Dynamic 3D images （a tongue model） are crucial for tongue movement analysis in patients with speech disorders. Therefore, a tongue model construction tool was developed at the Showa University School of Dentistry and Tokyo City University to examine tongue movements during phonation. First, the ultrasound images of the tongue were obtained at a resting position and during speech using the 3D/4D probes of an ultrasound diagnostic device, both for a healthy subject （Normal subject） and a patient with lateral articulation （LA patient）. Then, a tongue model construction tool was developed, which created a tongue model based on 2D ultrasound images. Subsequently, the 3D movies of the tongue movements of a both subjects were developed and analyzed. By observing the 3D tongue movements of the LA patient, the tongue model construction tool revealed asymmetrical heights at the lingual edges, upper protrusion of the tongue, and groove formation for airflow. Therefore, this study generated 3D movies using the tongue model construction tool, which were considered useful for conducting detailed observations of tongue movements. Furthermore, visualizing tongue models may be effective in patients with speech disorders, thereby helping them regain normal speech.

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[in Japanese]

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Fractional exhaled nitric oxide （FeNO） is a clinically established noninvasive marker of airway inflammation in bronchial asthma. In allergic rhinitis, lower airways contain inflammatory cell infiltrates such as CD4^＋ lymphocytes and eosinophils, which are purported to affect the FeNO levels. In this study, we investigated whether exposure to cedar pollen affects the interpretation of FeNO levels and thus improves the accuracy of FeNO clinical test results. Accordingly, FeNO was measured in 14 healthy adults and 33 patients with cedar pollinosis during the pollen-free and dispersal periods from September, 2015, to April, 2016. The allergenic factors were evaluated through various blood tests. Symptoms of rhinitis were also evaluated by calculating the total nasal symptom score. The FeNO level of the healthy group was 17.1ppb and 17.7ppb during the pollen dispersal period and pollen-free period, respectively. Meanwhile, the FeNO level of the pollinosis group was 24.4ppb during the pollen dispersal period and 23.9ppb during the pollen-free period. These findings suggest that there are no seasonal variations in FeNO levels between the pollinosis and healthy groups. Although no significant difference was observed between the two groups in both periods, FeNO in the pollinosis group was consistently above the cutoff value of 22ppb, which was used as a threshold for differentiating between the healthy group and the asthmatic group in both periods. In the specific allergen test administered to cedar pollinosis patients, the positivity rate for cedar was determined to be 100％. However, 97％ of the individuals were also detected as positive for inhalant allergens besides cedar. Various confounding factors, such as smoking and eosinophilic diseases, could contribute to abnormal levels of FeNO. Thus, the seasonal variations in FeNO levels of pollinosis patients should be evaluated and analyzed in a larger cohort of patients to adjust for possible confounding patient data.

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Hirschsprung’s disease （HD） is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the distal intestine, resulting in functional intestinal obstruction. Surgical excision of the aganglionic segment is the standard treatment for HD. The presence of ganglion cells is generally confirmed by histological examination during surgery. A transition zone between histologically normoganglionic and aganglionic segments exists in almost every patient. This zone should be excised because a residual transition zone may contribute to postoperative obstructive symptoms. However, there is no definite criterion for determining the number of ganglion cells present in normoganglionic bowel segments in patients with HD. This study aimed to determine the distribution and number of ganglion cells in normoganglionic bowel segments in patients with HD. A pull-through procedure was performed in nine patients with HD, and the number of ganglion cells in their intestines was counted histologically using immunohistochemistry with anti-Hu C/D antibody. The distribution of ganglion cells on the antimesenteric side of the transition zone tended to extend more distally than that on the mesenteric side. The number of Meissner and Auerbach ganglion cells in the normoganglionic bowel of patients with HD was 93.77±20.9 /cm and 110.3±23.0 /cm, respectively. The present study suggests that multiple tissue samples should be obtained from both the mesenteric and antimesenteric sides of the intestine for intraoperative histologic examination. Moreover, the presence of at least 100 Auerbach ganglion cells per centimeter circumferentially should be confirmed to avoid a residual transition zone.

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Follicular lymphoma （FL） is a low-grade B-cell lymphoma with an indolent clinical course, although histological transformation （HT） worsens the prognosis. Duodenal-type follicular lymphoma （DFL） is a type of FL that was recently introduced to the World Health Organization classification in 2017. Although the risk of HT in DFL is low, there have been few reports on its incidence. Further studies on the incidence of HT in DFL will provide useful information for establishing therapeutic strategies. Patients with DFL were followed for a long time, and their intestinal biopsies were examined to detect histological changes and study the incidence of HT in DFL. Twenty patients with FL in the duodenum or small intestine and stage I FL of the Lugano classification were studied. Specimens were stained with hematoxylin and eosin and examined morphologically. In addition, an immunohistochemistry assay was performed. All patients had FL histological grade 1-2 at the time of diagnosis. The median follow-up period was 56 months （range: 12-147 months）. There was no evidence of clinical progression or HT in any of the included patients. We detected a very low incidence of HT in DFL. Despite the limited number of patients studied, treatment for nodal FL may be unnecessary and even hazardous in patients with DFL.

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Pyomyositis is common in the tropics but rare in Japan. Obturator muscle pyomyositis, particularly, is a rare pyomyositis with difficult pathogen identification due to its deep location in the trunk. A healthy 4-year-old boy developed gastroenteritis a few days before hospitalization after eating grilled meat. He was then referred to our hospital with a fever and right hip pain. He was unable to walk due to pain, and a blood test revealed an elevated C-reactive protein level. He was diagnosed with obturator muscle pyomyositis after a T2-weighted magnetic resonance imaging revealed a high-intensity lesion in the right obturator muscle. He was first given cefazolin, but his clinical symptoms did not improve. The cefazolin was then replaced with meropenem and vancomycin, which significantly alleviated his symptoms. Because the lesion was so deep in the trunk, blood culture yielded negative results, and puncture fluid could not be collected for culture. However, Salmonella enterica, a bacterium responsive to meropenem in vitro, was detected in the stool culture, and thus, a single-agent treatment was also enough to improve the patient’s clinical findings. The patient received antibiotic therapy for six weeks and had no recurrence afterward. He was successfully treated with no complications, such as a limited joint range of motion. Although identifying the pathogen causing obturator muscle pyomyositis is challenging, significant organisms can be detected in stool culture. Therefore, stool culture results may be beneficial in the treatment of obturator muscle pyomyositis.

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This study aimed to clarify the experiences of patients with gastrointestinal stomas by reviewing previous publications. A total of 26 original articles were identified in the field of nursing from 1985 to 2019 in the ICHUSHI-Web database using “stoma” and “elderly people” combined with “experience” as key terms. Furthermore, the CINAHL database was explored for original nursing articles in English using “stoma or ostomy” combined with “aged or elderly” and “experience” as key terms and identified 37 articles. After reading the extracted contents, six Japanese and two English articles on the experiences of elderly people with stomas were included in a literature review. This literature review revealed that participants were “shocked” preoperatively, “looked directly at the stoma” and “obtained an education on stoma care postoperatively,” and “tried to accept the stoma construction” while experiencing “inconveniences and glitches associated with the stoma” after hospital discharge. Subsequently, they reported to experience “thinking about the future and becoming anxious,” but “being supported by others” “changed the way they think about their health and life.” Nursing management for elderly people with stoma should involve the elderly people themselves so that they can proactively overcome mental and physical changes perioperatively. In particular, when being told the disease characteristics, looking directly at a stoma, or receiving education on stoma care, family members and medical staff should become supporters and be actively involved.

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