[Endoscopic ultrasound-guided fine-needle biopsy for diagnosis of pancreatic metastases producing parathyroid hormone-related protein]

A 66-year-old man was admitted to our department with hypercalcemia, pancreatic and liver tumors, and periportal lymph node enlargement. Contrast-enhanced computed tomography revealed a tumor in the pancreatic tail and the right hepatic lobe along with periportal lymphadenopathy. Laboratory data revealed hypercalcemia and high serum parathyroid hormone-related protein (PTHrP) levels. Using a 22-gauge Franseen needle, we performed endoscopic ultrasonography-guided fine-needle biopsy of the pancreatic mass and an enlarged lymph node. Histopathological examination of the biopsy specimen revealed moderately to well-differentiated pancreatic adenocarcinoma with poorly differentiated squamous cell elements, as well as squamous cell carcinoma of the lymph node. Immunohistochemical examination showed that the pancreatic tissue was weakly immunopositive and the lymph node was strongly immunopositive for anti-PTHrP antibody. We diagnosed the patient with pancreatic adenosquamous carcinoma with liver and lymph node metastasis, associated with hypercalcemia of malignancy secondary to PTHrP secretion. We administered systemic chemotherapy comprising gemcitabine and nab-paclitaxel. Unfortunately, the patient died 8 months after being diagnosed with this malignancy. PTHrP-producing adenosquamous carcinoma of the pancreas is rare;only 14 cases are reported in the literature. Based on immunohistochemical evaluation, this case report suggests that metastatic lymph nodes may lead to the overproduction of PTHrP in such cases.

Endoscopic Biliary Intervention Using Traction Devices for Periampullary Diverticulum

We describe the case a 92-year-old woman who was admitted to our hospital with choledocholithiasis and periampullary diverticulum (PAD). Due to PAD, clear visualization of the ampulla of Vater could not be obtained. Although selective bile duct cannulation was difficult, a 7-Fr plastic stent was placed during the first session. Fifteen days later, endoscopic retrograde cholangiopancreatography was retried using traction devices, and the papilla became visible. Endoscopic sphincterotomy and stone extraction were performed without any complications. The application of traction devices in endoscopic submucosal dissection may be a promising technique in cases in which endoscopic biliary intervention is difficult due to PAD.

In Vivo Testing of a Magnetically Suspended Centrifugal Pump Designed for Long-Term Use

The life of currently-available centrifugal pumps is limited to no more than three days. As a magnetically suspended centrifugal pump (MSCP) contains no shaft or seal, it could be expected to have a longer life expectancy. The MSCP was evaluated in a chronic animal model using eight adult sheep. Left ventricular assist with the MSCP was instituted between the left atrium and the descending aorta. The flow rates ranged from 2.5 to 6.0 L/min. The duration of the experiments ranged from 14 to 60 days. No mechanical failure occurred. The plasma free hemoglobin levels remained within an acceptable range (3-19 mg/dL). No reduction in the counts of red blood cells or platelets was observed. Thrombus formation within the MSCP was recognized in one pump. The main reason for termination was thromboembolism derived from the circuits. Three types of regulation methods (constant rotational speed, constant motor current, and controlled motor current) were also investigated. Regulation by a constant motor current mode altered the pressure-flow (P-Q) characteristics, and thereby, a steadier pump flow was obtained compared with regulation in the constant rotational speed mode. Moreover, the controlled motor current mode can change the P-Q relationship. These results demonstrate that the MSCP is a promising device for long-term use.

Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients

BACKGROUND AND AIM

The opportunities of endoscopic retrograde cholangiopancreatography (ERCP)-related procedure for hemodialysis (HD) patients have been increasing recently. However, the complication rate of ERCPs in HD patients has not been evaluated sufficiently. We aimed to clarify the feasibility of ERCPs in HD patients.

METHODS

We retrospectively reviewed 76 consecutive ERCPs for HD patients between January 2005 and December 2012 in one university hospital and three tertiary-care referral centers. Endoscopic sphincterotomy (EST) was performed in 21 HD patients. We evaluated the incidence and risk factors for complications of all ERCPs and EST in HD patients.

