[A case of retrograde intussusception due to transverse colon cancer detected by abdominal ultrasonography].

A 78-year-old female patient presented to our hospital with abdominal pain and melena. Abdominal ultrasonography detected a multiple concentric ring sign and retrograde invagination mass near the hepatic flexure. Colonoscopy revealed a 40-mm diameter type 1 tumor in the transverse colon near the splenic flexure, and the biopsy specimen demonstrated a well-differentiated adenocarcinoma. Retrograde intussusception due to transverse colon cancer was diagnosed, and laparoscopic transverse colon resection with lymph node dissection was performed. The resected specimen revealed a 48×40mm diameter type 1 tumor in the transverse colon and was diagnosed as pT2N0M0 pStage I. Contrast-enhanced computed tomography was unavailable, but real-time assessment of the invaginated mass and bowel blood flow was possible by abdominal ultrasonography, which was useful in determining the diagnosis and treatment strategy.

Outcomes of methotrexate-associated lymphoproliferative disorders in rheumatoid arthritis patients treated with disease-modifying anti-rheumatic drugs.

Recently, the use of targeted synthetic or biological disease-modifying anti-rheumatic drugs (ts/bDMARDs) in addition to conventional synthetic (cs)DMARDs including methotrexate (MTX) for rheumatoid arthritis (RA) has increased. However, whether ts/bDMARDs are associated with the development and clinicopathological features of MTX-associated lymphoproliferative disorder (MTX-LPD) in patients with RA remains unknown. Therefore, we evaluated the clinical outcomes of 121 patients with MTX-LPD. Results showed that prior use of ts/bDMARDs was not associated with the different histopathological subtypes of MTX-LPD. Patients with polymorphic-type LPD had a better event-free survival than those with diffuse large B-cell lymphoma (DLBCL), classical Hodgkin lymphoma and peripheral T-cell lymphoma. The pathological subtype of lymphoma could predict the clinical outcome of MTX-LPD. In patients with DLBCL, the use of tumour necrosis factor-alpha (TNF-α) inhibitors prior to MTX-LPD onset was associated with a higher non-relapse mortality. Further, patients with RA previously treated with Janus kinase (JAK) inhibitors more commonly required chemotherapy than those treated with csDMARDs alone, indicating disease aggressiveness. Hence, special caution should be observed when managing patients with MTX-LPD previously treated with JAK or TNF-α inhibitors for RA.

Successful closure with covered self-expandable metal stent for severe anastomotic leakage in the cervical esophagus.

Anastomotic leakage is one of the major complications of esophageal surgery with a high mortality rate and significant morbidity. We describe a case of severe anastomotic leakage close to the hypopharynx after esophageal cancer resection. Despite the conservative management with external drainage, the severe leak did not improve. A fully covered self-expandable metal stent (SEMS) with short flares, which was designed for the cervical esophagus, was subsequently placed bridging the anastomosis to seal the fistula. The post-procedural course was uneventful, and the stent was endoscopically removed after three weeks without any complications. The patient was discharged home three weeks after the stent removal. Our results suggest that placement of fully covered SEMS with short flares may be a safe and effective treatment in this condition of patients.

Pleuropulmonary Paragonimiasis with Multiple Nodules in the Pleura.

An asymptomatic 47-year-old woman was admitted with pleural effusion and pulmonary infiltrates 1 month after ingesting raw wild boar and deer meat. Both her blood and pleural fluid were eosinophilic. Thoracoscopy revealed multiple nodules of the pleura, and biopsy samples of the nodules showed necrosis with epithelioid cell granulomas. An enzyme-linked immunosorbent assay was positive for antibodies against Paragonimus westermani, and the patient was successfully treated with praziquantel. This is the first reported case of pulmonary or pleuropulmonary paragonimiasis where several pleural nodules were observed. The detection of pleural nodules on thoracoscopy can contribute to the prompt and accurate diagnosis of paragonimiasis.

DNA polymerase mu interacts with a meiosis-specific RecA homolog Lim15 during meiosis in Coprinus cinereus.

