Hemodynamic predictors of negative false lumen remodeling after frozen elephant trunk for acute aortic dissection.

OBJECTIVE: We evaluated the blood flow within the downstream aortic false lumen after frozen elephant trunk repair for acute aortic dissection and identified hemodynamic predictors of false lumen expansion and negative false lumen remodeling using four-dimensional flow magnetic resonance imaging. METHODS: Thirty-one patients (Stanford type A, n = 28; Stanford type B, n = 3) with patent false lumen who underwent frozen elephant trunk procedures for acute aortic dissection were included in this observational study. Each patient underwent computed tomography during the follow-up period and four-dimensional flow magnetic resonance imaging within 3 postoperative months. The false lumen volumetric expansion rate was calculated using computed tomography data. The direction and the rate of flow in the lower descending aortic false lumen were analyzed. Negative false lumen remodeling was defined as a volumetric increase of > 10% from the baseline volume. RESULTS: Negative false lumen remodeling had developed in 6 of the 31 patients during the observation period. Most of the false lumen flows were biphasic during systole. The range between peak and nadir flow rates was associated with the false lumen volumetric expansion rate (ß coefficient = 6.77; p < 0.01, R2 = 0.43). CONCLUSIONS: The range between peak and nadir flow rates may serve as a hemodynamic predictor of negative false lumen remodeling, enabling further treatment for patients at risk of expansion in the downstream aorta.

A protocol-based treatment for ruptured abdominal aortic aneurysm contributed to improving aorta-related mortality: a retrospective cohort study.

BACKGROUND: Recent guidelines state that improving the survival rate of patients with ruptured abdominal aortic aneurysm (rAAA) requires a protocol or algorithm for the emergency management of these patients. We aimed to investigate whether introducing a protocol treatment for rAAA improves clinical outcomes compared with the pre-protocol strategy. METHODS: At our institution, 92 patients treated for rAAA between June 2008 and August 2022 were retrospectively analyzed. In 2014, the protocol-based treatment was introduced comprising a transfer algorithm to shorten the time to proximal control, use of an endovascular occlusion balloon, strict indications for endovascular aortic aneurysm repair (EVAR) or open surgical repair, and perioperative care, including for abdominal compartment syndrome (ACS). Clinical outcomes were compared between the protocol and pre-protocol group, including operative status, all-cause mortality, and rAAA-related death at 30-day, in-hospital, and 1-year postoperative follow-ups. RESULTS: Overall, 52 and 40 patients received the protocol-based and pre-protocol treatments, respectively. EVAR was more frequently performed in the protocol group. The rate of achieving time to proximal control was significantly faster, and the transfusion volume was lower in the protocol group. ACS occurred more frequently in the protocol group with a higher EVAR. No difference was found in all-cause mortality between the two groups. The protocol group exhibited fewer rAAA-related deaths than the pre-protocol group during the following time points: 30 days (9.6% vs. 22.5%), during the hospital stay (11.5% vs. 30.0%), and 1 year (14.5% vs. 31.5%). CONCLUSIONS: The protocol-based treatment improved the survival rate of patients with rAAA.

Cortical bone microdamage affects primary stability of orthodontic miniscrew.

BACKGROUND: The aim of this study was to investigate the effects of orthodontic miniscrew pitch and thread shape on microdamage in cortical bone. The relationship between the microdamage and primary stability was also examined. METHODS: Ti6Al4V orthodontic miniscrews and 1.0-mm-thick cortical bone pieces from fresh porcine tibia were prepared. The orthodontic miniscrews had custom-made thread height (H) and pitch (P) size geometries, and were classified into three groups: control geometry; HCPC (HC; thread height = 0.12 mm, PC; pitch size = 0.60 mm), geometry with a narrower pitch; HCPN (HC; thread height = 0.12 mm, PN; pitch size = 0.30 mm), and geometry with a taller thread height; HTPC (HT; thread height = 0.36 mm, PC; pitch size = 0.60 mm). The orthodontic miniscrews were inserted into a pilot hole in the cortical bone, and maximum insertion torque and Periotest value were measured. After insertion, the samples were stained with basic fuchsin. Histological thin sections were obtained and the bone microdamage parameters, i.e., total crack length and total damage area, and insertion state parameters, i.e., orthodontic miniscrew surface length and bone compression area were calculated. RESULTS: The orthodontic miniscrews with the taller thread height resulted in lower primary stability with minimal bone compression and microdamage; however, the narrower thread pitch led to maximum bone compression and extensive bone microdamage. CONCLUSIONS: A wider thread pitch reduced microdamage, and decreased thread height resulted in increased bone compression, ultimately resulting in increased primary stability.

