Hemostasis using a covered self-expandable metal stent for pseudoaneurysm bleeding from the perihilar bile duct.

Although there are many reports of hemostasis with covered self-expandable metal stent (CSEMS) for bleeding from the papilla of Vater and the intrapapillary and distal bile duct, there are rare reports of its use for hemostasis in the perihilar bile duct. We report the case of a patient undergoing supportive care for perihilar cholangiocarcinoma with acute cholecystitis after side-by-side placement of uncovered SEMS for perihilar bile duct obstruction. Percutaneous transhepatic gallbladder aspiration was performed upon admission, and hematemesis occurred the next day. Since computed tomography scanning showed a pseudoaneurysm in the right uncovered SEMS, hemostasis by interventional radiology (IVR) was performed thrice for massive bleeding; however, hemostasis could not be achieved. When endoscopic retrograde cholangiopancreatography was performed for scrutiny and treatment of melena and increased hepatobiliary enzyme, the endoscopic visual field could not be secured by bleeding, and changes in hemodynamics were observed; thus, IVR was required, but it was difficult to perform. Since bleeding from the right bile duct was expected, hemostasis was performed using CSEMS. This is the first report of hemostasis performed by placing a covered SEMS for bleeding from a pseudoaneurysm of the intrahepatic bile duct.

Electrochemical antioxidant capacity measurement: a downsized system and its application to agricultural crops.

An on-site electrochemical antioxidant capacity measurement system was developed using a screen print electrode (SPE) and circuit tester. The antioxidant capacities of eight antioxidants were evaluated with the handheld electrochemical antioxidant capacity measurement system to compare with those measured with spectroscopic methods, namely, oxygen radical absorbance capacity (ORAC) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging assays, as well as the reported electrochemical method with three conventional electrodes (a glassy carbon electrode, Ag/AgCl electrode and platinum wire electrode) and a potentiostat. Additionally, the potential shifts were proportional to the logarithm of the antioxidant concentration, which obeyed the Nernstian equation. Moreover, the antioxidant capacities of extracts from vegetables (green pepper, ginger and eggplant) were measured with a handheld electrochemical system. Each measurement was finished in only ca. 3 min. The electrochemically obtained antioxidant data were comparable to those from DPPH free-radical scavenging assays and superoxide anion scavenging activity (SOSA) assays, as well as the total phenolic compound content.

Extracellular acidity in tumor tissue upregulates programmed cell death protein 1 expression on tumor cells via proton-sensing G protein-coupled receptors.

Acidity in the tumor microenvironment has been reported to promote cancer growth and metastasis. In our study, we examined a potential relation between extracellular acidity and expression level of the immune checkpoint molecule programmed cell death protein 1 (PD-L1) in murine squamous cell carcinoma (SCC) and melanoma cell lines. PD-L1 expression in the tumor cells was upregulated by culturing in a low pH culture medium. Tumor-bearing mice were allowed to ingest sodium bicarbonate, resulting in neutralization of acidity in the tumor tissue, a decrease in PD-L1 expression in tumor cells and suppression of tumor growth in vivo. Proton-sensing G protein-coupled receptors, T-cell death-associated gene 8 (TDAG8) and ovarian cancer G-protein-coupled receptor 1 (OGR1), were upregulated by low pH, and essentially involved in the acidity-induced elevation of PD-L1 expression in the tumor cells. Human head and neck SCC RNAseq data from the Cancer Genome Atlas also suggested a statistically significant correlation between expression levels of the proton sensors and PD-L1 mRNA expression. These findings strongly suggest that neutralization of acidity in tumor tissue may result in reduction of PD-L1 expression, potentially leading to inhibition of an immune checkpoint and augmentation of antitumor immunity.

Comparison of the anti-colitis activities of Qing Dai/Indigo Naturalis constituents in mice.

Qing Dai/Indigo Naturalis (QD) has been shown to ameliorate ulcerative colitis (UC) in clinical trials; however, its mechanism remains elusive. This study investigates the effects of QD on murine dextran sulfate sodium salt-induced colitis. Oral administration of QD protected the animals from colitis as manifested by weight loss, diarrhea, and rectal bleeding. QD was distinguishingly more effective than 5-aminosalicylate. Focused microarray analysis of genes expressed in the distal colon suggested that QD influences the inflammatory pathway. Anti-inflammatory activity of QD was confirmed by the suppression of nitric oxide (NO) production in response to interleukin-1ß in cultured hepatocytes. Some of the constituents in QD, such as tryptanthrin (TRYP) and indigo, suppressed NO production. TRYP maintained body weight but did not inhibit bleeding. Indigo, on the other hand, partially ameliorated bleeding, but did not maintain body weight. The combination of TRYP and indigo did not show additive ameliorating activity. The methanol extract of QD showed an anti-colitis activity like that of TRYP. In contrast, the methanol-insoluble QD fraction moderately ameliorated diarrhea and bleeding. Combining these two fractions resulted in full anti-colitis activity. Further clarification of the active constituents will help in the discovery of a safe and potent prescription for UC.

