Prevalence of Onchocerca japonica and O. takaokai infections in the Japanese wild boar, Sus scrofa leucomystax, and the Ryukyu wild boar, S. s. riukiuanus, in Japan

Reports of zoonotic infections with Onchocerca japonica (Nematoda: Filarioidea), which parasitizes the Japanese wild boar, Sus scrofa leucomystax, have recently increased in Japan. To predict the occurrence of infection in humans, it is necessary to determine the prevalence of O. japonica infection in the natural host animals. We investigated the presence of adult worms in the footpads, and of microfilariae in skin snips, taken from the host animals, between 2000 and 2018. Onchocerca japonica was found in 165 of 223 (74%) Japanese wild boars in Honshu and Kyushu. Among the nine regions studied, the highest prevalence of O. japonica infection was found in Oita, Kyushu, where 47 of 52 (90.4%) animals were infected. The ears were the predilection sites for O. japonica microfilariae. Adult worms of O. japonica were found more frequently in the hindlimbs than in the forelimbs of the host animals. Onchocerca takaokai was found in 14 of 52 (26.9%) Japanese wild boars in Oita. In Kakeroma Island among the Nansei Islands, both O. japonica and O. takaokai were isolated from the Ryukyu wild boar, S. s. riukiuanus. These observations could help predict future occurrences of human zoonotic onchocercosis in Japan.

A pilot study of adjuvant chemotherapy with carboplatin and oral S-1 for patients with completely resected stage II to IIIA non-small cell lung cancer

Background

Adjuvant chemotherapy with platinum‐based regimens for completely resected early‐stage non‐small cell lung cancer (NSCLC) provides overall survival benefit in several clinical trials.

Objectives

We conducted this prospective study to evaluate the efficacy and safety of adjuvant chemotherapy with carboplatin and S‐1 for patients with completely resected stage II to IIIA NSCLC.

Methods

Patients with completely resected stage IIA to IIIA NSCLC were treated with four cycles of carboplatin with area under the concentration time curve of 5 mg/mL/min on day 1 plus S‐1 at 80–120 mg/bodyweight per day for two weeks, followed by one‐week rest as adjuvant chemotherapy. The primary endpoint was the completion rate of three cycles of the treatment. The secondary endpoints were safety and two‐year survival rate.

Results

A total of 19 patients were enrolled, until the study was terminated prematurely because of fatal pulmonary embolism in two patients. The median number of treatment cycles was three (range: 1–4). The completion rate of three cycles was 78.9% (95% confidence interval [CI]: 56.6–91.4%). Two‐year disease‐free survival rate was 57.8%. Grade 3 or 4 hematological toxicities included neutropenia (26.2%), anemia (5.2%), and thrombocytopenia (15.7%). Grade 3 or 4 nonhematological toxicities were anorexia (10.5%) and nausea (10.5%). Febrile neutropenia developed in 5.2%. In two patients (10.5%), grade five pulmonary embolism was observed, and the causal relationship with treatment could not be denied.

Conclusions

Carboplatin and oral S‐1 had modest survival benefit, but this regimen was not tolerable in an adjuvant setting because fatal pulmonary embolism occurred in two patients.

Key points

Carboplatin and oral S‐1 had modest survival benefit but this regimen was not tolerable.

Fatal pulmonary embolism occurred in this regimen.

Motor activation is modulated by visual experience during cyclic gait observation: A transcranial magnetic stimulation study

Transcranial magnetic stimulation (TMS) has been widely utilized to noninvasively explore the motor system during the observation of human movement. However, few studies have characterized motor cortex activity during periodic gait observation. Thus, this study examined the effects of an observer's visual experience and/or intention to imitate on corticospinal excitability during the observation of another's gait. Twenty-six healthy volunteers were included in this study and allocated to two different groups. Participants in the visual experience group had formal experience with gait observation (physical therapist training), while those in the control group did not. Motor-evoked potentials induced by TMS in the tibialis anterior and soleus muscles were measured as surrogates of corticospinal excitability. Participants were seated and, while resting, they observed a demonstrator's gait or observed it with the intention to subsequently reproduce it. Compared with the resting state, cyclic gait observation led to significant corticospinal facilitation in the tibialis anterior and soleus muscles. However, this pattern of corticospinal facilitation in the measured muscles was not coupled to the pattern of crural muscle activity during actual gait and was independent of the step cycle. This motor cortex facilitation effect during gait observation was enhanced by the observer's visual experience in a manner that was not step cycle-dependent, while the observer's intent to imitate did not affect corticospinal excitatory input to either muscle. In addition, visual experience did not modulate corticospinal excitability in gait-related crural muscles. Our findings indicate that motor cortex activity during gait observation is not in line with the timing of muscle activity during gait execution and is modulated by an individual's gait observation experience. These results suggest that visual experience acquired from repetitive gait observation may facilitate the motor system's control on bipedal walking, but may not promote the learning of muscle activity patterns.

