Construction and evaluation of a neurofeedback system using finger tapping and near-infrared spectroscopy

Introduction

Neurofeedback using near-infrared spectroscopy (NIRS) has been used in patients with stroke and other patients, but few studies have included older people or patients with cognitive impairment.

Methods

We constructed a NIRS-based neurofeedback system and used finger tapping to investigate whether neurofeedback can be implemented in older adults while finger tapping and whether brain activity improves in older adults and healthy participants. Our simple neurofeedback system was constructed using a portable wearable optical topography (WOT-HS) device. Brain activity was evaluated in 10 older and 31 healthy young individuals by measuring oxygenated hemoglobin concentration during finger tapping and neurofeedback implementation.

Results

During neurofeedback, the concentration of oxygenated hemoglobin increased in the prefrontal regions in both the young and older participants.

Discussion

The results of this study demonstrate the usefulness of neurofeedback using simple NIRS devices for older adults and its potential to mitigate cognitive decline.

Non-invasive intraductal oncocytic papillary neoplasm forming a protruding lesion toward the duodenum from the accessory papilla: a case report

BACKGROUND

Intraductal oncocytic papillary neoplasm (IOPN), previously classified as a subtype of intraductal papillary mucinous neoplasm (IPMN), has been described as an independent disease by the WHO since 2019. IOPN is a rare tumor, with few reported cases. Herein, we report a case of resected non-invasive IOPN that formed a lesion protruding toward the duodenum from the accessory papilla.

CASE PRESENTATION

An 80-year-old woman was referred to our hospital because of a giant mass in the pancreatic head detected on abdominal contrast-enhanced computed tomography (CT) performed for a close examination of a mass in the right breast. CT revealed a 90-mm-sized tumor with a mixture of solid and cystic components, with contrast enhancement in the pancreatic head, and a dilated main pancreatic duct. Esophagogastroduodenoscopy revealed a semi-circumferential papillary tumor protruding toward the duodenal lumen, which did not protrude from the papilla of Vater. Transpapillary biopsy led to a preoperative diagnosis of IPMN with an associated invasive carcinoma. As there were no distant metastasis, open subtotal stomach-preserving pancreaticoduodenectomy was performed. Analysis of the surgical specimen and histopathological examination revealed that the tumor was an IOPN that protruded toward the duodenal mucosa from the accessory papilla while replacing the duodenal mucosa with no obvious stromal invasion.

CONCLUSION

IOPN is a rare and poorly recognized tumor with few reported cases. There have been no reports describing IOPN forming a protruding lesion toward the duodenum from the accessory papilla. Therefore, further accumulation of cases such as this one is important to advance the study of IOPN.

Clinical Impact of Preoperative Neutrophil-to-Lymphocyte Ratio in Surgical Patients With Pancreatic Cancer

BACKGROUND/AIM

The prognosis of patients with pancreatic cancer remains poor, despite recent advances in surgical techniques, perioperative care, neoadjuvant and adjuvant chemotherapy. This study aimed to investigate the preoperative neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor and determine the optimal cutoff value in surgical patients with pancreatic cancer.

PATIENTS AND METHODS

We retrospectively enrolled 461 patients with pancreatic cancer who underwent resection between January 2013 and December 2022 in the Department of Gastrointestinal Surgery at Kanagawa Cancer Center. The association between continuous or categorical variables and NLR was analyzed using the Mann-Whitney U-test and Fisher's exact test. Overall survival (OS) and relapse-free survival (RFS) rates were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional-hazard regression models.

RESULTS

The optimal cutoff value for the preoperative NLR was 3.2. The NLR≥3.2 was associated with a large tumor size (p=0.005), poor histological differentiation (p=0.002), and less adjuvant chemotherapy (p=0.048). The NLR≥3.2 had an important influence on the decreased OS (21.6 vs. 25.8 months), and RFS (10.3 vs. 14.3 months). In univariate and multivariate analyses, the preoperative NLR was an independent prognostic factor for OS (p=0.022) and RFS (p=0.002).

CONCLUSION

Preoperative NLR (cutoff value: 3.2) within two weeks before surgery is a prognostic factor for OS and RFS in surgical patients with pancreatic cancer. This study could help establish evidence on the immune system's impact and a unified treatment strategy pre-surgery, potentially improving the prognosis for patients with pancreatic cancer.

Risk factors for early recurrence in patients with pancreatic ductal adenocarcinoma who underwent curative resection

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, and surgical resection is the only potentially curative approach. However, the rate of recurrence remains high, particularly within the first 6 months, and is associated with a poor prognosis. The present study evaluated the clinical characteristics and risk factors for early recurrence in pancreatic ductal adenocarcinoma (PDAC) patients who underwent curative resection, regardless of the use of neoadjuvant chemotherapy, to identify predictive factors associated with early recurrence and poor outcomes as well as to determine the optimal treatment strategy for patients at high risk of early recurrence after surgical resection.

METHODS

Patients who underwent pancreatic resection for PDAC at our institution from 2013 to 2021 were included in this study. We investigated the clinicopathological features of patients in groups: those with recurrence within 6 months, recurrence between 6 and 12 months, and recurrence beyond 12 months or no recurrence. A logistic regression analysis identified covariates associated with early recurrence at 6 and 12 months.

RESULTS

The study included 403 patients with a median follow-up of 25.7 months. Recurrence was observed in 279 patients, with 14.6% recurring within 6 months, 23.3% within 6-12 months, and 62% after 12 months or not at all. The preoperative CA19-9 level, modified Glasgow prognostic score (mGPS), and positive peritoneal cytology were significant risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant risk factors for recurrence within 12 months. For patients who received preoperative chemotherapy or chemoradiotherapy, the preoperative CA19-9 level, mGPS, and positive peritoneal cytology were significant independent risk factors for early recurrence within 6 months, while positive peritoneal cytology, lymph node metastasis, and the absence of adjuvant chemotherapy were significant independent risk factors for recurrence within 12 months. The study concluded that the overall survival after surgical resection for potentially resectable PDAC worsened according to the number of risk factors present in the patient.

CONCLUSIONS

We clarified that preoperative CA19-9, positive peritoneal cytology, and the lack of adjuvant chemotherapy were consistent predictors for early recurrence within 6 and 12 months. In addition, an increased number of risk factors affecting the patient was associated with a poorer overall survival after potentially curable resection. Calculating the number of risk factors for early recurrence may be an essential predictive factor when considering treatment strategies.

