Treatment of a Malignant Soft Tissue Tumor Arising in the Vicinity of the Sciatic Nerve with an In-Situ Preparation Technique and Intensive Multidisciplinary Therapy

Preservation of the sciatic nerve is difficult in cases of highly malignant soft tissue tumors closely surrounding the nerve. Herein, we present the first case of preservation of this nerve by combining an in-situ preparation technique (ISP; a technique enabling the preparation of neurovascular bundles without contamination by tumor cells) with intensive concurrent neoadjuvant chemo-radiotherapy with hyperthermia (RHC; radio-hyperthermo-chemotherapy). A 62-year-old man presented with a soft tissue mass in the right thigh and was diagnosed with undifferentiated pleomorphic sarcoma. The tumor arose in the multi-compartment areas of the posterior thigh muscles and was closely intertwined with the sciatic nerve. As preoperative therapy, RHC was performed for surgical down-staging and the tumor partially responded. Afterwards, wide resection of the tumor with preservation of the sciatic nerve using ISP was performed. Following the surgery, there has not been recurrence in the affected site and the functional outcomes of the lower extremity achieved 80% in the Musculoskeletal Tumor Society score. The patient is still alive with disease five years postoperatively. This is the first case in which ISP and RHC procedures were combined for the preservation of the neurovascular structure. Further study is needed for the validation of the feasibility of this method.

Low-dose of olanzapine has ameliorating effects on cancer-related anorexia

Background

Olanzapine (OLZ) has become well-known for its antiemetic effects on chemotherapy-induced nausea and vomiting. However, it remains unclear whether OLZ also has efficacy for treating cancer-related anorexia. This study, therefore, retrospectively examined whether or not OLZ administration affects the food intake in anorexic cancer patients who exhibit neither nausea nor vomiting.

Methods

Eighty patients prescribed OLZ were extracted from 951 inpatients who consulted with our palliative care team at Chiba University Hospital from April 2008 to March 2016. Their food intake described on a nursing record was compared before and after OLZ administration. The observation period was 3 days before and after the start of OLZ treatment, because most inpatients whose food intake increased were discharged in 3 days.

Results

In those 80 patients, the average dose of OLZ for 3 days was 2.28±0.87 (mean±SD) mg/day. First, the food intake in 80 patients was significantly higher after than before starting OLZ, and the relative change in food intake was 149% on average (P<0.0001, Student’s paired t-test). Second, OLZ increased the food intake even in 40 out of 80 patients without nausea or vomiting, and the relative change in food intake was 143% on average (P<0.001, Student’s paired t-test). Third, the average food intake increased in 13 out of 40 patients who were prescribed 1.5 mg/day of OLZ, and the relative change in food intake was 124% on average (P<0.01, Student’s paired t-test). There was no significant difference in food intake between a dose of 1.5 mg/day and a dose of >1.5 mg/day of OLZ (P=0.18, Welch’s unpaired t-test).

Conclusion

We have herein reported OLZ’s ameliorating efficacy in cancer-related anorexia at the low dose of 1.5 mg/day. Although our study has many limitations, low-dose OLZ can be a promising treatment for cancer-related anorexia.

Synthesis of the extended phenacene molecules, [10]phenacene and [11]phenacene, and their performance in a field-effect transistor

The [10]phenacene and [11]phenacene molecules have been synthesized using a simple repetition of Wittig reactions followed by photocyclization. Sufficient amounts of [10]phenacene and [11]phenacene were obtained, and thin-film FETs using these molecules have been fabricated with SiO₂ and ionic liquid gate dielectrics. These FETs operated in p-channel. The averaged measurements of field-effect mobility, <μ>, were 3.1(7) × 10⁻² and 1.11(4) × 10⁻¹ cm² V⁻¹ s⁻¹, respectively, for [10]phenacene and [11]phenacene thin-film FETs with SiO₂ gate dielectrics. Furthermore, [10]phenacene and [11]phenacene thin-film electric-double-layer (EDL) FETs with ionic liquid showed low-voltage p-channel FET properties, with <μ> values of 3(1) and 1(1) cm² V⁻¹ s⁻¹, respectively. This study also discusses the future utility of the extremely extended π-network molecules [10]phenacene and [11]phenacene as the active layer of FET devices, based on the experimental results obtained.

