Laparoscopic Removal of an Infected Mesh Following TEP Procedure for Femoral Hernia with Omental Patch Closure of a Peritoneal Defect.

BACKGROUND Mesh infection following inguinal hernia repair is rare, and mesh removal is mandatory. However, the laparoscopic approach is challenging to perform. Here, we present a case of laparoscopic repair of a mesh infection using a totally extraperitoneal approach (TEP). CASE REPORT A 76-year-old woman underwent repair of a right femoral hernia via TEP approach using a prosthetic mesh with unabsorbable tacks. A month and a half after the surgery, she reported pain in the right groin. Computed tomography revealed a subcutaneous abscess in the right groin. We suspected mesh infection and initially chose conservative management, which included percutaneous drainage and systemic antibiotic administration. Her symptoms temporarily resolved; however, symptom relapse and purulent discharge from the right groin were observed. We performed laparoscopic removal of the infected mesh and all tacks via the transabdominal preperitoneal approach. A drain was placed in the infected preperitoneal space, and the peritoneal defect was covered using the greater omentum. The patient's postoperative course was uneventful, and she was discharged on postoperative day 20. Infection relapse, symptoms of femoral hernia, and adhesive intestinal obstruction have not been observed. CONCLUSIONS A laparoscopic approach for mesh infection after TEP hernia repair is feasible, even if the mesh is fixed using a tack. Greater omental use for peritoneal defects is useful in clinical situations associated with a contaminated surgical field.

Classification tree analysis to evaluate the most useful magnetic resonance image type in the differentiation between early and progressed hepatocellular carcinoma.

AIM: Using classification tree analysis, we evaluated the most useful magnetic resonance (MR) image type in the differentiation between early and progressed hepatocellular carcinoma (eHCC and pHCC). METHODS: We included pathologically proven 214 HCCs (28 eHCCs and 186 pHCCs) in 144 patients. The signal intensity of HCCs was assessed on in-phase (T1in) and opposed-phase T1-weighted images (T1op), ultrafast T2-weighted images (ufT2WI), fat-saturated T2-weighted images (fsT2WI), diffusion-weighted images (DWI), contrast enhanced T1-weighted images in the arterial phase (AP), portal venous phase (PVP), and the hepatobiliary phase. Fat content and washout were also evaluated. Fisher's exact test was performed to evaluate usefulness for the differentiation. Then, we chose MR images using binary logistic regression analysis and performed classification and regression tree analysis with them. Diagnostic performances of the classification tree were evaluated using a stratified 10-fold cross-validation method. RESULTS: T1in, ufT2WI, fsT2WI, DWI, AP, PVP, fat content, and washout were all useful for the differentiation (p < 0.05), and AP and T1in were finally chosen for creating classification trees (p < 0.05). AP appeared in the first node in the tree. The area under the curve, sensitivity and specificity for eHCC, and balanced accuracy of the classification tree were 0.83 (95% CI 0.74-0.91), 0.64 (18/28, 95% CI 0.46-0.82), 0.94 (174/186, 95% CI 0.90-0.97), and 0.79 (95% CI 0.70-0.87), respectively. CONCLUSIONS: AP is the most useful MR image type and T1in the second in the differentiation between eHCC and pHCC.

Isolation of cyanide-degrading bacteria and molecular characterization of its cyanide-degrading nitrilase.

