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Classical definitions of weak higher-dimensional categories are given inductively, for example, a bicategory has a set of objects and hom categories, and a tricategory has a set of objects and hom bicategories. However, more recent definitions of weak n-categories for all natural numbers n, or of weak $\omega$ -categories, take more sophisticated approaches, and the nature of the ‘hom is often not immediate from the definitions’. In this paper, we focus on Leinster’s definition of weak $\omega$ -category based on an earlier definition by Batanin and construct, for each weak $\omega$ -category $\mathcal{A}$ , an underlying (weak $\omega$ -category)-enriched graph consisting of the same objects and for each pair of objects x and y, a hom weak $\omega$ -category $\mathcal{A}(x,y)$ . We also show that our construction is functorial with respect to weak $\omega$ -functors introduced by Garner.

Aspergillosis is a rare disease that often occurs in patients with diabetes mellitus or compromised hosts. This study describes a 60-years-old woman with unusual pseudo-malignant paranasal invasive aspergillosis with 18F-fluorodeoxyglucose (18F-FDG) uptake treated by endoscopic sinus surgery. To the best of our knowledge, there are few reported cases of paranasal fungal infection with 18F-FDG uptake.A 60-years-old woman was presented with headache and nasal obstruction.Computed tomography (CT) showed a shadow with bone destruction in the sinus cavity and accumulation of 18F-FDG uptake. The patient was diagnosed with a malignant tumor or pseudo-malignant paranasal invasive aspergillosis.The patient underwent endoscopic sinus surgery; no neoplastic lesions were detected in the areas with CT shadows. All the observed fungal mass reservoirs were removed.The patient remained hospitalized for 1 week after the surgery with no significant postoperative abnormalities. There was no recurrence of the disease for 6 months, and the patient's symptoms resolved, indicating a good course of follow-up.Invasive aspergillosis should be considered a differential disease when positron emission tomography (PET)/CT scans show FDG uptake, CT shows bone destruction, and T2-weighted MRI scans show a low signal.

Eosinophilic chronic rhinosinusitis (ECRS) is a Type 2 inflammatory disease that manifests as chronic inflammation of the paranasal sinus. IL-4/IL-13 receptor monoclonal antibodies (dupilumab) to suppress Type 2 inflammation have become a good treatment option for patients who are refractory to surgery. Most patients respond normally, although significant side effects such as eosinophilic pneumonia may occur, requiring discontinuation of dupilumab. Here, we present a case in which dupilumab administration caused a side-effect of eosinophilic pneumonia. A 65-year-old woman presented with nasal obstruction and olfactory dysfunction due to a nasal polyp. Her symptoms temporarily improved with dupilumab; however, dupilumab was discontinued due to eosinophilic pneumonia. Discontinuation of dupilumab resulted in the rapid resolution of eosinophilic pneumonia and reappearance of nasal polyps. We, therefore, resumed dupilumab treatment in combination with low-dose steroids; eosinophilic pneumonia did not flare up, and the nasal polyps shrank steadily. There is no established treatment strategy in cases where a side effect of eosinophilic pneumonia arises while treating ECRS with dupilumab. Based on the described case, we recommend that a combination of a low-dose steroids and dupilumab be considered as a treatment option to counter the side-effect of eosinophilic pneumonia induced by dupilumab alone.

An 86-year-old man was admitted to another hospital with ataxia and general fatigue. Brain MRI scan revealed a high-intensity area in the bilateral thalamus, and he was referred to Okayama University Hospital for detailed examination. Cerebrospinal fluid (CSF) and blood tests showed no evidence of infection or autoimmune encephalitis. An FDG-PET/CT scan revealed systemic lymphadenopathy, and cervical lymph node biopsy showed classical Hodgkin lymphoma. Neurological symptoms were suspicious of paraneoplastic neurological syndrome (PNS), but onco-neural antibodies were not detected in either serum or CSF. He was referred to our hospital, Okayama Red Cross Hospital, for treatment and administered 6 cycles of an ABVD regimen, and an FDG-PET/CT scan showed a complete remission. The brain lesion disappeared and neurological symptoms were improved, so he was diagnosed with PNS. PNS is rare complication associated with malignant lymphoma and early diagnosis is important because neurological symptoms can be improved with anti-cancer treatment.

