[Colitis Suggested to be Related to Nivolumab in a Gastric Cancer Patient with a History of Ulcerative Colitis: A Case Report].

We experienced a case in which long-term use of nivolumab in a patient with a history of ulcerative colitis led to disease control of gastric cancer. The case is a 77-year-old man. The patient had a history of ulcerative colitis and remained in remission on mesalazine 1500 mg/d. With continuous monitoring, nivolumab could be continued up to 16 courses, but was withdrawn due to the appearance of diarrhea (grade 1) and bloody stools, which was relieved with prednisolone (PSL) 40 mg/d. After two more courses, diarrhea (grade 3) appeared again, which improved with PSL 60 mg/d and increased dose of mesalazine. It is difficult to distinguish whether colitis that occurs after nivolumab administration is due to relapse exacerbation or irAE. The onset of irAE colitis is often reported within 3 months, and the fact that this patient developed irAE colitis after 8 months, despite having ulcerative colitis, is considered novel. In the future, we hope to accumulate cases so that immune checkpoint inhibitors can be used safely in patients with ulcerative colitis, and to establish appropriate methods for their use.

Impact of the COVID-19 pandemic on patients with mental health problems and the differences among diagnostic categories.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a total upending of our daily lives. While anxiety and depression were frequently reported among the general population, the pandemic's impact on patients with mental health problems remains unknown. METHODS: A cross-sectional questionnaire survey involving 1,166 patients was conducted at one psychiatric hospital and one mental health clinic. RESULTS: Symptom deterioration was reported in 23% to 34% of the patients and 9% to 20% reported increase in drug dosage. No significant differences were reported in these items among diagnostic categories. Patients with F3 (mood disorders) reported more psychological stress during the pandemic's beginning and during the emergency. Patients with F2 (schizophrenia, schizotypal, and delusional disorders) did online shopping and meetings less frequently, and reported poorer adherence of 3C's, while mask management was stricter in patients with F4 (neurotic, stress-related, and somatoform disorders). Symptom deterioration was significantly associated with increase in drug dosage, new physical symptoms, anxiety unrelated to COVID-19, stress at the beginning of pandemic, stress during the 'state of emergency', poor adaptability to environmental change, daily life changes, decrease in sleeping time, and decrease in time spent outside. CONCLUSION: One third of patients reported symptom deterioration during the pandemic, which was associated with stress and daily life changes. Patients with good adaptability to environmental changes might resilient against symptom deterioration. Providing continuous support to help patients manage their daily life in this COVID-19 era may minimize the risk of symptom deterioration.

Rare-earth ions as antibacterial agents for woven wool fabric.

Woven fabrics were bestowed with antibacterial property by the simple adsorption of rare-earth metal ions, and the underlying mechanism was investigated using electron spin resonance (ESR) spectroscopy. The adsorption of Ce3+ ions on wool, silk, and cotton fabrics resulted in significant inhibition of Staphylococcus aureus (a gram-positive bacterium), with maximum antibacterial activities (viable bacterial count compared to the reference) of 4.7, 5.8, and 5.2, respectively. Even after 50 wash cycles, the values remained at 3.9, 2.9, and 4.8, respectively. The adsorption of La3+ and Gd3+ ions on wool fabrics also resulted in antibacterial activities of 5.8 and 5.9, respectively. In addition, wool adsorbed with Ce3+ exhibits a satisfactory antibacterial activity of 6.2 against Escherichia coli (a gram-negative bacterium). Such bacterial inhibition is attributed to Fenton reactions between the adsorbed rare-earth ions and hydrogen peroxide (H2O2) produced during bacterial metabolism, as determined from the ESR spectra collected using the spin trap method in the presence of H2O2. The safety of cerium nitrate was also investigated, and no significant issues arose, indicating that it was a safe antibacterial agent. This facile method of imparting antibacterial properties to natural fabrics may be useful for preventing infections in humans. Supplementary Information: The online version contains supplementary material available at 10.1007/s11696-021-01999-9.

