Reverse Posterior Interosseous Artery Flap for Human Bite Injury to the Hand

Bite injuries frequently occur on human hands. Human bite injuries to the hand may lead to an infection because of limited soft tissue protection and wound contamination. However, no studies have reported severe bite injuries on hands treated by flaps. We report a case of an 80-year-old woman diagnosed with a major neurocognitive disorder. The patient accidentally had a self-bite injury accompanied with an open metacarpal fracture. Debridement and fixation of the first metacarpal fracture were performed. Afterward, skin necrosis occurred gradually on the dorsum of the hand. Therefore, a reverse posterior interosseous artery (PIA) flap was used, and the postoperative course was uneventful. Given the high risk of infection, human bite injuries, particularly hand bites, should be treated immediately. Delayed treatment for such injuries may lead to extensive soft tissue defects requiring reconstruction with flaps.

Species-differences in the in vitro biotransformation of trifluoroethene (HFO-1123)

1,1,2-Trifluoroethene (HFO-1123) is anticipated for use as a refrigerant with low global warming potential. Inhalation studies on HFO-1123 in rats indicated a low potential for toxicity (NOAELs ≥ 20,000 ppm). In contrast, single inhalation exposure of Goettingen® minipigs (≥ 500 ppm) and New Zealand white rabbits (≥ 1250 ppm) resulted in severe toxicity. It has been suggested that these pronounced species-differences in toxicity may be attributable to species-differences in biotransformation of HFO-1123 via the mercapturic acid pathway. Therefore, the overall objective of this study was to evaluate species-differences in glutathione (GSH) dependent in vitro metabolism of HFO-1123 in susceptible versus less susceptible species and humans as a basis for human risk assessment. Biotransformation of HFO-1123 to S-(1,1,2-trifluoroethyl)-L-glutathione (1123-GSH) and subsequent cysteine S-conjugate β-lyase-mediated cleavage of the corresponding cysteine conjugate (1123-CYS) was monitored in hepatic and renal subcellular fractions of mice, rats, minipigs, rabbits, and humans. While 1123-GSH formation occurred at higher rates in rat and rabbit liver S9 compared to minipig and human S9, increased β-lyase cleavage of 1123-CYS was observed in minipig kidney cytosol as compared to cytosolic fractions of other species. Increased β-lyase activity in minipig cytosol was accompanied by time-dependent formation of monofluoroacetic acid (MFA), a highly toxic compound that interferes with cellular energy production via inhibition of aconitase. Consistent with the significantly lower β-lyase activity in human cytosols, the intensity of the MFA signal in human cytosols was only a fraction of the signal obtained in minipig subcellular fractions. Even though the inconsistencies between GSH and β-lyase-dependent metabolism do not allow to draw a firm conclusion on the overall contribution of the mercapturic acid pathway to HFO-1123 biotransformation and toxicity in vivo, the β-lyase data suggest that humans may be less susceptible to HFO-1123 toxicity compared to minipigs.

A Diabetic Patient with Prolonged Hyperammonemia Due to Urinary Tract Infection Caused by Urease-producing Bacteria

Obstructive tract infection caused by urease-producing bacteria can lead to hyperammonemia. We herein report a 73-year-old woman with diabetes and compensated liver cirrhosis who developed obstructive pyelonephritis. Her consciousness level declined on day 3 of hospitalization. Blood tests revealed an elevated ammonia level of 140 μg/dL. Urine and blood cultures identified Proteus mirabilis as a urease-producing bacterium. The treatment included double J (WJ) catheter insertion and administration of antimicrobial agents. On day 7 of hospitalization, the ammonia level gradually decreased, and the patient's consciousness improved. However, despite these interventions, perinephric overflow of urine persisted, necessitating nephrectomy.

A Type 2 Diabetes Mellitus Patient With Severe Diabetic Gastroparesis Successfully Treated With Intravenous Erythromycin

Gastroparesis, characterized by a decrease in gastric emptying, can lead to worsened diabetes control and a reduced quality of life. The patient was a 32-year-old male with type 2 diabetes. He was initially admitted for control of diabetes, and two months later, he was readmitted due to nausea and vomiting. He showed resistance to various drugs, including antiemetics, and an upper gastrointestinal endoscopy revealed significant gastric residue, leading to a diagnosis of gastroparesis. We administered intravenous erythromycin. After three days of treatment, the vomiting resolved. Gastroparesis is challenging to manage, and there are limited effective treatment options. We experienced a case of diabetic gastroparesis with severe vomiting and loss of appetite that responded remarkably well to intravenous erythromycin treatment. Intravenous administration of erythromycin may be a potentially effective treatment for gastroparesis.

