Negative association between basal oxytocin and oxytocin changes after repetitive transcranial magnetic stimulation in patients with treatment-resistant depression.

Repetitive transcranial magnetic stimulation (rTMS) is a neuromodulator effective for treating depressive symptoms in patients with treatment-resistant depression (TRD). One of the multiple mechanisms for its antidepressant effects proposed is related to the hypothalamus. Oxytocin is a neuropeptide synthesized in the hypothalamus that affects human behavior and psychology, including social and affiliative behaviors, stress regulation, and fear and emotion processing. There have been no reports on the relationship between rTMS and oxytocin for the treatment of TRD. Therefore, we aimed to investigate changes in salivary oxytocin concentrations in patients with TRD before and after 6 weeks of rTMS treatment. A total of 28 patients with TRD who received rTMS at Saga University Hospital between August 2013 and August 2020 were included. Although rTMS treatment significantly improved 24-item Hamilton Depression Rating Scale scores, rTMS treatment did not change mean salivary oxytocin after 6 weeks of treatment in patients with TRD. Multiple regression analysis revealed that the change in salivary oxytocin levels after rTMS treatment was negatively associated with basal oxytocin levels before rTMS treatment, suggesting that rTMS treatment tends to decrease oxytocin levels in patients with depression with high basal oxytocin levels while increasing them in those with low basal levels. These findings suggest that rTMS treatment improved depressive symptoms through mechanisms other than the modulatory effect on oxytocin levels in patients with TRD, while there is room for further studies to confirm these findings using a larger patient sample size and/or a sham rTMS procedure.

[Investigation of the Leakage Radiation Dose Rate from an Auto Infusion Device in 18F-FDG PET].

PURPOSE: The aim of this study was to investigate the leakage radiation dose rate on the surface of an auto infusion device in 18F-fludeoxyglucose (FDG) positron emission tomography. METHOD: We preliminary measured the radioactivity of delivery-supplied FDG drugs. Leakage radiation doses on the six (front, rear, right, left, top, and bottom) surface points of the auto infusion device were measured ninety minutes before the assay time using an energy-compensated gamma scintillation survey meter and an ionization chamber-type survey meter. RESULT: Leakage radiation doses on the front, rear, right, left, and top surfaces were less than 7 µSv/h and satisfied specification of the auto infusion device. However, a leakage dose exceeding 40 µSv/h was detected on the bottom surface.

Postoperative hyperthermia-induced multiple organ failure in a child with Down syndrome: a case report.

BACKGROUND: Psychological stress has been reported to cause hyperthermia. Persistent excessive hyperthermia can, in turn, cause hypercytokinemia and organ damage. We report a case of postoperative severe hyperthermia leading to a systemic inflammatory response and multiple organ failure in a child with Down syndrome. CASE PRESENTATION: A 10-month-old native Japanese boy with Down syndrome and Hirschsprung's disease is described. Newborn screening showed congenital hypothyroidism and a ventricular septal defect, but these conditions were stable upon administration of levothyroxine and furosemide. His development was equivalent to that of a child with Down syndrome. He developed a noninfectious high fever twice after preoperative preparations at age 8 months and again at 9 months. He was readmitted to hospital at age 10 months to undergo the Soave procedure to correct Hirschsprung's disease. However, he contracted a fever immediately after the surgical procedure. Hyperthermia (42 °C) was refractory to acetaminophen treatment and deteriorated to multiple organ failure due to hypercytokinemia, with increased serum levels of interleukin-6 (44.6 pg/mL) and interleukin-10 (1010 pg/mL). He died on postoperative day 2 with hypoxemia, respiratory/metabolic acidosis, increased serum levels of transaminases, reduced coagulation, and pancytopenia. Various infectious and noninfectious causes of hyperthermia could not be identified clearly by culture or blood tests. CONCLUSIONS: We speculated that the proximate cause of the fever was psychological stress, because he suffered repeated episodes of hyperthermia after the invasive procedure. Hyperthermia, together with the immune-system disorders associated with Down syndrome, may have induced hypercytokinemia and multiple organ failure. This rare case of noninfectious postoperative hyperthermia leading to multiple organ failure may help to shed further light on the currently unclear pathogenic mechanism of hyperthermia and associated multiple organ failure during the perioperative period in children.

[Suggestion of the Relative Artifact Index for Noise-independent Evaluation of the Streak Artifact].

The aim of this study was to inspect the usefulness of relative artifact index (AIr), which divided artifact index (AI) by standard deviation of the noise image for noise-independent evaluation of the streak artifact in computed tomography images. A water phantom without/with a cylindrical phantom filled with diluted contrast medium was scanned with different tube voltages (100/120/140 kV) and radiation doses (5/10/20 mGy), then images were reconstructed with different kernels (B10/30/50f). AI, location parameter in Gumbel method and AIr were measured in each condition and compared. The higher tube voltage or radiation dose or lower spatial resolution kernel, the lower quantitative values were presented by both AI and Gumbel method. AIr showed quantitative values independent of radiation dose and kernel, and substantial artifact amounts affected only by tube voltage. Our results showed AIr can evaluate quantitative artifact amount independent of image noise.

