A case of primary lung adenocarcinoma mimicking metastatic papillary thyroid carcinoma.

A 61-year-old woman, who had a history of total thyroidectomy for follicular variant of papillary thyroid carcinoma (PTC), visited our hospital for assessment of an enlarging nodule which appeared in the lung with multiple metastatic lesions of PTC which had been stable for 17 years. Wedge resection of the lung was performed. Miliary nodules were confirmed to be metastatic PTCs based on their morphological as well as immunohistochemical findings. As for the main nodule, its morphological features suggested a diagnosis of metastatic PTC, while its immunohistochemical findings were identical with primary lung adenocarcinoma. Further genetic analysis provided no definitive information for the diagnosis of the main nodule. The present case shows the need of comprehensive analyses for differentiation between primary lung adenocarcinoma and metastatic PTCs.

[A Recurrent Colon Cancer Successfully Treated by Nivolumab plus Ipilimumab with On and Off for Preventing Exacerbation of Skin Disorders].

Here, we report a case in which nivolumab plus ipilimumab combination therapy was significantly effective for MSI-high recurrent colon cancer with acute exacerbation after 5-FU/L-OHP/CPT-11 treatment. At the end of 4 cycles of combination therapy, clinical CR was obtained on diagnostic imaging. At the end of the 2 cycles of transition from combination therapy to monotherapy, eosinophilia was observed in a quadratic function, and exacerbation of skin disorders was observed. Eosinophil counts normalized promptly after discontinuation of treatment, and skin disorders gradually improved. Two months after the discontinuation of treatment, monotherapy was restarted. After the resumption of treatment, an increase in eosinophils and worsening of skin symptoms were observed again, and stopped treatment. We report an interesting case in which immune checkpoint inhibiter were turned on and off according to eosinophil counts for preventing exacerbation of skin disorders, and for maintaining cancer remission by continuing immune checkpoint inhibitor treatment.

Signatures of a magnetic superstructure phase induced by ultrahigh magnetic fields in a breathing pyrochlore antiferromagnet.

The mutual coupling of spin and lattice degrees of freedom is ubiquitous in magnetic materials and potentially creates exotic magnetic states in response to the external magnetic field. Particularly, geometrically frustrated magnets serve as a fertile playground for realizing magnetic superstructure phases. Here, we observe an unconventional two-step magnetostructural transition prior to a half-magnetization plateau in a breathing pyrochlore chromium spinel by means of state-of-the-art magnetization and magnetostriction measurements in ultrahigh magnetic fields available up to 600 T. Considering a microscopic magnetoelastic theory, the intermediate-field phase can be assigned to a magnetic superstructure with a three-dimensional periodic array of 3-up-1-down and canted 2-up-2-down spin molecules. We attribute the emergence of the magnetic superstructure to a unique combination of the strong spin-lattice coupling and large breathing anisotropy.

Signature of spin-triplet exciton condensations in LaCoO3 at ultrahigh magnetic fields up to 600 T.

Bose-Einstein condensation of electron-hole pairs, exciton condensation, has been effortfully investigated since predicted 60 years ago. Irrefutable evidence has still been lacking due to experimental difficulties in verifying the condensation of the charge neutral and non-magnetic spin-singlet excitons. Whilst, condensation of spin-triplet excitons is a promising frontier because spin supercurrent and spin-Seebeck effects will be observable. A canonical cobaltite LaCoO3 under very high magnetic fields is a propitious candidate, yet to be verified. Here, we unveil the exotic phase diagram of LaCoO3 up to 600 T generated using the electromagnetic flux compression method and the state-of-the-art magnetostriction gauge. We found the continuous magnetostriction curves and a bending structure, which suggest the emergence of two distinct spin-triplet exciton condensates. By constructing a phenomenological model, we showed that quantum fluctuations of excitons are crucial for the field-induced successive transitions. The spin-triplet exciton condensation in a cobaltite, which is three-dimensional and thermally equilibrated, opens up a novel venue for spintronics technologies with spin-supercurrent such as a spin Josephson junction.

Double dome structure of the Bose-Einstein condensation in diluted S = 3/2 quantum magnets.

Bose-Einstein condensation (BEC) in quantum magnets, where bosonic spin excitations condense into ordered ground states, is a realization of BEC in a thermodynamic limit. Although previous magnetic BEC studies have focused on magnets with small spins of S ≤ 1, larger spin systems potentially possess richer physics because of the multiple excitations on a single site level. Here, we show the evolution of the magnetic phase diagram of S = 3/2 quantum magnet Ba2CoGe2O7 when the averaged interaction J is controlled by a dilution of magnetic sites. By partial substitution of Co with nonmagnetic Zn, the magnetic order dome transforms into a double dome structure, which can be explained by three kinds of magnetic BECs with distinct excitations. Furthermore, we show the importance of the randomness effects induced by the quenched disorder: we discuss the relevance of geometrical percolation and Bose/Mott glass physics near the BEC quantum critical point.