Meiosis is a fundamental process in eukaryotes. Homologous chromosomes are paired and recombined during meiotic prophase I, which results in variation among the gametes. However, the mechanism of recombination between the maternal and paternal chromosome is unknown. In this study, we report on the identification of interaction between Coprinus cinereus DNA polymerase mu (CcPol mu) and CcLim15/Dmc1, a meiosis-specific RecA-like protein, during meiosis. Interaction between these two proteins was confirmed using a GST-pull down assay. A two-hybrid assay revealed that the N-terminus of CcPol mu, which includes the BRCT domain, is responsible for binding the C-terminus of CcLim15. Furthermore, co-immunoprecipitation experiments indicate that these two proteins also interact in the crude extract of the meiotic cell. A significant proportion of CcPol mu and CcLim15 is shown to co-localize in nuclei from the leptotene/zygotene stage to the early pachytene stage during meiotic prophase I. Moreover, CcLim15 enhances polymerase activity of CcPol mu early in the reaction. These results suggest that CcPol mu might be recruited by CcLim15 and elongate the D-loop structure during homologous recombination in meiosis.

Segment sizes of supramolecular polymers of N,N',N"-tris(3,7-dimethyloctyl)benzene-1,3,5-tricarboxamide in n-decane.

The average segment sizes of rather flexible supramolecular polymers formed by a racemic mixture of N,N',N"-tris(3,7-dimethyloctyl)benzene-1,3,5-tricarboxamide (DO3B) in n-decane (C10) (DO3B/C10) and a mixture of DO3B and homochiral (S)-N,N',N"-tris(3,7-dimethyloctyl)benzene-1,3,5-tricarboxamide ((S)DO3B) in C10 (DO3B:(S)DO3B/C10) were determined using mechanical relaxation techniques, including linear and nonlinear viscoelastic experiments in addition to dielectric relaxation measurements. To evaluate the average sizes of segments for the supramolecular polymers formed in these systems, the conventional rubber elasticity theory was employed for the linear viscoelastic behavior and a non-Gaussian-type three-chain model assuming chains constructed with freely joined chain segments with finite sizes for nonlinear viscoelastic responses. Concentration-independent similar segment sizes for the supramolecular polymer formed in DO3B/C10 were evaluated using both the mechanical techniques. However, the segment size of the formed supramolecular polymer increased upon increasing the component of (S)DO3B to the total amount of DO3B and (S)DO3B in DO3B:(S)DO3B/Ci0o. The formed supramolecular polymer in the racemic DO3B/C10 system possessed threefold intermolecular hydrogen bonding aligned along its stiff columnar structure, with equimolar right- and left-handed helicities connected by defective portions, which were DO3B molecules containing defects in hydrogen bond formation. In the case of DO3B:(S)DO3B/C10, the addition of the chiral (S)DO3B component induced the majority rule effect for the helicity of the system to increase the major part of helicity, which led to the reduction of the number of defects and an increase in segment seizes. Because large macrodipoles are naturally generated by helical three-fold hydrogen bonding of amide groups in a head-to-tail arrangement, as in type-A polymers possessing parallel electric dipoles along their backbones, profound dielectric behavior provided a concentration-independent segment size for a supramolecular polymer formed in both the DO3B/ C10 and DO3B:(S)DO3B/C10 systems, the value of which was about one-third of that determined mechanically. A free-rotation chain model that is slightly more realistic than the freely jointed chain model was employed to consider the discrepancy in the evaluated segment sizes. Then, helical columns consisting of nine DO3B molecules and supramolecular polymer chain portions formed by a three-column connection behaved as equivalent freely jointed (Kuhn) segments.

Reversible photochromism of a ferrocenylazobenzene monolayer controllable by a single green light source.

A 3-ferrocenylazobenzene monolayer on an ITO electrode exhibits reversible azobenzene isomerization using a single green light source, assisted by electrochemical control of the ferrocene redox state.

Immunoglobulin G4-related Coronary Periarteritis and Luminal Stenosis in a Patient with a History of Autoimmune Pancreatitis.