High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection.

BACKGROUND: We hypothesized that thermal damage accumulation during endoscopic submucosal dissection (ESD) causes the pathogenesis of post-ESD electrocoagulation syndrome (PECS). AIM: To determine the association between Joule heat and the onset of PECS. METHODS: We performed a retrospective cohort study in patients who underwent colorectal ESD from May 2013 to March 2021 in Japan. We developed a novel device that measures swift coagulation time with a sensor adjacent to the electrosurgical coagulation unit foot switch, which enabled us to calculate total Joule heat. PECS was defined as localized abdominal pain (visual analogue scale ≥ 30 mm during hospitalization or increased by ≥ 20 mm from the baseline) and fever (temperature ≥ 37.5 degrees or white blood cell count ≥ 10000 µ/L). Patients exposed to more or less than the median Joule heat value were assigned to the high and low Joule heat groups, respectively. Statistical analyses included Mann-Whitney U and chi-square tests and logistic regression and receiver operating characteristic curve (ROC) analyses. RESULTS: We evaluated 151 patients. The PECS incidence was 10.6% (16/151 cases), and all patients were followed conservatively and discharged without severe complications. In multivariate analysis, high Joule heat was an independent PECS risk factor. The area under the ROC curve showing the correlation between PECS and total Joule heat was high [0.788 (95% confidence interval: 0.666-0.909)]. CONCLUSION: Joule heat accumulation in the gastrointestinal wall is involved in the onset of PECS. ESD-related thermal damage to the peeled mucosal surface is probably a major component of the mechanism underlying PECS.

Sternal Metastasis of Brain Meningioma - A Case Report.

BACKGROUND: Metastases of meningiomas are infrequent and the site of extracranial metastasis such as the bone is extremely rare. CASE REPORT: A 75-year-old male had a history of five sessions of surgery and gamma-knife treatment for brain meningioma over a period of 29 years. He visited our hospital because he noticed a swelling in his anterior chest 2 years and 6 months after the final treatment. After an open biopsy, histopathological analysis revealed the mass to be a metastatic grade II meningioma. We resected the tumor along with the sternum, ribs, pleura, and pericardium. The patient had recurrences in the thoracic cavity and pericardium postoperatively and received radiation therapy. He also had metastasis in the abdominal cavity, which spread rapidly. CONCLUSION: We report on a rare instance of metastasis to the sternum in a case of atypical meningioma, showing rapid growth and invasion after long-term treatment.

Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding.

BACKGROUND: Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding (CDB) is recommended. However, little is known about rates of rebleeding within 30 d. We posited that a group of patients who underwent contrast-enhanced computed tomography (CT) within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding. AIM: To evaluate the outcomes of early colonoscopy for CDB among different groups of patients. METHODS: Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed. Patients were divided into groups based on the timing of the CT imaging, within or at 4 h were defined as urgent CTs (n = 100) and those performed after 4 h were defined as elective CTs (n = 82). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH) (i.e., active bleeding, non-bleeding visible vessels, or adherent clots). RESULTS: In total, 182 patients (126 men and 56 women) with median ages of 68.6 (range, 37-92) and 73.7 (range, 48-93) years, respectively, underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group (n = 100) and patients for whom CT was performed after 4 h were included in the elective CT group (n = 82). SRH were identified in 35.0% (35/100) of the urgent CT cases and 7.3% (6/82) of the elective CT cases (P < 0.01). Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0.01). Furthermore, rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases (P < 0.05). Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates. Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image. CONCLUSION: To improve rates of rebleeding, colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hema-tochezia. Otherwise, elective colonoscopy can be performed.

[Lung Metastasis from High-grade Uterine Endometrial Stromal Sarcoma;Report of a Case].

