Recurrent pulmonary emboli with characteristic histopathology

We report a unique case of recurrent thromboembolism and its histological findings that were revealed in an autopsy. Although it is well known that repeating thrombosis presents organization and recanalization, we also observed rare findings of thickening of the bronchial artery and fixation of the valve of the lower extremity vein in this case.

Terahertz-Field-Induced Large Macroscopic Polarization and Domain-Wall Dynamics in an Organic Molecular Dielectric

A rapid polarization control in paraelectric materials is important for an ultrafast optical switching useful in the future optical communication. In this study, we applied terahertz-pump second-harmonic-generation-probe and optical-reflectivity-probe spectroscopies to the paraelectric neutral phase of an organic molecular dielectric, tetrathiafulvalene-p-chloranil and revealed that a terahertz pulse with the electric-field amplitude of ∼400  kV/cm produces in the subpicosecond time scale a large macroscopic polarization whose magnitude reaches ∼20% of that in the ferroelectric ionic phase. Such a large polarization generation is attributed to the intermolecular charge transfers and breathing motions of domain walls between microscopic neutral and ionic domains induced by the terahertz electric field.

Ultrafast Photoinduced Electric-Polarization Switching in a Hydrogen-Bonded Ferroelectric Crystal

Croconic acid crystals show proton displacive-type ferroelectricity with a large spontaneous polarization reaching 20  μC/cm^{2}, which originates from the strong coupling of proton and π-electron degrees of freedom. Such a coupling makes us expect a large polarization change by photoirradiations. Optical-pump second-harmonic-generation-probe experiments reveal that a photoexcited croconic-acid crystal loses the ferroelectricity substantially with a maximum quantum efficiency of more than 30 molecules per one absorbed photon. Based on density functional calculations, we theoretically discuss possible pathways toward the formation of a one-dimensional domain with polarization inversion and its recovery process to the ground state by referring to the dynamics of experimentally obtained polarization changes.

Omental flap transposition for inferior vena cava filter penetration

A 40-year-old woman presented with uterine malignancy, deep vein thrombosis, and nonmassive pulmonary embolism in both lungs. Gunter-tulip filter was inserted, because she had severe genital bleeding, which is one of the contraindications to anticoagulation therapy. Total hysterectomy was conducted and anticoagulation therapy was started afterward. The thrombus worsened perioperatively, and the filter could not be retrieved. Since there was lymph node recurrence, the second time operation was performed. During operation, the struts were found to be penetrating the inferior vena cava. Omental flap was used to cover the struts, and no associated complications occurred after operation.

Assessment of the Safety and Efficacy of Edoxaban for the Treatment of Venous Thromboembolism Secondary to Active Malignancy

Objective: To assess the safety and efficacy of edoxaban for the treatment of venous thromboembolism (VTE) secondary to active malignancy.

Materials and Methods: We enrolled 48 patients with newly diagnosed VTE secondary to active malignancy that was treated with oral edoxaban for 1 year between September 2014 and August 2015. We retrospectively examined the presence or absence of recurrent symptomatic VTE, VTE-related mortality, and bleeding events.

Results: No recurrent symptomatic VTE or VTE-related deaths were recorded, enabling efficient assessment. Treatment safety was determined based on the reports of bleeding. Bleeding was reported in two patients, with serious bleeding in one of them.

Conclusion: Edoxaban is safe and effective for the treatment of VTE secondary to active malignancy.

Three-day regimen of oseltamivir for postexposure prophylaxis of influenza in wards

Inpatients who had been in close contact with patients with influenza were given oseltamivir [75mg capsules once daily for adults or 2mg/kg (maximum of 75mg) once daily for children] for three days as postexposure prophylaxis (PEP). The index patients with influenza were prescribed a neuraminidase inhibitor and were discharged immediately or transferred to isolation rooms. The protective efficacy of oseltamivir for three days was 93% overall [95% confidence interval (CI) 53-99%; P=0.023] and 94% for influenza A (95% CI 61-99%; P=0.017), which is comparable to that of seven- to 10-day regimens of oseltamivir as PEP.

Haemostasis with fibrin glue injection into the pericardial space for right ventricular perforation caused by an iatrogenic procedural complication

An 89-year-old woman with severe aortic valve stenosis and bradycardia presented with circulatory shock due to cardiac tamponade. We performed pericardiocentesis, and then diagnosed right ventricular perforation by echocardiography with microcavitation contrast medium just before inserting a drainage tube. We then inserted the drainage tube in the appropriate position and withdrew blood-filled fluid. The patient was haemodynamically stabilised, but haemorrhage from the perforation site continued for a few days. We injected fibrin glue into the pericardial space through the drainage tube and achieved haemostasis. Thus, we avoided surgery to close the perforation in this high-risk patient. There was no recurrence of haemorrhage. She subsequently had elective aortic valve replacement at another hospital. No adhesions in the pericardial space were seen during surgery.

