Peliosis hepatis disseminated rapidly throughout the liver in a patient with prostate cancer: a case report

INTRODUCTION

In the World Health Organization histological classification of the liver tumor, peliosis hepatis is defined as a tumor-like lesion. The entity is characterized by the appearance of multiple cyst-like, blood-filled spaces within the liver parenchyma.

CASE PRESENTATION

A 77-year-old Japanese man with prostate cancer was referred to our department because he was diagnosed as having two hepatic tumors. The tumors were confirmed to be peliosis hepatis by repeated needle biopsies and because of their atypical images by enhanced computed tomography and enhanced magnetic resonance imaging. Later these tumors grew rapidly, increased in number, and disseminated throughout his whole liver. We are now treating the patient conservatively due to his age and his existing medical conditions.

CONCLUSION

Peliosis hepatis is a rare hepatic benign tumor that should be considered in the differential diagnosis of multiple unknown liver tumors that are revealed by atypical radiological images.

ASSESSMENT OF MOLECULAR GENETIC STABILITY BETWEEN LONG-TERM CRYOPRESERVED AND TISSUE CULTURED WASABI (Wasabia japonica) PLANTS

BACKGROUND

Maintaining the genetic integrity in long-term tissue cultured and cryopreserved plants is important for the conservation of plant genetic resources.

OBJECTIVE

In this study, the genetic stability of cryopreserved wasabi shoot tips stored for 10 years at -150 degree C was visualized using Amplified Fragment Length Polymorphism (AFLP) and Methylation Sensitive Amplified Polymorphism (MSAP).

MATERIALS AND METHODS

The study included plants derived from cryopreserved shoot tips after 10.5 years storage at -150 degree C (LN10yr), after 2 h storage at -196 degree C (LN2hr), cryopreservation controls (No LN cooling (TC)) and non-treated controls without LN cooling (LC). The donor plants for LN2hr, TC and LC were also maintained in vitro at 20 degree C for the same period.

RESULTS

Neither technique detected genetic variations in either control or cryopreserved plants. Some mutations were noted in plants maintained in tissue culture for 10 years. Comparison of genome stability for TC and LN2hr plants showed only a minor change in DNA. However, when comparing the LC and Ln10yr, many differences were found.

CONCLUSION

We conclude that cryopreservation is a superior conservation method compared to tissue culture in maintaining genetic stability for a long-term storage of wasabi germplasm.

Bufavirus genotype 3 in Turkish children with severe diarrhoea

Recently a parvovirus called bufavirus (BuV) has been implicated as a causative agent of diarrhoea. To further reveal the epidemiology and genetic characteristics of BuV, this study was performed in Turkish children with diarrhoea. BuV was detected in 1.4% (8/583) of stool samples. All stool samples from healthy children (n = 148) were negative for BuV. Diarrhoea in BuV-positive patients was severe and occurred mainly during the colder months of the year. Complete genome sequences were generated from four BuVs. Only BuV3 was found, which was genetically and phylogenetically similar to Bhutanese BuV3, indicating that BuV3 is prevalent in Asian countries.

Formation of Pt decorated Ni-Pt nanocubes through low temperature atomic diffusion--time-resolved elemental analysis of nanoparticle formation

The formation process of Pt decorated Ni-Pt nanocubes was investigated by analysing the elemental distribution of Ni and Pt in the particles obtained from time-resolved in situ sampling during the synthesis in the oleylamine-1-heptanol system. The analysis confirmed the formation of Pt(core)-Ni(shell) nanoparticles at the initial stages of the reaction. However, as the reaction time progressed, the Pt atoms at the centre diffused outward and reached the corners and edges of the particle, whose shape changed from nearly spherical at the initial stages of the reaction to a perfect cube at the end of the reaction, forming a Ni rich cube (core)-Pt(cage). The cage obtained by dissolving the Ni rich cube was composed mainly of Pt and the Ni content in the frame was a mere 12%. The catalytic activity of the Pt cage was measured using cyclic voltammetry. The initial measurements suggested that the activity was comparable to some of the commercially available Pt catalysts.

