Effect of Preoperative Transbronchial Biopsy on Prognosis of Non-Small Cell Lung Cancer

The aim of this study was to examine the hypothesis that post-surgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative transbronchial biopsy (TBLB) was inferior to that of patients with NSCLC determined at time of surgery. Patients with NSCLC undergoing complete resection were divided into two groups. Group 1: pathologic diagnosis determined by TBLB consisting of 335 cases, and Group 2 where TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection, consisting of 186 cases. The post-surgical recurrence-free rate and survival rate were significantly higher in Group 2 than Group 1. Recurrence-free survival rate of stage IA patients in Group 2 (93 cases) was also significantly higher than that of stage IA Group 1 patients (70 cases) ( p = 0.0018). Multivariate analyses demonstrated that positive TBLB yield was an independent negative determinant of prognosis in addition to pathologic staging and other clinicopathological factors. In conclusion, post-surgical prognosis of NSCLC patients was superior if preoperative TBLB was unsuccessful. This result suggested that advanced NSCLC had a tendency to be diagnosed with TBLB, and that the TBLB procedure might negatively impact the prognosis of patients with resectable NSCLC.

A case of TAFRO syndrome with a large mediastinal mass treated with debulking surgery

Multicentric Castleman’s disease is a polyclonal lymphoproliferative disorder. Recently, a new variant of the disease was reported and named TAFRO syndrome, an acronym for thrombocytopenia, ascites, myelofibrosis, renal dysfunction, and organomegaly. A 55-year-old woman presented to our hospital with dyspnea on exertion and high fever. Laboratory tests revealed anemia, thrombocytopenia, and proteinuria. Computed tomography (CT) revealed a large anterior mediastinal mass, mild splenomegaly, bilateral pleural effusion, pericardial effusion, and mild systemic lymphadenopathy. A CT-guided biopsy was unable to establish a definitive diagnosis, so we resected the mediastinal mass for diagnostic and therapeutic purposes. Pathological findings were consistent with the hyaline vascular type of Castleman’s disease (CD), and she was diagnosed with TAFRO syndrome. There has been no description of a patient with TAFRO syndrome with a large mass, and this is the first case of TAFRO syndrome treated with debulking surgery.

Bilateral posterior fossa chronic subdural hematoma treated with craniectomy: Case report and review of the literature

Background:

Posterior chronic subdural hematomas (pCSHs) are rare. Their diagnosis and treatment are difficult.

Description:

A 69-year-old woman was admitted to our hospital with nausea, headache, and mild consciousness disturbance. Computed tomography and magnetic resonance imaging showed bilateral pCSH. To prevent further neurological deterioration, we performed surgery under general anesthesia by midline suboccipital craniectomy. Unexpected bleeding from a developed circuitous occipital sinus was stopped with hemoclips. After hematoma removal, she recovered and was transferred to a rehabilitation hospital. By the 19^th postoperative day, she had developed no neurologic deficits.

Conclusion:

This experience demonstrates the risk of blind surgical therapy in patients with pCSH. In such patients, posterior fossa craniectomy may be preferable in terms of diagnosis and safe treatment.

A spontaneous superficial temporal artery pseudoaneurysm possibly related to atherosclerosis: Case report and review of literature

Background:

Spontaneous superficial temporal artery (STA) pseudoaneurysms are very rare; only four cases, including ours, have been reported to date. Therefore, the cause of them has not been studied.

Case Description:

A 57-year-old woman was admitted to our hospital with a pulsatile mass in the left preauricular region. Her medical history included hypertension, dyslipidemia, and angina pectoris. She denied a history of head injury or minor head trauma. Three-dimensional computed tomography angiography showed a well-enhanced saccular aneurysm on the main trunk of the STA. To prevent rupture it was removed surgically. The histological diagnosis was pseudoaneurysm with atherosclerosis. By the 2^nd postoperative day, she had completely recovered and was discharged home. There has been no relapse.