Comparison of Cerebral Blood Volume during Cold and Warm Stimulation in Elderly and Young Subjects

Background

Dementia involves a neuronal loss in the primary somatosensory cortex of the parietal lobe, causing dementia patients to perceive pain stimuli hardly. The function of temperature sensation declines. Studies measuring brain blood volume using near-infrared light have reported that patients suffering from dementia have less activation than healthy elderly people. However, the majority of these studies used tests related to cognitive function and the frontal lobe, and few have examined thermal sensation.

Objective

The present study aimed to investigate the effect of cold and warm stimulation on cerebral blood volume in elderly and young subjects.

Material and Methods

This observational study measured changes in oxygenated hemoglobin concentrations in the frontal cortex during cold and warm stimulation in elderly and young subjects using a near-infrared light device. The mean and standard deviation of the change in oxygenated hemoglobin concentration before and after cold and warm stimulation, as well as the center-of-gravity values, were compared between the young and the elderly.

Results

During warm stimulation, the younger subjects showed an increase in blood oxygenated hemoglobin levels; however, the difference was not significant. For the elderly, no change was observed during the task. The center of gravity values was lower in the young compared to the elderly which was similar to the reaction threshold. No significant changes were observed during cold stimulation.

Conclusion

Thermal sensation thresholds were impaired in the elderly compared to the young; however, cerebral blood volume changes were unclear.

Carbon Ion Radiotherapy Versus Perioperative Adjuvant Chemotherapy and Curative Surgery for Resectable Pancreatic Cancer

BACKGROUND/AIM

The standard treatment for resectable pancreatic cancer is preoperative adjuvant chemotherapy (NAC) + curative surgery + adjuvant chemotherapy. Although excellent local control results of carbon ion radiotherapy (CIRT) for pancreatic cancer have been reported, no reports have compared CIRT with the standard treatment for resectable pancreatic cancer. In this study, we compared the results of CIRT for resectable pancreatic cancer with those of standard therapy and investigated the usefulness of CIRT.

PATIENTS AND METHODS

The subjects were 35 patients who underwent CIRT for clinical cT1-2, N0-1, and M0 cancers at Kanagawa Cancer Center, Yokohama, Japan, from September 2018 to September 2021, and 110 patients who underwent standard treatment (NAC + curative surgery + adjuvant). Overall survival (OS) and recurrence-free survival (PFS) were compared between the two groups using propensity score-matching (PSM).

RESULTS

Twenty-three CIRT monotherapy patients were matched with NAC + curative surgery + adjuvant chemotherapy patients by PSM. Although there was no significant difference in RFS between the two groups, OS was significantly poorer in the CIRT monotherapy group than in the NAC + curative surgery + adjuvant chemotherapy group.

CONCLUSION

This single-centre retrospective propensity score-matched comparison of CIRT and NAC + curative resection + adjuvant chemotherapy as the standard therapy for resectable pancreatic cancer showed an inferiority of CIRT in terms of OS, but no difference in PFS. Therefore, CIRT monotherapy may be a treatment strategy for patients with contraindications for standard treatment of curative surgery plus perioperative chemotherapy.

Clinical therapeutic effects of neoadjuvant chemotherapy in resectable pancreatic cancer

677

Background: Results from the phase III Prep-02/JSAP-05 trial demonstrated the efficacy and safety of gemcitabine plus S-1 as neoadjuvant chemotherapy for resectable pancreatic cancer. However, consensus on neoadjuvant chemotherapy for pancreatic cancer has not yet been established, and the effects of neoadjuvant therapy on clinical features of the tumor and improvement in prognosis have not been fully investigated. We aimed to investigate the effect of neoadjuvant chemotherapy on resectable pancreatic cancer. Methods: Between 2013 and 2021, 291 patients who underwent curative resection for resectable pancreatic cancer at our hospital were enrolled. The patients were categorized into groups of those who received neoadjuvant chemotherapy (NAC group: n = 91) and those who received up-front surgery (US group: n = 200). Prognostic predictors were examined in (i) all patients, (ii) US group, and (iii) NAC group. Statistical significance was considered at p < 0.05. Results: The median follow-up periods were 20.7 and 33.2 months in the NAC and US groups, respectively. In the NAC group, 84 of the 91 patients (94.5%) received gemcitabine-based chemotherapy, and three (3.3%) received chemoradiotherapy. There was no difference in overall survival (OS) and recurrence free survival (RFS) between the two groups. In the background, the NAC group had lower preoperative CA19-9 levels, lower lymph node ratio (LNR), and smaller tumor size than in the US group. During multivariable analysis of OS, preoperative CA19-9 levels, LNR, modified Glasgow prognostic score (mGPS), resection margin, and tumor size were identified as possible prognostic predictors in all patients and in the US group, whereas LNR and mGPS were identified in the NAC group. Conclusions: The prognostic significance of preoperative CA19-9 level, tumor size, and LNR were counteracted in the NAC group. These findings may indicate the effect of neoadjuvant chemotherapy for resectable pancreatic cancer.

Additional clinical impact of plaque analysis for on-site CT-derived FFR in coronary CT angiography on midterm prognosis

Background

We previously reported that per-patient on-site computed tomography-fractional flow reserve (CT-FFR), which can be acquired on-site workstation using fluid structure interaction during the multiple optimal diastolic phases measured 1 to 2 cm distal to a target lesion may be feasible for risk stratification based on future cardiac events for patients who did not undergo planned revascularization. However, per-vessel CT-FFR and the additional impact of plaque analysis on CT-FFR have not been evaluated.

Purpose

The aim of this study is to assess the clinical and additional impact of novel plaque analysis using labeling method for per-vessel CT-FFR on midterm prognosis.

Methods

A total of 254 consecutive patients with 354 vessels showing 50–90% stenosis but not revascularized within 90 days from coronary CT angiography (CCTA) on 320-row CT were retrospectively analyzed and followed during a median follow up 3.6 years. Plaque characteristics by labeling method (necrotic core/total plaque volume (% necrotic core), non-calcified plaque (NCP)/vessel volume (%NCP), and total plaque/vessel volume (%total plaque) for both total vessel volume (mm3) and at minimum lumen area (MLA, mm2)), positive remodeling (PR) and CT-FFR were analyzed on per-target vessels. The endpoint was vessel oriented-composite outcome (VOCO), including cardiac death, non-fatal MI, and unplanned revascularization.

