A 42-year-old patient with renal cell carcinoma presenting as low back pain: A case report.

RATIONALE: Renal cell carcinoma (RCC) is the most common renal neoplasm, accounting for 2.4% of all cancers in Korea. Although the usual clinical manifestations of RCC include flank pain, hematuria, and palpable mass, RCC is generally characterized by a lack of early warning signs and is mostly discovered incidentally in advanced stage. This case report describes a 42-year-old Korean man diagnosed with giant RCC who presented with simple back pain. PATIENT CONCERNS: The clinical manifestation of a 42-year-old Korean man was chronic back pain. DIAGNOSES: Contrast-enhanced computed tomography showed a 19.1-cm sized heterogeneous enhancing mass on the right kidney and tumor thrombosis extending into inferior vena cava. INTERVENTION: Due to the large size of the tumor and extensive tumor thrombosis, the multidisciplinary team decided to administer neoadjuvant chemotherapy and an anticoagulant. Following 12 cycles of treatment with nivolumab and cabozantinib, he underwent a right radical nephrectomy with an adrenalectomy and tumor thrombectomy. OUTCOMES: Treatment was successful and posttreatment he started a cancer rehabilitation program. He was followed-up as an outpatient and no longer complains of back pain. LESSONS: RCC can manifest clinically as back pain, with diagnosis being difficult without appropriate imaging modalities. RCC should be included in the differential diagnosis of patients with low back pain, even at a young age.

Validity Study for Clinical Use of Hand-Held Spirometer in Patients with Chronic Obstructive Pulmonary Disease.

A spirometer is a medical device frequently used clinically for the diagnosis and prediction of lung disease. This study aimed to investigate the clinical usefulness of a hand-held spirometer (The Spirokit), compared with conventional spirometry in patients with chronic obstructive pulmonary disease (COPD). This study was conducted from February 2022 to October 2022. Measurements from 80 patients with COPD (male: 53, female: 27) were obtained using The Spirokit and PC-based pulmonary function test equipment, and the resulting values were compared and analyzed. For the concurrent validity comparison of The Spirokit, the intra-class correlation (ICC 2, 1), coefficients of variation (CVME), 95% limits of agreement (95% LOA), and Cohen's Kappa Index were analyzed. The Spirokit showed high agreement (ICC: 0.929-0.989; 95% LOA: -0.525 to 2.559; and CVME: 0.05-0.08) with the PC-based pulmonary function tester. Using the Cohen's kappa coefficients, the device showed high sensitivity, specificity, and accuracy scores of Pa: 0.90, Pc: 0.52, and K: 0.79, respectively, indicating considerable agreement. The Spirokit, a portable pulmonary function test device, is a piece of equipment with high validity and portability, with high potential for replacing PC-based pulmonary function test equipment.

Effects of dietary trace mineral levels on physiological responses, reproductive performance, litter performance, blood profiles, and milk composition in gestating sows.

OBJECTIVE: This study was conducted to evaluate the effects of optimal trace mineral levels on the physiological responses, reproductive performance, litter performance, blood profiles and milk composition in gestating sows. METHODS: A total of 59 multiparous sows (Yorkshire×Landrace) with similar body weight (BW), backfat thickness (BF), and parity were assigned to one of four treatments with 14 or 15 sows per treatment using a completely randomized design. The treatments were 100% (M1), 300% (M3), 600% (M6), and 900% (M9) of the National Research Council (NRC) Nutrient Requirements of Swine. During lactation period, all the sows were fed the same commercial lactation diet. RESULTS: No significant differences were observed in the BW, BF, reproductive performance, milk composition, or growth performance of the piglets. On day 70 of gestation, the serum zinc concentration showed a quadratic response to M6 treatment (quadratic, p<0.05). Moreover, as the dietary mineral levels increased, the zinc concentration increased linearly at 110 days of gestation (linear, p<0.05). Furthermore, copper and iron concentrations in the serum of sows at 24 h postpartum decreased linearly when high levels of dietary minerals were provided (linear, p<0.05). In the serum of piglets, serum zinc concentrations decreased linearly (linear, p<0.05), and iron concentration showed a quadratic response (quadratic, p<0.05) with an increase in trace mineral premix levels in gestation diets. CONCLUSION: The current trace mineral requirements of NRC (2012) are suitable for gestating sows, and the addition of dietary mineral levels in the gestating diet did not show any improvements during the gestation and lactation periods.

