P3615The number of coronary risk factors and mortality in patients with acute myocardial infarction from Japanese nation-wide real-world database

Background

Hypertension, diabetes, dyslipidemia and smoking are so-called coronary risk factors for coronary heart disease, which were established by extensive epidemiological research. However, in Japanese patients with acute myocardial infarction (AMI), the impact of number of coronary risk factors on in-hospital morality has not been elucidated.

Methods

The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide real-world database integrated form 10 regional registries. We examined the association between number of coronary risk factors and in-hospital mortality from this JAMIR registry.

Results

The data were obtained from total of 20462 AMI patients (mean age, 68.8±13.3 years old; 15281 men, 5181 women). Figure 1 shows the prevalence of each coronary risk factors stratified by sex and decade. The prevalence of hypertension became higher with the advanced age while the prevalence of smoking became lower with the advanced age. Prevalence of diabetes and dyslipidemia were highest in middle age. Majority (76.9%) of the patients with AMI had at least 1 of these coronary risk factors and, 23.1% had none of them. Overall, except women under 50, number of coronary risk factor was relatively less in older age (Figure 2). In-hospital mortality by sex and decades was shown in figure 3. In-hospital mortality rates were 10.7%, 10.5%, 7.2%, 5.0% and 4.5% with 0, 1, 2, 3 and 4 risk factors, respectively (Figure 4A). After adjusting age and sex, there was an inverse association between the number of coronary risk factors and in-hospital mortality (adjusted odds ratio [1.68; 95% CI, 1.20–2.35] among individuals with 0 vs. 4 risk factors, Figure 4B).

Conclusion

In the present study of Japanese patients with AMI, who received modern medical treatment, in-hospital mortality was inversely related to the number of coronary risk factors.

Acknowledgement/Funding

Grant-in-Aid for Scientific Research

312 EFFECTS OF TRANSFORMING GROWTH FACTOR ALPHA AND INSULIN-LIKE GROWTH FACTOR 1 SUPPLEMENTATION ON IN VITRO MATURATION OF CANINE OOCYTES

Although in vitro maturation (IVM) of oocytes has been successfully established for many species, the efficiency of IVM in canine oocytes is still very low. As growth factors have been shown to promote oocyte maturation in some species, we investigated whether use of transforming growth factor α (TGF-a) and insulin-like growth factor 1 (IGF-1) might overcome the difficulties of achieving meiotic maturation in cultured canine cumulus-oocyte complexes (COC). Ovaries were obtained from bitches at 6 months to 7 years of age by ovariohysterectomy and were sliced repeatedly to release COC. In the first experiment, the COC were cultured at 38.8°C for 48 h in 5% CO2 in air in medium 199 supplemented with either TGF-a (0, 1, 10, or 100 ng mL–1) or IGF-1 (0, 0.5, 5, 10, or 50 µg mL–1). In the second experiment, the synergistic effect of TGF-a and IGF-1 was investigated by culturing COC in medium 199 supplemented with both TGF-a (0, 1, 10, or 100 ng mL–1) and IGF-1 (0, 0.5, 5, 10, or 50 µg mL–1). At the end of the culture period, the oocytes were denuded of cumulus cells by pipetting with a fine bore glass pipette; the denuded oocytes were then fixed in Carnoy's solution and stained with Hoechst 33342. The nuclear configuration and chromatin morphology of the oocytes were evaluated under confocal laser scanning microscopy. The cells were assigned to 1 of the following meiotic stages: germinal vesicle (GV), germinal vesicle breakdown (GVBD), metaphase I (MI), or metaphase II (MII). Data were analysed by ANOVA with Fisher's PLSD test. In experiment 1, no significant difference were observed in the rates of cells maturing to the MI and MII stages, but that in the 10 ng mL–1 of TGF-a group (56.3%) were larger than in the other treatment groups (38.8–51.0%). The frequencies of MII stage cells in the 5, 10, and 50 µg mL–1 of IGF-1 treatment groups (9.8, 13.3, and 12.2%, respectively) were significantly higher than in the 0.5 µg mL–1 of IGF-1 group and the control group (5.3 and 2.2%, respectively). In experiment 2, the frequency of MI and MII cells in the control, 1 ng mL–1 of TGF-a plus 0.5 µg mL–1 of IGF-1, 10 ng mL–1 of TGF-a plus 5 µg mL–1 of IGF-1, 10 ng mL–1 of TGF-a plus 10 µg mL–1 of IGF-1, and 100 ng mL–1 of TGF-a plus 50 µg mL–1 of IGF-1 group were 44.1, 36.1, 63.5, 70.8, and 50.8%, respectively. The frequency of MII cells in the control group and the same treatment groups were 2.8, 7.2, 10.4, 15.3, and 10.8%, respectively. Both frequencies in the 10 ng mL–1 of TGF-a plus 10 µg mL–1 of IGF-1 group were significantly higher than in the control group. The TGF-a may act in a paracrine fashion on the surrounding granulosa cells, and IGF-1 may play multiple roles in cellular metabolism, proliferation, growth, and differentiation in canine oocyte maturation, as has been reported for many other species. In conclusion, these results demonstrate that a synergistic effect between TGF-a and IGF-1 produces an increased rate of in vitro maturation to the MI and MII stages in canine oocytes.

