Tumor-to-Tumor Metastasis of Medullary Thyroid Carcinoma to Paraganglioma in a Multiple Endocrine Neoplasia Type 2B Patient: A Case Report and Literature Review.

Tumor-to-tumor metastasis is a rare phenomenon in which primary tumor cells metastasize to other tumors. Herein, we report an extremely rare case of tumor-to-tumor metastasis of medullary thyroid carcinoma to a paraganglioma in a patient with multiple endocrine neoplasia type 2B. Based on genetic examination, a 36-year-old woman was diagnosed with multiple endocrine neoplasia type 2B when she was 24 years old. She had a history of total thyroidectomy for medullary thyroid carcinoma and bilateral adrenalectomy for pheochromocytomas, which were performed when she was 15 years and 29 years old, respectively. Follow-up computed tomography demonstrated a retroperitoneal tumor of 30 mm in diameter beside the left kidney and a liver tumor of 16 mm in diameter located in segment 6. The retroperitoneal and liver tumors were surgically resected and examined by a pathologist. Histological examination revealed the classic Zellballen pattern in the retroperitoneal tumor, rendering the diagnosis of a paraganglioma recurrence. Inside the tumor, a white nodule positive for carcinoembryonic antigen, weakly positive for calcitonin, and negative for tyrosine hydroxylase, was identified and diagnosed as a metastatic medullary thyroid carcinoma with high malignant potential. The liver lesion was diagnosed as a metastasis of the medullary thyroid carcinoma. This is the first report of tumor-to-tumor metastasis of medullary thyroid carcinoma to paraganglioma in a patient with multiple endocrine neoplasia type 2B twenty years after total thyroidectomy.

Small Intestinal Adenocarcinoma Arising at the Anastomotic Site after Kasai Operation for Biliary Atresia: A Case Report and Literature Review.

Biliary atresia is an obliterative cholangiopathy of unknown etiology. Hepatic portoenterostomy, in which obliterated extrahepatic bile ducts are resected and bile flow is restored, known as Kasai operation, is performed within 3 months after birth. While this operation enhances long-term survival of patients, the occurrence of primary malignant hepatic tumors has been increasing. We report a case of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation. A 49-year-old man, who underwent Kasai operation for biliary atresia when he was 2 months old, experienced rapidly progressive jaundice and liver dysfunction. Deceased-donor liver transplantation was performed for liver failure. Macroscopically, there was a white-yellow tumor located at the anastomotic site of hepatic portoenterostomy of the resected liver. Pathological examination revealed a well-differentiated adenocarcinoma with some Paneth cells in the neoplastic lesion. Immunohistochemically, the tumor cells were negative for cytokeratin 7 (CK7) but positive for cytokeratin 20 (CK20) and a homeobox domain-containing transcription factor (CDX2). Mucin expression in tumor cells was negative for mucin 1 (MUC1) and mucin 6 (MUC6) and positive for mucin 2 (MUC2) and mucin 5AC (MUC5AC). The pathological diagnosis was small intestinal adenocarcinoma originating from the jejunum. The patient was discharged 48 days after the operation. The patient had not experienced recurrence at 10 months after the operation. This is the first report of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation for biliary atresia. Special care should be taken for the patients after Kasai operation with acute progressive jaundice and liver dysfunction because there is a possibility of malignancy in their native liver.

Limited medial posterior capsular release increases the intraoperative medial component gap while maintaining the joint varus angle at extension in posterior-stabilized total knee arthroplasty.

