Explore the vast range of titles available.

A 78-year-old man presenting with leukocytosis was admitted to our hospital. The patient was asymptomatic and showed no lymphadenopathy. Peripheral blood flow cytometry revealed a leukemic-phase B-cell lymphoma with medium-to-large abnormal cells with reticulum. Positron emission tomography/computed tomography revealed abnormal uptake in the right orbit, bone marrow, and spleen. We performed immunological staining and fluorescence in situ hybridization on tissues extracted from the right orbit and bone marrow, which led to the diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma. Polymerase chain reaction analysis of immunoglobulin heavy chain rearrangements in the right orbital mass and bone marrow suggested that they were identical clones. Based on these collective findings, the diagnosis of leukemic-phase MALT lymphoma was confirmed, with sites of involvement including the bone marrow, peripheral blood, right orbit, and spleen. This is a highly rare case of leukemic MALT lymphoma.

Initial staging by positron emission tomography/computed tomography (PET/CT) scanning is recommended for patients with diffuse large B-cell lymphoma (DLBCL). Whether both PET/CT and bone marrow biopsy (BMB) are required remains unclear. This study examined whether staging by PET/CT is sufficient. Participants with untreated DLBCL assessed using both PET/CT and BMB were included. Patients received independent diagnostic assessments from a radiologist and a hematopathologist. Both hematoxylin–eosin staining and CD20 immunostaining were performed to determine the bone marrow involvement in BMB. A total of 84 patients were included. The number of patients with positive bone marrow involvement identified by PET/CT and BMB was 16 (19%) and 22 (26%), respectively. Eight (10%) patients showed positive results in both tests. When considering BMB as a reference, PET/CT showed 36% sensitivity and 87% specificity, with positive and negative predictive values of 50% and 79%, respectively. BMB-positive patients had shorter progression-free (PFS) and overall (OS) survival than their BMB-negative counterparts. Compared to PET/CT-negative patients, patients with positive results did not show any significant differences in PFS and OS. However, among 16 PET/CT-positive patients, poor PFS and OS were observed among patients who were also BMB positive. BMB remains a mandatory step in staging of untreated DLBCL patients.

Aims/Introduction This study aimed to evaluate the problems in screening for gestational diabetes mellitus (GDM) by casual blood glucose (CBG) measurements at 24–28 gestational weeks. Materials and Methods Overall, 763 pregnant women who underwent the 50‐g glucose challenge test (GCT) at 24–28 gestational weeks were enrolled. The preload blood glucose (0‐h BG) level of 50‐g GCT was considered as CBG. Results A total of 240 women with BG levels at 1‐h after loading (1‐h BG) on 50‐g GCT ≥140 mg/dL underwent the 75‐g oral glucose tolerance test, and 98 (40.8%) were diagnosed with GDM. Of the 99 women with GDM, 71 (71.7%) had 0‐h BG on 50‐g GCT <100 mg/dL. Conclusions This study, where pregnant women underwent both CBG and 50‐g GCT simultaneously, showed that when CBG at 24–28 gestational weeks ≥100 mg/dL alone was used for screening GDM, many pregnant women with GDM were overlooked. Screening for gestational diabetes mellitus (GDM) by casual blood glucose (CBG) alone can overlook many GDM patients. Casual blood glucose was widely used as a screening method for GDM in Hyogo Prefecture, Japan. GDM in many Japanese pregnant women might be underdiagnosed.