Hydrogen cyanide is an industrially important chemical, and its annual production is more than 1.5 million tons. Because of its toxicity, the cyanide-containing effluents from industries have caused many environmental problems. Among various methods to treat the contaminated soils or water, the biological degradation is regarded to be promising. We isolated two cyanide-degrading microorganisms, Pedobacter sp. EBE-1 and Bacillus sp. EBE-2, from soil contaminated with cyanide. Among these bacteria, Bacillus sp. EBE-2 exhibited significantly a high cyanide-degrading ability. Bacillus sp. EBE-2 might be used for the remediation of cyanide contaminated water or soil. A nitrilase gene was cloned from Bacillus sp. EBE-2. Bacillus nitrilase was expressed in Escherichia coli and purified. Bacillus nitrilase exhibited cyanide-degrading activity as a large oligomer. Since formic acid formation from cyanide was observed, Bacillus nitrilase is likely to be a cyanide hydrolase. Although there exist various homologous enzymes annotated as carbon-nitrogen family hydrolases, this is the first report on the cyanide degrading activity. The structure and catalytic site of Bacillus nitrilase were studied by homology modeling and molecular docking simulation.

Drug sensitivity profile of minor KRAS mutations in colorectal cancer using mix culture assay: The effect of AMG-510, a novel KRAS G12C selective inhibitor, on colon cancer cells is markedly enhanced by the combined inhibition of MEK and BCL-XL.

Colorectal cancer with a Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) gene mutation is considered to be resistant to anti-EGFR agents. G12D is the most common KRAS mutation in colorectal cancer, followed by G12V and G13D. According to clinical and basic research data, patients with colorectal cancer exhibiting G12D and G12V KRAS mutations are resistant to anti-EGFR agents; however, this is not true of G13D and other minor mutations, which are still not well understood. The current study focused on minor KRAS mutations (G12A, G12C, G12S, Q61H and A146T) and evaluated whether these were resistant to anti-EGFR antibodies using a mix culture assay. The results demonstrated that all KRAS mutations, including minor mutations, were resistant to two anti-EGFR agents: Cetuximab and panitumumab. The combined effect of MEK and BCL-XL inhibition on colorectal cancer cells with KRAS minor mutations were subsequently evaluated. The combined effect of MEK and BCL-XL inhibitors was confirmed in all KRAS minor mutations. The sensitivity of AMG510, a novel KRAS G12C selective inhibitor, was also assessed. The mix culture assay revealed that AMG510 selectively exerted an antitumor effect on colon cancer cells with a G12C KRAS mutation. The combination of MEK and BCL-XL inhibition markedly enhanced the effect of AMG510 in colon cancer cells. The current study suggested that AMG510 may have potential clinical use in combination with MEK and BCL-XL inhibitors in the treatment of patients with colorectal cancer exhibiting the G12C KRAS mutation.

Quick response hydrogen LSPR sensor based on a hetero-core fiber structure with palladium nanoparticles.

A novel fiber optic localized surface plasmon resonance (LSPR) hydrogen sensor has been developed based on the hetero-core structured with palladium nanoparticles (PdNPs) onto a cylindrical cladding surface. In a light-intensity-based experiment with an LED operating at 850 nm, it has been observed that a transmitted loss change of 0.23 dB was induced with response and recovery times of 1.5 and 3.2 s for 4% hydrogen which are the fastest response times among optical fiber hydrogen sensors. The proposed sensor resolved the inevitable trade-off issue between sensitivity and response time which existed in the previously reported SPR sensors, with keeping the response time below 2.0 s even in a high sensitivity region of interest.

Dynamic contrast-enhanced computed tomography diagnosis of primary liver cancers using transfer learning of pretrained convolutional neural networks: Is registration of multiphasic images necessary?