Conclusions:

As all four documented patients were at high risk for atherosclerosis, we posit that a causal factor was weakening of the arterial wall due to atherosclerosis and chronic pressure on the STA from anatomical structures. Here, we present histological evidence to support this hypothesis.

A survey of gastrointestinal parasites of alpacas (Vicugna pacos) raised in Japan

This study aimed to determine the prevalence of gastrointestinal parasites in alpacas raised in Japan. From December 2010 to October 2011, 53 alpacas (Vicugna pacos) raised at a farm in the Kanto region, Japan, were examined for gastrointestinal parasites by 3 fecal tests: direct smear, centrifuged flotation and formalin-ether sedimentation. Eggs of Nematodirus sp. were found in 13.2%, Trichuris sp. in 11.3%, Capillaria spp. in 5.7%, strongyle-type in 50.9% and Moniezia sp. in 1.9%. Oocysts of Eimeria punoensis and/or E. alpacae were found in 69.8%, E. lamae in 1.9% and E. macusaniensis in 7.5%. We found that alpacas raised in Japan have gastrointestinal parasitic fauna similar to those in other countries.

Phosphatidylinositol 3,5-Bisphosphate-Rich Membrane Domains in Endosomes and Lysosomes

Phosphatidylinositol 3,5-bisphosphate (PtdIns(3,5)P2 ) has critical functions in endosomes and lysosomes. We developed a method to define nanoscale distribution of PtdIns(3,5)P2 using freeze-fracture electron microscopy. GST-ATG18-4×FLAG was used to label PtdIns(3,5)P2 and its binding to phosphatidylinositol 3-phosphate (PtdIns(3)P) was blocked by an excess of the p40(phox) PX domain. In yeast exposed to hyperosmotic stress, PtdIns(3,5)P2 was concentrated in intramembrane particle (IMP)-deficient domains in the vacuolar membrane, which made close contact with adjacent membranes. The IMP-deficient domain was also enriched with PtdIns(3)P, but was deficient in Vph1p, a liquid-disordered domain marker. In yeast lacking either PtdIns(3,5)P2 or its effector, Atg18p, the IMP-deficient, PtdIns(3)P-rich membranes were folded tightly to make abnormal tubular structures, thus showing where the vacuolar fragmentation process is arrested when PtdIns(3,5)P2 metabolism is defective. In HeLa cells, PtdIns(3,5)P2 was significantly enriched in the vesicular domain of RAB5- and RAB7-positive endosome/lysosomes of the tubulo-vesicular morphology. This biased distribution of PtdIns(3,5)P2 was also observed using fluorescence microscopy, which further showed enrichment of a retromer component, VPS35, in the tubular domain. This is the first report to show segregation of PtdIns(3,5)P2 -rich and -deficient domains in endosome/lysosomes, which should be important for endosome/lysosome functionality.

Damage control interventional radiology (DCIR) in prompt and rapid endovascular strategies in trauma occasions (PRESTO): A new paradigm

This article proposes an innovative concept of interventional radiology for hemodynamically unstable trauma patients. Damage control interventional radiology (DCIR) is an aggressive and time-conscious algorithm that prioritizes saving life of the hemorrhaging patient in extremis which conventional emergency interventional radiology (CEIR) cannot efficiently do. Briefly, DCIR aims to save life while CEIR aims to control bleeding with a constant concern to time-awareness. This article also presents the concept of "Prompt and Rapid Endovascular Strategies in Traumatic Occasions" (PRESTO) that entirely oversees and manages trauma patients from arrival to the trauma bay until initial completion of hemostasis with endovascular techniques. PRESTO's "Start soon and finish sooner" relies on the earlier activation of interventional radiology team but also emphasizes on a rapid completion of hemostasis in which DCIR has been specifically tailored. Both DCIR and PRESTO expand the role of IR and represent a paradigm shift in the realm of trauma care.

