Language：English   Publisher：Clinical Anatomy  

Endoscopic endonasal skull base surgery is increasingly prevalent, with its scope expanding from pathogens in the midline region to those in the paramedian region. Maximizing anterior sphenoidectomy is important for the median approach, and lateralizing the pterygopalatine fossa is crucial for the paramedian approach. Maximizing the surgical corridor in the nasal cavity and minimizing damage to neurovascular structures are vital for establishing a surgical field with minimal bleeding, ensuring safe, precise, and gentle procedures. However, the relationship between the maxillofacial and skull base bones in endoscopic endonasal skull base surgery is difficult to understand because these bones are intricately articulated, making it challenging to visualize each bone's outline. Understanding important bones and their related neurovascular structures is essential for all skull base surgeons to maximize the surgical corridor and minimize iatrogenic injury to neurovascular structures. This study aimed to elucidate the role of the palatine bone from a microsurgical anatomical perspective. Three dry skulls were used to demonstrate the structure of the palatine bone and its relationship with surrounding bones. A formalin-perfused cadaveric head was dissected to show the related neurovascular structures. The arteries and veins of the cadaveric heads were injected with red- and blue-colored silicon. Dissection was performed using a surgical microscope and endoscope. In addition, the utilization of the palatine bone as a landmark to identify neurovascular structures, which aids in creating a wider surgical field with less bleeding, was shown in two representative cases. The palatine bone consists of unique complex structures, including the sphenoidal process, ethmoidal crest, pterygopalatine canal, and sphenopalatine notch, which are closely related to the sphenopalatine artery, maxillary nerve, and its branches. The ethmoidal crest of the palatine bone is a well-known structure that is useful for identifying the sphenopalatine foramen, controlling the sphenopalatine artery and nerve, and safely opening the pterygopalatine fossa. The sphenoidal process of the palatine bone is a valuable landmark for identifying the palatovaginal artery, which is a landmark used to safely and efficiently expose the vidian canal. The sphenoidal process is easily cracked with an osteotome and removed to expose the palatovaginal artery, which runs along the pharyngeal groove, just medial to the vidian canal. By opening the pterygopalatine canal (also known as the greater palatine canal), further lateralization of the periosteum-covered pterygopalatine fossa contents can be achieved. Overall, the sphenoidal process and ethmoidal crest can be used as important landmarks to maximize the surgical corridor and minimize unnecessary injury to neurovascular structures.

DOI： 10.1002/ca.24170

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Language：English   Publisher：PNAS Nexus  

The activation and differentiation of B cells into plasma cells (PCs) play critical roles in the immune response to infections and autoimmune diseases. Toll-like receptor 9 (TLR9) responds to bacterial and viral DNA containing unmethylated CpG motifs and triggers immune responses in B cells; however, abnormal recognition of self-DNA by TLR9 can cause autoimmune diseases. When stimulated with TLR9 agonists, follicular (FO) B cells, a subset of B cells residing in the FO regions of secondary lymphoid organs, exhibit a propensity for activation but fail to give rise to PCs. The factors that enable the transition of TLR9-activated FO B cells from activation to differentiation into PCs remain unclear. In this study, we show that type I interferon-alpha (IFNα) signaling causes FO B cells activated by CpG stimulation to differentiate into PCs. Although CpG stimulation alone only temporarily increased interferon regulatory factor 4 (IRF4) expression in FO B cells, co-stimulation with both CpG and IFNα enhanced and maintained high IRF4 expression levels, ultimately enabling the cells to differentiate into PCs. Overexpression of IRF4 in FO B cells results in CpG-induced PC transition without IFN signaling. Furthermore, co-stimulation of TLR9 and IFNα receptors significantly enhanced mammalian target of rapamycin (mTOR) signaling, which regulates IRF4 expression and PC generation. These findings suggest that IFNα may play a key role in promoting the fate of PC differentiation in FO B cells activated by TLR9 stimulation.

