[Eight Cases of Catheter Fracture in Internal Jugular Vein Ports for Breast Cancer Chemotherapy].

Subcutaneous implantable venous ports were placed in 414 patients between April 2016 and August 2021 for the purpose of breast cancer chemotherapy in our hospital. Although the internal jugular vein approach was selected to prevent fractures caused by pinch-off syndrome, catheter fracture occurred in 8 patients(1.9%). All patients were ADL-independent women aged 44-62 years(median, 50.5 years). The intravenous ports were placed on the side of the dominant and non-dominant hands in 4 and 4 patients, respectively. Six patients received perioperative chemotherapy, while 2 had advanced breast cancer. Catheter fractures occurred 17.7-54.2 months(median, 41.7 months)after placement. The fractures were discovered when the patients presented with one or more of the following conditions: poor backflow of blood (n=4), subcutaneous emphysema observed on CT(n=1), subcutaneous leakage of CT contrast media(n=3), and no sign or symptom(n=1). The fractures occurred in the clavicular subcutaneous part in all patients. Partial and complete fractures of the catheter occurred in 5 and 3 patients, respectively. In 3 patients with complete fracture of the catheter, catheter tips had strayed into the right atrium and were removed using percutaneous endovascular procedures.

[Satisfaction and Difficulties in the Daily Life of Patients with Breast Cancer Who Received Chemotherapy through a Central Venous Port System-A Questionnaire Survey].

We conducted a questionnaire survey of patients with breast cancer who underwent implantation of a subcutaneous central venous port system for chemotherapy; we aimed to evaluate their satisfaction with the port and difficulties in daily life. Overall, 130 patients with breast cancer who underwent port implantation for chemotherapy between 2016 and 2018 responded to our survey. Although the overall satisfaction was high(78.5%), 82(63.1%)patients reported difficulties in daily life, such as"pain or discomfort,""irritation over the implanted area while wearing a seat belt,"and"unable to wear a bag across their bodies."Some patients(10.8%)responded that these negative factors were associated with difficulties in carrying out social roles. The proportion of patients who understood the explanation provided before port implantation was 80.0%, and the satisfaction of these patients tended to be high(85.6%).

[Selection of Operative Procedure for Breast Cancer in Carriers of BRCA VUS in Japan].

Risk classification and clinical management of the DNA variant of unknown significance(VUS)in BRCA 1/2 remains unestablished. The Japanese hereditary breast and ovarian cancer(HBOC)consortium and myriad genetics reported that the VUS rate of BRCA is 6.5% in Japanese patients, but is <2% in the USA. The types of mutation supposedly differ between Asian and European ethnicities. Breast-conserving therapy(BCT)is not recommended in HBOC breast cancer, according to the 2017 Japanese guidelines by the Ministry of Health, because of the risk of ipsilateral breast recurrence(IBR)and carcinogenesis by radiation. In our hospital, we recommend an initial mastectomy and breast reconstruction with an implant for patients with HBOC breast cancer, considering future surgery on the contralateral side and symmetry of the reconstructed breast. However, the risk of IBR after BCT is not significantly high in patients with HBOC breast cancer, and BCT is a reasonable option even for definite HBOC breast cancer under low risk conditions. Hence, BCT is feasible for treating breast cancer in carriers of VUS following decision-making and informed consent from the patients.

Mineral disorders in pediatric pre-emptive kidney transplantation.

BACKGROUND: Pre-emptive kidney transplantation (PEKT) is beneficial for patients, improves graft survival and minimizes the complications associated with chronic kidney disease. Reports on pediatric PEKT, however, are limited, and little is known about the parathyroid hormone (PTH) abnormalities and calcium-phosphorus disorders (CPD) in this condition. This study was the first to report on mineral disorders in pediatric PEKT patients during a 1 year period. METHODS: We conducted a comparative examination of the abnormalities in calcium, phosphorus, calcium-phosphorus products and PTH before and 1 year after living donor kidney transplantation in PEKT and non-PEKT patients. RESULTS: Thirty-one patients were included. The patients were divided into two groups: PEKT (n = 11; 5 months in CKD stage 4-5) and non-PEKT (n = 20; 31.5 months in dialysis). Mean age at transplantation was 9.4 ± 5.0 years. Hypercalcemia and hyperphosphatemia were observed before and after transplantation in the PEKT and non-PEKT groups, and >15% of patients in each group had bone disorder and ectopic calcification associated with mineral disorder. Mineral disorder was present for approximately 3 months after transplantation in both treatment groups. CONCLUSIONS: No significant differences in PTH or CPD were noted between PEKT and non-PEKT groups; moreover, normalization of abnormal values did not differ between the PEKT and non-PEKT groups. Compared with non-PEKT, PEKT did not improve the course of mineral metabolism disorders. Mineral and bone disorder treatment was likely insufficiently provided to pediatric PEKT patients. To obtain the maximum advantage of PEKT, calcium and phosphorus levels should be strictly controlled before kidney transplantation.