Effects of ß-glucan with vitamin E supplementation on the growth performance, blood profiles, immune response, pork quality, pork flavor, and economic benefit in growing and finishing pigs.

OBJECTIVE: This study was conducted to evaluate the effects of ß-glucan with vitamin E supplementation on the growth performance, blood profiles, immune response, pork quality, pork flavor, and economic benefit in growing and finishing pigs. METHODS: A total of 140 growing pigs ([Yorkshire×Landrace]×Duroc) were assigned to five treatments considering sex and initial body weight (BW) in 4 replications with 7 pigs per pen in a randomized complete block design. The experimental diets included a corn-soybean meal-based basal diet with or without 0.05% or 0.1% ß-glucan and 0.02% vitamin E. The pigs were fed the diets for 12 weeks (phase I, 0 to 3; phase II, 3 to 6; phase III, 6 to 9; phase IV, 9 to 12). The BW and feed intake were measured at the end of each phase. Blood samples were collected at the end of each phase. Four pigs from each treatment were selected and slaughtered for meat quality. Economic benefit was calculated considering the total feed intake and feed price. Pork flavor was analyzed through inosine monophosphate analysis. RESULTS: The average daily gain and feed efficiency were improved compared to the control when ß-glucan or vitamin E was added. Supplementing 0.05% ß-glucan significantly increased the lymphocyte concentration compared to the addition of 0.1% ß-glucan and the content of vitamin E in the blood increased when 0.02% vitamin E was added. The treatment with 0.1% ß-glucan and 0.02% vitamin E showed the most economic effect because it had the shortest days to market weight and the lowest total feed cost. The addition of ß-glucan or vitamin E had a positive role in improving the flavor of pork when considering that the content of inosine monophosphate was increased. However, carcass traits and meat quality were not affected by ß-glucan or vitamin E. CONCLUSION: The addition of 0.1% ß-glucan with 0.02% vitamin E in growing and finishing pig diets showed great growth performance and economic effects by supplying vitamin E efficiently and by improving the health condition of pigs due to ß-glucan.

Short-term effects of dietary selenium on lactating sows to improve litter performance, milk composition and tissue selenium retention in piglets.

OBJECTIVE: This study was conducted to evaluate the short-term effects of dietary selenium supplementation on lactating sows on the physiological response, litter performance, milk composition, and tissue selenium retention in piglets when selenium was provided by different sources and at different levels in a lactation diet. METHODS: A total of 48 multiparous sows (Yorkshire×Landrace) with average body weight, backfat thickness, and parity were assigned to one of the four treatments with 12 sows per treatment using a 2×2 factorial arrangement in a completely randomized design. Inorganic or organic Se sources were added to the diet at 0.30 ppm and 0.50 ppm Se. Treatments were as follows: i) IS30, basal diet + inorganic Se 0.30 ppm; ii) IS50, basal diet + inorganic Se 0.50 ppm; iii) OS30, basal diet + organic Se 0.30 ppm; and iv) OS50: basal diet + organic Se 0.50 ppm. RESULTS: At Day 21 of lactation, a high tendency of litter weight (p = 0.08) and litter weight gain (p = 0.09) were observed when sows were fed an organic Se source. The milk Se concentration in the organic Se treatment was higher than that in the inorganic Se treatment at Day 21 of lactation (p<0.05). The serum Se concentrations of sows and piglets at Day 21 of lactation were significantly higher when lactating sows were fed organic Se instead of inorganic Se (p<0.01). During the suckling period, the kidney and muscle Se concentrations of piglets at Day 21 of lactation were significantly higher when the sow dietary Se source was organic (p<0.05). Liver Se concentrations were affected by Se source and level (p<0.05). This also resulted in an interaction response at 21 days of lactation (p<0.05). CONCLUSION: The supplementation of dietary organic Se in a lactating diet could improve sow feed consumption, piglet performance, milk Se level, and the Se status of sows and piglets.

Effects of ß-glucan with vitamin E supplementation on the growth performance, blood profiles, immune response, fecal microbiota, fecal score, and nutrient digestibility in weaning pigs.