RESULTS

The incidence of pancreatitis, cholangitis, and cardiopulmonary complications for ERCPs in HD patients was 7.9% (6/76), 1.3% (1/76), and 1.3% (1/76), respectively. The mortality rate was 2.6% (2/76), and it occurred after acute pancreatitis in one patient and pneumonia in the other patient. The incidence of hemorrhage and pancreatitis with EST was 19% (4/21) and 4.8% (1/21), respectively. The duration of HD was significantly longer in the patients with hemorrhage after EST than without (19.5 vs 6 years; P = 0.029).

CONCLUSIONS

ERCP is feasible in HD patients. However, EST is not advisable because of the high hemorrhage rate, particularly for patients with a long duration of HD.

Mg-doped TiO2 nanorods improving open-circuit voltages of ammonium lead halide perovskite solar cells

Mg-doped TiO₂ nanorods were synthesized from colloidal titanate by a microwave hydrothermal reaction. Use of such TiO₂ having an elevated conduction band edge as an electron extracting material for ammonium lead halide perovskite solar cells resulted in a marked improvement of V_oc.

Essential role of high-mobility group box proteins in nucleic acid-mediated innate immune responses

Central to protective and pathological immunity is the activation of innate immune responses upon recognition of nucleic acids by transmembrane Toll-like receptors (TLRs) and cytosolic receptors. In mammals, the transmembrane pattern recognition receptors TLR3, TLR7 and TLR9 recognize double-stranded RNA, single-stranded RNA and hypomethylated DNA, respectively, while the retinoic acid-inducible gene-I (RIG-I)-like receptors (RLRs), RIG-I and MDA5 are known to be cytosolic RNA-sensing receptors. In addition, cytosolic DNA-sensing receptors that include DAI, RIG-I/MDA5 and AIM2 also trigger innate immune responses. High-mobility group box (HMGB)1, 2 and 3 proteins, which also bind immunogenic nucleic acids, are generally involved in the nucleic acid receptor-mediated activation of innate immune responses. There is a hierarchy in the nucleic acid-mediated activation of immune responses, wherein the selective activation of the nucleic acid-sensing receptors is contingent on the more promiscuous sensing of nucleic acids by HMGBs. The aim of this review is to summarize this novel feature of HMGB proteins, as essential frontline instigators of nucleic acid-mediated activation of innate immune responses. In addition, we will discuss the therapeutic implications of these findings.

Optical frequency comb spectroscopy

Optical frequency combs offer enormous potential in the detection and control of atoms and molecules by combining their vast spectral coverage with the extremely high spectral resolution of each individual comb component. Sensitive and multiplexed trace gas detection via cavity-enhanced direct frequency comb spectroscopy has been demonstrated for various molecules and applications; however, previous demonstrations have been confined to the visible and near-infrared wavelength range. Future spectroscopic capabilities are created by developing comb sources and spectrometers for the deep ultraviolet and mid-infrared spectral regions. Here we present a broadband high resolution mid-infrared frequency comb-based Fourier transform spectrometer operating in the important molecular fingerprint spectral region of 2100-3600 cm(-1) (2.8-4.8 microm). The spectrometer, employing a multipass cell, allows simultaneous acquisition of broadband, high resolution spectra (down to 0.0035 cm(-1) of many molecular species at concentrations in the part-per-billion range in less than 1 min acquisition time. The system enables precise measurements of concentration even in gas mixtures that exhibit continuous absorption bands. The current sensitivity, 2 x 10(-8) cm(-1) Hz-1/2 per spectral element, is expected to improve by two orders of magnitude with an external enhancement cavity. We have demonstrated this sensitivity increase by combining cavity-enhanced frequency comb spectroscopy with a scanning Fourier transform spectrometer in the near-infrared region and achieving a sensitivity of 4.7 x 10(-10) cm(-1) Hz(-1/2). A cavity-enhanced mid-infrared comb spectrometer will provide a near real-time, high sensitivity, high resolution, precisely frequency calibrated, broad bandwidth system for many applications.

Pleiotropic, Multidrug-Resistant Phenotype and P-Glycoprotein: A Review

This article is a brief review of recent knowledge about the pleiotropic resistant phenotype--multidrug-resistant (MDR) phenotype--which is responsible for cross-resistance in cancer chemotherapy. Thus it is possible to explain chemoresistance to vinca alkaloids, podophyllotoxins and anthracyclines. The MDR phenotype is associated with reduced intracellular drug accumulation by drug efflux, utilizing transmembrane P-glycoprotein (Gp170). The overexpression of Gp170 in normal and cancer tissues and the genetics are reported.

Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction

BACKGROUND AND AIM

The extent of liver drainage for palliative treatment of malignant hilar biliary obstruction is controversial. The aim of this study was to compare endoscopic unilateral versus bilateral drainage in patients with malignant hilar biliary obstruction using a self-expanding metal stent (SEMS).

METHODS

We carried out a retrospective review of 46 consecutive patients with malignant hilar biliary obstruction who were treated by endoscopic biliary drainage using SEMS between 1997 and 2005. Unilateral metal stenting (group A) was performed in 17 patients between 1997 and 2000, and bilateral metal stenting (group B) was performed in 29 patients between 2001 and 2005. The successful stent insertion, successful drainage, early complications, late complications, stent patency, and survival rate for groups A and B were evaluated and compared retrospectively.

RESULTS

There were no significant differences between the two groups in successful stent insertion (100% vs 90%, group A vs B, respectively), successful drainage (100% vs 96%), early complications (0% vs 10%), or late complications (65% vs 54%). Cumulative stent patency was significantly better in group B than in group A (P = 0.009). In cases of cholangiocarcinoma, cumulative stent patency was significantly better in group B than in group A (P = 0.009), whereas there were no inter-group differences for gallbladder carcinoma. Cumulative survival did not differ significantly between the groups.

CONCLUSIONS

Endoscopic bilateral drainage using SEMS for malignant hilar biliary obstruction is more effective than unilateral drainage in terms of cumulative stent patency, especially in cases of cholangiocarcinoma.

Pseudocyst in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage

We report a 50-year-old male with pseudocysts in the pancreatic tail associated with chronic pancreatitis successfully treated by transpapillary cyst drainage. He had previously undergone ultrasonography-guided percutaneous cyst drainage for a pancreatic pseudocyst in our hospital. He was readmitted due to abdominal pain and fever. Computed tomography showed recurrence of a pseudocyst in the pancreatic tail measuring 5 cm in diameter. Since conservative treatment failed, endoscopic retrograde pancreatography was performed. There was communication between the pseudocyst and the main pancreatic duct, and pancreatic duct stenosis proximal to the pseudocyst. First, transpapillary pancreatic duct drainage was performed using a plastic stent, but the pseudocyst did not decrease in size and became infected. After removal of the stent, a pigtail type nasocystic catheter was placed in the pseudocyst via the pancreatic duct. The pseudocyst infection immediately disappeared, and the pseudocyst gradually decreased and disappeared. After removal of the nasocystic catheter, no recurrence was observed. As transpapillary drainage of pancreatic pseudocyst, cyst drainage and pancreatic duct drainage have been reported. In our patient with pseudocyst in the pancreatic tail, duct drainage was ineffective and the pseudocyst was infected, whereas cyst drainage was very effective. We considered that cyst drainage by a nasocystic catheter was the first-line therapy as the transpapillary drainage of the pancreatic pseudocyst.

A case of gastrointestinal stromal tumor with spontaneous rupture in the greater omentum

BACKGROUND

Although GIST generally occurs in the digestive tract, such as the stomach, and small and small intestine primarily, Omental GIST tumours are very rare.

CASE PRESENTATION

A 63-year-old male patient, who recognized an abdominal tumor 1 year before admission, had a slight expansion of the tumor, reduction of the body and malaise, was consulted to our hospital. Abdominal CT and MRI revealed a cystic lesion of 26 cm in diameter with a clear boundary from immediately below the interseptum to the pelvic cavity, and imaged the septum and cystic wall. We considered that the patient had a cystic tumor in the abdomen, of which the primary lesion was unknown, and scheduled surgery. The patient unfortunately deteriorated with shock and sudden pain in the abdomen. Wediagnosed tumor rapture, and emergency surgery was performed. The tumor, weighing 3,600 g, was mostly cystic, and filled with sanguinous fluid and clot. Histologically, the tumor was composed of spindle cells, and was positive for c-KIT (CD117), slightly positive for alpha-smooth muscle actin (SMA), and S-100 protein positive. Based on these findings, the tumor was diagnosed as GIST primarily occurring in the greater omentum.

CONCLUSION

We experienced a rare case of GIST which originated from the greater omentum. Recently, the prognosis of GIST has been improved since the treatment with Imatinib.It is necessary to consider the diagnosis of GIST on encountering a mass in the greater omentum.