Mid-term outcomes of digital nerve injuries treated with Renerve® synthetic collagen nerve conduits: A retrospective single-center study

BACKGROUND

Biodegradable synthetic nerve conduits have become widely used for peripheral nerve injuries. Recently, bioabsorbable collagen conduits filled with collagen fibers (Renerve®) are commercially available in Japan. We investigated the clinical efficacy and safety of Renerve® conduits for digital nerve repair.

PATIENTS AND METHODS

We retrospectively reviewed data of patients who underwent digital nerve repair using Renerve® conduits between August 2017 and February 2022 at our hospital and were followed up for at least 12 months. Seventeen patients (20 nerves) with a median age of 46.5 years (interquartile rage: 26-48 years) were included in the analysis. We analyzed sensory nerve function recovery and residual pain or uncomfortable tingling, as well as safety outcomes. The relationship between nerve defect length and sensory function data was assessed using Spearman's rank correlation.

RESULTS

Sensory nerve function at 12 months postoperatively was excellent in six, good in 10, and poor in four nerves, and that at the final follow-up (median period, 24 months; range, 12-30 months) was excellent in nine, good in 10, and poor in one nerve. All nerves with a defect length of <12 mm had excellent or good sensory outcomes. At 12 months postoperatively, the correlation coefficients between nerve defect length and Semmes-Weinstein monofilament test results, static two-point discrimination, and dynamic two-point discrimination were 0.35 (p = 0.131), 0.397 (p = 0.0827), and 0.451 (p = 0.0461), respectively. Residual pain or tingling sensation were observed in four nerves at the final follow-up. No postoperative complications were observed in any of the patients.

CONCLUSIONS

This study demonstrated the clinical efficacy and safety of Renerve® conduits for digital nerve repair. Our results will be useful in clinical practice because of the scarcity of real-world data on the use of Renerve® conduits for digital nerve repair.

Outcomes of Window Therapy with Carboplatin and Ifosfamide for Pediatric Osteosarcoma: A Case Series

For the treatment of osteosarcoma, cisplatin (CDDP) can be substituted by carboplatin (CBDCA) to reduce toxicity. We report a single institution experience of CBDCA-based regimen. Two to three cycles of CBDCA + ifosfamide (IFO) therapy (window therapy) were administered as neoadjuvant therapy for osteosarcoma. Depending on the response of window therapy, the subsequent protocols were determined; for good responders, surgery is performed, and postoperative therapies with CBDCA + IFO, adriamycin (ADM) and high-dose methotrexate (MTX) were administered; for stable disease, the postoperative regimens were advanced before surgery, and the remaining amount of postoperative chemotherapy is deduced; for progressive disease, CBDCA-based regimen is changed to CDDP-based regimen. From 2009 to 2019, seven patients were treated with this protocol. During the window therapy, two patients (28.6%) were assessed as good responders and completed the regimen as planned. Four patients (57.1%) had stable disease, and the chemotherapy schedules were modified. One patient (14.2%) with progressive disease was shifted to the CDDP-based regimen. At final follow-up, four patients showed no evidence of disease and three patients died of the disease. Since the efficacy during window therapy was limited, a CBDCA-based regimen in the neoadjuvant setting was considered insufficient for performing adequate surgery.

Median Nerve Recovery and Morphological Change on MRI at 24 Months after Open Carpal Tunnel Release

Background: This study aimed to investigate the relationship between postoperative clinical results and long-term morphological changes in patients with carpal tunnel syndrome (CTS) as observed on magnetic resonance imaging (MRI) before and after open carpal tunnel release (OCTR). Methods: We retrospectively analysed data for 28 hands that had undergone OCTR with at least 24 months of follow-up data. Two-point discrimination (2PD) test results were examined for the first three fingers, as were the distal motor latency (DML) and sensory conduction velocity (SCV) of the median nerve. We also calculated the cross-sectional area (CSA) of the carpal tunnel and the distance from the median nerve to the volar carpal bone at the hamate and the pisiform levels using MRI images. Variables were compared before and 24 months after OCTR. Results: Significant improvements in all variables were observed, including average 2PD scores (Finger I: 13.1 ± 6.2 vs. 7.7 ± 4.3, p < 0.01, Finger II: 11.9 ± 6.6 vs. 7.0 ± 3.5, p < 0.01, Finger III: 13.6 ± 6.1 vs. 7.8 ± 4.5, p < 0.01), average DML (8.3 ± 3.3 vs. 4.3 ± 0.6 m/s, p < 0.01), average SCV (30.8 ± 11.0 vs. 41.3 ± 5.3 m/s, p < 0.01), CSA of the carpal tunnel (hamate level: 194.9 ± 30.6 vs. 254.2 ± 47.6 mm2, p < 0.01, pisiform level: 244.2 ± 46.5 vs. 274.7 ± 75.1 mm2, p = 0.01) and the distance between the median nerve and volar carpal bone (hamate level: 8.7 ± 1.4 vs. 11.2 ± 1.6 mm, p < 0.01, pisiform level: 11.8 ± 1.7 vs. 13.8 ± 2.5 mm, p < 0.01). Conclusions: Our results demonstrate that OCTR is successful in achieving long-term decompression and recovery of the median nerve in patients with CTS. Level of Evidence: Level III (Therapeutic).

