Comparison of complications and functional outcomes following total or subtotal glossectomy with laryngeal preservation using a deep inferior epigastric artery perforator free flap versus a rectus abdominis musculocutaneous free flap

OBJECTIVE

Wide defects resulting from subtotal or total glossectomy are commonly reconstructed using a bulk flap to maintain oral and speech functions. The flap, including muscle tissue, diminishes with time. This study aimed to compare the surgical outcomes of deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions after glossectomy with laryngeal preservation.

METHODS

Medical records of 13 and 26 patients who underwent deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions, respectively, from 2014 to 2022 at our institution were reviewed. Patients who underwent middle pharynx resection except for the base of the tongue, mandibular bone resection, and sensory reinnervation were excluded.

RESULTS

The rectus abdominis musculocutaneous groups showed a higher number of lymph node dissection and shorter operative time than the deep inferior epigastric artery perforator groups. No significant differences in postoperative complications or functional oral intake scale scores at 6 months were observed. Volumetric changes on computed tomography images at 6 and 12 months were significantly lower in the deep inferior epigastric artery perforator group. Cancer recurrence was significantly associated with reduced oral function.

CONCLUSIONS

Oral function in patients with cancer is influenced by various other factors. However, the deep inferior epigastric artery perforator flap may be suitable for tongue reconstruction because of the minimal postoperative changes in flap volume, easy adjustment of flap thickness, elevation of multiple flaps, and minimal complications at the donor site.

A mathematical model of network elastoplasticity

We introduce a mathematical model, based on networks, for the elasticity and plasticity of materials. We define the tension tensor for a periodic graph in a Euclidean space, and we show that the tension tensor expresses elasticity under deformation. Plasticity is induced by local moves on a graph. The graph is described in terms of the weights of edges, and we discuss how these weights affect the plasticity.

Management of recurrent acquired choanal atresia with radial forearm free flap transfer

Acquired choanal atresia is a rare complication of pharyngeal surgical interventions. Here, we report the case of a 72-year-old woman who was treated in our institution for acquired choanal atresia after failed previous treatments. We have excised the obstructing fibrotic scar tissue and then reconstructed the area using a mucosal local flap and free radial forearm flap transfer. Choanal stenosis caused by abnormal granulation was identified in the months after surgery; however, this was treated with endoscopic dilatation and steroid injections in the outpatient setting. No restenosis was identified 1 year after the operation. Postoperative evaluation of speech was satisfactory. Free flap transfer could be an option for refractory choanal atresia, and endoscopic dilatation with local steroid injections may be an effective method to treat postoperative restenosis.

Long-term oral administration of transgenic rice containing cedar pollen T-cell epitopes potentially improves medication- and allergy-related quality-of-life scores

Background: We previously developed a transgenic rice that contains seven linked human predominant T-cell epitopes (7Crp) derived from Japanese cedar (JC) pollen allergens Cry j 1 and Cry j 2. Oral administration of 80 g of transgenic rice for 20 weeks suppressed allergen-specific T-cell proliferation in participants with JC pollinosis, but their clinical symptoms did not improve. Objective: We examined the clinical efficacy of low-dose (5 g and 20 g) intake of the transgenic rice administered for two successive seasons. Methods: In this randomized, double-blind, placebo controlled study, transgenic rice seeds (5 g or 20 g) were orally administered to the participants for 24 weeks in each of two successive JC pollen seasons. We analyzed T-cell proliferation and cytokine expression, and monitored symptom and medication scores during the pollen season. Quality of life (QOL) was evaluated by using the Japanese Allergic Rhinitis Quality of Life Standard Questionnaire (JRQLQ). Results: Specific T-cell proliferation after stimulation with 7Crp, Cry j 1, and Cry j 2 was significantly suppressed in the second JC pollen season. No significant differences were found among the three groups (5 g, 20 g, and placebo) with regard to clinical symptoms or medication scores in the first season. However, the medication scores and face scale for overall condition of JRQLQ improved in the 5-g transgenic rice group in the second season, although careful re-examination with a large sample size is necessary to confirm the results. Conclusion: Low-dose oral administration of transgenic rice that contains 7Crp significantly reduced allergen-specific T-cell responses and improved medication scores during the second season of administration. Thus, oral intake of the transgenic rice has the potential to induce immune tolerance to JC pollen allergens when administered for at least two successive seasons.

