Single-Leg Loading Test to Predict Time to Jog and Return to Sports after Acute Lateral Ankle Sprain in Competitive Athletes.

In a previous study, the utility of a single-leg loading (SLL) test after acute lateral ankle sprain (LAS) was reported. However, whether the severity level assessed by the SLL test is associated with the time to jog and return to sports (RTS) remains unclear. Therefore, this study aimed to examine whether the time to jog and RTS differ depending on the severity level. A total of 240 athletes after sustaining acute LAS were included in this study. The SLL test was performed at the first visit, and the patients were classified into four levels (Levels 1-4). The Steel-Dwass multiple comparison method and multiple regression analysis was performed to verify whether the SLL test can predict the time to jog and RTS. On examining the relationship between the severity levels assessed by the SLL test and time to jog and RTS, significant differences were found among almost all the severity levels. Moreover, the multiple regression analysis revealed that only the SLL test showed a significant correlation with both the time to jog and RTS. This study suggested that the time to jog and RTS can be predicted by conducting the SLL test for acute LAS and dividing the severity into four levels.

Effect of resected lung lobe on the prediction of postoperative pulmonary function.

OBJECTIVES: This study examined whether a resected lung lobe can affect the accuracy of postoperative forced expiratory volume in 1 s (FEV1) predicted using the subsegment counting method and three-dimensional computed tomography (3D-CT) volumetry. METHODS: Overall, 125 patients who underwent lobectomy through video-assisted thoracic surgery were enrolled in this retrospective study. Pulmonary function tests were performed preoperatively and postoperatively at 3 months. We defined the accuracy index as the ratio of predicted postoperative FEV1 to measured postoperative FEV1 and compared the accuracy index of the subsegment counting method and 3D-CT volumetry. Factors affecting the accuracy index were also examined. RESULTS: The accuracy index of the subsegment counting method was 0.94 ± 0.12, versus 0.93 ± 0.11 for 3D-CT volumetry (P = 0.539). There was a significant difference among the resected lobes in the accuracy index of the subsegment counting method (P < 0.001) but not in that of 3D-CT volumetry (P = 0.370). The resected lobe, the number of staples used for interlobar dissection and interstitial pneumonia were significantly associated with the accuracy index of the subsegment counting method (all P < 0.001). The number of staples and interstitial pneumonia were significantly associated with the accuracy index of 3D-CT volumetry (P < 0.001, respectively), whereas the resected lobe was not a significant factor (P = 0.240). CONCLUSIONS: The resected lobe affected the accuracy of the subsegment counting method but not that of 3D-CT volumetry. Furthermore, 3D-CT volumetry predicted postoperative FEV1 independent of the resected lobe.

Quick and simple test to evaluate severity of acute lateral ankle sprain.

BACKGROUND/OBJECTIVE: For early return to sports after a lateral ankle sprain (LAS) and recurrence prevention, effective rehabilitation and gradual return to sports should be initiated while predicting the return time based on the appropriate severity evaluation immediately after injury. However, since severity evaluations performed in previous studies required large space and stairs and involved high-revel activity, their use as a test and index to evaluate severity after LAS was not appropriate considering convenience and risk of re-injury. Therefore, a quick and simple test was developed to evaluate the severity of acute LAS. This study aimed to verify the association between ankle function for severity evaluation and anterior talofibular ligament (ATFL) injury type by ultrasonography and to clarify the usefulness for acute LAS severity evaluation of the single-leg loading (SLL) test. METHODS: In total, 50 patients (34 men, 16 women) out of 58 patients who visited our sports clinic within 3 days after acute LAS and who conformed to the study criteria were included in this study. During the first visit, SLL test and objective/subjective ankle joint evaluation were performed. The SLL test consists of single-leg standing, single-leg heel raising and single-leg hopping, and patients were classified into four levels from 1 to 4 according to results. In addition, ultrasonographic evaluation was performed within 1 week after the first visit to evaluate the type of ATFL injury. Type I was defined as intact ATFL, Type II as swollen ATFL with an almost intact fibrillar pattern and Type III as ATFL appearing swollen with a disrupted fibrillar pattern. The relationship between the SLL test and each evaluation item was investigated using Spearman's correlation coefficient. RESULTS: As a result of the SLL test, 15 patients had Level 1 (30%), 19 Level 2 (38%), 5 Level 3 (10%) and 11 Level 4 (22%). With regard to correlation coefficients of the SLL test, Japanese Society for Surgery of the Foot ankle/hindfoot scale and sports activity were rs = 0.71 (p < 0.001) and rs = 0.66 (p < 0.001), respectively, showing a significant positive correlation. SLL test and the type of ATFL injury also showed a significant negative correlation (rs = -0.58, p < 0.001). CONCLUSIONS: The SLL test was a simple and useful test that can be used as an index to evaluate the severity of acute LAS.