DOI： 10.1093/pnasnexus/pgae152

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PubMed

Language：Japanese   Publisher：一般社団法人 日本耳鼻咽喉科頭頸部外科学会  

<p>　好酸球性副鼻腔炎は type2 炎症を主体とする難治性副鼻腔炎で, 内視鏡下鼻副鼻腔手術はその治療, 病勢コントロールの手段として大きな役割を果たしている. また近年, 内視鏡の発展は著しく, 画質もハイビジョンから 4K と高画質になり, またナビゲーションシステムや細径のシェーバーやドリルなどの機器や器具の進歩によって鼻副鼻腔の狭小部位 (前頭陥凹や嗅裂), 危険部位 (篩骨洞天蓋, 視神経管, 内頸動脈周囲など) においても安全で繊細な手術が可能となっている.</p><p>　本稿では, 好酸球性副鼻腔炎に対する内視鏡下鼻副鼻腔手術 (full house ESS: 病勢コントロールのために可能な限り cell の隔壁を切除し, 各副鼻腔を単洞化する手術) を対象とし, その鼻副鼻腔手術の中でも前頭陥凹 (frontal recess) の開放と中鼻道の癒着を防ぐ方法, central compartment である鼻中隔, 中鼻甲介, 上鼻甲介粘膜の浮腫状病変に対しての手術手技を中心にそのチップス, 筆者が大切にしていることを最近の知見をふまえ, 症例を提示し, 解説する.</p>

DOI： 10.3950/jibiinkotokeibu.126.12_1288

CiNii Research

Language：English   Publisher：Biomaterials  

Allergen immunotherapy (AIT) is the only curative treatment for allergic diseases. However, AIT has many disadvantages related to efficiency, safety, long-term duration, and patient compliance. Dendritic cells (DCs) have an important role in antigen-specific tolerance induction; thus, DC-targeting strategies to treat allergies such as glutaraldehyde crosslinked antigen to mannoprotein (MAN) have been established. However, glutaraldehyde crosslinking may reduce the antigen presentation efficiency of DCs. To overcome this, we developed a MAN-coated ovalbumin (OVA) nanoparticle (MDO), which uses intermolecular disulfide bond to crosslink OVA and MAN. MDO effectively targeted DCs resulting in tolerogenic DCs, and promoted higher antigen presentation efficiency by DCs compared with OVA or glutaraldehyde crosslinked nanoparticles. In vitro and in vivo experiments showed that DCs exposed to MDO induced Treg cells. Moreover, MDO had low reactivity with anti-OVA antibodies and did not induce anaphylaxis in allergic mice, demonstrating its high safety profile. In a mouse model of allergic asthma, MDO had significant preventative and therapeutic effects when administered orally or subcutaneously. Therefore, MDO represents a promising new approach for the efficient and safe treatment of allergies.

DOI： 10.1016/j.biomaterials.2023.122381

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Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：Journal of Colloid and Interface Science  

Nanoparticles (NPs) for allergen immunotherapy have garnered attention for their high efficiency and safety compared with naked antigen proteins. In this work, we present mannan-coated protein NPs, incorporating antigen proteins for antigen-specific tolerance induction. The heat-induced formation of protein NPs is a one-pot preparation method and can be applied to various proteins. Here, the NPs were formed spontaneously via heat denaturation of three component proteins: an antigen protein, human serum albumin (HSA) as a matrix protein, and mannoprotein (MAN) as a targeting ligand for dendritic cells (DCs). HSA is non-immunogenic, therefore suitable as a matrix protein, while MAN coats the surface of the NP. We applied this method to various antigen proteins and found that the self-disperse after heat denaturation was a requirement for incorporation into the NPs. We also established that the NPs could target DCs, and the incorporation of rapamycin into the NPs enhanced the induction of a tolerogenic phenotype of DC. The MAN coating provided steric hindrance and heat denaturation destroyed recognition structures, successfully preventing anti-antigen antibody binding, indicating the NPs may avoid anaphylaxis induction. The MAN-coated NPs proposed here, prepared by a simple method, have the potential for effective and safe allergies treatment for various antigens.

DOI： 10.1016/j.jcis.2023.06.170

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Language：English   Publishing type：Research paper (scientific journal)  

Language：Japanese   Publisher：耳鼻と臨床会  

DOI： 10.11334/jibi.69.5_398

CiNii Research

Language：Japanese   Publisher：JIBI TO RINSHO KAI  

<p>An 18-year-old male patient had developed epileptic seizures with loss of consciousness 3 years earlier, and despite subsequent drug treatment, he still had recurrent epileptic seizures. Imaging studies revealed a meningoencephalocele with protrusion of the temporal lobe from the middle cranial fossa to the lateral fossa of the sphenoid sinus. Since this was thought to be the focus of the temporal lobe epilepsy, he was admitted to our hospital for resection of the meningoencephalocele. The patient underwent transnasal endoscopic resection of the meningoencephalocele in the lateral fossa of the sphenoid bone, followed by multilayer skull base reconstruction using a pedicled middle turbinate mucosal (MT) flap. Postoperatively, the epileptic seizures disappeared, and the patient has recovered without cerebrospinal fluid leakage or wound complications. If the area is localized near the sphenopalatine foramen, such as the lateral fossa of the sphenoid sinus, an MT flap can be used instead of a nasal septal mucosal flap. Furthermore, by using a minimal transpterygoid approach and preserving the sphenopalatine artery and its branch, the middle turbinate artery, it was possible to use the MT flap during skull base reconstruction.</p>

