Case report: A surgically treated case of diaphragmatic clear cell carcinoma without relation to endometriosis.

INTRODUCTION AND IMPORTANCE: Diaphragmatic tumor is a rare neoplastic disease. Only three reports have revealed diaphragmatic primary clear cell carcinoma. On the other hand, secondary membranous nephropathy is sometimes triggered by the carcinoma. We describe a case of primary diaphragmatic clear cell carcinoma without relation to endometriosis or ovarian malignancies, and secondary membranous nephropathy was triggered by diaphragmatic primary clear cell carcinoma. CASE PRESENTATION: A 67-year-old woman was found to have membranous nephropathy due to examination for renal dysfunction. A rare diaphragmatic tumor was identified on CT scan for rule out secondary membranous nephropathy. She had underwent resection of the right diaphragm tumor and reconstruction with expanded polyterafluoroethylene (e-PTFE). CLINICAL DISCUSSION: Pathological examination revealed the presence of clear cells with papillary arrangement and no findings of the endometriosis. Immunohistochemistry revealed that the tumor was positive for CK7, p53, and HNF-1-beta. And there had been no evidence of ovarian malignancies. A diagnosed of clear cell carcinoma of the right diaphragm without relation to endometriosis or ovarian malignancies was made. After resection of the tumor, it was revealed that her renal function was improvement. CONCLUSION: This is the first report of diaphragmatic clear cell carcinoma without relation to endometriosis or ovarian malignancies that caused secondary membranous nephropathy. One year after the resection of the tumor, she is being followed up and has shown no signs of recurrence.

Equation of State of Liquid Water Written by Simple Experimental Polynomials and the Liquid-Liquid Critical Point.

Experimental and theoretical evidence has been accumulating to support the liquid-liquid critical point (LLCP) hypothesis for water. However, no agreement has yet been reached on the pressure and temperature of LLCP. Here we made simple experimental equations that reproduced the volume of liquid water measured over a wide pressure-temperature range. They were polynomials that calculate pressure using volume and temperature as variables, and coefficients were determined by the method of least-squares. We analyzed the polynomials by changing the volume data and the number of terms in the polynomials and extrapolated them slightly to low temperatures. Consequently, the available experimental volume of liquid water indicated (but did not prove) the existence of LLCP at low temperature. Representative polynomials suggested that LLCP locates around 105 ± ∼ 9 MPa, 207 ± ∼ 5 K, and 0.993 ± ∼ 0.009 cm3/g.

Simultaneous nodular lymphocyte-predominant Hodgkin lymphoma with papillary thyroid carcinoma: a case report.

We herein report the case of a 48-year-old man diagnosed with nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL, Stage IA) and papillary thyroid carcinoma (PTC, Stage I). Total thyroidectomy, left modified neck dissection and biopsy of the right cervical lymph node were performed. Postoperatively, NLPHL treatment was prioritized, and external radiation (30.6 Gy) was applied to the right neck. PTC was considered a high-risk category for recurrence due to extranodal invasion of lymph node metastasis, and radioactive iodine therapy (ablative dose, 1110 MBq) was administered. Both PTC and NLPHL showed no recurrence 18 months after surgery.

Angiomatoid fibrosis histiocytoma in the pulmonary artery: A case report.

Angiomatoid fibrosis histiocytoma (AFH) is a rare neoplastic disease. Only one report has demonstrated an intraluminal tumor of the pulmonary artery (PA) corresponding to AFH to date. We describe the case of AFH with EWSR1-CREB1 fusion occurring in the ascending artery. A 42-year-old man exhibited an abnormal nodule on chest computed tomography (CT) during checkup. It revealed an intraluminal mass in the ascending artery with significant metabolic uptake in positron emission tomography (PET)/CT. Therefore, right upper lobectomy with wedge resection of the PA trunk was performed. Histologically, the tumor was multinodular and surrounded by a dense lymphoplasmacytic cuff. Each nodule was composed of myxoid stroma and comprised ovoid or spindle cell fascicles with mild atypia. Fluorescent in situ hybridization (FISH) analysis confirmed EWSR1-CREB1 fusion. A diagnosed as AFH was made. This report widens the spectrum of differential diagnoses of primary tumors occurring in the PA.

