We observed mineralized blood vessels in the capsules of human pineal glands containing abundant fibrous calcareous concretions in the capsules as well as non-fibrous calcareous concretions (brain sands) in the gland matrix. The capsular blood vessels were sometimes scattered with mineralized, round deposits of various sizes containing minute spherical deposits (MSD). The MSD showed hypermineralization similar to that in capsular fibrous concretions reported in our recent study and some MSD resembled those consistent with Fahr's disease. Occasionally, the vessel lumens were completely embedded with mineralized deposits. As the characteristic means of detection from the mineralized blood vessels, the volume of Na was significantly higher than that of the matrix non-fibrous concretions. The origin of Na in the mineralized blood vessels containing MSD was likely derived from the connective tissue fluid. Our findings suggested that a human pineal gland matrix containing numerous non-fibrous concretions is likely to associate with mineralized deposits within the blood vessels as well as fibrous concretions in the capsule.

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Glioblastoma (GBM) is difficult to completely cure by surgical treatment alone, and it is generally treated with a combination of surgery, radiotherapy, and chemotherapy. However, GBM is resistant to radiotherapy and chemotherapy, and complete cure cannot be achieved. Cancer stem cells (CSC) and survivin, which inhibit apoptosis, are considered as factors underlying tumor recurrence and the radiation- and drug-resistance of these tumors. We analyzed CSC and survivin expression in surgically excised specimens of malignant brain tumors to establish the relationships between the grades and CSC and survivin expression and between MIB-1 (Ki-67) expression and resistance. No relationship was noted between the grades and CSC or survivin expression, or between MIB-1 and CSC expression or between Grade 3 and 4 MIB-1 and survivin expression, although a correlation was noted between MIB-1 and survivin expression in Grade II tumors. These findings suggested that CSC are consistently contained in tumor tissue at a specific rate regardless of the histological grade, and the apoptosis of cells with low-level proliferative and cell cycling activities does not occur because these cells do not respond to chemotherapy or radiation, being resistant to treatment.

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Factors contributing to mortality in healthcare-associated pneumonia (HCAP) have not been investigated fully. We reviewed the etiology and identified prognostic factors of HCAP in hospitalized patients. We conducted a retrospective study of 500 Japanese patients with HCAP to assess these factors, with special emphasis on microbial etiology. Patients with HCAP were older (73.4±11.4 years), more predominantly male (74.4%), and had more smoking history and comorbidity than did community-acquired pneumonia (CAP) patients. Microbes were identified in 52.8% of HCAP patients. The most frequent causative microbial agents were Streptococcus pneumoniae (n = 108, 21.6%), influenza virus (n = 47, 9.4%), and Pseudomonas aeruginosa (n = 40, 8.0%). Multiple drug-resistant (MDR) pathogens were more frequent in HCAP patients (9.8%) than CAP patients. Overall, 47 HCAP patients (9.4%) died, with mortality being higher in HCAP than CAP patients. The three leading causes of non-survival from HCAP were S. pneumoniae, influenza virus, and P. aeruginosa. MDR pathogens accounted for 21.3% of non-survivors. Multivariate analysis revealed disease severity on admission and treatment failure of initial antibiotics as independent factors for 30-day mortality. Among patients with treatment failure of initial antibiotics, 29.9% had received appropriate antibiotics. The most frequent pathogens in HCAP were S. pneumoniae, influenza virus, and P. aeruginosa, in both survivors and non-survivors. Disease severity on admission and treatment failure of initial antibiotics were independent factors for mortality. MDR pathogens are important therapeutic targets to mitigate negative results, and treatment strategies other than antibiotic selection are also required.