62 EFFECTS OF VARYING GLUTATHIONE CONCENTRATIONS IN SEMEN EXTENDER ON THE QUALITY OF FROZEN–THAWED CANINE SPERM

Trans-cervical insemination (TCI) with cryopreserved semen offers a potentially effective approach for breeding canids with specific genetic traits, such as guide dogs for the blind. However, there are technical difficulties in canine sperm cryopreservation, such as the composition of semen extender. The aim of this study was to evaluate the effects of glutathione (GSH) as an antioxidant in the semen extender to improve the quality of frozen-thawed dog sperm. A Tris-egg yolk-citrate extender containing 15.7 mg mL–1 of TRIS, 8.8 mg mL–1 of citric acid, 14.1 mg mL–1 of lactose, 25.4 mg mL–1 of raffinose, 1% (vol/vol) antibiotics, and 20% (vol/vol) egg yolk in ultra-pure water was used as the base medium. Twelve ejaculates were collected from 7 dogs. Each ejaculate was divided into 2 to 5 aliquots and extended with base extender supplemented with 0, 2.5, 5, 7.5, and 10 mM GSH as first dilution. The extended semen was equilibrated for 3 h at 4°C. An equal volume of second extender was added to obtain a final concentration of 6.5% glycerol and sperm per milliliter. The sperm samples were loaded in straws and frozen at 6 cm above the surface of LN2 for 15 min in a styrene foam box and plunged into the LN2. The frozen semen was thawed for evaluation. The motility of sperm was estimated with a phase-contrast microscope and the motile patterns were classified into the following grades: progressively motile at a high speed (+++), progressively motile at a moderate and low speed (++), motile without progression (+), and immotile (–). Then, the sperm motility index (SMI) was determined from the following formula as described previously (Iritani et al., 1975), with some modifications: the percentage of (+++) sperm + the percentage of (++) sperm × 0.75 + the percentage of (+) sperm × 0.5. Sperm motility and the SMI were determined at 0, 1, 2, 3, 4, 12, and 24 h after thawing. Acrosome status was evaluated at 4 h after thawing. Lipid peroxidation (LP) levels at 0 and 12 h after thawing were used to examine the antioxidant ability of GSH. Trans-cervical insemination was carried out on 5 bitches to evaluate the fertility of GSH-treated sperm. The TCI were performed nonsurgically with a laparoscope and deposited 2 mL of semen through a catheter. Each bitch was inseminated 1 to 2 times during oestrus. Data were analysed using ANOVA with the Tukey-Kramer method. We found that the rate of (+++) sperm in the 5 mM GSH group was higher than that in the 0 mM group from 1 to 24 h after thawing (P < 0.05). The SMI was higher in the 5 and 7.5 mM GSH groups than in the 0 mM group (P < 0.05). There were no significant differences in the control and 2.5 and 10 mM GSH groups. Long-term survival was increased in the 5 mM GSH group. Acrosome integrity was higher in the GSH-treated group. The level of LP was lower in the GSH-treated groups at 0 h after thawing (P < 0.05). Trans-cervical insemination with the 5 mM GSH-treated semen resulted in the delivery of 5 pups from 2 bitches. These results indicate that the cryopreservation with 5 mM GSH can improve the motility, viability, and fertility of frozen-thawed canine sperm by its antioxidant effects on the sperm membrane.