Results

The incidence of VOCO occurred in 6.8% (24/354). In the cox proportional hazard model, a multivariate analysis identified CT-FFR≤0.80 was the most associated factor with VOCO (all values &lt;0.01 for other plaque morphologies), but %necrotic core, %NCP, %total plaque at MLA and PR were significantly independent of CT-FFR≤0.80. (%necrotic core HR; 3.43 (p&lt;0.01 [95% confidence interval (CI) 1.42–8.29]), %NCP HR; 4.05 (p=0.03 [95% CI 1.19–13.71]), %total plaque at MLA HR; 2.82 (p=0.02 [95% CI 1.18–6.76]), and PR HR; 2.90 (p&lt;0.01 [95% CI 1.30–6.51]), respectively.)

Conclusion

From a view point of clinical outcomes for vessels with moderate to severe stenosis but not revascularized at initial CCTA, CT-FFR demonstrated the significant impact on per-vessel analysis. Moreover, %necrotic core, %NCP and %total plaque at MLA analyzed by labeling method provided better prognostic value in addition to CT-FFR.

Funding Acknowledgement

Type of funding sources: None.

Clinical impact of novel pericoronary adipose tissue measurement on ECG-gated non-contrast chest CT scan

Background

Pericoronary adipose tissue (PCAT) quantified from coronary computed tomography angiography (CCTA) is a new predictor of CT-derived high-risk plaque (HRP) and adverse cardiac events. There has been no report investigating the method to assess PCAT from non-contrast CT so far. In this present study, we developed a brand-new method to quantify the value of PCAT from electrocardiogram (ECG)-gated non-contrast CT (NC-PCAT).

Purpose

To develop a brand-new method to quantify NC-PCAT accurately, and evaluate its prognostic value.

Methods

We retrospectively studied two independent cohorts of patients undergoing CCTA and ECG-gated non-contrast CT for clinical indication of coronary artery disease (CAD). For former cohort of consecutive 300 patients, we validated the agreement between the NC-PCAT and PCAT, and evaluated the association between NC-PCAT and the prevalence of HRP. For latter cohort of consecutive 333 patients, we dichotomized them into two groups with median NC-PCAT, and assessed the prognostic value of NC-PCAT. To quantify NC-PCAT, we placed 15x15mm region of interest at epicardial fat tissue dorsally adjacent to right coronary ostium in axial slice of ECG-gated non-contrast CT, and defined NC-PCAT as the mean CT value of each 1x1mm pixel there. PCAT was quantified from CCTA using conventional method as described in former researches. Primary endpoint was defined as major adverse cardiac events (MACE), composite of all-cause death and non-fatal myocardial infarction. HRP was defined as coronary artery plaque which has two or more following features; positive remodeling, low attenuation, spotty calcification, and napkin-ring sign.

Results

NC-PCAT was well-correlated with PCAT (r=0.68, p&lt;0.0001). In former cohort, we found HRP in 34 (11.3%) patients. In multivariable logistic regression analysis, higher NC-PCAT (OR 1.06, 95% CI 1.03–1.10, p=0.0001), coronary artery calcium score (CACS) (OR 1.01 per 10 CACS increase, 95% CI 1.00–1.02, p=0.013), and current smoking (OR 2.58, 95% CI 1.03–6.49, p=0.044) were independent predictors of the prevalence of HRP. Among patients with CACS more than zero (n=193), NC-PCAT (OR 1.06, 95% CI 1.03–1.10, p=0.0002), current smoking (OR 3.02, 95% CI 1.17–7.82, p=0.027), and male (OR 2.81, 95% CI 1.06–7.48, p=0.028) were independent predictors of the prevalence of HRP, whereas CACS was not (p=0.15). In latter cohort, the median duration of follow-up was 2.9 years (IQR 1.9–3.9), and 16 (4.8%) cases of MACE were identified. The cumulative incidence of MACE was significantly higher in high NC-PCAT group. Multivariable cox hazard regression analysis revealed that higher NC-PCAT was an independent predictor of primary endpoint, even after adjustment for sex and age (HR 4.28, 95% CI 1.20–12.52, p=0.012).

Conclusions

There was a positive correlation between NC-PCAT and PCAT. Higher NC-PCAT is significantly associated with not only the prevalence of HRP, but also worse clinical outcome.

Funding Acknowledgement

Type of funding sources: None.

Comparative reproductive ecology of two sister Asarum species (Aristolochiaceae) in relation to the evolution of elongated floral appendage

Genus Asarum (Aristolochiaceae) shows diverse floral morphology and is hypothesized to have diversified as a result of pollinator-mediated selection. Yet most aspects of their reproductive ecology, including pollinators, remain unclear. This study focuses on A. costatum and A. minamitanianum in Japan, a sister species pair having remarkable differences in calyx lobe length (10-20 mm and 70-180 mm, respectively). The objectives of this study are to elucidate multiple aspects of reproductive ecology of these two species and obtain evolutionary insights into floral organ elongation. We adopted combined approaches, including field observations, molecular analyses and cultivation experiments, such as pollinator observation for 3 years, fine-scale spatial genetic analysis of 769 individuals, paternity analysis based on 566 seeds over 4 years, and control pollination experiments. Both Asarum species had strong spatial genetic structures, indicating limited seed dispersal. Pollinator observation revealed that flies and ground-dwelling insects visited flowers of both species, but that the pollinator fauna differed between the species. The visitation rate of flies was extremely low but was more than twice as high in the species with an elongated floral appendage. Paternity analysis revealed A. minamitanianum was predominantly outcrossing, while A. costatum showed a wide range of selfing rates among fruits. These two Asarum species are likely adapted to fly pollination in the shady forest understorey, where available pollinator fauna is limited. In addition, although its function remains unclear, the elongated calyx lobe of A. minamitanianum could have evolved for effective pollen dispersal by attracting fly visitors.

