Clinical Utility of Surgical Lung Biopsy for Patients with Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis.

BACKGROUND: Surgical lung biopsy (SLB) is performed in patients with acute respiratory distress syndrome (ARDS); however, its clinical utility remains unclear. OBJECTIVES: We categorized the pathological diagnoses and investigated the predictive value for short-term mortality. METHOD: Three electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) were searched for the included studies. The QUADAS-2 was used to evaluate the risk of bias and its applicability. The types and populations of pathological diagnoses were investigated. The pooled sensitivity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were estimated at a fixed specificity. Hierarchical summary receiver operating characteristic curves were drawn. RESULTS: A total of 16 studies that enrolled 758 patients were included. The pathological diagnoses were as follows: diffuse alveolar damage (DAD) 29.9%; infection 24.7%; interstitial lung disease 17.2%; malignancy 3.6%; cardiovascular disease 3.6%; drug toxicity 2.3%; connective tissue disease 2.2%; allergic disease 1.1%; and nonspecific diagnosis 15.4%. To predict short-term mortality, 13 studies that enrolled 613 patients used DAD as an index test and recorded a mortality rate of 56.9% (349 of 613 patients). A total of 3 studies that used index tests other than DAD were excluded. The pooled sensitivity, fixed specificity, LR+, LR-, and DOR were 0.46 (95% confidence interval [CI]: 0.29-0.56), 0.69, 1.48 (95% CI: 0.92-1.81), 0.78 (95% CI: 0.63-1.03), and 1.90 (95% CI: 0.89-2.86), respectively. CONCLUSIONS: SLB is unlikely to provide a specific diagnosis and should not be recommended for confirming DAD or predicting ARDS prognosis.

[Secondary Contamination by Wheat Allergens across Cooking Bowls through the Use of Sponge Scourers].

After washing the cooking utensils used to prepare liquid batter, flour may remain in the scrubbing sponge. Secondary contamination of cooking devices with wheat allergens is a concern if such scrubbing sponges are used to clean other equipment. Therefore, in this study, bowl washing with detergent, using a scrubbing sponge was evaluated as a cleaning method following liquid batter cooking. Multiple trials revealed that wheat allergens were transferred from a bowl coated with 10 g of liquid batter to an unused bowl via sponge scrubbing with a positive rate of approximately 80%. Residual batter was observed in the scrubbing sponge after cleaning and rinsing procedures, with a residual rate of about 20%. Detailed observation of the residue revealed that proteins such as gluten were attached to the cell skeleton, and between the skeletons of the sponge, and starch granules were attached to the proteins. Even with sponge rinsing conditions added to the protocol, complete removal of wheat allergen was difficult. These studies indicate that particular scrubbing sponges for cleaning the residual wheat on cooking utensils should be dedicated exclusively in cooking facilities that prepare allergy-friendly-foods to avoid risk of allergen contamination.

Injectable Biocatalytic Nanocomposite Hydrogel Factories for Focal Enzyme-Prodrug Cancer Therapy.

Systemic enzyme-prodrug therapy (EPT) using nanofactories, nanoparticles encapsulating prodrug-activating enzymes, is a promising concept for anticancer therapy. However, systemic delivery systems can be problematic. As nanofactories are typically carried by the blood circulation to tissues throughout the body, conversion of anticancer drugs in normal tissues can cause severe side effects. To overcome this problem, we developed a novel focal EPT approach utilizing nanocomposite hydrogels composed of a poly(dl-lactide-co-glycolide)-b-poly(ethylene glycol)-b-poly(dl-lactide-co-glycolide) (PLGA-PEG-PLGA) copolymer, LAPONITE, and ß-galactosidase (ß-gal). The nanocomposite gels can be easily injected locally, and the inherent enzyme activity of ß-gal can be preserved long-term. Prodrug 5-FU-ß-gal readily permeated into the interior space of gels and was converted into the active anticancer drug 5-FU. Importantly, a single local injection of nanocomposite gels and prodrug 5-FU-ß-gal provided long-lasting antitumor activity in vivo without observable side effects, demonstrating the potential utility of injectable biocatalytic hydrogel factories for novel focal EPT systems.

Radiation dose for 320-row dose-modulated dynamic coronary CT angiography.

