HLA typing of patients who developed subacute thyroiditis and Graves' disease after SARS-CoV-2 vaccination: a case report.

BACKGROUND: Cases of subacute thyroiditis (SAT) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported. A human leukocyte antigen (HLA) allele, HLA-B*35, appears to be involved in the pathogenesis of SAT. CASE PRESENTATION: We conducted HLA typing of one patient with SAT and another with both SAT and Graves' disease (GD), which developed after SARS-CoV-2 vaccination. Patient 1, a 58-year-old Japanese man, was inoculated with a SARS-CoV-2 vaccine (BNT162b2; Pfizer, New York, NY, USA). He developed fever (38 °C), cervical pain, palpitations, and fatigue on day 10 after vaccination. Blood chemistry tests revealed thyrotoxicosis and elevated serum C-reactive protein (CRP) and slightly increased serum antithyroid-stimulating antibody (TSAb) levels. Thyroid ultrasonography revealed the characteristic findings of SAT. Patient 2, a 36-year-old Japanese woman, was inoculated twice with a SARS-CoV-2 vaccine (mRNA-1273; Moderna, Cambridge, MA, USA). She developed fever (37.8 °C) and thyroid gland pain on day 3 after the second vaccination. Blood chemistry tests revealed thyrotoxicosis and elevated serum CRP, TSAb, and antithyroid-stimulating hormone receptor antibody levels. Fever and thyroid gland pain persisted. Thyroid ultrasonography revealed the characteristic findings of SAT (i.e., slight swelling and a focal hypoechoic area with decreased blood flow). Prednisolone treatment was effective for SAT. However, thyrotoxicosis causing palpitations relapsed thereafter, for which thyroid scintigraphy with 99mtechnetium pertechnetate was conducted, and the patient was diagnosed with GD. Thiamazole treatment was then initiated, which led to improvement in symptoms. CONCLUSION: HLA typing revealed that both patients had the HLA-B*35:01, -C*04:01, and -DPB1*05:01 alleles. Only patient 2 had the HLA-DRB1*11:01 and HLA-DQB1*03:01 alleles. The HLA-B*35:01 and HLA-C*04:01 alleles appeared to be involved in the pathogenesis of SAT after SARS-CoV-2 vaccination, and the HLA-DRB1*11:01 and HLA-DQB1*03:01 alleles were speculated to be involved in the postvaccination pathogenesis of GD.

Evaluation of an immunochromatography-based rapid antigen test, Inspecter Kowa® SARS-CoV-2, using saliva specimens for the detection of SARS-CoV-2.

BACKGROUND: In the context of the coronavirus disease 2019 (COVID-19) pandemic, a rapid and reliable point-of-care test is an essential tool for controlling the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In particular, an immunochromatography test (ICT) that uses saliva specimens for rapid antigen detection not only reduces the risk of secondary infections but also reduces the burden on medical personnel. METHODS: The newly developed salivary antigen test kit "Inspecter Kowa® SARS-CoV-2" is an ICT to which saliva specimens can be directly applied. We evaluated its usefulness in comparison with reverse transcription quantitative PCR (RT-qPCR) and the Espline® SARS-CoV-2 Kit for the detection of SARS-CoV-2 using nasopharyngeal swab specimens. In this study, 140 patients with suspected symptomatic COVID-19 who visited our hospital were enrolled, and nasopharyngeal swab and saliva specimens were collected after they consented to participate in the study. RESULTS: Inspector Kowa SARS-CoV-2 was positive in 45 of 61 (73.8%) saliva that were positive by RT-qPCR and the Espline® SARS-CoV-2 Kit was also positive in 56 of 60 (93.3%) Np swabs that were positive by RT-qPCR. Good antigen detection was achieved by ICT with saliva and nasopharyngeal swab specimens when viral load was ≥105 copies/mL, whereas detection sensitivity was low when viral load was <105 copies/mL, especially in saliva specimens. CONCLUSION: This ICT for the detection of SARS-CoV-2 salivary antigen is an attractive tool that does not require specialized equipment and allows patients to perform the entire process from sample collection to self-diagnose and to reduce the burden on medical care during a pandemic.

