Successful treatment of a patient with a 'flow-through' type II endoleak associated with an aberrant renal artery after endovascular aneurysm repair.

Identification and control of responsible feeding arteries are crucial in treating type II endoleaks after endovascular aortic repair (EVAR). A 78-year-old female patient required management of a type II endoleak 8 years after EVAR. A persistent endoleak from the inferior mesenteric artery (IMA) enlarged the size of an aneurysm sac. Sac angiography from the IMA revealed a flow-through endoleak from the IMA to an aberrant renal artery (ARA). After coil embolization of the ARA through the sac together with the IMA, the sac shrank. Control of flow-through vessels may be essential for managing post-EVAR enlargement due to type II endoleaks.

A Retrospective Study of Patients Undergoing Palliative Radiotherapy for Airway Obstruction due to Lung Cancer.

BACKGROUND/AIM: In advanced stage lung cancer, bulky tumors can cause serious symptoms such as malignant airway obstruction (MAO). Prompt response to airway obstruction might be essential to improve quality of life and prolong life expectancy. Palliative external beam radiotherapy (EBRT) is a less invasive and highly safe treatment method that can alleviate symptoms and at the same time treat lung cancer. However, there are few reports on the results of palliative radiotherapy performed for improving airway obstruction and obstructive pneumonia. Therefore, this study retrospectively examined the effectiveness of palliative radiotherapy. PATIENTS AND METHODS: We reviewed 38 lung cancer patients with MAO who underwent EBRT. Patients were treated with a median dose of 37.5 Gy (range=30-40 Gy) in 10-20 fractions. Whether a patient was a responder or non-responder was assessed by whether the bronchus that was obstructed before EBRT reopened or improvement of obstructive pneumonia was observed on follow-up chest X-ray or computed tomography after EBRT. RESULTS: The median survival time was 135 days (range=31-469 days) for the responders to EBRT and 45 days (range=23-355 days) for non-responders; this difference was statistically significant (p=0.03). One-year overall survival rate was 18.5% and 0% for the responders to EBRT and non-responders, respectively. CONCLUSION: Palliative EBRT might be an important option for non-curative lung cancer patients with MAO.

VMAT Planning With Xe-CT Functional Images Enables Radiotherapy Planning With Consideration of Lung Function.

Background/Aim: The most severe adverse event of radiotherapy in lung cancer is radiation pneumonitis (RP). Some indices commonly used to prevent RP are evaluated based on the anatomical lung volume. The irradiation dose may be more accurately assessed by using functional lung volume. We evaluated the usefulness of computed tomography (CT) incorporating functional ventilation images acquired by the inhalation of xenon (Xe) gas (Xe-CT functional images). Patients and Methods: Two plans were created for twelve patients: volumetric modulated arc therapy (VMAT) planning using conventional chest CT images (anatomical plans) and VMAT planning using Xe-CT functional images (functional plans), and the dosimetric parameters were compared. Results: Compared to the anatomical plans, the functional plans had significantly reduced V 20Gy in the high-functional lungs (p=0.005), but significant differences were not seen in the moderate-functional and low-functional lungs. Conclusion: The incorporation of Xe-CT functional images into VMAT plans enables radiotherapy planning with consideration of lung function.

Prussian blue in salt blocks decreases radiocesium activity concentration in milk from dairy cattle fed a diet contaminated by the Fukushima nuclear accident.

In Japan, the radiocesium activity concentration in milk must be less than 50 Bq/kg-fresh to meet shipping standards, and the radiocesium concentration of the diet fed to dairy cattle must be less than 500 Bq/kg-dry. After the Fukushima nuclear accident in 2011, we conducted two experiments to investigate whether Prussian blue (PB) could suppress the radiocesium (134Cs + 137Cs) activity concentration in Japanese cattle' milk. In experiment 1, four cattle were fed a diet with a radiocesium activity concentration of 175 Bq/kg-dry, with or without PB supplementation. The PB intake ranged from 0 to 3.0 g/day, and the average radiocesium intake was 3.42 kBq/day in all treatments. The radiocesium activity concentration in milk decreased from 16.4 to 8.6 Bq/kg-fresh, and the transfer coefficient of radiocesium from diet to milk (Fm) decreased from 4.77 × 10-3 to 2.61 × 10-3 with increased PB intake. In experiment 2, three cattle were fed another diet including a radiocesium activity concentration of 927 Bq/kg-dry of with or without PB supplementation. The PB intake ranged from 0 to 18.9 g/day, and the average radiocesium intake was 15.2 kBq/day in all treatments. The milk's radiocesium activity concentration decreased from 24.3 to 4.2 Bq/kg-fresh, and the Fm decreased from 1.68 × 10-3 to 0.28 × 10-3 with increased PB intake. Our results suggest that both the radiocesium activity concentration in milk and Fm can be reduced by PB, and that Fm is affected by diet. We recommend cattle should be fed absorbents such as PB to minimize the risk of milk radiocesium activity concentration exceeding 50 Bq/kg-fresh even if the diet has a radiocesium activity concentration of less than 500 Bq/kg-dry.