PURPOSE: To evaluate the effect of image registration on the diagnostic performance of transfer learning (TL) using pretrained convolutional neural networks (CNNs) and three-phasic dynamic contrast-enhanced computed tomography (DCE-CT) for primary liver cancers. METHODS: We retrospectively evaluated 215 consecutive patients with histologically proven primary liver cancers, including six early, 58 well-differentiated, 109 moderately differentiated, 29 poorly differentiated hepatocellular carcinomas (HCCs), and 13 non-HCC malignant lesions containing cholangiocellular components. We performed TL using various pretrained CNNs and preoperative three-phasic DCE-CT images. Three-phasic DCE-CT images were manually registered to correct respiratory motion. The registered DCE-CT images were then assigned to the three color channels of an input image for TL: pre-contrast, early phase, and delayed phase images for the blue, red, and green channels, respectively. To evaluate the effects of image registration, the registered input image was intentionally misaligned in the three color channels by pixel shifts, rotations, and skews with various degrees. The diagnostic performances (DP) of the pretrained CNNs after TL in the test set were compared by three general radiologists (GRs) and two experienced abdominal radiologists (ARs). The effects of misalignment in the input image and the type of pretrained CNN on the DP were statistically evaluated. RESULTS: The mean DPs for histological subtype classification and differentiation in primary malignant liver tumors on DCE-CT for GR and AR were 39.1%, and 47.9%, respectively. The highest mean DPs for CNNs after TL with pixel shifts, rotations, and skew misalignments were 44.1%, 44.2%, and 43.7%, respectively. Two-way analysis of variance revealed that the DP is significantly affected by the type of pretrained CNN (P = 0.0001), but not by misalignments in input images other than skew deformations. CONCLUSION: TL using pretrained CNNs is robust against misregistration of multiphasic images and comparable to experienced ARs in classifying primary liver cancers using three-phasic DCE-CT.

Total Syntheses of (+)-Aquatolide and Related Humulanolides.

The short, efficient total synthesis of (+)-aquatolide was achieved by a biomimetic transannular [2+2] photocycloaddition, and provides the first example of constructing a 5/5/4/8-ring system from asteriscunolides. Furthermore, the reaction leading to a 5/4/4/7-ring system, the originally proposed structure of aquatolide, was also developed. This strategy achieved syntheses of five more humulanolides, (-)-asteriscunolides A, C, D, and I, and (+)-tetradehydroasteriscanolide.

Compartment model analysis of intravenous contrast-enhanced dynamic computed tomography in hepatic hemodynamics: A validation study using intra-arterial contrast-enhanced computed tomography.

AIM: To verify the utility of the 2-in-1-out-compartment model analysis (CMA) of intravenous contrast-enhanced dynamic computed tomography (IV-CT) for evaluating hepatic arterial and portal venous flow using intra-arterial contrast-enhanced CT (IA-CT). METHODS: We retrospectively evaluated 49 consecutive patients who underwent IV-CT and were radiologically or histologically diagnosed as having hepatic malignant lesion (51 classical hepatocellular carcinomas [HCC], 4 early HCC, 3 cholangiolocellular carcinomas, 1 mixed HCC, 3 cholangiocellular carcinomas). As a gold standard for hepatic arterial and portal blood flows, we defined the normalized enhancement in CT values on CTAP (nCTAP) and CTHA (nCTHA). The hepatic arterial (k1a ) and portal venous inflow velocity (k1p ) constants in hepatic lesions and surrounding liver parenchyma were obtained from the CMA of IV-CT with various outflow velocity constant (k2 ) limits using the nonlinear least square method. The correlation coefficient between the normalized enhancement in IA-CT and CMA of IV-CT was statistically evaluated according to various k2 limits. RESULTS: The highest mean correlation coefficient between k1a and nCTHA (r = 0.65, P < 0.0001) was observed when k2 ≦0.035. The highest mean correlation coefficient between k1p and nCTAP (r = 0.69, P < 0.0001) was observed when k2 ≦0.045. The decrease in correlation coefficient was significant when the upper k2 limit was lower than 0.03 or higher than 0.07 compared to the best mean correlation coefficient (P < 0.05). CONCLUSION: Hepatic arterial and portal venous flows can be evaluated quantitatively to some extent with appropriate outflow velocity constant limits using the CMA of IV-CT.

Quantitative estimation of progression of chronic liver disease using gadoxetate disodium-enhanced magnetic resonance imaging.