Interatomic Coulombic decay as a new source of low energy electrons in slow ion-dimer collisions

We provide the experimental evidence that the single electron capture process in slow collisions between O^{3+} ions and neon dimer targets leads to an unexpected production of low-energy electrons. This production results from the interatomic Coulombic decay process, subsequent to inner-shell single electron capture from one site of the neon dimer. Although pure one-electron capture from the inner shell is expected to be negligible in the low collision energy regime investigated here, the electron production due to this process overtakes by 1 order of magnitude the emission of Auger electrons by the scattered projectiles after double-electron capture. This feature is specific to low charge states of the projectile: similar studies with Xe^{20+} and Ar^{9+} projectiles show no evidence of inner-shell single-electron capture. The dependence of the process on the projectile charge state is interpreted using simple calculations based on the classical over the barrier model.

Nitrosyl and carbene iron complexes bearing a κ3-SNS thioamide pincer type ligand

The monochelate iron complex with κ³-SNS thioamide pincer ligand, [Fe(THF)₂(κ3-LDPM)], gave novel complexes, [Fe(NHC)(κ3-LDPM)] and [Fe(NO)₂(κ3-LDPM)], by substitution reactions with N heterocyclic carbene and NO molecules, respectively.

Inverse internal conversion in C4− below the electron detachment threshold

Inverse internal conversion below the electron detachment threshold drives fast the radiative cooling of vibrationally hot C₄⁻ isolated in a vacuum.

[A case of cardiac tamponade due to pericarditis carcinomatosa of breast cancer successfully treated via pericardiocentesis and systemic chemo-endocrine therapy]

We report a case of lung and bone metastases of right advanced breast cancer in a 33-year-old woman. Her breast cancer (T4bN1M1, StageIV)was resected in December 2003 (mastectomy [BT] plus axillary lymph node dissection [AX]) after local arterial infusion therapy and subsequent systemic chemo-endocrine therapy was initiated and continued. In June 2007, a computed tomography (CT) scan revealed cardiac tamponade due to pericarditis carcinomatosa. Pericardiocentesis was performed, and the bloody effusion was drained immediately. Subsequently, the sysytemic chemo-endocrine therapy was modified. In 2009, multiple cerebellar metastases were discovered and treated via whole brain irradiation. In 2010, multiple liver metastases appeared, and they were treated by intravenous (IV) administration of nab-paclitaxel. In 2011, superior vena cava syndrome appeared gradually, and it was treated via venous metallic stenting. In 2012, epidural spinal cord compression appeared gradually, and it was treated via irradiation. In November 2012, the patient died because of lymphangitis carcinomatosa; her prognosis was good, as it was approximately 5 years after the pericardiocentesis.

Atomic site-sensitive processes in low energy ion-dimer collisions

Electron capture processes for low energy Ar(9+) ions colliding with Ar(2) dimer targets are investigated, focusing attention on charge sharing between the two Ar atoms as a function of the molecular orientation and the impact parameter. A preference for charge-asymmetric dissociation channels is observed, with a strong correlation between the projectile scattering angle and the molecular ion orientation. The measurements here provide clear evidence that projectiles distinguish each atom in the target and that electron capture from near-site atoms is favored. Monte Carlo calculations based on the classical over-the-barrier model, with dimer targets represented as two independent atoms, are compared to the data. They give new insight into the dynamics of the collision by providing, for the different electron capture channels, the two-dimensional probability maps p(b), where b is the impact parameter vector in the molecular frame.