[A Useful Case of Coronary Angiography during Surgery for Coronary Aneurysms:Report of a Case].

Coronary artery aneurysm with fistula is a relatively rare disease. After surgery, residual coronary fistula is often a problem. To prevent these problems, we perform coronary angiography during surgery, and have good grades. A 70-year-old-woman was admitted to our hospital with a chief complaint of palpitations. Enhanced computed tomography (CT) showed coronary aneurysms. Coronary angiography confirmed the coronary artery aneurysms with fistula to the pulmonary artery. Surgical intervention in the hybrid operating room was performed through median sternotomy with cardiopulmonary bypass. The fistulae were ligated, and the aneurysms were resected. Finally, coronary angiography was performed to confirm that there were no residual shunt aneurysm, or damage to the normal coronary artery, and the operation was completed. Postoperative course was uneventful, and she was discharged on postoperative day 19. Performing coronary angiography during surgery is very useful to confirm the aneurysms are completely closed, coronary artery fistulae are treated, and the coronary arteries are undamaged.

[On-pump Beating Pulmonary Embolectomy for Acute Pulmonary Thromboembolism].

BACKGROUND: Acute massive pulmonary embolism is a life-threatening disease and the reported rate of mortality is 52%.It is often treated with anticoagulation therapy or thrombolysis, but in case of critically ill patients with shock or cardiac arrest, its effect is limited. Surgical embolectomy is a treatment option for patients with hemodynamic instability. We studied the outcomes of our patients who underwent on-pump beating pulmonary embolectomy for acute pulmonary embolism. METHOD: We evaluated eight consecutive patients who underwent on-pump beating pulmonary embolectomy for acute pulmonary embolism since May 2012 to September 2016. Our surgical indications were hemodynamic instability, but one patient underwent pulmonary embolectomy without hemodynamic instability because the patient had floating thrombus in the right heart. Three patients experienced cardiac arrest, and two patients were treated with extracorporeal membrane oxygenation (ECMO). Four patients were treated with thrombolysis before surgical embolectomy. RESULT: All patients underwent on-pump beating pulmonary embolectomy. One patient could not be weaned from cardiopulmonary bypass, and was treated with ECMO after pulmonary embolectomy. The patient died due to low output syndrome, while the other seven patients were rescued. One patient had gastrointestinal bleeding after surgery, but the other patients had developed no major complication including thrombosis, hemorrhage, and prolonged respiratory failure during follow-up of 11.4±16.1 months. CONCLUSION: Pulmonary embolectomy is effective treatment for acute massive pulmonary embolism. On-pump beating pulmonary embolectomy is useful surgical procedure. Acute pulmonary embolism is often treated with anticoagulation therapy or thrombolysis, but in critically ill patients, surgical pulmonary embolectomy should be considered.

Imaging Findings of Pseudo-occlusion of Common Iliac Artery: Pitfall of Time-resolved Contrast-enhanced Magnetic Resonance Angiography.

Time-resolved contrast-enhanced magnetic resonance angiography (TRC-MRA) is a contrast-enhanced MRA technique commonly used for the qualitative hemodynamic assessment in digital subtraction angiography. TRC-MRA is a reliable method that seldom shows flow-related false findings which are sometimes observed on noncontrast or single-phase contrast-enhanced MRA techniques. Here we present a case of a patient with large fibroids that showed pseudo-occlusion of common iliac artery in TRC-MRA. Flow alternation can take place depending on patient posture and positioning status, especially in cases with large pelvic mass lesions. This is the first report of false image findings related to pelvic mass observed on TRC-MRA. For patient preparation, coil setting position is important and physicians should be familiar with the potential risk of transient arterial luminal stenosis or even occlusion in patients with large pelvic mass.

A new brain CT reference line: the lower eyelid to the inner occipital base line closely parallels the Talairach-Tournoux line.