We report a rare case of surgical treatment for lung metastasis from high-grade uterine endometrial stromal sarcoma( ESS) with deep vein thrombosis( DVT) and pulmonary embolism(PE) in a 66-yearold woman. Chest computed tomography (CT) revealed 3 nodules of 3.9 cm, 3.3 cm, 1.2 cm in diameter in the left S6, S8, S9 of the lung. About 1 month after the hysterectomy following anticoagulant treatment with unfractionated heparin/warfarin, the patient underwent left lower lobectomy of the lung and lymph node dissection by video-assisted thoracoscopic surgery( VATS). Microscopic and immunohistochemical examination showed that those tumors were metastases of high-grade ESS. The postoperative course was uneventful and adjuvant chemotherapy by ifosfamide, adriamycin, cisplatin was performed.

Fabrication of Silk Resin with High Bending Properties by Hot-Pressing and Subsequent Hot-Rolling.

This research reports the processability and mechanical properties of silk resins prepared by hot-pressing followed by hot-rolling and then analyzes their thermal and structural properties. The results show that regenerated silk (RS) resins are better suited for hot-rolling than Eri and Bombyx mori silk resins (untreated silk). When hot-rolling at 160 °C with a 50% of reduction ratio, maximum bending strength and Young's modulus of RS resin reaches 192 MPa and 10.2 GPa, respectively, after pretreatment by immersion in 40 vol% ethanol, and 229 MPa and 12.5 GPa, respectively, after pretreatment by immersion in boiling water. Increased strength of the material is attributed to the increased content of aggregated strands and intramolecular linking of ß sheets (attenuated total reflectance Fourier-transform infrared spectroscopy) and higher crystallinity (X-ray diffraction analysis). After hot-pressing and hot-rolling, RS resins have a stable decomposition temperature (297 °C).

Dataset on mechanical, thermal and structural characterization of plant fiber-based biopolymers prepared by hot-pressing raw coconut coir, and milled powders of cotton, waste bagasse, wood, and bamboo.

This article presents experimental data on visual, mechanical, thermal, and structural characterization by hot-pressing four sources of milled plant powders and coconut fibers. It correlates chemical composition obtained by (FTIR), particle size, and reports bending strength, water resistance morphological (SEM) and thermal stability, structural properties (FTIR and XRD). It further supplements findings of the influence of microfibrillation and chemical composition on hot-pressing plant fibers as presented in the research article "Effects of Chemical Composition, Mild Alkaline Pretreatment and Particle Size on Mechanical, Thermal, and Structural Properties of Binderless Lignocellulosic Biopolymers Prepared by Hot-Pressing Raw Microfibrillated Phoenix Dactylifera and Cocos Nucifera Fibers and Leaves" [1]. For more insights into the difference among non-lignin-, lignin-, and semi lignin-based adhesion refer to the research article [1]. This dataset is made publicly available for potential reuse in recycling agricultural waste fibers for value-added materials.

[Idiopathic Diffuse Pulmonary Ossification Diagnosed by Lung Biopsy].

A case of a 64-year-old woman who had undergone resection of a femoral giant cell tumor in another hospital 35 years before was referred to our hospital for diabetes education. Chest radiography and computed tomography (CT) revealed diffuse densely calcified nodular lesions that appear to be in both lung fields. Since pulmonary metastases of the giant cell tumor of the bone was suspected, she underwent a lung biopsy, which showed diffuse pulmonary ossification (DPO) of the dendriform type. It is extremely rare that idiopathic DPO is diagnosed by lung biopsy.

[Pigmented Paraganglioma in the Anterior Mediastinum].

Pigmented paraganglioma of the anterior mediastinum is extremely rare. We report a 72-year-old female patient who was pointed out an anterior mediastinum tumor showed by chest computed tomography(CT) scan during a medical check up. The tumor was 50×35 mm showing gradual enlargement and was slightly homogenously contrasted by CT scan and magnetic resonance imaging(MRI). During the resection of the tumor, sudden elevations of both blood pressure up to 205 mmHg and tachycardia up to 131 beat per minate(bpm)was noted on tumor manipulation. Pathologically, the tumor was diagnosed as pigmented paraganglioma with adjacent lymph node metastasis and microscopic extracapsular invasion. The patient is well 5 years post-surgery without recurrence.

