[A case of foveolar-type gastric adenocarcinoma with a raspberry-like appearance followed up by endoscopy].

A 47-year-old man was referred to our hospital for detailed examination of a gastric polypoid lesion. Esophagogastroduodenoscopy revealed a raspberry-like polyp at the gastric body. Pathological examination of the biopsy specimen revealed this polypoid lesion to be a gastric adenocarcinoma. Endoscopic submucosal dissection was performed, and histopathological examination revealed that lesion to be a well-differentiated adenocarcinoma. Immunohistochemical staining showed that the neoplasm was positive for MUC5AC and negative for MUC6, CD10, and pepsinogen I, indicating that this lesion was a foveolar-type gastric adenocarcinoma. From about 10 years now, this patient has been undergoing esophagogastroduodenoscopy almost every year. This lesion was absent until six years ago. Five years ago, a small polypoid lesion appeared at the gastric body, and this lesion gradually enlarged. The present case showed the growing process of the foveolar-type gastric adenocarcinoma with a raspberry-like appearance.

Initial Progressions of Carotid Artery Plaque Are Associated with Risk Factors of Cardiovascular Disease.

BACKGROUND: Carotid artery plaque, white matter disease (WMD), and silent lacunae infarcts (initial indicators) are associated with symptomatic cerebral infarction (CI) caused by atherosclerosis. We retrospectively examined the association between the initial indicators and risk factors for cerebrovascular disease, considering the primary prevention of symptomatic CI. METHODS: We divided 1503 individuals who were neurologically healthy and enrolled in a brain screening program (brain dock) at our institution, into three initial plaque grades (grade 0, 1, and 2) based on having no plaques, having plaques on the right or left carotid artery, or having plaques on both carotid arteries, respectively. We analyzed the risk factors according to the presence/absence of the initial indicators. RESULTS: WMD and the risk factors (low-density lipoprotein [LDL], hemoglobin A1c, systolic blood pressure [BP], and smoking cigarettes) were positively correlated with the initial plaque grades, even when their laboratory values were within normal ranges. Systolic BP (116.5 ± 14.0 mmHg) was significantly lower in group 00 (without carotid plaque and WMD) than that in age-adjusted others (with carotid plaque or WMD). In young participants aged between 40 and 52 years, LDL (132.8 ± 24.5 mg/dl) was significantly higher in subgroup ++ (with carotid plaque and WMD) compared to others (without carotid plaque or WMD). CONCLUSION: Initial plaque grade and WMD grade as clinical initial indicators of symptomatic CI are associated with risk factors. To avoid deterioration of the initial indicators, it was suggested that the risk factors should be maintained at the lower ends of normal ranges and smoking cessation should be recommended.

Exploration of an Easy and Simple Method for Decompressive Craniectomy: The "Spiral Dural Incision Method".

Decompressive craniectomy (DC) is performed to alleviate intracranial hypertension as much as possible. There are two additional goals that surgeons should strive to achieve: minimization of operating time (i.e., the time issue) and avoidance of manually pushing on the surface of the bulging brain to prevent iatrogenic brain injury (i.e., "stuffing risk"). Many authors have made progress on the time issue, but stuffing risk remains largely unmitigated. We recently presented a new DC method that resolved both issues, but the incision design was too complicated for general use. A recent study has presented a duraplasty method that does not use watertight sutures and does not exacerbate the risk associated with DC. Employing the simplified method without sutures, we developed a new, easy-to-perform DC method that resolves stuffing risk. We analyzed the incision design geometrically and verified it by simulations generated with a physics engine. Three patients with massive cerebral infarction, subarachnoid hemorrhage, and hemorrhagic infarction underwent the new procedure. The targeted incision design was composed of four or five curved incision lines. Expansion of the dura resulted in transformation into a centroclinal form with spiral rifts and canopy. The dura expanded as expected in each case, and no cases required manual stuffing of the bulging brain. The operative time was acceptable, and no complications were reported. The concept of the incision design could be applied to any polygonal duraplasty in DC. We developed a new DC method that involves a simple and easily executed incision design, avoided stuffing risk.