Gram staining of gallbladder bile samples is useful for predicting surgical site infection in acute cholecystitis patients undergoing an early cholecystectomy.

BACKGROUND: Microbiological assessment of gallbladder bile is important for postoperative management in cholecystectomy for acute cholecystitis (AC). Gram staining is used as the first step in the assessment, in order to preliminarily detect bacteria in the bile sample. This study was conducted to evaluate the clinical significance of Gram staining results in the development of postoperative surgical site infection (SSI) in AC patients. METHODS: A total of 428 AC patients, who underwent an early cholecystectomy with microbiological assessment of gallbladder bile, were enrolled in this retrospective study. The clinical usefulness of the Gram staining results was evaluated by univariate and multivariate regression analyses. RESULTS: Of the 428 patients, 298 patients (69.6%) were diagnosed with bile infection by the Gram staining method. The rate of SSI was higher in patients with bile infection (9.7%) than in those without the infection (0.8%). The multivariate analysis indicated that the bile infection diagnosed by Gram staining (odds ratio: 9.091; P = .033) was an independent factor to predict SSI development, along with open surgery. CONCLUSIONS: Gram staining diagnosis of bile infection in an early cholecystectomy for AC is useful for predicting postoperative SSI development, which should benefit postoperative management.

Dementia in elderly patients undergoing early cholecystectomy for acute cholecystitis: a retrospective observational study.

BACKGROUND: Dementia often adversely affects postoperative outcomes in surgical patients. This study evaluated postoperative outcomes among elderly patients with and without dementia undergoing early cholecystectomy for acute cholecystitis (AC). METHODS: A total of 182 patients over 85 years of age who were diagnosed with AC and treated from January 2005 to March 2018 were reviewed retrospectively; 59 patients who underwent early cholecystectomy were enrolled. The complication rates, length of postoperative hospital stay, and rates of routine discharge (i.e., returning to their preoperative living location) were compared between two groups of patients with and without dementia. RESULTS: The overall complication rate after early cholecystectomy for AC in 59 patients was 11.9%, and there was no mortality in this series. The median postoperative hospital stay was 9.0 days, and the routine discharge rate was 89.8%. Of the 59 patients, 22 patients (37.3%) had a history of dementia. Complication rates were comparable between the groups, despite the rate of delirium development being significantly higher in the dementia group. The median length of postoperative hospital stay and routine discharge rates did not significantly differ between groups. CONCLUSIONS: Early cholecystectomy for patients with AC over 85 years of age was performed safely, and elderly patients with dementia had similar postoperative outcomes as compared with patients without dementia.

A case of anaplastic lymphoma kinase (ALK)-positive ciliated muconodular papillary tumor (CMPT) of the lung.

Ciliated muconodular papillary tumor (CMPT) is a rare papillary tumor that arises in the peripheral lung fields and is associated with the proliferation of ciliate d and goblet cells and increased mucin production. We report a case of CMPT involving the rearrangement of the anaplastic lymphoma kinase (ALK) gene. The patient was an 84-year-old Japanese female who had exhibited a small nodular shadow on chest computed tomography during a regular checkup 10 years ago. She underwent a partial resection of segment S10 of the right lung. The cut surface of the surgical specimen revealed a well-circumscribed, jelly-like mass measuring 8 × 8 × 10 mm. Histologically, the tumor was composed of a mixture of ciliated, goblet, and basal cells arranged in a papillary pattern together with pools of mucin. A diagnosis of CMPT was made. The lung tumor cells were subjected to fluorescent in situ hybridization and highly sensitive immunohistochemical staining for the ALK protein, both of which produced positive results. CMPT usually follows a favorable course, but the exact nature of this tumor; i.e., whether it is benign or malignant, has not been established. This is the first reported case of an ALK-positive CMPT.

Effect of water polyamorphism on the molecular vibrations of glycerol in its glassy aqueous solutions.