Immunological and Symptomatic Effects of Oral Intake of Transgenic Rice Containing 7 Linked Major T-Cell Epitopes from Japanese Cedar Pollen Allergens

BACKGROUND

A rice-based peptide vaccine containing 7 linked human predominant T-cell epitopes (7Crp) derived from Japanese cedar (JC) pollen allergens, Cry j 1 and Cry j 2, was developed. Here, we examined the efficacy and safety of this transgenic rice in JC pollinosis patients.

METHODS

Transgenic rice (5, 20, and 80 g) was administered orally. We measured the T-cell proliferative activity against 7Crp, Cry j 1, and Cry j 2; the cytokine expression levels; and specific IgE and IgG4 production levels. In addition, the symptom and medication scores were monitored during the pollen season, and quality of life (QOL) was evaluated.

RESULTS

T-cell proliferative activities to Cry j 1, Cry j 2, and 7Crp were significantly depressed in a dose-dependent manner. Oral intake of 80 g transgenic rice for 20 weeks resulted in significant suppression of allergen-specific T-cell proliferation with downregulation of IL-13 and upregulation of IL-10 levels but no changes to specific IgE and IgG4 levels. The QOL symptom scores for allergic rhinitis were not significantly improved.

CONCLUSIONS

Allergen-specific T-cell responses were significantly reduced by oral intake of transgenic rice in a dose-dependent manner. However, neither medication score nor QOL symptom scores could be improved during the JC pollen season with oral intake of transgenic rice for 20 weeks.

Non-invasive Ultrasonic Urination Sensor for Ambulatory Patient Support

It is estimated that, in Japan, several million people suffer from urinary incontinence caused by, e.g., cerebrovascular disease, abdominal operations, spinal-cord damage, etc. Urinary incontinence is said to be a ‘hidden’ disease. When no adequate treatment is given, a serious situation may arise for both patients and their family. A non-invasive and unconstrained ultrasonic sensor has been designed enabling patients to discretely manage urination. The major problem of the sensor is how to maintain a proper irradiation angle to obtain an anteroposterior bladder diameter which corresponds to the actual bladder volume. Many types of ultrasonic probe holders have been tested and promising results have been obtained. The most practical, but as yet experimental, method is a four-element ultrasonic sensor, embedded in a flat probe.

Infant formula with galacto-oligosaccharides (OM55N) stimulates the growth of indigenous bifidobacteria in healthy term infants

The objective of the study was to investigate whether an infant formula supplemented with galacto-oligosaccharides (GOS; OM55N) was able to stimulate the growth of indigenous bifidobacteria and to establish microbiota similar to that of breastfed infants. A randomised, double-blind, placebo-controlled trial was performed using 35 healthy term infants (31-54 days of age; 42±6 days) to determine whether infant formula with 0.3 g/dl GOS (OM55N) stimulated the growth of bifidobacteria in the infants’ guts. At the trial onset and 2 weeks after, the infants’ faecal samples were examined for microbiota composition (bacterial abundance and α-diversity) and faecal characteristics. Among the 35 infants, 5 were withdrawn and 8 were excluded from the final evaluation before breaking the blinding since the indigenous bifidobacteria were not detected at the trial onset. After 2 weeks, the abundance of Bifidobacteriaceae was significantly increased in the GOS feeding group compared to the control (+11.6±24.1% vs -3.9±13.0%; P=0.043). The Shannon index, which accounts for both abundance and evenness of the present species, was significantly decreased with GOS supplementation (-0.1±0.4 vs +0.4±0.4; P=0.014). Faecal characteristics such as pH and organic acids were similar in both groups, with no statistical differences. No adverse side effects related to the formula consumption were reported. Although the concentration of GOS was relatively low, the infant formula with GOS increased the abundance of bifidobacteria and resulted in a reduced α-diversity of the microbiota.

