Circadian rhythms are fundamental biological systems in most organisms. Epidemiological and animal studies have demonstrated that disruption of circadian rhythms is linked to tumor progression and mammalian tumorigenesis. However, the clinical significance of in situ clock gene expression in precancerous and cancerous colorectal lesions remains unknown. The present study aimed to investigate mRNA transcript levels of circadian clock genes within human colorectal cancer and adenoma tissue sections. Using in situ hybridization, the expression of key clock genes, including period circadian protein homolog (Per) 1 and 2, cryptochrome 1 (Cry1), circadian locomoter output cycles protein kaput (Clock), brain and muscle ARNT-like protein 1 (Bmal1) and casein kinase 1ε (CK1ε) were retrospectively examined in 51 cases of colorectal carcinoma and 10 cases of adenoma. The expression of clock genes was almost undetectable in the majority of adenomas, whereas positive expression of clock genes was observed in 27–47% of carcinomas. Notably, positive Per1, Per2 and Clock staining in colorectal carcinomas were each significantly associated with a larger tumor size (P=0.012, P=0.011 and P=0.009, respectively). Tumors with positive Per2 and Clock expression tended to exhibit deeper depth of invasion and were generally more advanced than tumors that did not express these genes (P=0.052 and P=0.064, respectively). However, no statistically significant association was observed between clock gene expression and clinicopathological variables, including histopathological differentiation, lymph node metastasis, depth of invasion or disease stage, although Per2-positive tumors tended to be associated with poorer overall survival (P=0.060). The results of the current study suggest that dysregulated expression of clock genes may be important in human colorectal tumorigenesis.
A 61-year-old man was being treated for poor nutritional status. He had been on weekly methotrexate 6 mg and daily tacrolimus 1 mg and prednisolone 18 mg for 8 years due to dermatomyositis. On further workup, he was initially detected to have ileocecal ulcer with subsequent development of diffuse miliary shadows on chest radiograph. He was diagnosed as having ileocecal with miliary tuberculosis (TB). While receiving anti-tuberculous therapy, there was initial improvement of TB-related symptoms and he had no conditions that interfered with the efficiency of the anti-tuberculous therapy. However, he developed intestinal perforation. Emergency surgery for resection of the ileocecal ulcer and ileocolostomy led to improvement and he was finally discharged. Recently, cases of intestinal TB have been rare and perforation due to TB is extraordinary. In this case, paradoxical reaction and poor nutritional status may have contributed to the intestinal perforation.
A 26‐year‐old man with a 10‐year history of asthma was admitted to our hospital with a six‐week history of dry cough and slight fever. We observed the left pneumothorax with multiple cysts and cavities and performed partial cystectomy of the left upper lung. Y‐shaped mycelia were detected in the resected tissue, and Aspergillus fumigatus was cultured. Pulmonary aspergillosis was diagnosed from the histopathological and bacteriological findings, and the patient demonstrated positive immunological reactions to A. fumigatus. After administration of an intravenous antifungal agent for one month and an oral antifungal agent for another three months, all cysts and cavities disappeared. Aspergillus infection usually results from saprophytic growth within pre‐existing cavities. In this case, multiple cysts and cavities may have been caused by Aspergillus, possibly through a check‐valve mechanism.
Background and study aims
Mycobacterium tuberculosis is often detected in the feces of patients with active pulmonary tuberculosis. However, no study has examined the small intestine using small bowel capsule endoscopy (SBCE). This study aimed to investigate intestinal abnormalities in patients with active pulmonary tuberculosis.
Patients and methods
SBCE was performed in sputum/feces smear-positive pulmonary tuberculosis patients. From December 2013 to November 2016, 15 patients were enrolled from a dedicated tuberculous ward. The primary outcome was intestinal abnormalities identified by SBCE.
Results
Fourteen patients (median age 81 years, range 29 – 91; 3 female) underwent SBCE to the terminal ileum. The video was not recorded for one patient who was excluded from the analysis. Intestinal lesions, including 5 annular ulcers in 4 patients, were observed in 64 % (9/14). In subgroup analysis, prevalence tended to be higher in patients undergoing SBCE within 1 month of anti-tuberculous therapy (
P
= 0.051). Distribution of small intestinal lesions tended to be distal. Four of five annular ulcers were located close to the ileocecal valve.
Conclusion
Prevalence of intestinal lesions in patients with pulmonary tuberculosis is higher than expected before (UMIN 000017292)
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