A case of obstructive jaundice caused by impaction of a pancreatic stone in the papilla for which a needle knife precut papillotomy was effective

CONTEXT

Obstructive jaundice in chronic pancreatitis is generally caused by stenosis of the bile duct in the pancreas. Obstructive jaundice caused by the impaction of a pancreatic stone in the papilla is markedly rare, with only seven cases reported to date.

CASE REPORT

We report a case of obstructive jaundice caused by the impaction of a pancreatic stone in the papilla. A 41-year-old male with chronic pancreatitis was admitted because of epigastric pain. Blood analysis revealed increased levels of hepatobiliary system enzymes, mild jaundice and an increase in pancreatic enzymes. Computed tomography revealed a number of pancreatic stones in the main pancreatic duct, and a stone with a diameter of about 1 cm in the pancreatic head. Swelling of the papilla was observed using duodenoscopy while endoscopic ultrasonography revealed a strong echo with acoustic shadows in the papilla. Percutaneous transhepatic biliary drainage was performed for the obstructive jaundice. Contrast medium from the percutaneous transhepatic biliary drainage route regurgitated into the pancreatic duct and revealed the impaction of pancreatic stones in the common channel. The patient was referred to our hospital for treatment of the stone impaction. We performed a needle knife precut papillotomy and extracted a white stone which was diagnosed as a pancreatic stone by composition analysis.

CONCLUSION

Impaction of a pancreatic stone in the papilla is a markedly rare cause of obstructive jaundice in chronic pancreatitis. A needle knife precut papillotomy was effective in removing the impacted pancreatic stone in the papilla.

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures

BACKGROUND AND AIM

Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated.

METHODS

After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone.

RESULTS

The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage.

CONCLUSIONS

Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures

BACKGROUND AND AIM

Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated.

METHODS

After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone.

RESULTS

The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage.

CONCLUSIONS

Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.

DNA marker analysis for pyramided of Fusarium head blight (FHB) resistance QTLs from different germplasm

A pyramided FHB resistance line of wheat (WSY) was previously developed from three FHB resistant cultivars (Sumai 3, Wangshuibai, and Nobeokabouzu) in the Jiangsu Academy of Agricultural Sciences, China. In the present study, we analyzed the genetic relationship between WSY and the three parental cultivars using DNA markers in order to clarify how many and which resistance genes had accumulated in WSY. We analyzed 282 DNA markers from the 21 wheat chromosomes. WSY was found to include different chromosome regions that harbored putative FHB QTLs of the three parental germplasm. Haplotypes of DNA markers on these QTL regions revealed that the 1BL, 2BL, 5AS, and 7AL QTL regions were from Sumai 3, the 2AS, 2DS, 3AS, and 6BS QTL regions were from Wangshuibai, and the 3BS QTL region was from Nobeokabouzu. This study showed that different resistance genes from the different resistant germplasm had indeed accumulated in WSY. WSY is a potential resistant resource for FHB resistance in wheat breeding programs.

Velocity selective optical pumping of Rb hyperfine lines induced by a train of femtosecond pulses

We present direct observation of the velocity-selective optical pumping of the Rb ground state hyperfine levels induced by 5S(1/2) --> 5P(1/2) femtosecond pulse-train excitation. A modified direct frequency comb spectroscopy based on the fixed frequency comb and a weak cw scanning probe laser was developed. The femtosecond pulse-train excitation of a Doppler-broadened Rb four-level atomic vapor is investigated theoretically in the context of the density matrix formalism and the results are compared with the experiment.

Conversion of AFLP markers associated with FHB resistance in wheat into STS markers with an extension-AFLP method

Amplified fragment length polymorphism (AFLP) has proven a powerful tool for tagging genes or quantitative trait loci (QTLs) of interest in plants. However, conversion of AFLP markers into sequence-tagged site (STS) markers is technically challenging in wheat owing to the complicated nature of its genome. In this study, we developed an "extension-AFLP" method to convert AFLP markers associated with Fusarium head blight (FHB) resistance into STS markers. When an AFLP marker of interest was detected with an EcoRI+3-MseI+4-selective primer combination, the PCR product was used as a template for an additional selective amplification with four primer pairs, in which one additional selective base (either A, C, G, or T) was added to the 3' end of one of the two primers. The extended primer pair that produced the targeted band was further extended by adding each of the four selective nucleotide bases for the next round of selective amplification. Extension selective amplification was performed until the target bands became clear enough for subsequent cloning and sequencing. By using the extension-AFLP method, we successfully converted two AFLP markers located on chromosome 3BS and associated with FHB resistance into STS markers. Our results indicated that the extension-AFLP method is an efficient approach for converting AFLP markers into STS markers in wheat. The developed STS markers might be used for marker-assisted selection (MAS) for FHB resistance in wheat breeding programs.