Smallest Optical Gap for Pt(II)-Pt(IV) Mixed-Valence Pt-Cl and Pt-Br Chain Complexes Achieved by Using a Multiple-Hydrogen-Bond Approach

A multiple-hydrogen-bond approach was applied to shorten Pt-X-Pt distances in Cl- and Br-bridged Pt chain complexes. [Pt(dabdOH)₂Cl]Cl₂ (5) and [Pt(dabdOH)₂Br]Br₂ (6) (dabdOH = (2 S,3 S)-2,3-diaminobutane-1,4-diol) contain hydroxy groups, which form additional hydrogen bonds with counteranions. 5 has the shortest Pt-Cl-Pt distance (5.0747(8) Å) of all Cl-bridged Pt chain complexes reported to date. Furthermore, the smallest optical gap (1.45 eV for 5 and 1.19 eV for 6) in any Cl- or Br-bridged Pt chain complex was achieved. 6 has the highest electrical conductivity (1.9 × 10^-5 S cm^-1 at room temperature) of all Br-bridged Pt chain complexes. This study shows that the introduction of additional hydrogen bonds between the ligands and halides is effective to enhance the electronic properties of halogen-bridged metal complexes.

Evidence for solitonic spin excitations from a charge-lattice-coupled ferroelectric order

Topological defects have been explored in different fields ranging from condensed matter physics and particle physics to cosmology. In condensed matter, strong coupling between charge, spin, and lattice degrees of freedom brings about emergent excitations with topological characteristics at low energies. One-dimensional (1D) systems with degenerate dimerization patterns are typical stages for the generation of topological defects, dubbed "solitons"; for instance, charged solitons are responsible for high electrical conductivity in doped trans-polyacetylene. Here, we provide evidence based on a nuclear magnetic resonance (NMR) study for mobile spin solitons deconfined from a strongly charge-lattice-coupled spin-singlet ferroelectric order in a quasi-1D organic charge-transfer complex. The NMR spectral shift and relaxation rate associated with static and dynamic spin susceptibilities indicate that the ferroelectric order is violated by dilute solitonic spin excitations, which were further demonstrated to move diffusively by the frequency dependence of the relaxation rate. The traveling solitons revealed here may promise the emergence of anomalous electrical and thermal transport.

Palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus: possible involvement of CD163+ M2 macrophages in two cases, and a review of published works

BACKGROUND

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a commonly occurring condition related to systemic autoimmune disease. It is characterized histopathologically by a distinct pattern of granulomatous inflammation in the presence or absence of leukocytoclastic vasculitis. The properties of granulomatous cells in PNGD are still uncertain.

OBJECTIVE

We sought further investigation on the phenotype of the infiltrated cells in PNGD from two patients with systemic lupus erythematosus (SLE) and reviewed the previous published reports in order to provide a comprehensive summary on the clinical features of PNGD in SLE.

METHODS

The immunohistochemical features of granulomatous cells in PNGD associated with SLE were analyzed. Immunohistochemical studies were performed on sections from our two cases using antibodies against CD68, CD163, CD15, Factor XIIIa, myeloperoxidase and neutrophil elastase. The clinical characteristics of the SLE patients who developed PNGD were also evaluated. We included all cases retrieved through a PubMed search with the key words PNGD and SLE.

RESULTS

Cutaneous lesions consisted of erythematous plaques distributed on the face and upper limbs in both cases. The infiltrated cells were mainly positive for CD68 and CD163, a phenotype suggestive of M2 macrophages. Some mature neutrophils and lymphocytes were also present. A review of the literature of PNGD associated with SLE revealed a predominance in females, high prevalence of lupus nephritis and a good response to systemic steroids, with frequent skin lesions relapses during tapering of the treatment.