Small-cell carcinoma of the gallbladder - a clinicopathological, immunohistochemical and flow cytometric study of 15 cases

Small cell carcinoma (SC) of the gallbladder is an uncommon tumor, and not enough information of this tumor has been previously reported. The SCs in this series occured in nine women and six men (mean age; 64.5 years). Histologically, they consisted of small atypical cells with scanty cytoplasm, hyperchromatic nuclei and inconspicuous nucleoli growing in sheets and cords. Two tumors contained neoplastic glands similar to those of well-differentiated adenocarcinoma and a histological transition between SC and adenocarcinoma was seen in one of the two tumors. Argyrophil granules were present in 10 tumors. The tumor cells were immunoreactive to epithelial markers (epithelial membrane antigen: 12/14; AE1/AE3: 12/14; CAM 5.2: 9/14; carcinoembryonic antigen: 7/14) and neuroendocrine markers (neuron specific enolase: 11/14; chromagranin A: 4/14; Leu 7: 10/14; adrenocorticotrophic hormone: 6/14). Abnormalities in tumor suppressor gene p53 expression were found in 9 of 14 SCs by using monoclonal antibody PAb 1801. Flow cytometry revealed aneuploidy in 7 (78%) of 9 in the SC and 26 (40%) of 65 in the adenocarcinoma. The survival curve of the SCs was less favorable than that of papillary adenocarcinoma and well differentiated adenocarcinoma in pTNM stage 2-4 (P=0.0027, P=0.0017, respectively). These results suggested that the SCs of the gallbladder arose from common primitive cells capable of endocrine and epithelial differentiation, while most SCs (78%) showed DNA aneuploid by flow cytometry and their prognosis was worse than that of differentiated adenocarcinoma of the gallbladder.

Richtmyer-Meshkov instability: theory of linear and nonlinear evolution

A theoretical framework to study linear and nonlinear Richtmyer-Meshkov instability (RMI) is presented. This instability typically develops when an incident shock crosses a corrugated material interface separating two fluids with different thermodynamic properties. Because the contact surface is rippled, the transmitted and reflected wavefronts are also corrugated, and some circulation is generated at the material boundary. The velocity circulation is progressively modified by the sound wave field radiated by the wavefronts, and ripple growth at the contact surface reaches a constant asymptotic normal velocity when the shocks/rarefactions are distant enough. The instability growth is driven by two effects: an initial deposition of velocity circulation at the material interface by the corrugated shock fronts and its subsequent variation in time due to the sonic field of pressure perturbations radiated by the deformed shocks. First, an exact analytical model to determine the asymptotic linear growth rate is presented and its dependence on the governing parameters is briefly discussed. Instabilities referred to as RM-like, driven by localized non-uniform vorticity, also exist; they are either initially deposited or supplied by external sources. Ablative RMI and its stabilization mechanisms are discussed as an example. When the ripple amplitude increases and becomes comparable to the perturbation wavelength, the instability enters the nonlinear phase and the perturbation velocity starts to decrease. An analytical model to describe this second stage of instability evolution is presented within the limit of incompressible and irrotational fluids, based on the dynamics of the contact surface circulation. RMI in solids and liquids is also presented via molecular dynamics simulations for planar and cylindrical geometries, where we show the generation of vorticity even in viscid materials.