Quantitative analysis of chronological changes in the volume of flaps used for reconstruction of oral cavity defects.

Reconstruction of oral defects using flaps following resection of oral cancer has become a standard approach for restoration of oral function. The purpose of this study was to investigate chronological changes in the volume of such flaps used for reconstruction and the factors affecting flap volume. We performed a retrospective analysis of 17 patients who had undergone oral cancer resection and reconstruction with flaps. Measurements were performed using data from computed tomography, and the flaps were selected semi-automatically using a computer-operated region-of-interest system. The data indicated that the change in total flap volume at 1 year after surgery was 30.6%, and that body weight loss was a risk factor for volume reduction. Our results suggested that flaps should be at least 30% larger than the defects they are intended to repair. However, as large flaps have the potential to cause upper airway obstruction, flap volume should be determined on an individual basis according to defect size and location.

Dieulafoy lesion in a two-year-old boy: a case report.

BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis. He had no significant past medical illness, and he was well just before the episode of hematemesis. A clinical examination revealed anemia (hemoglobin, 8.0 g/dl). The rapidly progressive anemia associated with massive hematemesis indicated the presence of an active bleeding in his upper gastrointestinal tract. We performed emergency gastroscopy under general anesthesia. The gastroscopy revealed the presence of an abnormal visible vessel with an adherent clot on the lower body of his stomach. No mucosal abnormality surrounding the lesion was noted; the lesion was thus diagnosed as Dieulafoy lesion. One hemostatic clip was placed on the Dieulafoy lesion and excellent hemostasis was obtained. He recovered without blood transfusion and was discharged 4 days post-endoscopy. He has recovered well with no recurrence of hematemesis. CONCLUSIONS: Dieulafoy lesion is rare cause of sudden massive gastrointestinal bleeding in children. Nevertheless, it should be considered a differential diagnosis, even in babies. With advances in gastrointestinal endoscopy, as both a diagnostic and therapeutic modality, laparotomy secondary to gastrointestinal bleeding from Dieulafoy lesion has decreased in pediatric cases. Our case report demonstrates the feasibility of endoscopic hemoclipping for gastric Dieulafoy lesion in a child.

Extra-hepatic feeding arteries of hepatocellular carcinoma: An investigation based on intra-arterial CT aortography images using an angio-MDCT system.

OBJECTIVES: We investigated the frequencies and factors associated with the presence of extra-hepatic feeding arteries (EHFAs) of hepatocellular carcinoma (HCC) using intra-arterial CT aortography images. METHODS: A total of 173 patients with HCC who underwent transarterial chemoembolization (TACE) in our institution between January 2013 and March 2015 were enrolled. The types of EHFAs were evaluated by CT aortography images using an apparatus that combines multidetector-row computed tomography and angiography system. In addition, factors associated with the presence of EHFAs were determined. RESULTS: EHFAs were present in 22 (12.7%) patients with HCC. EHFAs most frequently branched from the right inferior phrenic artery (n=19), while others branched from the right adrenal artery (n=2), right renal artery (n=2), right internal thoracic artery (n=2), branches of the superior mesenteric artery (n=1), and an unknown artery from the aorta (n=1). Factors significantly associated with the presence of EHFAs in multivariate analysis were tumor size≥30mm (odds ratio (OR), 5.233 [95% confidence interval (CI), 1.507-17.413]; p=0.009) and number of prior TACE treatments≥3 (OR, 6.847 [95% CI, 1.928-24.311]; p=0.003). CONCLUSIONS: EHFAs of HCC were assessed with CT aortography images. Repeat TACE treatments and large tumor size were risk factors for the presence of EHFAs.

Accurate and rapid identification of feeding arteries with multidetector-row angiography-assisted computed tomography for transarterial chemoembolization for hepatocellular carcinoma.