OBJECTIVES: The area detector 320-row CT scanner, which can cover the whole heart in one rotation, can aid in reducing radiation exposure during electrocardiography (ECG)-gated coronary CT angiography (CCTA). Recently, researchers have proposed dose-modulated dynamic CCTA with a 320-row scanner for the detection of functional myocardial ischemia. In the present study, we compared and validated the radiation dose of this method with that of the standard CCTA method and the latest diagnostic reference levels (DRLs). MATERIALS AND METHODS: The study included a total of 164 consecutive patients with suspected or known coronary artery disease (CAD) who underwent CCTA with a 320-row scanner. The patients were randomly divided into dynamic and standard CCTA groups, and the CT dose index (CTDIvol) and dose length product (DLP) calculated by the CT system were compared between the two protocols and with the latest DRL. RESULTS: Standard and dynamic CCTA scans were performed in 77 and 87 patients, respectively. CTDIvol was significantly higher for standard CCTA than for dynamic CCTA (41 ± 35 mGy vs. 22 ± 7 mGy, p = 0.0014). DLP was also significantly higher for standard CCTA than for dynamic CCTA (864 ± 702 mGy × cm vs. 434 ± 106 mGy × cm, p < .0001). For standard scans, CTDIvol and DLP exceeded the 2020 DRL in Japan in 16% (12/77) and 17% (13/77) of cases, respectively. In contrast, rates for the dynamic scan were only 1% (1/87) for CTDIvol and 0% (0/87) for DLP. CONCLUSION: The dose of radiation exposure during dynamic CCTA with a 320-row scanner does not exceed that of standard CCTA and is sufficient to meet the latest DRL. Thus, our results suggest that the method is safe from the perspective of radiation exposure.

Locking versus nonlocking superior plate fixations for displaced midshaft clavicle fractures: A prospective randomized trial comparing clinical and radiografic results.

BACKGROUND: It is unknown whether locking or nonlocking superior plate fixation is better for managing displaced midshaft clavicle fractures. Therefore, we aimed to compare the clinical and radiographic outcomes of locking and nonlocking superior plate fixation of displaced midshaft clavicle fractures. METHODS: A total of 102 consecutive patients with displaced midshaft clavicle fractures (2B1 and 2B2 in Robinson classification) participated in this randomized controlled trial; 12 patients were excluded. Surgeries were performed using a 3.5-mm Locking Compression Plate (LCP) between 2007 and 2015. Patients were treated either with a locking plate (group L, n = 45) or a nonlocking plate (group N, n = 45). In both groups, the plates were fixed to the proximal and distal clavicle with two and/or three screws, respectively. The main outcome measures were complication rates, time to bone union, and Constant score. RESULTS: Forty-two patients in group L (mean age, 45.9 years) and 41 in group N (mean age, 43.6 years) were followed. The overall complication rates in groups L and N were 7.2% (three peri-implant fractures) and 7.3% (non-union, deformed plate, and peri-implant fracture), respectively (p = .98). The average time to union significantly differed between groups (L vs. N: 13.0 ± 4.1 vs. 17.5 ± 6.3 weeks; p < .01). However, the Constant score at the final follow-up was not significantly different between groups (L vs. N: 87.0 ± 12.3 vs. 89.8 ± 9.1). CONCLUSIONS: Similar complication rates and clinical results were found for locking and nonlocking superior plate fixation for displaced midshaft clavicle fractures. However, the time to bone union was shorter with the locking plate. This study suggests that both plating systems are effective for treating displaced midshaft clavicle fractures. LEVEL OF EVIDENCE: Therapeutic, level I.

Duplicated Middle Cerebral Artery Aneurysms Treated by Coil Embolization; A Report of Two Cases and Literature Review.

BACKGROUND: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). Aneurysms at the origin of a DMCA have been reported; however, most have been treated with clipping surgery. Here, we describe two cases of aneurysms at the origin of a DMCA treated with coil embolization. CASE PRESENTATION: Case 1: A seventy-three year-old man presented with severe headache and was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) and 3-dimensional (3-D) DSA showed an aneurysm arising from a DMCA. Coil embolization was performed with DMCA patency. The patient had an uneventful postoperative course. CASE 1: A 44-year-old woman presented with a history of clipping for an IC-anterior choroidal artery (AchA) aneurysm 8 years prior. Magnetic resonance imaging (MRI) showed regrowth of the aneurysm. 3-D DSA showed an IC-DMCA aneurysm located laterally and distal to the AchA. The DMCA arose from the bottom of the aneurysm. Coil embolization was performed without DMCA occlusion and showed no postoperative ischemic changes. CONCLUSION: An IC-DMCA aneurysm is rare and may be misdiagnosed as an AchA aneurysm. Clinicians should perform a 3D-DSA evaluation if the aneurysm arises from the lateral wall of the IC to obtain a precise diagnosis and to preserve the DMCA during coil embolization.

