Uterine endometrial carcinoma with trophoblastic differentiation: a case report with literature review

Choriocarcinoma is categorized as either gestational or nongestational depending on its origin. Nongestational choriocarcinoma originated in the trophoblastic differentiation is a rare but an aggressive tumor. This article reports a nongestational case of a uterine endometrial carcinoma with trophoblastic differentiation. A 54-year-old woman with a history of atypical genital bleeding that underwent semi-radical hysterectomy, bilateral salpingo-oophrectomy, and pelvic lymph nodes dissection. Pathological investigation showed that the tumor had endometrioid adenocarcinoma and choriocarcinomatous components. Although a series of multimodality treatments including craniotomy were performed, she died of aggressive lung and brain metastases one year after the primary surgery.

Protective effects of coenzyme Q10 against angiotensin II-induced oxidative stress in human umbilical vein endothelial cells

Angiotensin II is the major effector in the renin-angiotensin system, and angiotensin II-induced oxidative stress and endothelial dysfunction are profoundly implicated in the pathogenesis of hypertension and cardiovascular disease. In the present study, we investigated the effect of an antioxidant reagent, coenzyme Q10, on angiotensin II-induced oxidative stress in human umbilical vein endothelial cells (HUVEC) to assess its potential usefulness for antioxidant therapy. Treatment of HUVEC with coenzyme Q10 (1-10μM) increased its intracellular levels in a concentration-dependent manner. Coenzyme Q10 (10μM) prevented the actions of angiotensin II (100nM): overproduction of reactive oxygen species, increases in expression of p22(phox) and Nox2 subunits of NADPH oxidase, and inhibition of insulin-induced nitric oxide production. In addition, coenzyme Q10 prevented angiotensin II-induced upregulation of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) in HUVEC, and inhibited their adhesion to U937 monocytic cells. Moreover, treatment of HUVEC with coenzyme Q10 effectively ameliorated angiotensin II-induced increases in expression of Nox2 subunit of NADPH oxidase, ICAM-1, and VCAM-1. These results provide the first in vitro evidence that coenzyme Q10 is an efficient antioxidant reagent to improve angiotensin II-induced oxidative stress and endothelial dysfunction, possibly relevant to the causes of cardiovascular disease.

Long-term outcome of single institutional experience with conservative and surgical management for renal artery aneurysm

BACKGROUND

Spontaneous rupture risk of a renal artery aneurysm (RAA) is extremely low. Indications for surgical repair of RAA remain uncertain.

OBJECTIVE

Long-term outcomes of conservative therapy and surgical repair were evaluated.

PATIENTS

The study included 58 patients (17 males, 41 females) who were diagnosed with RAA during the last 21 years. Median age at the time of diagnosis was 62 (19-85) years, and the median follow-up 69 months (range 3-216).

METHODS

The patients were divided into two groups, conservative group (n = 30) who had been followed with blood pressure control, and treatment group (n = 29), who underwent an intervention.

RESULTS

Multiple efferent aneurysmal branches were observed in seven conservative and 16 treatment cases (P = .002). The median maximum diameter of the aneurysm was lower in the conservative than the treatment group (15 versus 25 mm, P = .005). Two conservative group cases showed increases in aneurysm size during follow-up. The hypertensive state showed essentially no change in either group during the follow-up. Renal function decreased with age similarly both in conservative and treatment groups.

CONCLUSIONS

Our conservative management criteria for RAA are justifiable and even too strict.

Percentages of water, muscle, and bone decrease and lipid increases in early period after successful kidney transplantation: a body composition analysis

BACKGROUND

Successful kidney transplantation (KT) can theoretically reconstitute body composition of a patient with chronic kidney disease (CKD). However, the practical changes have not been well documented. We evaluated changes in body composition among candidates before and 1 year after KT.

METHODS

We enrolled 37 male and 18 female kidney recipients eligible for comparison of their body mass index (BMI), body composition, and lipid metabolism before and 1 year after KT. Twenty-one patients had been induced with a calcineurin inhibitor, mycophenolate mofetil, steroid, and basiliximab, and 34 others underwent steroid withdrawal on postoperative day 3. The body composition was analyzed using bioelectrical impedance. We also analyzed changes in BMI and lipid profiles.