PURPOSE: There is a lack of robust evidence for the magnitude of the effects of posterior capsular release (PCR) on intraoperative component gaps during total knee arthroplasty (TKA). The purpose of the present study was to quantify and compare the effects of partial versus full PCR on the intraoperative component gaps at various degrees of flexion during posterior-stabilized TKA. METHODS: Full PCR was performed on 39 consecutive cases (full PCR group), and partial PCR (the medial side up to and including the intercondylar notch) was performed on the subsequent 39 consecutive cases (partial PCR group) during posterior-stabilized TKA using the measured resection technique for varus knee osteoarthritis. Medial component gaps and varus angles at 0°, 10°, 45°, 90°, and a maximum of flexion were measured with a tensor device before and after the PCR. Differences between the two groups in post-release medial component gap increase and post-release joint varus angle increase were assessed using a t test. Pre- to post-release medial component gaps and joint varus angles in each group were compared using a paired samples t test. RESULTS: In both groups at 0° and 10° of flexion, post-release medial compartment gaps were significantly greater than pre-release gaps (all P < 0.001). At 45°, 90° and maximum flexion, the medial compartment gap increase did not exceed the minimal detectable change in either group. At 0° and 10° of flexion, there was no significant difference in post-release medial compartment gap change between the two groups. In the full PCR group, post-release joint varus angles at 0° of flexion were significantly greater than pre-release angles (P < 0.001), while there was no significant pre- and post-release difference in the partial PCR group. The change in post-release joint varus angles at 0° of flexion was significantly greater in the full PCR group than in the partial PCR group. CONCLUSION: Both full and partial PCR show similar clinical usefulness for increasing the medial component gap at extension and reducing component gap mismatch. A partial PCR can be used to avoid increasing joint varus angles at 0° of flexion. LEVEL OF EVIDENCE: Level 2 (prospective comparative study).

Effect of posteromedial vertical capsulotomy with medial collateral ligament liberation on intraoperative medial component gap mismatch between extension and mid-flexion during total knee arthroplasty.

PURPOSE: The aim of this study was to quantify the effect of posteromedial vertical capsulotomy on intraoperative component gaps and angles from extension through mid-flexion to flexion during total knee arthroplasty (TKA). METHODS: In the present study, 47 cases of primary posterior-stabilized TKA using the measured resection technique for varus knee osteoarthritis (hip-knee-ankle angles < 0°) were reviewed. Component gaps and angles at 0°, 10°, 45°, 90°, and maximum flexion were measured intraoperatively, before and after posteromedial vertical capsulotomy. Differences in pre- and post-posteromedial vertical capsulotomy medial and lateral component gaps and angles and medial component gap mismatches among knee flexion angles were assessed using the Wilcoxon signed rank test for two paired samples. RESULTS: The medial component gaps at 0° and 10° of flexion of post-posteromedial vertical capsulotomy were significantly greater, exceeding the minimal detectable change, than those pre posteromedial vertical capsulotomy (change of the gap after the procedure at 0° of flexion was 0.7 ± 0.7 mm and at 10° of flexion was 0.8 ± 0.8 mm; all P values < 0.05). The medial component gap mismatches between both 0° and 10°, and 45°, 90°, and maximum flexion were significantly smaller post posteromedial vertical capsulotomy than pre posteromedial vertical capsulotomy, with the values of the change exceeding the minimal detectable change (change of the gap mismatch after the procedure: knee flexion at 0° and 45° was - 0.6 ± 0.9 [mm], at 0° and 90° was 0.7 ± 1.0, at 0° and maximum flexion was - 0.6 ± 1.2, at 10° and 45° was - 0.7 ± 0.9, at 10° and 90° was - 0.8 ± 0.9, at 10° and maximum flexion was - 0.7 ± 1.1; all P values < 0.05). CONCLUSIONS: Posteromedial vertical capsulotomy increased the medial component gaps during knee extension but not during mid-flexion or full flexion during posterior-stabilized TKA. Posteromedial vertical capsulotomy improved mild medial component gap mismatch between extension and mid-flexion and full flexion during posterior-stabilized TKA. Surgeons can consider posteromedial vertical capsulotomy when there is intraoperative constriction of the medial component gap during extension in patients undergoing posterior-stabilized TKA.

Association between timing of speech and language therapy initiation and outcomes among post-extubation dysphagia patients: a multicenter retrospective cohort study.

BACKGROUND: Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. METHODS: We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. RESULTS: A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02-1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05-1.55), 14th day (AOR, 1.34; 95% CI, 1.13-1.58), or 28th day (AOR, 1.21; 95% CI, 1.07-1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02-1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97-1.12). CONCLUSIONS: Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results.

Effect of posterior capsular release on intraoperative joint gap mismatch in the mid-flexion range during posterior-stabilized total knee arthroplasty.