Two Spin-State Crystallizations in LaCoO_{3}.

We report a magnetostriction study of a perovskite LaCoO_{3} above 100 T using our state-of-the-art strain gauge to investigate an interplay between electron correlation and spin crossover. There has been a controversy regarding whether two novel phases in LaCoO_{3} at high magnetic fields result from crystallizations or Bose-Einstein condensation during spin crossover as manifestations of localization and delocalization in spin states, respectively. We show that both phases are crystallizations rather than condensations, and the two crystallizations are different, based on the observations that the two phases exhibit as magnetostriction plateaux with distinct heights. The crystallizations of spin states have emerged manifesting the localizations and interactions in spin crossover with large and cooperative lattice changes.

Magnetic-field-induced insulator-metal transition in W-doped VO2 at 500 T.

Metal-insulator (MI) transitions in correlated electron systems have long been a central and controversial issue in material science. Vanadium dioxide (VO2) exhibits a first-order MI transition at 340 K. For more than half a century, it has been debated whether electron correlation or the structural instability due to dimerised V ions is the more essential driving force behind this MI transition. Here, we show that an ultrahigh magnetic field of 500 T renders the insulator phase of tungsten (W)-doped VO2 metallic. The spin Zeeman effect on the d electrons of the V ions dissociates the dimers in the insulating phase, resulting in the delocalisation of electrons. As the Mott-Hubbard gap essentially does not depend on the spin degree of freedom, the structural instability is likely to be the more essential driving force behind the MI transition.

Direct measurement of resistivity in destructive pulsed magnetic fields.

A simple method for measuring electrical resistivity under destructive pulsed magnetic fields is presented. This method uses pick-up voltage as the power source to allow the measurement of the absolute value of resistivity in ultra-high magnetic fields above 100 T. The experimental setup and its operation are described in detail, and its performance is demonstrated using critical field measurements of thin-film FeSe0.5Te0.5 samples. Possible scientific applications of this setup in high magnetic fields as well as in any other environment with a high field sweep rate are also discussed.

Inferior Vena Cava Compression Caused by a Retroperitoneal Hematoma Following an Abdominal Aortic Aneurysm Rupture.

This report presents the case of a 43-year-old man with inferior vena cava (IVC) compression caused by a retroperitoneal hematoma following an abdominal aortic aneurysm (AAA) rupture. Preoperative computed tomography scans revealed an infrarenal AAA with a retroperitoneal hematoma nearly occluding the IVC. After emergency aortic grafting, IVC thrombosis, deep venous thrombosis (DVT), and pulmonary thromboembolism (PTE) arose. Anticoagulation therapy resolved these thrombotic complications. Disappearance of the hematoma and IVC recanalization were confirmed 3 months postoperatively. Although IVC compression caused by a retroperitoneal hematoma is temporary, careful attention should be paid to IVC thrombosis, DVT, and PTE as possible complications.

A case of bilateral emphysematous pyelonephritis caused by Candida albicans.

Emphysematous pyelonephritis (EPN) is a life-threatening renal infection characterized by the formation of gas within the renal parenchyma and collecting duct system, as well as perinephric tissues. We herein report a case of bilateral EPN accompanied by the urinary tract infection caused by spherical growth of Candida albicans in a patient with underlying diabetes mellitus and prostate cancer. The diagnosis was assisted by computed tomography, urography, and gram staining. Despite immediate percutaneous catheter drainage and a 4-week course of antifungal treatment, the C. albicans infection was refractory, as indicated by continuous isolation from the urine, and the patient eventually died. A local autopsy of urinary organs revealed C. albicans in the renal tissue. EPN caused by Candida species frequently occurs in men, and almost all cases have underlying poorly controlled diabetes. This condition is subject to delayed diagnosis, which may lead to extended disease and high mortality. Candida species should be considered as causative microorganism for refractory EPN in patients with poorly controlled diabetes who are receiving antibiotic treatment. Gram staining may contribute to an early diagnosis of EPN caused by Candida species, which may require long-term antifungal therapy.

Note: Optical filter method for high-resolution magnetostriction measurement using fiber Bragg grating under millisecond-pulsed high magnetic fields at cryogenic temperatures.