Simple model of pH-induced protein denaturation

The pH-induced conformational changes of proteins are systematically studied in the framework of a hydrophobic-polar (HP) model, in which proteins are dramatically simplified as chains of hydrophobic (H) and polar (P) beads on a lattice. We express the electrostatic interaction, the principal driving force of pH-induced unfolding that is not included in the conventional HP model, as the repulsive energy term between P monomers. As a result of the exact enumeration of all of the 14- to 18-mers, it is found that lowest-energy states in many sequences change from single "native" conformations to multiple sets of "denatured" conformations with an increase in the electrostatic repulsion. The switching of the lowest-energy states occurs in quite a similar way to real proteins: it is almost always between two states, while in a small fraction of ≥16-mers it is between three states. We also calculate the structural fluctuations for all of the denatured states and find that the denatured states contain a broad range of incompletely unfolded conformations, similar to "molten globule" states referred to in acid or alkaline denatured real proteins. These results show that the proposed model provides a simple physical picture of pH-induced protein denaturation.

Gastric carcinoma with an invasive micropapillary carcinoma component showing HER2 gene amplification and CD10 expression: a case report and review of the literature

An 81-year-old man was referred to our hospital because gastric cancer was detected on screening esophagogastroduodenoscopy. Surgical resection of the tumor was performed. It was 25 × 20 mm in size and swollen lymph nodes were present nearby. Lymphadenectomy was also performed. Histopathologically, the tumor reached the proper muscle layer via venous invasion. There were three components that constituted the tumor, that is, 40% of mass was invasive micropapillary carcinoma (IMPC), 40% was papillary adenocarcinoma and 20% tubular adenocarcinoma. Vascular invasion was prominent. Immunohistochemistry revealed that the tumor showed an entirely intestinal mucin phenotype, being positive only for CD10 and negative for MUC2, MUC5AC, and MUC6. HER2 staining score ranged from 2+ to 3+, depending on the components described above. HER2 gene amplification was present in all the components according to dual-color in situ hybridization. The metastatic lymph nodes were similar to the primary site in morphology and immunohistochemistry, but HER2 amplification was higher in the lymph nodes. The IMPC component with HER2 amplification is rarely seen and its positivity for CD10 is an unexpected finding for gastric IMPC. Hence, this is a highly unusual case judging by the literature; further studies are needed to clarify the nature of gastric IMPC.

XANTHOMA-INDUCING β-LIPOPROTEIN IMMUNE COMPLEXES

Untreated rabbits and rabbits sensitized with human beta-lipoproteins were intracutaneously injected with either human or rabbit beta-lipoproteins (2 mg as protein). Forty-eight hours later, at the human beta-lipoprotein injection site, dense cell infiltrations stood out sharply demarcated from the surrounding region. The infiltrating cells were composed of polymorphonuclear cells, nuclear dust and histiocytes. Foam cell nests were observed in sensitized rabbit dermis one week after human beta-lipoprotein injection. Direct immunofluorescence employing fluorescein isothiocyanate labeled antihuman beta-lipoprotein antiserum showed that the injected human beta-lipoproteins were incorporated into the infiltrating cells of sensitized rabbit dermis up to 48 hours after injection. Specific fluorescence was greatly reduced but lipid autofluorescence remained in mature foam cells. During the 3-week examination period, no trace of foam cell nests was found at the site of human beta-lipoprotein injection on non-sensitized rabbits. Intracutaneous rabbit beta-lipoprotein injection revealed no histiocytic infiltrations in either sensitized or non-sensitized rabbits. These findings indicated that intracutaneously injected human beta-lipoporteins were incorporated into rabbit dermal histiocytes more easily in aggregated immune complex form than in their natural state. These histiocytes were easily transformed to foam cells. Apoproteins of the incorporated lipoproteins were degraded, and lipid residues accumulated in mature foam cells.