Influence of seasonal variations on physical activity in older people living in mountainous agricultural areas

Objectives: Increasing activity levels in older people is important for maintaining quality of life and ameliorating the risks of morbidity related to falls, depression, and dementia. This study aimed to clarify the seasonal variation effects on total energy expenditure, number of steps, time spent in low- and moderate- or high-intensity physical activities, and daily activities performed. Patients and Methods: This was a cross-sectional study of 22 community-dwelling older individuals (3 men, 19 women; mean age, 75.1 ± 7.3 years) living in three districts of Gero, Gifu, who participated in the Gero Salon Project hosted by the Social Welfare Councils. Evaluations were conducted in each season from September 2016 to August 2017. We used a uniaxial accelerometer, the Lifecorder device, which measures physical activity, and the Physical Activity Scale for the Elderly to evaluate activities of daily living. Data were analyzed using the multiple comparisons (Bonferroni correction) method. Results: Total energy expenditure and time spent in moderate- or high-intensity activities did not show seasonal variations. However, the lowest number of steps was taken during the winter, and the number of steps increased significantly from winter to spring. The time spent in low-intensity physical activities was significantly longer in the spring and summer than in the winter. There was no significant seasonal difference in total Physical Activity Scale for the Elderly score, leisure activities, domestic activities, or work-related activities. However, there was a significant difference between the summer and winter scores in "outdoor gardening," with the lowest score observed during the winter. Conclusions: With climate changes in the winter months, "outdoor gardening" becomes difficult, thus decreasing the number of steps taken. Therefore, it is necessary to identify other ways for older people to maintain physical activity during the winter season.

Activation and IL-10 production of specific CD4+ T cells are regulated by IL-27 during chronic infection with Plasmodium chabaudi

IL-27, a regulatory cytokine, plays critical roles in the prevention of immunopathology during Plasmodium infection. We examined these roles in the immune responses against Plasmodium chabaudi infection using the Il-27ra^-/- mice. While IL-27 was expressed at high levels during the early phase of the infection, enhanced CD4⁺ T cell function and reduction in parasitemia were observed mainly during the chronic phase in the mutant mice. In mice infected with P. chabaudi and cured with drug, CD4⁺ T cells in the Il-27ra^-/- mice exhibited enhanced CD4⁺ T-cell responses, indicating the inhibitory role of IL-27 on the protective immune responses. To determine the role of IL-27 in detail, we performed CD4⁺ T-cell transfer experiments. The Il-27ra^-/- and Il27p28^-/- mice were first infected with P. chabaudi and then cured using drug treatment. Plasmodium-antigen primed CD4⁺ T cells were prepared from these mice and transferred into the recipient mice, followed by infection with the heterologous parasite P. berghei ANKA. Il-27ra^-/- CD4⁺ T cells in the infected recipient mice did not produce IL-10, indicating that IL-10 production by primed CD4⁺ T cells is IL-27 dependent. Il27p28^-/- CD4⁺ T cells that were primed in the absence of IL-27 exhibited enhanced recall responses during the challenge infection with P. berghei ANKA, implying that IL-27 receptor signaling during the primary infection affects recall responses in the long-term via the regulation of the memory CD4⁺ T cell generation. These features highlighted direct and time-transcending roles of IL-27 in the regulation of immune responses against chronic infection with Plasmodium parasites.