Stand-up test could be a helpful adjunct for screening elbow disorders in Little League baseball players

BACKGROUND

The purpose of this study is to justify the result of the modified Stand-Up test (MSUT) in Little League baseball players and to clarify the association with sports related disorders in the elbow.

METHODS

A total of 245 (240 boys and 5 girls) Little League baseball players aged 9 to 12 underwent physical examination, elbow ultrasonography and questionnaires during a routine medical checkup. In addition, the MSUT, based on the Japanese Orthopaedic Association (JOA)'s original Stand-Up test to evaluate the risk of Locomotive syndrome, was performed.

RESULTS

Seventeen osteochondritis dissecans (OCD) of capitellum and 4 medial epicondylar fragmentation (MEF) cases were diagnosed with ultrasonography in 242 players. Based on the MSUT, five boys could not stand up from 40 cm platform with the single leg stance, two of whom complained of current elbow pain, three of whom diagnosed with a positive finding with ultrasonography. Odds ratio (95% confidence limits) of risk factors for failing to the 40 cm-MSUT with the single leg stance were: incidence of current elbow pain 5.7 (0.9-35.5); OCD (Grade 1b and 2) 8.2 (0.8-83); and MEF 19.5 (1.7-230).

CONCLUSION

Two percent of Little League baseball players were unable to stand up from a 40 cm high platform/stool with the single leg stance by the MSUT and it was associated with an increase in MEF or OCD diagnosis by ultrasonography and presence of elbow pain. These results suggest that players who failed to the 40 cm-MSUT with the single leg stance are at risk of elbow disorders. Also, these results are consistent with previous research on throwing injuries that have associated poor control in the legs or trunk with pain and injury involving the upper extremities. MSUT, a relatively simple procedure, may be a helpful adjunct for screening to estimate readiness for resuming general physical activity in Little League baseball players.

Solvent-dependent fluorescence behaviour of imide-fused [n]phenacenes (n = 3, 5, 7)

Imide-fused [n]phenacenes (nPDIs, n = 3, 5, 7) were systematically synthesised and their electronic features were investigated by electrochemical and electronic spectral measurements. nPDIs showed two reduction waves attributed to formation of radical ions and dianions. 3PDI produced blue fluorescence independent of solvent polarity. In contrast, 5PDI and 7PDI displayed marked positive solvatofluorochromism due to intramolecular charge transfer characters between the imide moieties and phenacene π cores in the excited state. The spectral features were analyzed by the Lippert-Mataga relationship and theoretical calculations.

Giant spin polarization and a pair of antiparallel spins in a chiral superconductor

Chiral molecules can exhibit spin-selective charge emission, which is known as chirality-induced spin selectivity^1,2. Despite the constituent light elements of the molecules, their spin polarization can approach or even exceed that of typical ferromagnets. This powerful capability may lead to applications in the chiral spintronics² field. Although the origin of spin selectivity is elusive, two microscopic phenomena have been suggested based on experimental results: effective enhancement of spin-orbit interactions³ and chirality represented by a pair of oppositely polarized spins^4,5. However, the hypotheses remain to be verified. Here we report the simultaneous observation of these two phenomena in an organic chiral superconductor by magnetoresistance measurements in the vicinity of the superconducting transition temperature. A pair of oppositely polarized spins is demonstrated by spatially mapping the spin polarity in an electric alternating current excitation. The obtained spin polarization exceeds that of the Edelstein effect^6-10 by several orders of magnitude, which indicates an effective enhancement of the spin-orbit interaction. Our results demonstrate a solid-state analogue of spin accumulations assumed for chiral molecules, and may provide clues to the origin of their molecular counterparts. In addition, the innovative capability of spin-current sourcing will invigorate superconducting spintronics research¹¹.

Reverse lateral upper arm flaps for treating large soft tissue defects extending from the elbow to the forearm

In this study, we report three cases wherein reverse lateral upper arm flaps were used to treat very large tissue defects extending from the elbow to the forearm. The flap sizes were 19 × 6.5 cm, 20 × 7 cm, and 17 × 7 cm. All flaps survived and elbow motion recovered sufficiently.