INTRODUCTION: Intraoperative mismatch between extension and mid-flexion joint gaps remains a critical issue in posterior-stabilized total knee arthroplasty (PS-TKA). Posterior capsular release has been found to increase the extension joint gap. However, there is still a lack of robust evidence for the effect of posterior capsular release on the mid-flexion joint gap. The purpose of the present study was to quantify the effect of posterior capsular release on the intraoperative joint gap from extension through 45° mid-flexion to flexion and to clarify how this procedure might affect the improvement of gap mismatch in the mid-flexion 45° range. MATERIALS AND METHODS: In total, 38 consecutive cases of primary PS-TKA were reviewed. The center, medial, and lateral component gaps from extension to flexion were measured with a tensor device before and after posterior capsular release. The minimal detectable change for joint gap measurement was calculated using two methods, error variance and intra-observer intraclass correlation coefficients. Pre- and post-release joint gap differences were assessed using the paired t-test. RESULTS: Minimal detectable change was found to be 0.59 mm. At 0° and 10° of flexion, the post-release center, medial, and lateral component gaps were significantly greater than at pre-release. At 45° and 90° and maximum flexion, there were no joint gap differences exceeding the minimal detectable change. The joint gap mismatches between 0° and 10°, and 45°, 90° and maximum flexion were significantly smaller at post-release than those at pre-release with the change values exceeding the minimal detectable change (P < 0.05). CONCLUSION: Posterior capsular release significantly decreased both joint gap mismatch between extension and 45° mid-flexion, and extension and flexion, showing clinical usefulness in PS-TKA.

Strenuous running exacerbates knee cartilage erosion induced by low amount of mono-iodoacetate in rats.

BACKGROUND: It is still debated whether strenuous running in the inflammatory phase produces beneficial or harmful effect in rat knees. We examined (1) the dropout rate of rats during a 30-km running protocol, (2) influences of strenuous running and/or low amounts of mono-iodoacetate injection on cartilage, and (3) the effect of strenuous running on synovitis. METHODS: Rats were forced to run 30 km over 6 weeks and the dropout rate was examined. One week after 0.1 mg mono-iodoacetate was injected into the right knee, rats were forced to run either 15 km or not run at all over 3 weeks, after which knee cartilage was evaluated. Synovium at the infrapatellar fat pad was also examined histologically. RESULTS: Even though all 12 rats run up to 15 km, only 6 rats completed 30 km of running. Macroscopically, 0.1 mg mono-iodoacetate induced erosion at the tibial cartilage irrespective of 15 km of running. Histologically, 0.1 mg mono-iodoacetate induced loss of cartilage matrix in the tibial cartilage, and an additional 15 km of strenuous running significantly exacerbated the loss. Synovitis caused by mono-iodoacetate improved after running. CONCLUSIONS: Only 50% of rats completed 30 km of running because of foot problems. Strenuous running further exacerbated tibial cartilage erosion but did not influence synovitis induced by mono-iodoacetate.

Impact of comorbidities on the postoperative outcomes of acute cholecystitis following early cholecystectomy.

PURPOSES: The purpose of this study was to evaluate the influence of comorbidities on the surgical outcomes of early cholecystectomy for acute cholecystitis. METHODS: Data were retrospectively collected for patients with acute cholecystitis who underwent early cholecystectomy. Patients were separated into three groups based on the cholecystitis severity grade, and the surgical outcomes of early cholecystectomy were analyzed. Patients with mild and moderate cholecystitis were subdivided into a comorbidity group (n = 10) and a non-comorbidity group (n = 83). RESULTS: There were 57 (55.3%) patients with mild cholecystitis, 36 (35.0%) with moderate cholecystitis, and 10 (9.7%) with severe cholecystitis. The surgical outcomes were significantly worse for patients with severe cholecystitis than for patients with mild or moderate cholecystitis. There were no postoperative deaths after cholecystectomy. There were no significant differences in the complication rate (P = 0.629), conversion rate (P = 0.114), or intraoperative blood loss (P = 0.147) between the comorbidity and non-comorbidity groups. CONCLUSION: Our findings suggest that early cholecystectomy can be performed safely for patients with mild and moderate cholecystitis even if comorbidities are present. Early cholecystectomy may be an alternative treatment strategy for patients with severe cholecystitis who are candidates for anesthesia and surgery.

Centralization of extruded medial meniscus delays cartilage degeneration in rats.