IMMUNOHISTOCHEMICAL STUDY OF HUMAN XANTHOMA

Specimens of human tuberous xanthomas obtained from two hyper-beta-lipoproteinemic patients were prepared with HE and Sudan III stain and by direct immunofluorescence with fluorescein isothiocyanate labeled antihuman beta-lipoprotein rabbit serum. In some histiocytes and foam cells in early stages, lipids were stained in granular patterns and specific fluorescence was observed. In some foam cell nests, specific fluorescence was weak or absent, and orange-colored lipid autofluorescence was present. The foam cells in such nests were probably late foam cells and corresponded to the large cytoplasmic foam cells stained densely and amorphously for lipids. It was concluded that at early stages of xanthoma formation, serum lipoproteins were incorporated into dermal histiocytes and early foam cells. The apoproteins of the incorporated lipoproteins were probably degraded and lipid residues accumulated in the cells. Specimens of tuberous xanthoma covered by plane xanthoma showed lipids and bright specific fluorescence at the basement membrane zone. A faint fluorescence was observed in the upper dermis and even in parts of the epidermal intercellular spaces.

Exposure assessment of organophosphorus and organobromine flame retardants via indoor dust from elementary schools and domestic houses

To assess the exposure of flame retardants (FRs) for school-children, organophosphorus flame retardants and plasticizers (PFRs) and organobromine flame retardants (BFRs) were determined in the indoor dust samples collected from elementary schools and domestic houses in Japan in 2009 and 2010. PFRs were detected in all the dust samples analyzed and the highest concentration of total PFRs was thousand-fold higher than that of BFRs. Among the PFRs, tris(butoxyethyl)phosphate (TBOEP) showed the highest concentration with a median (med.) of 270,000 ng g(-1) dry weight (3700-5,500,000 ng g(-1) dry weight), followed by tris(methylphenyl)phosphate (TMPPs)>triphenyl phosphate (TPHP)=tris(1,3-dichloro-2-propyl)phosphate (TDCIPP)=tris(2-chloroisopropyl)phosphate (TCIPP)=tris(2chloroethyl)phosphate (TCEP)>ethylhexyl diphenyl phosphate (EHDPP). Significantly higher concentrations of TBOEP, tri-n-butyl phosphate (TNBP), TPHP, TMPPs, and total-PFRs were found in dust samples from elementary schools than from domestic houses. It might be due to that higher concentrations of TBOEP (as leveling agent) were detected from the floor polisher/wax products collected in those elementary schools. On the other hand, significantly higher concentrations of TCEP, TCIPPs, and total chloroalkyl-PFRs were found in domestic houses than in elementary schools. Exposure assessments of PFRs via indoor dust from elementary schools and domestic houses were conducted by calculating the hazard quotient (HQ). Among PFRs, HQs for TBOEP exceeded 1 (higher than reference dose: RfD) and its highest value was 1.9. To reduce the intake of TBOEP by school-children, it is recommended that the use of floor polisher/wax containing TBOEP be reduced in schools.

Sources of hydroxyl radical in headwater streams from nitrogen-saturated forest

Hydroxyl radical (HO) photoformation rate (RHO) was determined in headwater stream samples from nitrogen (N)-saturated forests, (1) to quantify the sources of HO in headwater streams and (2) to evaluate the nitrate NO3(-)-induced enhancement of HO formation in stream water caused by N saturation in forested watersheds. Stream water fulvic acid extracted from the forested watersheds was used to quantify the contribution of dissolved organic matter (DOM) to RHO. The results showed that almost all (97%; 81-109%) RHO sources in our headwater stream samples were quantitatively elucidated; the photolysis of NO3(-) (55%; 34-75%), nitrite [N(III)] (2%; 0.5-5.2%), and DOM-derived HO formation, from which photo-Fenton reactions (18%; 12-26%) and the direct photolysis of fluorescent dissolved organic matter (FDOM) (22%; 10-40%), was successfully separated. FDOM, which accounted for 53% (24-96%) of DOM in total organic carbon bases, was responsible for HO formation in our headwater streams. High NO3(-) leaching caused by N saturation in forested watersheds increased RHO in the headwaters, indicating that N-saturated forest could significantly change photoinduced and biogeochemical processes via enhanced HO formation in downstream water.