[Epidemiological investigation of colonic diverticulosis detected by computed tomography colonography].

Among 586 patients who underwent computed tomography colonography (CTC) from May 2012 to September 2017, 333 were diagnosed with colonic diverticulosis. The incidence of colonic diverticulosis increases with age. Despite a high frequency of ascending colonic diverticulosis, multiple diverticulosis (>10 in a colonic segment) were the most frequent in the sigmoid colon. In previous studies, the frequency of detection of colonic diverticulosis by CTC was higher than that by colonoscopy and barium enema. In addition, using CTC, the detection rate of colonic diverticulosis has been recently increasing, suggesting that CTC is the most sensitive procedure for detecting colonic diverticulosis.

[A refractory case of ulcerative colitis developed after the cessation smoking achieved clinical and endoscopic remission after resuming smoking].

A 42-year-old man, who had stopped smoking almost one year ago, visited our hospital for hematochezia. He was diagnosed as having ulcerative colitis and was prescribed 5-amino salicylic acid and corticosteroids, which led to the remission of his disease. However, the disease relapsed after sufficient continuous corticosteroids administration and persisted despite 5-amino salicylic acid administration and intensive treatment with corticosteroids, immune modulators, leukocyte apheresis, and anti-TNF-α antibodies. Curiously, clinical remission was achieved after he resumed smoking, and colonoscopy revealed mucosal healing. Such remission may be attributable to anti-inflammatory effects of smoking nicotine and carbon oxides.

Diagnosis of a subarachnoid hemorrhage with only mild symptoms using computed tomography in Japan.

BACKGROUND: Japan is currently an aging society, with a huge proportion of elderly citizens. Consequently, the incidence and severity of subarachnoid hemorrhage (SAH) is predicted to increase in the future. Computed tomography (CT) is very important in the initial diagnosis of SAH. The proportion of hospitals owning CT systems in Japan is around four times greater than the mean number of systems owned by hospitals in other countries belonging to the Organisation for Economic Co-operation and Development. Because CT is readily available in Japan, it follows that this technique, with its impressive diagnostic power, might be more in demand in Japan compared to other countries. However, misdiagnosis of SAH is a relatively common problem and is associated with increased mortality and morbidity, even in individuals who initially present in good condition. CASE PRESENTATION: We describe a patient with subtle clinical and CT signs of SAH. A 39-year-old Japanese man visited our hospital with a 3-day history of mild headache, shoulder stiffness, and a feeling of dizziness. His physical examination was normal aside from mild neck stiffness. Although CT did not reveal obvious abnormalities, we noticed subtle signs of SAH on CT images, which have been observed in SAH patients with mild symptoms. Thus, we diagnosed our patient with SAH and provided appropriate treatment (aneurysm clipping). Following this, the patient progressed without development of the initial complications, and he was subsequently discharged from our hospital without sequela. CONCLUSION: Thus, physicians should be able to recognize subtle characteristics of CT imaging in case of SAH patients with low grade symptoms, as this can facilitate early diagnosis.

[A case of cavernous sinus aspergillosis].

We reported a case of cavernous sinus aspergillosis. A 62-year-old man complained of trigeminal neuralgia in the right V1 region. Neurological examination on admission showed ptosis, loss of light reflex and ophthalmoplegia externa in the right side. MRI enhanced with gadolinium demonstrated sphenoid sinusitis and mass lesion in the right cavernous sinus. MRA revealed right internal carotid artery occlusion. An open biopsy using the extradural temporopolar approach was performed. Pus discharge was observed from the cavernous sinus and histological examination showed hypha of Aspergillus. With early voriconazole treatment, the patient had improvement in headache, ptosis and ophthalmoplegia externa. Cavernous sinus aspergillosis is often found after sphenoiditis. It results in invasion to an internal carotid artery and worsens the patient's prognosis by cerebral infarction, so early diagnosis and treatment are important. We should consider aspergillosis as one of the differential diagnoses of a mass in the cavernous sinus. The epidural approach to this lesion was available to obviate aspergillus dissemination into the medullary cavity.