Left superior pulmonary vein stump thrombosis and right renal infarction after left upper lobectomy: case report and literature review

Left upper lobectomy (LUL) has been considered to have a higher risk of thrombus formation in the pulmonary vein stump (PVS) than other lobectomies. A case of thrombus formation in the PVS and right renal infarction detected by contrast-enhanced computed tomography (CECT) 12 days after LUL is presented. The thrombus in the PVS was considered to be related to the renal infarction because of the lack of other potential explanations. After intravenous heparin treatment for 1 week and continuous oral anticoagulation, the thrombus in the PVS became smaller 3 months after the operation, and it basically disappeared after 1 year. Scar formation was detected in the area of renal infarction 3 months after the operation, and no specific change was detected from then on. One should consider performing postoperative chest and abdominal CECT routinely within 1 week after LUL, and, if thrombosis is found, antithrombotic therapy might then be given.

Novel approach for predicting occult lymph node metastasis in peripheral clinical stage I lung adenocarcinoma

Background

Occult nodal metastasis results in a poor prognosis for lung cancer patients. The aim of this study was to develop an efficient approach for predicting occult nodal metastasis in peripheral clinical stage I lung adenocarcinoma.

Methods

Data for 237 peripheral clinical stage I lung adenocarcinoma patients who underwent complete resection were retrospectively reviewed. Univariate and multivariate analyses were performed to investigate predictors of occult nodal metastasis. Kaplan-Meier analysis was performed for survival.

Results

Occult nodal metastasis was detected in 26/237 (11.0%) patients. Nodule type, tumor SUVmax, whole tumor size, solid tumor size, and preoperative serum carcinoembryonic antigen (CEA) were identified as preoperative predictors of occult nodal metastasis (all P<0.05). Solid tumor size (P<0.001) and preoperative serum CEA (P=0.004) were identified as independent predictors on multivariate analysis. A prediction model was established using the independent predictors. The occult nodal metastasis rate was 2.4% with solid tumor size ≤2.3 cm (low-risk group), 17.0% with solid tumor size >2.3 cm and CEA ≤5 ng/mL (moderate-risk group), and 56.0% with solid tumor size >2.3 cm and CEA >5 ng/mL (high-risk group). The occult nodal metastasis rate was significantly higher in papillary-predominant (11.0%) and solid-predominant subtypes (28.6%; P=0.001). Patients having a micropapillary component had a significantly higher occult nodal metastasis rate (24.2%) compared with no micropapillary component (P=0.007). Histological subtype with micropapillary component and all preoperative predictors were significant prognostic factors affecting disease-free survival (DFS) (all P<0.05).

Conclusions

A novel approach to predict occult nodal metastasis was developed for peripheral clinical stage I lung adenocarcinoma. It would be helpful for selecting candidates for stereotactic ablative radiotherapy (SABR) or wedge resection and mediastinoscopy or endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA). Complete nodal dissection should be performed for moderate to high-risk patients or patients with poor histologic subtypes.

[Using Super Resolution to Denoise on PET Images]

A high-resolution display panel comes to practical use, but the resolution of the indicated contents does not change. The up-sampling processing is applied to indication of the low-resolution contents. In the up-sampling process, the super resolution enables an up-sampling process which estimates information of high frequency components lost by sampling while analyzing input images is noticed. In this paper, we aimed at reconstructing an image of normal resolution in which the influence of statistical noise is reduced by applying super resolution after down-sampling processing is applied to positron emission tomography (PET) image with many statistical noises. To evaluate the noise reduction effect, we compared it with the Gaussian filter which is frequently used to reduce the influence of the statistical noise of the PET image. A 3D Hoffman brain phantom was used to evaluate objectively by peak signal-to-noise ratio and power spectral density. The objective index of the PET image applying super resolution is positive results, suggesting the possibility of being useful as compared with the conventional method.

Role of IL-10 in inhibiting protective immune responses against infection with heterologous Plasmodium parasites

Malaria is induced by infection with Plasmodium parasites, which are genetically diverse, and the immune response to Plasmodium infection has both allele-specific and cross-reactive components. To determine the role of the cross-reactive immune response in the protection and disease manifestation in heterologous Plasmodium infection, we used infection models of P. chabaudi chabaudi (Pcc) and P. berghei ANKA (PbA). CD4⁺ T cells primed with Pcc infection exhibited strong cross-reactivity to PbA antigens. We infected C57BL/6 mice with Pcc and subsequently treated them with an anti-Plasmodium drug. The Pcc-primed mice exhibited reduced parasitemia and showed no signs of experimental cerebral malaria after infection with PbA. CD4⁺ T cells from the Pcc-primed mice produced high levels of IFN-γ and IL-10 in response to PbA early after PbA infection. The blockade of IL-10 signaling with anti-IL-10 receptor antibody increased the proportion of activated CD4⁺ and γδ T cells and the IFN-γ production by CD4⁺ T cells in response to PbA antigens, while markedly reducing the levels of parasitemia. In contrast, IL-10 blockade did not have a significant effect on parasitemia levels in unprimed mice after PbA infection. These data suggest a potent regulatory role of IL-10 in the cross-reactive memory response to the infection with heterologous Plasmodium parasites leading to the inhibition of the protective immunity and pathogenesis.