OBJECTIVE: This study was conducted to evaluate effects of ß-glucan with vitamin E supplementation on the growth performance, blood profiles, immune response, fecal microbiota, fecal score, and nutrient digestibility in weaning pigs. METHODS: A total of 200 weaning pigs with an average body weight (BW) of 7.64±0.741 kg were allotted to five treatment groups and were divided based on sex and initial BW in four replicates with ten pigs per pen in a randomized complete block design. The experimental diets included a corn‒soybean meal-based basal diet with or without 0.1% or 0.2% ß-glucan and 0.02% vitamin E. The pigs were fed the diets for 6 weeks. A total of 15 barrows were used to evaluate the nutrient digestibility by the total collection method. The BW and feed intake were measured at the end of each phase. Blood samples were collected at the end of each phase, and fecal samples were collected at the end of the experiment. RESULTS: The addition of ß-glucan with vitamin E to weaning pig feed increased BW, average daily gain, and average daily feed intake. A significant decrease in yeast and mold and Proteobacteria and a tendency for Lactobacillus to increase compared to the control was shown when 0.1% ß-glucan and 0.02% vitamin E were added. The fecal score in weaning pigs was lower in the treatments supplemented with 0.1% or 0.2% ß-glucan and 0.02% vitamin E compared to the control. In addition, vitamin E was better supplied to weaning pigs by increasing the concentration of α-tocopherol in the blood of weaning pigs when 0.02% vitamin E was supplemented. However, there was no significant difference in either the immune response or nutrient digestibility. CONCLUSION: Inclusion of 0.1% ß-Glucan with 0.02% vitamin E in a weaning pig's diet were beneficial to the growth performance of weaning pigs by improving intestinal microbiota and reducing the incidence of diarrhea.

Effects of ß-glucan with vitamin E supplementation on the physiological response, litter performance, blood profiles, immune response, and milk composition of lactating sows.

OBJECTIVE: This study was conducted to evaluate the effects of ß-glucan with vitamin E supplementation on the physiological response, litter performance, blood profiles, immune response, and milk composition of lactating sows. METHODS: A total of 50 multiparous F1 sows (Yorkshire×Landrace) with an average body weight (BW) of 233.6±4.30 kg and an average parity of 4.00±0.307 and their litters were used in this experiment. All sows were allotted to one of five treatments, taking into consideration BW, backfat thickness, and parity in a completely randomized design with 10 replicates. The experimental diets included a corn-soybean meal-based basal diet with or without 0.1% or 0.2% ß-glucan and 110 IU vitamin E/kg diet. RESULTS: All treatments added with ß-glucan or vitamin E were statistically higher in the average daily feed intake (ADFI) of lactating sows compared to those of the control (Diet, p<0.01). Additionally, the ADFI of lactating sows was significantly higher in the groups supplemented with 0.1% ß-glucan compared to 0.2% ß-glucan (BG, p<0.01). There was an increasing trend in piglet weight at weaning (BG, p = 0.07), litter weight at the 21st day of lactation (BG, p = 0.07) and litter weight gain (BG, p = 0.08) in groups supplemented with 0.1% ß-glucan. The addition of 110 IU vitamin E/kg diet increased vitamin E concentration significantly in lactating sows (VE, p<0.01) and exhibited a trend for higher concentrations of vitamin E (VE, p = 0.09) in piglets. Adding 0.1% ß-glucan compared to 0.2% ß-glucan induced a decrease in the concentration of tumor necrosis factor-α in lactating sows (BG, p = 0.06) and in piglets (BG, p = 0.09) on the 21st day of lactation. There were no significant differences in the milk composition of sows. CONCLUSION: Adding 0.1% ß-glucan and 110 IU vitamin E/kg to a lactating sow's diet was beneficial to the growth performance of piglets by leading to an increase in the feed intake of sows and efficiently supplying vitamin E to both the sows and piglets.

Lambert-Eaton myasthenic syndrome (LEMS) in a patient with lung cancer under treatment with pembrolizumab: a case study.

Pembrolizumab is an immune checkpoint inhibitor (ICI) against the programmed death-1 receptor. Herein, we introduce a rare adverse effect during using pembrolizumab. We present the case of an 80-year-old man with biopsy-proven unresectable double primary squamous cell carcinoma and large cell neuroendocrine carcinoma of the lung. After using pembrolizumab for 10 months, he complained of muscle weakness of both upper and lower extremities. In a nerve conduction study, the repetitive nerve stimulation test in the abductor digiti minimi was diagnostic of Lambert-Eaton myasthenic syndrome (LEMS): low in the amplitude of compound muscle action potential (1.4 mV), 28.6% decrement in the 5-Hz stimulation, and 579% increment in the 50-Hz stimulation. The disease did not progress after the discontinuation of pembrolizumab, even without any anti-cancer treatment for 12 months. We believe our clinical experience of this rare and unexpected adverse effect should be shared.