Optimal measurement location of on-site based CT-derived FFR on midterm prognosis

Background

Fractional Flow Reserve (FFR) derived from coronary computed tomography angiography (CCTA) enables anatomical and hemodynamical assessment of coronary artery disease. CT-FFR, which can be acquired on-site workstation using fluid structure interaction during the multiple optimal diastolic phase, has an incremental diagnostic value over conventional CCTA. However, few studies are focused on investigating the appropriate measurement location of CT-FFR, considering the prognosis, using CCTA as a standalone modality.

Purpose

The aim of this study is to assess the clinical impact on CT-FFR with an appropriate measurement.

Methods

A total of 370 consecutive patients who underwent CCTA in a single-heartbeat scan with a phase window of 70% to 99% of the R-R interval, showing 50–90% stenosis of at least one major epicardial vessel measuring ≥1.8 mm in diameter on CCTA were retrospectively analyzed and followed during a median follow up 2.9 years. CT-FFR values were measured at three points: 1, 2 cm distal to a target lesion (CT-FFR1cm, 2cm) and the vessel terminus (CT-FFRlowest), and a CT-FFR value ≤0.80 was considered abnormal. The endpoint was MACE, a composite of cardiac death, non-fatal MI, and unplanned revascularization.

Results

The incidence of MACE occurred in 8.4% (31/370) of the whole patients, including four cardiac deaths, ten all cause deaths, two non-fatal MI, and twenty unplanned revascularization. The Kaplan-Meier survival analysis demonstrated a significantly higher cumulative MACE rate in patients with positive CT-FFR1cm and 2cm than those with negative CT-FFR1cm and 2cm, while there was no significant difference between negative and positive in CT-FFRlowest, among patients with negative CT-FFR1cm and 2cm (Figure 1). Among 221 patients, who did not perform early revascularization within 90 days from CCTA, there was no significant difference in CT-FFRlowest in the incidence of MACE. In contrast, the risk of MACE was significantly higher in both positive CT-FFR1cm and CT-FFR2cm (Figure 2).

Conclusion

From a view point of clinical outcome for patients with moderate to severe stenosis on CCTA, a CT-FFR value when measured at 1-to-2 cm distal to a target lesion could be feasible for the deferral of unnecessary invasive coronary angiography safely. Moreover, CT-FFR1–2cm showed better risk stratification measurement rather than CT-FFRlowest, based on future adverse cardiac event.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Canon Medical Systems Corporation Kaplan-Meier 1Kaplan-Meier 2

[A Case of Laparoscopy-Assisted Surgery for Intestinal Malignant Lymphoma with Bowel Obstruction]

An 83-year-old woman visited our emergency department with a chief complaint of abdominal pain and vomiting. Abdominal computed tomography showed thickening of the wall of the small intestine in the right middle abdomen and marked bowel dilation and fluid retention in the oral side of the small intestine. The patient was diagnosed with adhesive bowel obstruction and hospitalized for conservative treatment. However, the treatment was unsuccessful, and laparoscopic surgery was performed. The intraoperative findings included thickening of the wall and hardening of the obstructed part, suggestive of an intestinal tumor; thus, this part was resected. A histopathological examination revealed diffuse infiltration of large-sized atypical lymphocytes in the tumor, and diffuse large B-cell lymphoma was diagnosed through immunochemical staining. The postoperative course was uneventful, and the lymphoma has not recurred. Intestinal malignant lymphoma rarely causes bowel obstruction without invagination. Here, we report this case and review the literature.

[A Case of Remnant Gastric Necrosis after Laparoscopy-Assisted Distal Gastrectomy]

A 77-year-old man with a medical history of hypertension, dyslipidemia, angina pectoris, and internal carotid artery stenosis underwent laparoscopy-assisted distal gastrectomy, D2 lymphadenectomy, and Billroth Ⅰ reconstruction for advanced gastric cancer. Hematologic examination revealed severe anemia on postoperative day 2, and abdominal CT scan detected contrast media leakage into the remnant gastric lumen. Upper gastrointestinal endoscopy revealed mucosal necrosis and ulceration of a large range. The patient recovered with conservative treatment and was discharged on postoperative day 18. Endoscopic balloon dilation was required to improve anastomotic stenosis after discharge, after which the patient received adjuvant chemotherapy. The stomach is resistant to ischemic changes because of the microvascular networks in the stomach wall; thus, gastric remnant necrosis after gastrectomy is rare. However, for patients with arterial sclerosis, such as in this case, physicians must consider the range of gastrectomy and reconstruction methods.

Toll-like receptor 9 polymorphisms in brazilian patients with systemic lupus erythematosus: a pilot study

Toll-like receptor 9 (TLR9) is an important component of the innate immune system and have been associated with several autoimmune diseases, such as Systemic Lupus Erythematosus (SLE). The aim of this study was to investigate polymorphisms in TLR9 gene in a Brazilian SLE patients group and their association with clinical manifestation, particularly Jaccoud's arthropathy (JA). We analyzed DNA samples from 204 SLE patients, having a subgroup of them presenting JA (n=24). A control group (n=133) from the same city was also included. TLR9 single nucleotide polymorphisms (SNPs) (-1237 C>T and +2848 G>A) were identified by sequencing analysis. The TLR9 gene genotype frequency was similar both in SLE patients and the control group. In the whole SLE population, an association between the homozygosis of allele C at position -1237 with psychosis and anemia (p < 0.01) was found. Likewise, the homozygosis of allele G at position +2848 was associated with a discoid rash (p < 0.05). There was no association between JA and TLR9 polymorphisms. These data show that TLR9 polymorphisms do not seem to be a predisposing factor for SLE in the Brazilian population, and that SNPs are not associated with JA.

[A Case of Port-Site Herniation from an Eight mm Port after Robot-Assisted Distal Gastrectomy]

A 63-year-old-woman was diagnosed with gastric cancer cStage ⅠA after ESD, and then, underwent robot-assisted distal gastrectomy. She vomited on the postoperative day 2 and then was inserted nasogastric tube. The amount of drainage from the tube was increased on the postoperative day 5, therefore, abdominal computed tomography scan was performed, which showed herniation of small bowel at the 8 mm port site in the left upper abdomen. The emergent surgery was performed because of difficulty in manual reduction. Intraoperative findings showed that small intestine was incarcerated at the left 8 mm port-site. The intestine was released by incising the fascia of hernia orifice, then, the fascia was repaired. There was no recurrence of gastric cancer and port-site hernia for 34 months after surgery. In general, the fascia of over 10 mm port site is sutured and closed to avoid port-site hernia, however, it is unclear whether the fascia of 8 mm port-site should be closed after robotic surgery. Since we experienced this case, we have also performed fascia suture on the 8 mm port-site in all cases. And then, we could prevent occurrence of port-site hernia in the 8 mm port-site.