LIMITATIONS

This study examined only two cases; the pathogenesis of the disease remains to be clarified.

CONCLUSION

PNGD lesions were abundantly infiltrated by M2 macrophages, suggesting that they may have a role in this condition. SLE accompanied by PNGD might be associated with lupus nephritis and frequent relapses of skin lesions.

Efficacy of radio-hyperthermo-chemotherapy as salvage therapy for recurrent or residual malignant soft tissue tumors

BACKGROUND

Recurrence after wide excision or residual tumor after an unplanned excision of a malignant soft tissue sarcoma (STS) is a complex problem, due to a higher recurrence rate and poorer survival rate compared with primary resection. Regional hyperthermia was used, with the expectation that it will enhance the anti-tumor effects of chemotherapy and radiotherapy. This study aimed to assess the efficacy of neoadjuvant concomitant radiotherapy, hyperthermia, and chemotherapy (RHC) for salvage of recurrent or residual malignant STS.

METHODS

We identified 64 patients with recurrent or residual STS treated between 1994 and 2013. After excluding those with low-grade malignancy, with recurrent bone tumor in the soft tissues, with truncal STS, and who declined to participate, 23 patients (7 with recurrence and 16 with residual tumor) underwent RHC. The histologic diagnoses were undifferentiated pleomorphic sarcoma (n = 11), synovial sarcoma (n = 3), leiomyosarcoma and myxoid liposarcoma (n = 2 each), and other histologic types. As primary outcomes, the 5-year overall survival (OS), distant metastasis-free survival (D-MFS), and local control (LC) rates were evaluated by Kaplan-Meier analysis.

RESULTS

The median follow-up period was 112.3 months. The 5-year OS, D-MFS, and LC were 86.4%, 77.4%, and 86.7%, respectively. In the univariate analysis, tumor depth was considered as a negative prognostic factor for OS and D-MFS, and a positive margin was also a negative prognostic factor for OS, D-MFS LC with retained on Cox proportional hazards model in OS, and D-MFS.

CONCLUSION

RHC is an effective option for salvage treatment of recurrent and residual STS.

Anatomical Basis for Arthroscopy of the Proximal Interphalangeal Joints

BACKGROUND

Arthroscopy is a widely used minimally invasive technique. Nevertheless, no report describes the arthroscopic anatomy of the proximal interphalangeal (PIP) joint for portal creation. To facilitate arthroscopy, this study elucidated the anatomy of the lateral bands of the extensor mechanism and collateral ligaments of PIP joints.

METHODS

A total of 39 fingers from the right hands of 10 cadavers (4 males, 6 females) were evaluated in this study. We defined the extension line from the proximal interphalangeal volar crease as the C-line. We also defined an imaginary line along the distal edge of the proximal phalanx, which is parallel to the C-line, as the J-line. The distance between J-line and C-line was measured. On the C-line and J-line, we measured the following: from the dorsal skin to the lateral edge of the lateral band (LB), the dorsal edge of the collateral ligament (CL) and from the lateral band and the collateral ligament (D), the width of the finger (W). The finger half-width (M) was measured on the J-line. Comparison between the digits and comparison between radial and ulnar distance were measured and statistical analysis was performed.

RESULTS

All PIP joint spaces were distal from the C-line, except for one ring finger. The average distances between the J-line and C-line were 1.8-3.2 mm. On the C-line, only 11 cases (14.1%) showed an interval between the lateral bands and the collateral ligaments, but, on the J-line 72, cases (92.3%) had such an interval. The interval was located 1.6-2.9 mm in a dorsal direction from the midlateral on the J-line.

CONCLUSIONS

Portal creation at the J-line is safer than at the C-line. This study revealed that safe portals for arthroscopy of the PIP joint are 2 mm dorsal to the midlateral line of the finger on the J-line.