AIM: The purpose of this study was to determine whether the liver stiffness (LS) measured on magnetic resonance (MR) elastography can be estimated by a combination of gadoxetate disodium-enhanced MR imaging (EOB-MRI) and ordinary blood tests. METHODS: We evaluated 33 consecutive patients with suspected liver disease who underwent EOB-MRI using a Differential Subsampling with Cartesian Ordering MR sequence and MR elastography using a 1.5-T MR system in this prospective study. A stepwise multiple linear regression model analysis of LS was performed using various predictive values obtained from two-in-one-uptake, two-compartment model analysis of EOB-MRI (velocity constants of arterial inflow [K1a ], portal venous inflow [K1p ], hepatocellular uptake [Ki ]), and ordinary blood test results (blood platelet count, serum albumin level [ALB], total serum bilirubin level [T-BIL], and prothrombin time [PT%]). RESULTS: Multiple linear regression model analysis revealed that hepatic perfusion-uptake index (HPUI = -K1a + K1p + Ki ) (P < 0.0001), albumin-bilirubin linear predictor (ALBI-LP = 0.66 × log10 T-BIL - 0.085 × ALB) (P = 0.034), and blood platelet count (P = 0.046) were significant independent predictors of LS (r = 0.863). The area under receiver operator characteristics curve of multiple linear regression model in prediction of the liver stiffness corresponding to higher (LS > 5.0 kPa) and lower (LS < 4.2 kPa) risk for developing hepatocellular carcinoma were 0.956 and 0.938, respectively. CONCLUSION: LS can be estimated quantitatively with the use of HPUI obtained from compartment model analysis of EOB-MRI combined with ALBI-LP and blood platelet count.

Evaluation of splenic perfusion and spleen size using dynamic computed tomography: Usefulness in assessing degree of liver fibrosis.

AIM: To enhance the usefulness of splenic perfusion evaluated by means of dynamic computed tomography (CT) and spleen size in assessing the degree of liver fibrosis. METHODS: We retrospectively studied 133 patients who had undergone dynamic CT before hepatectomy. Fibrosis was histologically established in all. First we calculated splenic perfusion parameters K1 (inflow rate constant), 1/k2 (mean transit time; MTT), and K1 /k2 (distribution volume; Vd ), using compartment model analysis. Then we compared the stage of fibrosis with splenic perfusion and spleen size (long axis, R), using the Kruskal-Wallis test and multiple comparisons. After that, we assessed the diagnostic accuracy of the combination of splenic perfusion, spleen size, age, gender, and the presence or absence of hepatitis B and hepatitis C viral infection in detecting liver fibrosis, using stepwise regression and receiver operating characteristic analysis. RESULTS: Significant differences (P < 0.05) in MTT were observed in comparisons between fibrosis stages F0 and F4, between F1 and F4, and between F2 and F4. Significant differences (P < 0.05) in R were observed in comparisons between F0 and F4, and between F1 and F4. Considering the presence or absence of hepatitis B and C viral infection along with MTT and R, the areas under the receiver operating characteristic curves were 0.89 for ≥F1, 0.83 for ≥F2, 0.82 for ≥F3, and 0.82 for F4. CONCLUSION: Splenic MTT and spleen size are helpful in assessing liver fibrosis.

Ecological and genomic profiling of anaerobic methane-oxidizing archaea in a deep granitic environment.

Recent single-gene-based surveys of deep continental aquifers demonstrated the widespread occurrence of archaea related to Candidatus Methanoperedens nitroreducens (ANME-2d) known to mediate anaerobic oxidation of methane (AOM). However, it is unclear whether ANME-2d mediates AOM in the deep continental biosphere. In this study, we found the dominance of ANME-2d in groundwater enriched in sulfate and methane from a 300-m deep underground borehole in granitic rock. A near-complete genome of one representative species of the ANME-2d obtained from the underground borehole has most of functional genes required for AOM and assimilatory sulfate reduction. The genome of the subsurface ANME-2d is different from those of other members of ANME-2d by lacking functional genes encoding nitrate and nitrite reductases and multiheme cytochromes. In addition, the subsurface ANME-2d genome contains a membrane-bound NiFe hydrogenase gene putatively involved in respiratory H2 oxidation, which is different from those of other methanotrophic archaea. Short-term incubation of microbial cells collected from the granitic groundwater with 13C-labeled methane also demonstrates that AOM is linked to microbial sulfate reduction. Given the prominence of granitic continental crust and sulfate and methane in terrestrial subsurface fluids, we conclude that AOM may be widespread in the deep continental biosphere.