Optimal timing of video-assisted thoracic surgery for acute pyothorax: a retrospective study.

OBJECTIVE: Although the value of video-assisted thoracic surgery for acute pyothorax is becoming widely recognized, the optimal timing of surgery has not been established. Therefore, we aimed to determine the optimal timing of video-assisted thoracic surgery in acute pyothorax. METHODS: We retrospectively reviewed 38 consecutive video-assisted thoracic surgeries performed for acute pyothorax between January 2013 and December 2017 at our institution. Data were analyzed using the independent samples t test and Mann-Whitney U test. A receiver-operating characteristic curve was used to identify the optimal time for intervention. RESULTS: The average time from disease onset to surgery was 17.9 days, and the average preoperative drainage period was 8.3 days. The operation was completed in all patients with video-assisted thoracic surgery curettage and drainage under general anesthesia; single lung ventilation was administered, and one or two thoracic drains were placed. The average postoperative drainage period was 10.8 days. Intraoperative complications were observed in two cases; no perioperative death occurred. Additional surgery was performed in four cases because of poor treatment response. There was no recurrence of pyothorax over a mean postoperative follow-up period of 42.5 months. A receiver-operating characteristic curve showed that the cut-off time from disease onset to surgery was 21.0 days; complication rates were 14.3% and 25.0% for patients operated on before and after 21 days, respectively. CONCLUSIONS: Thoracoscopic surgery for acute pyothorax is safe and curative, and should be performed within 21 days of disease onset to avoid postoperative complications.

Catamenial pneumothorax with partial liver herniation due to diaphragmatic laceration: a case report and literature review.

BACKGROUND: Catamenial pneumothorax is generally uncommon, with an incidence of less than 3-6% in women with spontaneous pneumothorax. As few cases of catamenial pneumothorax with diaphragmatic defect and liver herniation have been reported, this case report may be useful for understanding the cause and treatment. This case highlights the importance of the approach for liver hernia in patients with catamenial pneumothorax and endometriosis. CASE PRESENTATION: We report a case of catamenial pneumothorax in a 43-year-old woman with diaphragmatic partial liver hernia who was treated with thoracoscopic surgery. She was diagnosed with a right pneumothorax at menstruation onset. Chest computed tomography showed a nodule protruding above the right diaphragm. We performed thoracoscopic surgery to treat the persistent air leak and biopsied the nodule on the right diaphragm. There were blueberry spots on the diaphragm; the nodule was found to be the herniated liver. The diaphragmatic defect was sutured. Histological examination of the tissue near the partial prolapsed liver revealed endometrial tissue. CONCLUSIONS: It is speculated that ectopic endometrial tissue in the diaphragm will periodically necrose to become a diaphragmatic tear, which is a pathway for air to enter the thoracic cavity and eventually a herniated liver. Thoracoscopic surgery should be considered in patients with catamenial pneumothorax when a diaphragmatic lesion is suspected.

Drug Treatment for Patients with Postoperative Delirium and Consultation-Liaison Psychiatry in Japan: A Retrospective Observational Study of a Nationwide Hospital Claims Database.

BACKGROUND: Delirium is the most commonly experienced disorder in consultation liaisons. There are currently research and guidelines in Japan for delirium treatment. Still, there is no retrospective observational study of consultation-liaison psychiatry (CLP) and antipsychotic-centered drugs. This study aims to examine CLP's effectiveness and drug treatment. METHODS: Using a Japanese national inpatient database of 2016 and 2017, we investigated the presence or absence of CLP for the treatment of delirium in postoperative delirium patients, the status of drug selection, delirium days, and the average days from surgery to discharge. We examined factors affecting days from surgery to discharge using multiple linear regression analysis. RESULTS: This study was classified into a CLP group (n = 1,142) and a non-CLP group (n = 11,355). The days from surgery to discharge in the CLP and non-CLP groups was 16.7 and 17.1, respectively (p = 0.3613). There was a significant difference in the delirium days between the CLP and non-CLP groups (8.9 vs. 7.4; p < 0.00001). Haloperidol infusion was frequently used between the days from surgery to first day of delirium. It was prescribed less often than other oral drugs. Multiple regression analysis identified an association between age, men, CCI1-2, CCI ≥3, number of drugs used, days from surgery to first day of delirium, and early CLP (0-2days) with days from surgery to discharge. CONCLUSIONS: We investigated the effectiveness of CLP and the actual conditions of pharmacotherapy for postoperative delirium. Our findings suggest that early CLP may be associated with shorter days from surgery to discharge.