TRIPLE FUNGAL INFECTION-CHRONIC MUCOCUTANEOUS CANDIDIASIS, EXOPHYTIC DERMATOPHYTOSIS AND CRYPTOCOCCAL MENINGITIS: A NEW AND UNUSUAL COMBINATION-

The clinical and immunological studies of an unusual case of chronic mucocutaneous candidiasis (CMCC) are reported. An 18-year-old male with life-long CMCC was superinfected by a dermatophyte showing exophytic clinical features in his childhood. In addition he has suffered from fatal cryptococcal meningitis since the age of 18. The combination of three fungi, i.e., Candida albicans, Trichophyton mentagrophytes and Cryptococcus neoformans, has not been found in an examination of the literature. The author's hypothesis, "immune deviation theory" in the pathogenesis of CMCC, is presented in detail. The possible role of hypovitaminosis A anddisorder of iron metabolism in CMCC and treatment of CMCC are reviewed briefly.

Antiemetic efficacy of combined aprepitant and dexamethasone in patients at high-risk of postoperative nausea and vomiting from epidural fentanyl analgesia

BACKGROUND

Postoperative opioid analgesia increases the incidence of postoperative nausea and vomiting (PONV). We investigated whether a combination of the neurokinin-1 antagonist aprepitant and dexamethasone decreases PONV incidence compared with dexamethasone alone in high-risk patients receiving continuous epidural fentanyl.

METHODS

Sixty nonsmoking female patients scheduled for elective knee osteoarthritis surgery were randomly allocated to receive oral aprepitant 80 mg (aprepitant+dexamethasone group, N.=30) 2 h before anesthesia induction or no oral aprepitant (dexamethasone group, N.=30). All patients received intravenous dexamethasone 8 mg immediately before anesthesia induction. Anesthesia was maintained with remifentanil and sevoflurane. Continuous infusion of epidural analgesia, including fentanyl, was provided during and after surgery. We assessed complete response (no PONV and no rescue antiemetic use), incidence of nausea and vomiting, nausea severity scale, vomiting frequency, rescue antiemetic use, and postoperative pain at 2 and 24 h after surgery.

RESULTS

The cumulative incidence of vomiting at 24 h was 3% in the aprepitant+dexamethasone group and 27% in the dexamethasone group (P=0.011). The incidence and frequency of vomiting in the late postoperative period was also significantly lower in the aprepitant+dexamethasone group than in the dexamethasone group. However, there were no significant group differences in the proportion of patients who experienced a complete response, the incidence and severity of nausea, and rescue antiemetic use at 24 h.

CONCLUSION

The combination of aprepitant and dexamethasone was more effective in preventing postoperative vomiting compared with dexamethasone alone in patients at high-risk of PONV from continuous epidural fentanyl analgesia.

Lymphatic flow is mostly preserved after sentinel lymph node biopsy in primary cutaneous malignant melanoma

BACKGROUND

Knowledge of changes in lymphatic flow after sentinel lymph node biopsy (SLNB) is important for the development of strategies for postoperative adjuvant therapy in malignant melanoma.

OBJECTIVES

41 patients (22 males and 19 females; average age: 67.0 ± 24.0 years) with primary cutaneous malignant melanoma (PCMM) participated in the present study. The primary tumor sites were the upper extremities (9 patients), the lower extremities (20 patients), the trunk (11 patients) and the scalp (1 patient). The tumor thicknesses of the PCMM lesions were from 0.5mm to 9.0mm (average: 3.3 ± 2.5mm). All the participants underwent wide local excision and SLNB.

METHODS

We studied lymphatic flow before and after SLNB by near-infrared (NIR) imaging in all 41 cases. In addition, we performed NIR imaging of lymphatic flow after the lymph node dissection in one case with sentinel lymph node (SLN) metastasis.

RESULTS

Almost no changes in lymphatic flow were seen in 38 of the 41 patients (92.7%) after SLNB. Only in 3 patients (7.3%), one with SLN metastasis and the other two without SLN metastasis, was apparent alteration in the lymphatic flow observed after SLNB. Of the 16 patients without SLN metastasis, only 3 patients showed recurrence of the tumors. Interestingly, 1 of the 2 patients without SLN metastasis but with lymphatic flow alteration had recurrence (regional lymph node metastasis) of the melanoma, whereas only 2 of the 14 patients without SLN metastasis or lymphatic flow alteration had recurrence, 1 with regional lymph node metastasis and the other with distant lymph node metastasis. In 1 case, we re-examined the lymphatic flow after regional lymph node dissection and the lymphatic flow was found to be dramatically changed.

