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Abstract Background Granulocyte colony-stimulating factor (G-CSF) is increasingly used to prevent chemotherapy-associated febrile neutropenia. Generally, aortitis is not considered a side effect of G-CSF and is thought to be extremely rare. Aortitis is an inflammation of the aorta and occurs mainly in connective tissue diseases (Takayasu arteritis, giant cell arteritis, etc.) and infectious diseases (bacterial endocarditis, syphilis, etc.). We report herein a rare case of G-CSF associated with aortitis in a woman with breast cancer. Case presentation Here, we present a case involving a 63-year-old woman with luminal type stage IIa breast cancer. The patient’s treatment was initiated with docetaxel and cyclophosphamide, with pegfilgrastim (PEG-G) as support. After PEG-G administration on day 3, the patient developed an intermittent fever of up to 39.4 °C on day 10 and visited our outpatient clinic on day 13 with persistent high fever. Laboratory tests revealed a high neutrophil count (14,000/μL) and a high C-reactive protein (CRP) level (42.8 mg/dL) without any other abnormalities. Contrast-enhanced computed tomography scanning revealed soft tissue thickening with weak enhancement around the wall of the thoraco-abdominal aorta, aortic arch and left subclavian artery. The patient did not respond to antimicrobial agents. On the basis of these observations, the patient was diagnosed with PEG-G-induced aortitis, and her condition rapidly improved without corticosteroids. Conclusions Clinicians should be aware of aortitis as a potential complication in patients undergoing G-CSF chemotherapy. In cases with persistent high fever after PEG-G administration, and in the absence of infection, aortitis should be suspected.

Summary: Background: Various effects of fermented milks on the immune system have been reported. However, their effects on gut associated lymphoid tissue (GALT) remain controversial. We examined influences of a fermented milk with Lactobacillus bulgaricus and Streptococcus thermophilus on intestinal flora, GALT mass and mucosal IgA levels using uninjured and injured murine models. Methods: Experiment 1: Mice were fed a fermented milk diet containing 20% fermented milk with Lactobacillus bulgaricus and Streptococcus thermophilus (FM group) or an unfermented milk diet (UFM group) for 7 days (Days 0–6) ad libitum. The mice were killed on Day 7, and lymphocyte numbers in Peyer patches (PP), intraepithelial spaces (IE), and the lamina propria (LP) were determined, as well as the phenotypes of these lymphocytes (B cells, CD4+ T cells, CD8+ T cells, αβTCR+ T cells, γδTCR+ T cells), and the mucosal IgA levels in nasal, bronchoalveolar, and intestinal washings. We also measured bacterial flora in the cecum. Experiment 2: Mice were fed the FM or the UFM diet for 7 days ad libitum. On Day 7, the mice underwent gut ischemia reperfusion (IR). On Day 8, the mice were killed, and the same parameters as in experiment 1 were measured. Results: In experiment 1, the percentage of CD4+ T cells in the LP was significantly higher in the FM than in the UFM group. The percentage of bacteria of the order Lactobacillales in cecal contents was higher in the FM than in the UFM group, while the Bacteroides percentage of cecal contents was lower. In experiment 2, the phenotypic expressions of γδ+TCR cells in PP and IE lymphocytes were significantly lower in the FM-IR than in the UFM-IR group. Conclusion: The fermented milk with Lactobacillus bulgaricus and Streptococcus thermophilus examined herein does not clearly exert beneficial effects on GALT lymphocyte cell numbers and mucosal IgA levels in mice regardless of gut flora modulation.

Abstract Medial degeneration is a common histopathological finding in aortopathy and is considered a mechanism for dilatation. We investigated if medial degeneration is specific for sporadic thoracic aortic aneurysms versus nondilated aortas. Specimens were graded by pathologists, blinded to the clinical diagnosis, according to consensus histopathological criteria. The extent of medial degeneration by qualitative (semi-quantitative) assessment was not specific for aneurysmal compared to nondilated aortas. In contrast, blinded quantitative assessment of elastin amount and medial cell number distinguished aortic aneurysms and referent specimens, albeit with marked overlap in results. Specifically, the medial fraction of elastin decreased from dilution rather than loss of protein as cross-sectional amount was maintained while the cross-sectional number, though not density, of smooth muscle cells increased in proportion to expansion of the media. Furthermore, elastic lamellae did not thin and interlamellar distance did not diminish as expected for lumen dilatation, implying a net gain of lamellar elastin and intralamellar cells or extracellular matrix during aneurysmal wall remodeling. These findings support the concepts that: (1) medial degeneration need not induce aortic aneurysms, (2) adaptive responses to altered mechanical stresses increase medial tissue, and (3) greater turnover, not loss, of mural cells and extracellular matrix associates with aortic dilatation.