BACKGROUND: Meniscus extrusion often observed in knee osteoarthritis has a strong correlation with the progression of cartilage degeneration and symptom in the patients. We recently reported a novel procedure "arthroscopic centralization" in which the capsule was sutured to the edge of the tibial plateau to reduce meniscus extrusion in the human knee. However, there is no animal model to study the efficacy of this procedure. The purposes of this study were [1] to establish a model of centralization for the extruded medial meniscus in a rat model; and [2] to investigate the chondroprotective effect of this procedure. METHODS: Medial meniscus extrusion was induced by the release of the anterior synovial capsule and the transection of the meniscotibial ligament. Centralization was performed by the pulled-out suture technique. Alternatively, control rats had only the medial meniscus extrusion surgery. Medial meniscus extrusion was evaluated by micro-CT and macroscopic findings. Cartilage degeneration of the medial tibial plateau was evaluated macroscopically and histologically. RESULTS: By micro-CT analysis, the medial meniscus extrusion was significantly improved in the centralization group in comparison to the extrusion group throughout the study. Both macroscopically and histologically, the cartilage lesion of the medial tibial plateau was prevented in the centralization group but was apparent in the control group. CONCLUSIONS: We developed medial meniscus extrusion in a rat model, and centralization of the extruded medial meniscus by the pull-out suture technique improved the medial meniscus extrusion and delayed cartilage degeneration, though the effect was limited. Centralization is a promising treatment to prevent the progression of osteoarthritis.

Weekly injections of Hylan G-F 20 delay cartilage degeneration in partial meniscectomized rat knees.

BACKGROUND: Cross-linked hyaluronan--also called Hylan G-F 20--is a medical device developed to treat osteoarthritis of the knee. However, it is still controversial whether Hylan G-F 20 has a cartilage protective effect in trauma-induced osteoarthritis. We investigated whether Hylan G-F 20 delayed osteoarthritis progression in a partial meniscectomized rat model. METHODS: Lewis rats were used for the experiments. The anterior medial meniscus was resected at the level of the medial collateral ligament in both knees. From 1 week after the surgery, 50 µl of Hylan G-F 20 was injected weekly into the left knee and phosphate buffered saline was injected into the right knee. Cartilage was evaluated for macroscopic findings, histology with safranin-o, and expression of type II collagen at 2, 4, and 8 weeks. Synovitis was also evaluated, and immunohistochemical analysis was performed for ED1. RESULTS: Macroscopic findings demonstrated that India ink positive area, representing fibrillated cartilage, was significantly smaller in the Hylan G-F 20 group than in the control group at 2, 4, and 8 weeks (n = 5). There were no significant differences in osteophyte score between the Hylan G-F 20 group and the control group at 2, 4, and 8 weeks. Histologically, the cartilage in the medial tibial plateau was destroyed at 8 weeks in the control group, while type II collagen expression was still observed at 8 weeks in the Hylan G-F 20 group. OARSI score for cartilage histology was significantly lower in the Hylan G-F 20 group than in the control group at 4 and 8 weeks (n = 5). There were no significant differences in synovial cell number or modified synovitis score between the Hylan G-F 20 group and the control group at 2, 4, and 8 weeks (n = 5). In the Hylan G-F 20 group, foreign bodies surrounded by ED1 positive macrophages were observed in the synovium. CONCLUSION: Weekly injections of Hylan G-F 20 starting 1 week after surgery delayed cartilage degeneration after meniscectomy in a rat model. Synovitis induced by meniscectomy was not alleviated by Hylan G-F 20. Insoluble gels were observed in the synovium after the Hylan G-F 20 injection.

[A Case of Long-Term Survival in a Patient with Small Intestinal Adenocarcinoma with Peritoneal Dissemination].

Primary small intestinal adenocarcinoma is rare and its outcome is poor. A 46-year-old man admitted for vomiting was found in enhanced abdominal CT to have local jejunum stenosis and dilation at its oral site. A partial jejunectomy was performed and a jejunal tumor with multiple disseminated nodules in the peritoneum was revealed. Histologically, the adenocarcinoma of the jejunum appeared to be a papillary adenocarcinoma, and also, in part, a moderately differentiated tubular adenocarcinoma. After the jejunectomy, the patient was treated with S-1 chemotherapy, but 22 months after the initial diagnosis, a recurrence was detected. The patient underwent a second partial jejunectomy, and a weekly dose of paclitaxel (PTX) plus doxifluridine (5'-DFUR) was selected as the second-line treatment. The patient is still responding to the treatment 55 months after the last operation. Combination chemotherapy with weekly PTX/5'-DFUR may improve the prognosis for S-1-resistant small intestinal adenocarcinoma.