Metformin Promotes the Protection of Mice Infected With Plasmodium yoelii Independently of γδ T Cell Expansion

Adaptive immune responses are critical for protection against infection with Plasmodium parasites. The metabolic state dramatically changes in T cells during activation and the memory phase. Recent findings suggest that metformin, a medication for treating type-II diabetes, enhances T-cell immune responses by modulating lymphocyte metabolism. In this study, we investigated whether metformin could enhance anti-malaria immunity. Mice were infected with Plasmodium yoelii and administered metformin. Levels of parasitemia were reduced in treated mice compared with those in untreated mice, starting at ~2 weeks post-infection. The number of γδ T cells dramatically increased in the spleens of treated mice compared with that in untreated mice during the later phase of infection, while that of αβ T cells did not. The proportions of Vγ1⁺ and Vγ2⁺ γδ T cells increased, suggesting that activated cells were selectively expanded. However, these γδ T cells expressed inhibitory receptors and had severe defects in cytokine production, suggesting that they were in a state of exhaustion. Metformin was unable to rescue the cells from exhaustion at this stage. Depletion of γδ T cells with antibody treatment did not affect the reduction of parasitemia in metformin-treated mice, suggesting that the effect of metformin on the reduction of parasitemia was independent of γδ T cells.

Management of acute ischemic stroke after pulmonary resection: incidence and efficacy of endovascular thrombus aspiration

OBJECTIVE

We analyzed acute ischemic stroke by thromboembolism in the early period after lung cancer surgery.

METHODS

A retrospective review of the clinical records of patients who underwent lung resection for primary lung cancer was performed. Patients who underwent lobectomy, bilobectomy, and pneumonectomy were included. The clinical characteristics of the patients, the incidence of atrial fibrillation (Af) after surgery, and the incidence of acute ischemic stroke were analyzed. The clinical courses of patients having acute ischemic stroke were also reviewed.

RESULTS

In 4 (0.6%) of 696 patients, acute ischemic stroke occurred in the early period during hospitalization after lung cancer surgery. Acute ischemic stroke occurred within 4 days in three cases and after 4 days in one case. The resection site of the lung was the left side in all cases, and there were three cases of left upper lobectomy and one case of left lower lobectomy. As for the two recent patients, thrombus removal was performed by a neurosurgeon, and both cases achieved successful recanalization. The time between symptom detection and recanalization was 205 and 170 min, respectively. One patient was cured without any residual effect of disease, and the other patient's hemiplegia resolved and aphasia improved.

CONCLUSION

Since cerebral infarction impairs the patient's quality of life, thrombus removal should be considered if possible.

Differentiation of Brain Metastases and Gliomas Based on Color Map of Phase Difference Enhanced Imaging

Background and objective: Phase difference enhanced imaging (PADRE), a new phase-related MRI technique, can enhance both paramagnetic and diamagnetic substances, and select which phases to be enhanced. Utilizing these characteristics, we developed color map of PADRE (Color PADRE), which enables simultaneous visualization of myelin-rich structures and veins. Our aim was to determine whether Color PADRE is sufficient to delineate the characteristics of non-gadolinium-enhancing T2-hyperintense regions related with metastatic tumors (MTs), diffuse astrocytomas (DAs) and glioblastomas (GBs), and whether it can contribute to the differentiation of MTs from GBs.

Methods: Color PADRE images of 11 patients with MTs, nine with DAs and 17 with GBs were created by combining tissue-enhanced, vessel-enhanced and magnitude images of PADRE, and then retrospectively reviewed. First, predominant visibility of superficial white matter and deep medullary veins within non-gadolinium-enhancing T2-hyperintense regions were compared among the three groups. Then, the discriminatory power to differentiate MTs from GBs was assessed using receiver operating characteristic analysis.