A glassy dilute glycerol-water solution undergoes a mutual polyamorphic transition relating to the transition between high- and low-density amorphous ices of solvent water. The polyamorphic transition behavior depends on the glycerol concentration, indicating that the glycerol affects the water polyamorphism. Here, we used the glassy dilute glycerol-water solution of the solute molar fraction of 0.07 and examined the effect of the polyamorphic change in solvent water on the molecular vibrations of glycerol via Raman spectroscopy. It is found that the molecular vibration of glycerol in high-density liquid like solvent water is different from that in the low-density liquid like solvent water and that the change in the molecular vibration of glycerol is synchronized with the polyamorphic transition of solvent water. The dynamical change of the solute molecule relates to the polyamorphic state of solvent water. This result suggests that the polyamorphic fluctuation of water structure emanated from the presumed liquid-liquid critical point plays an important role for the function of aqueous solution under an ambient condition such as the conformational stability of solute, the functional expression of solute, and so on.

Experimentally proven liquid-liquid critical point of dilute glycerol-water solution at 150 K.

The experimental and theoretical studies of supercooled liquid water strongly suggest that the two liquid waters and their liquid-liquid critical point (LLCP) exist at low temperature. However, the decisive experimental evidence of the LLCP has not been obtained because of the rapid crystallization of liquid water in the "no-man's land." Here, we observed experimentally the pressure-induced polyamorphic transition in the dilute glycerol-water solution which relates to the water polyamorphism. We examined the effect of the glycerol concentration on the liquid-liquid transition, and found its LLCP around 0.12-0.15 mole fraction, 0.03-0.05 GPa, and ~150 K. A 150 K was above, or around, the recently recognized glass transition temperatures of amorphous ices, and the crystallization did not occur, indicating that the direct observation of LLCP is feasible. The low-temperature LLCP has implication to the argument of the relation between the interaction potential of water molecule and the polyamorphic phase diagram.

Efficacy of alogliptin, a dipeptidyl peptidase-4 inhibitor, on glucose parameters, the activity of the advanced glycation end product (AGE) - receptor for AGE (RAGE) axis and albuminuria in Japanese type 2 diabetes.

BACKGROUND: To examine the effects of alogliptin, a dipeptidyl peptidase-4 inhibitor, on glucose parameters, the advanced glycation end product (AGE)-receptor for AGE (RAGE) axis and albuminuria in Japanese type 2 diabetes patients. METHODS: Sixty-one patients whose HbAlc ≥ 6.1% (mean age 64.7 years; 67% men; mean HbAlc 7.4%; 57% were pharmacologically treated) underwent blood and urine sampling and analysis before and after 12 weeks of treatment with alogliptin (25 mg once daily). RESULTS: Alogliptin treatment significantly reduced fasting glucose (160.3 mg/dL at baseline versus 138.0 mg/dL at 12 weeks), glycoalbumin (21.1% at baseline versus 18.9% at 12 weeks), HbAlc (7.4% at baseline versus 6.9% at 12 weeks), circulating soluble form of RAGE concentrations (847.3 pg/mL at baseline versus 791.4 pg/mL at 12 weeks) and urine albumin to creatinine ratio (31.6 mg/g Cr at baseline versus 26.5 mg/g Cr at 12 weeks), whereas 1,5-anhydroglucitol concentrations were significantly increased (7.5 µg/mL at baseline versus 11.6 µg/mL at 12 weeks; all P < 0.05). Circulating AGEs concentrations were reduced only in patients with baseline AGEs ≥7 U/mL (n = 33, from 8.2 U/mL to 7.2U /mL; p < 0.01) after alogliptin treatment. The treatment-induced change of soluble form of sRAGE concentrations was associated with changes of 1,5-anhydroglucitol and HbAlc concentrations (rho = -0.32 and 0.29, respectively). Meanwhile, the treatment-induced change of urine albumin to creatinine ratio was associated with a change in the fasting glucose concentration (rho = 0.25; all p < 0.05). During the intervention, alogliptin treatment was well tolerated without any hypoglycemia or side effects. CONCLUSION: Alogliptin treatment improved the AGE-RAGE axis and reduced albuminuria in Japanese type 2 diabetes patients.