Phylogenetic and evolutionary relationships between Elymus humidus and other Elymus species based on sequencing of non-coding regions of cpDNA and AFLP of nuclear DNA

Species of the genus Elymus are closely related to some important cereal crops and may thus serve as potential alien genetic resources for the improvement of these crops. E. humidus is indigenous to Japan and is well adapted to a humid climate. However, the phylogenetic and evolutionary relationships between E. humidus and other Elymus species are unclear. To elucidate these relationships, we examined the sequences of three non-coding regions of chloroplast DNA (cpDNA) and the amplified fragment length polymorphism (AFLP) variation of nuclear DNA in E. humidus and other related species. A total of 15 sequence mutations from the three non-coding regions, trnL-trnF, trnF- ndhJ(C), and atpB-rbcL, covering approximately 1,800 bp, were detected in the Elymus species. A phylogenic tree resulting from the cpDNA sequence data revealed that all the species containing the St nuclear genome (St, StH, StY, and StHY) formed a well-supported clade that is remote from the Hordeum species (H). This result strongly supports the finding that Pseudoroegneria is the maternal genome donor to the genus Elymus. In addition, E. humidus showed the closest relationship with the cpDNA genome of the Pseudoroegneria species. The AFLP analysis detected 281 polymorphic bands with 11 AFLP primer combinations. The AFLP result showed that E. humidus is relatively closer to E. tsukushiensis. However, the cpDNA sequencing results indicated that E. humidus and E. tsukushiensis have different cytoplasmic origins. Our results suggest that the evolutionary process between E. humidus and E. tsukushiensis is not monophyletic, although the two species have similar morphological characters and adaptability.

The effects of chromosomes 3A and 3B on resistance to Fusarium head blight in tetraploid wheat

Fusarium head blight (FHB) caused by Fusarium graminearum is one of the most destructive diseases of wheat in areas where the weather is warm and humid after heading. Previous studies indicate that the level of resistance to FHB varies not only among wheat cultivars but also among some of their wild relatives. No accession, however, has yet been identified to be completely immune to FHB among the Gramineae. It is known that durum wheat (Triticum turgidum L. conv. durum) is consistently more susceptible to FHB than common wheat (T. aestivum L.). The importance of the D genome in conferring resistance to FHB has been emphasized. Meanwhile, recent studies using molecular markers report effective QTLs on chromosome 3BS in a hexaploid population and on 3A in tetraploid recombinant inbred chromosome lines. In this study, we performed an evaluation of the effects of homoeologous group 3 chromosomes of T. turgidum ssp. dicoccoides on resistance to FHB using a set of chromosome substitution lines of a durum wheat cultivar 'Langdon'. The accession of T. turgidum ssp. dicoccoides examined in this study was more susceptible for Type II resistance (resistance to spread of FHB in the head) than 'Langdon'. Both of the chromosome substitution lines of 3A and 3B showed the same level of resistance with 'Langdon', but bleaching of the heads was completely prevented in the substitution lines of chromosome 3A without relationship to rachis fragility. It was concluded that the chromosome 3A of T. turgidum ssp. dicoccoides carries resistance gene(s) to head bleaching caused by FHB.

[Multivessel off-pump coronary aortic bypass grafting with an impaired and severely dilated left ventricle using the Starfish heart positioner]

Off-pump coronary artery bypass grafting (OPCAB) is gaining acceptance and is now more widely used for coronary revascularization worldwide. Accessing the vessels, particularly on the lateral and inferior walls of the heart, can sometimes be challenging while the heart is beating, especially in hearts with an impaired and severely dilated left ventricle. The Starfish heart positioner was designed to achieve optimal exposure of the lateral and inferior walls of the heart with minimal hemodynamic compromise. This device was used in a patient with a severely impaired and dilated left ventricle to successfully position the heart for quadruple bypass grafting using all in situ arterial grafts, such as bilateral international thoracic arteries (ITAs) and the right gastroepiploic artery. The degree of hematoma caused by the pressure of the suction cup of this device was minimal. This case report suggests that the use of Starfish heart positioner will facilitate and expand the ability of surgeons to easily and consistently perform OPCAB.