Isolation and genomic characterization of a Dehalococcoides strain suggests genomic rearrangement during culture.

We have developed and characterized a bacterial consortium that reductively dechlorinates trichloroethene to ethene. Quantitative PCR analysis for the 16S rRNA and reductive dehalogenase genes showed that the consortium is highly enriched with Dehalococcoides spp. that have two vinyl chloride reductive dehalogenase genes, bvcA and vcrA, and a trichloroethene reductive dehalogenase gene, tceA. The metagenome analysis of the consortium by the next generation sequencer SOLiD 3 Plus suggests that a Dehalococcoides sp. that is highly homologous to D. mccartyi 195 and equipped with vcrA and tceA exists in the consortium. We isolated this Dehalococcoides sp. and designated it as D. mccartyi UCH-ATV1. As the growth of D. mccartyi UCH-ATV1 is too slow under isolated conditions, we constructed a consortium by mixing D. mccartyi UCH-ATV1 with several other bacteria and performed metagenomic sequencing using the single molecule DNA sequencer PacBio RS II. We successfully determined the complete genome sequence of D. mccartyi UCH-ATV1. The strain is equipped with vcrA and tceA, but lacks bvcA. Comparison with tag sequences of SOLiD 3 Plus from the original consortium shows a few differences between the sequences. This suggests that a genome rearrangement of Dehalococcoides sp. occurred during culture.

Evaluation of user input methods for manipulating a tablet personal computer in sterile techniques.

PURPOSE: To determine a quick and accurate user input method for manipulating tablet personal computers (PCs) in sterile techniques. METHODS: We evaluated three different manipulation methods, (1) Computer mouse and sterile system drape, (2) Fingers and sterile system drape, and (3) Digitizer stylus and sterile ultrasound probe cover with a pinhole, in terms of the central processing unit (CPU) performance, manipulation performance, and contactlessness. RESULTS: A significant decrease in CPU score ([Formula: see text]) and an increase in CPU temperature ([Formula: see text]) were observed when a system drape was used. The respective mean times taken to select a target image from an image series (ST) and the mean times for measuring points on an image (MT) were [Formula: see text] and [Formula: see text] s for the computer mouse method, [Formula: see text] and [Formula: see text] s for the finger method, and [Formula: see text] and [Formula: see text] s for the digitizer stylus method, respectively. The ST for the finger method was significantly longer than for the digitizer stylus method ([Formula: see text]). The MT for the computer mouse method was significantly longer than for the digitizer stylus method ([Formula: see text]). The mean success rate for measuring points on an image was significantly lower for the finger method when the diameter of the target was equal to or smaller than 8 mm than for the other methods. No significant difference in the adenosine triphosphate amount at the surface of the tablet PC was observed before, during, or after manipulation via the digitizer stylus method while wearing starch-powdered sterile gloves ([Formula: see text]). CONCLUSIONS: Quick and accurate manipulation of tablet PCs in sterile techniques without CPU load is feasible using a digitizer stylus and sterile ultrasound probe cover with a pinhole.

Deep microbial life in high-quality granitic groundwater from geochemically and geographically distinct underground boreholes.