[A Case of Undifferentiated Intestinal Carcinoma]

Undifferentiated cancer of the small intestine has a poor prognosis and has rarely been reported.We report a case of undifferentiated intestinal carcinoma.A 55-year-old man presented with epigastralgia in December 2018. Blood test results showed a high degree of anemia.Contrast -enhanced abdominal CT showed a small intestinal tumor with a diffuse thickened wall along with multiple liver metastases.Capsule endoscopy revealed a bleeding tumor.It was diagnosed as carcinoma by transhepatic-ultrasound-guided core needle biopsy.Given the preoperative diagnosis of intestinal carcinoma, we resected the tumor along with a part of the small intestine and the enlarged lymph nodes.The pathological diagnosis was undifferentiated intestinal carcinoma.The patient was discharged on the 6th postoperative day after surgery.He was scheduled to receive postoperative chemotherapy.There was no evidence of undifferentiated intestinal carcinoma.Herein, we review case reports from the literature.

[A Case of Malignant Peritoneal Mesothelioma Resected Four Times in Five Years]

We report a long-surviving case of malignant peritoneal mesothelioma requiring 4 operations in 5 years. A 63-year-old man was diagnosed with gastrointestinal stromal tumor(GIST)that was excised for the first time in June 2011. The pathological diagnosis was malignant peritoneal mesothelioma. Thereafter, we excised recurrences of the tumor in the hepatic hilum in December 2011. Similar operations were performed in March 2012 and August 2015 because of tumors in the small bowel mesentery and the segment 8 of the liver. The pathological diagnosis was malignant peritoneal mesothelioma. It is an extremely rare variant of malignant peritoneal mesothelioma. There is no record of multiple excision of malignant peritoneal mesothelioma for recurrences. In this case, the cause of long survival was considered to be the excision of recurrent tumors.

[Eight Cases of Primary Carcinoma of the Vermiform Appendix]

Primary carcinoma of the vermiform appendix is a rare neoplasm, and its treatment strategy has not yet been established. We retrospectively analyzed 8 cases of primary carcinoma of the vermiform appendix from 2007 to 2017. Six cases were male and two were female, with a median age of 60.5 years. Ileocecal resection and right hemicolectomy were performed in 7 cases and 1 case, respectively. Regarding pathological staging, 5 cases were of pStage Ⅱ, 2 were of pStage Ⅲa, and 1 was of pStage Ⅳ. Three cases had recurrences after curative resection. The postoperative median overall survival time was 45 months. Three cases with a tumor diameter of 20mm were alive without any recurrence; however, 3 of 5 cases with a tumor diameter of B21mm had recurrences. Although only 1 of 3 cases with adjuvant chemotherapy(pStage Ⅲa case)had recurrence, 2 of 4 cases without adjuvant chemotherapy, including a pStage Ⅱ case, had recurrences. Early diagnosis, surgery, and adjuvant chemotherapy could improve the long-term outcomes of patients with primary carcinoma of the vermiform appendix.

Arcuate nucleus neuropeptide coexpression and connections to gonadotrophin-releasing hormone neurones in the female rhesus macaque

The underlying hypothalamic neurocircuitry by which metabolism and feeding regulates reproductive function has been well-studied in the rodent; however, recent data have demonstrated significant neuroanatomical differences in the human brain. The present study had three objectives, centred on arcuate nucleus neuropeptides regulating feeding and reproduction: (i) to characterise coexpression patterns in the female nonhuman primate; (ii) to establish whether these neuronal populations make potential contacts with gonadotophin-releasing hormone (GnRH) neurones; and (iii) to determine whether these contacts differ between the low and high GnRH-releasing states of pre-puberty and adulthood, respectively. Female nonhuman primates have several coexpression patterns of hypothalamic neuropeptides that differ from those reported in rodents. Cocaine- and amphetamine-regulated transcript (CART) is not coexpressed with pro-opiomelanocortin but instead with neuropeptide Y (NPY). CART is also expressed in a subpopulation of kisspeptin cells in the nonhuman primate, similar to observations in humans but diverging from findings in rodents. Very few GnRH-expressing neurones received close appositions from double-labelled kisspeptin/CART fibres; however, both single-labelled kisspeptin and CART fibres were in frequent apposition with GnRH neurones, with no differences between prepubertal and adult animals. NPY/agouti-related peptide (AgRP) coexpressing fibres contacted significantly more GnRH neurones in prepubertal animals than adults, consistent with increased NPY and AgRP mRNA observed in prepubertal animals. The findings of the present study detail significant differences in arcuate nucleus neuropeptide coexpression in the monkey compared to the rodent and are consistent with the hypothesis that arcuate nucleus NPY/AgRP neurones play an inhibitory role in controlling GnRH neuronal regulation in the prepubertal primate.

43 WARMING TEMPERATURE AFFECTS THE VIABILITY AND MEIOTIC COMPETENCE OF IMMATURE PORCINE OOCYTES VITRIFIED IN A CHEMICALLY DEFINED SOLUTION