An unusual case of carotidynia preceding recurrent ischemic stroke with carotid thrombosis in a patient with systemic lupus erythematosus.

Carotid artery thrombosis following carotidynia is an uncommon manifestation of systemic lupus erythematosus. We report the case of a woman without evidence of a lupus flare-up who presented with the unusual clinical course of ipsilateral carotidynia and recurrent ischemic stroke due to carotid thrombosis. To our knowledge, this is the first case of such an unusual manifestation in lupus and highlights distinctive challenges in the diagnosis and management of carotid artery thrombosis following carotidynia.

Impact of Neuroimaging Patterns for the Detection of Atrial Fibrillation by Implantable Loop Recorders in Patients With Embolic Stroke of Undetermined Source.

Objectives: Atrial fibrillation (AF) is a well-known etiology of embolic stroke of undetermined source (ESUS), although the optimal detection strategy of AF was not been fully evaluated yet. We assessed AF detection rate by implantable loop recorder (ILR) in patients with ESUS and compared the clinical characteristics and neuroimaging patterns between the patients with AF and AF-free patients. Methods: We reviewed clinical characteristics and neuroimaging patterns of consecutive patients with who were admitted to our comprehensive stroke center for ESUS and underwent ILR insertion between August 1, 2019, and January 31, 202. The inclusion criteria were (1) 18 years of age or older; (2) classified as having cryptogenic stroke extracted from the group with undetermined stroke according to ESUS International Working Group; and (3) underwent ILR insertion during or after admission due to index ischemic events. Ischemic stroke pattern was classified as (1) tiny-scattered infarction, (2) whole-territorial infarction, (3) lobar infarction and (4) multiple-territorial infarction. Interrogations of data retrieved from the ILR were performed by cardiologists in every month after the implantation. Results: In this study, 41 ESUS patients who received an ILR implantation were enrolled (mean age, 64 years; male sex, 65.9%). The rate of AF detection at 6 months was 34% (14 patients), and the mean time from ILR insertion to AF detection was 52.5 days [interquartile range (IQR), 45.0-69.5]. The median initial NIH stroke scale scores were significantly greater in patients with AF than those without AF (6.5 vs. 3.0, p = 0.019). Whole-territorial infarction pattern was significantly more frequent in patients with AF than in those without AF (64.3% vs.11.1%, p = 0.002). Conclusions: Higher covert AF detection rates within the ESUS patients were most often associated with higher NIHSS and whole-territorial infarction patterns on brain imaging.

Microneedles in Action: Microneedling and Microneedles-Assisted Transdermal Delivery.

Human skin is a multilayered physiochemical barrier protecting the human body. The stratum corneum (SC) is the outermost keratinized layer of skin through which only molecules with less or equal to 500 Da (Dalton) in size can freely move through the skin. Unfortunately, the conventional use of a hypothermic needle for large therapeutic agents is susceptible to needle phobia and the risk of acquiring infectious diseases. As a new approach, a microneedle (MN) can deliver therapeutically significant molecules without apparent limitations associated with its molecular size. Microneedles can create microchannels through the skin's SC without stimulating the proprioceptive pain nerves. With recent technological advancements in both fabrication and drug loading, MN has become a versatile platform that improves the efficacy of transdermally applied therapeutic agents (TAs) and associated treatments for various indications. This review summarizes advanced fabrication techniques for MN and addresses numerous TA coating and TA elution strategies from MN, offering a comprehensive perspective on the current microneedle technology. Lastly, we discuss how microneedling and microneedle technologies can improve the clinical efficacy of a variety of skin diseases.

Effect of Acupuncture on Delayed Emesis for the Patients Who Received High-Emetogenic Chemotherapy with Standard Antiemetic Prophylaxis (KHMC-HO-01): An Open-Label, Randomized Study.