Results: The degree of visibility of superficial white matter was significantly better in MTs than in GBs (p = 0.017), better in GBs than in DAs (p = 0.014), and better in MTs than in DAs (p = 0.0021). On the contrary, the difference in the visibility of deep medullary veins was not significant (p = 0.065). The area under the receiver operating characteristic curve to discriminate MTs from GBs was 0.76 with a sensitivity of 80% and specificity of 64%.

Conclusion: Visibility of superficial white matter on Color PADRE reflects inferred differences in the proportion of vasogenic edema and tumoral infiltration within non-gadolinium-enhancing T2-hyperintense regions of MTs, DAs and GBs. Evaluation of peritumoral areas on Color PADRE can help to distinguish MTs from GBs.

Comparison of perioperative and oncological outcomes between video-assisted segmentectomy and lobectomy for patients with clinical stage IA non-small cell lung cancer: a propensity score matching study

Background

Segmentectomy for lung cancer remains controversial because of the complexity of the procedure and concern about an increased recurrence rate. It is important to compare perioperative and oncological outcomes between segmentectomy and lobectomy.

Methods

From January 2007 to December 2016, 41 segmentectomies by video-assisted thoracic surgery (VATS) and 122 VATS lobectomies for 163 patients with clinical stage IA non-small cell lung cancer (NSCLC) were performed. Clinicopathological factors, including recurrence rate and survival rate, were compared. In order to reduce biases of outcomes, clinicopathological factors were used for propensity score matching (PSM). Then, 41 VATS segmentectomies and 41 lobectomies were selected and further analyzed.

Results

No significant differences were seen between the two groups in age, pulmonary function, comorbidity, operative time, blood loss, chest tube duration days, postoperative stay days, complications, histological type, and multiple primary rate. Smoking index resected number of nodes, tumor size, lymph node metastasis rate, and pathological stage were higher in the lobectomy group than in the segmentectomy group (P<0.05). In the lobectomy group, 16 patients (13.1%) had recurrence, and 2 patients (1.6%) died because of cancer progression. There were no significant differences in the recurrence rate and prognosis between the two groups. In addition, Cox regression analysis suggested that sex, lymph node metastasis, and pathology stage were associated with recurrence (P<0.05), but no factor was an independent prognostic factor. After PSM, the two groups had similar clinicopathological factors, and the type of operation still had no relationship with the recurrence rate or the death rate.

Conclusions

Perioperative and oncological outcomes of VATS segmentectomy are similar to those of VATS lobectomy for patients with clinical stage IA NSCLC. VATS segmentectomy can be considered one of the surgical procedures appropriate for patients with clinical stage IA NSCLC.

Differential requirements for IRF4 in the clonal expansion and homeostatic proliferation of naive and memory murine CD8+ T cells

Interferon regulatory factor 4 (IRF4) has critical roles in immune cell differentiation and function and is indispensable for clonal expansion and effector function in T cells. Here, we demonstrate that the AKT pathway is impaired in murine CD8⁺ T cells lacking IRF4. The expression of phosphatase and tensin homolog (PTEN), a negative regulator of the AKT pathway, was elevated in Irf4^-/- CD8⁺ T cells. Inhibition of PTEN partially rescued downstream events, suggesting that PTEN constitutes a checkpoint in the IRF4-mediated regulation of cell signaling. Despite the clonal expansion defect, in the absence of IRF4, memory-like CD8⁺ T cells could be generated and maintained, although unable to expand in recall responses. The homeostatic proliferation of naïve Irf4^-/- CD8⁺ T cells was impaired, whereas their number eventually reached a level similar to that of wild-type CD8⁺ T cells. Conversely, memory-like Irf4^-/- CD8⁺ T cells underwent homeostatic proliferation in a manner similar to that of wild-type memory CD8⁺ T cells. These results suggest that IRF4 regulates the clonal expansion of CD8⁺ T cells at least in part via the AKT signaling pathway. Moreover, IRF4 regulates the homeostatic proliferation of naïve CD8⁺ T cells, whereas the maintenance of memory CD8⁺ T cells is IRF4-independent.