The aim of this study was to examine the viability and meiotic competence of porcine oocytes when immature porcine cumulus-oocyte complexes (COC) were pretreated for vitrification at different temperatures (25 and 39°C), vitrified in a chemically defined solution, and warmed at different temperatures (39 and 60°C). Cumulus-oocyte complexes were aspirated from middle-size follicles (3–6 mm in diameter) of abattoir-derived porcine ovaries. After collection, the COC were pretreated with cryoprotectants at different temperatures (25 and 39°C) and vitrified in a serum-free chemically defined solution containing 0.6 mg mL–1 of hydroxypropyl cellulose, basically according to a commercial protocol (Cryotop, Kitazato BioPharma Co. Ltd., Fuji, Japan). The vitrified COC were warmed in 1 M trehalose solution at 39 for 60 s or at 60°C for 30 s. The COC were cultured for in vitro maturation (IVM) in modified porcine oocyte medium (POM) supplemented with 50 μM β-mercaptoethanol, 10 IU mL–1 of eCG, 10 IU mL–1 of hCG, and 1 mM dibutyryl cyclic AMP (dbcAMP) for 20 h and then in the fresh medium without hormonal supplements and dbcAMP for another 24 h. Viability of COC was evaluated under fluorescent microscopy after stain with fluorescein diacetate and propidium iodide. Nuclear maturation of the oocytes was evaluated after 44 h of IVM. Statistical analyses of results from 5 replicated trials were performed by ANOVA with a Bonferroni/Dunn post-hoc test (significance, P < 0.05). Although viabilities of vitrified oocytes after 44 h of IVM [6.0% (9/149) to 37.8% (59/155)] were significantly lower than fresh controls [98.8% (158/160)], the viabilities of vitrified oocytes warmed at 60°C [32.0% (49/160) to 37.8% (59/155)] were significantly higher than those warmed at 39°C [6.0% (9/149) to 10.0% (16/160)]. Maturation rates in vitrified oocytes [2.7% (4/149) to 19.8% (31/155)] were also significantly lower than fresh controls [74.8% (120/160)]. Regardless of temperature during pretreatment for vitrification (25 and 39°C), maturation rate of the oocytes warmed at 60°C after vitrification [16.4% (25/154) to 19.8% (31/155)] was significantly higher than that warmed at 39°C [3.1% (5/160) to 2.7% (4/149)]. In conclusion, these results demonstrate that warming at 60°C for 30 s maintains the viability and meiotic competence of immature porcine COC.

81 VITRIFICATION OF IMMATURE PORCINE CUMULUS - OOCYTE COMPLEXES IN A CHEMICALLY DEFINED SOLUTION

A high concentration of serum supplements has been contained in basic vitrification solutions to protect plasma membranes. The objective of this study was to examine if vitrification of immature porcine oocytes could be achieved successfully in a chemical-defined solution containing 0.6 mg mL–1 hydroxypropyl cellulose (HPC). Cumulus–oocyte complexes (COC) were aspirated from follicles 3 to 6 mm in diameter in abattoir-derived porcine ovaries. The COC or denuded oocytes were vitrified according to a commercial protocol of Cryotop (Kitazato BioPharma Co. Ltd., Shizuoka, Japan) with original solutions or modified ones that had serum supplement replaced with HPC. After vitrification and warming, viabilities of oocytes and cumulus cells were evaluated under a fluorescent microscope after staining with fluorescein diacetate and propidium iodide (Table 1). Statistical analyses of results from 4 replicated trials were performed by ANOVA with a Bonferroni/Dunn post hoc test (significance, P < 0.05). Although viabilities of vitrified/warmed oocytes in all groups were significantly lower (82.7–89.1%) than those of fresh controls (99.5%), there were no significant differences among vitrified groups. When COC were vitrified, viability of cumulus cells (54.3%) in HPC group was not different from that of nonvitrified controls (72.5%) but higher than that in the original solution group (48.1%). In conclusion, these results demonstrate that HPC rather than serum supplement could be a suitable chemically defined supplement for vitrification of immature porcine COC. Table 1.Viabilities of vitrified/warmed porcine oocytes and cumulus cells1

Staircaselike suppression of supersolidity under rotation

There are a number of distinct signatures of superfluids, one of which is the appearance of quantized vortices. There have been some attempts to understand the putative supersolid 4He in the vortex framework, but no conclusive evidence that supports the existence of the vortices has been reported. Here, we investigate the rotation velocity dependence of the torsional oscillation of solid 4He at various temperatures. The velocity sweep reveals intriguing periodic staircaselike features below about 300 mK. The staircase patterns show remarkable periodicity, and we interpret these patterns as a consequence of vortex injection. However, there are some features that cannot be accounted for with simple injection of vortices into superfluid, and further investigation is required.

Long-term results of conventional varus half-wedge proximal femoral osteotomy for the treatment of osteonecrosis of the femoral head

We have previously described the mid- to long-term results of conventional simple varus intertrochanteric osteotomy for osteonecrosis of the femoral head, showing that 19 of the 26 hips had good or excellent results. We extended the follow-up to a mean of 18.1 years (10.5 to 26) including a total of 34 hips in 28 patients, with a mean age at surgery of 33 years (19 to 53). There were 18 men and ten women and 25 hips (74%) had a satisfactory result with a Harris hip score ≥ 80. In all, six hips needed total hip replacement (THR) or hemiarthroplasty. The collapse of the femoral head or narrowing of the joint space was found to have progressed in nine hips (26%). Leg shortening after osteotomy was a mean of 19 mm (8 to 36). With conversion to THR or hemiarthroplasty as the endpoint, the ten-year survival rate was 88.2% (95% confidence interval (CI) 82.7 to 93.7) and the 20-year survival rate was 79.7% (95% CI 72.1 to 87.3); four hips were converted at ten years and other two hips were converted at 20 years.

Shortening of the leg after osteotomy remains a concern; however, the conventional varus half-wedge osteotomy provides favourable long-term results in hips with less than two-thirds of the medial part of the femoral head affected by necrotic bone and with normal bone superolaterally.

Fluorescence immunoassay using an optical fiber for determination of Dermatophagoides farinae (Der f1)

Immunoassay methods are generally used for measuring of allergenic substances. However, they need special facilities, skilled handling, and time-consuming procedure. In this work, a fiber-optic immunoassay system which could measure allergen by fluorescent intensities of immune complexes formed by allergens and fluorescently labeled antibodies was established. Immune complexes absorbed on the optical fiber probe surface, and excitation light was injected into the probe, then evanescent field is created in the proximity of the probe. The fluorophores were excited by the evanescent light, and fluorescence was detected by a photo diode. The target allergen detected by our system was Der f1 derived from Dermatophagoides farinae that is one of the house dust mite and major source of inhaled allergens. The fluorophore used labeling on detecting antibody was cyanine 5. The system enabled to detect and quantitatively determine of Der f1. The measurement range was from 0.24 to 250 ng/ml, and the result competes with ELISA. The measurement time was 16 min/sample. The immunoassay system was applied to measurement of Der f1 from actual dust samples. Calculated values of Der f1 showed good correlations between the fiber-optic fluoroimmunoassay and ELISA.