Radiation-induced angiosarcoma of the parotid gland after postoperative radiotherapy for hypopharyngeal carcinoma.

Secondary carcinogenesis within the irradiation range is one of the most severe problems in cancer survivors. A 60-year-old woman developed hypopharyngeal carcinoma, and she received radical surgery and postoperative radiotherapy. Eight years later, brown pigmentation and induration were observed in the left subaural region. Fine-needle aspiration biopsy revealed malignancy and the parotid tumor was diagnosed as recurrence of hypopharyngeal carcinoma. Neoadjuvant chemotherapy followed by radical parotidectomy was performed. The pathological diagnosis was angiosarcoma, which was most likely induced by past irradiation. About two months after surgery, lung metastases were detected. Docetaxel did not affect to lung metastases, but paclitaxel therapy was partially effective. The lung tumors increased in size, and brain metastases developed, resulting in death. Both neoadjuvant chemotherapy and radical surgery played important roles in the local disease control. Administration of newer agents as adjuvant chemotherapeutic agent should also be considered for improving the prognosis.

Future Perspectives for the Treatment of Diabetes: Importance of a Regulatory Framework.

BACKGROUND: The number of diabetes patients is steadily increasing worldwide. Consequently, the social burden of diabetes is huge, requiring urgent countermeasures. We performed an intensive survey of antidiabetic drugs approved in Japan, the United States, and the European Union. METHODS: Information about approved antidiabetic drugs was obtained by searching databases of regulatory authorities in the 3 regions. Other relevant information was also obtained from publicly available literature and documents. RESULTS: No difference in the total number and types of approved drugs among the 3 regions was found (P = .173 by log-rank test). However, the numbers of approved dipeptidyl peptidase-4 and sodium-glucose cotransporter 2 inhibitors in Japan were almost double of those in the other regions. The average sample size in clinical trials used for antidiabetic drug approval in Japan (1134 patients) was much smaller than that in the other regions (P < .001 by analysis of variance repeated measures test adjusted by the Holm method). Currently, 6 drugs with known modes of action are being developed for type 1 diabetes in Japan, whereas at the end of 2016, nearly 7-fold more products with novel modes of action were in clinical development in the United States. CONCLUSION: Antidiabetic drug development in Japan costs less than that in the other regions, although novel development is less active because of regulatory differences. To achieve better pharmacotherapy for diabetes, the regulatory framework requires careful consideration.

A Case of Laryngeal Granuloma Likely Caused by Laryngopharyngeal Reflux Disease Following a Sagittal Split Ramus Osteotomy.

Laryngeal granuloma is an uncommon complication of prolonged endotracheal intubation. A 25-year-old woman with severe jaw deformity underwent sagittal split ramus osteotomy under general anesthesia. Two days after extubation, the patient complained of hoarseness, sore throat, and dyspnea. When symptoms persisted, she was evaluated in the Otolaryngology Department. She was diagnosed with laryngeal granuloma of the bilateral arytenoid cartilages, and conservative treatment was selected. Administration of corticosteroid hormones, proton pump inhibitors, and a subsequent follow-up examination performed in our outpatient clinic showed no evidence of recurrence 10 months after the initial presentation.

Effects of the delay and duration of self-generated wind on behavioral compensation in unilaterally cercus-ablated crickets, Gryllus bimaculatus.

The effects of the delay and duration of wind self-generated during walking on the compensational recovery of escape direction were investigated in unilaterally cercus-ablated crickets, Gryllus bimaculatus. Artificial self-generated winds (self-stimulations; hereafter, SSts) from a nozzle set in front of a cricket placed on a styrofoam ball for stationary walking were used for training after unilateral cercus ablation. The delay and duration of artificial SSts were separately controlled. When the stimulus duration was fixed to 100 msec, the crickets trained with artificial SSts of 1000 msec delay showed a compensational recovery of the escape direction. However, no such compensational recovery was observed in crickets trained with artificial SSts of 1200, 1500, and 2000 msec delays. The relationship between the delay and duration of artificial SSts for compensational recovery was investigated. An artificial SSt with a longer delay required a longer-duration air current to cause a recovery of the escape direction. In contrast, an artificial SSt with a shorter delay was effective even when the duration was short. On the basis of the results obtained in the present study, we propose a hypothesis to explain the initial step for the compensation, that is, how the delay and duration of SSts are traded in terms of the compensational recovery of the escape direction.