Effect of position of electrodes relative to the innervation zone onsurface EMG

We investigated the effect of the position of electrodes relative to the innervation zone (IZ) of the biceps brachii muscle during isometric elbow flexion using eight-channel surface array electrodes. We estimated the location of the IZ near the centre of the muscle in 20 male subjects. The pulse peaks from electromyogram (EMG) waveforms were detected for each channel and averaged, the triphasic pulse was determined, and the peak values of the first and third phases were compared. The results showed significantly greater pulse values for the first phase when the electrode placement was proximal to the estimated IZ, and for the third phase when the electrode placement was distal to the estimated IZ. Using this method, the positional relationship between electrodes and IZ can be determined using a surface EMG waveform recorded with a pair of bipolar electrodes. This method may be clinically useful in confirming the reliability of a recorded surface EMG.

A quantitative radiological assessment of outcomes of autogenous bone graft combined with platelet-rich plasma in the alveolar cleft

This longitudinal study evaluated the outcomes of secondary autogenous bone graft combined with platelet-rich plasma (PRP) in the alveolar cleft. Thirty-five alveolar clefts in 30 patients with grafted autogenous bone and PRP (PRP group), and 36 clefts in 30 patients with grafted autogenous bone alone (non-PRP group) were enrolled. PRP was extracted from autogenous blood using a plasma centrifuge system (SmartPReP SMP-1000). The density and resorption of grafted bone were evaluated at 1 week, and 1, 3, 6 and 12 months postoperatively. Bone density was quantitatively assessed as an aluminum-equivalence (Al-Eq) value. Moreover, relationships between bone resorption rate and prognostic factors were discussed. Al-Eq values decreased significantly until 3 months, and then increased up to 12 months in both groups. The Al-Eq rate in the PRP group was significantly smaller than that in the non-PRP group at 3 months. No significant differences were observed in the bone resorption rate between the groups. Regarding prognostic factors, continuous mechanical stress affected bone resorption with or without PRP. The authors suggest that PRP may enhance bone remodeling in the early phase, however, PRP seems to be insufficient as a countermeasure against bone resorption following secondary bone graft in the long term.

Contrasting alteration patterns of different cartilage plates in knee articular cartilage after spinal cord injury in rats

STUDY DESIGN

Experimental, controlled trial, animal study.

OBJECTIVE

To assess morphologic changes in different cartilage plates after spinal cord injury and identify the localization of these alterations.

SETTING

Saitama, Japan.

METHODS

A total of 16 Wistar rats were used. Eight rats underwent a spinal cord injury and eight rats had no intervention as control. The cartilage alterations of the knee joint were evaluated with radiography and histomorphometric analysis. To quantify cartilage alterations, we selected the histologic characteristics: thickness of the articular cartilage, number of chondrocytes, matrix staining to toluidine blue as a reflection of proteoglycan content and surface irregularity.

RESULTS

No differences in knee joints were found between the groups by radiography. In the medial knee joint, cartilage thickness of spinal-cord-injured knees increased at the anterior femoral region and decreased at the tibial and posterior femoral regions; however, in the lateral knee, that of spinal cord injuries did not change compared with control knees. Spinal cord injuries decreased the number of chondrocytes, especially at the anterior femoral regions. Matrix staining increased partially at the tibial regions. Surface irregularity of spinal-cord-injured knees was comparable to that of control knees in all cartilage plates.

CONCLUSION

The present findings exhibit characteristics of the cartilage after spinal cord injury. These alterations were different in nature between the medial and lateral regions. Future studies should assess separately different cartilage plates, to overestimate these severities when the changes at the medial knee were examined and to underestimate when the changes at the lateral knee were examined.

