Granulomatosis with polyangiitis with intestinal involvement successfully treated with rituximab and surgery.

Intestinal perforation is a rare and life-threatening complication in granulomatosis with polyangiitis (GPA). A 55-year-old Japanese man who had been undergoing maintenance haemodialysis was diagnosed with GPA via a pathologically proven nasal granuloma and proteinase 3-antineutrophil cytoplasmic antibody-positive status. He was started on 60 mg prednisolone. Haematochezia was observed due to the colon ulcer after treatment initiation. Two doses of intravenous cyclophosphamide were administered every 2 weeks. Despite the treatment, there were two episodes of severe abdominal pain with peritonitis within a week. Perforation of descending colon and severe ischaemia of the ascending colon was observed during each emergency laparotomy, and ileostomy was performed. Vasculitis in the small vessels was confirmed. In conclusion, patient with severe intestinal involvement and who was unresponsive to conventional therapy was treated with surgery followed by rituximab administration, and remission was achieved.

Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013.

BACKGROUND: The Tokyo Guidelines 2013 classifies acute cholecystitis (AC) into three grades and recommends appropriate therapy for each grade. For grade II AC, either early laparoscopic cholecystectomy (LC) or percutaneous transhepatic gallbladder drainage (PTGBD) should be performed. This study aimed to identify the risk factors for difficulty of LC for treating grade II AC. METHODS: Totally, 122 patients who underwent LC for grade II AC were enrolled and divided into difficult LC (DLC) and nondifficult LC (NDLC) groups. The DLC group included patients who experienced one of the following conditions: conversion from LC to open cholecystectomy, operating time ≥ 180 min, or blood loss ≥300 ml. Preoperative characteristics and postoperative outcomes were analyzed. RESULTS: In univariate analysis, risk factors included male sex, interval between symptom onset and admission, interval between symptom onset and LC, and anticoagulant therapy. The incidence of postoperative complications was higher in the DLC group than in the NDLC group (23.5% vs. 4.6%, p = 0.0016). According to receiver operating characteristic curves, the optimal cutoff value was calculated, and multivariate analysis showed that male sex [odds ratio (OR), 5.76; 95% confidence interval (CI), 1.979-19.51; p = 0.0009) and interval between symptom onset and LC of over 96 h (OR, 6.32; 95% CI, 2.126-20.15; p = 0.0009) were independent risk factors for difficulty of LC. CONCLUSIONS: In patients with grade II AC, LC was technically difficult when performed over 96 h after symptom onset. Moreover, male sex was a risk factor. Therefore, PTGBD should be considered in these patients.

Extreme dilatation of the interposed jejunal pouch after proximal gastrectomy associated with portal venous gas: A case report.

INTRODUCTION: The jejunal pouch interposition (JPI) after proximal gastrectomy (PG) was proposed as a reconstructive procedure to provide a gastric reservoir substitute and prevent postgastrectomy syndrome. However, food residue remaining in some of the pouches resulted in the adverse effect of abdominal bloating, thereby body weight loss. Here, we report a rare case with an extreme dilation of the interposed jejunal pouch (JP) 8 years after PG, requiring pouch resection. PRESENTATION OF CASE: A 65-year-old-man who had undergone PG with an inverted U-shaped JPI for early gastric cancer 8 years previously, suffered from shock after right hip joint implantation. Abdominal enhanced CT scan revealed an extremely dilated JP accompanied by portal venous gas. After 5 months of conservative therapy, he underwent resection of the JP and gastric remnant with Roux-en-Y esophagojejunostomy reconstruction. After the operation, the patient has remained in good health for over 3 years. DISCUSSION AND CONCLUSION: Long-term operative outcome following pouch operation for gastric cancer still remains controversial. Surgical intervention should be considered when we encounter patients who have refractory pouch dilatation after surgery for gastric cancer.

Optimal timing of cholecystectomy after percutaneous gallbladder drainage for severe cholecystitis.

BACKGROUND: The Tokyo guideline for acute cholecystitis recommended percutaneous transhepatic gallbladder drainage followed by cholecystectomy for severe acute cholecystitis, but the optimal timing for the subsequent cholecystectomy remains controversial. METHODS: Sixty-seven patients who underwent either laparoscopic or open cholecystectomy after percutaneous transhepatic gallbladder drainage for severe acute cholecystitis were enrolled and divided into difficult cholecystectomy (group A) and non-difficult cholecystectomy (group B). Patients who had one of these conditions were placed in group A: 1) conversion from laparoscopic to open cholecystectomy; 2) subtotal cholecystectomy and/or mucoclasis; 3) necrotizing cholecystitis or pericholecystic abscess formation; 4) tight adhesions around the gallbladder neck; and 5) unsuccessfully treated using PTGBD. Preoperative characteristics and postoperative outcomes were analyzed. RESULTS: The interval between percutaneous transhepatic gallbladder drainage and cholecystectomy in Group B was longer than that in Group A (631 h vs. 325 h; p = 0.031). Postoperative complications occurred more frequently when the interval was less than 216 h compared to when it was more than 216 h (35.7 vs. 7.6%; p = 0.006). CONCLUSIONS: Cholecystectomy for severe acute cholecystitis was technically difficult when performed within 216 h after percutaneous transhepatic gallbladder drainage.