Continuous Peripheral Nerve Blocks for Early Active Mobilization after Hand Surgery: Four Case Reports

Early active mobilization after hand surgery is extremely important for preventing scar tissue and adhesion. We examined four patients for whom continuous peripheral nerve blocks (CPNB) were used during and after hand surgery. This method was used for three median nerves and one ulnar nerve. A 2-cm incision was made at distal one-third of the forearm with local analgesia. The catheter tip was placed in the distal one-fourth of the forearm, and the hand surgery was begun. Early active mobilization and the self-rehabilitation exercise started immediately after the operation. The VAS scores during exercise were 0-2 (mean: 1.3); pain was controlled sufficiently. Regarding ROM, excellent results were obtained for tenolysis, with good results for arthrolysis. No infection or postoperative nerve compression was found. This method, using CPNB with a portable infusion pump, is effective and safe for use at home for postoperative pain control.

Probing ultrafast spin-relaxation and precession dynamics in a cuprate Mott insulator with seven-femtosecond optical pulses

A charge excitation in a two-dimensional Mott insulator is strongly coupled with the surrounding spins, which is observed as magnetic-polaron formations of doped carriers and a magnon sideband in the Mott-gap transition spectrum. However, the dynamics related to the spin sector are difficult to measure. Here, we show that pump-probe reflection spectroscopy with seven-femtosecond laser pulses can detect the optically induced spin dynamics in Nd2CuO4, a typical cuprate Mott insulator. The bleaching signal at the Mott-gap transition is enhanced at ~18 fs. This time constant is attributable to the spin-relaxation time during magnetic-polaron formation, which is characterized by the exchange interaction. More importantly, ultrafast coherent oscillations appear in the time evolution of the reflectivity changes, and their frequencies (1400-2700 cm-1) are equal to the probe energy measured from the Mott-gap transition peak. These oscillations can be interpreted as the interference between charge excitations with two magnons originating from charge-spin coupling.

Treatment of aneurysmal bone cysts using endoscopic curettage

Background

Although aneurysmal bone cysts (ABCs) are benign tumours, they have the potential to be locally aggressive. Various treatment approaches, such as en bloc resection, open curettage, radiotherapy, sclerotherapy, and embolization have been proposed, but the most appropriate treatment should be selected after considering the risk of tumour recurrence and treatment complications. Endoscopic curettage (ESC) may be a less invasive alternative to open curettage for ABC treatment. We aimed to describe the use of ESC for the treatment of ABCs and to report our clinical outcomes, including the incidence rate of recurrence, radiological appearance at final follow-up, time to solid union, complications, and postoperative function.

Methods

Between 1998 and 2015, 30 patients (18 men and 12 women; mean age, 17.4 years) underwent ESC for the treatment of primary ABCs at our hospital (mean postoperative follow-up, 55 months). ESC was performed under arthroscopic guidance for direct visualization, and curettage extended until normal bone was observed in the medullary cavity. To investigate bone healing after ESC, we evaluated the consolidation of cysts at the final evaluation (based on the modified Neer classification) and time to solid union after surgery, which was defined as sufficient cortical bone thickness to prevent fracture and allow physical activities.

Results

Recurrence was identified in 3 cases (10%). Curative outcomes were obtained after repeated ESC or open curettage. A log-rank analysis indicated that age < 10 years (p = 0.004) and contact of the tumour with the physis (p = 0.01) increased the risk of tumour recurrence. Residual tumours were identified in 9 cases (30%); these lesions remained inactive over the extended follow-up period. The average time to solid union after endoscopic curettage was 3.2 months. Transient radial nerve palsy was identified in 1 case. Good postoperative functional recovery occurred in all cases.

Conclusions

ESC is a minimally invasive technique for the treatment of ABCs, and the tumour recurrence rate is comparable to that of other standard procedures. However, the application of this method should be carefully considered, especially for patients < 10 years and when the tumour comes in contact with the physis.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2176-6) contains supplementary material, which is available to authorized users.