CONCLUSION

We clearly demonstrated that SLNB has only a minimal effect on lymphatic flow. The present results suggest that SLNB does not increase the risk of local recurrence/in-transit metastasis and may support the efficacy of post-SLNB local adjuvant injection to prevent local recurrence and in-transit metastasis.

Does Regular Post-exercise Cold Application Attenuate Trained Muscle Adaptation?

This study examined the effects of regular post-exercise cold application on muscular and vascular adaptations induced by moderate-intensity resistance training. 14 male subjects participated in resistance training: 5 sets of 8 wrist-flexion exercises at workload of 70-80% of the single repetition maximum, 3 times a week for 6 weeks. 7 subjects immersed their experimental forearms in cold water (10±1°C) for 20 min after wrist-flexion exercises (cooled group), and the other 7 served as control subjects (noncooled group). Measurements were taken before and after the training period; wrist-flexor thickness, brachial-artery diameter, maximal muscle strength, and local muscle endurance were measured in upper extremities. Wrist-flexor thicknesses of the experimental arms increased after training in both groups, but the extent of each increase was significantly less in the cooled group compared with the noncooled group. Maximal muscle strength and brachial-artery diameter did not increase in the cooled group, while they increased in the noncooled group. Local muscle endurance increased in both groups, but the increase in the cooled group tended to be lower compared to the noncooled group. Regular post-exercise cold application to muscles might attenuate muscular and vascular adaptations to resistance training.

Ambient pressure structural quantum critical point in the phase diagram of (Ca(x)Sr(1-x))(3)Rh(4)Sn(13)

The quasiskutterudite superconductor Sr_{3}Rh_{4}Sn_{13} features a pronounced anomaly in electrical resistivity at T^{*}∼138  K. We show that the anomaly is caused by a second-order structural transition, which can be tuned to 0 K by applying physical pressure and chemical pressure via the substitution of Ca for Sr. A broad superconducting dome is centered around the structural quantum critical point. Detailed analysis of the tuning parameter dependence of T^{*} as well as insights from lattice dynamics calculations strongly support the existence of a structural quantum critical point at ambient pressure when the fraction of Ca is 0.9 (i.e., x_{c}=0.9). This establishes the (Ca_{x}Sr_{1-x})_{3}Rh_{4}Sn_{13} series as an important system for exploring the physics of structural quantum criticality without the need of applying high pressures.

Relationship between the brain natriuretic peptide (BNP) level and remission of diabetic nephropathy with microalbuminuria: a 3-year follow-up study

The aim of the study was to examine the relationship between the brain natriuretic peptide (BNP) level and progression or remission of diabetic nephropathy with microalbuminuria for 3 years. The subjects were 100 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between metabolic parameters at baseline [HbA1c, systolic blood pressure (SBP), urine albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and BNP] and the progression or remission of diabetic nephropathy were examined for 3 years. A total of 83 patients were examined at the end of the 3-year period, including 17 with remission to normoalbuminuria, 47 with continuing microalbuminuria, and 19 with progression to macroalbuminuria. HbA1c, ACR, and BNP differed significantly among the 3 groups (p=0.024, p<0.001, p=0.002, respectively). Among baseline factors, HbA1c and BNP were significant predictors of the percentage increase in ACR for 3 years in multiple linear regression analysis (β=0.259, p=0.02; β=0.299, p=0.007, respectively). In multivariate logistic regression analysis, HbA1c and ACR were independently associated with progression of diabetic nephropathy (p=0.008, p=0.023, respectively), and ACR and BNP were independently associated with remission of diabetic nephropathy (p=0.029, p=0.012, respectively). ROC curve analysis gave a cutoff value for BNP of 14.9 pg/ml for prediction of remission of diabetic nephropathy (p=0.016). The BNP level has a relationship with diabetic nephropathy and a low BNP level predicts remission of diabetic nephropathy. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy.

