Transformed gastric mucosa-associated lymphoid tissue lymphoma originating in the colon and developing metachronously after Helicobacter pylori eradication:A case report

BACKGROUND Helicobacter pylori(H.pylori)eradication treatment for primary gastric mucosaassociated lymphoid tissue(MALT)lymphoma has already been established.However,t(11;18)(q21;q21)/API2-MALT1 translocation-positive lesions are a type of primary gastric MALT lymphoma in which a response to eradication treatment is difficult to achieve.In addition,trisomy 18 may be associated with diffuse large B-cell lymphoma(DLBCL)transformation of gastric MALT lymphoma.CASE SUMMARY A 66-year-old man was diagnosed with MALT lymphoma in the ascending colon by colonoscopy and biopsy.Two years later,esophagogastroduodenoscopy revealed chronic atrophic gastritis that was positive for H.pylori,and eradication treatment was administered.Two years and nine months later(at the age of 70),a new ulcerative lesion suggestive of MALT lymphoma appeared in the gastric body,and six months later,a similar lesion was also found in the fundus.One year later(4 years and 3 months after H.pylori eradication),at the age of 72,the lesion in the gastric body had become deeper and had propagated.A biopsy revealed a pathological diagnosis of DLBCL.Both MALT lymphoma lesions in the ascending colon and DLBCL lesions in the stomach were positive for the t(11;18)(q21;q21)/API2-MALT1 translocation,and trisomy 18q21 was also detected.After 6 courses of R-CHOP(rituximab,cyclophosphamide,doxorubicin,vincristine and prednisone)chemotherapy,all of the above lesions disappeared[complete remission(CR)],and CR has been maintained for more than 3 years.In addition,both the colonic and gastric lesions were proven to have the same clonality.CONCLUSION Because the patient had a MALT1 translocation with trisomy 18q21,it was thought that this gastric MALT lymphoma developed independently of H.pylori infection and progressed.

Helicobacter pylori eradication treatment for primary gastric diffuse large B-cell lymphoma:A single-center analysis

BACKGROUND Unlike the already established effect of Helicobacter pylori(H.pylori)eradication on gastric mucosa-associated lymphoid tissue(MALT)lymphoma,its therapeutic effect on primary gastric diffuse large B-cell lymphoma(DLBCL)is still unclear.AIM To clarify the efficacy of H.pylori eradication treatment for primary gastric DLBCL.METHODS We reported on 3 new cases,and added them to 3 previously reported cases.We analyzed the usefulness of H.pylori eradication treatment for gastric DLBCL for a total of 6 cases at our center.RESULTS Of the 6 patients(27-90 years old,3 males and 3 females),all 3 patients with single lesions(one transformed from MALT lymphoma)achieved complete remission(CR)after H.pylori eradication.Regarding the 2 newly reported cases,CR was maintained for more than 6 years with eradication treatment alone.In contrast,none of the 3 patients with 2 lesions achieved CR.In 1 newly reported case,endoscopic CR was achieved in one lesion,while stable disease was obtained in the other lesion.Two patients with progressive disease responded to standard chemo therapy±radiation and remained in CR for more than 6 years.CONCLUSION We believe it is worthwhile to attempt H.pylori eradication for elderly patients with primary gastric DLBCL in a single lesion with a small tumor burden.

Acquired hemophilia A in solid cancer: Two case reports and review of the literature

Acquired hemophilia A （AHA） is a rare, hemorrhagic autoimmune disease, whose pathogenesis involves reduced coagulation factor Ⅷ （FⅧ） activity related to the appearance of inhibitors against FⅧ. Common etiological factors include autoimmune diseases, ma-lignancy, and pregnancy. We report two cases of AHA in solid cancer. The first case is a 63-year-old man who developed peritoneal and intestinal bleeding after gastrectomy for gastric cancer. He was diagnosed with AHA, and was treated with prednisone, followed by cyclophosphamide. In the second case, a 68-year-old man developed a subcutaneous hemorrhage. He was diagnosed with AHA in hepatocellular carcinoma on CT imaging, and treated with rituximab alone. Hemostasis was achieved for both patients without bypassing agents as the amount of inhibitors was reduced and eradicated. However, both patients died within 1 yeardue to cancer progression. Successful treatment for AHA in solid cancer can be diffcult because treatment of the underlying malignancy is also required.