A case report of thin basement membrane nephropathy accompanied by sporadic glomerulocystic kidney disease.

BACKGROUND: Thin basement membrane nephropathy (TBMN) is a relatively common disease. Patients typically present with isolated hematuria, which has a good renal prognosis. In contrast, glomerulocystic kidney disease (GCKD) is a rare disease, associated with slow progressive renal dysfunction. To our knowledge, co-occurring diagnosis of TBMN with GCKD has not been reported previously. CASE PRESENTATION: A 30-year old woman was admitted to our hospital for evaluation of hematuria and renal insufficiency. Upon examination, her urinary protein level was 40 mg/day and occult blood in her urine was 2+. The patient's urinary dysmorphic red blood cell sediment was 30-49/high power field. In contrast, her serum creatinine levels increased from 0.57 mg/dl to 0.86 mg/dl during the previous 2-years, without special events. She suffered from far-sightedness and astigmatism beginning at birth; She had no family history of renal disease. Renal biopsy demonstrated cystic dilatation of the Bowman's capsule and atrophy of the glomerular tuft. The glomerular basement membrane (GBM) was thin, with an average thickness of 191 nm. Next-generation sequencing was used to evaluate for mutations in COL4A3 and COL4A4, associated with TBMN, and UMOD, MUC1, and SEC61A1, associated with hereditary GCKD. No pathogenic mutations were identified. We thus diagnosed the patient with TBMN coexistent with sporadic GCKD. CONCLUSION: We report the patient diagnosed with TBMN accompanied by sporadic GCKD, based on renal biopsy and genetic testing. Because it is possible that other diseases, such as GCKD, can coexist with TBMN, it is important to consider renal biopsy.

Greenstick fracture-hinge decompressive craniotomy in infants: illustrative case and literature review of techniques for decompressive craniotomy without bone removal.

PURPOSE: We present the potential usefulness of a greenstick fracture-hinge decompressive craniotomy, a variant of a hinge-craniotomy, as an alternative technique for use with a decompressive craniectomy (DC) in infants. A literature review of hinge-craniotomy procedures and technical variants is also provided, with a focus on complications associated with a DC peculiar to infants and children. METHODS: Illustrative case presentation along with literature review. RESULT: Significant rates of complications associated with a DC and subsequent cranioplasty have been reported, such as bone flap resorption, hydrocephalus, cerebrospinal fluid collection, and infection, especially in infants. A hinge-craniotomy is an older technique reported to have potential usefulness with some modifications, though concerns have been raised about adequate decompression and definitive indications. CONCLUSION: A DC procedure performed in children, especially infants, includes a significantly high risk of various complications; thus, a hinge-craniotomy technique is worthwhile for consideration to avoid such complications. Additional studies are required to clarify whether this technique may contribute to reduce complications related to a DC in infants and children.

ANALYSIS OF WHEAT ALLERGEN DISPERSED IN AIR BY THE ACTION OF THREE TYPES OF FLOUR SIFTER.

BACKGROUND: Since wheat flour, a cause of food allergy, tends to disperse rapidly in air, it can unintentionally mix other foods during the sieving process. Our aim was to analyze the dispersal of wheat flour dust in air in order to prevent unintentional mixing. METHODS: We measured particle size distribution of wheat flour, photographed the scattered flour for 60 seconds every 10 seconds after sieving through three types of flour sifter, constructed a velocity vector diagram of flour dust dispersal by each type of sifter, and measured the distance of wheat allergen dispersal over 20 minutes using a petri dish and immunochromatographic test. RESULTS: The particles were mainly 14.2µm and 60.4µm in diameter and settled at terminal velocities of about 8mm/s and 150mm/s, respectively. Wheat flour particles of more than 60µm (released in air by sifting) dropped mainly in the perpendicular direction, while particles of less than 30µm remained suspended and traveled 5m after sifting by all flour sifters. CONCLUSION: Our results suggested that wheat flour dust dispersed by sifting (regardless of sifter) could unintentionally mix other foods. To prevent contamination, it is necessary to control the flow of air or sift flour in a separate room.

Technique and Theory of Hollow-fiber Phantom for Cerebral CT Perfusion.

We developed a phantom using a hollow-fiber hemodialyzer to evaluate the quantitative reliability of cerebral computed tomography (CT) perfusion. Our phantom consisted of a hollow-fiber hemodialyzer and a syringe-shaped X-ray device made up of resin. The phantom can give theoretical true values for cerebral blood volume, cerebral blood flow, and mean transit time. We compared the values measured in the phantom with predicted theoretical values. The purpose of the current report is to describe the theory and experimental technique used to obtain an absolute value in a phantom.