Aims/Introduction To evaluate the efficacy of sensor‐augmented pump (SAP) for improving obstetric and neonatal outcomes among pregnant women with type 1 diabetes mellitus by comparing it with continuous subcutaneous insulin infusion plus self‐monitoring of blood glucose (continuous subcutaneous insulin infusion [CSII]/SMBG). Materials and Methods This retrospective cohort study included 40 cases of pregnancy complicated by type 1 diabetes mellitus treated with SAP (SAP group), and 29 cases of pregnancy complicated by type 1 diabetes mellitus treated with CSII/SMBG (CSII/SMBG group). The obstetric and neonatal outcomes were compared between the two groups. Results The median of the glycoalbumin levels in the first (18.8% vs 20.9%; P < 0.05) and second (15.4% vs 18.0%; P < 0.05) trimesters, the hemoglobin A1c levels in the peripartum period (6.1% vs 6.5%; P < 0.05) and the standard deviation score of birthweights (0.36 vs 1.52; P < 0.05) were significantly lower in the SAP group than in the CSII/SMBG group. The incidence rate of large for gestational age newborns was significantly lower in the SAP group than in the CSII/SMBG group (27.5% vs 65.5%; P < 0.05). No significant differences in the incidence rates of hypertensive disorders of pregnancy, small for gestational age, respiratory distress syndrome, neonatal hypoglycemia, hypervolemia and hyperbilirubinemia were observed between the groups. Conclusion The present study showed that SAP therapy is more effective in preventing large for gestational age newborns in pregnant women with type 1 diabetes mellitus than CSII/SMBG.

Background Intradialytic hypotension (IDH) occurs in 20–40% of hemodialysis patients and is associated with adverse cardiovascular events and a poor prognosis. Although early prediction of and prompt intervention for IDH are essential, early detection can be challenging because it often relies on subjective assessments, such as changes in blood pressure trends, facial complexion, facial expressions, and patient-reported symptoms. In this study, we constructed two machine learning models to detect and predict IDH based on facial images captured during dialysis sessions, and identified key facial features associated with IDH. Methods Eight dialysis patients who frequently experienced IDH were included in this study. Facial images and blood pressure data were collected at 15 min intervals from the start to the end of dialysis. In total, 14 facial features related to the eyes and mouth were extracted, including the eyebrow slope, inter-eyebrow area, eye aspect ratio, and the areas of the inner and outer lips. For each patient, a linear discriminant analysis model was used to construct IDH detection and prediction models. We evaluated the prediction accuracy and identified key facial regions that showed significant expression changes associated with IDH. This study was conducted with the approval of the Jichi Medical University Ethics Committee (approval no. 23-107). Results The accuracy rates of the detection and prediction models for IDH were 57.6–75.4% and 58.8–76.9%, respectively, with the precision rates ranging from 56.0–73.3% to 59.0–73.2%, recall rates ranging from 60.7–79.4% to 56.8–84.5%, and F-values ranging from 61.9–76.2% to 57.9–78.5%, respectively, demonstrating consistent accuracy. Notable facial expression changes for detection and prediction of IDH were observed: eye region changes were prominent in subjects A and F; mouth region changes were prominent in subjects B, C, and G; and both eye and mouth region changes were observed in subject D. In subjects E and H, different facial areas showed changes depending on the task—mouth region for prediction and eye region for detection. Conclusions In this study, we demonstrated the usefulness of detection and prediction models for IDH based on facial expression changes observed during hemodialysis. In particular, expressions involving the eyes and mouth were found to be important for predicting IDH, suggesting the potential usefulness of facial expression analysis as an effective supplementary tool to blood pressure monitoring in patients undergoing hemodialysis.

Light-chain plasma cell myeloma (LC-PCM) is a PCM subtype in which only immunoglobulin light-chain is secreted. However, the absence of immunoglobulin heavy-chain (IGH) production in this condition has not been fully elucidated. To address this issue, we retrospectively analyzed patients at our center with LC-PCM and found a group who had only split signals of IGH gene derived from 14q32/IGH translocations by fluorescence in situ hybridization (FISH). Six patients were identified with only split signals of the IGH gene derived from 14q32/IGH translocations. Five of these patients were newly diagnosed, while one had IgG-λ PCM at presentation, which transformed to λ LC-PCM after treatment. The translocation partners were identified in four patients: two cases of (11;14)(q13;q32) and two cases of (4;14)(p16;q32). The development of LC-PCM appears to be explained by the application of allelic exclusion in these patients, such that 14q32/IGH translocation in one allele contributes to the pathogenesis of PCM and the subsequent loss of the other allele is responsible for the loss of IGH production. These findings suggest that a FISH pattern of IGH with “split and loss” may constitute a unique subgroup of LC-PCM.

