Successful embolization of subcutaneous mesenteric varices within an ileal conduit in a patient with liver cirrhosis.

Introduction: Venous hemorrhage from ectopic varices is potentially fatal. This report describes a rare case in which bleeding from mesenteric varices in an ileal conduit was treated successfully by embolization therapy. Case presentation: The patient was an 82-year-old man who had previously undergone total pelvic exenteration for colon cancer with creation of an ileal conduit for urinary diversion. He subsequently developed liver cirrhosis and underwent partial hepatectomy for hepatocellular carcinoma. 9 years after his colon surgery, he was admitted with gross hematuria. Computed tomography revealed subcutaneous mesenteric varices in the ileal conduit and hemorrhage as a result of rupture of the varices. The bleeding continued despite repeated manual compression but was eventually stopped by embolization therapy. Conclusion: Embolization therapy may be helpful for hemostasis in the event of intractable bleeding from mesenteric varices in an ileal conduit.

The Clinical Performance of Cell Population Data for Diagnosis of Bloodstream Infection in Cancer Patients.

Background Bloodstream infection (BSI) induces a change in the number and morphology of blood cells. In this study, we compared cell population data (CPD) parameters between cancer patients with or without BSI to determine whether these parameters could serve as biomarkers of BSI. Methods Between April and June 2021, 43 BSI-negative and 22 BSI-positive cancer patients were enrolled in this study. We compared 18 CPD parameters and biomarkers between cancer patients with BSI-positive and BSI-negative. Results There were significant differences in the levels of several CPD parameters, including MO-WZ (p=0.040), MO-X (p<0.01), MO-Y (p=0.012), NE-SFL (p<0.01), and NE-WX (p=0.037), but not C-reactive protein (p=0.347) and procalcitonin (p=0.237) between BSI-positive and BSI-negative patients. The areas under the receiver-operating characteristic curves (AUCs) were above 0.7 for MO-X (0.762; 95% confidence intervals (CI): 0.624-0.901), NE-SFL (0.766; 95% CI: 0.625-0.880). And LY-WY (p=0.024) showed a significant difference between gram-negative and gram-positive BSI patients with high AUC (0.883; 95% CI: 0.703-1). Conclusion CPD parameters (MO-X and NE-SFL) provide additional information for discriminating between BSI-negative and BSI-positive BSI. And LY-WY provides useful information for discriminating between cancer patients with gram-negative BSI and gram-positive BSI.

Variants in HOXB13, G132E and F127C, Are Associated With Prostate Cancer Risk in Japanese Men.

BACKGROUND/AIM: Several studies have reported on the relationship between HOXB13 variants and an increased prostate cancer (PC) risk. To our knowledge there are not many studies on HOXB13 mutations in Japanese patients with prostate cancer, and there many issues remain uninvestigated. We herein clarified the association between HOXB13 genetic variants and PC risk in a Japanese population. PATIENTS AND METHODS: PC patients were diagnosed at the Gunma University Hospital and affiliated hospitals from 1994 to 2016. Sanger sequencing was performed on the coding regions of the HOXB13 gene in 152 familial PC (FPC) patients. Genotyping was performed on single nucleotide variants (SNVs) found in Sanger sequencing in 230 FPC patients from 152 pedigrees and 197 sporadic PC (SPC) patients and 144 controls. Allelic frequency and clinical data for each variant were studied in cases and controls. RESULTS: G132E and F127C were identified in FPC patients. The frequencies of G132E and F127C were significantly higher compared to the control group (p=0.039). In three families, seven PC patients shared the G132E variant, within second-to-third-degree relatives. It was not possible to clarify to pathogenicity of each SNV alone. CONCLUSION: We found two significant variants of the HOXB13 gene, G132E, F127C by analyzing and comparing gene samples from PC and non-PC patients. Furthermore, the HOXB13 G132E variant was found significantly increased in the FPC group.

Comparison of the lower limit of benchmark dose confidence interval with no-observed-adverse-effect level by applying four different software for tumorigenicity testing of pesticides in Japan.