Metabolomic investigation of pathogenesis of myxosporean emaciation disease of tiger puffer fish Takifugu rubripes

Serum biochemical analysis was undertaken to study the pathophysiological details of emaciation disease of the tiger puffer fish Takifugu rubripes (Temminck and Schlegel). Serum parameters were measured by biochemical analysis using automated dry chemistry and gas chromatography/mass spectrometry (GC/MS). Serum concentrations of albumin, amylase, calcium, creatinine, glucose and total protein were significantly lower in the emaciated fish when compared with those of normal fish. Regression analyses found close correlation between concentrations of total protein, albumin, amylase, glucose and progress of the disease. In contrast, serum alanine aminotransferase increased significantly in emaciated fish indicating liver function disorder. Further, GC/MS metabolic profiling of the puffer serum showed that the profile of the emaciated fish was distinct to that of non-infected control. The serum content of amino acids including glycine, 5-oxo-proline and proline, and ascorbic acid, fumaric acid and glycerol increased significantly in serum in moderately emaciated fish. The serum glucose, linolenic acid and tyrosine level decreased significantly in the late phase of the disease. Our results clearly show that prolonged intestinal damage caused by myxosporean infection impairs absorption of nutrients, resulting in extreme emaciation.

Partial lower axillary dissection for patients with clinically node-negative breast cancer

OBJECTIVE

To evaluate retrospectively the outcomes of partial lower axillary lymph node dissection caudal to the intercostobrachial nerve in patients with clinically node-negative (N(0)) breast cancer.

METHODS

Numbers of dissected and metastatic nodes, overall and disease-free survival rates, postoperative complication rates, and axillary recurrence were compared between patients who underwent breast cancer surgery with partial axillary node dissection (n = 1043) and historical controls who underwent conventional dissection (n = 1084).

RESULTS

The 5-year overall and disease-free survival rates were 95.6% and 89.7%, and 94.9% and 88.4%, respectively, in the partial dissection and conventional dissection groups; the differences were not significant. Mean duration of surgery (41.6 min versus 60.9 min), intraoperative blood loss (28.0 ml versus 51.3 ml), volume of lymphatic drainage at 2 weeks postoperatively (488 ml versus 836 ml), and persistent arm lymphoedema (0.0% versus 11.8%) were significantly different between the partial and conventional dissection groups, respectively.

CONCLUSIONS

Partial axillary lymph node dissection was associated with similar survival rates (but lower postoperative complication rates) compared with conventional axillary dissection and is recommended in patients with N(0) breast cancer.

CT-fluoroscopy in chest interventional radiology: sliding scale of imaging parameters based on radiation exposure dose and factors increasing radiation exposure dose

AIM

To verify the usefulness of a sliding scale of imaging parameters to reduce radiation exposure during chest interventional radiology (IR), and to identify factors that increase radiation exposure in order to obtain acceptable computed tomography (CT)-fluoroscopy image quality.

MATERIALS AND METHODS

The institutional review board approved this retrospective study, for which the need for informed consent was waived. Interventional radiologists determined the optimal CT-fluoroscopy imaging parameters using the sliding scale based on the radiation exposure dose. The imaging parameters were changed from those generating low radiation (120 kV/10 mA, 1.2 mGy/s) to others generating higher radiation exposure until acceptable image quality was obtained for each procedure. Validation of the imaging parameter sliding scale was done using regression analysis. Factors that increase radiation exposure were identified using multiple regression analysis.

