The forced oscillation technique（FOT）, which requires breathing without forced action, is a useful tool that can measure respiratory impedance. We investigated the physiological differences between asthma with smoking-unrelated airflow limitation and asthma-chronic obstructive pulmonary disease（COPD）overlap（ACO）using the FOT. Among 275 patients with asthma who presented at the Showa University Hospital from April 2018 through March 2019, 211 were enrolled and assigned into the asthma（BA）, asthma with airflow limitation（AL）, or ACO groups. Respiratory impedance measured using the FOT were compared among the groups. There were no significant differences in spirometry data between the AL and the ACO group. The AL group had higher respiratory resistance at 5Hz（R5）, 20Hz（R20）, and reactance at 5Hz than the ACO group, but there was no significant difference in subtracting R20 from R5（R5-R20）. R5 and R20 were similar between the ACO and the BA groups, but R5-R20, resonant frequency（Fres）, and low-frequency reactance area were significantly higher in the ACO group than the BA group. Fres yielded the highest area under the curve（AUC）to identify airflow limitation, and R20 yielded the highest AUC to identify the ACO group among patients with airflow limitation. An analysis using the cut off value to identify airflow limitation and ACO detected 33 patients as having ACO, 17 of whom were diagnosed with ACO. R5 and R20 measured by FOT are higher in AL than in ACO despite no difference in spirometry data, and are not significantly different between BA and ACO. Therefore, FOT aids our understanding of the physiological characteristics and provides clues for the treatment in asthmatics with airflow limitation.

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This retrospective study aimed to investigate the relationship between musical and linguistic abilities in patients with aphasia. We reviewed the clinical records of 32 stroke patients with aphasia admitted to subacute rehabilitation units between May 2014 and August 2018. We analyzed the results of melody and rhythm reproduction tests and subtests of auditory comprehension and speech sections in the Standard Language Test of Aphasia （SLTA） collected upon admission and discharge. The Spearman rank correlation coefficient （rs） was used to analyze the correlation between 1）the increase in melody reproduction test scores and SLTA auditory comprehension subtest scores, 2）the increase in melody reproduction test scores and SLTA speech subtest scores, 3）the increase in rhythm reproduction test scores and SLTA auditory comprehension subtest scores, and 4）the increase in rhythm reproduction test scores and SLTA speech subtest scores. There were significant positive correlations between melody reproduction and auditory comprehension subtest scores on the SLTA: “word comprehension” （n＝14, rs＝0.57, p＜0.05） and “following verbal instructions” （n＝31, rs＝0.42, p＜0.05）. An SLTA speech subtest score—action naming—was positively correlated with rhythm reproduction （n＝31, rs＝0.44, p＜0.05）. This study implies that melody reproduction ability is related to auditory comprehension and that rhythm reproduction ability is related to speech production in patients with aphasia after experiencing a stroke.

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This study is aimed at investigating the relationship between the polymeric immunoglobulin receptor （pIgR） expression and clinicopathological factors in advanced colorectal cancer （CRC） patients. The study involved 47 advanced CRC patients who were surgically resected and underwent KRAS gene test. The pIgR expression was analyzed by immunohistochemistry, and the patients were classified into high and low （pIgR-H and pIgR-L, respectively） groups based on the staining intensity and range. A total of 13 cases was classified under the pIgR-H group, and the remaining 34 were classified under the pIgR-L group. Results suggest no significant differences in most clinicopathological factors between the pIgR-H and pIgR-L groups, although the pIgR-L group had a significantly higher frequency of venous invasion than the pIgR-H group, whereas the frequency of KRAS gene mutation was significantly higher in the pIgR-H group than that in the pIgR-L group. The findings in this study showed little significant correlation between the pIgR expression and clinicopathological factors in advanced CRC patients. Further research on the biological behavior of pIgR as a drug treatment option for KRAS-mutated advanced CRCs is also warranted.

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MYD88 L265P mutation causes constitutive activation of NF-κB and possible driver mutation in B-cell lymphoid malignancies. It is frequently detected in Waldenstrom’s macroglobulinemia （WM） （50％-100％）, and its detection is important in diagnostic and therapeutic targets of this syndrome. Standard detection method of MYD88 L265P mutation in clinical practice has yet to be established. We developed semi-nested PCR-based restriction fragment length polymorphism （snPCR-RFLP） to detect the mutation. The snPCR-RFLP method is a modification of the PCR-RFLP method, which uses the restriction enzyme BsiEI that recognizes CGACT/CG, intending to increase detection sensitivity by amplification of mutated allele in the DNA sample using semi-nested PCR before enzyme digestion. The detection sensitivity of snPCR-RFLP was estimated as 0.1％, by detecting mutated allele in wild-type allele in the cloned plasmid DNA, which is comparable with allele-specific （AS） PCR method widely used as sensitive detection method. By analyzing 40 cases with IgM monoclonal gammopathy, snPCR-RFLP detected 29/40 （70％） of all cases, 22/31 （70.9％） of WM, and 6/9 （66.6%） of IgM-type monoclonal gammopathy with undetermined significance （IgMMGUS）, including five cases （three cases of WM and two cases of IgMMGUS） in which the mutation was detected only by snPCR-RFLP but not by Sanger sequencing method. Regarding DNA sample status, particularly five cases, a case was extracted from formalin-fixed paraffin-embedded tissue and four cases were extracted from cells by Ficoll-Hypaque density gradient. In correlation with clinical features, the MYD88 mutation detected by snPCR-RFLP method was associated with the adverse prognostic index （WMIPSS） of WM using patient age, hemoglobin （Hb） level, platelet count, β2MG level, and serum IgM level （p＝0.055）. The snPCR-RFLP method is a clinically useful MYD88 mutation detection method that can be performed in general laboratories.

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Sulbactam/ampicillin （SBT/ABPC） and ceftriaxone （CTRX） are the initial antibiotics recommended for treating aspiration pneumonia without risk factors for drug-resistant pathogens. However, the condition of some patients does not improve with these antibiotics. Therefore, we investigated the new risk factors associated with failure of initial antibiotic treatment in patients with aspiration pneumonia. This study included 487 patients diagnosed with aspiration pneumonia who received initial antibiotic treatment with SBT/ABPC or CTRX, and were hospitalized at the Respiratory Medicine Department of the Yokohama City Minato Red Cross Hospital. The outcome was initial antibiotic treatment failure, which was defined as a change from initial to secondary antibiotic treatment. The characteristics of patients with and without antibiotic treatment failure were compared using univariate analyses, and significant independent risk factors for the initial antibiotic treatment failure were selected using multivariate analyses. The mean age of the patients was 84.1 ± 9.6 years; 302 （62％） of them were men and 93 patients experienced antibiotic treatment failure. Logistic regression analysis extracted no restriction of diet on admission （odds ratio ［OR］, 3.23; 95% confidence interval ［CI］, 1.35-7.74）, history of hospitalization due to aspiration pneumonia （OR, 1.81; 95％CI, 1.12-2.93）, the severity of pneumonia （OR, 1.37; 95％CI, 1.01-1.86）, and C-reactive protein （CRP） level （OR, 1.26; 95％CI, 1.09-1.45） as risk factors for initial antibiotic treatment failure. Our results suggested that no restriction of diet on admission, history of hospitalization due to aspiration pneumonia, severity of pneumonia, and increased CRP levels were the risk factors associated with failure of initial antibiotic treatment in patients with aspiration pneumonia. These factors will be useful for determining an effective initial treatment strategy for patients with aspiration pneumonia.

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