RESULTS

There was no significant change in BMI (21.4 ± 3.1 vs 21.7 ± 3.5 kg/m(2)). Regarding body composition, the water level decreased significantly (61.2 ± 4.9% vs 58.3 ± 5.3%; P < .05). In contrast, fat significantly increased (16.4 ± 6.7% vs 20.3 ± 7.1%; P < .05). More interestingly, successful KT significantly decreased the muscle and bone mass at 1 year after KT (37.3 ± 5.1% vs 34.8 ± 4.7%; 16.3 ± 2.1% vs 15.2 ± 2.1%; respectively; P < .05). Serum lipid profiles of total cholesterol, low-density lipoprotein cholesterol, and triglyceride worsened after KT. Comparing the 2 protocols, there was no difference in any item.

CONCLUSIONS

Care must be taken even after successful KT to avoid dyslipidemia, which is a risk factor for cardiovascular disease. Well programmed dietary and/or exercise protocols to prevent muscle atrophy and fat gain should be considered even after successful KT.

Successful kidney transplantation ameliorates arterial stiffness in end-stage renal disease patients

PURPOSE

Successful kidney transplantation (KTx) can ameliorate bodily damage caused by end-stage renal disease (ESRD). Arterial stiffness (AS) is one of the critical factors that shorten the survival of patients due to cardiovascular events. KTx may reduce AS as well; however, this has not been investigated well. We therefore conducted a retrospective study using noninvasive pulse wave velocity (PWV), which is a useful index of aortic damage.

PATIENTS AND METHODS

Fifty-eight consecutive kidney recipients (34 men, 24 women) were enrolled in this study. Mean age at transplantation was 40.5 ± 12.3 years and the dialysis period was 73.1 ± 95.8 months. The brachial-ankle PWV was measured preoperatively and 6 months postoperatively. First, we investigated the relationship between the PWV and the other parameters related to AS. Second, we studied the pre- to posttransplant change in PWV to evaluate the amelioration of AS after successful KTx.

RESULTS

PWV showed significant positive correlations with age, systolic blood pressure (BP), diastolic BP, and abdominal aortic calcification index. After successful KTx, PWV significantly decreased (P < .01). In addition, systolic and diastolic BP significantly decreased (P < .01 and P < .05, respectively).

CONCLUSION

Successful KTx ameliorates AS in ESRD patients. This might explain the improved cardiovascular prognosis of ESRD patients who undergo KTx.

Comparison of aldosterone production among human adrenocortical cell lines

Several human adrenocortical cell lines have been used as model systems for aldosterone production. However, these cell lines have not been directly compared with each other. Human adrenal cell lines SW13, CAR47, the NCI-H295 and its sub-strains and sub-clones were compared with regard to aldosterone production and aldosterone synthase (CYP11B2) expression. Culture media was collected 48 h after incubation, aldosterone secretion was measured and the data were normalized to the amount of cell protein. RNA was isolated for microarray analysis and quantitative RT-PCR (qPCR). The cell lines with the highest aldosterone production were further tested with regard to angiotensin II (Ang II) stimulation. Neither aldosterone nor CYP11B2 transcript were detected in SW13 or CAR47 cells. The aldosterone production by the NCI-H295, H295A, H295R-S1, H295R-S2, H295R-S3, HAC13, HAC15 and HAC50 were 119, 1, 6, 826, 18, 139, 412, and 1 334 (pmol/mg protein/48 h), respectively. H295A and H295R-S1 expressed less CYP11B2 than the commonly used H295R-S3 cells; while NCI-H295, H295R-S2, HAC13, HAC15 and HAC50 expressed 24-, 14-, 3-, 10-, and 35-fold higher CYP11B2 compared with the H295R-S3 cells. When treated with Ang II, NCI-H295, H295R-S2, HAC13, HAC15 and HAC50 showed significantly higher aldosterone production than the basal level (p<0.05). A comparison of the available human adrenal cell lines indicates that the H295R-S2 and the clonal cell lines, HAC13, HAC15 and HAC50 produced the highest levels of aldosterone and responded well to Ang II.