Urea-Assisted Reconstitution of Discoidal High-Density Lipoprotein.

High-density lipoprotein (HDL) is a naturally occurring composite of lipids and lipid-binding proteins. The cholate dialysis method, first reported by Jonas in 1969, is the most widely used approach for reconstituting discoidal HDL (dHDL) in test tubes with phospholipids and the most dominant protein, apolipoprotein A-1 (apoA-I). Here, we show that a dHDL-relevant complex can also be prepared by gently mixing 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) and apoA-I or its mutants in ethanol/H2O solutions containing urea at a concentration of a few molar and then incubating the mixture at the gel-liquid crystalline phase transition temperature in test tubes. Subsequent purification steps involve quick dialysis following size exclusion chromatography. The yields (73 ± 3% and 70 ± 1% protein and DMPC, respectively) of the resulting HDL-like nanoparticles, designated as uHDL, were comparable to the values of 68 ± 9% and 71 ± 12% obtained in the cholate dialysis method. Using apoA-I and two mutants, the key factor in this method was found to be urea at the folded and unfolded transition midpoint concentration. By using this urea-assisted method in the presence of a hydrophobic drug, all-trans-retinoic acid (ATRA), one-step preparation of ATRA-loaded uHDL was also possible. The loading efficiency was comparable to that in the mixing of ATRA and uHDL or dHDL reconstituted by the cholate dialysis method. Atomic force microscopy analysis revealed that uHDL and ATRA-loaded uHDL were discoidal. Our urea-assisted method is an easy and efficient method for reconstituting dHDL and can be utilized to prepare various drug-dHDL complexes.

Characteristic of K3 (CpG-ODN) as a Transcutaneous Vaccine Formulation Adjuvant.

Transcutaneous immunization (TCI) is easy to use, minimally invasive, and has excellent efficacy in vaccines against infections. We focused on toll-like receptor (TLR) ligands as applicable adjuvants for transcutaneous formulations and characterized immune responses. TCI was performed using poke-and-patch methods, in which puncture holes are formed with a polyglycolic acid microneedle on the back skin of mice. Various TLR ligands were applied to the puncture holes and covered with an ovalbumin-loaded hydrophilic gel patch. During the screening process, K3 (CpG-oligonucleotide) successfully produced more antigen-specific antibodies than other TLR ligands and induced T helper (Th) 1-type polarization. Transcutaneously administered K3 was detected in draining lymph nodes and was found to promote B cell activation and differentiation, suggesting a direct transcutaneous adjuvant activity on B cells. Furthermore, a human safety test of K3-loaded self-dissolving microneedles (sdMN) was performed. Although a local skin reaction was observed at the sdMN application site, there was no systemic side reaction. In summary, we report a K3-induced Th1-type immune response that is a promising adjuvant for transcutaneous vaccine formulations using MN and show that K3-loaded sdMN can be safely applied to human skin.

Immunogenicity of Milk Protein-Containing Hydrophilic Gel Patch for Epicutaneous Immunotherapy for Milk Allergy.

PURPOSE: Epicutaneous immunotherapy (EPIT) involving the skin's immune system is easy to use, painless and has a low risk of systemic side effects; it can be applied to food allergies that have a high morbidity rate in children. In this study, we evaluated the safety and efficacy of hydrophilic gel patch (HG) for EPIT. METHODS: Milk protein concentrate (MPC)-containing HG was applied to the skin that maintained a barrier function or formed puncture holes with microneedle, and MPC-specific antibodies were measured. The clinical study was conducted involving patients with severe milk allergy. RESULTS: No specific immune response was induced when immunizing to intact skin, and antibody production was observed by forming puncture holes. It was suggested that MPC contained in HG has immunogenicity and a very small amount of MPC was delivered to intact skin. In the clinical study, the symptom induction threshold increased in four of eight subjects, allowing them to consume milk and switch to oral immunotherapy. Although local skin reactions and temporary elevation of specific IgE antibodies were observed, no systemic side effects appeared throughout the study. CONCLUSIONS: EPIT using HG is a safe method to enable oral administration even in patients with severe milk allergies.

[Feasibility Study for the Development of an Application for Simulated Virtual Reality Radiation Therapy Experiences Using Android and iOS Devices].

