A novel EWSR1-VGLL1 gene fusion in a soft tissue malignant myoepithelial tumor.

Soft tissue myoepithelial tumors are very rare mesenchymal tumors that are currently categorized as miscellaneous neoplasms with uncertain differentiation. Although the molecular pathogenesis of soft tissue myoepithelial tumors remains unclear, EWSR1 gene fusions with a variety of partner genes are regarded as one of the major pathogenic driver events in these tumors. We herein present a case of a deep soft tissue malignant myoepithelial tumor arising in the thigh with multiple pulmonary metastases. This tumor displayed diverse and unique histological features, namely, an epithelioid glandular growth pattern, pseudorosette-like formation, and a diffuse nest and cord-like pattern within an abundant myxoid matrix. Next-generation RNA sequencing identified a novel fusion transcript, in which the in-frame junctional reads contained exon 9 of EWSR1 and exon 2 of VGLL1, resulting in the formation of a putative chimeric protein with the N-terminal transcriptional activation domain of EWSR1 and C-terminal full length of the VGLL1 protein. EWSR1-VGLL1 fusion has not been described in neoplasm before. Further molecular and functional experiments on the present EWSR1-VGLL1 fusion gene are required to elucidate its tumorigenic effect.

Enhancement of Meniscus Pump by Multiple Particles.

We numerically investigate the behavior of a droplet spreading on a smooth substrate with multiple obstacles. As experimental works have indicated, the macroscopic contact line or the three-phase boundary line of a droplet exhibits significant deformation resulting in a local acceleration by successive interactions with an array of tiny obstacles settled on the substrate (Mu et al., Langmuir 2019, 35). We focus on the menisci formation and the resultant pressure and velocity fields inside a liquid film in a two-spherical-particle system to realize an optimal design for the effective liquid-transport phenomenon. Special attention is paid to the meniscus formation around the second particle, which influences the liquid supply related to the pressure difference around the first particle as a function of the distance between the two particles. We find that the meniscus around the first particle plays an additional role as the reservoir of the liquid supplied toward the second particle, which is found to enhance the total pumping effect.

[Mediastinal Shift Due to the Rapidly Expanded Giant Bulla Probably Caused by the Lung Cancer].

A 39-year-old man was admitted to our hospital with back pain and numbness of the left leg. Computed tomography (CT) showed a giant bulla and tumor in the right lung, mediastinal shift to the left side and lesions suggestive of metastatic sacral tumor. Three days later, the patient visited the emergency room with dyspnea and tachycardia. Chest CT showed the progression of mediastinal shift due to the rapid expansion of the giant bulla, and an emergency surgery was performed. After induction of anesthesia, sudden respiratory and circulatory failure occurred. Considering further expansion of the giant bulla by positive pressure ventilation, veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) was applied. After establishing ECMO, the condition of the patient became stable and the giant bulla could be resected successfully.

[Temporary Bypass with 5-Fr Catheter for Reconstruction of Superior Vena Cava].

A 21-year-old man was referred to our hospital because of an abnormal shadow on a routine chest radiogram. Enhanced computed tomography showed an 83×74 mm mass in the anterior mediastinum, with invasion of the superior vena cava (SVC). Surgical resection with sternotomy was performed. Intraoperative temporary bypass grafting with a 5-Fr catheter was performed between the right brachiocephalic vein and right atrium. The mediastinal tumor was resected with the SVC, and SVC reconstruction with a 16 mm expanded polytetrafluoroethylene graft was performed. The bypass stabilized intraoperative vital signs and enabled safe completion of the operation. The pathological diagnosis was seminoma. SVC replacement combined with temporary bypass using a small diameter catheter is technically feasible and safe.

[Successful Treatment of a Patient with Idiopathic Subglottic Stenosis].

Idiopathic subglottic stenosis (ISS) is defined as the narrowing of the upper airway without any known cause. A 40-year-old female was referred to our hospital with the complaint of exacerbation of dyspnea causing difficulty in going out. Chest computed tomography (CT) scan and bronchoscopy revealed subglottic tracheal stenosis with a luminal diameter of 5 mm at the narrowest part. Tracheal mucosa of the stenotic lesion was smooth, and the patient had no previous medical history. Subglottic tracheal resection of the stenotic lesion and reconstruction were performed. The postoperative course was good, and the symptom of dyspnea improved significantly. Recently, some reports have suggested conservative treatments such as laser and balloon dilation for ISS, but the recurrence rate after these treatments is still high. Surgery is recommended rather than conservative treatments for patients with less severe inflammation of tracheal mucosa and other comorbidities like present case.

Pumping effect of heterogeneous meniscus formed around spherical particle.

HYPOTHESIS: A disturbance such as a microparticle on the pathway of a spreading droplet has shown the tremendous ability to accelerate locally the motion of the macroscopic contact line (Mu et al., 2017). Although this ability has been linked to the particle-liquid interaction, the physical mechanisms behind it are still poorly understood despite its academic interest and the scope of numerous industrial applications in need of fast wetting. EXPERIMENTS: In order to better understand the mechanisms behind the particle-liquid interaction, we numerically investigate the pressure and velocity fields in the liquid film. The results are compared to experiments assessing the temporal shape variation of the liquid-film meniscus from which pressure difference around the particle is evaluated. FINDINGS: The particle-induced acceleration of the film front depends both on the shape of the meniscus that forms around the particle foot and the liquid "reservoir" in the film that can be pumped thanks to the presence of the particle. The study validates the presence of three stages of pressure difference between the upstream and downstream regions of the meniscus around the particle, which leads to the local acceleration/deceleration of the macroscopic contact line. We indicate that asymmetric meniscus around the particle foot produces a net pressure force driving liquid and accelerating the liquid-film front.

Oxidized regenerated cellulose for a clear thoracoscopic view: a single-centre randomized trial.

OBJECTIVES: During video-assisted thoracoscopic surgery (VATS), blood oozing from the surface of the access port wound can hamper the surgical view. Although this oozing is difficult to prevent, it can be decreased by placing a wound edge protector with oxidized regenerated cellulose (ORC) on the surface of the access port wound, thereby improving the surgical outcomes and safety of VATS. METHODS: We conducted a prospective, single-centre, open-label, randomized clinical trial to evaluate the operative outcomes of VATS when using the ORC (ORC group) compared with operative outcomes without using the ORC (non-ORC group). The primary end point was interruption of the operation as a result of blood oozing from the surface of the access port wound. The secondary end points were the other intraoperative and postoperative outcomes. RESULTS: A total of 108 patients were divided into the ORC group (n = 54) and the non-ORC group (n = 54). Compared with the non-ORC group, the ORC group had fewer patients with an interruption in the operation (11.1% vs 51.8%; P < 0.001), less need for wound haemostasis of the access ports during wound closure (44.4% vs 72.2%; P = 0.003), similar rates of postoperative deaths and complications and a tendency for shorter operation times (149.3 vs 168.8 min, respectively; P = 0.083). CONCLUSION: The use of an ORC sheet around a wound edge protector for haemostasis can ensure a clear view during VATS. CLINICAL TRIAL REGISTRATION NUMBER: UMIN000031112.