Dasatinib-induced Nonspecific Interstitial Pneumonia That Developed 7 Years after the Initiation of Dasatinib.

We report the case of a 56-year-old man with chronic myeloid leukemia (CML) who developed dasatinib-induced interstitial lung disease (ILD) 7 years after starting dasatinib, a BCR-ABL1 inhibitor. The patient presented with dyspnea. Chest imaging showed diffuse ground-glass opacities. A surgical lung biopsy showed cellular non-specific interstitial pneumonia (NSIP). Corticosteroid treatment ameliorated his condition. Bosutinib, another BCR-ABL1 inhibitor, was successfully re-instituted. The present case and relevant literature suggest that dasatinib-induced ILD can present as NSIP after an extended period, responds to corticosteroids, and is amenable to re-challenge at a lower-dose or with alternative BCR-ABL1 inhibitors.

Definitive lobectomy without frozen section analysis is a treatment option for large or deep nodules selected carefully with clinical diagnosis of malignancy.

BACKGROUND: Tissue harvesting for patients with a lung nodule is sometimes unsuitable due to the size and location of the nodule. In such cases, it is unclear whether it is acceptable to proceed to definitive lobectomy without intraoperative frozen section analysis. METHODS: We retrospectively reviewed patients who underwent definitive lobectomy or wedge resection for frozen section analysis at our institution between 2014 and 2018. The sensitivity, specificity, and accuracies of the clinical and frozen section diagnoses were evaluated against the final pathological diagnosis. RESULTS: There were 141 patients in the definitive lobectomy group and 58 patients in the frozen section analysis group, with the latter having smaller and less deep nodules and a lower rate of malignancy on clinical and final pathological diagnoses. The sensitivity, specificity, and accuracy of the clinical diagnosis were 100%, 82%, and 95%, respectively, in the frozen section analysis group and 99%, 67%, and 97%, respectively, in the definitive lobectomy group; values of frozen section diagnosis were 98%, 82%, and 93%, respectively. On subgroup analysis, all ground-glass nodules clinically diagnosed as malignant had a final pathological diagnosis of malignancy. CONCLUSIONS: The accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis. These data suggest that definitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground-glass nodules clinically diagnosed as malignant. To avoid unnecessary lobectomy, frozen section diagnosis should be considered for nodules likely to be benign. KEY POINTS: Significant findings of the study The accuracy of the clinical diagnosis was high and was not inferior to the frozen section diagnosis. What this study adds Definitive lobectomy is an acceptable treatment option for carefully selected patients with large or deep nodules and ground-glass nodules with a clinical diagnosis of malignancy.

Effective exchange to a larger size catheter for a lung abscess with initial percutaneous drainage failure: a case report.

BACKGROUND: Percutaneous catheter drainage is an effective therapy for antibiotic-refractory lung abscesses. Pulmonary resection is usually considered in cases of drainage failure, although it remains controversial. CASE PRESENTATION: A 42-year-old man with antibiotic-refractory lung abscess underwent percutaneous abscess drainage with a 10-Fr pigtail catheter. However, adequate evacuation of the abscess content was not achieved, and his respiratory condition worsened and he required a ventilator. To achieve and maintain effective drainage, insertion of a larger size 28-Fr catheter to replace the 10-Fr catheter was performed under general anesthesia and one-lung ventilation with a double-lumen tube to isolate the left lung. Exchange with a larger size catheter was effective and achieved adequate drainage. The procedure was performed safely by expanding the route of the old catheter as a guide for accessing the abscess cavity. His condition immediately improved and he was discharged on day 40 post-catheter exchange with no complications and cured with a small residual thin wall cavity. CONCLUSIONS: Small size catheters are generally recommended for initial percutaneous drainage; however, we argue that exchange with larger size catheters should be primarily considered instead of pulmonary resection in cases of initial drainage failure. This may avoid the need for pulmonary resection.

Simultaneous Two-Dimensional and Three-Dimensional Simulation of Thoracoscopic Sleeve Lobectomy: A Quick Understanding of Pitfalls.