Evaluation of Cortical Bone Microdamage and Primary Stability of Orthodontic Miniscrew Using a Human Bone Analogue.

Orthodontic miniscrews have gained popularity; however, they have some drawbacks, including screw loosening that results from bone resorption caused by excess microdamage created during screw insertion. Pilot hole preparation through the cortical bone is considered beneficial to avoid such microdamage, while an overly large pilot hole impairs primary stability. Hence, we used a human bone analogue to evaluate the microdamage and primary stability to estimate the optimal pilot hole size that would minimize the screw loosening risk. Ti6Al4V orthodontic miniscrews and 1.0-mm-thick synthetic cortical bone pieces were prepared. Various compressive loads were applied in indentation tests to test pieces' surfaces, and the microdamaged areas were confirmed as stress-whitening zones. Screw insertion tests were performed in which a miniscrew was inserted into the test pieces' pilot hole with a diameter of 0.7-1.2 mm in 0.1-mm intervals, and the stress-whitening area was measured. The insertion and removal torque were also measured to evaluate primary stability. The stress-whitening areas of the 1.0-1.2 mm pilot hole diameter groups were significantly smaller than those of the other groups (p < 0.05), whereas the 0.9 and 1.0 mm pilot hole diameter groups showed higher primary stability than other groups. In conclusion, the bone analogue could be utilized to evaluate microdamage in cortical bones and the primary stability of miniscrews.

Measurement of laryngeal elevation time using a flexible surface stretch sensor.

BACKGROUND: Dysphagia is a growing health problem in aging societies. An observational cohort study targeting community-dwelling populations revealed that 16% of elderly subjects present with dysphagia. There is a need in elderly communities for systematic dysphagia assessment. OBJECTIVE: This study aimed to verify whether laryngeal elevation in the pharyngeal phase could be measured from the body surface using thin and flexible stretch sensors. METHODS: Thirty-two elderly subjects (17 males, 15 females; mean age ± SD: 89.2 ± 6.2 years) with suspected dysphagia underwent a swallowing contrast examination in which seven stretch sensors were attached to the front of the neck. The elongation of the sensors was measured and compared to the laryngeal elevation time values obtained using videofluorography. The sensor signal detected the laryngeal elevation start time, conclusion of the descent of the larynx, and the laryngeal elevation time. The respective laryngeal elevation times obtained using videofluorography and using the sensor were compared using the Bland-Altman method. RESULTS: The laryngeal elevation time was 1.34 ± 0.46 s with the stretch sensor and 1.49 ± 0.56 s with videofluorography. There was a significant positive correlation between the duration obtained by both methods (r = .69, P < .0001). A negative additional significant bias of -0.15 s (95% confidence interval -0.30 to -0.03, P = .046) was noted in the laryngeal elevation time from the videofluorography measurement. CONCLUSION: Laryngeal elevation time can be measured non-invasively from the neck surface using stretch sensors.

[Intraoperative Pancreatoscopy to Assess the Resection Margin in Intraductal Papillary Mucinous Neoplasm-A Case Report].

Intraductal papillary mucinous neoplasm(IPMN)of the pancreas often presents with multifocal lesions. Complete resection without residual skip lesions is essential for complete eradication of the disease. We experienced a case of IPMC in which intraoperative pancreatoscopy was used to determine the surgical margin. Intraoperative pancreatoscopy is a useful and easy method to evaluate the remnant duct and exclude residual tumor. A cystic lesion was incidentally detected in the pancreatic head of a 78-year-old man. Ultrasonography, abdominal computed tomography, magnetic resonance imaging, and endoscopic ultrasound revealed enhancing mural nodules in the pancreatic head and dilation of the entire main pancreatic duct. We performed pancreaticoduodenectomy for mixed IPMN. Intraoperative pancreatoscopy, which was performed to rule out skip lesions, showed no mucosal abnormalities in the remnant duct. The pathological diagnosis was non-invasive intraductal papillary-mucinous carcinoma(IPMC). No signs of recurrence were seen for 6 postoperative months.