[Relationship of Distal Anterior Cerebral Artery Aneurysm Arising from the Supracallosal Portion and Accessory Anterior Cerebral Artery].

Median artery of the corpus callosum(MACC)refers to the median artery of the triplicate anterior cerebral artery(ACA). When MACC distributes to one or to both hemispheres, it is known as the accessory ACA. We performed detailed angiographic analysis of 32 consecutive patients operated upon for distal ACA(DACA)aneurysms, and noted that all DACA aneurysms occurring in the supracallosal portion were accompanied by an accessory ACA as vascular malformation. Such relationship between accessory ACA and DACA aneurysm in the supracallosal portion has not been previously reported.

Visualization of acetaminophen-induced liver injury by time-of-flight secondary ion mass spectrometry.

Time-of-flight secondary ion mass spectrometry (MS) provides secondary ion images that reflect distributions of substances with sub-micrometer spatial resolution. To evaluate the use of time-of-flight secondary ion MS to capture subcellular chemical changes in a tissue specimen, we visualized cellular damage showing a three-zone distribution in mouse liver tissue injured by acetaminophen overdose. First, we selected two types of ion peaks related to the hepatocyte nucleus and cytoplasm using control mouse liver. Acetaminophen-overdosed mouse liver was then classified into three areas using the time-of-flight secondary ion MS image of the two types of peaks, which roughly corresponded to established histopathological features. The ion peaks related to the cytoplasm decreased as the injury became more severe, and their origin was assumed to be mostly glycogen based on comparison with periodic acid-Schiff staining images and reference compound spectra. This indicated that the time-of-flight secondary ion MS image of the acetaminophen-overdosed mouse liver represented the chemical changes mainly corresponding to glycogen depletion on a subcellular scale. In addition, this technique also provided information on lipid species related to the injury. These results suggest that time-of-flight secondary ion MS has potential utility in histopathological applications.

On-line visualization of multicolor chemical images with stimulated Raman scattering spectral microscopy.

We demonstrate multicolor, on-line visualization in label-free biomedical microscopy based on stimulated Raman scattering (SRS). Fast data acquisition of SRS spectral images and subsequent image generation are achieved. The loading vectors for the blind separation of chemical components are predetermined by multivariate analysis at a certain field of view (FOV) and are applied to execute on-line visualization of chemical images at other FOVs. We also show that the response time can be shortened by reducing the number of spectral data points. This on-line visualization system is expected to increase the usability of the Raman imaging system and the analytical throughput for screening.

Correction: Imaging mass spectrometry of a mouse brain by tapping-mode scanning probe electrospray ionization.

Correction for 'Imaging mass spectrometry of a mouse brain by tapping-mode scanning probe electrospray ionization' by Yoichi Otsuka et al., Analyst, 2014, 139, 2336-2341.

Chemical characterization of unburned carbon in coal fly ashes by use of TPD/TPO and LRS methods.

Functional forms of the unburned carbon present in six kinds of coal fly ashes have been examined mainly by the temperature-programmed desorption (TPD)/temperature-programmed oxidation (TPO) and laser Raman spectroscopy (LRS) methods. The carbon contents of the ash samples range from 0.4 to 4.1 mass%. The LRS analysis shows that the C consists of both amorphous and crystallized forms, and the proportion of the former is as large as 50-65 C%. Further, the TPD measurement exhibits that the C contains several types of surface oxygen species, such as carboxyl and lactone/acid anhydride groups, which can readily be decomposed into CO2 up to 700 °C to provide active carbon sites. The results of the TPD also indicate that the ashes have surface CaCO3, and most of this species can be converted to CaO and CO2 around 600-700 °C. Interestingly, there is a significant correlation between organic fluorine concentrations and carboxyl/lactone/acid anhydride groups or surface CaCO3 contents in the ash samples. It might thus be possible that the formation of organic F forms proceeds through gas-solid-solid interactions among HF (and/or F2) in flue gas, active carbon sites and surface Ca species produced around 600-700 °C downstream of coal-fired boilers.

Imaging mass spectrometry of a mouse brain by tapping-mode scanning probe electrospray ionization.

Methods for ambient sampling and ionization enable chemical information to be obtained with minimal sample preparation. Also, imaging mass spectrometry (IMS) enables the spatial distribution of multiple components to be determined by a single measurement. Here, we report an improved method of tapping-mode scanning probe electrospray ionization (t-SPESI) for ambient sampling and ionization in which probe oscillation is stabilized by using a piezo actuator. We demonstrate negative-mode IMS of a mouse coronal brain section and show that, compared with desorption electrospray ionization, t-SPESI provides unique features in the mass spectra: signal enhancement of fatty acid and lipids, and formation of multivalent ions tentatively assigned to gangliosides. These results would indicate the capability for the generation of multiple types of ions with t-SPESI.