寡糖对土壤微生物多样性及群落结构的调节作用

土壤微生物种群类型,对土壤质量和作物生长具有重要影响,研究寡糖对土壤微生物种群的影响特征,有助于正确、高效及安全使用寡糖。本研究利用人工气候室进行土壤培养,土壤施加50mg·L^(−1)的壳寡糖(CSOS)和纤维寡糖(COS)溶液,以清水(CK)为对照处理,培养6d后取样,利用高通量测序技术,分析土壤微生物群落结构组成及多样性分布特征。结果表明:壳寡糖(CSOS)和纤维寡糖(COS)处理均显著改变细菌、真菌的群落结构,提高细菌的物种观测数。变形菌门(Proteobacteria)、酸杆菌门(Acidobacteria)、放线菌门(Actinobacteria)、绿弯菌门(Chloroflexi)、芽单胞菌门(Gemmatimonadetes)和拟杆菌门(Bacteroidetes)为优势细菌门,子囊菌门(Ascomycota)、担子菌门(Basidiomycota)和被孢霉门(Mortierellomycota)为优势真菌门。通过组间群落组成比较分析可知,壳寡糖(CSOS)和纤维寡糖(COS)处理均不同程度降低酸杆菌门(Acidobacteria)的相对丰度,增加变形菌门(Proteobacteria)、放线菌门(Actinobacteria)、芽单胞菌门(Gemmatimonadetes)、壶菌门(Chytridiomycota)以及有益菌属溶杆菌属(Lysobacter)、硝化螺旋菌属(Nitrospira)、Haliangium、芽球菌属(Blastococcus)和链霉菌属(Streptomyces)的相对丰度,但与纤维寡糖(COS)相比,壳寡糖(CSOS)处理微生物群落组成的变化幅度更大。此外,壳寡糖(CSOS)和纤维寡糖(COS)处理在调节土壤微生物群落结构上存在一定差异。其中,壳寡糖(CSOS)处理有益菌属Talaromyces的相对丰度增加195%,纤维寡糖(COS)处理有益菌属假单胞菌属(Pseudomonas)的相对丰度增加215%。综上,壳寡糖和纤维寡糖处理均能优化土壤微生物群落的结构组成,其调控差异性有助于理解不同寡糖的调控机制,推动寡糖的应用与推广。

Duodenal-type follicular lymphoma more than 10 years after treatment intervention:A retrospective single-center analysis

BACKGROUND Duodenal-type follicular lymphoma(D-FL)has been recognized as a rare entity that accounts for approximately 4%of primary gastrointestinal lymphomas.D-FL follows an indolent clinical course compared with common nodal FL and is generally considered to have a better prognosis.Therefore,the“watch and wait”approach is frequently adopted as the treatment method.Alternatively,there is an option to actively intervene in D-FL.However,the long-term outcomes of such cases are poorly understood.AIM To clarify the clinical outcomes after long-term follow-up in cases of D-FL with treatment intervention.METHODS We retrospectively analyzed patients who met the following criteria:the lesion was confirmed by endoscopy,the diagnosis of D-FL was confirmed histopathologically,and the patient was followed-up for more than 10 years after the intervention at our center.RESULTS We identified 5 cases of D-FL.Two patients showed a small amount of bone marrow involvement(Stage IV).Rituximab was used as a treatment for remission in all 5 patients.It was also used in combination with chemotherapy in 2 Stage IV patients as well as for maintenance treatment.Radiation therapy was performed in 2 cases,which was followed by complete remission(CR).Eventually,all 5 patients achieved CR and survived for more than 10 years.However,3 patients experienced recurrence.One patient achieved a second CR by retreatment,and in another case,the lesion showed spontaneous disappearance.The remaining patient had systemic widespread recurrence 13 years after the first CR.Biopsy results suggested that the FL lesions were transformed into diffuse large B-cell lymphoma.The patient died 4 years later despite receiving various chemotherapies.CONCLUSION In this study,the treatment for patients of D-FL in Stage IV was successful.In the future,criteria for how to treat“advanced”D-FL should be established based on additional cases.This study of patients with D-FL indicates that whole-body follow-up examinations should continue for a long time due to a fatal recurrence 13 years after reaching CR.

