Phase II trial of nivolumab monotherapy and biomarker screening in patients with chemo-refractory germ cell tumors.

OBJECTIVES: Germ cell tumors are highly susceptible to chemotherapy; however, there is a lack of established treatments for consistently relapsing germ cell tumor. Therefore, in this phase II study, we evaluated the efficacy and safety of nivolumab for relapsed germ cell tumor. METHODS: Seventeen adult patients (median age 34 years) with refractory primary germ cell tumor after second-line or higher chemotherapy were enrolled. Nivolumab was administered over 30 min at 240 mg/body every 2 weeks until disease progression or intolerable adverse event occurrence. The primary endpoint was the overall response rate. RESULT: We performed a biomarker analysis of programmed death ligand-1 expression and genomic sequencing. Tumor histology revealed nonseminoma and seminoma in 14 and three patients, respectively. Patients were pretreated with a median of three chemotherapy lines, and three patients received high-dose chemotherapy. The median number of nivolumab doses was 3 (range 2-46). One patient showed a partial response and three showed stable disease. Responses were durable in one patient with a partial response and one patient with stable disease (median 90 and 68 weeks, respectively). Nivolumab was well-tolerated, with only two Grade 3 adverse events observed. Programmed death ligand-1 expression was not associated with objective responses. Genomic sequencing revealed a high tumor mutation burden in a patient with a durable partial response. While a small subset of chemorefractory germ cell tumors may respond to nivolumab, programmed death ligand-1 is unreliable to measure response. CONCLUSIONS: Tumor mutation burden is a potential biomarker for future testing of germ cell tumor response.

Outpatient Treatment of Refractory Morel-Lavallée Lesion Infection With Retention Sutures: A Case Report.

We report the case of a 41-year-old man with a Morel-Lavallée lesion (MLL) that developed an infection. The patient was initially treated with intravenous antibiotics, but the infection persisted. He was then treated with outpatient cleansing and retention sutures, which resulted in successful wound healing. This case report demonstrates the efficacy of outpatient cleansing and retention sutures for the treatment of MLL infection. This treatment modality is less expensive than inpatient treatment, and it allows the patient to return to their normal activities sooner.

High-pressure water jet injury to the chest.

The high-pressure water jet cutting method, which uses a high-pressure water stream to cut hard materials, is widely used because it does not generate sparks or dust. However, once the high-pressure water jet is accidentally fired at a human body, a large amount of water containing abrasive materials flows into the body in a short time, causing severely contaminated injuries (Dailiana et al., 2008 [1]). Water jet injury (WJI) should be treated as a surgical emergency, but the severity is often underestimated, and treatment is delayed because the wound often shows only small holes [1]. Previous reports have shown that the majority of WJI occur in the extremities [1] (Rodríguez et al., 2019 [2]). On the other hand, abdominal and thoracic WJIs have been rarely reported, with only two cases of thoracic WJI [2]. Here, a case of thoracic WJI in which the patient was brought to our hospital the day after injury and treatment intervention was delayed is presented, and points to consider in the diagnosis and treatment strategy for WJI to the chest are discussed.

A Case of Severe Fever With Thrombocytopenia Syndrome With Recurrent Shock and Erythema.

Severe fever with thrombocytopenia syndrome (SFTS) is a fatal infectious disease often transmitted through tick bites and exposure to fluids from infected individuals. Early diagnosis is critical due to the high mortality rates of the disease; however, it might be challenging if a patient's history of tick contact is unclear. We report a detailed diagnosis of SFTS in a 69-year-old man with atypical symptoms but without identifiable tick bites. The diagnosis was made on the basis of massive diarrhea, recurrent shock, and unusual erythema presentation following hospital admission.

Selective Arterial Catheterization as a Bridging Therapy for Blunt Traumatic Aortic Injury With Intraperitoneal Organ Malperfusion.

Blunt thoracic aortic injury (BTAI) is fatal and requires thoracic endovascular aortic repair (TEVAR) for its optimal management. Performing TEVAR requires multidisciplinary specialists and supportive facilities.  We report a case of an 89-year-old man who presented to the emergency department with blunt trauma. Whole-body computed tomography (CT) revealed grade II aortic injury with disrupted blood flow to the left kidney. Sudden paralysis of the left lower extremity and distal progression of the aortic dissection occurred. However, TEVAR could not be performed immediately. Therefore, an external shunt from the right common femoral artery to the left lower extremity was created with angioplasty, superior mesenteric artery (SMA) stenting, and celiac artery (CA) balloon dilatation. The patient's condition stabilized, and he was transferred to a hospital where TEVAR was performed. Selective arterial catheterization (SAC) for treating intraperitoneal organ malperfusion caused by BTAI may be an effective bridging therapy for TEVAR.

A Survey of the Menstrual Status of Female College Students.

Education about menstruation is a sensitive topic for young female students; providing appropriate knowledge is essential for maintaining and improving their health. The present study was conducted to collect data corresponding to different factors affecting health among young individuals; the menstrual status, exercise habits, sleep status, and body composition of these individuals as well as the relationships among these factors, were evaluated. Altogether, 200 female students responded to the survey; 129 completed all the physical measurement items. As a case study, face-to-face interviews regarding menstrual symptoms were conducted. Results showed that 49/200 (25%) and 120/200 (60%) participants experienced moderate or severe pain before and during menstruation, respectively. The degree of pain one week before menstruation and during menstruation were significantly positively correlated (r = 0.573, p < 0.01). When analyzed as group data, it was difficult to identify the relationship between menstrual status, exercise habits, and sleep status; these were found to be intricately associated with various factors. The case study analysis confirmed that some individuals experienced physical and psychological symptoms, such as irregular menstrual cycles, premenstrual syndrome, and severe menstrual cramps.

