[18F]FDG PET/CT Findings of Mass-Forming Actinomycosis in an Uncontrolled Diabetic Patient.

We report a case of cervicofacial actinomycosis mimicking malignant sarcoma in a 78-year-old man with diabetes. High lesion uptake and decreased cerebral uptake on [18F]FDG PET/CT provide a potentially important diagnostic clue suggesting infectious disease in a poorly controlled diabetic patient.

Endoscopic evaluation technique using a camera port for valve-sparing root reconstruction.

Intraoperative aortic valve evaluation should be accurate in valve-sparing root replacement to minimize postoperative aortic valve regurgitation. Ascending aorta de-clamping and weaning of cardiopulmonary bypass are required in intraoperative transoesophageal echocardiography. Aortic valve endoscopy aids in the magnification of structures and enables image sharing within the operative team. While a rigid endoscope and saline infusion line are directly inserted from the Valsalva graft end, a Kelly clamp is needed for graft gap closure, affecting the valve morphology due to graft deformation. The accurate inner pressure of the neo-Valsalva sinus cannot be measured in this method. We propose a technique to accurately evaluate aortic valve conformation using a balloon blunt-tip system that enables aortic valve evaluation under the measured pressure and without Valsalva graft deformation.

[Preoperative Evaluation of Saphenous Vein Graft Using Plain Computed Tomography for Endoscopic Saphenous Vein Harvesting].

We report the preoperative evaluation of saphenous vein (SV) graft using plain computed tomography (CT) for endoscopic saphenous vein harvesting (EVH). We made three-dimensional (3D) images of SV by using plain CT images. EVH was performed in 33 patients from July 2019 to September 2020. The mean age of the patients was 69±23 years, and 25 patients were men. The success rate of EVH was 93.9%. Hospital mortality was 0%. Postoperative wound complications was 0%. The early patency was 98.2% (55/56). 3D images of SV by plain CT are very important information for EVH because of surgical procedure in a closed space. Early patency is good and mid and long term patency of EVH may be improved due to safety and gentle technique by CT information.

[Posterior Mediastinal Cyst Resection during Cardiac Surgery through Median Sternotomy:Report of a Case].

A 47-year-old man presented with hematuria. Computed tomography( CT) showed a posterior mediastinal cyst. Chest magnetic resonance imaging showed a well defined mass with high intensity on T2-weighted images. Echocardiogram revealed severe aortic regurgitation, moderate mitral regurgitation and no continuity between the cyst and the pericardium. We performed aortic valve replacement, mitral annuloplasty and cyst resection after confirming it was not malignant by intraoperative rapid pathological examination. We performed sufficient and safe cyst resection through full sternotomy under cardiac arrest. Pathological examination revealed that cyst was bronchogenic. Bronchogenic cyst has malignant potential and it is very difficult to resect after presenting symptoms. We need to consider the differential diagnosis, the timing of operation and operative strategy.

[Incidental Diagnosis of Giant Cell Myocarditis at Open Heart Surgery:Report of Case].

Giant cell myocarditis (GCM) is one of the rare diseases that cause fatal heart failure and suspected to be associated with autoimmune disorder. There are few reports that the patients of GCM live long because of their progressive heart failure. We report a rare case of patient who was suspected two long hospitalizations due to heart failure in her childhood and peripartum period, and incidentally diagnosed with GCM by myocardial biopsy performed at the aortic valve replacement and mitral annuloplasty for severe aortic valve regurgitation and moderate mitral regurgitation.

High-dose fludrocortisone therapy was transiently required in a female neonate with 21-hydroxylase deficiency.

For salt-wasting 21-hydroxylase deficiency (21OHD), fludrocortisone (FC) is usually supplemented at 0.05-0.2 mg/d dose. To date, no report has described 21OHD neonates requiring > 0.4 mg/d of FC. Our female 21OHD patient was lethargic and experienced weight loss with hyponatremia (133 mEq/L), hyperkalemia (6.5 mEq/L), and elevated active renin concentration (ARC, 1942.2 pg/mL) at 6 days of life. Hydrocortisone and FC replacement were initiated. FC dose was gradually increased to 0.4 mg/d at 21 days of life, but her hyperkalemia (6.4 mEq/L) and high ARC (372.3 pg/mL) persisted. We increased FC to 0.6 mg/d and used a low-potassium and high-sodium formula. Hyperkalemia subsequently improved. At 33 days of life, the ARC decreased to 0.6 pg/mL and FC dosage was gradually decreased. At 3 months of age, the low-potassium and high-sodium formula was discontinued, but the serum potassium level was normal and ARC remained low at 0.1 mg/d of FC. We speculated that severe mineralocorticoid resistance was the reason why her hyperkalemia persisted even with 0.4 mg/d of FC; however, the pathophysiology of transiently severe resistance to FC in this patient is unknown. In conclusion, 21OHD neonates may show severe salt-wasting that transiently require > 0.4 mg/d of FC.