Progression-free survival in patients with untreated follicular lymphoma (FL) has significantly improved with obinutuzumab plus chemotherapy followed by obinutuzumab maintenance, compared with rituximab plus chemotherapy. However, the survival outcome and adverse event profile in Japanese FL patients treated with obinutuzumab plus bendamustine (GB) therapy are not well investigated. Recently, we encountered some cases of grade 3-4 thrombocytopenia during GB therapy in patients with FL. This retrospective multicenter survey aimed to identify the characteristics of patients who received GB therapy and developed thrombocytopenia. A total of 54 patients with FL treated by GB therapy between August 2018 and December 2020 were investigated. After a median follow-up of 12.6 months, thrombocytopenia of any grade was observed in 48 (88.9%) patients, including 9 (16.7%) patients with grade 3-4 thrombocytopenia. Notably, although eight of nine patients with grade 3-4 thrombocytopenia were female, no patient characteristics (including gender) were significantly associated with grade 3-4 thrombocytopenia. Importantly, grade 3-4 thrombocytopenia frequently occurred in the first GB therapy cycle, which suggests that platelet count should be monitored carefully in patients who have just started GB therapy.

A 44-year-old Japanese man presented with fever and sore throat. He had a history of refractory chronic sinusitis that did not respond to several years of pharmacotherapy, and underwent endoscopic sinus surgery (ESS) 5 months prior to his presentation, but his symptoms persisted. A biopsy specimen was taken from the right nasal cavity, and extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) was diagnosed. Two years after complete remission was achieved by chemoradiation therapy, he developed hemophagocytic lymphohistiocytosis (HLH) without recurrence of ENKTL. Epstein-Barr virus (EBV)-DNA copy number was relatively high and EBV-infected lymphocytes (CD8 + T cells) were detected in the peripheral blood. Pathological review of the biopsy specimens taken during ESS showed that CD8 + T cells with slightly atypia infiltrating the stroma were EBV positive. These findings suggested that the patient had underlying chronic active EBV infection (CAEBV) that caused the refractory chronic sinusitis, eventually developed into ENKTL, and also caused HLH. Clinicians should consider adult-onset CAEBV in the differential diagnosis of patients with refractory chronic sinusitis.

We show that for any quantale $\mathcal{Q}$, a $\mathcal{Q}$-category is skeletal and complete if and only if it is injective with respect to fully faithful $\mathcal{Q}$-functors. This is a special case of known theorems due to Hofmann and Stubbe, but we provide a different proof, using the characterisation of the MacNeille completion of a $\mathcal{Q}$-category as its injective envelope. For Lawvere metric spaces, our results yield those of Kemajou, K\"unzi and Otafudu. We point out that their notion of Isbell convexity can be seen as a geometric formulation of categorical completeness for Lawvere metric spaces., Comment: 14 pages; v2: final journal version. arXiv admin note: text overlap with arXiv:1909.07620

A 78-year-old Japanese man was referred to our hospital after experiencing black feces. No abnormal finding was detected in the endoscopic examination of his stomach and large intestines. Computed tomography (CT) of the abdomen revealed a tumor lesion in the right lobe of the liver. A needle biopsy of the tumor under ultrasound guidance was performed. A pathological examination of the biopsy specimen showed a diffuse proliferation of lymphoma cells, which was compatible with diffuse large B-cell lymphoma (DLBCL). F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT demonstrated increased FDG uptake only in the liver tumor. We made the diagnosis of primary DLBCL of the liver. After six cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), the patient achieved complete remission and has maintained remission for 2 years since the diagnosis. The R-CHOP regimen might be effective therapy for primary DLBCL of the liver.

We consider an extant infinitary variant of Lawvere's finitary definition of extensivity of a category $\mathcal V$. In the presence of cartesian closedness and finite limits in $\mathcal V$, we give two characterisations of the condition in terms of a biequivalence between the bicategory of matrices over $\mathcal V$ and the bicategory of spans over discrete objects in $\mathcal V$. Using the condition, we prove that $\mathcal{V}﹣\mathrm{Cat}$ and the category $\mathrm{Cat}_\mathrm{d}(\mathcal{V})$ of internal categories in $\mathcal V$ with a discrete object of objects are equivalent. Our leading example has $\mathcal{V} = \mathrm{Cat}$, making $\mathcal{V}﹣\mathrm{Cat}$ the category of all small 2-categories and $\mathrm{Cat}_\mathrm{d}(\mathcal{V})$ the category of small double categories with discrete category of objects. We further show that if $\mathcal V$ is extensive, then so are $\mathcal{V}﹣\mathrm{Cat}$ and $\mathrm{Cat}(\mathcal{V})$, allowing the process to iterate.

Work in Progress: Communication skills are indispensable for becoming successful in the global engineering community. Among various communication skills, presentation skills are regarded as one of the greatest career enhancers for engineers. Nevertheless, it is the weakest skill of most Japanese engineering students. To overcome this inadequacy, we offered a presentation skills course for sophomore Science, Technology, Engineering, and Mathematics (STEM) students by integrating video streaming and numerical peer evaluation using IT technology. This paper examines the feasibility and the students' acceptability of the newly developed IT peer evaluation system. In implementing the system, three research questions were posed: 1. Does the new system facilitate classroom management? 2. Is the new system more accepted than the existing paper-based method by the students? 3. Does the new system promote the overall improvement of students' presentation skills? The preliminary results showed that the new system facilitated classroom management, and that it was accepted by the students primarily due to its functional requirement such as utility and non-functional requirement such as promptness. Furthermore, the students' average numerical peer evaluation scores of physical messages and audience interaction mostly improved.