Intradural microsurgery and extradural gamma knife surgery for hypoglossal schwannoma: case report and review of the literature

There have been only 26 cases of hypoglossal schwannomas reported to originate intradurally and extend extradurally into the hypoglossal canal. This 31-year-old mother of two children presented with a 5-day history of progressive headache, nausea, vomiting and vertigo. Her neurological exam was significant for nystagmus and left tongue deviation with marked atrophy. An initial head CT revealed extensive left hypoglossal canal erosion with 4th ventricle compression. T1-weighted MR images with contrast revealed a 4x3 cm left cerebellopontine angle non-homogeneously enhancing mass with an intracranial cystic component and prominent extension into the eroded hypoglossal canal. A left lateral suboccipital craniotomy was performed for subtotal microsurgical resection of the intradural posterior fossa mass. A schwannoma was diagnosed after resection and gamma knife surgery (GKS) was performed three months later for the extradural residual tumor without further deficits. This is a rare report of a hypoglossal schwannoma in a young patient who was treated with a multimodality approach in order to minimize risks. A review of the literature and discussion of the respective benefits of microsurgery versus GKS and long-term follow-up issues are presented.

[Cavitating pleomorphic carcinoma of the lung; report of a case]

We report a case of a previously healthy 76-year-old male with cavitating pleomorphic carcinoma of the lung. He was admitted because of an abnormal lung shadow on chest X-ray. Computed tomography (CT) showed a well-demarcated nodular shadow within thin-walled cavity in the right upper lobe. Because the lesion was revealed as adenocarcinoma by transbronchial lung biopsy, right upper lobectomy was performed. By histopathologic examination of the resected specimen, the nodule contained a component of spindle cell features and the cavity wall was composed of adenocarcinoma. The final diagnosis was pleomorphic carcinoma. Postoperative course has been uneventful for 12 months after surgery.

Multiscale character of the nonlinear coherent dynamics in the Rayleigh-Taylor instability

We report nonlinear solutions for a system of conservation laws describing the dynamics of the large-scale coherent structure of bubbles and spikes in the Rayleigh-Taylor instability (RTI) for fluids with a finite density ratio. Three-dimensional flows are considered with general type of symmetry in the plane normal to the direction of gravity. The nonlocal properties of the interface evolution are accounted for on the basis of group theory. It is shown that isotropic coherent structures are stable. For anisotropic structures, secondary instabilities develop with the growth rate determined by the density ratio. For stable structures, the curvature and velocity of the nonlinear bubble have nontrivial dependencies on the density ratio, yet their mutual dependence on one another has an invariant form independent of the density ratio. The process of bubble merge is not considered. Based on the obtained results we argue that the large-scale coherent dynamics in RTI has a multiscale character and is governed by two length scales: the period of the coherent structure and the bubble (spike) position.

Improvement of productivity of active horseradish peroxidase in Escherichia coli by coexpression of Dsb proteins

Coexpression of two classes of folding accessory proteins, molecular chaperones and foldases, can be expected to improve the productivity of soluble and active recombinant proteins. In this study, horseradish peroxidase (HRP), which has four disulfide bonds, was selected as a model enzyme and overexpressed in Escherichia coli. The effects of coexpression of a series of folding accessory proteins (DnaK, DnaJ, GrpE, GroEL/ES, trigger factor (TF), DsbA, DsbB, DsbC, DsbD, and thioredoxin (Trx)) on the productivity of active HRP in E. coli were examined. Active HRP was produced by very mild induction with 1 microM isopropyl-beta-D-thiogalactopyranoside (IPTG) at 37 degrees C, whereas the amount of active HRP produced by the induction with 1 mM IPTG was negligibly small. Active HRP production was increased significantly by coexpression of DsbA-DsbB (DsbAB) or DsbC-DsbD (DsbCD), while coexpression of molecular chaperones did not improve active HRP production. The growth of E. coli cells was inhibited significantly by the induction with 1 mM IPTG in a HRP single expression system. In contrast, when HRP was coexpressed with DsbCD, the growth inhibition of E. coli was not observed. Therefore, coexpression of Dsb proteins improves both the cell growth and the productivity of HRP.