Background: Chemotherapy-induced nausea and vomiting (CINV) is one of the most important issues associated with chemotherapy. The additional or synergistic effect of acupuncture on CINV remains controversial. Methods: Patients were randomized into either the group that received standard antiemetics with acupuncture (Arm A) or standard antiemetics only (Arm C). Acupuncture with manual stimulation was applied at eight predefined points and was started before the first cycle of chemotherapy on the first day and two additional sessions were administered on the second day of chemotherapy. Acute and delayed CINV was assessed using the Rhodes Index of Nausea, Vomiting, and Retching (RINVR) and the MASCC Antiemesis Tool (MAT). The primary outcome was the delayed nausea score assessed using the RINVR. Results: Overall, 42 patients were included. In the delay phase, the severity of delayed nausea was slightly lower without significance in Arm A than in Arm C (5.35 vs. 5.98, p = 0.3011). Similarly, patients in Arm A reported less severe vomiting than those in Arm C (0.75 vs. 1.25, p = 0.3064). Delayed nausea and vomiting assessed by the MAT showed significant relief with acupuncture compared to standard antiemesis alone. In terms of acute emesis, there was no significant difference between the two arms according to either scoring method. Conclusions: Delayed nausea after HEC tended to decrease with acupuncture using the RINVR score, though it was also not significant. With the MAT assessment, delayed emesis (nausea and vomiting) was significantly improved with acupuncture, suggesting a promising effect of acupuncture. This trial is registered with KCT0006477.

Natural Products as a Novel Therapeutic Strategy for NLRP3 Inflammasome-Mediated Gout.

Gout is the most common form of inflammatory arthritis. It occurs when monosodium urate crystals (MSU) are deposited within joints due to hyperuricemia and persistent elevations of serum uric acid levels. Traditional gout treatment such as urate-lowering therapy is difficult to continue for a long period of time due to the risk of side effects. Recent studies have shown that the modulation of MSU-induced inflammatory responses is dependent on the inflammatory cytokine IL-1ß, which has a central role in a chain of processes involving multiple cytokines and mediators. In this regard, the NLRP3 inflammasome is known to play a crucial part and thus has been proposed as a novel target in the treatment for gout. However, the biochemical mechanism for NLRP3 inflammasome activation has not yet been clearly elucidated. Therefore, this report can provide an overview of natural extractions targeted to prevent or treat NLRP3 inflammasome-mediated gout in the MSU-induced gout model. In addition, the research and development of such natural products are suggested as a potential strategy in the treatment of gout.

Pulmonary Metastasizing Low-Grade Endometrial Stromal Sarcoma: Case Report and Review of Diagnostic Pitfalls.

Pulmonary manifestations of benign metastasizing leiomyoma (BML) usually include multiple well-defined, round, bilateral nodules. Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine tumor. A 70-year-old woman visited the clinic complaining of acute cough and dyspnea in April 2017. Chest computed tomography (CT) revealed pneumothorax and multiple pulmonary nodules. She had a history of hysterectomy for uterine leiomyoma 23 years ago. Biopsy revealed that the pulmonary masses were consistent with BML. However, the patient had two subsequent episodes of acute, recurrent respiratory distress, accompanied by massive pleural effusions and hydropneumothorax over the next two years. A chest CT performed for acute dyspnea revealed large and multiple hydropneumothoraces. The size and distribution of pulmonary masses were aggravated along with cystic changes and bilateral pleural effusions. Given this aggressive feature, additional immunohistochemical findings and gynecologic pathologist review confirmed the correct diagnosis to be LG-ESS. After initiating anti-estrogen therapy, the patient achieved a partial response, without recurrence of symptoms, for 28 months. Metastatic LG-ESS responds well to anti-hormonal therapy. If the clinical pattern of a disease is different than expected, the possibility of a correction in the diagnosis should be considered.

Effects of Lysine Cell Mass Supplementation as a Substitute for L-Lysine·HCl on Growth Performance, Diarrhea Incidence, and Blood Profiles in Weaning Pigs.