[A Case of Breast Carcinoma with Cartilaginous Differentiation and Distant Metastasis with Complete Response to Post-Operative Chemotherapy].

We report a case of breast cancer with cartilaginous differentiation that responded well to chemotherapy, which completely eliminated distant metastasis. A 63-year-old woman visited our hospital complaining of a large hemorrhagic mass measuring 15 cm in diameter with ulceration of the left breast. Palpation revealed swelling of the left axillary and right supraclavicular (SC)lymph nodes, suggesting breast cancer metastasis. A CT scan revealed metastasis in the right lung measuring 2.5 cm in size. She underwent a total mastectomy with axillary dissection. The pathological findings were as follows; breast carcinoma with cartilaginous differentiation accompanied by a single lymph node metastasi(s 1/21)and skin involvement, ly0, v0, ER(-), PgR(-), HER2 0, Ki-67 80%. Four courses of AC therapy were administered as postoperative chemotherapy, which resulted in a decrease in the size of the SC lymph node to 1 cm. Subsequently, 12 courses of weekly paclitaxel yielded a complete response of the lung and SC lymph node metastasis. Oral administration of S-1 after paclitaxel therapy resulted in no recur- rence for 16 months after the operation.

The Evaluation of D-Dimer Levels for the Comparison of Fibrinogen and Fibrin Units Using Different D-Dimer Kits to Diagnose VTE.

The cutoff values of D-dimer levels for diagnosing or predicting the occurrence of deep vein thrombosis (DVT) were evaluated in preoperative patients and compared to those in non-DVT patients. The levels of 8 different D-dimers were measured using the latex agglutination method or enzyme immunoassay before surgery in 262 orthopedic surgery patients to diagnose subclinical DVT or predict postoperative DVT. There were 15 patients with subclinical DVT and 47 with postoperative DVT, but 200 patients had no DVT at all. All 8 plasma D-dimer values were significantly higher in the patients with subclinical or postoperative DVT than in those without DVT or in healthy volunteers. There were differences in the cutoff values between the assays highly sensitive for low D-dimer levels and wild-range assays of D-dimers. Some D-dimer assays might therefore be more useful than others for diagnosing low levels of D-dimer. Although the measurement of D-dimer levels was useful for diagnosing subclinical DVT and predicting the risk of DVT, the cutoff values for the diagnosis or prediction of DVT varied. The cutoff values for the prediction of postoperative DVT were ≥1.7 µg/mL (D-dimer A-D) and ≥1.0 µg/mL (D-dimer E-H).

An Evaluation of the Activated Partial Thromboplastin Time Waveform.

The activated partial thromboplastin time (APTT) waveform includes several parameters that are related to various underlying diseases. The APTT waveform was examined in various diseases. Regarding the pattern of APTT waveform, a biphasic pattern of the first or second derivative curve (DC) was observed in patients with hemophilia and patients positive for antiphospholipid (aPL) antibodies or coagulation factor VIII (FVIII) inhibitors. The time of the first and second DC and fibrin formation at 1/2 height were prolonged in patients with hemophilia, patients with inhibitors, patients positive for aPL, patients treated with anti-Xa agents, and patients with disseminated intravascular coagulation (DIC). These values all tended to decrease in pregnant women (at 28-36 weeks' gestation). The height of the second derivative peak 1 was significantly lower in patients with hemophilia, patients with FVIII inhibitors, patients positive for aPL, patients treated with anti-Xa agents, and patients with DIC; these values tended to be significantly higher in pregnant women. The height of the first DC was significantly lower in patients who were positive for FVIII inhibitors and was significantly higher in patients treated with anti-Xa agents and pregnant women. The height of the first and second DC was useful for the analysis of hemophilia, FVIII inhibitor, and aPL.

Diagnosis and treatment of TMA based on Japanese clinical guides.