Metabolic syndrome (MetS) has been redefined by a new criterion in Japan, in which waist circumference cut-off points, that is 85 cm for men and 90 cm for women, are used; however, objections are rising against this criterion. The present study examined the criterion for waist circumference to predict the accumulation of the components of MetS. In the present study, we used data for 5972 Japanese people who received annual health examinations, and 621 men (16.3%) and 51 women (2.4%) were diagnosed as having MetS. A cut-off point as a predictor for two or more components of MetS was evaluated by the sensitivity/specificity and a receiver operating characteristic analysis. The optimal point of waist circumference was estimated as being approximately 84 cm for men and 80 cm for women. We therefore recommend revising the cut-off value for the criterion of MetS in women according to our results and studies from other investigators. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00020.x, 2010)

We report seven large B cell lymphoma patients showing the involvement of tumor cells with cyclin D3 (CCND3) expression in bone marrow (BM) at the initial diagnosis. All patients presented with B symptoms, splenomegaly, and anemia/thrombocytopenia lacking hemophagocytosis in the BM. Five of the seven patients had suffered from immunological diseases or cancers. The tumor cells were divided into those with a lymphoplasmacytoid or blastoid appearance. Six cases were confirmed to express CD5 antigen on tumor cells. Three cases presented a chromosomal translocation between CCND3 and the immunoglobulin heavy chain (IGH) loci, t(6;14)(p21;q32). Three and two cases showed unmutated and mutated sequences of the variable region of IGH (VH), respectively, and one case showed deletion of an entire segment of VH. Two cases with t(6;14)(p21;q32) showed an unmutated VH sequence and chromosomal translocation within the switch region of IGH. Further studies are required to determine whether CCND3 expression is associated with a unique subset of diffuse large B cell lymphoma.

Background Lymphoid neoplasm with 18q21.3/BCL2 and 8q24/MYC translocation to immunoglobulin (IG) genes as dual-hit lymphoma/leukemia is very rare and known to have a poor clinical outcome.Design and Methods To clarify the clinicopathological characteristics of this malignancy, we analyzed 27 cases of cytogenetically proven dual-hit lymphoma/leukemia.Results Dual-hit lymphoma/leukemia was diagnosed at presentation in 22 cases and at relapse or disease progression in 5 cases. At the time of diagnosis of dual-hit lymphoma/leukemia, extranodal involvement was found in 25 cases (93%) and central nervous system involvement occurred in 15 cases (56%). The median survival and 1-year survival rate of the 27 cases were only 6 months and 22%, respectively, after diagnosis of the dual-hit lymphoma/leukemia. Seven cases of triple-hit lymphoma/leukemia (dual-hit lymphoma/leukemia with 3q27/BCL6 translocation) were included; the median survival of these patients was only 4 months from the diagnosis of the dual-hit lymphoma/leukemia. The duration of survival of the patients with a triple-hit malignancy was shorter than that of the other 20 cases of dual-hit lymphoma/leukemia (p=0.02). The translocation partner of MYC subdivided the dual-hit cases into two groups; 14 cases of IGH and 13 cases of IGK/L. The MIB-1 index was investigated in 14 cases with aggressive B-cell lymphoma, and was higher in the group with MYC-IGH translocation (n=7) than in the MYC-IGK/L group (n=7) (p=0.02). Overall survival was not different between the MYC-IGH translocation group (n=14) and the MYC-IGK or MYC-IGL translocation group (n=13).Conclusions Dual-hit lymphoma/leukemia is a rare but distinct mature B-cell neoplasm with an extremely poor prognosis characterized by frequent extranodal involvement and central nervous system progression with either of the translocation partners of MYC.

A 78-year-old male, who had CKD and chronic heart failure, was referred to our hospital for evaluation of leukocytosis. His bone marrow contained 12% blast cells and chromosome analysis showed the Ph chromosome as well as other changes. The patient was diagnosed with the accelerated-phase CML because FISH and RT-PCR disclosed BCR/ABL fusion signals and minor BCR/ABL, respectively. Imatinib was administered, but the CML was resistant to this treatment. We gave him nilotinib employing a reduced and intermittent administration protocol because of the progression of anemia and heart failure. The patient achieved PCyR in 8 months, but, 12 months later, his WBC count increased and 83% of the cells were blasts. Because the probable diagnosis was the blast crisis of CML, we switched from nilotinib to dasatinib. However, leukocytosis worsened and he died of pneumonia. It was later revealed that he had a normal karyotype and both FISH and RT-PCR analysis of BCR/ABL were negative. His final diagnosis was Ph negative AML developing from Ph positive CML in PCyR. Since there were no dysplastic changes indicative of MDS, it was assumed that the AML was not secondary leukemia caused by the tyrosine kinase inhibitor but, rather, de novo AML.