This study was conducted to evaluate the effects of lysine cell mass (LCM) as an alternative lysine source in diets for weaning pigs on growth performance, diarrhea incidence, and blood profiles. In experiment 1, a total of 200 weaning pigs, with an average body weight (BW) of 6.89 ± 1.04 kg, were allotted into one of five treatments with four replicates of 10 pigs per pen in a randomized complete block design (RCBD). The dietary treatments were composed of LCM supplementation (0, 0.25, 0.5, 0.75, or 1.0%) with partial replacement of L-lysine·HCl (0 to 0.8% for phase 1 diets and 0 to 0.07% for phase 2 diets). The BW and feed intake were recorded at the end of each phase (d 0 to 14 for phase 1, d 14 to 35 for phase 2), and diarrhea incidence was checked daily throughout the experimental period. Blood samples were taken from the jugular vein of pigs at 2 weeks and 5 weeks to determine the blood profiles of weaning pigs. In experiment 2, a total of 144 weaning pigs with an average BW of 6.44 ± 1.19 kg were allotted into one of six treatments with six replicates of four pigs per pen in RCBD. The dietary treatments were composed of LCM supplementation (0 to 3.5% for phase 1 diets and 0 to 2.2% for phase 2 diets) with replacement of L-lysine·HCl from 0 to 100%. In experiment 1, partial replacement of L-lysine·HCl with 0 to 1% LCM did not affect growth performance and diarrhea incidence of pigs. An increase in the LCM supplementation from 0 to 1% with partial replacement of L-lysine·HCl had no influence on the blood urea nitrogen concentrations, whereas it resulted in a linear decrease (p < 0.05) in the serum IgG concentrations for 5 weeks. In experiment 2, increasing the dietary level of LCM with replacement of L-lysine·HCl quadratically decreased (p < 0.05) ADG and G-F ratio for phase 2 and G-F ratio for the overall period such that 100% replacement of L-lysine·HCl with LCM decreased ADG and G-F ratio of weaning pigs. An increase in the LCM supplementation with replacement of L-lysine·HCl tended to decrease linearly (p < 0.10) the diarrhea incidence of weaning pigs for the overall period and linearly decrease (p < 0.05) the serum IgG concentrations for 2 weeks. In conclusion, partial replacement of L-lysine·HCl with LCM from 0 to 1% had no negative impacts on the growth performance, but 100% replacement of L-lysine·HCl with LCM decreased the growth performance of weaning pigs. Therefore, LCM could be included in the diets for weaning pigs up to 2.8% and 1.76% for phase 1 and phase 2, respectively, as a substitute for L-lysine·HCl without detrimental effects on the performance of weaning pigs.

A Novel Treatment Strategy by Natural Products in NLRP3 Inflammasome-Mediated Neuroinflammation in Alzheimer's and Parkinson's Disease.

Alzheimer's disease (AD) and Parkinson's disease (PD) are the most common neurodegenerative diseases. Many studies have demonstrated that the release of NLRP3 inflammasome-mediated proinflammatory cytokines by the excessive activation of microglia is associated with the pathogenesis of AD and PD and suggested that the NLRP3 inflammasome plays an important role in AD and PD development. In both diseases, various stimuli, such as Aß and α-synuclein, accelerate the formation of the NLRP3 inflammasome in microglia and induce pyroptosis through the expression of interleukin (IL)-1ß, caspase-1, etc., where neuroinflammation contributes to gradual progression and deterioration. However, despite intensive research, the exact function and regulation of the NLRP3 inflammasome has not yet been clearly identified. Moreover, there have not yet been any experiments of clinical use, although many studies have recently been conducted to improve treatment of inflammatory diseases using various inhibitors for NLRP3 inflammasome pathways. However, recent studies have reported that various natural products show improvement effects in the in vivo models of AD and PD through the regulation of NLRP3 inflammasome assembly. Therefore, the present review provides an overview of natural extraction studies aimed at the prevention or treatment of NLRP3 inflammasome-mediated neurological disorders. It is suggested that the discovery and development of these various natural products could be a potential strategy for NLRP3 inflammasome-mediated AD and PD treatment.

A Case of Congenital Common Bile Duct Web Treated with Balloon Dilation under Endoscopic Retrograde Cholangiopancreatography in a Young Child.

Web in common bile duct (CBD web) is very rare. It is usually asymptomatic and detected incidentally during surgery for other causes in adults. It can be congenital or acquired, however congenital CBD web is extremely rare. Currently, despite its invasiveness and complications, endoscopic retrograde cholangiopancreatography (ERCP) is considered as a useful diagnostic and therapeutic modality in children with hepatobiliary pancreatic diseases as in adults. Herein we report a case of congenital CBD web presenting with acute pancreatitis and choledocholithiasis in a 4-year-old girl which was diagnosed and treated using balloon dilation under ERCP. After balloon dilation of the web, a common pancreatobiliary channel was observed. To the best of our knowledge, a case of congenital CBD web with pancreatobiliary junctional abnormality treated using ERCP in a child has not been reported to date.