Modulation of immune responses by Plasmodium falciparum infection in asymptomatic children living in the endemic region of Mbita, western Kenya

Individuals living in malaria endemic areas become clinically immune after multiple re-infections over time and remain infected without apparent symptoms. However, it is unclear why a long period is required to gain clinical immunity to malaria, and how such immunity is maintained. Although malaria infection is reported to induce inhibition of immune responses, studies on asymptomatic individuals living in endemic regions of malaria are relatively scarce. We conducted a cross-sectional study of immune responses in asymptomatic school children aged 4-16years living in an area where Plasmodium falciparum and Schistosoma mansoni infections are co-endemic in Kenya. Peripheral blood mononuclear cells were subjected to flow cytometric analysis and cultured to determine proliferative responses and cytokine production. The proportions of cellular subsets in children positive for P. falciparum infection at the level of microscopy were comparable to the negative children, except for a reduction in central memory-phenotype CD8⁺ T cells and natural killer cells. In functional studies, the production of cytokines by peripheral blood mononuclear cells in response to P. falciparum crude antigens exhibited strong heterogeneity among children. In addition, production of IL-2 in response to anti-CD3 and anti-CD28 monoclonal antibodies was significantly reduced in P. falciparum-positive children as compared to -negative children, suggesting a state of unresponsiveness. These data suggest that the quality of T cell immune responses is heterogeneous among asymptomatic children living in the endemic region of P. falciparum, and that the responses are generally suppressed by active infection with Plasmodium parasites.

The influence of seawater properties on toxicity of copper pyrithione and its degradation product to brine shrimp Artemia salina

Copper pyrithione (CuPT) is a biocide, used worldwide to prevent biofouling on submerged surfaces. In aquatic environments it rapidly degrades, however, one of the degradation products (HPT) is known to react with cupric ion back to its parent compound. Not much is known about the behavior and toxicity of CuPT and its degradation product HPT in different water systems. Hence, our aim was to investigate the ecotoxicity of CuPT, HPT as well as Cu²⁺ to the brine shrimp Artemia salina in natural seawater and organic matter-free artificial seawater. Moreover, in order to elucidate the influence of ionic strength of water on CuPT toxicity, tests were performed in water media with modified salinity. The results showed that CuPT was the most toxic to the exposed crustaceans in a seawater media with the highest salinity and with no organic matter content. HPT in a presence of cupric ion converted to CuPT, but the measured CuPT concentrations and the mortality of A. salina in natural water were lower than in artificial water. The toxicity of CuPT to A. salina was significantly influenced by the organic matter content, salinity, and proportions of constituent salts in water. In a combination with cupric ion, non-hazardous degradation product HPT exhibits increased toxicity due to its rapid transformation to its parent compound.

Nutritional status and management of risks due to physical therapy in patients hospitalized for long periods

[Purpose] This study aimed to understand the nutritional status of patients hospitalized for long periods and the risk of physical therapy (PT) for such patients. [Subjects and Methods] Participants were selected from patients who were hospitalized at a designated medical long-term care sanatorium. The participants were divided into 5 groups (A–E) depending on their mode of energy intake and ambulatory ability during PT. The serum albumin level, energy intake, total daily energy expenditure, and total daily energy expenditure per session of PT (EEPT) were evaluated for each group. [Results] Protein-energy malnutrition was observed in 69.6% of the participants. No significant association was identified between the serum albumin level and body mass index. Energy intake was significantly higher in Groups D and E, whose energy intake was via ingestion, than in Groups A and B, whose intake was via tube feeding. EEPT was highest in patients of Group E who had gait independence different from the ability of those in groups A–D. [Conclusion] The actual energy intake is lower with tube feeding than with ingestion. Risk management and energy intake should be revisited in elderly patients who have been hospitalized for long periods and subsequently obtain gait independence.

In vitro Study of Serial Changes to Carmustine Wafers (Gliadel) with MR Imaging and Computed Tomography

PURPOSE

Implantation of carmustine wafers (Gliadel) in vivo is accompanied by characteristic serial changes on MRI and CT, such as transient hyperintensity of the wafers on T₁-weighted images (T₁WIs) and considerable gas accumulation in surgical resection cavities. The purpose of this study was to evaluate intrinsic imaging changes to carmustine wafers in vitro.

METHODS

Three phantoms simulating a surgical resection cavity were constructed. Each contained either a carmustine wafer fixed with oxidized regenerated cellulose and fibrin sealant, an unfixed carmustine wafer, or a fixed polyethylene control disk, immersed in phosphate-buffered saline. Image acquisition of the phantoms was performed on MRI and CT until 182 days after construction. The radiological appearances of the object in each phantom were assessed by visual evaluation and quantification of the region of interest. The volume of gas around the objects at 24 h after constructing the phantoms was also measured.

