Differentiating Brown Tumor From Bone Metastasis in Parathyroid Cancer Using 18 F-FDG PET and 99m Tc-MIBI SPECT.

ABSTRACT: A 69-year-old woman presented with a right clavicle pain. CT revealed a pathological fracture of the right clavicle, multiple osteolytic lesions, and a left cervical mass. 18 F-FDG PET/CT demonstrated a marked FDG uptake in the cervical mass and osteolytic lesions indicative of metastatic parathyroid cancer. 99m Tc-MIBI SPECT/CT revealed either faint or no uptake in the osteolytic lesions. However, a histopathological analysis after a parathyroidectomy and right clavicle biopsy confirmed the diagnosis of parathyroid cancer and the presence of benign brown tumors secondary to hyperparathyroidism. Postoperative imaging showed sclerotic change and a decreased FDG uptake in the bone lesions.

Transcatheter arterial embolization of the subclavian and axillary artery branches for hemorrhage control.

OBJECTIVE: To evaluate the effectiveness and safety of transcatheter arterial embolization (TAE) of the branches of the subclavian and axillary arteries for hemorrhage control. METHODS: Between January 2015 and June 2022, 35 TAE procedures were performed for hemorrhage from the branches of the subclavian and axillary arteries in 34 patients (22 men, 12 women; 1 male underwent TAE twice; mean age = 76 years). Pre-TAE CT showed hematomas in the chest (n = 25) and abdominal walls (n = 3), shoulder (n = 2), and lower neck (n = 2). CT showed hemothorax in eight cases. Angiographic findings, embolization technique, and technical and clinical success of TAE were retrospectively assessed in all cases. RESULTS: TAE was performed by transfemoral (n = 16), transradial (n = 12), and transbrachial (n = 7) approaches. Angiography revealed contrast media extravasation or pseudoaneurysms in 32 cases (91.4%). The most commonly embolized arteries were the internal thoracic (n = 12), lateral thoracic (n = 6), and thoracoacromial (n = 6) arteries. Technical and clinical success rates were 100 and 85.7%, respectively. A complication (skin necrosis after injection of the liquid embolic agent) developed in only one patient (2.9%) and was conservatively managed. CONCLUSION: TAE is an effective and safe treatment for hemorrhage from the branches of the subclavian and axillary arteries. ADVANCES IN KNOWLEDGE: Transfemoral approach has been used for TAE of the branches of the subclavian and axillary artery. Transradial and transbrachial approaches can also be considered.

Two Cases of Epstein-Barr Virus-Positive Mucocutaneous Ulcer Mimicking Head and Neck Cancers in 18F-FDG PET/CT.

ABSTRACT: Epstein-Barr virus-positive mucocutaneous ulcer is a newly recognized clinicopathological entity among mature B-cell neoplasms according to the 2016 revision of the World Health Organization diagnostic criteria. Here, we present FDG PET/CT images of 2 Epstein-Barr virus-positive mucocutaneous ulcer cases. Both cases shown in the images mimicked head and neck cancers, which are similar to carcinomas of the tonsil and gingiva, respectively, and both lesions showed intense FDG uptake on PET scan.

Inverted papilloma originating from the lacrimal sac and the nasolacrimal duct with marked FDG accumulation.

Inverted papilloma originating from the lacrimal sac and the nasolacrimal duct is rare, although that in the sinonasal region is a relatively common lesion with local invasion, malignant potential and high recurrence rates after surgery. We report a 52-year-old woman with inverted papilloma of the right lacrimal sac and the nasolacrimal duct, who underwent CT, MR imaging and FDG-PET/CT preoperatively. In addition to CT and MR imaging features similar to those in previous reports, the inverted papilloma exhibited marked FDG accumulation with a maximum standardized uptake value of 7.34 and no other significant FDG accumulation was detected. In summary, our case of inverted papilloma originating from the right lacrimal sac and the nasolacrimal duct noted marked FDG accumulation on PET/CT, which enabled visualization of the localized tumor extension with no metastases.