BACKGROUND: There is no standardized brain computed tomography (CT) reference line that can be determined on both scout and reformatted sagittal CT images. Here, a tangential line from the anterior edge of the lower eyelid to the inner table of the occipital base (LEL/O line) appears nearly parallel to the Talairach-Tournoux (T/T) line, which shows a consistent intracranial anatomical relationship among subjects, and acts as a standard reference line for magnetic resonance (MR) imaging. PURPOSE: To quantitatively validate the LEL/O line as a new standard brain CT reference line. MATERIAL AND METHODS: We measured: angle 1 = the LEL/O line on scout images from the LEL/O line on parasagittal CT images (n=93); and angle 2 = the LEL/O line on scout images from the T/T line on high resolution midsagittal MR images (n=97). Angles in a clockwise direction were defined as positive and were expressed as mean±SD with the 95% confidence interval (CI) of the SD. Angle 2 was measured independently by two observers and intraclass correlation coefficients (ICCs) were calculated. RESULTS: Angle 1 was -0.4°±1.2° (95% CI of SD 1.1°-1.5°); angle 2 was -0.4°±2.0° (95% CI of SD, 1.8°-2.4°). The ICC in the angle 2 measurement was 0.780 (P<0.001), which indicated high inter-observer reliability. CONCLUSION: The LEL/O lines on scout and parasagittal CT images show practically the same gradient, and these LEL/O lines are almost parallel to the T/T line. Use of the LEL/O line either for direct scanning or reformation can minimize intra- and inter-subject variations on CT images and mismatch between CT and MR images.

The Mechanism of the Propagation in the Anionic Polymerization of Polystyryllithium in Non-Polar Solvents Elucidated by Density Functional Theory Calculations. A Study of the Negligible Part Played by Dimeric Ion-Pairs under Usual Polymerization Conditions.

The elementary processes occurring in the anionic polymerization of styrene with dimerically associated polystyryllithium (propagation during the anionic polymerization of dimeric polystyryllithium) in the gas phase and cyclohexane were studied using MX062X/6-31+G(d), a recently developed density functional theory (DFT) method and compared with the polymerization of styrene with non-associated polystyryllithium, which was described in a previous study. The most stable transition state in the reaction of styrene with dimeric polystyryllithium has a structure in which the side chains of styrene and the two chain end units of polystyryllithium are located in the same direction around the Li atom near the reactive site. The relative enthalpy for this transition state in cyclohexane is 28 kJ·mol-1, which is much lower than that for the reaction of non-associated polystyryllithium (51 kJ·mol-1). However, the relative free energy (which determines the rate constant) for the former is 93 kJ·mol-1, which is greater than that for the latter by 7 kJ·mol-1, indicating that the latter reaction (reaction with non-associated polystyryllithium) is advantageous over the former (reaction with dimeric polystyrylllithium). Their rates of reaction are also affected by initiator concentrations; in the case of reactions with low initiator concentrations, from which high molecular weight polymers are usually obtained, the rate of reaction corresponding to non-associated polystyryllithium is much larger than that corresponding to dimeric polystyryllithium.

Accuracy of the first interpretation of early brain CT images for predicting the prognosis of post-cardiac arrest syndrome patients at the emergency department.

BACKGROUND: Early brain CT is one of the most useful tools for estimating the prognosis in patients with post-cardiac arrest syndrome (PCAS) at the emergency department (ED). The aim of this study was to evaluate the prognosis-prediction accuracy of the emergency physicians' interpretation of the findings on early brain CT in PCAS patients treated by targeted temperature management (TTM). METHODS: This was a double-center, retrospective, observational study. Eligible subjects were cardiac arrest patients admitted to the intensive care unit (ICU) for TTM between April 2011 and March 2017. We performed the McNemar test to compare the predictive accuracies of the interpretation by emergency physicians and radiologists and calculated the kappa statistic for determining the concordance rate between the interpretations by these two groups. RESULTS: Of the 122 eligible patients, 106 met the inclusion criteria for this study. The predictive accuracies (sensitivity, specificity) of the interpretations by the emergency physicians and radiologists were (0.34, 1.00) and (0.41, 0.93), respectively, with no significant difference in either the sensitivity or specificity as assessed by the McNemar test. The kappa statistic calculated to determine the concordance between the two interpretations was 0.66 (0.48-0.83), which showed a good conformity. CONCLUSIONS: The emergency physicians' interpretation of the early brain CT findings in PCAS patients treated by TTM was as reliable as that of radiologists, in terms of prediction of the prognosis.