The benchmark dose (BMD) approach is updated to create an international harmonizing process following rapid theoretical sophistication. We calculated the lower limit of BMD confidence interval (BMDL) for carcinogenicity based on 193 tumorigenicity bioassay data published in 50 pesticide risk assessment reports by the Food Safety Commission of Japan (FSCJ) to validate the appropriateness and necessity for the refinement of the FSCJ-established BMD guidance. Three well-known BMD software, PROAST, BMDS, and BBMD were used to compare their BMDLs with no-observed-adverse-effect levels (NOAELs) for carcinogenicity. Recently implemented methodologies such as model averaging or Bayesian inference were also used. Our results indicate that the BMD approach provides a point of departure similar to the NOAEL approach if the data used exhibit a clear dose-response relationship. In some cases, particularly in software with a frequentist approach, the calculation failed to provide BMDL or provided considerably lower BMDLs than NOAELs. However, most of the datasets that resulted in failed calculations or extremely low BMDLs exhibited unclear dose-response relationships, i.e., non-monotonous and sporadic responses. The expert review on the shape of the dose-response plot would help better apply the BMD approach. Furthermore, we observed that Bayesian approaches provided fewer failed or extreme BMD calculations than the frequentist approaches.

Area-Efficient Post-Processing Circuits for Physically Unclonable Function with 2-Mpixel CMOS Image Sensor.

In order to realize image information security starting from the data source, challenge-response (CR) device authentication, based on a Physically Unclonable Function (PUF) with a 2 Mpixel CMOS image sensor (CIS), is studied, in which variation of the transistor in the pixel array is utilized. As each CR pair can be used only once to make the CIS PUF resistant to the modeling attack, CR authentication with CIS can be carried out 4050 times, with basic post-processing to generate the PUF ID. If a larger number of authentications is required, advanced post-processing using Lehmer encoding can be utilized to carry out authentication 14,858 times. According to the PUF performance evaluation, the authentication error rate is less than 0.001 ppm. Furthermore, the area overhead of the CIS chip for the basic and advanced post-processing is only 1% and 2%, respectively, based on a Verilog HDL model circuit design.

[Therapy-related acute promyelocytic leukemia developing during chemotherapy for thymic carcinoma].

A 74-year-old man was admitted to hospital due to suspected acute leukemia. He had a history of thymic carcinoma, which had been treated with carboplatin in combination with either paclitaxel or amrubicin. However, the tumor remained unresponsive to these treatments. Administration of tegafur/gimeracil/oteracil (TS-1) was initiated, which resulted in tumor size reduction and a partial response. However, leukopenia persisted after the last TS-1 treatment, and four years after the initial treatment, increased blast cell counts were found in a blood film . Bone marrow analysis showed blasts with Auer rods, faggot cells, and dysplastic promyelocytes. Flow cytometry was positive for CD13, CD33, CD34, CD117, and myeloperoxidase, but negative for HLA-DR. PML-RARA fluorescence in situ hybridization was positive. Cytogenetic analysis revealed 47,XY,t (15;17) (q22;q21),+21. Thus, therapy-related acute promyelocytic leukemia (tAPL) was diagnosed. The patient achieved and maintained complete remission for more than 20 months by a de novo APL-treatment regimen including all-trans retinoic acid, arsenic trioxide and tamibarotene. Moreover, the thymic carcinoma has remained stable. Although secondary malignancies of thymic carcinoma have been previously reported, therapy-related leukemia, especially tAPL, is very rare.

[SQUAMOUS CELL CARCINOMA WITH CLOACAL EXSTROPHY: A CASE REPORT].

A 41-year-old man with a history of cloacal exstrophy presented to a local clinic with abdominal pain and bowel sounds. He was noted to have pain at the site of scarring due to cloacal exstrophy and a laceration at its center, which was stained with feces. He was referred to our department because of an enterocutaneous fistula. Skin biopsy of the neoplastic lesion at this site led to a diagnosis of squamous cell carcinoma. Computed tomography showed tumor invasion of the ileum and right inguinal lymph node enlargement. We performed tumor resection, partial enterectomy, intestinal anastomosis, abdominal wall reconstruction with a left pedicled anterolateral thigh flap, split-thickness skin grafting, and right inguinal lymph node biopsy. Histopathological examination revealed cancer growth, invasion, and pearl formation in the lymph nodes, leading to a diagnosis of abdominal squamous cell carcinoma with metastasis to the inguinal lymph nodes. The skin graft took well, and the patient was discharged. He is scheduled for right inguinal lymph node dissection at a later date.

Middle-term surgical outcomes of microscopic posterior decompression for far-out syndrome.