Three-year denosumab treatment in postmenopausal Japanese women and men with osteoporosis: results from a 1-year open-label extension of the Denosumab Fracture Intervention Randomized Placebo Controlled Trial (DIRECT)

SUMMARY

A 12-month extension phase of DIRECT in Japanese subjects with osteoporosis showed that total 3 years of denosumab treatment in Japanese postmenopausal women and men with osteoporosis was associated with low fracture rates, persistent bone turnover marker (BTM) reductions, continuous bone mineral density (BMD) increases, and a favorable overall benefit/risk profile.

INTRODUCTION

The DIRECT trial demonstrated that 2 years of treatment with denosumab 60 mg subcutaneously every 6 months significantly reduced the incidence of vertebral fracture compared to placebo in Japanese postmenopausal women and men with osteoporosis. The purpose of this study is to evaluate the efficacy and safety of denosumab treatment for up to 3 years.

METHODS

This study includes a 2-year randomized, double-blind, placebo-controlled phase and a 1-year open-label extension phase in which all subjects received denosumab. The data correspond to 3 years of denosumab treatment in subjects who received denosumab (long-term group) and 1 year of denosumab treatment in subjects who received placebo (cross-over group) in the double-blind phase.

RESULTS

Eight hundred and ten subjects who completed the double-blind phase enrolled into the extension phase, and 775 subjects completed the study. All subjects received denosumab with daily supplements of calcium and vitamin D. The cumulative 36-month incidences of new or worsening vertebral fractures and new vertebral fractures were 3.8 and 2.5 %, respectively, in the long-term group. In this group, the BMD continued to increase, and the reduction in BTMs was maintained. In the cross-over group, comparable BMD increases and BTMs reductions to those of in their first year of the long-term group were confirmed. Adverse events did not show a notable increase with long-term denosumab administration. One event of osteonecrosis of the jaw occurred in the cross-over group.

CONCLUSIONS

Three-year denosumab treatment in Japanese subjects with osteoporosis showed a favorable benefit/risk profile.

A radiographic analysis of alignment of the lower extremities--initiation and progression of varus-type knee osteoarthritis

OBJECTIVE

This study aimed to investigate alignment based on age in normal knees and alignment based on deformity in osteoarthritis (OA) knees using detailed radiographic parameters.

DESIGN

Various parameters were measured from weight-bearing long leg radiographs of 1251 legs (797 normal and 454 OA knees) as a cross-sectional study. Normal knees were classified by age (young, middle aged, aged, and elderly) and symptomatic OA knees on the basis of the alignment (femorotibial angle (FTA): mild, moderate, severe and profound). The mean measurements in each group were calculated and compared within each group.

RESULTS

The femoral shaft showed medially bowed curvature (femoral bowing) of approximately 2° in the young normal group, which shifted to lateral bowing with age. However, OA knees showed larger lateral bowing with OA grade, which might reduce the condylar-shaft angle and subsequently shifted the mechanical axis medially. Progression of mild to moderate OA might be associated with a decreasing condylar-shaft angle (femoral condylar orientation) and widening condylar-plateau angle (joint space narrowing) rather than decreasing tibial plateau flattering. Steeping of the tibial plateau inclination due to increasing tibial plateau shift (tibial plateau compression) rather than medial tibial bowing might be the main contributor to worsening of varus deformity in knees with severe and profound OA.

CONCLUSIONS

This cross-sectional study might provide the possibility of OA initiation and progression. The lateral curvature of the femoral shaft associated with aging may contribute to the initiation of varus-type OA of the knee. These changes in the femur may be followed by secondary signs of OA progression including varus femoral condylar orientation, medial joint space narrowing, and tibial plateau compression.

Rain influences the physiological and metabolic responses to exercise in hot conditions

Outdoor exercise often proceeds in rainy conditions. However, the cooling effects of rain on human physiological responses have not been systematically studied in hot conditions. The present study determined physiological and metabolic responses using a climatic chamber that can precisely simulate hot, rainy conditions. Eleven healthy men ran on a treadmill at an intensity of 70% VO2max for 30 min in the climatic chamber at an ambient temperature of 33°C in the presence (RAIN) or absence (CON) of 30 mm · h(-1) of precipitation and a headwind equal to the running velocity of 3.15 ± 0.19 m · s(-1). Oesophageal temperature, mean skin temperature, heart rate, rating of perceived exertion, blood parameters, volume of expired air and sweat loss were measured. Oesophageal and mean skin temperatures were significantly lower from 5 to 30 min, and heart rate was significantly lower from 20 to 30 min in RAIN than in CON (P < 0.05 for all). Plasma lactate and epinephrine concentrations (30 min) and sweat loss were significantly lower (P < 0.05) in RAIN compared with CON. Rain appears to influence physiological and metabolic responses to exercise in heat such that heat-induced strain might be reduced.