Successful management of life-threatening bleeding of intraductal papillary mucinous neoplasms in the pancreatic head.

Complications associated with intraductal papillary mucinous neoplasms, such as acute pancreatitis, perforation, and fistula formation, have been documented. Intraductal papillary mucinous neoplasm with intratumoral hemorrhage is rare. To the best of our knowledge, there have been no previous reports of intraductal papillary mucinous neoplasm rupture and bleeding with intra-abdominal hemorrhage. A 74-year-old woman complained of acute upper right abdominal pain. She was under follow-up for an intraductal papillary mucinous neoplasm in the pancreatic head. Contrast-enhanced computed tomography revealed intraductal papillary mucinous neoplasm rupture and bleeding with intra-abdominal hemorrhage. The bleeding was treated with selective endovascular embolization of a branch of the gastroduodenal artery. Follow-up examinations are recommended even for intraductal papillary mucinous neoplasm patients without malignant findings because of the potential risk of rupture and bleeding with intra-abdominal hemorrhage. Clinicians should be aware of this possibility to ensure that patients are appropriately treated.

Successful Interventional Management for Pulmonary Arterial Injury Secondary to Pacemaker Implantation.

Subclavian vein puncture is a relatively fast and safe technique to access the right heart for placement of pacemaker leads. Hemothorax related to injury of the pulmonary artery (PA) is a rare complication of subclavian vein access but can be life-threatening. We report a case of hemothorax occurring after subclavian vein puncture for pacemaker implantation. No cases of transcatheter arterial embolization for PA injury secondary to pacemaker implantation have been reported. Understanding of this rare complication after pacemaker implantation along with its specific clinical presentation may lead to early diagnosis and intervention.

New Vistas on the Anionic Polymerization of Styrene in Non-Polar Solvents by Means of Density Functional Theory.

The elementary processes of anionic styrene polymerization in the gas phase and in cyclohexane were studied using M062X (a recently developed density functional theory (DFT) method) combined with the 6-31+G(d) basis sets, in order to clarify the complicated phenomena caused by the association of the active chain-ends and elucidate the details of the polymerization mechanism. Three types of HSt2Li (a model structure of polystyryllithium chain-ends) were obtained; the well-known first structure in which Li is coordinated to the side chain, the second structure in which Li is coordinated to the phenyl ring, (both without the penultimate unit coordination), and the third structure in which Li is coordinated to both the chain-end unit and the penultimate styrene unit. Although the third HSt2Li is the most stable as expected, the free energy for the transition state of its reaction with styrene is higher than those for the other two transition states due to its steric hindrance. The free energy for the transition state of the reaction of the second HSt2Li with styrene is the lowest, suggesting that the route through it is the predominant reaction path. The penultimate unit effect, slower addition of styrene to HSt2Li than to HStLi, is attributed to coordination of the penultimate styrene units of the polystyryllithium dimer (one of the starting materials) to its Li atoms. The calculated enthalpy for the reaction barrier of the second HSt2Li with styrene in cyclohexane was found to agree with the observed apparent activation energy in benzene.

Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta.

BACKGROUND: Many hemodynamically stable patients with blunt abdominal solid organ injuries are successfully managed nonoperatively, while unstable patients often require urgent laparotomy. Recently, therapeutic angioembolization has been used in the treatment of intra-abdominal hemorrhage in hemodynamically unstable patients. We undertook this study to review a series of hemodynamically unstable patients with abdominal solid organ injuries managed nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta. METHODS: The institutional review board approved this study. All patients were appropriately resuscitated with transfusions, and angiography was performed after computed tomography. Resuscitative endovascular balloon occlusion of the aorta was performed before computed tomography in all patients. RESULTS: Seven patients underwent resuscitative endovascular balloon occlusion of the aorta following severe blunt abdominal trauma. The 28-day survival rate was 86% (6 of 7). There were no complications related to the procedure. CONCLUSION: We describe the first clinical series of hemodynamically unstable patients with abdominal solid organ injury treated nonoperatively with angioembolization and resuscitative endovascular balloon occlusion of the aorta. Survival rate was 86%, supporting the need for further study of this modality as an adjunct to the nonoperative management of patients with severe traumatic injuries. LEVEL OF EVIDENCE: Therapeutic study, level V.