RESULTS

The carmustine wafers showed low signal intensities on T₁WIs and T₂-weighted images (T₂WIs), and high densities on CT images at 24 h. The signal intensities and CT densities gradually approximated those of saline over a period of months. However, the carmustine wafers never showed hyperintensity on T₁WIs in vitro. The fixed carmustine wafer showed slower radiological changes, as compared to the unfixed wafer. The gas volume around the fixed carmustine wafer was greater than that around the fixed control disk.

CONCLUSION

Changes to the carmustine wafers probably reflected penetration of fluid inside and degradation of the hydrophobic matrix. Reported transient hyperintensity of wafers on T₁WIs in vivo is regarded as the result of biological reactions, whereas the initial production of gas is considered as an intrinsic characteristic of wafers.

Spontaneous regression of anterior mediastinal seminoma with normalization of β-human chorionic gonadotropin levels

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Spontaneous regression of anterior mediastinal seminoma with normalization of β-human chorionic gonadotropin (β-hCG) levels shows good clinical outcome and sensitive to chemotherapy.

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Video-assisted thoracic surgery (VATS) is effective solution for definite diagnosis of anterior mediastinal.

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Apoptosis may be a reason of tumors’ spontaneous regression.

Introduction

Although spontaneous regression (SR) of anterior mediastinal seminoma is very rare with normalization of β-human chorionic gonadotropin (β-hCG) level, video-assisted thoracic surgery (VATS) is the most effective solution for definite diagnosis of indeterminate anterior mediastinal masses.

Diagnosis, therapeutic interventions, and outcomes

A rare case of an asymptomatic 37-year-old man with an anterior mediastinal mass that was detected on a routine chest X-ray is presented. Computed tomography (CT) showed a large anterior mediastinal tumor with superior vena cava invasion and SR before VATS for definitive diagnosis. On pathology, the definitive diagnosis was seminoma. Microscopic examination showed abundant apoptotic cells within the tumor. Chemotherapy (bleomycin 30 mg/day, etoposide 200 mg/day, cisplatin 40 mg/day) was given to this patient, and the tumor showed high sensitivity.

Conclusion

Anterior mediastinal seminoma showing SR induced by spontaneous apoptosis of tumor cells may have good sensitivity to chemotherapy, and a good clinical outcome may be achieved in these patients. This case also highlights that VATS is the most effective solution for definite diagnosis of indeterminate anterior mediastinal masses.

Acute mesenteric ischemia and hepatic infarction after treatment of ectopic Cushing's syndrome

Summary

Patients with Cushing’s syndrome and excess exogenous glucocorticoids have an increased risk for venous thromboembolism, as well as arterial thrombi. The patients are at high risk of thromboembolic events, especially during active disease and even in cases of remission and after surgery in Cushing’s syndrome and withdrawal state in glucocorticoid users. We present a case of Cushing’s syndrome caused by adrenocorticotropic hormone-secreting lung carcinoid tumor. Our patient developed acute mesenteric ischemia after video-assisted thoracoscopic surgery despite administration of sufficient glucocorticoid and thromboprophylaxis in the perioperative period. In addition, our patient developed hepatic infarction after surgical resection of the intestine. Then, the patient was supported by total parenteral nutrition. Our case report highlights the risk of microthrombi, which occurred in our patient after treatment of ectopic Cushing’s syndrome. Guidelines on thromboprophylaxis and/or antiplatelet therapy for Cushing’s syndrome are acutely needed.

Learning points:

Activation and exhaustion of antigen-specific CD8+ T cells occur in different splenic compartments during infection with Plasmodium berghei