Idiopathic Hepatic Portal Venous Gas in a Healthy Young Man.

BACKGROUND: Hepatic portal venous gas (HPVG) is a pathological condition characterized by gas in the portal venous system and its branches. The clinical manifestations of HPVG range from benign to life-threatening conditions. Here, we present a rare case of HPVG accompanied by free air in a healthy young patient without any suspicious etiology. CASE PRESENTATION: A 28-year-old man without any specific medical history complained of sudden-onset dyspnea. On admission, his vital signs were stable, and the laboratory tests and physical examinations were within normal range. A plain chest and abdominal film revealed subphrenic free air and HPVG. Contrast-enhanced computed tomography (CT) showed extensive portal venous gas throughout the liver; however, there were no abnormal findings indicative of the etiology. Considering the stable vital signs and the lack of physical findings suggesting a surgical acute abdomen, the patient was managed conservatively. On admission day 3, the subphrenic free air and HPVG shown in the initial study had almost resolved, with no new symptoms. He was discharged on the fourth day after admission without any complications. Esophagogastroduodenoscopy, colonoscopy, and colonography protocol CT scan showed no significant abnormalities. CONCLUSION: This case suggests that idiopathic HPVG could appear in healthy patients complaining only of vague symptoms. Initial conservative management could be considered if HPVG does not result from a life-threatening condition that needs immediate management, and if the patient is stable.

Lenvatinib-Induced Acute Pancreatitis in a Patient with Metastatic Thyroid Cancer: A Case Report.

BACKGROUND: Lenvatinib, a novel multi-target tyrosine kinase inhibitor, has been approved for treating differentiated thyroid cancer. Herein, we describe a rare case of acute pancreatitis that developed during lenvatinib treatment in a 65-year-old man with recurrent thyroid cancer. CASE PRESENTATION: The patient was admitted to our department following a complaint of acute-onset epigastric pain and indigestion. He had been receiving lenvatinib since 34 days. Although his serum amylase and lipase levels were normal, he had acute-onset persistent epigastric pain and typical computed tomography findings, which were consistent with those of acute pancreatitis. As other common etiologies were excluded, it was concluded that the patient had lenvatinib-induced acute pancreatitis. On admission day 14, he could consume food orally, after conservative care, including drug cessation, intravenous hydration, and pain control. CONCLUSION: Physicians should consider acute pancreatitis as a differential diagnosis for patients complaining of abdominal pain while on lenvatinib, regardless of hyperamylasemia or hyperlipasemia. Systematic collection of data on acute pancreatitis development during lenvatinib treatment should be considered, and further research is warranted to identify the mechanism of acute pancreatitis associated with multi-target tyrosine kinase inhibitors such as lenvatinib.

Cinnamaldehyde and Hyperthermia Co-Treatment Synergistically Induces ROS-Mediated Apoptosis in ACHN Renal Cell Carcinoma Cells.

Renal cell carcinoma (RCC) represents the most common form of kidney cancer, which accounts for 3-5% newly diagnosed cancer cases. Since limited therapies are available for RCC, a search for new options is required. Therefore, in this study, we evaluated the combination effect of cinnamaldehyde (CNM) and hyperthermia treatment. CNM treatment combined with 43 °C hyperthermia synergistically increased cytotoxicity in RCC cell line ACHN cells. Through Western blot assays, we observed increased apoptosis signaling and decreased proliferation/metastasis signaling, along with a repressed heat shock protein 70 level. In flow cytometry analyses, CNM and hyperthermia combination clearly induced apoptosis and mitochondrial potential of ACHN cells, while arresting the cell cycle. Investigation of reactive oxygen species (ROS) suggested a significant increase of ROS generation by CNM and 43 °C hyperthermia co-treatment. We could verify that ROS is crucial in the apoptotic action of combination treatment with CNM and hyperthermia through further experiments regarding an ROS scavenger. Overall, we suggest CNM and hyperthermia combination treatment as an alternative option of anticancer strategies for RCC.