Stent graft placement for traumatic lumbar artery injury in which coil embolization is not feasible.

Lumber artery injuries are anatomically difficult to treat surgically, and coil embolization is a first-line treatment option for them. In some cases, however, there is not enough space for coil embolization, for which stent graft placement can be an alternative therapy. We report a case of traumatic lumbar artery injury in which stent graft placement was performed due to lack of space for coil embolization.

How far is the left circumflex coronary artery from the mitral annulus?

INTRODUCTION: The relationship between the distance from the mitral annulus to the left circumflex coronary artery (LCX) and iatrogenic LCX injury has been questioned. This study was designed to determine the high-risk sites of LCX injury with an anatomical approach using multiple detector-computed tomography (MDCT) scanning taken before mitral valve annuloplasty (MVA). The purpose of this study is to prevent LCX injury in patients unable to receive MDCT before mitral valve surgery. METHODS: In 2018, we performed MVA on 59 patients, 52 of whom had undergone preoperative MDCT scanning. We retrospectively analyzed the MDCT images of these 52 patients and measured the shortest distance from the mitral annulus to the LCX in three dimensions. Also, we divided the mitral annulus into 12 clockwise areas (A0-A11) to identify the exact location. RESULTS: The site of closest proximity and their numbers of patients were as follows: A6, 1 patient; A8, 2 patients; A9, 32 patients; and A10, 17 patients. Nine (17.3%) of the 52 patients had the shortest distance of less than 2 mm. The shortest distance according to the dominance of coronary artery showed no significant difference (p = 0.81). CONCLUSION: The site of closest proximity from the mitral annulus to the LCX was concentrated on the A8 to A10 areas and it is an interesting result that as many as 17% of patients have their coronary arteries less than 2 mm away from the annulus.

Higher Training Frequency Is Important for Gaining Muscular Strength Under Volume-Matched Training.

Background: This study investigated the effect of volume-matched strength training programs with different frequency and subsequent detraining on muscle size and strength. Methods: During a training period of 11 weeks, untrained subjects (age: 22.3 ± 0.9 years, height: 173.1 ± 4.8 cm and body mass: 66.8 ± 8.4 kg) performed knee-extension exercise at 67% of their estimated one-repetition maximum either one session per week (T1 group: 6 sets of 12 repetitions per session; n = 10) or three sessions per week (T3 group: 2 sets of 12 repetitions per session; n = 10). Rating of perceived exertion (RPE) and muscle stiffness were measured as an index of muscle fatigue and muscle damage, respectively. The magnitude of muscle hypertrophy was assessed with thigh circumference and the quadriceps muscle thickness. The changes in muscle strength were measured with isometric maximum voluntary contraction torque (MVC). Results: During the training period, RPE was significantly higher in the T1 than in the T3 (p < 0.001). After 11 weeks of training, both groups exhibited significant improvements in thigh circumference, muscle thickness, and MVC compared with baseline values. However, there was a significant group difference in MVC improvement at week 11 (T1: 43.5 ± 15.5%, T3: 65.2 ± 23.2%, p < 0.05). After 6 weeks of detraining, both groups showed the significant decreases in thigh circumference and muscle thickness from those at the end of training period, while no significant effect of detraining was observed in MVC. Conclusion: These results suggest that three training sessions per week with two sets are recommended for untrained subjects to improve muscle strength while minimizing fatigue compared to one session per week with six sets.

GaInAsP/InP membrane BH-DFB lasers directly bonded on SOI substrate.

A room-temperature continuous-wave operation under optical pumping was demonstrated with GaInAsP/InP membrane buriedheterostructure (BH) distributed-feedback (DFB) laser directly bonded on an SOI substrate. A threshold pump power of 2.8 mW and a sub-mode suppression ratio of 28 dB were obtained with a cavity length of 120 microm and a stripe width of 2 microm.

Kinetic analysis of the function of the upper body for elite race walkers during official men 20 km walking race.

BACKGROUND: This study investigated the function of the upper extremities of elite race walkers during official 20 km races, focusing on the angular momentum about the vertical axis and other parameters of the upper extremities. METHODS: Sixteen walkers were analysed using the three-dimensional direct linear transformation method during three official men's 20 km walking races. The subjects, included participants at the Olympics and World Championships, who finished without disqualification and had not been disqualified during the two years prior to or following the races analysed in the present study. RESULTS: The angular momenta of the upper and lower body were counterbalanced as in running and normal walking. The momentum of the upper body was mainly generated by the upper extremities. The joint force moment of the right shoulder and the joint torque at the left shoulder just before right toe-off were significantly correlated with the walking speed. These were counterbalanced by other moments and torques to the torso torque, which worked to obtain a large mechanical energy flow from the recovery leg to the support leg in the final phase of the support phase. CONCLUSIONS: Therefore, a function of the shoulder torque was to counterbalance the torso torque to gain a fast walking speed with substantial mechanical energy flow.