Pancreatic Carcinoma with Prominent Mucin Production: A Clinicopathologic and Immunohistochemical Study of 9 Cases

Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimation of the amount of mucous area, and there has been no report on a quantitative evaluation of the amount of mucinous area in the tumor. To examine the feature of PCM, we analyzed 9 cases of PCM among 243 cases of pancreas carcinoma and evaluated the amount of mucin by imaging analysis. Morphologically, 5 cases were classified as intradactal papillary mucinous neoplasms (IPMN)-derived PCM and 4 cases were as ductal adenocarcinoma (DA)-derived PCM. Mucous composition was found to be more than 50% in all IPMN-derived PCM cases, and that was 40% - 50% in DA-derived PCM cases with one exception. IPMN-derived PCM cases showed expansive growth with pancreatic duct dilatation filled with mucin, while DA-derived PCM cases possessed mucin infiltration into interstitial tissue. Immunohisto-chemically, three of 4 DA-derived PCM cases were MUC1(–)/MUC2(+), and the results of expressions for p16 and Dpc4 suggesting that DA-derived PCM was similar to IPMN-derived PCM rather than ordinary DA. Survival rate of DA-derived PCM cases was lower than that of IPMN-derived PCM cases. We advocate that DA-derived PCM may constitute a borderline group between IPMN and ordinary DA.

^(18)F-FDG PET/CT imaging for a gastrointestinal mantle cell lymphoma with multiple lymphomatous polyposis

Multiple lymphomatous polyposis(MLP)is an uncommon type of gastrointestinal lymphoma characterized by the presence of multiple polyps along the gastrointestinal tract.Most of this entity is in fact considered the counterpart of gastrointestinal tract involvement for mantle cell lymphoma(MCL).To our knowledge,there have been no reports on[fluorine-18]-fluorodeoxy-glucose(18F-FDG)-positron emission tomography(PET)/computed tomography(CT)imaging for gastrointestinal MCL with MLP.We present the results of 18F-FDG PET/CT imaging in a patient with gastrointestinal tract involvement of MCL showing continuous MLP from the stomach to the rectum and intestinal intussusception.FDG-PET/CT findings were false negative in typical MLP spreading widely over the gastrointestinal tract,but uptake was noted in large lesions with deep infiltration considered atypical as MLP.On FDG-PET/CT imaging,the Ki-67proliferative index,which is a cell proliferation marker,showed neither correlation with the presence of uptake nor the maximum standardized uptake value.

Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia:A case report

BACKGROUND Phlegmonous gastritis(PG)is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall.The most representative causative bacterium is Streptococcus pyogenes,followed by Staphylococcus,Pneumococcus and Enterococcus.Hepatic portal venous gas(HPVG)is considered a potentially fatal condition and is rarely associated with PG.CASE SUMMARY The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy.Her vital signs were consistent with septic shock.Venous blood culture revealed the presence of Bacillus cereus.Abdominal computed tomography(CT)and esophagogastroduodenoscopy(EGD)showed marked thickening of the gastric wall.As with the other findings,CT was suggestive of HPVG,and EGD showed pseudomembrane-like tissue covering the superficial mucosa.Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils.Culture of gastric specimens revealed the presence of Bacillus cereus.We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG.This patient recovered successfully with conservative treatment,chiefly by using carbapenem antibiotics.CONCLUSION The histopathological finding of this gastric biopsy specimen should be called"neutropenic necrotizing gastritis".