Using virtual reality (VR) technology such as head-mounted displays, users can be immersed in a virtual world and perceive it as reality. In radiation therapy departments, pretreatment patients and students rarely observe treatment rooms and treatment devices, making it difficult to understand the overall flow of radiation therapy. In this study, to facilitate the understanding and teaching of radiation therapy, we suggest the implementation of VR technology and develop software compatible with VR to enable a pertinent comprehension of radiation therapy. With versatility and accessibility in mind, the software is developed as an application for Android and iOS devices.Omnidirectional movies in treatment rooms were acquired from both the patient view and a third-person view using an omnidirectional camera. The Android/iOS devices used were AQUOS R (SHARP), iPhone 7 Plus (Apple), and iPad air (Apple). The software was developed using Unity 2018.4.7f (Unity Technologies). The main components of the software were as follows: (i) a home window featuring a user interface with which people can access arbitrarily rooms by tapping on floor maps or a list of treatment rooms, (ii) a snapshot mode providing 2D images of a treatment room as a slide show, and (iii) a movie mode displaying omnidirectional movies from the patient view or a third-person view. The virtual radiation therapy experience was executed by attaching the Android/iOS devices to 3D VR goggles (SAMONIC).The main components of the application operated in good conjunction on the Android/iOS devices, and live viewing in the virtual world ran smoothly with the VR technology. However, there were resolution limitations due to the specs of the camera and the devices. It will therefore be necessary to adjust the resolution and the frame rate according to the performance of the relevant devices. The application is instructive for both patients and students because the virtual radiation therapy experience is immersive when using the VR technology. In addition, the developed software can transfer data in a single package and has the ability to substitute images and omnidirectional movies with those appropriate for diagnostic radiology and nuclear medicine departments. Therefore, the developed application is highly versatile.

Correction: Development of Novel Faster-Dissolving Microneedle Patches for Transcutaneous Vaccine Delivery. Pharmaceutics, 2017, 9(3), 27.

The authors wish to make a change to their published paper [1].[...].

Development of Novel Faster-Dissolving Microneedle Patches for Transcutaneous Vaccine Delivery.

Microneedle (MN) patches are promising for transcutaneous vaccination because they enable vaccine antigens to physically penetrate the stratum corneum via low-invasive skin puncturing, and to be effectively delivered to antigen-presenting cells in the skin. In second-generation MN patches, the dissolving MNs release the loaded vaccine antigen into the skin. To shorten skin application time for clinical practice, this study aims to develop novel faster-dissolving MNs. We designed two types of MNs made from a single thickening agent, carboxymethylcellulose (CMC) or hyaluronan (HN). Both CMC-MN and HN-MN completely dissolved in rat skin after a 5-min application. In pre-clinical studies, both MNs could demonstrably increase antigen-specific IgG levels after vaccination and prolong antigen deposition compared with conventional injections, and deliver antigens into resected human dermal tissue. In clinical research, we demonstrated that both MNs could reliably and safely puncture human skin without any significant skin irritation from transepidermal water loss measurements and ICDRG (International Contact Dermatitis Research Group) evaluation results.

Synthesis of 8-aza-3,7-dideaza-2'-deoxyadenosines possessing a new adenosine skeleton as an environmentally sensitive fluorescent nucleoside for monitoring the DNA minor groove.

8-Aza-3,7-dideaza-2'-deoxyadenosine 1 and its C3-naphthylethynylated derivative (3n7z)A (2) comprising a 8-aza-3,7-dideazapurine (pyrazolo[4,3-c]pyridine) skeleton were synthesized for the first time. In particular, nucleoside (3n7z)A (2) exhibited environmentally sensitive intramolecular charge transfer (ICT) emission because of electron transition in the coplanar conformer formed by nucleobase and naphthalene moieties. Its incorporation into oligodeoxynucleotide (ODN) probes enable a clear identification of a perfectly matched thymine (T) in the complementary strand by a distinct change in the emission wavelength. In addition, the fluorescence emission of the duplexes containing a cytosine/guanine (C/G) base pair flanking (3n7z)A (2) was strongly quenched by guanine only when the opposite base of the modified nucleoside was mismatched, enhancing its base identification ability. Thus, ODN probes containing (3n7z)A (2) acted as effective reporter probes for homogeneous single nucleotide polymorphism (SNP) typing.

Imma perovskite-type oxynitride LaTiO2N: structure and electron density.

We present the first example of Imma perovskite-type oxynitride. LaTiO(2)N was found to have an Imma perovskite-type structure with a(0)b(-)b(-) tilt system. The Ti-(O,N) covalent bonding and existence of N atoms are responsible for the reduced band gap of LaTiO(2)N photocatalyst.

Contralateral cervicomediastinal lymph node metastases from clinically occult adenocarcinoma of the lung.

A 69-year-old woman with a right cervical lymphadenopathy presented with an adenocarcinoma on excisional biopsy. Computed tomography (CT) scans and a positron emission tomography scan demonstrated that the tumor was localized in the right paratracheal and cervical region. A clinical diagnosis of lung cancer arising from an unknown primary site was made based on the radiologic and immunohistochemical findings. Serial CT scans showed a growing nodule in the left apex from pinpoint size to 1 cm in diameter after several months, which was defined as the primary site at autopsy. The finding of a clinically occult lung cancer directly spreading to the contralateral mediastinal and cervical nodes by skipping ipsilateral hilar and mediastinal nodes is rare.