The relationship of Epstein-Barr virus (EBV) has been well characterized with a wide range of lymphoproliferative lesions and lymphomas of B-cell, T-cell, and NK-cell origin. However, the association of EBV with mantle cell lymphoma (MCL) is exceedingly rare and not well established. We report a case of classic MCL which transformed to pleomorphic MCL after a clinical course of 19 years. Particularly, EBV infection was detected in the transformed high-grade pleomorphic MCL. Molecular and genetic analyses confirmed the clonal relationship between the original and transformed lymphomas. To the best of our knowledge, there has only been one case reported in 2003 which documented an EBV-associated high-grade transformation of MCL. Therefore, our case report further expanded the spectrum of EBV in the pathogenesis of B-cell lymphoma transformation.

Although wild bird rehabilitation facilities are important for the conservation of wild species, individuals may be kept within the facilities for long periods, consequently posing a risk for the bird to be infected with pathogens to which they are not naturally exposed. In turn, novel pathogens may be introduced through rescued migratory species. Avian malaria and West Nile fever are important avian diseases transmitted by mosquitoes. To understand the transmission dynamics of such diseases at rehabilitation facilities, the ecology of vector mosquitoes, including species composition, seasonality, and feeding behaviors, were explored. Mosquitoes were collected at a wild bird rehabilitation facility and wildlife sanctuary in Japan from 2019 to 2020 using mouth aspirators, sweep nets, and light traps. A total of 2,819 mosquitoes of 6 species were captured, all of which are potential vectors of avian diseases. Culex pipiens pallens and Cx. pipiens form molestus were the dominant species (82.9% of all collected mosquitoes). Density and seasonality differed between sampling locations, presumably because of differences in mosquito behaviors including feeding preferences and responses to climatic factors. Blood-fed Culex mosquitoes fed solely on birds, and many mosquito species are thought to have fed on birds within the facility. Particularly, Cx. pipiens group probably fed on both rescued and free-living birds. The rehabilitation facility may be an important site for the introduction and spread of pathogens because 1) numerous mosquitoes inhabit the hospital and its surroundings; 2) blood-fed mosquitoes are caught within the hospital; 3) there is direct contact between birds and mosquitoes; 4) both birds within the hospital and wild birds are fed upon. Furthermore, blood-fed Cx. pipiens form molestus were observed in the winter, suggesting that pathogens might be transmitted even during the winter when other mosquito species are inactive. [ABSTRACT FROM AUTHOR]

It is difficult to identify patients with isolated dizziness caused by cerebrovascular events. The estimated risk of cerebrovascular events in isolated dizziness patients is not completely understood. We aimed to evaluate the association of the finger-to-nose test (FNT) in diagnosing cerebrovascular events in isolated dizziness patients in emergency departments (EDs). We combined 2 datasets from a single center for consecutive isolated dizziness patients, with the same inclusion and exclusion criteria. Those who met any of the following criteria were excluded: no FNT data, age < 16 years, and psychological trauma. The primary outcome was cerebrovascular event, which was defined as cerebral stroke due to cerebral infarction, cerebral hemorrhage, vertebral artery dissection, or transient ischemic attack. In the combined dataset, there were 357 patients complaining of isolated dizziness and 31 cerebrovascular events. After adjusted by 5 previously reported risk factors for cerebrovascular event, (age, hypertension, hyperlipidemia, diabetes mellitus, nystagmus), a multivariable logistic model analysis showed that the existence of FNT abnormalities was significantly associated with cerebrovascular events (odds ratio, 25.3; 95% confidence interval, 7.3–88.2; p < 0.001). There was a significant increase in predictive accuracy, with an AUC increase of 0.116 in the in a ROC analysis (p = 0.023). The existence of FNT abnormalities is considered as a strong risk factor that could be useful for predicting cerebrovascular events in isolated dizziness patients. We recommend the FNT for screening isolated dizziness patients in EDs to judge whether they need to undergo further diagnostic evaluation. [ABSTRACT FROM AUTHOR]