Immunoglobulin G4 (IgG4)-related disease is a systemic inflammatory disorder that was first described in patients with autoimmune pancreatitis. Although IgG4-related disease is thought to involve the cardiovascular system, case reports describing coronary artery involvement are relatively rare. We describe a patient who was previously diagnosed with autoimmune pancreatitis and found to have coronary periarteritis and luminal narrowing. After the initiation of steroid treatment, the patient's coronary periarteritis and luminal stenosis were both ameliorated with an improvement in the serum IgG4 concentration. The present findings collectively suggest that IgG4-related immuno-inflammation may have a role in the development of coronary periarteritis and luminal atherosclerosis.

Initial closed trocar entry for laparoscopic surgery: Technique, umbilical cosmesis, and patient satisfaction.

BACKGROUND/AIMS: Despite the benefits of laparoscopic surgery, which is being performed with increasing frequency, complications that do not occur during laparotomy are sometimes encountered. Such complications commonly occur during the initial trocar insertion, making this a procedural step of critical importance. METHODS: In 2002, we experienced, upon initial trocar insertion, a serious major vascular injury (MVI) that led to hemorrhagic shock, and we thus modified the conventional closed entry method to an approach that we have found to be safe. We began developing the method by first measuring, in a patient undergoing laparoscopic cystectomy, the distance between the inner surface of the abdominal wall and the anterior spine when the abdominal wall was lifted manually for trocar insertion and when it was lifted by other methods, and we determined which method provided the greatest distance. We then devised a new approach, summarized as follows: The umbilical ring is elevated with Kocher forceps. The umbilicus is everted, and the base is incised longitudinally. This allows penetration of the abdominal wall at its thinnest point, and it shortens the distance to the abdominal cavity. A bladeless trocar (Step trocar) is used to allow insertion of the Veress needle. We began applying the new entry technique in July 2002, and by December 2014, we had applied it to 9676 patients undergoing laparoscopic gynecology surgery. RESULTS: All entries were performed successfully, and no MVI occurred. The umbilical incision often resulted in an umbilical deformity, but in a questionnaire-based survey, patients generally reported satisfaction with the cosmetic outcome. CONCLUSION: A current new approach provides safe outcome with a minor cosmetic problem.

Sumoylation of a meiosis-specific RecA homolog, Lim15/Dmc1, via interaction with the small ubiquitin-related modifier (SUMO)-conjugating enzyme Ubc9.

Sumoylation is a post-translational modification system that covalently attaches the small ubiquitin-related modifier (SUMO) to target proteins. Ubc9 is required as the E2-type enzyme for SUMO-1 conjugation to targets. Here, we show that Ubc9 interacts with the meiosis-specific RecA homolog, Lim15/Dmc1 in the basidiomycete Coprinus cinereus (CcLim15), and mediates sumoylation of CcLim15 during meiosis. In vitro protein-protein interaction assays revealed that CcUbc9 interacts with CcLim15 and binds to the C-terminus (amino acids 105-347) of CcLim15, which includes the ATPase domain. Immunocytochemistry demonstrates that CcUbc9 and CcLim15 colocalize in the nuclei from the leptotene stage to the early pachytene stage during meiotic prophase I. Coimmunoprecipitation experiments indicate that CcUbc9 interacts with CcLim15 in vivo during meiotic prophase I. Furthermore, we show that CcLim15 is a target protein of sumoylation both in vivo and in vitro, and identify the C-terminus (amino acids 105-347) of CcLim15 as the site of sumoylation in vitro. These results suggest that sumoylation is a candidate modulator of meiotic recombination via interaction between Ubc9 and Lim15/Dmc1.

Hydration of poly(ethylene oxide)s in aqueous solution as studied by dielectric relaxation measurements.

The hydration state of poly(ethylene oxide)s (PEOs) in aqueous solutions was investigated using dielectric relaxation measurements at 25 degrees C over a frequency range up to 20 GHz, which is the relaxation frequency of water molecules in a bulk state. The dielectric relaxation spectra obtained indicated decomposition into two major and one minor relaxation modes with relaxation times of 8.3, 22, and 250 ps, respectively. The two major modes were attributed to rotational relaxation of water molecules belonging to the bulk state and water molecules hydrogen bonded to ethylene oxide (EO) monomer units. The number of hydration water molecules per EO unit depended on the molar mass of PEO (M) and reached a constant value of 3.7 at M > 1500, which agrees with the value obtained by other experiments.