Evaluation of Effective Field-Effect Mobility in Thin-Film and Single-Crystal Transistors for Revisiting Various Phenacene-Type Molecules

The magnitude of the field-effect mobility μ of organic thin-film and single-crystal field-effect transistors (FETs) has been overestimated in certain recent studies. These reports set alarm bells ringing in the research field of organic electronics. Herein, we report a precise evaluation of the μ values using the effective field-effect mobility, μ_eff, a new indicator that is recently designed to prevent the FET performance of thin-film and single-crystal FETs based on various phenacene molecules from being overestimated. The transfer curves of a range of FETs based on phenacene are carefully categorized on the basis of a previous report. The exact evaluation of the value of μ_eff depends on the exact classification of each transfer curve. The transfer curves of all our phenacene FETs could be successfully classified based on the method indicated in the aforementioned report, which made it possible to evaluate the exact value of μ_eff for each FET. The FET performance based on the values of μ_eff obtained in this study is discussed in detail. In particular, the μ_eff values of single-crystal FETs are almost consistent with the μ values that were reported previously, but the μ_eff values of thin-film FETs were much lower than those previously reported for μ, owing to a high absolute threshold voltage, |V _th|. The increase in the field-effect mobility as a function of the number of benzene rings, which was previously demonstrated based on the μ values of single-crystal FETs with phenacene molecules, is well reproduced from the μ_eff values. The FET performance is discussed based on the newly evaluated μ_eff values, and the future prospects of using phenacene molecules in FET devices are demonstrated.

Insidious Onset Compartment Syndrome of the Forearm in a Teenager: A Case Report and Review of the Literature

Compartment syndrome affecting the upper extremities is a relatively underreported event compared with compartment syndrome affecting the lower extremities. Moreover, insidious onset forearm compartment syndrome has been rarely reported and is usually limited to single case reports. We report a compartment syndrome of the forearm in a teenager. She hit her right proximal forearm lightly on the cash register, but there was no pain. However, the next day, she had difficulty in moving her right hand. Although she underwent electrotherapy, her right forearm gradually became swollen, and she felt numbness in the ring and little fingers of her right hand. Six day after the onset, she came to our hospital and underwent fasciotomy. There was no aftereffect, and very good functional recovery was obtained. All clinicians need to keep the case of forearm compartment syndrome in a young individual with a diffuse course, such as in this case in mind.

Different patterns of pneumothorax in patients with soft tissue tumors treated with pazopanib: A case series analysis

To investigate pneumothorax patterns in pazopanib treatment by focusing on the positional relationship between the visceral pleura and metastatic lung tumor, we examined 20 patients with advanced soft tissue tumors who developed lung metastases and underwent pazopanib treatment between 2012 and 2019. Pneumothorax was classified into two types based on the location of the metastatic lesion around the visceral pleural area before pazopanib treatment: subpleural type, within 5 mm from the pleura; and central type, >5 mm from the pleura. We investigated the rates of pneumothorax and the associated risk factors. Five patients experienced pneumothorax (three subpleural and two central types). Cavitation preceded pneumothorax in 83% of patients and led to connection of the cavitated cyst of the metastatic lesion to the chest cavity in the shorter term in patients with the subpleural type. Conversely, a more gradual increase in the cavity size and sudden cyst rupture were observed in the central type. The risk factors for pneumothorax were cavitation after initiating pazopanib and intervention before pazopanib, either ablation or surgery. The location of the metastatic lesions was not a risk factor for the occurrence of pneumothorax. In conclusion, pneumothorax is an adverse event associated with pazopanib treatment. Therefore, attention must be paid to predisposing factors such as the formation of cavitation after pazopanib initiation and previous interventions to the lungs. Moreover, because subpleural pneumothorax tends to occur earlier than the central type, a different time course can be anticipated based on the positional relationships of the metastatic lesions to the visceral pleura.

Volar RIM Plate Rarely Causes Flexor Tendon Complications in a Short Period Despite Its Plate Prominence over the Watershed Line: A Descriptive Study