OBJECTIVE: Far-out syndrome (FOS) is a rare incident caused by L5 nerve root entrapment in the far-out area, the L5-S1 extraforaminal area between the transverse process and the sacral ala. The purpose of this study is to disclose the middle-term surgical outcomes of microscopic posterior decompression in the far-out area (MPDFA). MATERIAL AND METHODS: From June 2008 to November 2010, eight patients with FOS (six men and two women, mean age 65.4 years) were treated with MPDFA. Their chief complaint was leg pain in the L5 nerve root distribution area. Nerve root impingements in the far-out area were confirmed by magnetic resonance imaging, computed tomography and selective radiculography. Indications for MPDFA were given when pain was uncontrollable with conservative treatments for more than 1 month. MPDFA was performed according to the following procedure: a 4-to-5-cm skin incision was made just above the far-out area. The far-out area was exposed using Wiltse's intermuscular approach. The nerve root was decompressed with partial resection of the transverse process and the sacral ala, and removal of the iliolumbar ligament. Surgical outcomes were evaluated at periodical examinations with the Japanese Orthopedic Score (JOA) and a Visual Analogue Scale (VAS) of the leg pain. The mean follow-up period was 24.3 months (ranging from 12 to 40 months). RESULTS: All patients had reduced radicular leg pain after their operations. The mean postoperative hospital stay was 11.4 days, and the patients returned to their normal activities of daily living immediately after discharge. Both JOA and the VAS scores improved after surgery. The scores temporarily worsened in two patients with degenerative scoliosis; the worsening was attributed not to recurrence of the radiculopathy but to pain arising from knee arthropathy. The scores were maintained in the other patients at least until the final examinations during the follow-up. CONCLUSION: MPDFA is a less-invasive surgery for treating FOS and can provide a good middle-term surgical outcome.

Transmission of periodontopathic bacteria from natural teeth to implants.

PURPOSE: Prevention of peri-implantitis is essential for the success of implant rehabilitation. Infection by periodontopathic bacteria is a major cause of peri-implantitis. The aim of the present study was to identify the source of peri-implant colonization by periodontopathic bacteria. MATERIALS AND METHODS: Twenty-one patients with implants were enrolled in the study. Subgingival plaque samples from the adjacent, occluding, and contralateral natural teeth were collected prior to second-stage surgery. Samples from implant sulci were then obtained 2 weeks later. Detection of periodontopathic bacteria was performed by the polymerase chain reaction. RESULTS: The detection rates for Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Fusobacterium nucleatum in all subgingival samples from natural teeth were similar to that in the peri-implant sulci. Multiple logistic regression analysis revealed an association between the detection of A. actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and F. nucleatum in the gingival crevices of adjacent teeth and that of the peri-implant sulcus, but no association for Tannerella forsythia. CONCLUSIONS: The present findings suggest that colonization by A. actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, and F. nucleatum at the implant sulcus was affected by these microorganisms in the gingival crevice of adjacent teeth rather than those on occluding and contralateral teeth.

Mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma--case report.

A 56-year-old man presented with a very rare case of mobile schwannoma of the cauda equina incarcerated following caudal migration after trauma, manifesting as attack of severe back pain and bilateral sciatica which developed just after a fall. Magnetic resonance imaging demonstrated a large intradural tumor at the L4-5 level with redundant nerve roots below that. Two days before the surgery, his pain unexpectedly lessened without additional treatment. Computed tomography showed that the tumor had migrated cranially and was now located at the L3-4 level. These findings suggest that the severe symptoms were caused by incarceration of a mobile tumor at the L4-5 level following the trauma. The tumor was successfully removed using minimally invasive procedures with guidance provided by the intraoperative myelography. The patient was relieved from pain postoperatively. The histological diagnosis was schwannoma. This case suggests that intraoperative myelography is a useful method for guiding the removal of mobile tumors.

Radiculopathy caused by osteoporotic vertebral fractures in the lumbar spine.

The clinical features of radiculopathy caused by osteoporotic vertebral fractures (OVFs) in the lumbar spine were investigated in 66 patients treated for pain caused by OVFs from January 2006 to December 2009. Ten of the patients complained of persistent radiculopathy. The cause of radiculopathy was initially diagnosed as lumbar canal stenosis (LCS) in seven patients, lumbar foraminal stenosis (LFS) in two, and both in one. One patient with LFS had reduced pain with conservative treatment, and the other nine needed surgical treatments. LCS was treated with posterior decompression, and LFS complicated with LCS at the same spinal level was treated with posterior lumbar interbody fusion (PLIF). Vertebroplasty was performed for one patient with LFS to attain indirect nerve root decompression achieved as a result of vertebral reconstruction and stabilization. Four of the patients treated with posterior decompression for LCS suffered from residual radiculopathy postoperatively, which was caused by LFS at the same level or the level below the treated level. Two patients underwent second operative procedure (PLIF) for recurrent radiculopathy. The Japanese Orthopedic Association and Visual Analogue Scale scores of the pain improved after operations, but the scores of the patients treated without spinal fusion gradually worsened during the follow-up period, whereas the scores of the patients treated with PLIF remained stable at various levels. Seven of the ten patients developed LFS following OVF, suggesting that radiculopathy following OVF involves LFS with high frequency.