Multikinase inhibitor-associated hand-foot skin reaction as a predictor of outcomes in patients with hepatocellular carcinoma treated with sorafenib.

AIM: To investigate the relationship between the onsets of multikinase inhibitor (MKI)-associated hand-foot skin reaction (HFSR) and prognosis under intervention by pharmacists after the introduction of sorafenib. METHODS: We conducted a retrospective study involving 40 patients treated with sorafenib. Intervention by pharmacists began at the time of treatment introduction and continued until the appearance of symptomatic exacerbation or non-permissible adverse reactions. We examined the relationship between MKI-associated HFSR and overall survival (OS) after the initiation of treatment. RESULTS: The median OS was 10.9 mo in the MKI-associated HFSR group and 3.4 mo in the no HFSR group, showing a significant difference in multivariate analysis. A multivariate analysis of the time to treatment failure indicated that the intervention by pharmacists and MKI-associated HFSR were significant factors. The median cumulative dose and the mean medication possession ratio were significantly higher in the intervention group than in the non-intervention group. A borderline significant difference was observed in terms of OS in this group. CONCLUSION: Intervention by pharmacists increased drug adherence. Under increased adherence, MKI-associated HFSR was an advantageous surrogate marker. Intervention by healthcare providers needs to be performed for adequate sorafenib treatment.

Biodegradable Composites Developed from PBAT/PLA Binary Blends and Silk Powder: Compatibilization and Performance Evaluation.

Silk fibroin powder and biodegradable polybutylene adipate terephthalate (PBAT)/poly lactide (PLA) blends were melt-mixed together to fabricate natural and synthetic polymers as possible new sources of biomaterials. Morphological observations conducted through scanning electron microscopy indicated poor dispersion of the silk powder agglomerates, which resulted from strong hydrogen interactions between silk powder chains in the PBAT/PLA matrix. Although the silk powder agglomerates decreased the mechanical properties, as silk powder fractions increased, the ternary blend with 10 wt % silk powder still displayed high impact strength of 108 J/m and tensile modulus of 1.2 GPa. On the basis of mechanical analysis, this blend offered potential applications in fields which required high impact strength. Blends which contained Joncryl experienced a decrease in storage modulus. Furthermore, rheological studies confirmed that the viscosity of the PBAT/PLA/Silk powder blends decreased, which indicated possible weakening of hydrogen bonds between the silk chains, caused by the reaction between the epoxy groups of Joncryl. This reaction provides a possible method to improve the processability of this natural polymer and to improve its distribution in polymer blends.

[Two Cases of Invasive Thymoma with Taste Disorder].

Two 50s female patients with the taste disorder of sweet taste loss and stage IV a type B2 invasive thymoma underwent surgery at our hospital. One patient with myasthenia gravis (MG) developed postoperative myasthenic crisis and recovered by the treatment with plasma apheresis and steroid pulse therapy. Her taste disorder fully recovered together with her MG symptom. The taste disorder of the other patient without MG had persisted for 3 years after the surgery. The taste disorder of sweet taste loss was reported as one of non-motor symptoms caused by MG-related autoimmune mechanisms associated with thymoma, improving with the therapy for MG. Anti-Kv 1.4 antibody was reported to be positive in nearly half patients with the taste disorder and MG and is speculated to affect selectively the sweet taste receptor.

Thienopyridine derivatives as risk factors for bleeding following high risk endoscopic treatments: Safe Treatment on Antiplatelets (STRAP) study.