[Usefulness of the eradication of Helicobacter pylori for the patient with idiopathic thrombocytopenic purpura and lung cancer: report of a case]

A 61-year-old female was admitted because of an abnormal lung shadow on chest X-ray. She had suffered from idiopathic thrombocytopenic purpura (ITP) for more than 7 years. Computed tomography (CT) revealed that an irregular shadow, about 2 cm in diameter, was located in the upper lobe of the right lung. After intravenous immunogrobulin injections for 5 days, a hematology test indicated increased platelet counts and we performed thoracoscopic surgery successfully without blood transfusions. However, 4 months after surgery, a hematology test indicated decreased platelet counts again. Thirteen months after the operation, gastrointestinal fiberscopic examination showed Helicobacter pylori infection. After the urea breath test, eradication therapy let to a recovery in platelet counts.

Normal velocity freeze-out of the Richtmyer-Meshkov instability when a shock is reflected

It is known that for some values of the initial parameters that define the Richtmyer-Meshkov instability, the normal velocity at the contact surface vanishes asymptotically in time. This phenomenon, called freeze-out, is studied here with an exact analytic model. The instability freeze-out, already considered by previous authors [K.O. Mikaelian, Phys. Fluids 6, 356 (1994), Y. Yang, Q. Zhang, and D.H. Sharp, Phys. Fluids 6, 1856 (1994), and A.L. Velikovich, Phys. Fluids 8, 1666 (1996)], is the result of a subtle interaction between the unstable surface and the corrugated shock fronts. In particular, it is seen that the transmitted shock at the contact surface plays a key role in determining the asymptotic behavior of the normal velocity at the contact surface. By properly tuning the fluids compressibilities, the density jump, and the incident shock Mach number, the value of the initial circulation deposited by the reflected and transmitted shocks at the material interface can be adjusted in such a way that the normal growth at the contact surface will vanish for large times. The conditions for this to happen are calculated exactly, by expressing the initial density ratio as a function of the other parameters of the problem: fluids compressibilities and incident shock Mach number. This is done by means of a linear theory model developed in a previous work [J.G. Wouchuk, Phys. Rev. E. 63, 056303 (2001)]. A general and qualitative criterion to decide the conditions for freezing-out is derived, and the evolution of different cases (freeze-out and non-freeze-out) are studied with some detail. A comparison with previous works is also presented.

Ion generation in a low-density plastic foam by interaction with intense femtosecond laser pulses

Energetic proton generation in low-density plastic (C5H10) foam by intense femtosecond laser pulse irradiation has been studied experimentally and numerically. Plastic foam was successfully produced by a sol-gel method, achieving an average density of 10 mg/cm(3). The foam target was irradiated by 100 fs pulses of a laser intensity 1 x 10(18) W/cm(2). A plateau structure extending up to 200 keV was observed in the energy distribution of protons generated from the foam target, with the plateau shape well explained by Coulomb explosion of lamella in the foam. The laser-foam interaction and ion generation were studied qualitatively by two-dimensional particle-in-cell simulations, which indicated that energetic protons are mainly generated by the Coulomb explosion. From the results, the efficiency of energetic ion generation in a low-density foam target by Coulomb explosion is expected to be higher than in a gas-cluster target.

Proposed double-layer target for the generation of high-quality laser-accelerated ion beams

In order to achieve a high-quality, i.e., monoenergetic, intense ion beam, we propose the use of a double-layer target. The first layer, at the target front, consists of high-Z atoms, while the second (rear) layer is a thin coating of low-Z atoms. The generation of high-quality proton beams from the double-layer target, irradiated by an ultraintense laser pulse, is demonstrated with three-dimensional particle-in-cell simulations.