NaCl ion detection using a silica toroid microcavity.

An optical-microcavity-based sensor is an important building block for an optofluidics system, because it allows us to fabricate small devices with high sensitivity. Here we describe the detection of NaCl and pH in water using a silica toroid microcavity. First we demonstrate the detection of NaCl particles, and show that a detection sensitivity of 0.38 mM is possible with a sample volume of 0.03 nl. Then, we report the detection of NaCl ions in liquid and demonstrate a sensitivity of 3.20 mM and also, in principle, the detection of pH with a sensitivity of 0.14 pH. Finally, we integrate a tapered optical fiber, a silica toroid microcavity, and a fluidic channel for future optofluidics applications.

[Mesothelioma of Unknown Primary Site with Resection of Mediastinal Lymph Node Metastasis].

A 63-year-old male underwent biopsy of a mediastinal lymph node. Intra-operative frozen section diagnosis was metastatic mesothelioma. The primary site of mesothelioma was not detected in the thoracic cavity. One year later, he was again removed a mediastinal lymph node metastasis, but the primary site was not detected. Eight months later, he was performed right neck and mediastinal lymph node dissection due to additionally appeared lymph node metastases, but the primary site was not detected. He is well 6 months after last surgery with postoperative adjuvant chemotherapy.

[Localized Malignant Mesothelioma of the Pleura].

A 65-year-old man presented with the chief complaint of cough. Chest computed tomography showed the mediastinal tumor. The tumor was resected under the 4th intercostal thoracotomy and the mediastinal approach. The biphasic type of localized malignant mesothelioma was diagnosed by the pathological findings. The postoperative course was uneventful. After postoperative adjuvant radiotherapy and chemotherapy (cisplatin and pemetrexed sodium hydrate), he is well without relapse 7 months after surgery.

A Gelatin Hydrogel Nonwoven Fabric Combined With Adipose Tissue-Derived Stem Cells Enhances Subcutaneous Islet Engraftment.

Subcutaneous islet transplantation is a promising treatment for severe diabetes; however, poor engraftment hinders its prevalence. We previously revealed that a gelatin hydrogel nonwoven fabric (GHNF) markedly improved subcutaneous islet engraftment. We herein investigated whether the addition of adipose tissue-derived stem cells (ADSCs) to GHNF affected the outcome. A silicone spacer sandwiched between two GHNFs with (AG group) or without (GHNF group) ADSCs, or a silicone spacer alone (Silicone group) was implanted into the subcutaneous space of healthy mice at 6 weeks before transplantation, then diabetes was induced 7 days before transplantation. Syngeneic islets were transplanted into the pretreated space. Intraportal transplantation (IPO group) was also performed to compare the transplant efficiency. Blood glucose, intraperitoneal glucose tolerance, immunohistochemistry, and inflammatory mediators were evaluated. The results in the subcutaneous transplantation were compared using the Silicone group as a control. The results of the IPO group were also compared with those of the AG group. The AG group showed significantly better blood glucose changes than the Silicone and the IPO groups. The cure rate of AG group (72.7%) was the highest among the groups (GHNF; 40.0%, IPO; 40.0%, Silicone; 0%). The number of vWF-positive vessels in the subcutaneous space of the AG group was significantly higher than that in other groups before transplantation (P < 0.01). Lectin angiography also showed that the same results (P < 0.05). According to the results of the ADSCs tracing, ADSCs did not exist at the transplant site (6 weeks after implantation). The positive rates for laminin and collagen III constructed around the transplanted islets did not differ among groups. Inflammatory mediators were higher in the Silicone group, followed by the AG and GHNF groups. Pretreatment using bioabsorbable scaffolds combined with ADSCs enhanced neovascularization in subcutaneous space, and subcutaneous islet transplantation using GHNF with ADSCs was superior to intraportal islet transplantation.