The spleen is the major organ in which T cells are primed during infection with malaria parasites. However, little is known regarding the dynamics of the immune responses and their localization within the splenic tissue during malaria infection. We examined murine CD8⁺ T cell responses during infection with Plasmodium berghei using recombinant parasites expressing a model antigen ovalbumin (OVA) protein and compared the responses with those elicited by Listeria monocytogenes expressing the same antigen. OVA-specific CD8⁺ T cells were mainly activated in the white pulp of the spleen during malaria infection, as similarly observed during Listeria infection. However, the fates of these activated CD8⁺ T cells were distinct. During infection with malaria parasites, activated CD8⁺ T cells preferentially accumulated in the red pulp and/or marginal zone, where cytokine production of OVA-specific CD8⁺ T cells decreased, and the expression of multiple inhibitory receptors increased. These cells preferentially underwent apoptosis, suggesting that T cell exhaustion mainly occurred in the red pulp and/or marginal zone. However, during Listeria infection, OVA-specific CD8⁺ T cells only transiently expressed inhibitory receptors in the white pulp and maintained their ability to produce cytokines and become memory cells. These results highlighted the distinct fates of CD8⁺ T cells during infection with Plasmodium parasites and Listeria, and suggested that activation and exhaustion of specific CD8⁺ T cells occurred in distinct spleen compartments during infection with malaria parasites.

[Primary Lung Cancer Associated with Dilated Phase of Hypertrophic Cardiomyopathy;Report of a Case]

A 66-year-old man diagnosed as dilated phase of hypertrophic cardiomyopathy (D-HCM) was pointed out an abnormal shadow on routine chest radiography. The patient had past medical history of hypertension, congestive heart failure and chronic obstructive pulmonary disease. The computed tomography showed a 3.8 cm-sized tumor in the left lower lobe of the lung, and histopathological examination revealed squamous cell carcinoma (cT2aN0-1M0, cStage I B-II A). Cardiosonography showed diffuse hypokinesis from basal to mid area, and ejection fraction was 36.3%. Sporadic ventricular premature contraction was seen by the Holter electrocardiogram. The patient underwent left lower lobectomy with node lymph node dissection (ND1b). The circulatory condition of the patient was stable during surgery. After surgery, careful management of electrolytes and fluid infusion, and the regular medication was started again on the next day of surgery.

Evaluation of facilitative factors for preventing cognitive decline: A 3-year cohort study of community intervention

AIM

We conducted a cohort study to elucidate paticipants' facilitative factors that may help to prevent cognitive decline.

METHODS

This study followed 100 participants (average age: 74.1 ± 5.8; 10 men, 90 women) for 3 years; participants had previously been part of the Taketoyo Project (n = 366) in 2007-2011. The end-point was defined as reduced cognitive function in elderly community residents participating in a preventive intervention for dementia. The presence or absence of reduced cognitive function at the end of the third year of intervention was the dependent variable, and all evaluation items were considered explanatory variables. After Fisher's exact test (P < 0.15), stepwise multiple logistic regression analysis (P < 0.05) was performed, and facilitative factors for prevention of cognitive decline were extracted.

RESULTS

Items with a significant adjusted odds ratio (OR) based on multiple logistic regression analysis were the three-word delayed recall test (OR: 0.330, 95% confidence interval (CI): 0.142-0.767; P < 0.05), word fluency (OR: 0.565, 95%CI: 0.359-0.891; P < 0.05), frequency of going out (OR: 2.790, 95%CI: 0.803-6.380; P < 0.05) and number of friends with whom they engaged in activities (OR:0.344, 95%CI: 0.127-0.932; P < 0.05).

CONCLUSION

Subjects who had maintained a certain level of cognitive function, engaged in activities with friends, and went out frequently at baseline were extracted. In other words, the results suggested that enhancement of social networks and leisure activities prompted by recreational centre participation had a positive effect on maintaining cognitive function. The results also suggest that to improve the effectiveness of preventive interventions for cognitive dysfunction, support for social factors and leisure activities, in addition to cognitive function, may improve the long-term effectiveness of maintaining cognitive function.

[Tension Pneumothorax Developing Hemothorax after Chest Tube Drainage]

A 61-year-old man visited a physician complaining of progressive chest pain and dyspnea. The chest radiography showed complete collapse of the right lung suggesting tension pneumothorax. The patient was transferred to our hospital. A small amount of the right pleural effusion was also seen in addition to pulmonary collapse on the chest radiography. Chest drainage was performed, and continuous air leakage was seen. At 2 hours later, air leakage was disappeared but the bloody effusion was noted. The chest radiography revealed massive effusion and the enhanced computed tomography showed active bleeding. The emergency surgery was conducted. The bleeding point was a ruptured vessel between the apical parietal pleura and the pulmonary bulla. Hemostasis and the resection of the bullae was performed. Careful observation after chest drainage is necessary to prepare unexpected hemothorax in case of tension pneumothorax with pleural effusion.