Nodal signaling regulates specification of ascidian peripheral neurons through control of the BMP signal

The neural crest and neurogenic placodes are thought to be a vertebrate innovation that gives rise to much of the peripheral nervous system (PNS). Despite their importance for understanding chordate evolution and vertebrate origins, little is known about the evolutionary origin of these structures. Here, we investigated the mechanisms underlying the development of ascidian trunk epidermal sensory neurons (ESNs), which are thought to function as mechanosensory neurons in the rostral-dorsal trunk epidermis. We found that trunk ESNs are derived from the anterior and lateral neural plate border, as is the case in the vertebrate PNS. Pharmacological experiments indicated that intermediate levels of bone morphogenetic protein (BMP) signal induce formation of ESNs from anterior ectodermal cells. Gene knockdown experiments demonstrated that HrBMPa (60A-subclass BMP) and HrBMPb (dpp-subclass BMP) act to induce trunk ESNs at the tailbud stage and that anterior trunk ESN specification requires Chordin-mediated antagonism of the BMP signal, but posterior trunk ESN specification does not. We also found that Nodal functions as a neural plate border inducer in ascidians. Nodal signaling regulates expression of HrBMPs and HrChordin in the lateral neural plate, and consequently specifies trunk ESNs. Collectively, these findings show that BMP signaling that is regulated spatiotemporally by Nodal signaling is required for trunk ESN specification, which clearly differs from the BMP gradient model proposed for vertebrate neural induction.

A new simple navigation for anatomic liver resection under intraoperative real-time ultrasound guidance

Anatomic liver resection is indispensable for liver surgeons. However, recognition of the precise intrahepatic resectional plane is difficult because intrahepatic Glissonean branches cannot be visualized. We have devised a new surgical procedure to accurately determine the resectional plane of deep parts of the liver. After dividing the surrounding ligaments, the echo probe is placed on the back of liver and the monitor image is reversed, right to left and up to down. This provides images almost the same as those from the usual position of the echo probe. This method enables the targeted Glissonean pedicle to be approached without losing the intrahepatic resectional plane. Because both the excision side and preserved side are depicted, injury to the hepatic vein and Glissonean branch on the preserved side is readily avoided. Real-time ultrasonographic guidance contributes to not only safe and precise hepatectomy, but also the education of inexperienced liver surgeons.

Lesser omental hernia after total colectomy: report of a case

Lesser omental hernia is a rare type of hernia that can cause intestinal obstruction. To our knowledge, there are only 16 documented cases of lesser omental hernia, including the present case. The subject of this case report was a 42-year-old man with a history of total colectomy for colon perforation caused by Crohn's disease 15 years earlier, who presented with epigastralgia and vomiting. Abdominal computed tomography (CT) revealed a distended bowel loop ventral to the stomach and convergence of mesenteric vessels at the lesser curvature of the stomach. Based on a diagnosis of intestinal obstruction caused by a lesser omental hernia, he underwent emergency surgery, which revealed a 150-cm jejunal segment herniating through a 5-cm defect in the lesser omentum from the retrogastric space. We reduced the herniated loop and closed the hernial orifice successfully. We describe the characteristic CT findings, which allowed us to make the preoperative diagnosis, and speculate how the past total colectomy, in which the gastrocolic ligament was isolated and the transverse colon was resected, probably caused by this hernia. This case serves to demonstrate that lesser omental hernia could be a postoperative complication of total colectomy.

Clinical effects of oseltamivir, zanamivir, laninamivir and peramivir on seasonal influenza infection in outpatients in Japan during the winter of 2012-2013

BACKGROUND

The neuraminidase inhibitors (NAIs) oseltamivir, zanamivir, laninamivir and peramivir are available in Japan. However, the selective use of NAIs for treating outpatients with influenza has not been clearly defined.

METHODS

We assigned 191 patients with influenza to 4 groups, each treated with a different NAI, and then compared how long it took to alleviate fever and other symptoms and to eliminate the virus.

RESULTS

Alleviation of fever occurred significantly sooner with peramivir than with either zanamivir (p = 0.0002) or oseltamivir (p = 0.0059), but was not significantly different from that with laninamivir (p = 0.0457; p < 0.0083). Other symptoms were also alleviated sooner by peramivir than by the other 3 NAIs.

CONCLUSIONS

The ability of each NAI to alleviate influenza symptoms and fever varied. The appropriate use of NAIs requires further study.