Label-free visualization of acetaminophen-induced liver injury by high-speed stimulated Raman scattering spectral microscopy and multivariate image analysis.

We recently established a high-speed, label-free, spectral imaging method based on stimulated Raman scattering (SRS). This method enables examination of cellular features within relatively short periods, thus enabling new imaging applications in pathology. Previously, we reported on label-free visualization of mouse tissue using SRS spectral microscopy combined with multivariate image analysis, but the feasibility of applying this approach to diseased tissues with diverse morphology and irregular chemical species has not been examined. We, therefore, assessed acetaminophen-induced liver injury to evaluate the potential use of Raman spectral microscopy for visualizing histopathologic specimens. Acetaminophen-overdosed mouse liver was prepared and the pathologic changes including centrilobular necrosis were confirmed. Multi-colored images were reconstructed through principal component analysis (PCA) of a multi-band SRS dataset, which provided rich information compared with a monochrome single-band SRS dataset. A wide view of the multi-colored principal component (PC) images showed the distribution of cellular constituents, which was similar to that observed by fat staining. In addition, different types of cells in liver parenchyma were also demonstrated. In conclusion, the combination of SRS spectral microscopy and PCA has the potential to reveal both the morphological and chemical features of specimens and therefore has potential utility in diagnostic pathology.

Rapid deterioration of primary fourth ventricular outlet obstruction resulting in syndrome of inappropriate antidiuretic hormone secretion.

Fourth ventricular outlet obstruction (FVOO) is a rare cause of obstructive hydrocephalus. Although FVOO accompanied by malformative syndrome and secondary causes of obstruction are common, there are few reports of primary FVOO (PFVOO). The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a rare presenting feature of hydrocephalus. A 1-year, 8-month-old boy with a normal head circumference developed SIADH accompanied by rapid deterioration of symptoms of intracranial hypertension. PFVOO was diagnosed because magnetic resonance imaging revealed an enlarged ventricular system with a barely visible membranous obstacle at the foramen of Magendie. All symptoms were resolved by endoscopic third ventriculostomy. PFVOO should be considered as a rare form of congenital obstructive hydrocephalus, especially in patients with tetraventricular hydrocephalus. To the best of our knowledge, this is the first case of an infant with SIADH, resulting from acute deterioration of non-tumoral raised pressure hydrocephalus.

[Successful surgical treatment of an extrasinusal dural arteriovenous fistula located in the lateral wall of the cavernous sinus: a case report].

We report the successful surgical treatment of a dural arteriovenous fistula(AVF)located in the lateral wall of the cavernous sinus. A 44-year-old woman presented with facial numbness in the left V3 area. Magnetic resonance imaging showed a flow void sign around the sphenoid ridge on a T2-weighted image. Digital subtraction angiography(DSA)demonstrated a dural AVF that was supplied by feeding arteries from the C4 portion of the left internal carotid artery. Without sinus enhancement, the draining vein flowed directly through the superficial sylvian vein into the vein of Labbé. Following treatment of the dural AVF located in the anterior cranial fossa, we ligated the draining vein at the penetrating point in the intradural region using surgical management. Intraoperative findings showed that the shunt point was located in the left lateral wall of the cavernous sinus. The postoperative course was uneventful and DSA showed no evidence of the AVF. The patient was discharged with no neurological deficits. Few studies have reported the use of direct surgery alone for the treatment of dural AVFs located in the cavernous sinus with a perfusion pattern as in this case.

[Percutaneous transluminal angioplasty using a stent for an aberrant left subclavian artery stenosis with a right-sided aortic arch: a case report].

An aberrant left subclavian artery is a rare variant that has been reported to coexist with the right-sided aortic arch in many cases. We encountered a case in which percutaneous transluminal angioplasty using a stent was performed for an aberrant left subclavian artery and left carotid artery. The patient was a 63-year-old man in whom left carotid artery stenosis and abnormal flow pattern of the left vertebral artery was accidently found during an ultrasound screening of his carotid artery. The right-sided aortic arch with the aberrant left subclavian artery was revealed by a cerebral angiogram via the right femoral artery. Despite difficulty in inserting a catheter at the origin of the aberrant left artery, the treatment was completed successfully. To our knowledge, endovascular treatment for an aberrant left subclavian artery has not been reported until date.