Percutaneous image-guided biopsy for non-mass-forming isolated splenomegaly and suspected malignant lymphoma.

BACKGROUND: The aim of this study was to evaluate the accuracy, safety, and role of splenic biopsy in the management of patients with non-mass-forming isolated splenomegaly and suspected malignant lymphoma. METHODS: Between 2001 and 2013, 137 biopsies were performed under computed tomography (CT) fluoroscopic guidance in 39 patients. All patients had splenomegaly based on the CT findings and a suspected diagnosis of malignant lymphoma based on their clinical symptoms. The spleen was the only accessible site to perform a biopsy, and no mass lesions could be identified in the spleen. RESULTS: The overall sensitivity, specificity, and diagnostic accuracy of image-guided biopsy for malignant lymphoma were 88%, 100% and 92%, respectively. Major complications occurred in 3 patients. In 1 patient, transcatheter arterial embolization was performed due to hemorrhage, and two patients needed blood transfusion because of hematoma development, without the need for further treatment. CONCLUSIONS: Image-guided splenic core-needle biopsy is a safe and accurate technique with a high diagnostic accuracy in most patients who with non-mass-forming isolated splenomegaly and suspected underlying malignant lymphoma.

Added value of contrast-enhanced CISS imaging in relation to conventional MR images for the evaluation of intracavernous cranial nerve lesions.

INTRODUCTION: The normal cranial nerves (CNs) of the cavernous sinus can be clearly demonstrated using contrast-enhanced constructive interference in steady-state (CISS) magnetic resonance imaging (MRI). This study used the method to evaluate pathological CNs III, IV, V(1), V(2), and VI in cavernous sinuses affected by inflammatory and neoplastic diseases. METHODS: MR images from 17 patients with diseases involving the cavernous sinuses and/or causing neuropathy in CNs III-VI were retrospectively evaluated. The patients were divided into inflammatory (n=11) and neoplastic (n=6) groups. We defined CNs as abnormal when they exhibited enlargement or enhancement. CNs were evaluated using both contrast-enhanced CISS and T1-weighted MRI. RESULTS: In the inflammatory group, abnormal CNs were identified by contrast-enhanced CISS MRI in 13 of 25 symptomatic CNs (52%) in eight patients, but in only two CNs (8%) in two patients by contrast-enhanced T1-weighted MRI. In the neoplastic group, both sequences of contrast-enhanced CISS and T1-weighted MRI detected abnormalities in the same three of eight symptomatic CNs (37.5%), i.e., the three CNs were all in the same patient with adenoid cystic carcinoma. CONCLUSION: Contrast-enhanced CISS MRI is useful for detecting CN abnormalities in inflammatory pathological conditions of the cavernous sinuses.

Successful interventional management for subclavian artery injury secondary to internal jugular catheterization: a report of two cases.

Central venous cannulation through the right internal jugular vein is a widely used technique, and complications due to this procedure are very rare. We report two cases of right massive hemothorax due to inadvertent puncture of a right subclavian artery. Digital subtraction angiography demonstrated a perforated subclavian artery in both cases. These were successfully treated with transcatheter arterial embolization for the bleeding points of the right subclavian arteries.

Air embolism detected during computed tomography fluoroscopically guided transthoracic needle biopsy.

Air embolism is a rare but potentially fatal complication of percutaneous needle biopsy of the lung. We report a case of cerebral air embolism which occurred during computed tomography (CT)-guided needle biopsy. Air entering the aorta is depicted on CT-fluoroscopy images of the procedure.

Pole and global shape of 25143 Itokawa.