Analysis of individual differences in radiosensitivity using genome editing

Current standards for radiological protection of the public have been uniformly established. However, individual differences in radiosensitivity are suggested to exist in human populations, which could be caused by nucleotide variants of DNA repair genes. In order to verify if such genetic variants are responsible for individual differences in radiosensitivity, they could be introduced into cultured human cells for evaluation. This strategy would make it possible to analyse the effect of candidate nucleotide variants on individual radiosensitivity, independent of the diverse genetic background. However, efficient gene targeting in cultured human cells is difficult due to the low frequency of homologous recombination (HR) repair. The development of artificial nucleases has enabled efficient HR-mediated genome editing to be performed in cultured human cells. A novel genome editing strategy, 'transcription activator-like effector nuclease (TALEN)-mediated two-step single base pair editing', has been developed, and this was used to introduce a nucleotide variant associated with a chromosomal instability syndrome bi-allelically into cultured human cells to demonstrate that it is the causative mutation. It is proposed that this editing technique will be useful to investigate individual radiosensitivity.

Abstract P3-07-38: Increment of neutrophil/lymphocyte ratio (NLR) can be one of the useful predictive markers for the metastatic breast cancer (MBC) with first line hormonal therapy (HT)

[Introduction] Cancer microenvironment formed by the immune and inflammatory cells is noticed to be one of the factors for tumor growth, invasion or metastasis. To figure out the systemic inflammatory environment, the neutrophil / lymphocyte ratio (NLR) is a useful method and a simple indicator. We have some reports that NLR can predict the prognosis in many malignancies, including breast cancer, as I reported in SABCS 2014, however, NLR cannot be a predictive marker in major cancers, because the usage with anti-cancer agents will make NLR status out of order. In hormonal receptor positive metastatic breast cancer (HR+ve MBC), we choice hormonal therapy (HT) for the first line, mainly. HTs have little influence for NLR, therefore, the change of NLR, increment or decrement, can reflect the systemic inflammatory status and be a useful predictive marker for the HR+ve MBC with HTs.

[Purpose] I define dNLR as the difference between NLR at the 2-3 months after HT and before HT. To evaluate the dNLR affects the Overall Survival (OS) and Progression Free Survival (PFS) of the patients of MBC or not.

[Patients] From 2003 to 2013, we have 299 MBC patients in our hospital. Out of them, 134 patients had HTs as first line, included 18 Stage4 patients at the first visit. Median Disease free survival (DFS) is 1497-day, the median OS after the recurrence is 1472-day. Average value of the NLR before HT is 2.62. The reasons of MBC are bone metastases (mets), pleural and pulmonary mets, liver mets, lymph node mets, central nervous system (CNS) mets, unresectable metastatic chest wall recurrence, or other.

[Results] By univariate analysis, DFS < 1000 (p<0.01) and liver mets (p<0.05) made a contribution to poor OS. dNLR>=0.5 (p<0.05), liver mets (p<0.05) and 2 or more organs involvements (p < 0.05) made a contribution to poor PFS. With multivariate analysis, for OS, only DFS < 1000 was an independent prognostic factor. And for PFS, only dNLR>=0.5 was an independent predictive factor. Poor OS factors by univariate analysis had no influence for PFS as well as poor PFS factors did not reflect the OS.

[Discussion] The dNLR was a predictive marker for HR+ve MBC which we can easily and simply examine by blood sample. Now we cannot reveal the relationship with dNLR and OS, however, this fact suggests that we can decide to stop the first line HT and select the second line therapy using with not only images or tumor makers but also dNLR. This can certainly contribute for good OS. It remains some questions between dNLR and other examinations, for example, which can detect the patient status earlier and more accurate? First, we need to accumulate further retrospective cases and plan the prospective study to make sure of the adequate treatment divided by dNLR.

[Conclusion] The dNLR>=0.5 is one of the independent predictive markers for HR+ve MBC with first line HT.

Citation Format: Miyamoto T, Fujisawa T, Morishita A, Yanagita Y, Kuwano H. Increment of neutrophil/lymphocyte ratio (NLR) can be one of the useful predictive markers for the metastatic breast cancer (MBC) with first line hormonal therapy (HT). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-38.