Background: The DePuy Synthes variable angle LCP^® Volar RIM Plate has been designed with its contour to overhang volar rim fragments of the distal radius to prevent secondary displacement after fracture fixation. Therefore, RIM potentially contributes to a risk of flexor tendon rupture due to its plate prominence over the watershed line. This is a retrospective cross-sectional study that aims at describing the occurrence of complications by utilizing RIM as well as three standards VLPs to evaluate the impact of plate design on flexor tendons. Methods: A total of 84 patients with a volar locking plate fixation were analyzed retrospectively (Far-distal; RIM: 14 cases, Juxta-articular; AcuLoc2 (ACUMED): 20 cases, Dual-Loc V7 (MEIRA): 25 cases, Extra-articular; VA-TCP (DePuy Synthes): 25 cases). Tendinous problems were evaluated with a reported adverse event and flexor tendon appearance examined by utilizing ultrasonography and direct observation during hardware removal. Plate prominence was graded according to Soong's classification and the distance to flexor tendons was measured to describe the risk that each plate damage the flexor tendons. Results: The mean follow-up period was 13.0 months. All RIM plates were placed in grade 2 (85.7%) and grade 1 (14.3%). Symptomatic and asymptomatic tendinous problems were barely reported in RIM. The examination of ultrasonography and direct observation during hardware removal showed that tendons smoothly slid without attrition on the curved plate surface of RIM despite their adjacent appositions came from its high and distal plate prominence. Conclusions: Smooth profile of RIM showed an ability to decrease the potential risk of flexor tendon damage regardless of its prominence over the watershed line. RIM can be applied more to challenging far distal fractures when used judiciously and surgeons need to be even more vigilant for symptoms of tendon irritation as usually recommended without being coward more than necessary.

Photochemical synthesis and device application of acene-phenacene hybrid molecules, dibenzo[n]phenacenes (n = 5-7)

Dibenzo[n]phenecenes (DBnPs, n = 5-7) were conveniently synthesised through Mallory photocyclization as the key step. Effective mobilities of single-crystal field-effect transistors of DBnPs were evaluated to demonstrate that C2h-symmetrical DB6P shows higher performance than C2v-symmetrical DB5P and DB7P.

Terahertz-field-induced polar charge order in electronic-type dielectrics

Ultrafast electronic-phase change in solids by light, called photoinduced phase transition, is a central issue in the field of non-equilibrium quantum physics, which has been developed very recently. In most of those phenomena, charge or spin orders in an original phase are melted by photocarrier generations, while an ordered state is usually difficult to be created from a non-ordered state by a photoexcitation. Here, we demonstrate that a strong terahertz electric-field pulse changes a Mott insulator of an organic molecular compound in κ-(ET)₂Cu[N(CN)₂]Cl (ET = bis(ethylenedithio)tetrathiafulvalene), to a macroscopically polarized charge-order state; herein, electronic ferroelectricity is induced by the collective intermolecular charge transfers in each dimer. In contrast, in an isostructural compound, κ-(ET)₂Cu₂(CN)₃, which shows the spin-liquid state at low temperatures, a similar polar charge order is not stabilized by the same terahertz pulse. From the comparative studies of terahertz-field-induced second-harmonic-generation and reflectivity changes in the two compounds, we suggest the possibility that a coupling of charge and spin degrees of freedom would play important roles in the stabilization of polar charge order.

Fabrication of ring oscillators using organic molecules of phenacene and perylenedicarboximide

Organic field-effect transistors (FETs) can be applied to radio-frequency identification tags (RFIDs) and active-matrix flat-panel displays. For RFID application, a cardinal functional block is a ring oscillator using an odd number of inverters to convert DC voltage to AC. Herein, we report the properties of two ring oscillators, one formed with [6]phenacene for a p-channel FET and N,N′-dioctyl-3,4,9,10-perylenedicarboximide (PTCDI-C8) for an n-channel FET, and one formed with 3,10-ditetradecylpicene ((C₁₄H₂₉)₂-picene) for a p-channel FET and PTCDI-C8 for an n-channel FET. The former ring oscillator provided a maximum oscillation frequency, f_osc of 26 Hz, and the latter a maximum f_osc of 21 Hz. The drain–drain voltage, V_DD, applied to these ring oscillators was 100 V. This may be the first step towards a future practical ring oscillator using phenacene molecules. The values of field-effect mobility, μ in the p-channel [6]phenacene FET and n-channel PTCDI-C8 FET, which form the building blocks in the ring oscillator with an f_osc value of 26 Hz, are 1.19 and 1.50 × 10⁻¹ cm² V⁻¹ s⁻¹, respectively, while the values in the p-channel (C₁₄H₂₉)₂-picene FET and n-channel PTCDI-C8 FET, which form the ring oscillator with an f_osc of 21 Hz, are 1.85 and 1.54 × 10⁻¹ cm² V⁻¹ s⁻¹, respectively. The μ values in the p-channel FETs are higher by one order of magnitude than those of the n-channel FET, which must be addressed to increase the value of f_osc. Finally, we fabricated a ring oscillator with ZrO₂ instead of parylene for the gate dielectric, which provided the low-voltage operation of the ring oscillator, in which [6]phenacene and PTCDI-C8 thin-film FETs were employed. The value of f_osc obtained in the ring oscillator was 24 Hz. In this ring oscillator, the V_DD value applied was limited to 20 V. The durability of the ring oscillators was also investigated, and the bias stress effect on the f_osc and the amplitude of the output voltage, V_out are discussed. This successful operation of ring oscillators represents an important step towards the realization of future practical integrated logic gate circuits using phenacene molecules.