Patients with thrombotic microangiopathies (TMAs), which include thrombotic thrombocytopenic purpura (TTP), atypical hemolytic uremic syndrome (aHUS), and Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS), exhibit multiple symptoms. These include thrombocytopenia (platelet count <15×104/µl), microangiopathic hemolytic anemia (hemoglobin <10 g/dl), and organ damage, such as renal dysfunction or neurological abnormalities. Guidelines for the management of TTP, aHUS, and STEC-HUS have been published. Diagnosis of TTP, STEC-HUS, or aHUS requires ADAMTS13 activity <10%, the detection of STEC or Shiga toxins, or a genetic analysis to investigate the complement regulatory system, respectively. In the established management of TMAs, fresh frozen plasma is used for congenital TTP to supplement ADAMTS13. Plasma exchange (PE) is used in acquired TTP (ATTP) to remove inhibitors and replace ADAMTS13. Steroid therapy is administered in ATTP to suppress inhibitor production, and rituximab is administered in ATTP without response to PE or with high titers of ADAMTS13 inhibitors. Eculizumab, a monoclonal antibody for complement protein 5, is used for the treatment of aHUS. Supportive therapy is required for some TMAs, particularly STEC-HUS, but platelet transfusion is generally contraindicated for other TMAs, such as TTP. Treatments should be administered in accordance with these guidelines to improve the outcome of TMAs.

DIC: an update on diagnosis and treatment.

Disseminated intravascular coagulation (DIC) was considered to be a fatal disease. However, it has recently been suggested that very early DIC protects the host against microthrombosis and infection localization. Therefore, early treatment of DIC may be contraindicated in patients with sepsis. These factors suggest that the diagnosis and treatment of DIC will gain further importance. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG2016), which include details regarding the management of DIC, have been recently published. Differences in recommendations for DIC treatment, such as antithrombin and recombinant human thrombomodulin, between J-SSCG2016 and other guidelines, including the Japanese Society on Thrombosis and Hemostasis (JSTH), British Committee for Standards in Haematology (BCST), Italian Society for Thrombosis and Haemostasis (SISET), and International Society on Thrombosis and Haemostasis (ISTH) have been discussed. Furthermore, differences in the diagnostic criteria for DIC between the Japanese Ministry of Health, Labor and Welfare, ISTH overt, ISTH non-overt, Japanese Association for Acute Medicine, and JSTH have been discussed.

Ten-Second Epitaxy of Cu on Repeatedly Used Sapphire for Practical Production of High-Quality Graphene.

Epitaxial copper (Cu) films yield graphene with superior quality but at high cost. We report 1-3 µm thick epitaxial Cu films prepared on c plane sapphire substrates in 10-30 s, which is much faster than that of the typical sputtering method. Such rapid deposition is realized by vapor deposition using a Cu source heated to 1700-1800 °C, which is much higher than its melting point of 1085 °C. Continuous graphene films, either bilayer or single-layer, are obtained on the epitaxial Cu by chemical vapor deposition and transferred to carrier substrates. The sapphire substrates can be reused five to six times maintaining the quality of the epitaxial Cu films and graphene. The mechanisms and requirements are discussed for such quick epitaxy of Cu on reused sapphire, which will enable high-quality graphene production at lower cost.

Spread of CTX-M-15 extended-spectrum ß-lactamase-producing Escherichia coli isolates through household contact and plasmid transfer.

We document the household spread of extended-spectrum ß-lactamase-producing Escherichia coli. One isolate belonged to sequence type 1193 and caused urinary tract infection in a 4-month-old female, and the other isolate belonged to sequence type 131 and colonized three family members, including the index patient. These isolates carried similar Inc-I1-Iγ plasmids, harboring blaCTX-M-15.

Methane-assisted chemical vapor deposition yielding millimeter-tall single-wall carbon nanotubes of smaller diameter.

We examined the use of low purity H2 (96 vol % H2 with 4 vol % CH4) in chemical vapor deposition (CVD) using a C2H2 feedstock, and obtained vertically aligned single-wall carbon nanotubes (VA-SWCNTs) with unexpectedly smaller diameters, larger height, and higher quality compared with those grown using pure H2. During the catalyst annealing, carbon deposited at a small amount from CH4 on the Fe particles, which kept them small and dense. During CVD, CH4 prevented the Fe particles from coarsening, resulting in an enhanced growth lifetime and suppressed diameter increase of growing SWCNTs. These effects were observed only for CH4, and not for C2H4 or C2H2. CH4-assisted CVD is an efficient and practical method that uses H2 containing CH4 that is available as a byproduct in chemical factories.

Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children.