DOI： 10.11334/jibi.69.2_116

CiNii Research

Language：English  

DOI： 10.7759/cureus.35932

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PubMed

Language：Japanese   Publisher：耳鼻と臨床会  

症例は18歳、男性。3年前に意識消失を伴うてんかん発作を発症、その後薬物治療を行うもてんかん発作を繰り返す状態であった。画像検査で中頭蓋窩から蝶形骨洞側窩に陥入する側頭葉の髄膜脳瘤を指摘され、側頭葉てんかんの焦点と考えられたため髄膜脳瘤切除目的に当院入院となった。経鼻内視鏡下に蝶形骨側窩の髄膜脳瘤を切除し、その後、有茎中鼻甲介粘膜弁を用いて多層での頭蓋底再建を行った。術後、てんかん発作は消失、髄液漏や創部の合併症なく経過している。蝶形骨洞側窩のように蝶口蓋孔近傍で限局した箇所であれば鼻中隔粘膜弁でなくても中鼻甲介粘膜弁での代用が可能で、minimal transpterygoid approachを用い、さらに蝶口蓋動脈とその分枝である中鼻甲介動脈を温存することで頭蓋底再建時に中鼻甲介粘膜弁の利用が可能となった。(著者抄録)

Language：Japanese   Publisher：JIBI TO RINSHO KAI  

<p>We experienced 15 surgical cases of petrous apex-11 cholesteatomas and 4 cholesterin granulomas-between January 2013 and July 2021. Among the four cases of cholesterin granuloma, one underwent transmastoid surgery, while the others received intranasal endoscopic surgery to create drainage routes. Among the 11 cases of cholesteatoma, 5 received initial surgery, and 6 were reoperations. The extent of the lesion based on Sanna's classification was supralabyrinthine in seven patients, massive in two, and infralabyrinthine in two. In the supralabyrinthine type, the middle fossa approach or combined approach of the middle cranial fossa and translabyrinthine approach was necessary in cases with severe extensions or those receiving reoperation. The minimally invasive procedure through the superior semicircular canal approach was performed in cases with a small extension. In the massive type, the transcochlear and middle fossa combined approach was used, while in the infralabyrinthine type, the infracochlear or infralabyrinthine approach was performed, depending on the localization and degree of the extension. The hearing was preserved in all cases of cholesterin granuloma and three cases of cholesteatomas. Since the petrous apex is located in the deepest part of the temporal bone, it is crucial to have a thorough understanding of the anatomy and select a surgical approach that considers the lesion and hearing.</p>

DOI： 10.11334/jibi.69.1_1

CiNii Research

Language：Japanese   Publisher：耳鼻と臨床会  

2013年1月から2021年7月の期間に手術治療を行った錐体尖病変15例を検討した。コレステリン肉芽腫4例では、1例が経乳突的に、3例は経鼻的にドレナージルートを作成した。錐体尖真珠腫11例では初発例5例、再手術例が6例であり、進展経路は迷路上型が7例、広範迷路型2例、迷路下型2例であった。迷路上型では進展範囲の小さな症例は経上半規管法により低侵襲に摘出し得たが、進展例や再手術例では中頭蓋窩法や、中頭蓋窩法と経迷路法のcombined approachが必要であった。広範迷路型では経蝸牛+中頭蓋窩法のcombined approachを行い、迷路下型では進展範囲に応じて蝸牛下法や迷路下法を用いた。コレステリン肉芽腫全例と錐体尖真珠腫の3例で聴力温存できた。錐体尖は側頭骨最深部に位置し、手術アプローチの選択が重要である。聴力や病変と解剖学的構造の位置関係を考慮して術式を選択する必要がある。(著者抄録)