A ring oscillator consisting of p-channel and n-channel organic FETs.

A case of pubic abscess after prostate cancer surgery and radiotherapy treated with rectus femoris muscle flap

We report the case of a 95-year-old man with soft tissue deficiency associated with a pubic abscess that occurred 30 years after prostate cancer surgery and radiation therapy. A fistula with purulent discharge without any obvious cause appeared in the midline of the lower abdomen and progressed to a soft tissue defect in which several calcium phosphate stones of 5-8 mm in diameter were found. Computed tomography showed calcium deposits on the surface of the pubis and irregular zonal calcifications extending from the pubis to the medial region of both thighs. Conservative treatment did not improve the patient's condition; thus, surgical treatment was performed. The pedicled rectus femoris muscle flap was elevated from the left thigh and transferred to fill the tissue defect, then a split thickness skin graft was applied on it. The tissue defect was successfully repaired, and the patient was able to regain ambulation ability. In the present case, it was presumed that urine exudation around the bladder due to radiation cystitis was involved in the formation of ectopic calculi and subsequent infection. In reconstructing a complex defect associated with infection, using muscle flaps to fill the dead space with well vascularized tissue is considered to be appropriate. In our case, we chose a rectus femoris muscle flap, which has advantages in volume and versatility of transposition owing to long vascular pedicle and requires no microsurgical vascular anastomosis. As a result, the preoperative activity was maintained, the infection was treated, and a good course was obtained.

Efficacy of combination-chemotherapy with pirarubicin, ifosfamide, and etoposide for soft tissue sarcoma: a single-institution retrospective analysis

Background

The standard chemotherapy regimens for soft tissue sarcoma are doxorubicin-based. This retrospective study aimed to assess the efficacy and safety of pirarubicin, ifosfamide, and etoposide combination therapy for patients with this disease.

Methods

Between 2008 and 2017, 25 patients with soft tissue sarcoma were treated with pirarubicin (30 mg/m², 2 days), ifosfamide (2 g/m², 5 days), and etoposide (100 mg/m², 3 days) every 3 weeks. The primary endpoint was overall response, and the secondary endpoint was adverse events of this regimen.

Results

Responses to this regimen according to RECIST criteria were partial response (n = 9, 36%), stable disease (n = 9, 36%) and progressive disease (n = 7, 28%). During the treatment phase, frequent grade 3 or worse adverse events were hematological toxicities including white blood cell decreases (96%), febrile neutropenia (68%), anemia (68%), and platelet count decreases (48%). No long-term adverse events were reported during the study period.

Conclusion

This regimen was comparable to previously published doxorubicin-based combination chemotherapy in terms of response rate. Although there were no long-lasting adverse events, based on our results, severe hematological toxicity should be considered.

Distribution of Solitary and Multiple Enchondromas of the Hand

BACKGROUND/AIM

Although some patients with enchondroma have multiple lesions, no study has investigated the distribution of lesions in patients with multiple enchondromas.

PATIENTS AND METHODS

This retrospective study included 118 patients with enchondroma of the hand. The incidence and characteristic feature of multiple enchondromas of the hand were investigated.

RESULTS

Four patients (3.4%) had multiple enchondromas. In all the patients with multiple enchondromas, the lesions occurred in the middle phalanx, proximal phalanx, and metacarpal bone in the same digital ray.

CONCLUSION

The development of the hand rapidly progresses from intrauterine day 33 to day 54. The digital rays are evident on intrauterine day 41, and separation of the distal phalanx, middle phalanx, proximal phalanx, and metacarpal bone is completed until intrauterine day 54. The successive occurrence of multiple enchondroma lesions in the same digital ray in all four cases suggests that the occurrence of lesions preceded the separation of the hand bones and the lesions were divided during the development of these bones.