Congenital Toxoplasma gondii (T. gondii) infection, which can be caused by a primary T. gondii infection during pregnancy, results in severe neurological sequelae in affected children. We have been conducting a prospective cohort study since January 2019 on pregnant women who were suspected of having primary T. gondii infection based on serological tests. In this study, congenital infection was diagnosed using semi-nested polymerase chain reaction (PCR) to detect the B1 gene in the body fluids of newborns. Up until December 2023, forty-one newborns born to mothers suspected of having primary T. gondii infection during pregnancy underwent B1 gene semi-nested PCR tests and anti-T. gondii immunoglobulin (Ig) G and IgM measurements of their blood samples. Eight newborns showed no clinical symptoms of congenital T. gondii infection; however, they were diagnosed with congenital T. gondii infection according to positive PCR results. However, none of the eight infants eventually exhibited any sign of congenital infection, as their serum samples tested negative for anti-T. gondii IgM and IgG until 12 months of age. Therefore, clinicians should consider discrepancies in the diagnosis of congenital T. gondii infection between PCR tests using body fluids of newborns and serological tests during their infantile period.

Peripheral T‐ or natural killer (NK)‐cell lymphomas are rare and difficult‐to‐recognize diseases. It remains arduous to distinguish between NK cell‐ and cytotoxic T‐lymphocyte‐derived lymphomas through routine histological evaluation. To clarify the cells of origin, we focused on NK‐cell receptors and examined the expression using immunohistochemistry in 22 cases with T‐ and NK‐cell neoplasms comprising angioimmunoblastic T‐cell lymphoma, anaplastic lymphoma kinase (ALK)‐positive and ‐negative anaplastic large‐cell lymphomas, extranodal NK/T‐cell lymphoma, nasal type, monomorphic epitheliotropic intestinal T‐cell lymphoma, aggressive NK‐cell leukemia, and other peripheral T‐cell lymphomas. Inhibitory receptor leukocyte immunoglobulin‐like receptor subfamily B member 1 (LILRB1) was detected in 14 (64%) cases, whereas activating receptors DNAM1, NKp46, and NKG2D were expressed in 7 (32%), 9 (41%), and 5 (23%) cases, respectively. Although LILRB1 was detected regardless of the disease entity, the activating NK‐cell receptors were expressed predominantly in TIA‐1‐positive neoplasms (DNAM1, 49%; NKp46, 69%; and NKG2D, 38%). In addition, NKp46 and NKG2D were detected only in NK‐cell neoplasms and cytotoxic T‐lymphocyte‐derived lymphomas including monomorphic epitheliotropic intestinal T‐cell lymphoma. One Epstein‐Barr virus‐harboring cytotoxic T‐lymphocyte‐derived lymphoma mimicking extranodal NK/T‐cell lymphoma, nasal type lacked these NK‐cell receptors, indicating different cell origin from NK and innate‐like T cells. Furthermore, NKG2D expression showed a negative impact on survival among the 22 examined cases, which mainly received the standard chemotherapy regimen (log‐rank test, P = .024). We propose that the presence of activating NK‐cell receptors may provide new insights into understanding peripheral T‐cell lymphomas and characterizing them as innate‐like T‐cell neoplasm. It remains difficult to distinguish between NK‐cell‐ and cytotoxic T‐lymphocyte‐derived lymphomas through routine histological evaluation. Cytotoxic T‐lymphocyte‐derived lymphomas are characterized as innate‐like T‐cell neoplasms by the expression of activating NK‐cell receptors. NKG2D expression might show a negative impact on survival in T‐ and NK‐cell lymphoma cases receiving the standard CHOP‐like regimen.