High-resolution magnetostriction measurement of ΔL/L ∼ 10-6 at a speed of 5 MHz is performed using the optical filter method as the detection scheme for the fiber Bragg grating (FBG) based strain monitor under 35-ms pulsed high magnetic fields up to 45 T at 2.2 K. The resolution of magnetostriction is about the same order as the conventionally reported value from FBG based magnetostriction measurement systems for millisecond pulsed magnetic fields. The measurement speed is ∼100 times the conventional ones. The present system can be a faster alternative for the conventional FBG based magnetostriction measurement system for millisecond pulsed high magnetic fields.

Magnetic-Field-Induced Kondo Metal Realized in YbB_{12}.

The specific heat of the Kondo insulator YbB_{12} has been measured up to 60 T. The Sommerfeld coefficient γ significantly increases at around 50 T, where the insulator metal transition occurs with a steep increase of the magnetization. γ reaches 67 mJ/(mol K^{2}) at high fields, which directly indicates that the quasiparticles gain a heavy thermodynamic effective mass and transform into a Kondo metal under magnetic fields. The field-induced Kondo metal has a rather high Kondo temperature around 200 K. The strong Kondo coupling proves that the energy gap collapse does not correspond to the breakdown of the Kondo bound state. The steep increase of the magnetization at the transition manifests the sharp density of states at the Fermi energy formed via the Kondo resonance.

Localized Aortic Root Dissection with a Superior Mesenteric Artery Aneurysm.

In this study, the case of a 46-year-old female patient with localized aortic root dissection and a superior mesenteric artery (SMA) aneurysm is described. Computed tomographic angiography could not clearly delineate an intimal flap in the aortic root, but it detected SMA aneurysm, which implied the presence of a vulnerability of the aortic wall. Finally, transesophageal echocardiography (TEE) evidently showed the intimal flap localized in the aortic root. The present case suggests that TEE is of paramount importance for detecting localized aortic root dissection. In addition, a coexisting vascular lesion may be a clue to diagnose another vascular lesion.

High-speed 100 MHz strain monitor using fiber Bragg grating and optical filter for magnetostriction measurements under ultrahigh magnetic fields.

A high-speed 100 MHz strain monitor using a fiber Bragg grating, an optical filter, and a mode-locked optical fiber laser has been devised, whose resolution is ΔL/L∼10-4. The strain monitor is sufficiently fast and robust for the magnetostriction measurements of materials under ultrahigh magnetic fields generated with destructive pulse magnets, where the sweep rate of the magnetic field is in the range of 10-100 T/µs. As a working example, the magnetostriction of LaCoO3 was measured at room temperature, 115 K, and 7 ∼ 4.2 K up to a maximum magnetic field of 150 T. The smooth dependence on the squared magnetic field and the first-order transition were observed at 115 K and 7 ∼ 4.2 K, respectively, reflecting the field-induced spin state evolution.

Mediastinal Abscess Caused by an Expanded Polytetrafluoroethylene Membrane.

A 76-year-old man who had undergone tricuspid annuloplasty 13 years earlier was admitted to our hospital because of a high fever. Although he was treated with antibiotics for pneumonia, a mild fever persisted. Computed tomography and gallium scintigraphy revealed a mediastinal abscess with an expanded polytetrafluoroethylene (ePTFE) membrane. There were no positive cultures or sternal changes indicating poststernotomy mediastinitis. The membrane was removed by a left parasternal approach without resternotomy, and its total removal was essential for the patient's recovery. This is the first reported case of sterile mediastinal abscess caused by an ePTFE membrane after a cardiac operation.

The Superiority of Vonoprazan-based First-line Triple Therapy with Clarithromycin: A Prospective Multi-center Cohort Study on Helicobacter pylori Eradication.