Facile synthesis of picenes incorporating imide moieties at both edges of the molecule and their application to n-channel field-effect transistors

Picene derivatives incorporating imide moieties along the long-axis direction of the picene core (C_n-PicDIs) were conveniently synthesized through a four-step synthesis. Photochemical cyclization of dinaphthylethenes was used as the key step for constructing the picene skeleton. Field-effect transistor (FET) devices of C_n-PicDIs were fabricated by using ZrO₂ as a gate substrate and their FET characteristics were investigated. The FET devices showed normally-off n-channel operation; the averaged electron mobility (μ) was evaluated to be 2(1) × 10⁻⁴, 1.0(6) × 10⁻¹ and 1.4(3) × 10⁻² cm² V⁻¹ s⁻¹ for C₄-PicDI, C₈-PicDI and C₁₂-PicDI, respectively. The maximum μ value as high as 2.0 × 10⁻¹ cm² V⁻¹ s⁻¹ was observed for C₈-PicDI. The electronic spectra of C_n-PicDIs in solution showed the same profiles irrespective of the alkyl chain lengths. In contrast, in thin films, the UV absorption and photoelectron yield spectroscopy (PYS) indicated that the lowest unoccupied molecular orbital (LUMO) level of C_n-PicDIs gradually lowered upon the elongation of the alkyl chains, suggesting that the alkyl chains modify intermolecular interactions between the C_n-PicDI molecules in thin films. The present results provide a new strategy for constructing a high performance n-channel organic semiconductor material by utilizing the electronic features of phenacenes.

Picenediimide derivatives serve as the active layer of n-channel thin-film field-effect transistors displaying a maximum charge carrier mobility as high as 2.0 × 10⁻¹ cm² V⁻¹ s⁻¹.

Pyogenic tenosynovitis of the wrist due to Corynebacterium striatum in a patient with dermatomyositis: A case report

INTRODUCTION

Corynebacterium striatum is common contaminant in clinical specimens. Here, we report a rare case of pyogenic tenosynovitis of the wrist caused by C striatum in a dermatomyositis patient taking oral immunosuppressants.

PATIENT CONCERNS

A 67-year-old Japanese woman with dermatomyositis had a history of multiple intraarticular injections of corticosteroids to the right wrist joint for the treatment of osteoarthritis. She was admitted to our hospital with a painful lump on the right dorsal wrist lasting for three months. MRI revealed cellulitis of the dorsum of the right wrist and hand and fluid collection in the extensor tendon sheath. C striatum was detected in the cultures of three samples of synovial fluid taken from the dorsal hand.

DIAGNOSIS

Pyogenic tenosynovitis of the wrist due to C striatum.

INTERVENTIONS

The infection was successfully controlled with synovectomy and adjuvant antibiotic therapy.

OUTCOMES

There has been no sign of recurrence for 12-months after the surgical treatment.

LESSONS

This is the first reported case of pyogenic tenosynovitis due to C striatum in a patient with dermatomyositis. Clinicians should be aware that patients undergoing immunosuppressive therapy have a risk of C striatum infection.

Successful treatment with hydroxychloroquine for systemic lupus erythematosus with cutaneous involvement accompanied by a xanthomatous reaction

Antimalarials are usually recommended for the first-line systemic treatment of cutaneous lupus erythematosus. Alopecia in patients with discoid lupus erythematosus (DLE) is sometimes a refractory condition in spite of topical therapies. We herein described a case of DLE on the scalp with a pathological change of a xanthomatous reaction, which was successfully treated with hydroxychloroquine (HCQ). A 34-year-old woman presented with hair loss to the parietal region. She had been diagnosed with systemic lupus erythematosus (SLE) four years previously. Treatment with 30 mg/day of prednisolone (PSL) had been initiated, and the dose was gradually reduced. At 10 mg/day of PSL, she had noticed her hair loss. Physical examination revealed some small erythematous lesions to the parietal region with accompanying hair loss. Pathological findings of the erythematous lesion on her head revealed thickening of the basement membrane zone, the interface dermatitis with vacuolar degeneration, and both superficial perivascular and perifollicular infiltration of inflammatory cells in the dermis. In addition, there was an infiltrate of xanthomatous cells detected in the papillary dermis, which were positive for CD68 and CD163. The patient started treatment with HCQ at a dose of 200 mg/day. The skin lesions completely resolved within five months after initiation of HCQ without increase in the dose of PSL. Xanthomatous reactions are rarely recognized in lupus erythematosus. The chronic epithelial injury in DLE could be implicated in triggering the secondary reactive process of a xanthomatous reaction. We believe that the reaction seen in our patient was a secondary change to pathological alteration due to SLE. However, as yet unrecognized factors may play a role in the development of a xanthomatous reaction in DLE.