Acupoint stimulation device using focused ultrasound

Acupuncture is used widely in oriental medicine. But it is difficult to stimulate continuously or intermittently in daily life with conventional acupuncture. An acupoint stimulation device using focused ultrasound has been developed. Because the device size is about 6 mm in diameter, it can be easily put on the skin during daily life. Appropriate stimulation intensity and pattern can be chosen by changing driving voltage and pattern. In this paper, we stimulated acupoints with this device and measured the blood flow volume of brachial artery. As a result, the blood flow volume increased significantly as well as acupuncture. Because the device stimulate acupoints with intactness of skin, advantages of this device is free from infection and fear and pain by insertion of acupuncture needles.

Perioperative morbidity and mortality in patients treated by radical cystectomy: A multi-institutional retrospective study

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Background: It is well known that radical cystectomy is associated with comparatively high perioperative morbidity and mortality. In the present study, we collected data of perioperative outcomes from Hokkaido University Graduate School of Medicine and our teaching hospitals and assessed the complications and death rate within 90 days after radical cystectomy.

Methods: We collected clinical data of 970 patients undergoing radical cystectomy for nonmetastatic bladder cancer in 21 institutions between 1999 and 2009. We then assessed 90-day complications and death after radical cystectomy. The complications were classified according to the modified Clavien classification. Over 40 variables were included in the analysis, including age, ASA score, BMI, comorbidity, neoadjuvant chemotherapy, clinical stage, type of urinary diversion, operative time, estimated blood loss, transfusion, and hospital stay. Statistical analysis was performed utilizing Student's t-tests, chi-square tests, and logistic regression analysis.

Results: The median patient age was 70 (range, 25-91) years old. 62.5% of patients had an ASA score≥2. Regarding the urinary diversion, ileal conduit was performed in 523 (53.6%) patients, neobladder in 178 (18.4%), ureterocutaneostomy in 255 (26.3%). Median operative time was 399 (range, 100-927) minutes. Median hospital stay was 39 (0-364) days. Regarding the complications, 660 (68%) patients experienced at least one complication and death rate within 90 days after surgery was 1.34% (n=13), respectively. Of the complications, 34.1% was classified as grade 1, 41.5% as grade 2, 20.1% as grade 3, 1.1% as grade 4, 1.2% as grade 5. Multivariate analysis identified age≥70 (odds ratio 1.41), urinary diversion utilizing intestine (OR 1.58) and operative time ≥ 400 (OR 1.54) were independent risk factors.

Conclusions: Death rate was 1.34%, which was compatible to reports form western high- volume centers. About two-thirds of the patients experienced at least one complication, although they were mostly classified as grade 2 or less. Age, urinary diversion, and operative time were significant risk factors for perioperative complications after radical cystectomy.

No significant financial relationships to disclose.

Size Dependence of Bombardment Characteristics Produced by Cluster Ion Beams

Cluster ion beam processes provide new surface modification techniques, such as surface smoothing, high rate sputtering and very shallow implantation, because of the unique interactions between cluster and surface atoms. To understand interactions with cluster and surface, Scanning Tunneling Microscope (STM) observations have been done for single impact traces.

Highly Oriented Pyrolitic Graphite (HOPG) surfaces were bombarded by carbon cluster ions (Va≤300kV), and large ridges and craters have been observed as a result of single cluster ion impact. The impact site diameters are proportional to the cluster size up to 10 atoms, and increase drastically for cluster sizes above 10. This indicates that non-linear multiple collisions occur only when a local area is bombarded by more than 10 atoms at the same time.

Surface-assisted spin Hall effect in Au films with Pt impurities

We show, both experimentally and theoretically, a novel route to obtain giant room temperature spin-Hall effect due to surface-assisted skew scattering. In the experiment, we report the spin-Hall effect in Pt-doped Au films with different thicknesses t(N). The giant spin-Hall angle γ(S)=0.12±0.04 is obtained for t(N)=10 nm at room temperature, while it is much smaller for the t(N)=20 nm sample. Combined ab initio and quantum Monte Carlo calculations for the skew scattering due to a Pt impurity show γ(S)≅0.1 on the Au (111) surface, while it is small in bulk Au. The quantum Monte Carlo results show that the spin-orbit interaction of the Pt impurity on the Au (111) surface is enhanced, because the Pt 5d levels are lifted to the Fermi level due to the valence fluctuation. In addition, there are two spin-orbit interaction channels on the Au (111) surface, while only one in bulk Au.