Conformational Control of [2]Rotaxane by Hydrogen Bond.

A series of [2]rotaxanes with various functional groups in the axle component was synthesized by the oxidative dimerization of alkynes, which is mediated by a macrocyclic phenanthroline-Cu complex. The rotaxanes were fully characterized by spectroscopic methods, and the structure of a rotaxane was determined by X-ray crystallographic analysis. The interaction between the ring component and the axle component was studied in detail to understand the conformation of the rotaxanes. The presence of the hydrogen bond between the phenanthroline moiety in the macrocyclic component and the acidic proton in the axle component influenced the conformation of rotaxane.

[Coronary Artery Bypass Grafting and Mitral Annuloplasty in a Patient with Left Ventricular Noncompaction with Low Ejection Fraction:Report of a Case].

A 71-year-old man who hospitalized frequently for heart failure was referred to our hospital for severe coronary disease with mitral regurgitation. Transthoracic echocardiography revealed marked left ventricular dilatation, low ejection fraction (20%) and moderate mitral regurgitation with leaflet tethering. It also revealed myocardium with prominent trabeculations and deep intertrabecular recesses. Coronary angiography showed triple vessel disease. Coronary artery bypass grafting and mitral annuroplasty was performed. Coronary microcirculatory dysfunction by left ventricular noncompaction( LVNC) and myocardial ischemia made us pay more attention to myocardial protection. Aortic cross clamp time was 67 minnutes, total cardiopulmonary bypass time was 116 minnutes and operation time was 214 minnutes. The postoperative course was uneventful and the patient was discharged 15 days after the operation. Postoperative echocardiography revealed no mitral regurgitation and improving left ventricular function. Postoperative coronary computed tomography showed all grafts patent. Careful observation of cardiac function is vital because of the possibility of progression to heart failure in a patient with LVNC.

[Aortic Valve Replacement through an Upper Hemisternotomy in an Eldery Patient with Heart Failure:Report of a Case].

Cardiac surgery for elder patients should be minimally invasive because of their frailty and concomitant multiple chronic diseases. We performed aortic valve replacement (AVR) via upper hemisternotomy (UHS) on an 85-year-old patient who suffered from severe aortic regurgitation with dobutamine support. The postoperative course was uneventful. AVR via UHS is safer than that via right axiallary thoracotomy AVR with shorter aortic cross-clamp time, shorter cardiopulmonary bypass time and fewer complications. AVR via UHS makes ambulation and rehabilitation easier than AVR via full sternotomy, because of thoracic stability. It is more effective and should be more prevalent as minimally invasive cardiac surgery for eldery patients with frailty.

[A Case of Malignant Lymphoma of the Jejunum That Developed Stenosis and Perforation after a Complete Response to Chemotherapy].

A 57-year-old woman was admitted owing to epigastric pain.Abdominal computed tomography demonstrated a tumor in the origin of the jejunum.After an endoscopic biopsy, we diagnosed diffuse large B-cell lymphoma.We treated her with CHOP chemotherapy because pancreaticoduodenectomy is highly invasive.After 1 course of chemotherapy, the tumor was reduced.However, she developed a jejunal stenosis; therefore, we performed laparoscopic gastrojejunostomy.Furthermore, she developed perforated peritonitis on the sixth day after the surgery, and therefore, an emergency partial jejunum resection was performed.Histopathologically, viable lymphoma cells were not found in the resected intestine.She had a complete response 10 months after the surgery.Chemotherapy may cause intestinal stenosis and perforation requiring surgery; therefore, decisions about surgical procedures must be made carefully.

Syncope caused by coronary artery spasm without chest pain leading to ventricular fibrillation.

We present a case of syncope caused by coronary artery spasm without chest pain leading to ventricular fibrillation despite of vasodilator therapy with a calcium channel blocker (CCB). A 68-year-old man presented with two episodes of syncope without chest pain. Ergonovine provocation test induced a diffuse spasm in the right coronary artery (RCA) and subsequently, ventricular fibrillation. Under the therapy with multiple vasodilators including two CCBs, a second ergonovine provocation induced a spasm of the proximal RCA resulting in complete obstruction. Owing to drug-resistant coronary spasm complicated by ventricular fibrillation, an implantable cardioverter defibrillator (ICD) was implanted. This case report highlights the occurrence of syncope caused by coronary artery spasm without chest pain that was refractory to single CCB therapy and needed ICD implantation. Therapy with multiple vasodilators, including two or more CCBs, along with ICD implantation may be required to treat such refractory coronary artery spasms leading to lethal arrhythmia.