ALK-positive anaplastic large cell lymphoma presenting multiple lymphomatous polyposis: A case report and literature review

BACKGROUND Anaplastic large cell lymphoma(ALCL)is a type of T-cell lymphoma that can be divided into two categories:anaplastic lymphoma kinase-positive(ALK+)and ALK-negative.Gastrointestinal ALK+ALCL is rare.Multiple lymphomatous polyposis(MLP)is thought to be a representative form of gastrointestinal lesion in mantle cell lymphoma,and T-cell lymphomas seldom show this feature.Here,we report the first known case of ALK+ALCL with gastroduodenal involvement to present with MLP.CASE SUMMARY The patient was a 43-year-old man who was complained of a mass in the left inguinal area and was performed open biopsy.ALK+ALCL was diagnosed pathologically.Computed tomography scan demonstrated multiple lymph node lesions in the abdomen-pelvis/inguinal region,and scattered nodular lesions in both lung fields.He did not complain of gastrointestinal symptoms.While,esophagogastroduodenoscopy identified MLP lesions from the antrum of the stomach to the descending portion of the duodenum and mild thickened folds on the corpus of the stomach,and biopsy showed invasion of ALK+ALCL.We treated this patient with six cycles of CHOEP(Cyclophosphamide,Doxorubicin,Vincristine,Etoposide,and Prednisone)chemotherapy.At the conclusion of treatment,there was complete remission.Numerous white scars were found on the stomach,endoscopically consistent with a remission image of lymphoma.The endoscopic features of this case were thought to be similar to those of MCL.CONCLUSION The macroscopic/endoscopic features of gastrointestinal ALK+ALCL may be more similar to those of B-cell lymphomas rather than T-cell lymphomas.

Evaluation of a Recombinant Measles Virus as the Expression Vector of Hepatitis C Virus Envelope Proteins

Measles virus (MV) is a negative strand RNA virus of the family Paramyxoviridae, and the attenuated Edmonston-B strain can be engineered by the reverse genetics system. Here we constructed the recombinant Edmonston strain of measles virus (MV-Ed) that expressed hepatitis C virus (HCV) envelope proteins (rMV-E1E2). The rMV-E1E2 successfully expressed HCV E1 and E2 proteins. To evaluate its immunogenicity, NOD/Scid/Jak3null mice that were engrafted with human peripheral blood mononuclear cells (huPBMC-NOJ) were infected with this rMV-E1E2. Although human lymphocytes could be isolated from the spleens of mock-infected mice during the 2-weeks-long experiment, the proportion of mice that were infected with MV or rMV-E1E2 was decreased in a viral dose-dependent manner. Over 103 PFU of virus infection decreased the human PBL to less than 5%. Significant decrease of B cell population in human PBL from rMV-E1E2 infected NOD-SCID mice and decrease of T cell population in those from MV infected mice were observed. Human antibody production in these mice was also examined. Thus, the results in this study may contribute for future improvement of recombinant vaccine using measles virus vector.

Development of a Training Textbook for Countermeasures to “Verbal Abuse, Physical Assault, and Harassment in Pediatric Medical Settings”

Background: Recently, abuse, assault, and harassment in pediatric medical settings have become more serious. We extracted typical problems from a nationwide simultaneous survey on abuse in the pediatric medical field and developed a training textbook to simulate or discuss these issues with colleagues. This study aimed to confirm the validity and usability of the contents of this training textbook. Methods: The textbook was mailed to the heads of 51 medical institutions affiliated with the Society of Ambulatory and General Pediatrics of Japan (SAGPJ) and the participants of the SAGPJ online workshop, who were asked to evaluate the textbook using a three-point scale to answer the following questions and provide opinions and impressions about the textbook. Q1. Do you think the whole content and structure of this textbook are useful? Q2. Would you use this textbook as a training textbook for all staff at your facility? A simple tabulation was performed on the evaluation using a three-point scale, while content analysis was performed on the opinions and impressions of the participants. Results: In response to Q1 and Q2, all 63 staff members from 55 facilities answered “3: Yes.” Opinions and impressions on the training textbook included “I think it can be used for workplace training” and “it is useful for exchanging various opinions among staff members and gaining a common opinion.” Conclusion: We developed a training textbook on abuse, assault, and harassment in pediatric medical settings based on a nationwide survey and confirmed the validity and usability of its contents.

Skyrmion-Like Solitons, Topological Quasi-Positroniums, and Soliton-Catalytic Effects in Graphite-Potassium Intercalation Compounds and Metal Surfaces

We have analyzed the narrow components in the positron annihilation angular correlation spectra of graphite-potassium intercalation with the theoretical formula, which is extended from “topological quasi-positronium” model and discusses the relation to the catalytic activity of hydrogens. One mechanism of the soliton-catalytic effect is proposed.

