposition disease (LCDD), the underlying disease was found to be multiple myeloma BJ-lambda. After the administration of melphalan and prednisolone, followed by further addition of zoledronic acid, the patient's nephrosis remitted. However, renal dysfunction gradually deteriorated further and hemodialysis was instituted. He eventually died of gastrointestinal bleeding and biliary infection. The period of time from the initial diagnosis to death was thirty months. Autopsy revealed pervasive infiltration of plasma cells and light chain deposition in multiple organs. The uncontrollable gastrointestinal bleeding appears to have been caused by light chain deposition in the vascular walls of a bile duct. Although medical treatment for elderly LCDD cases depends on chemotherapy alone, it is difficult to obtain a complete remission with melphalan and prednisolone, according to the literature. Reports on the validities of biological agents, such as bortezomib, are beginning to appear, and accumulation of further therapeutic experience is eagerly awaited.

Model position sensing method for low fineness ratio models in a magnetic suspension and balance system.

A new model-position-sensing method for the levitation of models with a low fineness ratio (ratio of the longitudinal length to the diameter) in a magnetic suspension and balance system (MSBS) is proposed. MSBS is an ideal model-support device for wind-tunnel testing, which enables the study of flow fields around blunt bodies without flow disturbances introduced by mechanical support devices, with the aerodynamic forces determined from the magnetic forces using a pre-calibrated relationship. The new method allows wind tunnel experiments without mechanical supports with a low fineness ratio model. This method adopts two line sensors placed parallel to the central axis of the model image and measures the position with a resolution finer than 0.06 mm or deg even for thin model geometries. In addition, measurement errors were reduced by correcting a second-order term in the depth direction of the camera. A low fineness ratio circular cylinder model was levitated following sensor calibration. The model was supported in conditions with and without freestream flow. This position measurement method was also applied to a reentry capsule model. The model was levitated while keeping its position and attitude stabilized near the origin.

[Retrospective analysis of progression to multiple myeloma or related disorders in 114 patients with monoclonal gammopathy of undetermined significance in a single institute].

In 114 patients with monoclonal gammopathy of undetermined significance (MGUS) followed-up in Tachikawa Sougo hospital, we retrospectively analyzed progression of their disease to multiple myeloma (MM) or related disorders. The analysis was based on a total of 1,170 person-years of follow-up in a cohort with a median age at diagnosis of MGUS of 68 years 3 months, and with a median follow-up period of 9 years 5 months. Of these 114 patients, 13 (11%) showed progression to MM or related disorders with a median time to progression of 9 years 4 months; and the median age of these 13 patients was 78 years 8 months. The cumulative hazard ratio of progression at 5, 10, 15, and 20 years after diagnosis was 3.0%, 9.0%, 11.4%, and 32.1%, respectively. The risk of progression of MGUS to MM or related disorders in Japanese patients was as high as in Western patients studied previously, demonstrating that MGUS should be carefully monitored as a preneoplastic condition.

[Mild hemophilia A diagnosed at the onset of acute epidural hematoma after lumbar epidural block].

The patient was a 36-year-old man who had been aware of a mild bleeding tendency since childhood, but did not show any history of severe bleeding. After lumbar epidural block was performed for pain caused by lumbar disc herniation, the patient developed paraplegia due to an acute epidural hematoma, and rectovesical disorder. He was admitted to our hospital, and wide fenestration and hematoma evacuation were performed. Because of persistent bleeding, reoperation was performed to achieve hemostasis. Although factor VIII antigen was 138%, its activity was decreased to 18% of normal. A diagnosis of cross-reacting material positive mild hemophilia A was made. Postoperative injection of a factor VIII preparation resulted in complete hemostasis. The activated partial thromboplastin time was within normal range. A thrombin generation test showed reduced endogenous thrombin potential, peak thrombin levels, and prolonged time-to-peak levels. The thrombin generation test, which allows comprehensive assessment of the coagulation profile, was useful for diagnosis and treatment of this case.

A depressurization assistance system with a suitable posture for a seated patient on a wheelchair.