Structural basis of UV DNA-damage recognition by the DDB1-DDB2 complex.

Ultraviolet (UV) light-induced pyrimidine photodimers are repaired by the nucleotide excision repair pathway. Photolesions have biophysical parameters closely resembling undamaged DNA, impeding discovery through damage surveillance proteins. The DDB1-DDB2 complex serves in the initial detection of UV lesions in vivo. Here we present the structures of the DDB1-DDB2 complex alone and bound to DNA containing either a 6-4 pyrimidine-pyrimidone photodimer (6-4PP) lesion or an abasic site. The structure shows that the lesion is held exclusively by the WD40 domain of DDB2. A DDB2 hairpin inserts into the minor groove, extrudes the photodimer into a binding pocket, and kinks the duplex by approximately 40 degrees. The tightly localized probing of the photolesions, combined with proofreading in the photodimer pocket, enables DDB2 to detect lesions refractory to detection by other damage surveillance proteins. The structure provides insights into damage recognition in chromatin and suggests a mechanism by which the DDB1-associated CUL4 ubiquitin ligase targets proteins surrounding the site of damage.

Characterization of distamycin A binding to damaged DNA.

We previously reported that distamycin A, a natural antibiotic known as a minor groove binder, could bind to DNA duplexes containing the (6-4) photoproduct formed at its target site, whereas the binding was not observed for duplexes containing the cis-syn cyclobutane pyrimidine dimer in the same sequence context. In this study, we have further analyzed the binding of this drug to lesion-containing duplexes to elucidate its damaged-DNA recognition mechanism. Surface plasmon resonance measurements using various types of DNA showed that distamycin A could bind to several types of lesion-containing DNA. Curve fitting of the CD titration data revealed that the complex formation occurred with K(d) values around 10(-6) and a stoichiometry of 1:1. The results obtained in this study suggested that distamycin A binds to damaged DNA in the same way as to the normal target site, by recognizing the chemical structure of the minor groove.

Characterization of the binding of distamycin A to damaged DNA: a comparison with the DNA recognition of the human DDB protein.

Distamycin A binds to DNA containing the (6-4) photoproduct, a major UV lesion that is recognized by the damaged DNA-binding (DDB) protein in human cells. We analyzed the binding properties of distamycin A and compared the results with those of the DDB protein. Structural change of the DNA duplex was not observed for distamycin A in two types of experiments, whereas the protein induced a large bending of the helix. Although the substrate specificity was different between the drug and the protein, thymine glycol was recognized by both of them, and inhibition of the DDB protein binding to the (6-4) photoproduct-containing DNA by distamycin A was tested.

Preferential formation of (5S,6R)-thymine glycol for oligodeoxyribonucleotide synthesis and analysis of drug binding to thymine glycol-containing DNA.

We previously reported the chemical synthesis of oligonucleotides containing thymine glycol, a major form of oxidative DNA damage. In the preparation of the phosphoramidite building block, the predominant product of the osmium tetroxide oxidation of protected thymidine was (5R,6S)-thymidine glycol. To obtain the building block of the other isomer, (5S,6R)-thymidine glycol, in an amount sufficient for oligonucleotide synthesis, the Sharpless asymmetric dihydroxylation (AD) reaction was examined. Although the reaction was very slow, (5S,6R)-thymidine glycol was obtained in preference to the (5R,6S) isomer. The ratio of (5S,6R)- and (5R,6S)-thymidine glycols was 2:1, and a trans isomer was also formed. When an ionic liquid, 1-butyl-3-methylimidazolium hexafluorophosphate, was used as a co-solvent, the reaction became faster, and the yield was improved without changing the preference. The phosphoramidite building block of (5S,6R)-thymidine glycol was prepared, and oligonucleotides containing 5S-thymine glycol were synthesized. One of the oligonucleotides was used to analyze the binding of distamycin A to thymine glycol-containing DNA by Circular dichroism (CD) spectroscopy and surface plasmon resonance (SPR) measurements. Distamycin A bound to a duplex containing either isomer of thymine glycol within the AATT target site, and its binding was observed even when the thymine glycol was placed opposite cytosine.