Fast Photochromism Involving Thermally-Activated Valence Isomerization of Phenoxyl-Imidazolyl Radical Complex Derivatives.

Open-shell biradicals have received considerable attention in material science because of their high two-photon absorption cross sections and broad and high absorptive features over the visible region. However, the instability of the biradical caused by the open-shell nature was one of the drawbacks; therefore, novel radical compounds which can suppress unwanted reactions by tuning the open-shell features are desired to expand the versatility of the radical compounds. Here, we report a novel radical-dissociation-type photochromic compound whose photochromic reaction involves a valence isomerization from the open-shell biradical to closed-shell quinoidal forms by using a phenoxyl-imidazolyl radical complex framework. The valence isomerization from the biradical to quinoid forms effectively tunes the open-shell feature in time and drastically changes the spectral features, which were revealed by time-resolved Fourier transform infrared spectroscopy. This novel fast photochromic property not only is important for fundamental spin chemistry but also expands the versatility of the radical compounds for novel advanced photofunctional materials.

Relationship between activation volume and polymer matrix effects on photochromic performance: bridging molecular parameter to macroscale effect.

Photochromic compounds have attracted attention as ophthalmic lenses because of their reversible color modulation upon irradiation with light. However, the efficiency of the photochromism is strongly affected by their surrounding because of the structural changes concomitant with the photochromism, which causes the decrease in the photochromic performance in the polymer matrix. Therefore, the clarification of the degree of the structural changes is necessary to apply to the ophthalmic lenses. Bridged imidazole dimers are one of the fast photoswitch molecules possessing high photochromic quantum yield and durability. Although the enhancement of the photochromic properties of bridged imidazole dimers has been vigorously studied, the quantitative information about the structural changes has not been revealed in detail. In this study, we investigated the pressure effects on the photochromic properties of bridged imidazole dimers. The activation volume for the thermal back-reaction of the photogenerated biradical species becomes an effective measure to predict the degree of the structural change during the photochromic reaction. We revealed that the smaller activation volume is suitable for keeping the efficient photochromic reaction in the polymer matrix because the photochromic reaction is not affected by the surroundings. These fundamental insights into the molecular dynamics provide valuable information to develop fast photochromic compounds that are suitable for the use in the polymer matrix and pressure sensitive photochromic materials.

Sudden disappearance of the blood flow in a case of pancreatic acinar cell carcinoma.

A 55-year-old man was referred to our hospital for a further examination of a pancreatic cystic tumor with a solid component exhibiting vascularity. A few days later, the patient was admitted with a complaint of sudden severe epigastric pain. Enhanced CT showed the loss of vascularity in the tumor. In particular, contrast-enhanced endoscopic ultrasonography (EUS) clearly demonstrated the disappearance of the blood flow, and a histological examination revealed acinar cell carcinoma with central necrosis. To our knowledge, this is the first case in the literature of acinar cell carcinoma associated with the sudden disappearance of vascularity. In this case, contrast-enhanced harmonic EUS was especially useful for assessing the degree of vascularity.

Enhancing the versatility and functionality of fast photochromic bridged imidazole dimers by flipping imidazole rings.

The widely tunable optical properties and the visible sensitivity have been required for fast photochromic molecules whose coloration-decoloration cycle completes in µs to ms time scale not only for practical applications such as full-color holographic displays but also for fundamental researches in biochemistry. However, the so far developed [2.2]paracyclophane-bridged imidazole dimers, which are one of the best candidates for fast photochromic molecules, have their weaknesses for these requirements. Herein, we overcome the issues with sustaining fast photochromism and high durability by flipping the two imidazole rings (the head-to-tail and tail-to-tail forms). The alteration in the relative configuration of the imidazole rings suppresses the broad absorption band resulting from the radical-radical interaction. The substitution to the 2-position of the imidazole ring of the tail-to-tail form gives the drastic changes in the steady-state and the transient absorption spectra. The pyrene-substituted tail-to-tail form demonstrates that the transient absorption spectrum is featured by the inherent spectrum of the imidazolyl radical. This molecular framework is easy to functionalize fast photochromic molecules such as sensitizations to the red light, chirality, and biological tagging, and therefore it is versatile for various fast photochromic applications.