Thoracoscopic sleeve lobectomy is challenging, considering the technical difficulty in controlling the needle angle and thread through the port. However, effective simulation of the procedure remains to be established. Here, we describe our first experience with thoracoscopic sleeve lobectomy simulation using a three-dimensional printed thoracic model and a handmade rolled sponge. Owing to the transparent structure, we could simultaneously confirm the suturing technique through the monitor (two-dimensional) and direct vision (three-dimensional). We are certain that our realistic and easily repeatable simulation will assist in developing better technique and conduct feasible thoracoscopic sleeve lobectomy.

Wireless Monitoring Using a Stretchable and Transparent Sensor Sheet Containing Metal Nanowires.

Mechanically and visually imperceptible sensor sheets integrated with lightweight wireless loggers are employed in ultimate flexible hybrid electronics (FHE) to reduce vital stress/nervousness and monitor natural biosignal responses. The key technologies and applications for conceptual sensor system fabrication are reported, as exemplified by the use of a stretchable sensor sheet completely conforming to an individual's body surface to realize a low-noise wireless monitoring system (<1 µV) that can be attached to the human forehead for recording electroencephalograms. The above system can discriminate between Alzheimer's disease and the healthy state, thus offering a rapid in-home brain diagnosis possibility. Moreover, the introduction of metal nanowires to improve the transparency of the biocompatible sensor sheet allows one to wirelessly acquire electrocorticograms of nonhuman primates and simultaneously offers optogenetic stimulation such as toward-the-brain-machine interface under free movement. Also discussed are effective methods of improving electrical reliability, biocompatibility, miniaturization, etc., for metal nanowire based tracks and exploring the use of an organic amplifier as an important component to realize a flexible active probe with a high signal-to-noise ratio. Overall, ultimate FHE technologies are demonstrated to achieve efficient closed-loop systems for healthcare management, medical diagnostics, and preclinical studies in neuroscience and neuroengineering.

Recovery of pulmonary function after lung wedge resection.

BACKGROUND: Pulmonary function following lung wedge resection is not fully understood. This study aimed to assess the influence of wedge resection upon postoperative pulmonary function. METHODS: We retrospectively evaluated pulmonary function at 3, 6, and 12 months postoperatively in 29 patients who underwent lung wedge resection. The values of the pulmonary function tests (PFTs) were compared among the time points using a paired t-test. RESULTS: The vital capacity (VC) values before surgery and at 3, 6 and 12 months postoperatively were 2,994±793, 2,845±799, 2,941±801, and 2,964±839 mL, respectively. The VC decreased at 3 months postoperatively (P=0.002) and recovered by 6 and 12 months postoperatively (P=0.003 and 0.003, respectively). The VC values at 6 and 12 months postoperatively did not significantly differ from that before surgery (P=0.152 and 0.361, respectively). The forced expiratory volume in one second (FEV1) values before surgery and at 3, 6, and 12 months postoperatively were 2,156±661, 2,034±660, 2,091±672 and 2,100±666 mL, respectively. The values decreased at 3 months postoperatively (P<0.001) and recovered; however, they remained lower than the preoperative value (P=0.036). CONCLUSIONS: The postoperative VC decreased temporarily but recovered to near the preoperative level after 12 months. We concluded that the loss of VC following lung wedge resection is minimal. These findings are beneficial for planning surgery and explaining the procedure to patients who are undergoing lung wedge resection.

Ultralow-Noise Organic Transistors Based on Polymeric Gate Dielectrics with Self-Assembled Modifiers.

In this study, ultralow 1/f noise organic thin-film transistors (OTFTs) based on parylene gate dielectrics modified with triptycene (Trip) modifiers were fabricated. The fabricated OTFTs showed the lowest 1/f noise level among those of previously reported OTFTs. It is well known that 1/f noise causes degradation of signal integrity in analog and digital circuits. However, conventional OTFTs still possess high 1/f noise levels, and the factors that strongly affect 1/f noise are still ambiguous. In this work, the effect of gate dielectric surface on 1/f noise was investigated. First, by comparing OTFTs composed of various channel lengths, we revealed that contact resistance did not affect 1/f noise. Second, we compared parylene OTFTs with and without a self-assembled Trip modifier layer in terms of 1/f noise and trap density of states (Trap DOS). The experiments revealed that a specific Trip modifier layer suppresses the shallow Trap DOS in the OTFTs, leading to a low 1/f noise. Moreover, the 1/f noise level and Trap DOS of various kinds of OTFTs were comprehensively compared, which highlighted that the 1/f noise of OTFTs strongly depends on the gate dielectric surface. Finally, detailed analysis of the gate dielectric interface led us to conclude that the disorder of gate dielectrics and the crystalline quality of semiconductor films are related to shallow Trap DOS, which correlates with 1/f noise.

