Myasthenic Crisis and Concomitant Takotsubo Syndrome Complicated by Shock: A Case Report.

A man in his 80s with myasthenia gravis (MG) developed dysmobility and chest discomfort. An electrocardiogram revealed ST-segment elevation, and coronary angiography revealed Takotsubo syndrome (TTS). He experienced myasthenic crisis that required ventilation and shock that was refractory to vasopressors and required intra-aortic balloon pump (IABP) insertion. He was managed conservatively without MG-specific treatment until his hemodynamics improved. On hospital day 6, he was weaned from IABP. MG is a high-risk condition for TTS, and TTS with MC is associated with high mortality. We successfully managed this case of TTS with MC with intubation and IABP, without MG-specific treatment.

Ruptured Sinus of Valsalva Aneurysm in a Patient with a Ventricular Septal Defect Who Dropped Out of Lifelong Medical Follow-up.

Ruptured sinus of Valsalva aneurysm (RSOVA) is a rare cardiac condition associated with high morbidity and mortality rates. We herein report a 35-year-old man with a history of ventricular septal defect (VSD). He had a history of interrupted hospital visits and presented to the emergency department with dyspnea, palpitations, and dizziness for a few days. Auscultation detected a continuous murmur. Transthoracic echocardiography followed by transesophageal echocardiography demonstrated RSOVA in the right ventricle with an aorto-right ventricular fistula. The fistula was resected, and the aneurysm was surgically repaired. The patient made a good recovery.

[Efficacy of a Dexamethasone Dose Escalation Regimen with a Cumulative Dose for Preventing Oxaliplatin Hypersensitivity Reactions].

Oxaliplatin is a platinum complex antineoplastic agent widely used for chemotherapy of colorectal cancer. However, one of its side effects is hypersensitivity reactions, the incidence of which increases with a cumulative dose, thereby posing a difficulty to continue oxaliplatin use. Our hospital changed the premedication of oxaliplatin in August 2009 and September 2012. We retrospectively investigated the usefulness of these premedication changes. The results showed no significant difference in the incidence of hypersensitivity between the control group(12.1%)and the group receiving H1 and H2-blockers (12.3%); however, the incidence of hypersensitivity was significantly reduced in the group receiving increased dexamethasone based on the number of courses(2.7%). Therefore, our regimen was found to be effective in preventing hypersensitivity reactions to oxaliplatin.

Perifosine enhances the potential antitumor effect of 5-fluorourasil and oxaliplatin in colon cancer cells harboring the PIK3CA mutation.

Phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutation in colon cancer contributes to the poor prognosis of the disease and chemoresistance of tumors. New therapies are needed; however, the lack of knowledge of the mechanism of chemoresistance has hindered progress. In this study, we investigated the mechanism of the reduced sensitivity of colon cancer cells to 5-fluorouracil (5-FU) and oxaliplatin (L-OHP), and the effects of perifosine, an Akt inhibitor that enhances the cytotoxicity of 5-FU and L-OHP in colon cancer cells harboring the PIK3CA mutation. The use of 5-FU or L-OHP alone or in combination induced significant death of Caco-2 cells (PIK3CA wild type), but only weakly decreased the viability of DLD-1 and SW948 cells harboring the PIK3CA mutation. The use of 5-FU and L-OHP, either alone or in combination, strongly suppressed Akt activation, Survivin, Bcl-2, and Bcl-xL expression, and enhanced Puma, phospho-p53, and p53 expression in Caco-2 cells than in DLD-1 cells. In addition, perifosine enhanced the cytotoxicity of the 5-FU and L-OHP combination, inhibited Akt activation and the expression of Survivin, Bcl-2, and Bcl-xL, and increased the expression of Puma, phospho-p53, and p53 in DLD-1 cells. These results indicate that PIK3CA mutation contributes to reduced sensitivity to 5-FU and L-OHP via Akt activation in colon cancer cells. Perifosine increases the efficacy of 5-FU and L-OHP by suppressing Akt activation. Thus, the use of an Akt inhibitor in combination with 5-FU and L-OHP may be beneficial in colon cancer with cells harboring the PIK3CA mutation.

Diplatinum(II)-coordinated polyoxotungstate: synthesis, molecular structure, and photocatalytic performance for hydrogen evolution from water under visible-light irradiation.

The synthesis and molecular structure of a monomeric diplatinum(II) complex composed of mono-lacunary α-Keggin polyoxometalate is described. The polyoxometalate, Cs(3)[α-PW(11)O(39){cis-Pt(NH(3))(2)}(2)]·8H(2)O (Cs-1), afforded by a stoichiometric reaction of mono-lacunary Keggin polyoxotungstate with cis-diamminedichloroplatinum(ii) in water, followed by crystallization from water, was obtained as analytically pure, homogeneous, yellow crystals. The compound Cs-1 was characterized by elemental analysis, thermogravimetric/differential thermal analysis (TG/DTA), Fourier transform infrared (FTIR) and UV-visible spectroscopy, solution (1)H and (31)P nuclear magnetic resonance (NMR), and X-ray crystallography. The single-crystal X-ray structure analysis revealed that the two cis-platinum(ii) moieties, [cis-Pt(NH(3))(2)](2+), were coordinated each to two oxygen atoms in a mono-vacant site of [α-PW(11)O(39)](7-) with asymmetric configuration, resulting in an overall C(1) symmetry. Furthermore, hydrogen evolution from an EDTA·2Na (ethylenediamine tetraacetic acid disodium salt) aqueous solution under visible-light irradiation (≥400 nm) was achieved by using polyoxoanion 1 and titanium dioxide.