BACKGROUND AND STUDY AIMS: The optimal method of perioperative management of antiplatelet agents during endoscopic procedures that carry a high risk of bleeding is still controversial. The aim of this study was to evaluate the safety of continuing aspirin treatment during these procedures in an Asian population. PATIENTS AND METHODS: A multicenter, prospective, observational cohort study was conducted at six high volume endoscopy centers in Japan. The study included patients at high risk of thromboembolism who were regularly taking antiplatelet agents (e. g. thienopyridine derivatives and aspirin). Enrolled patients continued their aspirin therapy, and underwent endoscopic procedures that had a high risk of bleeding for treatment of lesions in the upper and lower gastrointestinal tracts. The primary end point was the rate of major bleeding complications after endoscopic procedures. RESULTS: The study was terminated in accordance with predetermined safety criteria because 7 of 28 consecutive patients experienced major bleeding complications (25.0 %; 95 % confidence interval 10.7 % - 44.9 %). All major bleeding complications occurred following endoscopic submucosal dissection (ESD; 6 stomach, 1 colon). Univariate analysis showed that postoperative administration of thienopyridine derivatives was the only significant factor associated with postoperative bleeding (P = 0.01). Subanalysis of gastric ESD (23 lesions in 19 patients) confirmed that the administration of thienopyridine derivatives (P = 0.01) and that of multiple agents (P = 0.02) were the significant factors. All bleeding complications (postoperative day 11.2 ±â€Š3.5) occurred after resuming thienopyridine derivative therapy postoperatively (postoperative day 2.3 ±â€Š2.4). CONCLUSION: In Asian patients taking thienopyridine derivatives with aspirin, cautious postoperative care is necessary for those undergoing endoscopic procedures that are associated with a high risk of bleeding, especially gastric ESD. Continuation of aspirin alone during these endoscopic procedures may be acceptable. STUDY REGISTRATION: UMIN000009176.

Carbon dioxide absorption and release properties of pyrolysis products of dolomite calcined in vacuum atmosphere.

The decomposition of dolomite into CaO and MgO was performed at 1073 K in vacuum and at 1273 K in an Ar atmosphere. The dolomite calcined in vacuum was found to have a higher specific surface area and a higher micropore volume when compared to the dolomite calcined in the Ar atmosphere. These pyrolysis products of dolomite were reacted with CO2 at 673 K for 21.6 ks. On the absorption of CO2, the formation of CaCO3 was observed. The degree of absorption of the dolomite calcined in vacuum was determined to be above 50%, which was higher than the degree of absorption of the dolomite calcined in the Ar atmosphere. The CO2 absorption and release procedures were repeated three times for the dolomite calcined in vacuum. The specific surface area and micropore volume of calcined dolomite decreased with successive repetitions of the CO2 absorption and release cycles leading to a decrease in the degree of absorption of CO2.

A randomized phase II study comparing S-1 plus weekly split-dose cisplatin with S-1 plus standard-dose cisplatin as first-line chemotherapy for advanced gastric cancer.

BACKGROUND: S-1 plus weekly split-dose cisplatin demonstrated promising results in previous phase I and II studies for advanced gastric cancer (AGC) patients. METHODS: In this randomized phase II study, the efficacy and safety of S-1 plus weekly split-dose cisplatin (SWP, S-1 daily oral dose of 80-120 mg according to body surface area on days 1-14, and cisplatin 20 mg/m(2) i.v. on days 1 and 8 every 3 weeks) were compared with those of S-1 plus standard-dose cisplatin (SP) as first-line chemotherapy for AGC patients. The primary endpoint was 1-year survival rate. RESULTS: Patients were randomized into two groups: 18 in the SWP arm and 19 in the SP arm. This trial was terminated early because of low patient enrollment. The 1-year survival rate was 61 % [95 % confidence interval (CI), 36-86 %] and 53 % (95 % CI, 30-75 %) in the SWP and SP arms, respectively. However, the median survival time was 12.3 months (9.9-14.6 months) and 15.7 months (4.0-27.4 months), respectively (P = 0.064). Progression-free survival was significantly shorter in the SWP arm than in the SP arm (P = 0.047). Toxicity tended to be milder in the SWP arm than in the SP arm. For approximately 40 % of patients in the SWP arm, cisplatin was omitted on day 8 and treatment delayed because of prolonged myelosuppression. CONCLUSIONS: No clear benefits of adding cisplatin to S-1 in the SWP arm were demonstrated in this study. At this point, split-dose cisplatin combined with S-1 cannot be recommended for use in clinical practice.