The locations of the pole and rotation axis of asteroid 25143 Itokawa were derived from Asteroid Multiband Imaging Camera data on the Hayabusa spacecraft. The retrograde pole orientation had a right ascension of 90.53 degrees and a declination of -66.30 degrees (52000 equinox) or equivalently 128.5 degrees and -89.66 degrees in ecliptic coordinates with a 3.9 degrees margin of error. The surface area is 0.393 square kilometers, the volume is 0.018378 cubic kilometers with a 5% margin of error, and the three axis lengths are 535 meters by 294 meters by 209 meters. The global Itokawa revealed a boomerang-shaped appearance composed of two distinct parts with partly faceted regions and a constricted ring structure.

MR signal of the solid portion of pilocytic astrocytoma on T2-weighted images: is it useful for differentiation from medulloblastoma?

BACKGROUND AND PURPOSE: Although imaging features of cerebellar pilocytic astrocytoma and medulloblastoma have been described in many texts, original comparisons of magnetic resonance intensity between these two tumours are limited. In the present study the results of magnetic resonance imaging (MRI) were reviewed, focusing especially on the signal intensity of the solid portion of these neoplasms. METHODS: MR images of ten cerebellar pilocytic astrocytomas and ten medulloblastomas were reviewed. The signal intensities of the solid components were graded on a scale of 1 to 5, with higher scores indicating a signal intensity closer to that of water. The degree of enhancement, tumour cysts and peripheral oedema were evaluated on MR images. When the solid portion was heterogeneous (i.e. mixed signal intensity or degree of enhancement), the dominant area was selected for evaluation. RESULTS: On T2-weighted images, the signal intensity of the solid portion was equal to that of cerebrospinal fluid (CSF) in 50% of pilocytic astrocytomas. No medulloblastomas showed such hyperintensity. Most medulloblastomas (80%) were isointense to grey matter. On T1-weighted images, the signal intensity varied widely in pilocytic astrocytomas; however, all medulloblastomas were iso- or hypointense to grey matter. The MR enhancement pattern, cystic component and peripheral oedema all varied in both tumour types and no specific features were identified. CONCLUSION: A signal intensity of the solid portion isointense to CSF on T2-weighted images was characteristic of cerebellar pilocytic astrocytomas; this was not observed in medulloblastomas. Attention to T2-weighted imaging of the solid portions of a tumour is easy and helpful in differentiating between cerebellar pilocytic astrocytoma and medulloblastoma.

Normal cranial nerves in the cavernous sinuses: contrast-enhanced three-dimensional constructive interference in the steady state MR imaging.

BACKGROUND AND PURPOSE: Three-dimensional (3D) constructive interference in steady state (CISS) MR imaging is useful for demonstrating cranial nerves (CNs) in the cistern. The purpose of this study was to evaluate normal CNs III, IV, V1, V2, and VI in the cavernous sinuses by using contrast-enhanced, three-dimensional (3D), Fourier transformation CISS MR imaging. METHODS: In 76 normal cavernous sinuses from 38 patients, detectability of CNs III-VI in the bilateral cavernous sinuses was evaluated by using contrast-enhanced 3D CISS MR imaging. In 40 cavernous sinuses from 20 patients, contrast-enhanced 3D CISS and contrast-enhanced T1-weighted MR imaging were compared for the detectability of these CNs. RESULTS: Each CN was separately demonstrated, and in 11 patients (29%), all CNs in the cavernous sinuses were identified on contrast-enhanced 3D CISS MR imaging. The images depicted the intracavernous segments of CNs III, IV, V1, V2, and VI in 76 (100%), 46 (61%), 70 (92%), 67 (88%), and 73 (96%) of the 76 sinuses, respectively. In comparison of imaging techniques, contrast-enhanced 3D CISS MR imaging had a detection rate significantly higher than that of enhanced T1-weighting imaging (P < .05) in all CNs except for CN III, which was detected in 100% of cases with both techniques. CONCLUSION: Contrast-enhanced 3D CISS MR imaging provides clear images of each CN in the cavernous segment. This useful method may contribute to the diagnosis of diseases involving the cavernous sinuses, such as Tolosa-Hunt syndrome.