Risk factors and cancer recurrence associated with postoperative complications after thoracoscopic lobectomy for clinical stage I non-small cell lung cancer.

BACKGROUND: Minimally invasive thoracoscopic lobectomy is the recommended surgery for clinical stage I non-small cell lung cancer (NSCLC). The purpose of this study was to identify the risk factors, including sarcopenia, for postoperative complications in patients undergoing a complete single-lobe thoracoscopic lobectomy for clinical stage I NSCLC, as well as the impact of complications on disease-free survival. METHODS: We retrospectively investigated 173 patients with pathologically-diagnosed NSCLC who underwent curative thoracoscopic lobectomies between April 2013 and March 2018. Sarcopenia was assessed using the psoas muscle index calculated from preoperative computed tomography images at the third lumbar vertebral level. RESULTS: Complications developed in 38 (22%) patients, including 21 with prolonged air leak. In univariate analysis, the significant risk factors for complications were advanced age, male sex, higher Charlson Comorbidity Index (CCI) score, lower cholinesterase, lower albumin, higher creatinine level, pleural adhesion, operative time ≥ five hours, nonadenocarcinoma cancer, and larger tumor size. Multivariate analysis showed that age ≥ 75 years (P = 0.002) and pleural adhesion (P = 0.026) were significant independent risk factors for complications. Compared with the patient group without complications, postoperative complications were independently associated with shorter disease-free survival (P = 0.01). CONCLUSIONS: Advanced age and pleural adhesion were independent risk factors for complications after complete single-lobe thoracoscopic lobectomies for clinical stage I NSCLC, and postoperative complications were statistically associated with poor prognosis. Surgical teams should ensure an experienced surgeon leads the operation for patients at higher risk to avoid prolonged postoperative hospitalization and a possible poor prognosis.

Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery.

BACKGROUND: Recurrence of pneumothorax after thoracoscopic surgery is a concerning issue for thoracic surgeons. In this study, we aimed to determine the risk factors for recurrence of spontaneous pneumothorax after thoracoscopic surgery. METHODS: A total of 192 patients with spontaneous pneumothorax aged <50 years who underwent thoracoscopic surgery from January 2010 to December 2016 were included in this study. Pre- and post-operative characteristics were obtained from medical records, and recurrent and non-recurrent cases were compared. RESULTS: Fourteen patients (7.3%) experienced pneumothorax recurrence. Pneumothorax recurrence was observed more frequently in patients aged <20 years (P=0.041) and those in whom bullae were not identified on preoperative computed tomography (CT) (P=0.049). The use of polyglycolic acid (PGA) sheets during surgery significantly decreased the recurrence rate (P=0.031). A history of ipsilateral pneumothorax before surgery was a significant risk factor for recurrence after thoracoscopic surgery (P=0.001). In the multivariate analysis, a history of ipsilateral pneumothorax and identification of bullae on CT were identified as significant risk factors for recurrence. CONCLUSIONS: A history of ipsilateral pneumothorax, and inability to identify bullae on preoperative CT were risk factors for postoperative recurrence of pneumothorax.

Fine printing method of silver nanowire electrodes with alignment and accumulation.

One-dimensional metal nanowires offer great potential in printing transparent electrodes for next-generation optoelectronic devices such as flexible displays and flexible solar cells. Printing fine patterns of metal nanowires with widths <100 µm is critical for their practical use in the devices. However, the fine printing of metal nanowires onto polymer substrates remains a major challenge owing to their unintended alignment. This paper reports on a fine-printing method for transparent silver nanowires (AgNWs) electrodes miniaturized to a width of 50 µm on ultrathin (1 µm) polymer substrate, giving a high yield of >90%. In this method, the AgNW dispersion, which is swept by a glass rod, is spontaneously deposited to the hydrophilic areas patterned on a hydrophobic-coated substrate. The alignment and accumulation of AgNWs at the pattern periphery are enhanced by employing a high sweeping rate of >3.2 mm s-1, improving electrical conductivity and pattern definition. The more aligned and more accumulated AgNWs lower the sheet resistance by a factor of up to 6.8. In addition, a high pattern accuracy ≤ 3.6 µm, which is the deviation from the pattern designs, is achieved. Quantitative analyses are implemented on the nanowire alignment to understand the nanowire geometry. This fine-printing method of the AgNW electrodes will provide great opportunities for realizing flexible and high-performance optoelectronic devices.