Novel electronic ferroelectricity in an organic charge-order insulator investigated with terahertz-pump optical-probe spectroscopy

In electronic-type ferroelectrics, where dipole moments produced by the variations of electron configurations are aligned, the polarization is expected to be rapidly controlled by electric fields. Such a feature can be used for high-speed electric-switching and memory devices. Electronic-type ferroelectrics include charge degrees of freedom, so that they are sometimes conductive, complicating dielectric measurements. This makes difficult the exploration of electronic-type ferroelectrics and the understanding of their ferroelectric nature. Here, we show unambiguous evidence for electronic ferroelectricity in the charge-order (CO) phase of a prototypical ET-based molecular compound, α-(ET)₂I₃ (ET:bis(ethylenedithio)tetrathiafulvalene), using a terahertz pulse as an external electric field. Terahertz-pump second-harmonic-generation(SHG)-probe and optical-reflectivity-probe spectroscopy reveal that the ferroelectric polarization originates from intermolecular charge transfers and is inclined 27° from the horizontal CO stripe. These features are qualitatively reproduced by the density-functional-theory calculation. After sub-picosecond polarization modulation by terahertz fields, prominent oscillations appear in the reflectivity but not in the SHG-probe results, suggesting that the CO is coupled with molecular displacements, while the ferroelectricity is electronic in nature. The results presented here demonstrate that terahertz-pump optical-probe spectroscopy is a powerful tool not only for rapidly controlling polarizations, but also for clarifying the mechanisms of ferroelectricity.

P450 oxidoreductase deficiency with maternal virilization during pregnancy

PURPOSE

The authors report on a rare case of maternal virilization during pregnancy caused by autosomal recessive P450 oxidore- ductase (POR) deficiency.

MATERIALS AND METHODS

A 24-year-old primigravida developed a deepening voice and hirsutism in the second trimester. Prenatal ultrasonography failed to detect any fetal abnormality and fetal growth was normal. POR deficiency was suspected, but the mother declined fetal genetic testing. A female neonate was delivered by cesarean section at 41 weeks' gestation.

RESULTS

The neonate had skeletal abnormalities. Mutational analysis of the POR gene demonstrated homozygosity for c.1370 G>A and p.R457H in the patient and heterozygosity in her parents. POR deficiency was confirmed in the neonate.

CONCLUSION

POR deficiency should be suspected in cases of maternal virilization. Maternal urinary estriol, fetal magnetic resonance imaging, and parental genetic testing should be performed. Parental consent for fetal genetic testing should be sought to ensure prompt diagnosis and early treatment.

A case report of successful permanent pacemaker implantation via the iliac vein

An 85-year-old man was referred to our hospital with a pacemaker pocket infection. A permanent pacemaker had been implanted via the right subclavian vein. The pacemaker and pacing leads were removed and a temporary pacemaker was implanted. After vancomycin treatment for 4 weeks, pacemaker implantation via the right external iliac vein was performed under local anesthesia because of left subclavian vein occlusion, infection of the right pocket, and difficulty with epicardial lead insertion. The iliac vein approach is an effective alternative in patients in whom the pectoral approach cannot be used.

Learning objective: Permanent pacemaker implantation using the conventional pectoral approach is impossible or contraindicated in 1–6% of patients. In such patients, implantation via the iliac vein is considered an effective alternative. The advantages of this approach are that the wound size and bleeding amount are very small and that it can be performed under local anesthesia. Therefore, this approach can be used in patients with a poor general condition, including elderly patients.

Early application of related SCT might improve clinical outcome in adult T-cell leukemia/lymphoma

Allogeneic hematopoietic SCT (allo-HSCT) is a curative treatment for aggressive adult T-cell leukemia/lymphoma (ATLL). Considering the dismal prognosis associated with conventional chemotherapies, early application of allo-HSCT might be beneficial for patients with ATLL. However, no previous study has addressed the optimal timing of allo-HSCT from related donors. Hence, to evaluate the impact of timing of allo-HSCT for patients with ATLL, we retrospectively analyzed data from patients with ATLL who received an allo-HSCT from a related donor. The median age was 52 years. Patients were grouped according to the interval from diagnosis to allo-HSCT: early transplant group, <100 days, n=72; late transplant group, ⩾100 days, n=428. The corresponding constituents of disease status were not statistically different between the two groups (P=0.11). The probability of OS in the early transplant group was significantly higher than that in the late transplant group (4-year OS, 49.3% vs 31.2%). Multivariate analysis revealed that late allo-HSCT was an unfavorable prognostic factor for OS (hazard ratio, 1.46; 95% confidence interval (CI), 1.01-2.11; P=0.04). Despite the limitations of a retrospective study, it might be acceptable to consider early application of allo-HSCT for ATLL.