[Relationship between living arrangements and stroke in Sano-Kosei General Hospital].

We retrospectively reviewed the relationship between living arrangements and stroke in Sano-Kosei General Hospital, for the 3-year period from December, 2007 to November, 2010. The proportion of live-alone among stroke patients was 14.9% (131/877). The indirect standardized live-alone ratio (95% confidence interval), compared with Sano city's live-alone ratio as a standard group, was 1.34 (1.13-1.60). Among live-alone patients with stroke, sex ratio showed no significant difference (p=0.46). Comparing live-alones with non-live-alones in stroke patients, the mean age of live-alones was younger for men, but older for women (p<0.001). There was no significant difference between living arrangements and diseases risk factors. However, on the point of the mean number of risk factors, live-alones tended to have more risk factors than non-live-alones (p=0.032). Therefore, living arrangements are considered as an important factor for prevention of stroke.

Radiolytic cyclization of stem-and-loop structured oligodeoxynucleotide with neighboring arrangement of α,ω-bis-disulfides.

Upon X-ray irradiation of hypoxic aqueous solution, modified oligodeoxynucleotides (ODNs) bearing a pair of disulfides at both ends of the strand that forms a stem-and-loop structure with a neighboring arrangement of α,ω-bis-disulfides underwent efficient cyclization via an intramolecular exchange reaction at the disulfide moieties with a multiple turnover process. Mechanistic studies revealed that hydrogen atoms generated in the radiolysis of water are key active species initiating a chain reaction to produce cyclic ODN disulfides, in which addition of hydrogen atom results in dissociation of the original disulfide bond to generate a thiyl radical intermediate as the chain carrier for the succeeding disulfide exchange into cyclization. The properties were also assessed for the resultant cyclic ODN disulfide that has several favorable features for use in the transcriptional decoy strategy. The cyclic ODN disulfides produced by the present radiolytic method showed high thermal stability, resistance to nuclease, and high binding activity to a representative transcriptional factor of nuclear factor κB.

[A case of liposarcoma of the ascending colon mesenterium].

We encountered a rare case of liposarcoma of the ascending colon mesenterium. A 53-year-old man visited our hospital because of a mass, 12x8cm in diameter, in the right upper abdomen. On computed tomography (CT), the tumor showed irregular density with a smooth surface and was enhanced irregularly. A part of the tumor protruded into the colon in the upper portion of the ascending colon. The tumor was surgically resected by right hemicolectomy. Histological diagnosis of the tumor was well-differentiated liposarcoma, sclerosing variant. Radiological findings seemed to reflect the pathological findings well.

Usefulness of radiofrequency ablation with micro-convex probe for hepatocellular carcinoma.

BACKGROUND/AIMS: It was aimed to assess whether a micro-convex probe is superior to the present conventional probe for ultrasonography from the points of safety and efficacy during percutaneous radiofrequency ablation therapy for hepatocellular carcinoma. METHODOLOGY: Twenty-one patients with 23 hepatocellular carcinoma lesions who had one or 2 lesions, each 4 cm or less in diameter, and liver function of Child-Pugh class A or B were enrolled. All the patients except for 2 patients were seropositive for hepatitis C virus. Radiofrequency ablation was carried out under a real-time US guidance. The cooled-tip electrodes used were single and clustered. RESULTS: It was possible to perform safe and accurate percutaneous radiofrequency ablation procedure using micro-convex probes for the treatment of all hepatocellular carcinoma nodules. It was also possible to treat hepatocellular carcinoma located in the right subphrenic region without artificial pleural effusion under intercostal ultrasonography guide. Improved clustered needles were successfully applied to treat the nodules more than 3 cm in diameter with less resistance for penetration compared with the conventional needle. The findings of advanced dynamic flow image on ultrasonography to assess the therapeutic efficacy indicated the consistency with those of dynamic CT which was done 3 to 5 days later radiofrequency ablation. Major complication of radiofrequency ablation procedure was noted in none. CONCLUSIONS: These results suggest that micro-convex probe with clustered tips is superior to conventional probe for ultrasonography from the points of safety and efficacy during radiofrequency ablation for hepatocellular carcinoma nodule located in the right subphrenic region and for larger sized nodule more than 3 cm.