Objective We evaluated the safety and efficacy of vonoprazan-based amoxicillin and clarithromycin 7-day triple therapy (VAC) in comparison to proton pump inhibitor (PPI)-based (PAC) as a first-line treatment and vonoprazan-based amoxicillin and metronidazole 7-day triple therapy (VAM) in comparison to PPI-based (PAM) as a second-line treatment for the eradication of Helicobacter pylori in Japan. Methods We performed a non-randomized, multi-center, parallel-group study to compare first-line VAC to PAC and second-line VAM to PAM. A pre-planned subgroup analysis on CAM resistance was also performed. Safety was evaluated with an adverse effects questionnaire (AEQ), which was completed by patients during therapy. Results The first-line eradication rates (ER) in the intention-to-treat (ITT) and per protocol (PP) analyses were 84.9% (95% CI: 81.9-87.6%, n=623) and 86.4% (83.5-89.1%, n=612), respectively, for VAC and 78.8% (75.3-82.0%, n=608) and 79.4% (76.0-82.6%, n=603), respectively, for PAC. The ER of VAC was higher than that of PAC in the ITT (p=0.0061) and PP analyses (p=0.0013). The ERs for VAC in patients with CAM-resistant and CAM-susceptible bacteria were 73.2% (59.7-84.2%, n=56) and 88.9% (83.4-93.1%, n=180), respectively. PAC was associated with higher AEQ scores for diarrhea, nausea, headache, and general malaise. In the second-line ITT and PP analyses VAM achieved ERs of 80.5% (74.6-85.6%, n=216) and 82.4% (76.6-87.3%, n=211), respectively, while PAM achieved ERs of 81.5% (74.2-87.4%, n=146) and 82.1% (74.8-87.9%, n=145), respectively. No significant differences were observed in the ITT (p=0.89) or PP (p=1.0) analyses. Conclusion The ER of first-line VAC was higher than that of PAC, but still <90%. No difference was observed between second-line VAM and PAM. Vonoprazan-based triple therapy was safe and well tolerated.

Radiopaque Ruler-Guided Frozen Elephant Trunk Technique.

Frozen elephant trunk (FET) technique combines open surgery and endovascular repair for extensive thoracic aortic aneurysms. When a FET is inserted into the descending thoracic aorta, it is difficult to confirm its proper positioning. Here we report a radiopaque ruler-guided FET technique. On the basis of preoperative computed tomography, we create a roadmap which shows the relationship between the descending thoracic aorta and vertebrae. During surgery, a radiopaque ruler placed beneath the patient's back provides the accurate target position under fluoroscopy. Our technique is effective to prevent spinal cord injury because it avoids an overly deep implantation of a FET.

Thick lung wedge resection for acute life-threatening massive hemoptysis due to aortobronchial fistula.

Massive hemoptysis from an aortobronchial fistula due to thoracic aortic dissection is an extremely rare symptom, but is a potentially life-threatening condition. We report a case of acute massive hemoptysis due to aortobronchial fistula that was successfully controlled by a simple and rapid thick wedge resection of the lung with hematoma by using the black cartilage stapler. A 65-year-old man was admitted to our hospital with acute massive hemoptysis. After tracheal intubation, chest computed tomography revealed hematoma in the left lung and ruptured aortic dissection from the distal arch to the descending aorta. He was diagnosed with aortobronchial fistula and underwent an emergency surgery on the same day. We performed posterolateral thoracotomy. A dissecting aortic aneurysm (diameter, ~80 mm) with adhesion of the left upper lobe and the superior segment of the lower lobe was found. The lung parenchyma expanded with the hematoma. We stapled the upper and lower lobes by using the black cartridge stapler along the aortopulmonary window. Massive hemoptysis disappeared, and the complete aortic dissection appeared. Aortic dissection with adherent lung was excised, and graft replacement of the distal arch and descending thoracic aorta was performed. Proximal lung wedge resection using black cartridge stapler is a simple and quick method to control massive hemoptysis from aortic dissection; hence, this procedure is an effective option to control massive hemoptysis due to aortobronchial fistula. This technique could rapidly stop massive hemoptysis and prevent dissection of the adherent lung tissue and intra-thoracic bleeding.

Intravenous Lobular Capillary Hemangioma in the Subclavian Vein.

We report the case of a 73-year-old man with severe edema of the right upper extremity. Computed tomography, magnetic resonance imaging, and venography revealed an intravenous tumor in the middle portion of the right subclavian vein. The tumor was completely resected, and an accompanying thrombus was also removed using the transmanubrial osteomuscular sparing approach. The patient recovered well without any complications or recurrence. The histopathologic diagnosis was intravenous lobular capillary hemangioma, which is also called pyogenic granuloma. To our knowledge, this is the first reported surgical case involving this type of benign tumor originating in a thoracic vein.

[A Patient with Stage IV Advanced Gastric Cancer with Multiple Liver Metastases Living for More Than 6 Years after Treatment with TS-1 Alone].

The patient was a 58-year-old man with advanced gastric cancer with multiple liver metastases. He received TXL/TS-1 therapy during February 2009, but treatment was stopped immediately when he developed anorexia, diarrhea, and numbness in his fingers. Therefore, only TS-1 was administered. Following treatment initiation, tumor marker levels promptly dropped. The gastric lesion disappeared and, to date, only a slight scar remains since April 2010. Similarly, liver metastases have not been detected since August 2011. There has been no lesion progression for 6 years since the start of the chemotherapy.