The expression of S100A4 in human pancreatic cancer is associated with invasion.

OBJECTIVES: Pancreatic cancer is one of the most lethal malignancies; its poor prognosis is strongly associated with invasion and metastasis. Expression of S100A4 has been reported to correlate with poor prognosis in various cancers. We have investigated the role of S100A4 in pancreatic cancer tumorigenesis and its clinicopathologic significance. METHODS: Protein expression of S100A4 was examined by Western blot in pancreatic cancer cell lines and a human pancreatic ductal epithelium cell line, HPDE-6. Then the expressions of S100A4, TP53, and CD133 were examined immunohistochemically in resected specimens from 83 patients with pancreatic cancer to clarify their clinicopathologic significance. Survival analyses were performed using the Kaplan-Meier method and the Mantel-Cox method. RESULTS: Forty-eight (58%) of 83 patients with pancreatic cancer positively expressed S100A4, and 50 (60%) and 29 (36%) patients positively expressed TP53 and CD133, respectively. S100A4 expression was significantly correlated with perineural invasion (P = 0.029) and invasion pattern (P = 0.001). Neither TP53 nor CD133 expression showed significant correlations with any other parameters. CONCLUSIONS: Our present results suggest that S100A4 plays an important role in the invasiveness, particularly with perineural invasion and invasion pattern, of pancreatic cancer. Development of new strategies targeting S100A4 or its downstream effectors is warranted.

Photochromism of a naphthalene-bridged imidazole dimer constrained to the "anti" conformation.

Anti-1,8-bisTPI-naphthalene in which two imidazole rings are constrained to an anti-conformation leading to the first-formed 1,4'-isomer of the bridged imidazole dimer has been synthesized. The color of the radicals is different from that of the previously reported bridged-imidazolyl radicals because the intramolecular interaction between the radicals becomes weak due to the anti-conformation. This molecular design would be a profitable strategy to control the color of the radicals of the bridged imidazole dimer for application in ophthalmic lenses.

Potential utility of eGFP-expressing NOG mice (NOG-EGFP) as a high purity cancer sampling system.

PURPOSE: It is still technically difficult to collect high purity cancer cells from tumor tissues, which contain noncancerous cells. We hypothesized that xenograft models of NOG mice expressing enhanced green fluorescent protein (eGFP), referred to as NOG-EGFP mice, may be useful for obtaining such high purity cancer cells for detailed molecular and cellular analyses. METHODS: Pancreato-biliary cancer cell lines were implanted subcutaneously to compare the tumorigenicity between NOG-EGFP mice and nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mice. To obtain high purity cancer cells, the subcutaneous tumors were harvested from the mice and enzymatically dissociated into single-cell suspensions. Then, the cells were sorted by fluorescence-activated cell sorting (FACS) for separation of the host cells and the cancer cells. Thereafter, the contamination rate of host cells in collected cancer cells was quantified by using FACS analysis. The viability of cancer cells after FACS sorting was evaluated by cell culture and subsequent subcutaneous reimplantation in NOG-EGFP mice. RESULTS: The tumorigenicity of NOG-EGFP mice was significantly better than that of NOD/SCID mice in all of the analyzed cell lines (p < 0.01). Sorting procedures enabled an almost pure collection of cancer cells with only slight contamination by host cells. Reimplantation of the sorted cancer cells formed tumors again, which demonstrated that cell viability after sorting was well maintained. CONCLUSIONS: This method provides a novel cancer sampling system for molecular and cellular analysis with high accuracy and should contribute to the development of personalized medicine.

Local environments of coumarin dyes within mesostructured silica-surfactant nanocomposites.

The local environments surrounding dye molecules were studied with use of coumarin dyes in a mesostructured silica-surfactant nanocomposite, which was formed in a porous alumina membrane by a surfactant-templated method and has an average pore diameter of 3.4 nm. Coumarin dyes, such as coumarin 480 (C480), coumarin 343 (C343), and propylamide coumarin 343 (PAC343), were extracted into the silica-surfactant nanocomposite and time-resolved fluorescence spectra of these dyes were examined. C480 and C343 show slow dynamic Stokes shifts and the decay curve can be fitted by a biexponential function. The decay-time constants obtained from the fitting are almost identical for C480 and C343: 0.87 and 7.5 ns for C480, and 0.86 and 7.6 ns for C343. In contrast to these two coumarin dyes, short decay-time constants (0.50 and 4.8 ns) were obtained for PAC343 in the silica-surfactant nanocomposite. These results indicate that the local environments of C480 and C343 are almost identical but different from that of PAC343. By considering the origin of the dynamic Stokes shift and the mesostructure of the silica-surfactant nanocomposite, the location and microenvironment of coumarin dyes within the silica-surfactant nanocomposite are discussed.