Radiolytic one-electron reductive cyclization of oligodeoxynucleotides possessing a disulfide bond.

Radiolytic one-electron reduction of oligodeoxynucleotides (ODNs) possessing a disulfide bond induced strand exchange reaction in a hypoxia selective manner. In this study, we attempted to apply this radiolytic reaction to stem-and-loop structured ODNs. Hypoxic X-irradiation to an aqueous solution of stem-and-loop structured ODNs produced a cyclized DNA in good yield via an intrastrand ligation reaction.

Warfare rather than agriculture as a critical influence on fires in the late Holocene, inferred from northern Vietnam.

Fire has played an essential role in the development of human civilization. Most previous research suggests that frequent-fire regimes in the late Holocene were associated with intensification of human activities, especially agriculture development. Here, we analyze fire regimes recorded in the Song Hong delta area of Vietnam over the past 5,000 years. In the prehistoric period, 2 long-term, low-charcoal abundance periods have been linked to periods of low humidity and cool climate, and 5 short-term fire regimes of 100-150 years in duration occurred at regular intervals of approximately 700 years. However, over the last 1,500 years, the number, frequency, and intensity of fire regimes clearly increased. Six intensified-fire regime periods in northern Vietnam during this time coincided with changes of Vietnamese dynasties and associated warfare and unrest. In contrast, agricultural development supported by rulers of stable societies at this time does not show a positive correlation with intensified-fire regime periods. Thus, warfare rather than agriculture appears to have been a critical factor contributing to fire regimes in northern Vietnam during the late Holocene.

Implications of excess 210Pb and 137Cs in sediment cores from Mikawa Bay, Japan.

Four sediment cores were collected from Mikawa Bay, Japan, and excess 210Pb and 137Cs were measured by gamma spectrometry. Sedimentation rates for the four cores were determined by 210Pb method. The sedimentation rate range is 0.10-0.70 g/(cm2 x year). The bio-mixing depth for each core is less than 7.0 cm, and was determined by the excess 210Pb profiles as well. Therefore, the bioturbation is slight. The 210Pb-derived dates coincided with the results from 137Cs geochronology. Acceleration in sedimentation rate due to environmental alteration has been found in cores A2.5 and 05AS8, representing two depocenters due to their topography. Evidence of the Tokai Flood in 2000 was found in core 05AS8 according to the profiles of both radioisotopes and trace metals.

Radiolytic ligation of oligodeoxynucleotides possessing disulfide bond.

Hypoxic X-radiolysis of diluted aqueous solutions was performed to generate hydrated electrons that induced one-electron reduction of oligodeoxynucleotides (ODNs) possessing a disulfide bond. Upon hypoxic irradiation, reductive ligation reaction between two types of ODNs occurred in the presence of a template ODN strand, resulting in the formation of a prescribed ODN in substantial amounts.

Papillary adenocarcinoma occurring in a gastric hyperplastic polyp observed by magnifying endoscopy and treated with endoscopic mucosal resection.

The patient was a 75-year-old man. He had been diagnosed with gastric hyperplastic polyp 4 years previously. The color of the apex of this polyp was whitish. Magnifying endoscopy findings revealed disappearance of the mucosal microstructure with irregular branched capillaries at the top of the polyp. Endoscopic mucosal resection (EMR) was performed. Histological examination revealed that a part of the polyp surface was replaced with papillary adenocarcinoma. Diagnosis of papillary adenocarcinoma in a hyperplastic polyp with mucosal invasion was made. Magnifying endoscopy was useful for the detection of gastric cancer occurring in the hyperplastic polyp in the present case.

Risk factors for local and distant recurrence of hepatocellular carcinomas after local ablation therapies.