RESULTS

In 125 patients, 217 procedures were performed, of which 72 procedures (33.2%, 72/217) were performed with imaging parameters of minimum radiation exposure, but increased radiation exposure was necessary in 145 (66.8%, 145/217). Significant correlation was found between the radiation exposure dose and the percentage achievement of acceptable image quality (R(2) = 0.98). Multivariate regression analysis showed that high body weight (p < 0.0001), long device passage (p < 0.0001), and lesions above the aortic arch (p = 0.04) were significant independent factors increasing radiation exposure.

CONCLUSION

Although increased radiation exposure dose might be necessary to obtain acceptable chest CT-fluoroscopy images depending on the patient, lesion, and procedure characteristics, a sliding scale of imaging parameters helps to reduce radiation exposure.

Evaluation of whole-body FDG-PET in breast cancer screening

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Background: The utility of whole-body FDG-PET for the detection of breast cancers in a screening program is not well investigated.

Methods: We analyzed data from a cancer screening program including whole-body FDG-PET performed for consecutive 2065 asymptomatic women (age: 40 to 80 y.o. with mean ± SD of 56.1 ± 8.6 y.o.) without a previous history of breast cancer. They underwent the initial screening between September 2003 and December 2008. The screening included neither mammography nor ultrasonography of the breast. Final results of cancers and/or follow-up data more than 1 year following the screening were available in 1822 of the 2065 (88.2%: 941 by the following screening and 881 by the response to questionnaires). Data of the second screening in 670 women (age: 55.0 ± 8.0 y.o.) of the 941, who didn’t have cancer at the initial screening and received the second screening by December 2008 and within 2 years of the initial screening were also analyzed. Final results and/or follow-up data more than 1 year were available in 642 of the 670 (95.8%: 573 by a subsequent screening and 69 by the response to questionnaires).

Results: Data were analyzed as of the end of 2010. In 2 years after the initial screening, 57 cancers of a variety of organs including 12 of the breast were confirmed. Nine (stage 0: 1, I: 7 and IIA: 1) of the 12 were proven in 29 women with PET positive results and 3 (stage I: 1, IIA: 1 and not available: 1) in 2036 women with PET negative results. In 2 years after the second screening, 9 cancers including 4 of the breast were confirmed. Three of the 4 (stage 0: 1, I: 1 and IIB: 1) were diagnosed in 9 women with PET positive results and 1 (stage I) in 661 with PET negative results. Two of the 4 PET negative cancers were diagnosed after developing symptoms and the remaining 2 were detected by another screening. Sensitivity, specificity, positive and negative predictive values and false positive rate of the initial screening were 75.0% (9/12), 99.0% (2033/2053), 31.0% (9/29), 99.9% (2033/2036) and 1.0% (20/2053), respectively.

Conclusions: Whole-body FDG-PET had the capability to screen the breast with a very low false positive rate and high positive and negative predictive values, and could detect breast cancers of asymptomatic women at early stages with reasonable sensitivity.

Carbon isotope composition of dissolved humic and fulvic acids in the Tokachi River system

This study reports carbon isotopic ratios (Δ(14)C and δ(13)C) of dissolved humic and fulvic acids in the Tokachi River system, northern Japan. These acids have a refractory feature and they represent the largest fraction of dissolved organic matter in aquatic environments. The acids were isolated using the XAD extraction method from river water samples collected at three sites (on the upper and lower Tokachi River, and from one of its tributaries) in June 2004 and 2005. δ(13)C values were -27.8 to -26.9 ‰ for humic and fulvic acids. On the other hand, the Δ(14)C values ranged from -247 to +26 ‰ and the average values were -170 ± 79 ‰ for humic acid and -44 ± 73 ‰ for fulvic acid. The difference was attributed to the residence time of fulvic acid in the watershed being shorter than that of humic acid. The large variation suggested that humic substances have a different pathway in each watershed environment.