[The Current State of Inappropriate Drug Use among Elderly Assisted-Living Residents].

Previous studies have reported that elderly assisted-living residents use multiple drug combinations and inappropriate drugs.The aim of this study was to assess the drug use and its consequences in residents of a nursing facility.We examined the prescriptions of all residents in a nursing facility in Osaka from their medical records.Of the total 67 residents, 48 were women.The average age of the residents was 86 years, the average number of prescription drugs they took was 6.4, and the average number of diseases present was 4.9. Correlation between the number of diseases and the drugs taken was significant (p<0.05), but the correlation between the degree of independence for activities of daily living and the number of the drugs taken was not significant.The most commonly present health condition was bone fracture.About 50% of the residents used a psychotropic drug and prescription drugs such as amantadine and hydroxyzine, which are not advisable for elderly people.It is necessary for the elderly to avoid the use of drugs that cause delirium and drowsiness, and future studies should focus on methods to prevent disuse syndrome in the elderly.

[A study on comparison of learning effects between a board game and a lecture about infection control].

  In order to provide an opportunity for community pharmacists to actively learn about infection control, this study created learning materials through a board game format and verified characteristics of learning by determining and comparing evaluation according to viewpoint and motivational effects between a lecture and the game. To create the board game, we collected cases of infection from 30 community pharmacists. The game was created using collected and created case studies, and we held a workshop on infection control. Participants were assigned to a lecture (n=32) or game group (n=27) and completed a questionnaire before and after the workshop. The questionnaire included the evaluation according to viewpoint based on the ministry's curriculum guidelines and the motivational effect of Keller's ARCS motivation model. In the evaluation according to viewpoint, the lecture group scores were significantly higher on "knowledge and understanding" than the game group scores. In the comparison of the motivational effects, the game group was significantly higher in three out of the four items of the ARCS motivation model, "Attention", "Relevance", and "Satisfaction". These results indicate that learning through the game aroused the curiosity of the learners, increased the learning outcome, and maintained certain levels of motivation. In addition, the evaluation according to viewpoint showed that the lecture group understood the key concepts and knowledge regarding infection control, whereas there was a possibility that the game group required additional motivational factors for learning and maintaining motivation level.

Multiple proteasome-interacting proteins assist the assembly of the yeast 19S regulatory particle.

The 26S proteasome is a highly conserved multisubunit protease that degrades ubiquitinated proteins in eukaryotic cells. The 26S proteasome consists of the proteolytic core particle (CP) and one or two 19S regulatory particles (RPs). Although the mechanisms of CP assembly are well described, the mechanism of RP assembly is largely unknown. Here, we show that four proteasome-interacting proteins (PIPs), Nas2/p27, Nas6/gankyrin, Rpn14/PAAF1, and Hsm3/S5b, bind specific Rpt subunits of the RP and interact each other genetically. Lack of these PIPs resulted in defective assembly of the 26S proteasome at an early stage, suggesting that these proteins are bona fide RP chaperones. Each of the RP chaperones formed distinct specific subassemblies of the base components and escorted them to mature RPs. Our results indicate that the RP assembly is a highly organized and elaborate process orchestrated by multiple proteasome-dedicated chaperones.

[Target range of PTH in ESRD patients].

The normal bone turnover is important for ESRD patients in not only skeletal problem but also patients QOL and survival. The abnormal bone turnover often induces the renal osteodystrophy and ectopic calcification. The major regulative factor on bone turnover is PTH. We propose here the target zone of PTH in ESRD patients with skeletal resistance for PTH. We recommended the intact-PTH 100 - 150 pg/mL for normal Ca/Pi/bone metabolism. This range of intact-PTH is equivalent to C-PTH 4.0 - 6.2 ng/mL, HS-PTH 10.0 - 16.0 ng/mL, and whole-PTH 80 - 110 pg/mL. The maintenance of normacalcemia and normophosphatemia are important for the arrival into the target zone of PTH using active vitamin D.