BACKGROUND: Myocarditis (MC) is an important cause of cardiac dysfunction in children. Fulminant MC is sometimes fatal, and sequelae may develop during follow-up. We conducted a nationwide survey to determine the clinico-epidemiological features of MC in Japanese children and adolescents. METHODS AND RESULTS: Survey questionnaires were mailed to 627 hospitals, which were asked if they had treated MC patients aged between 1 month and 17 years during the period from January 1997 through December 2002. Responses were collected until December 2005, and data were collected and analyzed until January 2008. A total of 169 patients were reported: 64 fulminant cases, 89 acute cases, and 8 chronic cases. Incidence was 43.5 cases/year and 0.26 cases/100,000. Pathogens were identified in 37 patients; coxsackie virus accounted for 60%. Major cardiovascular manifestations at onset were congestive heart failure, refractory arrhythmia, and syncope in 70, 37, and 17 patients, respectively. Intravenous immunoglobulin was administered to 73 patients. Mechanical support seemed to be effective and life-saving. Among the 169 patients, 123 survived. Cardiovascular sequelae were reported in 49 patients. CONCLUSIONS: The survival rate for children with fulminant MC was disappointing. Overall, two-thirds of survivors had no sequelae. Mechanical support may reduce the mortality and the risk of clinical worsening.

Millimeter-tall single-walled carbon nanotubes rapidly grown with and without water.

Millimeter-tall vertically aligned single-walled carbon nanotubes (SWCNTs) were grown in 10-15 min by chemical vapor deposition from C(2)H(2)/Ar with or without water addition using Fe catalyst supported on an Al-Si-O underlayer. Using combinatorial catalyst libraries coupled with the real-time monitoring of SWCNT growth, the catalyst and chemical vapor deposition conditions were systematically examined, and millimeter-tall SWCNTs were obtained even without water addition. The key for millimeter-scale growth of SWCNTs is to limit the C(2)H(2) supply to below a certain partial pressure to retain an active catalyst. Water prolongs the catalyst lifetime under excess C(2)H(2) supply, whereas it deactivates small catalyst particles and degrades the quality of SWCNTs at the same time. We also observed a gradual increase in the diameter of SWCNTs with growth because of the coarsening of catalyst particles and found that water had no effect on this phenomenon. We demonstrate millimeter-tall SWCNTs grown by simply using C(2)H(2)/Ar gas without water addition, which revealed the mysterious role of water, and we show a practical route for the large-scale production of SWCNTs.

A girl with Peters plus syndrome associated with myelomeningocele and chronic renal failure.

A girl was born with sclerocornea of the right eye, corneal staphyloma of the left eye and lumbar myelomeningocele. The myelomeningocele was repaired soon after birth. The corneal staphyloma was perforated during infancy. She received keratoplasty and achieved light perception. Her right kidney revealed multicystic dysplasia and was non-functioning at birth. She had neurogenic bladder, and her renal function deteriorated gradually. Peters plus syndrome was diagnosed based on anterior ocular segment anomalies, short stature, developmental delay and characteristic face. Anterior ocular segment anomalies are rare findings, but seem to be occasionally associated with spina bifida and renal anomalies. Myelomeningocele and chronic renal failure in patients with Peters plus syndrome have not been reported to our knowledge.

Growth window and possible mechanism of millimeter-thick single-walled carbon nanotube forests.

Our group recently reproduced the water-assisted growth method, so-called "SuperGrowth", of millimeter-thick single-walled carbon nanotube (SWNT) forests by using C2H4/H2/H2O/Ar reactant gas and Fe/Al2O3, catalyst. In this current work, a parametric study was carried out on both reaction and catalyst conditions. Results revealed that a thin Fe catalyst layer (about 0.5 nm) yielded rapid growth of SWNTs only when supported on Al2O3, and that Al2O3 support enhanced the activity of Fe, Co, and Ni catalysts. The growth window for the rapid SWNT growth was narrow, however. Optimum amount of added H2O increased the SWNT growth rate but further addition of H2O degraded both the SWNT growth rate and quality. Addition of H2 was also essential for rapid SWNT growth, but again, further addition decreased both the SWNT growth rate and quality. Because Al2O3 catalyzes hydrocarbon reforming, Al2O3 support possibly enhances the SWNT growth rate by supplying the carbon source to the catalyst nanoparticles. The origin of the narrow window for rapid SWNT growth is also discussed.

Acute glomerulonephritis in three siblings and suspected emm49-type Streptococcus pyogenes infection.

Three siblings with poststreptococcal acute glomerulonephritis are presented. Streptococcal infection, impetigo, and pharyngitis preceded the acute glomerulonephritis. In one patient, emm49-type Streptococcus pyogenes was isolated, a strain which has not been reported as nephritogenic in Japan.