Highly-ordered Triptycene Modifier Layer Based on Blade Coating for Ultraflexible Organic Transistors.

We present a highly ordered surface modification layer for polymers based on ambient solution-processed triptycene (Trip) derivatives for high-mobility organic thin-film transistors (OTFTs). The nested packing of Trip molecules results in the formation of 2D hexagonal arrays, which stack one-dimensionally on the surface of polymer dielectrics without anchoring groups. The Trip surface was previously shown to be preferable for the growth of organic semiconductors (OSCs), and hence for enhancing the mobility of OTFTs. However, although the Trip modifier layer has been realized by thermal evaporation in a high-vacuum environment (TVE), it still has grain-boundary disorders that hinder the optimal growth of OSCs. To fabricate OTFTs with higher mobility, a disorder-free Trip layer is needed. We developed highly ordered Trip layers on polymer dielectrics via blade coating. In addition, we clarified that the highly ordered Trip modifier layer enhances the mobility of the OTFTs by more than 40%, relative to the disordered Trip layer prepared by TVE. Finally, we realized a ring oscillator composed of OTFTs with a highly ordered Trip layer.

Long-Term Implantable, Flexible, and Transparent Neural Interface Based on Ag/Au Core-Shell Nanowires.

Neural interfaces enabling light transmittance rely on optogenetics to control and monitor specific neural activity, thereby facilitating deeper understanding of intractable diseases. This study reports the material strategy underlying an optogenetic neural interface comprising stretchable and transparent conductive tracks and capable of demonstrating high biocompatibility after long-term (5-month) implantation. Ag/Au core-shell nanowires contribute toward improving track performance in terms of stretchability (<60% strain), transparency (<83%), and electrical resistance (15 Ω sq-1 ). The neural interface integrated with gel-coated exterior microelectrodes preserves low impedance (1.1-3.2 Ω cm2 ) in a saline solution over the evaluated 5-month period. Besides the use of efficient conductive materials, surface treatment using antithrombogenic polymer tends to prevent the growth of granulation tissue, thereby facilitating clear monitoring of electrocorticograms (ECoG) in a rodent during chronic implantation. The flexible and transparent neural interface pathologically exhibits noncytotoxicity and low inflammatory response while efficiently recording evoked ECoG in a nonhuman primate via optogenetic stimulation. The proposed highly reliable interface can be employed in multifaceted approaches for translational research based on chronic implants.

Desmoid-type fibromatosis arising in a bifid rib chest wall.

Desmoid-type fibromatosis is a rare soft tissue tumor and the chest wall is one of the common sites of its extra-abdominal occurrence. A bifid rib is one of the congenital rib abnormalities. We report a case of desmoid-type fibromatosis arising in a chest wall's bifid rib. A 42-year-old female complained of right chest pain without remarkable medical, traumatic, or familial history. Chest-computed tomography revealed a chest wall tumor located adjacent to a bifid costal cartilage of third rib. We performed chest wall resection of second and third ribs. Pathologically, the tumor was diagnosed a desmoid-type fibromatosis of the chest wall. We surmise mechanical stimulation due to the bifid rib may be related to the occurrence of the tumor. In case of desmoid-type fibromatosis without somatic gene mutation, traumatic history, wound, implants, or use of female hormonal agents, we should search also local congenital abnormality.

Structure of constituents isolated from the bark of Cassipourea malosana and their cytotoxicity against a human ovarian cell line.

Three aromatic compounds, 2α,3α-epoxyflavan-5,7,4'-triol-(4ß â†’ 8)-afzelechin (1), 2ß,3ß-epoxyflavan-5,7,4'-triol-(4α → 8)-epiafzelechin (2), and methyl 4-ethoxy-2-hydroxy-6-propylbenzoate (3), as well as eight known compounds (4-11) were isolated from the bark of Cassipourea malosana (Rhizophoraceae). Their structures were determined on the basis of an analysis of spectroscopic data. The in vitro cytotoxic activities of these compounds against human ovarian cancer cell line TOV21G were evaluated. Most compounds showed little activity; however, the methyl derivatives of flavan dimers (1a and 2a) showed higher activity (IC50 value of 30.3 and 75.4 µM) than parent compounds 1 and 2.