Adhesive interaction between peripheral blood mononuclear cells and activated platelets in the presence of anti-human leukocyte antigen Class I alloantibody causes production of IL-1β and IL-8

BACKGROUND

Activated platelets form heterogeneous aggregates of platelets and monocytes, which are involved in a variety of inflammatory disorders. Some anti-human leukocyte antigen (HLA) Class I antibodies have been shown to activate platelets.

MATERIALS AND METHODS

Human leukocyte antigen-A2-positive or HLA-A2-negative platelets were incubated with HLA-A2-negative peripheral blood mononuclear cells (PBMNCs) in the presence of anti-HLA-A2 serum at 37°C. The binding of platelets to monocytes was analysed by flow cytometry. The levels of IL-1 β and IL-8 in the culture supernatant were determined by ELISA.

RESULTS

Anti-HLA-A2 serum increased the formation of aggregates between monocytes and HLA-A2-positive platelets, but not HLA-A2-negative platelets, in a dose-dependent manner. Antiserum also increased the number of platelets bound to monocytes in a time-dependent manner. The addition of anti-P-selectin glycoprotein ligand (PSGL-1) mAb almost completely inhibited the formation of platelet-monocyte aggregates as well as the number of platelets bound to monocytes. When HLA-A2-positive or HLA-A2-negative platelets were incubated with HLA-A2-negative PBMNCs in the presence of anti-HLA-A2, the level of IL-1β and IL-8 in the supernatant of coculture was significantly higher in HLA-A2-positive platelets than in HLA-A2-negative platelets. The addition of anti-PSGL-1 mAb partially but significantly inhibited the production of both IL-1β and IL-8.

CONCLUSIONS

The activation of platelets with anti-HLA Class I alloantibody caused the formation of platelet-monocyte aggregates, followed by the production of IL-1β and IL-8, in a cognate antigen-antibody manner. The adhesive interaction of P-selectin and PSGL-1 at least partially contributed to these phenomena.

Nonunity permeability in metamaterial-based GaInAsP/InP multimode interferometers

We demonstrated an InP-based optical multimode interferometer (MMI) combined with metamaterials consisting of minute split-ring resonators (SRRs) arrayed on the MMI. The MMI could operate at an optical fiber communication wavelength of 1.5 μm. Magnetic resonance occurred between the SRR metamaterial and light at 1.5 μm, and the relative permeability of the metamaterial increased to 2.4 around this wavelength. This result shows that it is possible to use new materials with nonunity permeability to construct semiconductor-based photonic devices.

Soft contact lens biosensor for in situ monitoring of tear glucose as non-invasive blood sugar assessment

A contact lens (CL) biosensor for in situ monitoring of tear glucose was fabricated and tested. Biocompatible 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer and polydimethyl siloxane (PDMS) were employed as the biosensor material. The biosensor consists of a flexible Pt working electrode and a Ag/AgCl reference/counter electrode, which were formed by micro-electro-mechanical systems (MEMS) technique. The electrode at the sensing region was modified with glucose oxidase (GOD). The CL biosensor showed a good relationship between the output current and glucose concentration in a range of 0.03-5.0mM, with a correlation coefficient of 0.999. The calibration range covered the reported tear glucose concentrations in normal and diabetic patients. Also, the CL biosensor was applied to a rabbit for the purpose of tear glucose monitoring. The basal tear glucose was estimated to 0.11 mM. Also, the change of tear glucose induced by the change of blood sugar level was assessed by the oral glucose tolerance test. As a result, tear glucose level increased with a delay of 10 min from blood sugar level. The result showed that the CL biosensor is expected to provide further detailed information about the relationship between dynamics of blood glucose and tear glucose.

An autonomous drug release system based on chemo-mechanical energy conversion "Organic Engine" for feedback control of blood glucose

A novel autonomous drug release system was fabricated and tested. The system consists of two integrated units: decompression unit and drug release unit. The decompression unit was fabricated by separating a cylindrical cell into a top cell (gas phase) and a bottom cell (liquid phase) by glucose oxidase (GOD) enzyme immobilized membrane. The enzyme membrane recognizes glucose and converts chemical energy found in glucose to mechanical energy. The linear correlation between glucose concentration and de-pressure slope of the top cell was revealed as applying glucose solution to the bottom cell. Afterward, the drug release unit which utilizes the energy of the decompression unit as a power source was fabricated and evaluated by recording its release actions. The drug release unit was made to release at a constant quantity of drug in the liquid phase. The system was then fabricated by combining the decompression unit and the drug release unit. And it was evaluated in an open loop and in a closed loop by applying a mixture of glucose solution (100 mmol/l) and NADH(+) using glucose dehydrogenase enzyme (GDH) as a glucose reducer. Glucose concentration decreased gradually in the closed loop and, as a consequence, interval time of the GDH release became longer. In other words, an inverse correlation between actuation interval of the system and glucose concentration was shown. As a result, the possibility of feedback control of glucose concentration by the drug release system without external energy was confirmed.

Promoter region sequence differences in the A and G gamma globin genes of Brazilian sickle cell anemia patients

Fetal hemoglobin (HbF), encoded by the HBG2 and HBG1 genes, is the best-known genetic modulator of sickle cell anemia, varying dramatically in concentration in the blood of these patients. This variation is partially associated with polymorphisms located in the promoter region of the HBG2 and HBG1 genes. In order to explore known and unknown polymorphisms in these genes, the sequences of their promoter regions were screened in sickle cell anemia patients and correlated with both their HbF levels and their betaS-globin haplotypes. Additionally, the sequences were compared with genes from 2 healthy groups, a reference one (N = 104) and an Afro-descendant one (N = 98), to identify polymorphisms linked to the ethnic background.The reference group was composed by healthy individuals from the general population. Four polymorphisms were identified in the promoter region of HBG2 and 8 in the promoter region of HBG1 among the studied groups. Four novel single nucleotide polymorphisms (SNP) located at positions -324, -317, -309 and -307 were identified in the reference group. A deletion located between -396 and -391 in the HBG2 promoter region and the SNP -271 C-->T in the HBG1 promoter region were associated with the Central African Republic betaS-globin haplotype. In contrast, the -369 C-->G and 309 A-->G SNPs in the HBG2 promoter region were correlated to the Benin haplotype. The polymorphisms -396_-391 del HBG2, -369 SNP HBG2 and -271 SNP HBG1 correlated with HbF levels. Hence, we suggest an important role of HBG2 and HBG1 gene polymorphisms on the HbF synthesis.