[A Case of Gastrointestinal Stromal Tumor Re-Resected Ten Years after the Resection of Its Recurrence].

The patient was a 75-year-old man who was diagnosed as having jejunal gastrointestinal stromal tumor(GIST)and underwent partial resection of the small intestine including the tumor 12 years ago. Two years after the first resection, recurrence was detected, and a second resection was performed. Ten years after the second resection following recurrence, he took imatinib, and computed tomography(CT)revealed abdominal and liver tumors. We was diagnosed as having GIST recurrence, and a third resection, which included an abdominal tumor resection and partial hepatectomy, was performed. The pathological findings were metastatic abdominal GIST and angiomyolipoma of the liver. The Japanese Clinical Practice Guidelines for GIST suggest a surgical indication only for local recurrence of GIST and resectable liver metastases. Recurrent GIST cannot be completely cured with antineoplastic drugs alone. Multidisciplinary treatment is necessary for long-term survival of patients with recurrent GIST.

Shape Optimization of Bone-Bonding Subperiosteal Devices with Finite Element Analysis.

Subperiosteal bone-bonding devices have been proposed for less invasive treatments in orthodontics. The device is osseointegrated onto a bone surface without fixation screws and is expected to rapidly attain a bone-bonding strength that successfully meets clinical performance. Hence, the device's optimum shape for rapid and strong bone bonding was examined in this study by finite element analyses. First, a stress analysis was performed for a circular rod device with an orthodontic force parallel to the bone surface, and the estimate of the bone-bonding strength based on the bone fracture criterion was verified with the results of an animal experiment. In total, four cross-sectional rod geometries were investigated: circular (Cr), elliptical (El), semicircular (Sc), and rectangular (Rc). By changing the height of the newly formed bone to mimic the progression of new bone formation, the estimation of the bone-bonding strength was repeated for each geometry. The rod with the Rc cross section exhibited the best performance, followed by those with the Sc, El, and Cr cross sections, from the aspects of the rapid acquisition of strength and the strength itself. Thus, the rectangular cross section is the best for rod-like subperiosteal devices for rapid bone bonding.

Sam2bam: High-Performance Framework for NGS Data Preprocessing Tools.

This paper introduces a high-throughput software tool framework called sam2bam that enables users to significantly speed up pre-processing for next-generation sequencing data. The sam2bam is especially efficient on single-node multi-core large-memory systems. It can reduce the runtime of data pre-processing in marking duplicate reads on a single node system by 156-186x compared with de facto standard tools. The sam2bam consists of parallel software components that can fully utilize multiple processors, available memory, high-bandwidth storage, and hardware compression accelerators, if available. The sam2bam provides file format conversion between well-known genome file formats, from SAM to BAM, as a basic feature. Additional features such as analyzing, filtering, and converting input data are provided by using plug-in tools, e.g., duplicate marking, which can be attached to sam2bam at runtime. We demonstrated that sam2bam could significantly reduce the runtime of next generation sequencing (NGS) data pre-processing from about two hours to about one minute for a whole-exome data set on a 16-core single-node system using up to 130 GB of memory. The sam2bam could reduce the runtime of NGS data pre-processing from about 20 hours to about nine minutes for a whole-genome sequencing data set on the same system using up to 711 GB of memory.

[A Case Report of Clinical Complete Response with Chemotherapy for Descending Colon Cancer Complicated with Severe Pulmonary Dysfunction].

A 76-year-old male patient was diagnosed with progressive descending colon cancer. Since the patient had severe respiratoryfunction impairment after right pneumonectomy, the anesthesiologydepartment of our hospital determined that general anesthesia induction was too difficult. He was thus started on capecitabine plus oxaliplatin(XELOX)therapy. Three months after starting this treatment, colonoscopyshowed that the site had become scarred, and tissue examination revealed no indication of malignancy. Accordingly, the patient achieved clinical complete response. The patient had no findings of recurrence 1 year and 11 months after the start of chemotherapy. Chemotherapy for unresectable progressive recurrent colorectal cancer is based on the 5-FU anticancer agent, which exerts its antitumor effect byinhibiting DNA synthesis. The antitumor effect is reportedly high when the expression of thymidylate synthase(TS), a target agent, is low. In this patient, TS expression was low based on tissue examination. TS expression maybe an effective useful predictive factor for the efficacyof chemotherapyadministered to patients with unresectable progressive recurrent colorectal cancer.