Phase control and its mechanism of CuInS2 nanoparticles.

CuInS(2) nanoparticles (NPs) usually take chalcopyrite-(CP) structure. Recently, CuInS(2) NPs with pseudo-wurtzite (WZ) structure, which is thermodynamically less favored, have been synthesized. However, the formation mechanism of this metastable-phase has not been understood yet. In this report, the key issue of phase selectivity of CuInS(2) (CIS) NPs has been investigated using various metal sources and ligands. Experimental results suggested that the crystalline structure and morphology of CIS NPs were decided by the stability of indium ligand complex; the active ligand reduces the precipitation rate of In(2)S(3), resulting in pre-generation of Cu(2)S seed NPs. Crystallographic analogy and superionic conductivity of Cu(2)S remind us that the formation of WZ CIS NPs is attributed to the pre-generation of Cu(2)S seed NPs and the following cation exchange reaction. In order to confirm this hypothesis, Cu(2-)(x)S seed NPs with various structures have been annealed in indium-ligand solution. This experiment revealed that the crystalline structure of CIS NP was determined by that of pre-generation Cu(2-)(x)S NPs. Our results provide the important information for the phase control and synthesis of ternary chalcogenide NPs with a novel crystalline structure.

Safety of the paravertebral block in patients ineligible for epidural block undergoing pulmonary resection.

OBJECTIVE: We previously reported the noninferiority of paravertebral block (PVB) to epidural block. In this study, we assessed whether PVB via an intrathoracic approach was also safe for the patients ineligible for epidural block because of, for example, anticoagulation or antiplatelet therapy. METHODS: Patients admitted to our hospital for pulmonary resection between April 2010 and March 2012, and who were ineligible for epidural block for various reasons, were enrolled in this study. A catheter for PVB was inserted in the operative field by the surgeons just before closing the chest. Ropivacaine of 0.2 % was injected at 4 ml/h using an infuser pump for 5 days. Concurrent use of intravenous patient controlled analgesia (IVPCA) for 2 days with PVB was permitted as a post-operative analgesic at the discretion of anesthesiologists. We estimated the post-operative complications in these patients. RESULTS: A total of 35 (15.8 %) consecutive patients were enrolled in this study and successfully completed the study protocol. Thirty-two patients received concurrent IVPCA treatment. Post-operative complications due to PVB were not observed, but other complications included 1 incidence of atrial fibrillation, 1 hypertension, 1 pleural fluid accumulation, 1 respiratory failure requiring mechanical ventilation, and 1 of late chest pain requiring intercostal nerve block. CONCLUSION: This study suggests that PVB is safe in patients ineligible for epidural block and can contribute to their pain relief following pulmonary resection procedure including video-assisted thoracic surgery.

[Effect of the continuous epidural saline infusion for patients with postdural puncture headache after pulmonary resection].

The dual puncture is one of the diseaseful complications at the induction of the epidural anesthesia, which causes severe symptoms of intracranial hypotension such as headache and nausea. The clinical courses of 3 patients with the dual puncture symptoms after pulmonary resections were retrospectively reviewed, and the effect of the continuous epidural saline infusion treatment (CESI) for the dual puncture was evaluated. Pneumococcal empyema developed in 1 patient who had been treated with conservative management. In contrast, the symptoms of the others who were treated with the CESI were quickly recovered or were effectively prevented. This report strongly suggested that the CESI was convenient and effective treatment for dual punctune symptoms by suppressing the cerebrospinal fluid leakage by elevation of the fluid pressure in the extradural space.