BACKGROUND AND AIM: Hepatocellular carcinoma (HCC) recurs frequently after local ablation therapies. Recurrence following the therapies may be of two types: local recurrence and distant recurrence. The aim of the current study is to separately elucidate the predisposing factors for each recurrence. METHODS: Among the 2141 consecutive patients with HCC who were admitted to our institute and affiliated hospital between May 1997 and April 2004, 621 patients who had undergone local ablation therapies as the initial treatment were enrolled. Correlations between the clinical backgrounds of the patients and the type of recurrence were analyzed by the Cox proportional hazard model. RESULTS: A multivariate analysis revealed that tumor size (>30 mm; risk ratio 2.80; 95% confidence interval, 1.77-4.45; P < 0.0001), tumor number (> or =2; 1.74, 1.23-2.47, P = 0.002), and the serum alpha-fetoprotein level (>100 ng/mL; (1.62, 1.09-2.41, P = 0.014), which were classified as "tumor factors", were significant predisposing factors for the local recurrence of HCC. In contrast, a low platelet count (<100,000/microL; 1.34, 1.04-1.74, P = 0.03) and the presence of ascites (1.73, 1.16-2.57, P = 0.008), which were classified as "background factors", as well as tumor size (1.83, 1.11-3.01, P = 0.02) and tumor number (2.23, 1.72-3.00, P < 0.0001) were predisposing factors for distant recurrence. CONCLUSION: The predisposing factors for local and distant recurrence of HCC differ and different precautions must be observed to prevent recurrence, depending on the HCC status and background liver functions.

Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp.

We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection (EMR) was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma.

Stiffness evaluation of contacting surfaces by bulk and interface waves.

This paper describes ultrasonic measurements of normal and tangential stiffnesses of the contacting interface between polished aluminum blocks subjected to nominal contact pressures up to about 3.8 MPa. These stiffnesses were evaluated by ultrasonic spectroscopy methods for the bulk (longitudinal and transverse) wave reflection coefficients and the anti-symmetric mode interface wave velocity. The measurements revealed the interfacial stiffnesses as functions of the frequency as well as the applied contact pressure. The ratio of the tangential and normal stiffnesses is discussed in the light of foregoing theoretical and experimental findings. Furthermore, possible explanations for the frequency dependence of the measured stiffnesses are reviewed, invoking the spatial inhomogeneity of the interfacial stiffness as well as its lossy nature.

Expression of Toll-like receptors in chronic hepatitis C virus infection.

BACKGROUND: Toll-like receptors (TLRs) are involved in innate immunity. Certain viruses interact with TLRs and mediate antiviral effects as well as immune responses. The aim of this study was to investigate the effect of TLRs on pathogenesis in hepatitis C virus (HCV)-infected patients. METHODS: Peripheral blood mononuclear cells (PBMC) and CD14+ (monocytes) or CD14- cells from 25 patients with chronic liver disease and 15 healthy subjects were studied for expression of TLRs 2-9 and cytokines of extracted RNA using real-time PCR. Then TLR expression was examined in HepG2 cells transfected with entire or parts (core-NS3, NS3-NS5B) of the HCV open reading frame. TLR expression was calculated as the relative mRNA levels. RESULTS: Expression of TLRs 4, 7 and 8 in CD14+ cells of PBMC was increased in patients. Levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6 and IL-12 p35 for PBMC were also increased in patients. When PBMC were incubated with HCV core protein, enhancement of TLR2 expression and suppression of TLR4 and TLR7 were noted in patients. Similar alteration of TLRs expression was observed in controls. Among HepG2 transfectants, only TLR3 expression was changed; it was suppressed in entire gene transfectant and enhanced in core-NS3 transfectant. Expression of some proteins related to the TLR signaling pathway was suppressed in the entire gene transfectant. CONCLUSIONS: The results suggest a correlation between expression levels of TLRs and cytokines, and chronic HCV infection. TLR3 recognizes double-stranded RNA and induces type 1 interferon synthesis. Collectively, suppressed expression of TLR3 in cells transfected with entire HCV may be responsible for continuous HCV infection, although a part of the HCV gene enhances its expression.