Carcinosarcoma of the fallopian tube with disappearance of carcinoma cells by neoadjuvant chemotherapy: case study

The authors report a case of carcinosarcoma (CS) of the fimbria of the fallopian tube in which carcinoma cells disappeared with neoadjuvant chemotherapy (NAC). A 74-year-old woman visited the present hospital with a large pelvic mass and pleural effusion. A magnetic resonance image of the tumor was highly suggestive of ovarian carcinoma. Due to the presence of both serous.adenocarcinoma cells in pleural effusion and pulmonary thrombosis, the patient was given NAC consisting of carboplatin plus paclitaxel (TC) and anticoagulant therapy with warfarin potassium. With six courses of NAC, the pleural effusion and pulmonary thrombosis disappeared, and the tumor decreased 36.2% in greatest diameter. Maximum debulking surgery was then performed. The tumor was found to be located in the fimbria of the right fallopian tube. Hysterectomy and bilateral salpingo-oophorectomy were performed, and histologic examination revealed chondrosarcoma with the presence of necrotic epithelial cells. The necrotic areas were interspersed with papillary structures, and immunohistochemical study showed positivity for CK7 and negativity for CK20, p53, and estrogen receptor (ER), indicating serous adenocarcinoma. Thus, heterologous CS with disappearance of viable carcinoma cells by NAC was diagnosed. The patient was given adjuvant chemotherapy consisting of three courses of TC, and there has been no evidence of disease for 20 months. The authors' experience in this case of gynecologic CS indicates that a serous adenocarcinomatous component of tubal CS can be well cured by TC-based NAC.

A Patient with Pancreatic Castleman's Disease Arising around the Main Pancreatic Duct

Castleman's disease of the pancreas is extremely rare. To the best of our knowledge, Castleman's disease arising around the main pancreatic duct has not been previously reported. The patient was a 74-year-old man. Abdominal ultrasonography performed at a health check-up revealed a dilated main pancreatic duct. Pancreatic cancer was strongly suspected on various imaging studies. However, the results of a cytological examination of the pancreatic juice were negative for malignancy. The patient did not want to undergo a histological diagnosis by endoscopic ultrasound-guided fine-needle aspiration, thus pylorus-preserving pancreatoduodenectomy was performed. Pancreatic Castleman's disease arising around the main pancreatic was diagnosed by the histopathological examination.

Coagulation function and mechanisms in various clinical phenotypes of patients with acquired factor V inhibitors

BACKGROUND

The clinical phenotype of individuals with acquired factor V (A-FV) inhibitors varies from asymptomatic (non-B group) to life-threatening bleeding (B group), but the mechanism(s) underlying this variation in hemorrhagic phenotype are poorly understood.

OBJECTIVE

To investigate coagulation mechanistically in a range of patients with A-FV antibodies.

METHODS AND RESULTS

Ten cases of A-FV inhibitors in the non-B (n = 5) and B groups (n = 5) were studied. Thrombin generation assays in these plasmas revealed little thrombin generation, despite similar FV activity levels in both groups. However, prothrombin time-based clot waveform analysis revealed that the clot times were significantly prolonged and the maximum velocity and acceleration of coagulation were lower in the B group than in the non-B group, suggesting that this technique might be useful for predicting and monitoring hemorrhagic symptoms. A-FV inhibitors from the non-B group recognized predominantly the FV heavy chain, whereas those from the B group recognized the light chain. Purified anti-FV autoantibodies (autoAbs) from the B group inhibited FV binding to phospholipid by 60-90%, whereas there was little effect on this reaction in the non-B group. In addition, anti-FV autoAbs from the non-B group impaired the activated protein C (APC) cofactor activity of FV in FVIIIa inactivation mechanisms, and delayed APC-catalyzed cleavage of FVa at Arg306, but not at Arg506, indicating the presence of APC resistance in the non-B group.