Olfactory mucosal transplantation after spinal cord injury improves voiding efficiency by suppressing detrusor-sphincter dyssynergia in rats.

PURPOSE: Several recent studies showed that olfactory mucosal transplantation after spinal cord injury promotes extensive regeneration of the injured spinal cord. We examined the efficacy of olfactory mucosal transplantation for bladder dysfunction after spinal cord injury in rats. MATERIALS AND METHODS: In adult female rats the Th9-10 spinal cord was completely transected, followed by olfactory mucosal transplantation or gelatin sponge filling as the control. Each group was examined by cystometrogram and external urethral sphincter electromyogram. Calcitonin gene-related peptide and growth associated protein 43 double positive expression in the L6/S1 dorsal horn was evaluated by immunohistochemistry. Transplant sites were examined by immunohistochemistry with antibodies against neurofilament M and neuronal class III beta-tubulin. RESULTS: On cystometrogram voiding efficiency was significantly higher in the transplantation group than in controls. On external urethral sphincter electromyogram with simultaneous cystometrogram the transplantation group showed a larger ratio of interburst silent periods to burst activity duration and a greater number of high frequency oscillations. In the transplantation group calcitonin gene-related peptide and growth associated protein 43 double positive expression in the L6/S1 dorsal horn was less dense than in controls. The transplantation group showed strong neurofilament M and neuronal class III beta-tubulin expression at the transplant site. CONCLUSIONS: Olfactory mucosal transplantation after spinal cord injury weakened external urethral sphincter excessive bursting and increased the urethral opening to improve voiding efficiency. Olfactory mucosal transplantation may modify emergence of the spinal micturition reflex after spinal cord injury. Transplantation resulted in new axons growing at the transplant site, implying the possible existence of interneuron bridging across the injured spinal cord.

[Lateral fenestration combined with spinal canal decompression through contralateral laminotomy for radiculopathy caused by lumbar canal stenosis and lumbar foraminal stenosis: a case report].

Lumbar canal stenosis (LCS) and lumbar foraminal stenosis (LFS) are frequently observed in elder patients. For patients with radiculopathy caused by both LCS and LFS, surgical manipulations require nerve root decompression from its exit zone to the lateral part of the vertebral foramen, and often need spinal instrumentation. In the present report, we performed a new strategy of surgical decompression without spinal fixation. An 81-year-old woman suffered from bilateral buttock pain, left leg pain and right leg numbness in the L4 and L5 nerve root distribution. MRI and CT scans showed LCS at L3-5 levels and left LFS at L4-5 level. Although the L5 radiculopathy diminished with conservative treatment for 3 weeks, she could not walk due to residual L4 radiculopathy. We tried to perform surgical decompression as follows; the left L4 nerve root was decompressed by lateral fenestration on the left L4 lamina and simultaneously by bilateral spinal canal decompression through right laminotomy for LCS. This method can achieve decompression of the left L4 nerve root from the spinal canal to the vertebral foramen under direct observation while preserving the continuity of the lamina. The patient was relieved from the radicular pain after the operation, and returned to her previous activity of daily living. One-year after the operation, she was free from the radiculopathy, and radiograms showed no fracture in the preserved left L4 lamina. Lateral fenestration combined with bilateral spinal canal decompression through contralateral laminotomy is potentially a surgical option for radiculopathy caused by both LSC and LFS.

Limited functional recovery in rats with complete spinal cord injury after transplantation of whole-layer olfactory mucosa: laboratory investigation.

OBJECT: The olfactory mucosa (OM) consists of 2 layers, the epithelium and the lamina propria. Attempts have been made to restore motor function in rat models of spinal cord injury (SCI) by transplanting olfactory ensheathing cells from the lamina propria, but there has been no attempt to transplant the OM in animal models. To investigate the potential of the OM to restore motor function, the authors developed a rat model of SCI and delayed transplantation of syngenic OM. METHODS: Two weeks after complete transection of the spinal cord at the T-10 level in Wistar rats, pieces of syngenic whole-layer OM were transplanted into the lesion. Rats that underwent respiratory mucosa transplantation were used as controls. The authors evaluated the locomotor activity according to the Basso-Beattie-Bresnahan scale for 8 weeks after transplantation. Obtained spinal cords were analyzed histologically. Results The OM transplantation rats showed significantly greater hindlimb locomotor recovery than the respiratory mucosa-transplanted rats. However, the recovery was limited according to the Basso-Beattie-Bresnahan scale. In the histological examination, the serotonergic raphespinal tract was regenerated. The pseudocyst cavity volume in the vicinity of the SCI lesion correlated negatively with the functional recovery. CONCLUSIONS: Transplantation of whole-layer OM in rats contributes to functional recovery from SCI, but the effect is limited. In addition to OM transplantation, other means would be necessary for better outcomes in clinical situations.