For reducing a risk of pressure sore caused by long period sitting on a wheelchair, a patient is required to depressurize buttocks by changing the posture suitably. Thus, we have been developed an automatic depressurization motion assistance system for a seated patient on a wheelchair. In our previous work, we developed a sitting surface coordination system which can lift or incline and assists a depressurization motion of a patient. However, in some cases, it is difficult to change his posture suitably for patients who do not have enough physical strength in their upper body using our proposed device. Therefore, in this paper, we propose a novel posture coordination assistance system for a wheelchair user. Our system consists of the adjustable sitting surface and novel proposed adjustable backrest. These two devices coordinate the sitting posture of the patient automatically. Our key ideas are two topics. One topic is mechanical design of the adjustable backrest for practical use. We realize small mechanism which enables easy implementation to a general wheelchair without special reconstruction. The other topic is a natural posture coordination scheme using the sitting surface and the backrest. We analyze buttocks depressurization operation by a nursing specialist and drive our proposed devices for realizing it. The performance of our system is verified by experiments using our prototype.

A novel five-way translocation t(7;11;9;22;9)(q22;q13;q34;q11.2;q34) involving Ph chromosome in a patient of chronic myeloid leukemia: a case report.

About 5-10 % of chronic myelogenous leukemia (CML) patients show variant Philadelphia (Ph) translocations. The formation mechanisms and clinical significance of variant Ph translocations remain unclear. We report a CML case with a novel five-way complex translocation. Although the result of initial G-banding was 46,XY,t(7;11;9)(q22;q13;q34),t(9;22)(q34;q11.2), fluorescence in situ hybridization (FISH) demonstrated t(7;11;9;22;9)(q22;q13;q34;q11.2;q34) consisting of sequential rearrangements involving five chromosomes. The patient was successfully treated by imatinib and obtained a major molecular response. To our knowledge, this is the tenth CML case with a complicated Ph translocation involving five chromosomes and the third one treated by imatinib. Good response with imatinib therapy suggested that a single-event rearrangement was involved in the chromosomal changes.

A depressurization assistance control based on the posture of a seated patient on a wheelchair.

For reducing the risk of pressure sore caused by long period sitting on a wheelchair, we develop a depressurization motion assistance system which is low cost and suitable for practical use. Our developing system consists of a seating cushion which the patient sits on and four air cells which can lift or incline the seating cushion. Each air cell is actuated by small air compressor, which can drive using batteries on the wheelchair respectively, and each compressor has a pressure sensor on its body. In this paper, our key ideas are two topics. One topic is mechanical design for practical use. We realize thin mechanism which enables easy implementation to the general wheelchair. For realizing this thinly design, we develop the tilt mechanism using elasticity of acrylic resin and the controller which uses only pressure sensors for estimating its lifting height and inclination. The other topic is assistance control scheme based on the patient's depressurization operation for increasing a rehabilitation performance. For realizing the proposed control scheme, we analyze the hip depressurization operation by the nursing specialists and use its results for estimating the patient's condition. Using our system, the patient can depressurize by his own will on the general wheelchair easily. The performance of our system is verified by experiments using our prototype.

Case of subcutaneous abscess caused by Nocardia farcinica in an aplastic anemia patient.

We report a case of subcutaneous abscess caused by Nocardia farcinica in a 44-year-old man, who had been treated with systemic prednisolone and cyclosporin for aplastic anemia. He had been affected by aplastic anemia for 8 years, and was previously treated with antithymocyte globulin. The effect was insufficient, and platelet and erythrocyte transfusion was required. Bone marrow transplantation was not adopted due to a psychological problem. He had also been treated with prednisolone and cyclosporin for 3 years. Without apparent cause, swelling and pain of left upper extremity developed in April, 2008. There was no abnormality in cutaneous macroscopic findings, such as a wound or a sting. He was administered antibiotics, but they were ineffective and effusion were excreted into the skin. After hospitalization, he was treated by incision and drainage and antibiotics were started. The pathogen was identified as Nocardia farcinica by its biochemical characters. There was no dissemination to other organs like lung or brain and he recovered completely with a treatment of antibiotics for 1 year. We studied the epidemiological and clinical characteristics of Nocardia infections reported in Japan from 2000 to 2008 and identified 92 cases using the medical article search engine Ichushi-Web (Japan Medical Abstract Society). The results indicate that the most important risk factor in systemic nocardiosis ia an immunosuppressive agent such as prednisolone, cyclosporine, or azathioprine. We believe that we should take the possibility of Nocardia infection into consideration in a compromised host.