Stimulation of human neutrophils with sera containing HLA Class I alloantibody causes preferential degranulation of azurophilic granules and secretory vesicles

BACKGROUND AND OBJECTIVES

The activation of neutrophils by human leukocyte antigen (HLA) Class I alloantibody is thought to be involved in transfusion-related acute lung injury. Neutrophils contain various biological substances in four groups of granules, including secretory vesicles, azurophilic granules, specific granules and gelatinase granules. To characterize the activation of neutrophils by HLA Class I alloantibody, we investigated whether HLA Class I alloantibody could cause the degranulation of these groups of granules either coordinately or selectively.

MATERIALS AND METHODS

Sera containing HLA-A24 alloantibody were incubated with neutrophils in a washed whole blood system. CD11b expression (secretory vesicles) on neutrophils was analysed by flow cytometry, and the secretion of markers of each granule was determined by ELISA.

RESULTS

The treatment of cross-matching-positive neutrophils with sera containing HLA-A24 alloantibody caused the significant expression of CD11b, and the significant secretion of neutrophil elastase and myeloperoxidase, azurophilic granule markers and heparin-binding protein (HBP), which is localized in secretory vesicles and azurophilic granules when compared with cross-matching-negative neutrophils. In contrast, no significant differences were observed in the secretion of lactoferrin, a marker of specific granules, and matrix methalloproteinase-9, a marker of gelatinase granules between cross-matching-positive and cross-matching-negative cells upon stimulation with sera. CD11b expression and secretion of HBP by serum was partially inhibited by p38 mitogen-activated protein (MAP)-kinase inhibitors.

CONCLUSION

Neutrophils activated with sera containing HLA Class I alloantibody caused the preferential degranulation of azurophilic granules and secretory vesicles. This process was at least in part mediated by p38 MAP kinase-involved signal transduction.

Vitamin D receptor polymorphisms and prognosis of patients with epithelial ovarian cancer

Background:

Recently, the vitamin D receptor (VDR) polymorphism FokI was shown to be associated with susceptibility to ovarian cancer. We aimed to examine whether VDR FokI polymorphisms influence the survivals of patients with epithelial ovarian cancer (EOC).

Methods:

VDR polymorphisms from FokI in 101 patients with EOC were genotyped by sequencing. Overall survival was compared between FokI single nucleotide polymorphism using Kaplan–Meier survival curves with log-rank tests and the Cox proportional hazard model adjusted for ages, stages, histology, and existence of residual tumour.

Results:

The FokI C/C genotypes were associated with better prognosis compared with the C/T and T/T genotypes (log-rank test: P=0.008; adjusted hazard ratio, 0.18; 95%CI 0.05–0.61; P=0.006).

Conclusions:

These results suggest that the VDR polymorphisms from the FokI genotype may be associated with improved prognosis of patients with EOC.

Novel quantum criticality in CeRu2Si2 near absolute zero observed by thermal expansion and magnetostriction

We report linear thermal expansion and magnetostriction measurements for CeRu2Si2 in magnetic fields up to 52.6 mT and at temperatures down to 1 mK. At high temperatures, this compound showed Landau-Fermi-liquid behavior: The linear thermal expansion coefficient and the magnetostriction coefficient were proportional to the temperature and magnetic field, respectively. In contrast, a pronounced non-Fermi-liquid effect was found below 50 mK. The negative contribution of thermal expansion and magnetostriction suggests the existence of an additional quantum critical point.

[Treatment of massive endobronchial hemorrhage after cardiopulmonary bypass by selective coil embolization of the bronchial artery]

A 68-year-old woman underwent aortic valve replacement to treat her aortic regurgitation. The operation was performed successfully. Just before coming off cardiopulmonary bypass, massive hemorrhage occurred through the endotracheal tube. Fiberoptic bronchoscopy could not find the bleeding site and 1,350 ml of blood had been lost. Bronchial angiography under percutaneous cardiopulmonary bypass revealed the right middle branch to be the bleeding site. The endotrachial bleeding was treated successfully by selective coil embolization of the bronchial artery. No further bronchial bleeding occurred. Although we found the bleeding site, we could not identify the cause of hemorrhage.

Genetic polymorphisms at FCER1B and PAI-1 and asthma susceptibility

BACKGROUND

We previously detected a promoter polymorphism (- 109C/T) in the gene for the beta-chain of the high-affinity receptor for IgE (FCER1B), which was associated with total serum IgE levels but not with asthma in a Japanese population. A genetic interaction is biologically plausible between FcepsilonRI-beta and the plasminogen activator inhibitor 1 (PAI-1), which is highly expressed in mast cells in asthmatics and plays an essential role in airway remodelling. We hypothesized that FCER1B promoter polymorphisms, by modifying the intensity of mast cell activation signals, modulate the genetic effects of a functional 4G/5G polymorphism in the PAI-1 gene on asthma. OBJECTICIVE: To examine whether FCER1B promoter polymorphisms (- 109C/T and - 654C/T) influence the genetic effects of the functional polymorphism (4G/5G) at the PAI-1 promoter region on asthma susceptibility using a case-control analysis.

METHODS

Subjects (374 asthmatic patients and 374 non-asthmatic controls) were divided into combined genotype groups based on the presence of FCER1B - 109TT and - 654CC genotypes and the PAI-1 4G allele. Logistic regression analysis was used to estimate adjusted odds ratios for asthma associated with the different genotype groups.

RESULTS

Individuals homozygous for the FCER1B - 109T/ - 654C haplotype and the PAI - 1 5G allele had a reduced susceptibility to asthma; the odds ratio for the development of asthma was 0.20 (95% confidence interval, 0.084 - 0.46; P = 0.00015) for them, compared with individuals also homozygous for the - 109T/- 654C haplotype at FCER1B but carrying the 4G allele at PAI-1. The regression model also showed an interaction of the PAI-1 4G/5G genotype with the FCER1B-109C/T (P for interaction = 0.0017) or FCER1B-654C/T (P for interaction = 0.031) on asthma.

CONCLUSION

The present findings suggest a synergistic interaction between FCER1B and PAI-1 genes in asthma susceptibility.