Experiences and Countermeasures of a Perinatal Ward Nursing Manager Dealing with Family Members’ Problematic Behaviors

Background: When family members and/or patients behave in a problematic way, this hinders the provision of safe and secure medical care. During the perinatal period, a family’s relationships and functions change significantly, and each family member is prone to experiencing stress. As such, conflict arises easily between family members and medical staff. Aims: Therefore, we conducted this study to shed light on the following phenomena: 1) family members’ problematic behaviors;2) the concerns of a perinatal ward nurse manager (hereafter referred to as the manager) and ward nurses;and 3) countermeasures carried out by the manager, together with the ward nurses, based on the manager’s experiences. Methods: We conducted an 80-minute, semi-structured interview with the manager, following which we analyzed the content of her narrated accounts. Results: According to the findings, 1) family members’ problematic actions include verbal abuse;arrogance, unreasonableness, and selfish behaviors;and violent conduct;2) the manager’s and ward nurses’ fears and worries about family members’ problematic behaviors;responses to gradually becoming involved with family members;and resistance to staying involved with family members following patient discharge. In addition, we examined 3) countermeasures carried out by the manager together with the ward nurses: resolute and consistent responses to family members’ problematic behaviors;attempted enforcement measures taken to deal with family members who exhibit problematic behaviors;engagement while trying to avoid conflict with family members;preparation that anticipates the occurrence of problematic conduct;cooperation with the medical team;cooperation with the hospital organization;cooperation with social resources outside the hospital;and patient protection. Conclusions: With awareness of cooperation with the medical team toward family members who engage in problematic actions, the medical staff members try to unify their response and share their feelings of hardship with each other.

资秩学院单元07

日益增加的对于艺术的自治和自知，导致出现了这种范例式的建筑：白色立方体（白色的盒子）。这种白色盒子系统的边界被质疑：外部有来自社会的和经济上的压力，内部有在艺术实践中的压力，包括外部形象。本单元的目的是要研究在这些边界冲突的地方建筑的含意，发展一种新的自由诗歌样的系统模式，以及界定开放空间和封闭空间的途径。

Mixed-Oligosaccharides Promote Seedling Growth of Direct-Seeded Rice under Salt and Alkaline Stress

Rice direct seeding technology is an appealing alternative to traditional transplanting because it conserves labor and irrigation resources.Nevertheless,there are two main issues,salt stress and alkaline stress,which contribute to poor emergence and seedling growth,thereby preventing the widespread adoption and application of this technique in the Ningxia Region of China.Therefore,to determine whether germination can be promoted by mixed-oligosaccharide(KP)priming(in which seeds are soaked in a KP solution before sowing)under salt and alkaline stress,a proteomics study was performed.KP-priming significantly mitigated abiotic stress,such as salt and alkaline stress,by inhibiting root elongation,ultimately improving seedling establishment.By comparing the proteomics analyses,we found that energy metabolic pathway was a vital factor in KP-priming,which explains the alleviation of salt and alkaline stress.Key proteins involved in starch mobilization,pyruvate mobilization,and ATP synthesis,were up-regulated by KP-priming,significantly blocking salt and alkaline-triggered starch accumulation while enhancing pyruvate metabolism.KP-priming also up-regulated ATP synthase to improve energy efficiency,thereby improving ATP production.In addition,it enhanced antioxidant enzymatic activities and reduced the accumulation of reactive oxygen species.All of these factors contributed to a better understanding of the energy regulatory pathway enhanced by KP-priming,which mediated the promotion of growth under salt and alkaline conditions.Thus,this study demonstrated that KP-priming can improve rice seed germination under salt and alkaline stress by altering energy metabolism.

Cerebral aneurysms and inflammation

Multiple inflammatory factors,playing a crucial role in cerebral aneurysm formation,have been identified.Tumor necrosis factor‑alpha(TNF‑α)has been revealed to have a close connection with several risk factors that affect aneurysm formation.Remarkable expression in aneurysm walls of mRNA for TNF‑αhas been observed in humans.Possible therapeutic interventions to reduce the formation of cerebral aneurysms may include the inhibition of mediators of inflammation.