Language：English   Publisher：Pediatrics International  

Background: Stuttering is a childhood-onset fluency disorder. Part of the counseling for middle and high school students with persistent stuttering is related to school refusal. Anxiety disorders are known to contribute to school refusal. However, it is not known whether social anxiety disorder (SAD) is a factor in school refusal among adolescents who stutter. Methods: In our first study, we examined the relationship between school refusal and SAD in 84 middle and high school students who stutter; 26% of the 84 students were in the school refusal group and the remaining 74% were in the school attendance group. The second study examined whether SAD was associated with 10 factors related to speech and stuttering frequency using the Japanese version of the Liebowitz Social Anxiety Scale for Children and Adolescents to determine the presence of SAD. Of the 84 students in the first study, 40 participated in the second study. Results: The school refusal group of adolescents who stutter had significantly higher rates of SAD than the school attendance group. Fifty percent of adolescents who stutter met the criteria for SAD. Moreover, adolescents who stutter with SAD had significantly higher scores on the items “When speaking in public, do you experience tremors in your limbs?” and “After you stutter, do you have negative thoughts about yourself?” than the adolescents who stutter without SAD. Conclusions: When examining adolescents who stutter, checking for comorbid SAD may lead to better support. Moreover, noticing their repetitive negative thinking, nervousness, and trembling during speech may help to resolve SAD.

DOI： 10.1111/ped.15622

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

吃音を主訴として受診した中・高校生を対象に、不登校と社交不安障害(SAD)の関連について検討するとともに(研究1)、発話に関連する10項目とSADの関連について検討した(研究2)。研究1において、84名中22名(26%)が不登校群、62名(74%)が登校群であった。不登校群では登校群に比べてリボビッツ社交不安尺度(LSAS-CA)日本語版の得点が有意に高かった(p=0.004)。研究1の参加者のうち40名を対象とした研究2において、LSAS-CA日本語版による評価で40名中20名がSAD群、20名が非SAD群であった。SAD群では非SAD群に比べて「人前で話をする際に手足が震えることがありますか」および「吃音が出た後に自己否定する思考に陥ることがありますか」の項目の得点が有意に高かった。

Publisher：東京医学社  

DOI： 10.24479/pm.0000000704

CiNii Research

Language：Japanese   Publisher：(公財)日本眼科学会  

背景:炎症性筋線維芽細胞性腫瘍(IMT)は筋線維芽細胞の増殖と炎症細胞浸潤を特徴とする中間悪性腫瘍であり,肺,腹腔骨盤内,後腹膜に好発し,眼窩に発生することはまれである.今回,眼窩に発生したIMTの1例を経験したので報告する.症例:46歳,女性.複視を主訴に近医眼科を受診し,眼窩に腫瘍を指摘され九州大学病院眼科を紹介受診した.初診時に右眼球結膜下の赤色調腫瘤および画像診断で右眼窩内下方に35×20×15mmの紡錘形腫瘤を認め,眼球運動障害を来していた.結膜下の腫瘤を生検したところ,炎症細胞浸潤を伴った紡錘形細胞の増殖を認めた.免疫染色の結果,増殖細胞はanaplastic lymphoma kinase(ALK),α-平滑筋アクチン(α-SMA),desmin陽性であり,IMTと診断した.結膜切開および鼻内視鏡下にアプローチして全摘出し,術後24ヵ月の現在,再発は認めていない.結論:眼窩腫瘍で非上皮性腫瘍を疑う際はIMTの可能性も検討する必要がある.(著者抄録)

Language：Japanese   Publisher：耳鼻と臨床会  

DOI： 10.11334/jibi.68.4_318

CiNii Research

Language：English   Publisher：Auris Nasus Larynx  

Rapidly growing mycobacteria rarely causes parotitis. We report a rare case of Mycobacteroides abscessus subspecies abscessus (MAB) parotitis in a previously healthy 26-year-old woman. She presented to the previous hospital with a swelling over the right parotid region, and a computed tomography scan revealed multiple abscesses in the swollen parotid gland. Histopathology showed granulomatous inflammation with acid-fast bacilli; however, a subsequent culture failed to isolate mycobacterium. Despite repeated antibiotic therapy and multiple surgical interventions including partial incision and drainage of the abscesses, the parotitis did not resolved. At six months after presentation, she was referred to our institute. We performed enlarged resection of the necrotic tissue and abscesses, and the sample cultivated after homogenization was positive for mycobacterium. The isolate was finally identified as MAB. She underwent long-term postoperative antibiotic therapy for MAB, with a favorable outcome. To the best of our knowledge, this is the first case of MAB parotitis where the subspecies has been identified. MAB is much more intractable than the other subspecies. We highlight the importance of the correct identification of MAB, which leads to the appropriate treatment.