BACKGROUND: Transarterial chemoembolization (TACE) is an important treatment modality for hepatocellular carcinoma (HCC). Accurate identification of feeding arteries and catheterization are necessary for achieving treatment efficacy, especially with selective TACE. However, this often requires multiple imaging studies. We evaluated the utility of a newly developed apparatus that combines multidetector-row computed tomography (MDCT) and angiography (angio-MDCT) to facilitate TACE for treatment of HCC. METHODS: A total of 73 patients who underwent selective TACE with angio-MDCT were compared with 57 patients who had undergone selective TACE with single-row computed tomography assisted by angiography (angio-CT) in terms of the number of imaging studies needed to complete TACE. RESULTS: The mean number of digital subtraction arteriography (DSA) and CT studies required for characterization of feeding arteries before embolization was 3.53 (range 1-8) and 5.16 (range 2-11), respectively, with single-row angio-CT, and 1.67 (range 1-5) and 2.90 (range 1-5), respectively, with angio-MDCT. Fewer studies were needed in patients who underwent TACE with angio-MDCT (p < 0.0001 for both DSA and CT). Whereas single-row angio-CT failed to identify extrahepatic feeders in three patients (37.5%), all extrahepatic feeders could be identified with angio-MDCT. CONCLUSIONS: Angio-MDCT facilitates rapid and accurate identification of feeding arteries in patients undergoing TACE through the three-dimensional image analyses by the reconstruction with the workstation.

Degradation of Abies veitchii wave-regeneration on Mt. Misen in Ohmine Mountains: effects of sika deer population.

How has the degradation of Abies veitchii wave-regeneration occurred under the sika deer (Cervus nippon) pressure? We conducted tree census and ground vegetation survey in a 1 ha plot in Mt. Misen (Nara prefecture, Japan). We found 15 tree species (over 50 cm in height). Abies accounted for 60.0 % of all living trees, and 46.9 % of Abies were damaged (herbivory, bark stripping and/or fraying) by deer. Spatial distribution of Abies trees showed Abies-wave, although there were few saplings in the dieback zone. Estimated deer population density in 2009 was 57.3 head/km(2). Number of living Abies and standing dead conifer trees, and ground vegetation cover for each quadrat (5 × 5 m) were used to assign the quadrats into 6 clusters. The hierarchical clustering-approach revealed that living Abies distributed mainly on the moss and/or Carex fernaldiana dominated quadrats, but did not on the Dennstaedtia scabra, or Brachypodium sylvaticum dominated quadrats. While standing dead conifer trees distributed mainly on the Carex dominated quadrats, they hardly occur on the moss, the Dennstaedtia or the Brachypodium dominated quadrats. Regeneration of Abies tree and thus the wave-regeneration is hindered for now owing to deer herbivory and bark-stripping. The ground vegetation under the dieback zone has changed from the moss and/or the Carex dominated one to the Carex, the Dennstaedtia or the Brachypodium covered vegetation with the canopy remained open and without Abies regeneration.

[Evaluation of docetaxel, CDDP and 5-FU combined therapy as second-line chemotherapy for esophagus cancer].

The combined therapy of docetaxel (70 mg/m(2), day 1), CDDP (80 mg/m(2), day 1) and 5-FU (800 mg/m(2), day 1-5) is used as second-line chemotherapy for esophagus cancer. First-line chemotherapy for 32 advanced squamous cell carcinomas of the esophagus is not effective, and early recurrences after chemotherapy were examined. Pretreatment surgery was used in 20 cases,radiation therapy in 19 and chemotherapy by 3.1 courses (1-9) on average. PR was found in 16 patients (response rate 50%) in the first course, MR in 2, NC in 6, and PD in 7 cases. Among 16 patients,one was discontinued due to aspiration pneumonia and two by leukopenia. Thirteen patients received 3-5 courses. The operation was continuously enforced in three patients among 13, radiation therapy was added in three, and they survived for one year or more. Five for whom imaging became virtually impossible lived for six months or more. Additional treatment proved ineffective in 2, so it was discontinued. There were 18 lymph node examples of lesions effectively treated, 6 main lesions, 1 pulmonary metastasis and 1 bone metastasis. As for deleterious events, leukopenia was admitted in 95%. G-CSF was needed by 68% during use and 3 days on average. The CDDP+5-FU+docetaxel therapy was comparatively safe in patients with much pre-treatment and demonstrated a maximum effect at more than the expected rate.

Primary omental-mesenteric myxoid hamartoma of the mesoappendix incidentally detected after abdominal trauma in a child: report of a case.

A 14-year-old boy was brought to our hospital with abdominal pain and nausea after suffering a blow to the abdomen. A mass was felt in the right hypogastrium, and the patient was hospitalized for possible hematoma resulting from the abdominal trauma. Initially, we treated him conservatively and observed his course, but on the 20th day after trauma, enhanced computed tomography showed that the area of strong enhancement in the tumor was unchanged. Superior mesenteric angiography showed findings indicative of a pseudoaneurysm caused by the trauma, and surgery was performed 26 days after the injury. Laparotomy revealed a tumor with a clear boundary, thought to originate in the mesoappendix, without any sign of pseudoaneurysm. Histopathological examination confirmed that the tumor was an omental-mesenteric myxoid hamartoma. The patient had an uneventful postoperative course and was discharged from hospital on the 12th day after surgery. More than 5 years have elapsed since the operation and no sign of recurrence or metastasis has been recognized.