[A Case of Multiple Liver Metastases and Peritoneal Dissemination after Resection of a Gastrointestinal Stromal Tumor of the Stomach Successfully Treated with Imatinib Mesylate].

A 71-year-old man was diagnosed with a gastric tumor approximately 50mm in diameter on computed tomography (CT). In January 2000, he underwent a proximal gastrectomy. Pathological examination showed 5 mitoses per 50 high-power fields, while immunohistochemical analysis showed positive staining for KIT. Accordingly, the tumor was diagnosed as an intermediate- risk malignant gastrointestinal stromal tumor (GIST) for which the patient was followed. In January 2002, an abdominal CT scan revealed multiple hepatic tumors and a lower abdominal tumor, and the patient was diagnosed with liver metastases and peritoneal disseminations from GIST. After informed consent was provided, chemotherapy with 400 mg/day imatinib was initiated. The patient demonstrated a partial response 2 months after treatment. At 12 years 8 months after the diagnosis of liver metastasis and peritoneal disseminations, the patient shows no sign of recurrence.

[A Case of Idiopathic Thrombocytopenic Purpura during Adjuvant Chemotherapy for Colon Cancer].

A 76-year-old man underwent surgery for sigmoid colon cancer. The pathological finding was stage Ⅱ with a high-risk of recurrence (SI [bladder], l y0, v2, pN0, H0, P0, M0). He was treated with TS-1 as adjuvant chemotherapy. After the 1 course of chemotherapy, his platelet count was 4,000/mL. The high index of platelet associated IgG (PA-IgG) and bone marrow examination suggested that thrombocytopenia was caused by idiopathic thrombocytopenic purpura. The platelet count improved by prednisolone administration and Helicobacter pylori eradication treatment. After 6 months with no administration of adjuvant chemotherapy, the colon cancer recurred locally, and we performed a Hartmann's operation.

[A successful case with TS-1+CDDP chemotherapy for recurrent gastric cancer].

A 64-year-old woman underwent cholecystectomy for treatment of cholecystolithiasis in January 2005. Pathological examination rendered a diagnosis of gallbladder carcinoma. Wedge resection of the liver and dissection of the lymph nodes was performed. No tumor cells in either the liver nodule or lymph nodes were found during pathological examination. At 4 years after surgery, paraaortic lymph node recurrence was confirmed by computed tomography (CT). Gemcitabine was administered once weekly for the first 3 weeks in a monthly cycle, but the tumor continued to increase in size. Gemcitabine was then switched to TS-1, after which it was changed to cisplatin because of continued tumor growth. After 35 courses of chemotherapy, CT showed the disappearance of the paraaortic lymph node, and the patient achieved a complete response. She is currently free of disease at 9 years after surgery.

[A case of recurrent gastric cancer successfully treated with TS-1+CDDP chemotherapy].

A 74-year-old woman underwent distal gastrectomy and D1+ α dissection for the treatment of gastric cancer (pT2a, pN2, H0, P0, M0, Stage IIIA) in February 2008. She was treated with adjuvant postoperative chemotherapy consisting of TS-1. However, 32 months after the operation, paraaortic lymph node recurrence was confirmed by computed tomography (CT). She was treated with combined TS-1 and cisplatin chemotherapy. After 14 courses, CT revealed that the paraaortic lymph node metastasis had disappeared, and a complete response was attained. The patient is currently disease-free, 6 years after the operation.

Identification of Anogeissus latifolia Wallich and analysis of refined gum ghatti.