Relationship between serum IgG4 concentrations and atherosclerotic coronary plaques assessed by computed tomographic angiography.

BACKGROUND: Immunoglobulin G4 (IgG4)-related immuno-inflammation has been suggested to affect the development of coronary artery atherosclerosis. The aim of this study was to analyze the association of serum IgG4 concentrations with calcified and non-calcified coronary plaques. METHODS: Serum IgG4 concentrations were measured in 263 patients who underwent 320-slice coronary computed tomographic (CT) angiography. Vulnerable coronary plaques were evaluated for CT plaque characteristics, including low-density plaque (LDP), positive remodeling, and spotty calcification. RESULTS: Serum concentrations of IgG4 were significantly higher in patients with non-calcified plaque (NCP) than in those without (32.2mg/dL vs. 23.7mg/dL, p=0.029). By contrast, the median serum IgG4 concentrations in patients with and without calcified plaque were 31.2mg/dL and 26.2mg/dL, respectively (p=0.107). Serum IgG4 concentrations were significantly elevated in patients with LDP (33.5mg/dL vs. 26.9mg/dL, p=0.002) and in those with positive remodeling (31.4mg/dL vs. 28.4mg/dL, p=0.039) than in those without. Patients with spotty calcification also had significantly higher serum IgG4 concentrations than those without (32.1mg/dL vs. 24.9mg/dL, p=0.049). In age- and gender-adjusted logistic regression analysis, the highest IgG4 quartile (≥56.7mg/dL) was significantly associated with LDP with an odds ratio of 2.49 (95% CI, 1.15-5.36, p=0.020). CONCLUSIONS: Serum IgG4 concentrations were significantly associated with NCP, especially with LDP, suggesting that IgG4-related immuno-inflammation may play a role in coronary plaque vulnerability.

Functional expression of CCL6 by rat microglia: a possible role of CCL6 in cell-cell communication.

There is growing evidence that chemokines play important roles in the immune surveillance of central nervous system (CNS). In the CNS, microglia are primary immune effector cells and secrete various chemokines in response to their microenvironment. Using the RT-PCR procedure and indirect immunofluorescence analysis, we found that CCL6 (known as C10/MRP-1 in mouse) was expressed in rat primary microglia without any stimulation, but not in primary astrocytes, although both cell types expressed CCR1 mRNA, which is a receptor for CCL6. Furthermore, immunohistochemical analysis demonstrated that microglia produced CCL6 protein in a normal brain, suggesting that microglia may be the primary source of CCL6 in a normal brain. Recombinant rat CCL6 mediated the migration of microglia and astrocytes in vitro. The CCL6-mediated cell migration was blocked by treating the cells with LY294002, a PI3-kinase inhibitor and Western blot analysis showed that the phosphorylation of Akt could be induced by treating microglia with a recombinant CCL6, suggesting that CCL6 functions by activating the PI3-kinase/Akt pathway. A proinflammatory cytokine, interferon-gamma enhanced the expression of both CCL6 mRNA and protein in microglia, while other proinflammatory cytokines, interleukin-6 and tumor necrosis factor-alpha and an anti-inflammatory cytokine, transforming growth factor-beta exerted no effect on CCL6 expression in microglia. These findings suggest that CCL6 may be a mediator released by microglia for cell-cell communication under physiological as well as pathological conditions of CNS.

Pioglitazone Reduces Vascular Lipid Accumulation in Angiotensin II-Induced Hypertensive Rat.