Sudden switchover between the polyamorphic phase separation and the glass-to-liquid transition in glassy LiCl aqueous solutions.

Lithium chloride aqueous solutions (LiClaq solutions) below 10 mol.% are vitrified by cooling from room temperature to 77 K at 0.3 GPa. We examine the solvent state of the glassy sample and its transformation by heating at 1 atm using low-temperature differential scanning calorimetry and Raman spectroscopy. This experimental study suggests strongly that the solvent state of the glassy LiClaq solution closely relates to the state of high-density amorphous ice. Moreover, we reconfirm that the separation into the low-density amorphous ice and the glassy highly concentrated LiClaq solution occurs in the glassy dilute LiClaq solution at ∼130 K, not the glass-to-liquid transition which is commonly observed in the glassy LiClaq solution above ∼10 mol.%. In order to interpret the sudden switchover between the glass-to-liquid transition and the phase separation at ∼10 mol.%, we propose a state diagram of LiClaq solution which connects with a polyamorphic state diagram of pure water and discuss a possibility that the electric field induces a polyamorphic transition of water.

Easy fabrication of a new type of mouthguard incorporating a hard insert and space and offering improved shock absorption ability.

The positive effects of wearing a mouthguard have been indicated in various epidemiological surveys and experiments, and their usage appears to be increasing in many sports. However, many preventable sports-related dental injuries still occur even with the use of a conventional mouthguard. We have developed a mouthguard (the Hard & Space mouthguard) with sufficient injury prevention ability (more than 95% shock absorption ability against impact with a steel ball carrying 15.2 kg m(2) S(-2) potential energy) and ease of clinical application. This mouthguard consists of an outer and an inner EVA layer and a middle layer of acrylic resin (hard insert), with a space to prevent contact between the inner surface of the mouthguard and the buccal surfaces of the maxillary front teeth or teeth already weakened through prior damage or treatment. The purpose of this article is to describe the method by which the Hard & Space mouthguard may easily be fabricated. We believe that this new type of mouthguard has the potential to reduce sports-related dental injuries.

Melting of the precipitated ice IV in LiCl aqueous solution and polyamorphism of water.

Melting of the precipitated ice IV in supercooled LiCl-H(2)O solution was studied in the range of 0-0.6 MPa and 160-270 K. Emulsified solution was used to detect this metastable transition. Ice IV was precipitated from the aqueous solution of 2.0 mol % LiCl (or 4.8 mol % LiCl) in each emulsion particle at low-temperature and high-pressure conditions, and the emulsion was decompressed at different temperatures. The melting of ice IV was detected from the temperature change of the emulsified sample during the decompression. There was an apparently sudden change in the slope of the ice IV melting curve (liquidus) in the pressure-temperature diagram. At the high-pressure and high-temperature side of the change, the solute-induced freezing point depression was observed. At the low-pressure and low-temperature side, ice IV transformed into ice Ih on the decompression, and the transition was almost unrelated to the concentration of LiCl. These experimental results were roughly explained by the presumed existence of two kinds of liquid water (low-density liquid water and high-density liquid water), or polyamorphism in water, and by the simple assumption that LiCl dissolved maily in high-density liquid water.

Volume of supercooled water under pressure and the liquid-liquid critical point.

The volume of water (H(2)O) was obtained at about 200-275 K and 40-400 MPa by using emulsified water. The plot of volume against temperature showed slightly concave-downward curvature at pressures higher than ≈200 MPa. This is compatible with the liquid-liquid critical-point hypothesis, but hardly with the singularity-free scenario. When the critical point is assumed to exist at ≈50 MPa and ≈223 K, the experimental volume and the derived compressibility are qualitatively described by the modified Fuentevilla-Anisimov scaling equation.

Polyamorphism in water.