Natural medicinal exudates such as gum arabic are high-molecular-weight natural polysaccharides and are highly soluble in water. The dissolved solutions of these exudates show viscous behavior and exhibit favorable emulsion stability. These exudates have been widely used not only as a medicinal additive, such as a coating agent for tablets and as an emulsifier and stabilizer in beverage and food products, but also for other industrial applications, such as paints and ink. Gum ghatti was originally used as an alternative to gum arabic due to its similar properties to those found in gum arabic. Gum ghatti has been used as a food additive due to its excellent emulsification properties. In this study, we obtained gum ghatti nodules and branches as botanical specimens, which were collected from the same harvesting area. Refined gum ghatti processed from the collected gum ghatti nodules was found to comply with the specifications set by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and also to be identical to commercially available gum ghatti products as a food additive. Component analysis of the refined gum ghatti samples revealed that they contain arabinose (34.0-38.0 %), galactose (21.0-24.6 %), mannose (5.3-7.9 %), xylose (0.8-1.2 %), rhamnose (0.8-1.2 %), and glucuronic acid (15.4-18.6 %) as constituent sugars, protein (2.7-3.6 %), moisture (4.9-8.3 %), and tannin (0.041-0.092 %). As a result of the investigation of collected branches as botanical specimens, they were identified as Anogeissus latifolia Wallich. Detailed observation of their morphological characteristics revealed that many crystal cells were aligned in the lengthwise section of branch specimens.

Pattern-effect-free all-optical wavelength conversion using a hydrogenated amorphous silicon waveguide with ultra-fast carrier decay.

Ultra-fast carrier decay, recently discovered in a hydrogenated amorphous silicon waveguide, can be exploited for pattern-effect-free all-optical signal processing based on optical Kerr nonlinearity. In this study, we utilized a 10 Gbit/s RZ-OOK data stream as a pump for degenerate four-wave mixing in a low-loss hydrogenated amorphous silicon waveguide. The propagation loss of the waveguide used was 1.0±0.2 dB/cm at 1550 nm. Unlike crystalline silicon waveguides, no noticeable difference was observed in the BER characteristics between the cases of PRBS 2(7)-1 and 2(31)-1.

[A case of complex (type IV) paraesophageal hiatal hernia with herniation of the small intestine].

A 78-year-old woman was admitted to our hospital because of abdominal pain. She was diagnosed with complex (type IV) paraesophageal hiatal hernia, for which an operation was performed. At laparotomy, a 50 cm long ileum was found to have herniated into the thoracic cavity through the esophageal hiatus along with the sliding hiatal hernia of the stomach. Both the organs were reduced to the abdominal cavity. The hiatal hernia defect (diameter, 7cm) was repaired with a direct suture, and the gastric fundus was sutured to the diaphragm. Presently, 6 years have passed since the operation, there is no sign of recurrence.

[A case of hepatoid adenocarcinoma of the stomach].

The patient was a 76-year-old man with no chief complaint. He presented to an internist of our hospital for an evaluation of anemia. An upper gastrointestinal endoscopy revealed a type 2 tumor at the lesser curvature of the gastric body. Although the blood analysis showed a high amount of AFP(2, 328 ng/mL), there was no abnormality found in the liver with a CT scan. The tumor was presumed to be an AFP-producing gastric cancer on the basis of the tumor biopsy. We performed total gastrectomy, splenectomy and cholecystectomy. The tumor cells were positive for AFP by immunohistochemistry. The final diagnosis was hepatoid adenocarcinoma, pT3(SS), INF b, ly1, v2, pN1(3/42), pStage II B. Tumor cells were negative for antihepatocyte antibody and anti-HER2 antibody. The amount of AFP normalized postoperatively. After discharge, he was treated with S-1(80mg/day)orally. He is relapse-free now, 14 months after the operation. Hepatoid adenocarcinoma is an extremely aggressive tumor with a poor prognosis, and effective chemotherapy has still not been established. A larger number of analyses, along with a molecular biological approach, is sure to be helpful for the establishment of an effective treatment for hepatoid adenocarcinoma.

[A case of multiple bone metastasis of gastric carcinoma accompanying DIC successfully controlled with combination of S-1 and low-dose CDDP].

The patient was a 50-year-old man who underwent total gastrectomy twelve years ago. Ahigh level of ALP was found in the patient in April 2008. Based on various examinations, the diagnosis of multiple bone metastasis of gastric carcinoma accompanying disseminated intravascular coagulation(DIC)was made. The patient was treated with S-1/CDDP. S-1(80mg/ m / / 2day)was administered for 14 days followed by a 7-day rest period, and a CDDP(20mg/m2)infusion was administered on days 1 and 8. After one course of treatment, the DIC was controlled, and the patient was given a one-year prognosis. The combination of S-1 and low-dose CDDP may be considered effective even for multiple bone metastases of gastric carcinoma with DIC.