AIM: In an insulin-resistant state, excess lipids may accumulate in various non-adipose tissues, leading to histological and functional damage. It has been suggested that peroxisome proliferator-activated receptor-gamma (PPARγ) may ameliorate disorganized lipid balance. In the current study, we analyzed whether pioglitazone, an agonist of PPARγ, reduces angiotensin II-induced vascular lipid accumulation. METHODS: Angiotensin II was infused into rats at doses of 0.7 mg/kg/day via a subcutaneously implanted osmotic minipump for 7 consecutive days. Pioglitazone was orally given at a dose of 2.5 mg/kg/day for 7 days. RESULTS: Pioglitazone significantly reduced angiotensin II-induced enhanced lipid deposition and superoxide production in the adventitia of the aorta, as detected by oil red O and dihydroethidium (DHE) staining, respectively. Increased DHE signals, some observed at the site of lipid deposition, were mainly localized in ED-1-positive monocytes/macrophages. Angiotensin II-induced upregulation of the expression of LDL receptor and Nox1 was inhibited by pioglitazone treatment. In addition, angiotensin II significantly reduced the expression of PCSK9, and this reduction was ameliorated by pioglitazone. On the other hand, pioglitazone did not significantly alter the expression of the phosphorylated forms of AMPKα and ACC, which was downregulated by angiotensin II. CONCLUSIONS: Pioglitazone treatment suppressed excess lipid accumulation and superoxide production in the aorta in an angiotensin II-induced rat model of hypertension.

Association between serum IgG4 concentrations and the morphology of the aorta in patients who undergo cardiac computed tomography.

BACKGROUND: Immunoglobulin G4 (IgG4)-related disease has been suggested to be involved in cardiovascular disorders such as chronic periaortitis. However, it remains unclear whether IgG4-related immuno-inflammation affects the subclinical stages of aortic remodeling. Here, we analyzed the relationship between serum IgG4 concentrations and the morphology of the ascending aorta. METHODS: Serum concentrations of IgG4 were measured in 322 patients who underwent 320-slice cardiac computed tomography (CT). We assessed the aortic wall area and intravascular area at the portion between the aortic valve and the bifurcation of the pulmonary artery. RESULTS: In total, 174 patients (54.0%) were diagnosed to have coronary artery disease (CAD) by cardiac CT. The intravascular area was significantly larger in patients with CAD than in those without (893mm(2) vs. 811mm(2), p=0.001). The aortic wall area was slightly, but not significantly, larger in patients with CAD than in those without (183mm(2) vs. 176mm(2), p=0.051). Serum concentrations of IgG4 were significantly higher in patients with an aortic wall area of median or greater size (≥181mm(2)) than in those with a smaller area (<181mm(2)) (32.9mg/dL vs. 23.1mg/dL, p=0.026). In logistic regression analysis using age, gender, and CAD as covariates, the fourth quartile of IgG4 (≥55.4mg/dL) was significantly associated with an aortic wall area of median or greater size with an odds ratio of 2.09. CONCLUSIONS: Serum concentrations of IgG4 were found to be significantly associated with the aortic wall area. These findings collectively suggest that immuno-inflammatory processes may play a role in the subclinical stages of aortic remodeling.

Optimized heart rate for 320-row cardiac CT can be feasibly predicted from prescan parameters.

To evaluate the degree of heart rate (HR) changes at rest (HRrest), during breath hold (HRtest), and during cardiac CT examinations (HRscan) in a large group of patients , and to derive and asses the feasibility of a predictive formula for HRscan. HRrest, HRtest, and HRscan were retrospectively compared in a total of 563 consecutive patients who underwent 320-row cardiac CT. Multiple regression analysis was performed to derive predictive formulae for HRscan in the entire study population and, in each group of patients with decreased (Dec) or increased (Inc) HR during breath hold. The predictive formula was evaluated as accurate when less than 5 % of the actual HRscan exceeded the predicted HRscan by ±5 beats per minute (bpm). The average values of the HRtest (65.3 ± 12.0 bpm) and HRscan (63.7 ± 11.9 bpm) significantly decreased from those of the HRrest (68.4 ± 11.9 bpm) (p < 0.0001). The predictive formula (HRscan = 3.601 + 0.113HRrest + 0.8HRtest) was determined to be accurate only in Group Dec. The HRtest significantly decreased from the HRrest, and the HRscan significantly decreased from the HRtest. An accurate predictive formula for HRscan could be built only for Group Dec.

Association of serum IgG4 and soluble interleukin-2 receptor levels with epicardial adipose tissue and coronary artery calcification.