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We had found previously that calcitonin treatment (elcatonin once a week for 10 weeks) results in significant decreases in blood pressure. The aim of the present study was to determine whether these effects were due to a cumulative effect of elcatonin or could be elicited by treatment with a single dose. To this end, we recruited 62 patients (eight men, 54 women; mean age 83 years; range 67-101 years) with a chief complaint of lower back pain to the present study and examined changes in blood pressure following administration of the first dose of elcatonin. All subjects in the study had been hospitalized either at our institution or an affiliated hospital. After acute phase symptoms had settled, subjects received 1 U (1mL), i.m., elcatonin S20. Blood pressure was measured the day before the first scheduled treatment and on the day of treatment. Both systolic and diastolic blood pressure decreased from 2 h after administration, and dropped significantly 4 and 6 h after administration. Therefore, elcatonin decreased blood pressure without first having to be accumulated in the body. There are several possible explanations for the results, including effects mediated by changes in concentrations of calcitonin gene-related peptide and calcium ions, as well as involvement of the parasympathetic nervous system. In conclusion, calcitonin inhibits bone resorption and pain, lowers blood pressure, and is easy to use in elderly patients who exhibit age-related increases in blood pressure.

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There is evidence for sensory and cognitive impairments at multiple levels in schizophrenia, which may be related to the clinical symptoms of the condition. Inner speech involves both auditory and language systems and dysfunction of inner speech and may be associated with auditory hallucinations in schizophrenia. We used functional magnetic resonance imaging to examine this association by measuring brain activation in 23 patients with schizophrenia and 23 healthy control individuals. The participants performed an auditory verbal working memory task that required inner speech in the form of subvocal rehearsal. The control participants showed prominent activation in the inferior frontal cortex (IFC), premotor cortex (PMC), superior temporal cortex (STC), and lateral parietal cortex (LPC) bilaterally, throughout the task. In contrast, patients with schizophrenia showed significant activation in STC bilaterally during encoding phase and in the IFC, PMC, STC, and LPC bilaterally during the recognition phase. A comparison between groups showed that controls had greater activation during rehearsal in the IFC, LPC, and PMC bilaterally than patients with schizophrenia. In the region-of-interest analysis, we observed a significant negative correlation between right PMC activation and Auditory Hallucination Rating Scale scores as well as the hallucination item in the Positive and Negative Syndrome Scale. These observations indicate that inner speech is impaired in schizophrenia and that the severity of auditory hallucinations is associated with abnormal activation in the right PMC during inner speech.

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We investigated the effects of cryopreservation on CD34+ cells and aldehyde dehydrogenase (ALDH) -positive cells (ALDH (+) cells) in the umbilical cord blood (UCB) of unrelated donors. Ten units of UCB were collected at the Kanagawa Cord Blood Bank from September 2009 to November 2010. These UCB units were frozen for 2 weeks or 1 year, and then assayed for quality by flow cytometry analysis and colony-forming assay. We found that both ALDH (+) cells and the numbers of total colony-forming units and colony-forming units of granulocyte/macrophage from the isolated CD34+ cells were significantly decreased after all cryopreservation. The numbers of ALDH (+) /CD34+ cells, ALDH (+) /CD34+CD38- cells, and total colony-forming units from the cryopreserved UCB units continued to decrease over time with cryopreservation. In contrast, levels of traditional primitive surface markers were not significantly decreased in CD34+ cells and CD34+CD38- cells after cryopreservation, although this result depended on the duration of cryopreservation. These findings suggested that ALDH (+) cells could be a new marker for assessing cryopreserved UCB quality prior to hematopoietic cell transplantation.

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An 83-year-old woman presented with a right lower abdominal mass, lower abdominal pain, and distension. She had no medical or surgical history. Clinical examination revealed a right lower abdominal mass, abdominal distension, and decreased bowel sounds in the lower abdomen. Abdominal computed tomography showed an intussusception involving the ileocecal junction. A Gastrografin enema showed a tumor shadow with an irregular defect caused by the intussusception in the transverse colon. The protruding tumor was also pushed back into the cecum by the enema pressure. Colonoscopy revealed a protruding mass at the leading edge of the intussusception in the ascending colon, and biopsy results of the cecal mass indicated an adenocarcinoma. The patient underwent laparoscopic ileocecal resection of the intussuscepted cecal cancer using reduced port surgery. The resected specimen contained a type 1 tumor measuring 40mm that was histopathologically diagnosed as cecal cancer. The patient remains asymptomatic 8 months after surgery.

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