Metabolic syndrome (MetS) has been redefined by a new criterion in Japan, in which waist circumference cut‐off points, that is 85 cm for men and 90 cm for women, are used; however, objections are rising against this criterion. The present study examined the criterion for waist circumference to predict the accumulation of the components of MetS. In the present study, we used data for 5972 Japanese people who received annual health examinations, and 621 men (16.3%) and 51 women (2.4%) were diagnosed as having MetS. A cut‐off point as a predictor for two or more components of MetS was evaluated by the sensitivity/specificity and a receiver operating characteristic analysis. The optimal point of waist circumference was estimated as being approximately 84 cm for men and 80 cm for women. We therefore recommend revising the cut‐off value for the criterion of MetS in women according to our results and studies from other investigators. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00020.x, 2010)

We devised a new epirubicin-based combination chemotherapy (Epi-COP) regimen for the patients with elderly non-Hodgkin's lymphoma and have treated 30 patients aged 66 years and older who had measurable diseases. In Epi-COP therapy, epirubicin was used as a substitute for doxorubicin in the CHOP regimen, and some dose modifications were made for the other agents. Combined modality treatment (CMT; chemotherapy plus radiotherapy) was adopted for 9 patients with localized disease. Complete response was obtained in 21 of all the 30 patients (70%), 8 in 9 (89%) of the CMT group and 13 in 21 (62%) of the patients with chemotherapy only (chemotherapy group). The median follow up time is 350 days, ranging from 2 to 77 months. The 2 year survival rate was 56% in all patients, 67% in the CMT group and 52% in the chemotherapy group. Granulocyte colony-stimulating factor (G-CSF) was administered when the leucocyte count decreased below 2,000/microliter, and 16 patients received it in the first course. The regimen could be repeated every three weeks in most cases. Although we encountered two early deaths, the overall toxicity level seemed to be acceptable. Even when we take account of the small number of patients and the short observation period, it might be concluded that Epi-COP was effective in inducing a good remission rate with moderate toxic effect in elderly patients with non-Hodgkin's lymphoma and CMT should be adopted if it is localized. A randomized comparative study with the CHOP regimen is necessary.

The aim of this study was to evaluate the usefulness of F-18 fluorodeoxyglucose (FDG) dual-time-point (DTP) positron emission tomography (PET)/computed tomography (CT) with semiquantitative analyses for the initial staging in patients with malignant lymphoma.Forty-three patients had DTP PET/CT, with 60-min and 2-h scan [n = 8, Hodgkin's lymphoma (HL); n = 12, indolent non-Hodgkin lymphoma (NHL); n = 23, aggressive NHL].A total of 524 lesions were evaluated (406 lymph nodes and 118 extra-nodal lesions). The maximum standardized uptake value (SUV(max)) on 2-h delayed scan (SUV(2)) was significantly higher than those on 1-h early scan (SUV(1)) for all groups (P0.0001 for HL; P0.0001 for indolent NHL; P0.0001 for aggressive NHL). Significant differences were detected between HL and indolent NHL, between indolent NHL and the aggressive NHL for both SUV(1) and SUV(2) (each P0.0001). No significant differences were detected between HL and aggressive NHL for both SUV(1) and SUV(2) (P = 0.6891 for SUV(1); P = 0.8828 for SUV(2)); however, significant differences were detected for the retention index of SUV(max) between these groups (P = 0.0238).DTP F-18 FDG PET/CT with a semiquantitative technique may have the potential to provide the more accurate diagnoses for the staging of malignant lymphoma and the more important role in predicting the histological grades of malignancy compared with single-time-point F-18 FDG-PET scan.

We describe a patient with acute myelogenous leukemia (AML) who was complicated with severe tumor lysis syndrome (TLS) after a single day of chemotherapy; a previously unreported occurrence. A 48-year-old man was admitted because of fever and bleeding tendency, and was diagnosed as having AML: M1. His white blood cell count (WBC) was 66, 300/microliter with 96% myeloblasts. Chemotherapy with idarubicin and cytarabine was started. On the second day of the therapy, he developed acute renal failure (ARF) and deterioration of disseminated intravascular coagulation (DIC) with a marked reduction in his WBC (8500/microliter). Immediately after a diagnosis of tumor lysis syndrome (TLS), the following chemotherapy was discontinued. Hemodiafiltration and hemofiltration were initiated to treat the ARF, concomitant with anticoagulant and antifibrinolysis therapy for the DIC. Chemotherapy with daunorubicin and cytarabine was resumed on the 12th day, recognizing a regrowth of leukemic cells. Thereafter a complete remission was achieved without recurrence of the TLS.