OBJECTIVES: Immunoglobulin G4 (IgG4)-related immuno-inflammation may play a role in the development of coronary artery disease (CAD). We analyzed the association of serum IgG4 and soluble interleukin-2 receptor (sIL-2R) levels with epicardial fat volume (EFV) and coronary artery calcification (CAC). METHODS: Serum IgG4 and sIL-2R levels were measured in 267 patients who underwent 320-slice cardiac computed tomography. RESULTS: THE median serum levels of IgG4 and sIL-2R were higher in patients with CAD than in those without. Serum IgG4 levels were significantly greater in patients with EFV within the second and fourth quartile (≥75 mL) than in those with low EFV (b75 mL) (33.5 mg/dL vs. 22.5 mg/dL). On the other hand, serum sIL-2R levels were significantly higher in patients with CAC than in those without (409 U/mL vs. 345 U/mL). In age- and gender-adjusted logistic regression analysis, the fourth quartile of IgG4 (≥56.7 mg/dL) was associated with EFV within the second and fourth quartile (≥75 mL) with an odds ratio of 3.13. CONCLUSION: Serum IgG4 levels were greater in patients with EFV within the second and fourth quartile, whereas serum sIL-2R levels were increased in patients with CAC. These two biomarkers may reflect different mechanisms underlying development of cardiovascular remodeling.

The prevalence of malignant neoplastic and non-malignant gastrointestinal lesions in cardiology inpatients.

BACKGROUND: Although gastrointestinal (GI) complications are receiving more attention in cardiovascular patients owing to the widespread use of antithrombotic drugs, information seems to be limited over the prevalence of GI malignancies in those patients. METHODS AND RESULTS: The prevalence of malignant as well as non-malignant GI lesions diagnosed in cardiology inpatients was investigated. We retrospectively analyzed 274 cardiology inpatients who underwent upper and/or lower GI tract endoscopies. A total of 97 patients (35.4%) were taking multiple antithrombotic drugs and the mean number of antithrombotic drugs used was 1.19. Malignant neoplasm was found in 26 patients (9.5%), and non-malignant lesions (ulcers, adenomas, polyps) were found in 106 patients (38.7%). Multivariate analysis showed that antiplatelet drug usage was negatively (odds ratio [OR] 0.38, 95% confidence interval [CI] 0.16-0.91) whereas positive fecal occult blood test was positively (OR 4.44, 95% CI 1.44-13.66) associated with GI malignancies. On the other hand, for non-malignant GI lesions, both antiplatelet drug usage (OR 1.85, 95% CI 1.05-3.25) and positive fecal occult blood test (OR 1.99, 95% CI 1.14-3.47) were found to be positive predictors. CONCLUSIONS: During the 59-month study period, 26 and 106 patients were diagnosed to have GI malignancies and non-malignant GI lesions, respectively, among cardiology inpatients. Cardiology physicians should not overlook the possibility of GI malignancies in an era of multiple antithrombotic drug usage.

Comparison of the impact of changes in waist circumference and body mass index in relation to changes in serum gamma-glutamyltransferase levels.

AIM: Serum gamma-glutamyltransferase (GGT) levels, which are associated with insulin resistance, may predict the incidence of cardiovascular disease and mortality. Here, the relationship was analyzed between changes in obesity parameters and those in serum GGT over a one-year period. METHODS: Data were analyzed from individuals who underwent general health screening two years running. RESULTS: Among 3086 individuals (1954 men, 1132 women), percent changes in both waist circumference (%dWC) and body mass index (BMI) (%dBMI) were significantly correlated with percent changes in GGT (%dGGT) in men (r=0.17 and r=0.31, respectively). On the other hand, in women, %dBMI, but not %dWC, had a significant association with %dGGT. When age, %dWC, %dBMI, smoking status, and alcohol intake were all included as independent variables, %dBMI, but not %dWC, showed a graded association with the highest %dGGT quartile in both genders. Furthermore, incorporation of %dWC as an additional independent variable to age, gender, and %dBMI did not show an incremental improvement in prediction for the highest %dGGT quartile (C statistic, 0.643 to 0.648; p= 0.380), suggesting that taking WC changes into account does not significantly improve the prediction of GGT changes when BMI has already been taken into consideration. CONCLUSION: Changes in BMI are dose-dependently associated with GGT changes in both genders; however, the additional consideration of changes in WC does not show a significant statistical improvement in the prediction of GGT changes.