CONCLUSIONS

The results suggest that the different hemorrhagic phenotypes in A-FV inhibitors depend on the specific epitope of anti-FV autoAbs, and appear to be associated with an imbalance of procoagulant and anticoagulant function.

5-hydroxytryptamine- and dopamine-releasing effects of ring-substituted amphetamines on rat brain: a comparative study using in vivo microdialysis

Using in vivo microdialysis, a comparative study was conducted to examine the effects of amphetamine-related compounds (methamphetamine, MAP; 3,4-methylenedioxymethamphetamine, MDMA; p-methoxyamphetamine, PMA; p-methoxymethamphetamine, PMMA; 4-methylthioamphetamine, 4-MTA; 3,4,5-trimethoxyamphetamine, TMA; 2,5-dimethoxy-4-iodoamphetamine, DOI) on extracellular levels of serotonin (5-HT) and dopamine (DA). Dialysates were assayed using HPLC equipped with electrochemical detector following i.p. administration with each drug at a dose of 5 mg/kg. MAP was found to drastically and rapidly increase 5-HT and DA levels (870% and 1460%, respectively). PMA, PMMA, and 4-MTA slightly increased DA levels (150-290%) but remarkably increased 5-HT levels (540-900%). In contrast, TMA and DOI caused no detectable changes in levels of both monoamines. We observed that the potent DA-releasing action of MAP was remarkably decreased by introduction of methoxy or methylthio group at the para position (MAP vs. PMMA or 4-MTA), but introduction of two additional adjacent methoxy groups into PMA totally abolished its 5-HT-/DA-releasing action (PMA vs. TMA). In addition, para-mono-substituted compounds inhibited both monoamine oxidase (MAO) enzymes more strongly than other compounds; PMA and 4-MTA exhibited submicromolar IC50 values for MAO-A. On the other hand, TMA scarcely affected the activity of both MAO enzymes as well as extracellular levels of 5-HT and DA. In this comparative study, MDMA, PMA, and 4-MTA functioned similar to PMMA, a typical empathogen; these findings therefore could be helpful in clarifying the psychopharmacological properties of amphetamine-related, empathogenic designer drugs.

Survival analysis of platinum-refractory patients with advanced esophageal cancer treated with docetaxel or best supportive care alone: a retrospective study

The survival benefit of second-line chemotherapy with docetaxel in platinum-refractory patients with advanced esophageal cancer (AEC) remains unclear. A retrospective analysis of AEC patients with Eastern Cooperative Oncology Group performance status (PS)≤2 was performed, and major organ functions were preserved, who determined to receive docetaxel or best supportive care (BSC) alone after failure of platinum-based chemotherapy. The post-progression survival (PPS), defined as survival time after disease progression following platinum-based chemotherapy, was analyzed by multivariate Cox regression analysis using factors identified as significant in univariate analysis of various 20 characteristics (age, sex, PS, primary tumor location, etc) including Glasgow prognostic score (GPS), which is a well-known prognostic factor in many malignant tumors. Sixty-six and 45 patients were determined to receive docetaxel and BSC between January 2007 and December 2011, respectively. The median PPS was 5.4 months (95% confidence interval [CI] 4.8-6.0) in the docetaxel group and 3.3 months (95% CI 2.5-4.0) in the BSC group (hazard ratio [HR] 0.56, 95% CI 0.38-0.84, P=0.005). Univariate analysis revealed six significant factors: treatment, PS, GPS, number of metastatic organs, liver metastasis, and bone metastasis. Multivariate analysis including these significant factors revealed three independent prognostic factors: docetaxel treatment (HR 0.62, 95% CI 0.39-0.99, P=0.043), better GPS (HR 0.61, 95% CI 0.46-0.81, P=0.001), and no bone metastasis (HR 0.31, 95% CI 0.15-0.68, P=0.003). There was a trend for PPS in favor of the docetaxel group compared with patients who refused docetaxel treatment in the BSC group (adjusted HR 0.61, 95% CI 0.29-1.29, P=0.20). Docetaxel treatment may have prolonged survival in platinum-refractory patients with AEC.