A gelatin hydrogel nonwoven fabric improves outcomes of subcutaneous islet transplantation.

Subcutaneous islet transplantation is a promising treatment for severe diabetes; however, poor engraftment hinders its prevalence. We previously reported that a recombinant peptide (RCP) enhances subcutaneous islet engraftment. However, it is impractical for clinical use because RCP must be removed when transplanting islets. We herein investigated whether a novel bioabsorbable gelatin hydrogel nonwoven fabric (GHNF) could improve subcutaneous islet engraftment. A silicon spacer with or without GHNF was implanted into the subcutaneous space of diabetic mice. Syngeneic islets were transplanted into the pretreated space or intraportally (Ipo group). Blood glucose, intraperitoneal glucose tolerance, immunohistochemistry, CT angiography and gene expression were evaluated. The cure rate and glucose tolerance of the GHNF group were significantly better than in the control and Ipo groups (p < 0.01, p < 0.05, respectively). In the GHNF group, a limited increase of vWF-positive vessels was detected in the islet capsule, whereas laminin (p < 0.05), collagen III and IV were considerably enhanced. TaqMan arrays revealed a significant upregulation of 19 target genes (including insulin-like growth factor-2) in the pretreated space. GHNF markedly improved the subcutaneous islet transplantation outcomes, likely due to ECM compensation and protection of islet function by various growth factors, rather than enhanced neovascularization.

Ideal Duration of Pretreatment Using a Gelatin Hydrogel Nonwoven Fabric Prior to Subcutaneous Islet Transplantation.

Subcutaneous islet transplantation is a promising treatment for severe diabetes; however, poor engraftment hinders its prevalence. We previously revealed that a gelatin hydrogel nonwoven fabric (GHNF) markedly improved subcutaneous islet engraftment in comparison with intraportal islet transplantation. We herein investigated whether the duration of pretreatment using GHNF affected the outcome of subcutaneous islet transplantation. A silicone spacer with GHNF was implanted into the subcutaneous space of healthy mice at 2, 4, 6, or 8 weeks before transplantation, and then diabetes was induced 7 days before transplantation. Syngeneic islets were transplanted into the pretreated space. Blood glucose, intraperitoneal glucose tolerance, immunohistochemistry, inflammatory mediators, and gene expression were evaluated. The 6-week group showed significantly better blood glucose changes than the other groups (P < 0.05). The cure rate of the 6-week group (60.0%) was the highest among the groups (2-week = 0%, 4-week = 50.0%, 8-week = 15.4%). The number of von Willebrand factor (vWF)-positive vessels in the 6-week group was significantly higher than in the other groups at pre-islet and post-islet transplantation (P < 0.01 [vs 2-and 4-week groups] and P < 0.05 [vs all other groups], respectively). Notably, this beneficial effect was also observed when GHNF was implanted into diabetic mice injected with streptozotocin 7 days before GHNF implantation. The positive rates for laminin, collagen III, and collagen IV increased as the duration of pretreatment became longer and were significantly higher in the 8-week group (P < 0.01). Inflammatory mediators, including interleukin (IL)-1b, granulocyte colony-stimulating factor (G-CSF), and interferon (IFN)-γ, were gradually downregulated according to the duration of GHNF pretreatment and re-elevated in the 8-week group. Taken together, the duration of GHNF pretreatment apparently had an impact on the outcomes of subcutaneous islet transplantation, and 6 weeks appeared to be the ideal duration. Islet graft revascularization, extracellular matrix compensation of the islet capsule, and the inflammatory status at the subcutaneous space would be crucial factors for successful subcutaneous islet transplantation.

A Gelatin Hydrogel Nonwoven Fabric Enhances Subcutaneous Islet Engraftment in Rats.