Deep granitic aquifer is one of the largest, but least understood, microbial habitats. To avoid contamination from the surface biosphere, underground drilling was conducted for 300 m deep granitic rocks at the Mizunami underground research laboratory (URL), Japan. Slightly alkaline groundwater was characterized by low concentrations of dissolved organic matter and sulfate and the presence of > 100 nM H2 . The initial biomass was the highest (∼10(5) cells ml(-1) ) with the dominance of Hydrogenophaga spp., whereas the phylum Nitrospirae became predominant after 3 years with decreasing biomass (∼10(4) cells ml(-1) ). One week incubation of groundwater microbes after 3 years with (13) C-labelled bicarbonate and 1% H2 and subsequent single-cell imaging with nanometer-scale secondary ion mass spectrometry demonstrated that microbial cells were metabolically active. Pyrosequencing of microbial communities in groundwater retrieved at 3-4 years after drilling at the Mizunami URL and at 14 and 25 years after the drilling at the Grimsel Test Site, Switzerland, revealed the occurrence of common Nitrospirae lineages at the geographically distinct sites. As the close relatives of the Nitrospirae lineages were exclusively detected from deep groundwaters and terrestrial hot springs, it suggests that these bacteria are indigenous and potentially adapted to the deep terrestrial subsurface.

Prevalence and management of colorectal neoplasia in surgically treated esophageal cancer patients.

AIMS: The existence of other primary tumors during the treatment of esophageal cancer patients has been an important issue. Our aim is to investigate the prevalence and management of colorectal neoplasia (CRN) in surgically treated esophageal cancer patients. METHODS: Between 2002 and 2008, 93 patients with esophageal cancer were surgically treated. Seventy-three patients underwent subtotal esophagectomy and 20 underwent lower esophagectomy for esophageal cancer. Colonoscopy was available for detecting CRN before and after surgery. RESULTS: Eighty-nine (95.7%) of the 93 patients were screened by colonoscopy preoperatively or within a year from the operation. Thirty-nine patients (43.8%) with CRN were synchronously identified: adenoma in 34 (38.2%) and adenocarcinoma in 5 patients (5.6%). Eleven adenomas with high grade-dysplasia and 8 adenomas with low grade-dysplasia were removed endoscopically. Three superficial adenocarcinomas were endoscopically removed before surgery, and 2 adenocarcinomas were surgically removed. Seventy-four patients (83.1%) were followed using colonoscopy, and 11 subsequent CRN, including 2 superficial adenocarcinomas, were endoscopically detected in 8 patients (10.8%). The size of esophageal cancer was larger in the patients with than without CRN (p = 0.036). The body mass index in esophageal cancer patients with CRN tended to be higher than in those without CRN (p = 0.065). CONCLUSIONS: We noted that esophageal cancer is frequently associated with synchronous and/or metachronous colorectal cancer and adenomas. Colonoscopy is useful to detect and manage CRN before and after esophagectomy, although a few limitations exist.

Biogeochemical signals from deep microbial life in terrestrial crust.

In contrast to the deep subseafloor biosphere, a volumetrically vast and stable habitat for microbial life in the terrestrial crust remains poorly explored. For the long-term sustainability of a crustal biome, high-energy fluxes derived from hydrothermal circulation and water radiolysis in uranium-enriched rocks are seemingly essential. However, the crustal habitability depending on a low supply of energy is unknown. We present multi-isotopic evidence of microbially mediated sulfate reduction in a granitic aquifer, a representative of the terrestrial crust habitat. Deep meteoric groundwater was collected from underground boreholes drilled into Cretaceous Toki granite (central Japan). A large sulfur isotopic fractionation of 20-60‰ diagnostic to microbial sulfate reduction is associated with the investigated groundwater containing sulfate below 0.2 mM. In contrast, a small carbon isotopic fractionation (<30‰) is not indicative of methanogenesis. Except for 2011, the concentrations of H2 ranged mostly from 1 to 5 nM, which is also consistent with an aquifer where a terminal electron accepting process is dominantly controlled by ongoing sulfate reduction. High isotopic ratios of mantle-derived 3He relative to radiogenic 4He in groundwater and the flux of H2 along adjacent faults suggest that, in addition to low concentrations of organic matter (<70 µM), H2 from deeper sources might partly fuel metabolic activities. Our results demonstrate that the deep biosphere in the terrestrial crust is metabolically active and playing a crucial role in the formation of reducing groundwater even under low-energy fluxes.