DOI： 10.1016/j.anl.2020.11.005

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PubMed

Language：English   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

症例は26歳女性で、生来健康であったが、最近、活動性結核の患者と濃厚接触する機会があった。その後に右耳下腺領域に腫脹が生じたため近医を初診し、1週間後に総合病院へ紹介された。CT検査で耳下腺内の多発性膿瘍が示され、各種の抗生物質による集中治療を受けたが症状は改善しなかった。初診2ヵ月の膿瘍切開時に採取された組織検体では炎症性肉芽腫と類上皮細胞が認められ、加えてZiehl-Neelsen染色にて抗酸菌の存在も示された。PCR検査ではMycobacterium tuberculosisとの結果が得られ、培養検査は陰性であった。抗生物質、部分切開術、ドレナージによる治療を繰り返すも耳下腺炎は改善せず、初診から6ヵ月後に当院紹介となった。壊死組織と膿瘍の拡大切除術を施行したが、その際に得た切除検体をホモジナイズし抗酸菌用の培地で培養した。分離株をDNA-DNAハイブリダイゼーション法で分析した結果、M.abscessus subsp.abscessus(MAB)と同定された。感受性試験の結果に従い、抗生物質治療を長期間継続した。その結果、最後の手術から5ヵ月後のCT評価にて耳下腺炎と腺内膿瘍の消退が確かめられ、その後も再発しなかった。外傷など、MABの侵入経路として考えられるものは本例では判然としなかった。

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.anl.2020.12.009

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DOI： doi: 10.1111/ped.14405.

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DOI： 10.1111/tid.13205

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DOI： 10.3960/jslrt.18008

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DOI： 10.1371/journal.pone.0217504

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DOI： 10.1155/2019/3129286

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DOI： 10.1016/j.jfludis.2017.11.002

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DOI： 10.1038/srep46142

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DOI： 10.5631/jibirin.109.822

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DOI： 10.3950/jibiinkoka.119.1263

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DOI： 10.1016/j.alit.2014.10.009

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DOI： 10.1017/S0022215114002382

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DOI： 10.1017/S0022215114002394

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DOI： 10.1016/j.anl.2014.02.010

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DOI： 10.1002/lary.23690

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DOI： 10.1016/j.jaci.2006.02.018

Event date： 2022.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：金沢市文化ホール   Country：Japan  

Event date： 2021.9

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：琵琶湖ホテル   Country：Japan  

Event date： 2021.5

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Venue：国立京都国際会館   Country：Japan  

Event date： 2019.10

Language：Japanese   Presentation type：Oral presentation (general)  

Venue：都市センターホテル　東京   Country：Japan  

Event date： 2019.7

Language：Japanese   Presentation type：Oral presentation (invited, special)  

Venue：西鉄グランドホテル　福岡市   Country：Japan  

Event date： 2018.9

Language：Japanese   Presentation type：Oral presentation (general)  

Country：Japan  

Event date： 2017.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：ホテルメトロポリタン盛岡ニューウイング   Country：Japan  

Event date： 2017.9

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Venue：山梨県甲府市　甲府富士屋ホテル   Country：Japan  

Event date： 2017.2

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Country：Japan  

Event date： 2016.10 - 2017.10

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Event date： 2016.6 - 2017.6

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Venue：城山観光ホテル   Country：Japan  

Event date： 2011.5

Presentation type：Oral presentation (general)  

Venue：京都　国立京都国際会館   Country：Japan  

Event date： 2010.8

Presentation type：Oral presentation (general)  

Venue：札幌　札幌コンベンションセンター   Country：Japan  

Event date： 2010.5

Presentation type：Oral presentation (general)  

Venue：福岡　福岡大学8号館   Country：Japan  

Event date： 2009.10

Presentation type：Oral presentation (general)  

Venue：東京　京王プラザホテル   Country：Japan  

Language：English  

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Language：Japanese   Publisher：耳鼻と臨床会  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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DOI： https://doi.org/10.11334/jibi.66.1_28

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：English   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

Type：Competition, symposium, etc. 

Number of participants：20

Type：Peer review 

Number of peer-reviewed articles in Japanese journals：1

Type：Competition, symposium, etc. 

Number of participants：20

Type：Competition, symposium, etc. 

Number of participants：400

Type：Peer review 

Number of peer-reviewed articles in Japanese journals：1

Type：Peer review 

Number of peer-reviewed articles in Japanese journals：6

Type：Academic society, research group, etc. 

Type：Academic society, research group, etc. 

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Seminar, workshop

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

Audience： General,　Scientific,　Company,　Civic organization,　Governmental agency

Type：Lecture

「とっても健康らんど」副鼻腔炎

テレビとっても健康ランド　花粉症

花粉症　治療法は　舌下免疫療法　効果１～２年後　個人差も