Although subcutaneous islet transplantation has many advantages, the subcutaneous space is poor in vessels and transplant efficiency is still low in animal models, except in mice. Subcutaneous islet transplantation using a two-step approach has been proposed, in which a favorable cavity is first prepared using various materials, followed by islet transplantation into the preformed cavity. We previously reported the efficacy of pretreatment using gelatin hydrogel nonwoven fabric (GHNF), and the length of the pretreatment period influenced the results in a mouse model. We investigated whether the preimplantation of GHNF could improve the subcutaneous islet transplantation outcomes in a rat model. GHNF sheets sandwiching a silicone spacer (GHNF group) and silicone spacers without GHNF sheets (control group) were implanted into the subcutaneous space of recipients three weeks before islet transplantation, and diabetes was induced seven days before islet transplantation. Syngeneic islets were transplanted into the space where the silicone spacer was removed. Blood glucose levels, glucose tolerance, immunohistochemistry, and neovascularization were evaluated. The GHNF group showed significantly better blood glucose changes than the control group (p < 0.01). The cure rate was significantly higher in the GHNF group (p < 0.05). The number of vWF-positive vessels was significantly higher in the GHNF group (p < 0.01), and lectin angiography showed the same tendency (p < 0.05). The expression of laminin and collagen III around the transplanted islets was also higher in the GHNF group (p < 0.01). GHNF pretreatment was effective in a rat model, and the main mechanisms might be neovascularization and compensation of the extracellular matrices.

Minimally invasive procedure for accurate diagnosis of mucosa-associated lymphoid tissue lymphoma of the head and neck.

Sonography-guided cutting needle biopsy for the diagnosis of malignant lymphoma has recently come into wide use. However, surgery is sometimes unavoidable for the diagnosis of malignant lymphoma, particularly for low-grade malignant lymphoma such as extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, because cutting needle biopsy offers limited diagnostic accuracy for low-grade malignant lymphoma. Of course, unnecessary invasive procedures like open biopsy should be avoided wherever possible, given the cosmetic problems and burden on the patient. We tried to diagnose malignant lymphoma using the combination of cutting needle biopsy, flow cytometry and polymerase chain reaction to identify monoclonal rearrangement of immunoglobulin heavy chain genes. We have used this method in two cases in whom malignant lymphoma was suspected in the head and neck region, allowing diagnosis of mucosa-associated lymphoid tissue lymphoma in both cases. One case involved a 23-year-old woman with mucosa-associated lymphoid tissue lymphoma in the parotid glands, and the other involved a 77-year-old man with mucosa-associated lymphoid tissue lymphoma in the thyroid. The combination of cutting needle biopsy, flow cytometry and immunoglobulin heavy chain gene rearrangement testing might offer a useful alternative to open biopsy for the diagnosis of mucosa-associated lymphoid tissue lymphoma. We recommend this procedure, particularly for young women or patients with poor performance status in whom malignant lymphoma is suspected.

Medial osteophyte resection width correlates with correction of the medio-lateral component gap imbalance during posterior-stabilized total knee arthroplasty.

BACKGROUND: There is a lack of robust evidence for a correlation between the medial osteophyte resection and correction of the medio-lateral gap imbalance during total knee arthroplasty. The purpose of the present study was to quantify the effect of osteophyte resection on the medio-lateral component gap imbalance during posterior-stabilized total knee arthroplasty. METHODS: Forty-five cases of primary posterior-stabilized total knee arthroplasty using the measured resection technique with posterior-stabilized prosthesis for varus knee osteoarthritis were reviewed. Medial and lateral joint gaps at 0°, 10°, 45°, and 90° of flexion, and maximum flexion were measured intraoperatively before and after the osteophyte resection. The relationship between medial osteophyte resection width and change of joint varus angle and medial component gap were assessed using Pearson's correlation coefficient. FINDINGS: Medial component gap and joint varus angle values at post medial osteophyte resection were significantly larger and lower than at pre-resection (Medial gap: pre 9.5 ± 1.8 mm, post 10.3 ± 1.8 mm, P < 0.001, Joint angle: pre 5.2 ± 2.9°, post 4.2 ± 2.9°, P < 0.001). There was no significant difference between pre and post medial osteophyte resection in lateral component gaps. Per each 1 mm of medial osteophyte resection width, increases of 0.13 mm medial component gap and 0.2° valgus were observed (Medial gap: r = 0.38, P < 0.001, Joint angle: r = 0.38, P < 0.001). INTERPRETATION: Medial osteophyte resection increases the medial component gap without lateral component gap increase, while decreasing the joint varus angle in primary posterior-stabilized total knee arthroplasty for varus knee osteoarthritis. Osteophyte resection width was found to correlate with correction of the medio-lateral component gap imbalance.