Blue fluorescence from N,O-coordinated BF2 complexes having aromatic chromophores in solution and the solid state

We prepared amide-heterocycle (HC) compounds having various aromatic π-electron systems (Ar), such as phenyl, naphthyl, furyl, thienyl and phenanthryl moieties, and converted them as ligands to difluoroboronated complexes, Ar@HCs. Blue fluorescence from Ar@HCs was observed in solution and the solid state, and the fluorescence quantum yields (Φ_f) and lifetimes (τ_f) were determined. The Φ_f values in CHCl₃ were as small as 0.1 except for the phenanthrene derivatives (0.4-0.6). Observation of the triplet-triplet absorption upon laser flash photolysis of Ar@HCs in solution indicated that the fluorescence process competes with intersystem crossing to the triplet state. Blue fluorescence in the solid state was observed with the Φ_f values of 0.3-0.7. Based on the crystallographic data, the relationship between the crystal structures and emission features of Ar@HCs in the solid state is discussed.

Topological charge transport by mobile dielectric-ferroelectric domain walls

The concept of topology has been widely applied in condensed matter physics, leading to the identification of peculiar electronic states on three-dimensional (3D) surfaces or 2D lines separating topologically distinctive regions. In the systems explored so far, the topological boundaries are built-in walls; thus, their motional degrees of freedom, which potentially bring about new paradigms, have been experimentally inaccessible. Here, working with a quasi-1D organic material with a charge-transfer instability, we show that mobile neutral-ionic (dielectric-ferroelectric) domain boundaries with topological charges carry strongly 1D-confined and anomalously large electrical conduction with an energy gap much smaller than the one-particle excitation gap. This consequence is further supported by nuclear magnetic resonance detection of spin solitons, which are required for steady current of topological charges. The present observation of topological charge transport may open a new channel for broad charge transport-related phenomena such as thermoelectric effects.

P5612In vivo histological and clinical evaluation of layered culprit plaque by optical coherence tomography in stable angina patients

Background

In patients with stable angina pectoris (SAP), exact mechanism of plaque progression overtime is still unclear due to lack of histological evaluation. Directional coronary atherectomy (DCA) allows for the differential cutting of atherosclerotic lesions and for the histological examination.

Purpose

The aims of this study were to compare the histological features obtained by DCA and layered pattern (LP) by OCT, and to establish the prevalence and clinical characteristics of LP in culprit lesion form SAP patients.

Methods

SAP patients who underwent OCT imaging guide PCI in our medical school hospital between June 2016 and June 2018 were included into this study. This was two-fold histological and clinical studies. In a histological study, we evaluated histological features of 42 specimens from 18 patients who underwent DCA and compare OCT findings. Lesions were classified into the following categories based on the OCT finding before DCA cutting; homogeneous or heterogeneous group. Furthermore, lesions in heterogeneous group were classified into 2 categories; LP or non-LP group. In a clinical study, 205 target lesions form 205 patients were categorized as shown above at minimum lumen area (MLA) sites. Plaque characteristics were compared among these groups.

Results

In the histological study, 9 (21.4%) specimens were classified in homogeneous group and 33 (78.6%) in heterogeneous group. In 33 heterogeneous group, LP group were observed in 12 specimens (36.3%). Of 12 LP group, 10 LP group consisted of intramural thrombosis. In clinical study, 39 (19.0%) lesion were classified in homogeneous group and 166 (81.0%) in heterogeneous group. In 166 heterogeneous group, LP group were observed in 75 lesions (45.2%). Of heterogeneous group, LP group had significantly smaller MLA (1.5±0.9 mm2 vs 1.9±1.0 mm2, p<0.05) and higher rate of microchannels (57.3% vs 15.4%, p<0.05) than non-LP group.

A representative layered pattern case

Conclusions

LP in culprit lesion with SAP was significantly associated with intramural thrombosis. MLA sites in LP was significantly smaller than in non-LP group. These data suggest that thrombus formation and subsequent their organization overtime might contribute to the plaque progression even in SAP patients.

Doublon-holon pairing mechanism via exchange interaction in two-dimensional cuprate Mott insulators

Coupling of charge and spin degrees of freedom is a critical feature of correlated electron oxides, as represented by the spin-related mechanism of a Cooper pair under high-T _c superconductivity. A doublon-holon pair generated on an antiferromagnetic spin background is also predicted to attract each other via the spin-spin interaction J, similar to a Cooper pair, while its evidence is difficult to obtain experimentally. Here, we investigate such an excitonic effect by electroreflectance spectroscopy using terahertz electric field pulses in undoped cuprates: Nd₂CuO₄, Sr₂CuO₂Cl₂, and La₂CuO₄. Analyses of the spectral changes of reflectivity under electric fields reveal that the splitting of odd-parity and even-parity excitons, a measure of doublon-holon binding energy, increases with J. This trend is reproduced by t-J-type model calculations, providing strong evidence of the spin-related doublon-holon pairing. Agreement with the calculations supports the s-wave symmetry of the doublon-holon pair in contrast to the d-wave Cooper pair in doped cuprates.

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.