Photocatalytic hydroxylation of aromatic ring by using water as an oxidant.

Electrophilic oxygen species photocatalytically derived from water molecules can selectively react with the aromatic ring of both benzene and its derivatives to produce the corresponding phenols and hydrogen over platinum-loaded titanium oxide when illuminated with light of appropriate wavelength in the absence of oxygen.

Transplantation of olfactory mucosa following spinal cord injury promotes recovery in rats.

Several recent studies have demonstrated the potential therapeutic role of olfactory ensheathing cells in spinal cord injury. The aim of this study was to elucidate whether grafts of nasal olfactory mucosa containing olfactory ensheathing cells can repair the injured rat spinal cord as compared with the nasal respiratory mucosa containing no olfactory ensheathing cells. These grafts were then transplanted into the partially removed rat spinal cord. Compared with the respiratory mucosa-transplanted rats, the olfactory mucosa-transplanted rats partially recovered the movement of their hindlimbs and joints. Corticospinal tracing indicated that olfactory mucosa transplantation restored the severed tract. Therefore, olfactory mucosa has potential value in the repair of spinal cord injury.

Annual variations of the elemental concentrations of PM10 in ambient air of Nagoya City as determined by ICP-AES and ICP-MS.

PM10 samples were collected at an urban site of Nagoya City during September, 2003, to August, 2004, and annual variations of the concentrations of the elements in PM10 samples were examined by inductively coupled plasma atomic emission spectrometry (ICP-AES) and inductively coupled plasma mass spectrometry (ICP-MS). The annual concentration variations of ca. 30 elements in ambient air were in the range from sub-ng m(-3) to several microg m(-3). From an evaluation by the enrichment factors of the elements, elements such as Al, Ca, Fe, Mg, Ti, Mn, Ba, Sr, Ce, La, Nd, Co, Cs, and Pr, in PM10 samples were found to have originated mostly from natural sources, while the elements such as S, Zn, Pb, Cu, Ni, Sb, Sn, Cd, Bi, W, Tl, and In originated from anthropogenic emission sources. Furthermore, in seasonal variations of the elemental concentrations of PM10 samples in ambient air, the elements originated mostly from natural sources provided significantly high concentrations in spring during the "Kosa" period (the dust season from March to May). On the other hand, the elements mainly from anthropogenic emission sources provided relatively higher concentrations in autumn and winter, which may be explained by the fact that the urban atmospheric structure is stabilized by the temperature-inversion layer formed over the city in those seasons. In addition, all of the elements provided significantly low concentrations in the summer, due to the dilution effect of the oceanic winds as well as due to the convection of air mass up to the high levels.

Bilateral interlaminar fenestration and unroofing for the decompression of nerve roots by using a unilateral approach in lumbar canal stenosis.

BACKGROUND: Conventional laminectomy is a simple procedure that provides adequate decompression in cases of lumbar spinal canal stenosis. However, with this surgical modality, important posterior osteoligamentous elements necessary for spinal stability are lost; and it is often accompanied by damage to the facet joint. Bilateral interlaminar fenestration and unroofing of the intervertebral foramen to achieve decompression of the nerve roots by using a unilateral microsurgical approach in lumbar spinal canal stenosis are less invasive compared with conventional laminectomy. METHODS: We carried out bilateral interlaminar fenestration and unroofing of the intervertebral foramen to decompress the stenosed nerve roots under a microscope by using a unilateral approach. In particular, we performed the decompression of the contralateral nerve root with this surgical method by using a Caspar retractor. Surgery was performed on 47 patients (18 women and 29 men; 29-85 years; median age, 62 years). All cases were with single-level lumbar spinal canal stenosis and bilateral radiculopathy. RESULTS: The mean preoperative NCOS was 29.8 (range, 8-48). The mean NCOS after a postoperative period of 3 months was 79.9 (range, 32-100). After a postoperative period of 2 years, the mean NCOS increased to 83.2 (range, 32-100). The satisfaction measures indicated that the procedure was "very successful" in 45 cases, providing "almost complete relief"; "fairly successful" in one case, providing "a good deal of relief"; and "not very successful" in another case, affording "only a little relief." CONCLUSIONS: This unilateral, minimally invasive decompression provided satisfactory results.