Three-dimensional particle-in-cell simulations of energetic electron generation and transport with relativistic laser pulses in overdense plasmas

The interaction of relativistic laser light with overdense plasmas is studied by three-dimensional particle-in-cell simulations. Generation of layered current sheets and quasistatic magnetic fields is observed near the target surface owing to anisotropic laser filamentation and Weibel instabilities. Later these current sheets tear into filaments that partially merge with each other to form isolated magnetic channels penetrating into the dense plasmas. It is found that fast electron energy flow is not only inside the magnetic channels but also it is widely distributed outside the channels. This is possible because of electron anomalous diffusion across self-generated magnetic fields. Consequently, the total hot electron current exceeds a few hundred kiloamperes and is much larger than the Alfvén current. Hence a considerable amount of energy flows towards the plasma core. Significant heating of the bulk plasma electrons is also observed.

Polarization effects and anisotropy in three-dimensional relativistic self-focusing

The relativistic self-focusing of high-intensity laser pulses in underdense plasmas is investigated with three-dimensional particle in cell simulations. The different behavior of a linearly polarized pulse in the two transverse directions is interpreted as a combination of two two-dimensional responses with different polarizations. In the polarization plane a high density sheet is formed, which separates the two regions of oppositely directed quasistatic magnetic field.

Intracerebral hematoma due to ruptured nontraumatic middle meningeal artery aneurysm--case report

A 77-year-old woman suddenly lost consciousness and presented with right hemiparesis. Computed tomography showed a large subcortical hematoma in her left frontal lobe associated with subarachnoid hemorrhage. The first impression was hemorrhage due to a ruptured aneurysm of the middle cerebral or the internal carotid artery on the left. Left internal carotid angiography showed no aneurysm or vascular anomaly, but back flow of contrast medium into the external carotid artery disclosed two saccular aneurysms arising from the anterior branch of the left middle meningeal artery (MMA). Emergent surgical intervention confirmed that the hematoma was due to ruptured MMA aneurysm. Nontraumatic MMA aneurysm should be recognized as a possible causative lesion of intracranial hemorrhage despite the extremely low incidence. External carotid angiography should be performed in patients with intracranial hemorrhage in whom no vascular cause can be detected in the internal carotid system.

Anisotropic filamentation instability of intense laser beams in plasmas near the critical density

The relativistic filamentation instability (RFI) of linearly polarized intense laser beams in plasmas near the critical density is investigated. It is found that the RFI is anisotropic to transverse perturbations in this case; a homogeneous laser beam evolves to a stratified structure parallel to the laser polarization direction, as demonstrated recently with three-dimensional particle-in-cell simulations by Nishihara et al. [Proc. SPIE 3886, 90 (2000)]. A weakly relativistic theory is developed for plasmas near the critical density. It shows that the anisotropy of the RFI results from a suppression of the instability in the laser polarization direction due to the electrostatic response. The anisotropic RFI is also analyzed based on an envelope equation for the laser beam. Finally, the envelope equation is solved numerically, and anisotropic filamentation and self-focusing are illustrated.

A collision tumor composed of adenocarcinoma and malignant lymphoma in the remnant stomach after pancreatoduodenectomy: report of a case

The occurrence of a collision tumor in the stomach, consisting of adenocarcinoma and malignant lymphoma, is extremely rare. We report herein the case of a patient who had undergone a pancreatoduodenectomy for bile duct cancer 5 year earlier, in whom an ulcerating tumor of the remnant stomach developed and grew rapidly within 5 months. Surgical exploration revealed a tumor in the remnant stomach, multiple liver metastases, and multiple lymph node metastases. Total resection of the remnant stomach was performed, and pathological examination revealed a collision tumor consisting of adenocarcinoma and malignant lymphoma. The patient died of liver metastases and lymph node metastases 7 months after his second operation. The coexistence of both adenocarcinoma and malignant lymphoma of the remnant stomach and the etiology of this unusual combination, never previously reported, is discussed.