Electrochemical stimulation of microbial reductive dechlorination of pentachlorophenol using solid-state redox mediator (humin) immobilization.

Immobilized solid-phase humin on a graphite electrode set at -500 mV (vs. standard hydrogen electrode) significantly enhanced the microbial reductive dechlorination of pentachlorophenol as a stable solid-phase redox mediator in bioelectrochemical systems (BESs). Compared with the suspended system, the immobilized system dechlorinated PCP at a much higher efficiency, achieving 116 µmol Cl(-)g(-1) humin d(-1). Fluorescence microscopy showed a conspicuous growth of bacteria on the negatively poised immobilized humin. Electron balance analyses suggested that the electrons required for microbial dechlorination were supplied primarily from the humin-immobilized electrode. Microbial community analyses based on 16S rRNA genes showed that Dehalobacter and Desulfovibrio grew on the immobilized humin as potential dechlorinators. These findings extend the potential of BESs using immobilized solid-phase humin as the redox mediator for in situ bioremediation, given the wide distribution of humin and its efficiency and stability as a mediator.

Relationships of obesity and diabetes mellitus to other primary cancers in surgically treated gastric cancer patients.

BACKGROUND: Other primary cancers (OPC) have been reported in gastric cancer (GC) patients. Recent studies have shown relationships of obesity and diabetes mellitus to cancer development in several organs. The purpose of this study was to investigate the relationships of obesity and diabetes mellitus (DM) to the prevalence of OPC in GC patients. METHODS: We reviewed 435 GC patients who were treated surgically and followed their outcomes after surgery. Patients with body mass index (BMI) ≥ 25 kg/m(2) were defined as obese. Fasting plasma glucose (FPG) and HbA1c levels were examined before surgery. RESULTS: OPC was observed in 109 GC patients (25.1%): 40 (9.2%) with synchronous OPC and 76 (18.2%) with metachronous OPC. The most common OPC was colorectal cancer (22.8%). OPC was frequently observed in patients with DM (p = 0.0022), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.215; 95% confidence interval, 1.2007-4.0850; p = 0.011). Synchronous OPC was frequently observed in patients with obesity (p = 0.025), and obesity was an independent risk factor for the occurrence of synchronous OPC (odds ratio, 2.354; 95% confidence interval, 1.1246-4.9279; p = 0.023). Metachronous OPC was frequently observed in patients with DM (p = 0.0071), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.680; 95% confidence interval, 1.0291-6.9780; p = 0.044). CONCLUSION: There is a need to be aware of the possibility of OPC in GC patients with DM/obesity. They should undergo intensive screening for OPC before and after gastrectomy.

Liver dysfunction and thrombocytopenia diagnosed as intravascular large B-cell lymphoma using a timely and accurate transjugular liver biopsy.

A 72-year-old man suffered from paraparesis with a sensory impairment and bladder and rectal disturbances. Magnetic resonance imaging T2-weighted images depicted a high-intensity lesion in the spinal cord that was consistent with myelitis. A blood examination revealed severe thrombocytopenia and liver dysfunction. No malignant cells were detected by peripheral smears or bone marrow biopsy. Systemic computed tomography detected hepatosplenomegaly and ascites but no lymphadenopathies. Transjugular liver biopsy (TJLB) safely confirmed a diagnosis of intravascular large B-cell lymphoma (IVLBCL), and the patient achieved a complete response following treatment with an appropriate chemotherapy. TJLB is therefore a timely and accurate diagnostic approach for IVLBCL, especially when a bleeding tendency and ascites are noted.