Water, the most common and important liquid, has peculiar properties like the density maximum at 4 degrees C. Such properties are thought to stem from complex changes in the bonding-network structure of water molecules. And yet we cannot understand water. The discovery of the high-density amorphous ice (HDA) in 1984 and the discovery of the apparently discontinuous change in volume of amorphous ice in 1985 indicated experimentally clearly the existence of two kinds of disordered structure (polyamorphism) in a one-component condensed-matter system. This fact has changed our viewpoint concerning water and provided a basis for a new explanation; when cooled under pressure, water would separate into two liquids. The peculiar properties of water would be explained by the existence of the separation point: the liquid-liquid critical point (LLCP). Presently, accumulating evidences support this hypothesis. Here, I describe the process of my experimental studies from the discovery of HDA to the search for LLCP together with my thoughts which induced these experiments.

Intralobar pulmonary sequestration associated with marked elevation of serum carbohydrate antigen 19-9.

This report describes a 62-year-old man who experienced elevated serum carbohydrate antigen 19-9 (CA19-9) levels (>500 U/mL) for 4 years, and was finally diagnosed with right intralobar pulmonary sequestration. Surgery confirmed the presence an aberrant artery arising from the descending thoracic aorta and entering the right lower lobe basal segment. Immunohistochemistry demonstrated markedly positive staining of CA19-9 in the ciliated cylindrical epithelia, alveoli, and mucus in the cysts. After pulmonary resection, CA19-9 levels decreased to within a normal range. Therefore, the cause of the elevated serum CA19-9 levels in this case was almost certainly due to intralobar pulmonary sequestration.

Differences between pressure-induced densification of LiCl-H(2)O glass and polyamorphic transition of H(2)O.

We perform volumetric measurements of LiCl aqueous solution up to 1.00 GPa in the 100-170 K range, examine the pressure-induced vitrification and densification, and draw the pressure-temperature-volume surface. The pressure-induced vitrification of the solution corresponds to the cooling-induced vitrification of the liquid. We found that the volumetric decrease of glassy solution during the densification is continuous and this behavior depends on the glassy state before the compression. Raman profiles of the glassy solutions before and after the densification are similar. In contrast, the polyamorphic transition from low-density amorphous ice (LDA) to high-density amorphous ice (HDA) is discontinuous and their Raman profile before and after the transition is distinct. These results suggest that the densification relates to the structural relaxation and differs intrinsically from the polyamorphic transition. Furthermore, the densification of HDA is observed under high pressure, suggesting that very high-density amorphous ice (VHDA) may be the densified HDA. In order to recognize a polyamorphic transition under a non-equilibrium condition correctly, evidence of not only large volume change but also some distinct structural changes in glassy state is necessary.

Phase separation in dilute LiCl-H2O solution related to the polyamorphism of liquid water.

When an emulsified 4.8 mol % LiCl-H2O solution was cooled under a pressure of 0.35 or 0.45 GPa and decompressed to 0.1 GPa at 142 K, slightly above its glass transition temperature (approximately 140 K at 0.1 GPa), its volume increased suddenly. This was regarded as an appearance of the low-density amorphous ice in the liquid solution as suggested by x-ray and Raman measurements, and this appearance corresponded to the high-to-low-density polyamorphic transition of pure H2O. Hysteresis was considered to accompany this volumetric change. The hysteresis of the liquid transition proves its first-order nature and, as for the solution, this suggests that the transition is a polyamorphic phase separation.

Application of polyamorphism in water to spontaneous crystallization of emulsified LiCl-H2O solution.

Aqueous solutions are widely explained by the hydration or the bound waterfree water notion. Amorphous polymorphism (polyamorphism) in pure water, which is presently under vigorous discussion, may provide a different view over the solutions. Here, I changed pressure, P, temperature, T, and concentration, C, of emulsified LiCl-H2O solutions and studied their freezing by detecting its heat evolution. It was experimentally indicated that the homogeneous nucleation of low-density crystalline ice I (phase Ih or Ic), in pure water and in solutions, connects to the polyamorphic transition of high-density amorphous ice (HDA) to low-density amorphous ice (LDA). Thus, the polyamorphism of water relates to the phase behavior of aqueous solution. In accordance with the recent simulation result, the nucleation was thought to occur in two stages: the appearance of the LDA-like state and the crystallization. Usefulness of the polyamorphic point of view about the solutions was seen.