Endoscopic submucosal dissection for superficial esophageal neoplasms using the stag beetle knife.

Endoscopic submucosal dissection (ESD) is an accepted standard treatment for early gastric cancer but is not widely used in the esophagus because of technical difficulties. To increase the safety of esophageal ESD, we used a scissors-type device called the stag beetle (SB) knife. The aim of this study was to determine the efficacy and safety of ESD using the SB knife. We performed a single-center retrospective, uncontrolled trial. A total of 38 lesions were excised by ESD from 35 consecutive patients who were retrospectively divided into the following two groups according to the type of knife used to perform ESD: the hook knife (hook group) was used in 20 patients (21 lesions), and the SB knife (SB group) was used in 15 patients (17 lesions). We evaluated and compared the operative time, lesion size, en bloc resection rate, pathological margins free rate, and complication rate in both groups. The operative time was shorter in the SB group (median 70.0 minutes [interquartile range, 47.5-87.0]) than in the hook group (92.0 minutes [interquartile range, 63.0-114.0]) (P = 0.019), and the rate of complications in the SB group was 0% compared with 45.0% in the hook group (P = 0.004). However, the lesion size, en bloc resection rate, and pathological margins free rate did not differ significantly between the two groups. In conclusion, ESD using the SB knife was safer than that using a conventional knife for superficial esophageal neoplasms.

Shark depredation: future directions in research and management.

Shark depredation is a complex social-ecological issue that affects a range of fisheries worldwide. Increasing concern about the impacts of shark depredation, and how it intersects with the broader context of fisheries management, has driven recent research in this area, especially in Australia and the United States. This review synthesises these recent advances and provides strategic guidance for researchers aiming to characterise the occurrence of depredation, identify the shark species responsible, and test deterrent and management approaches to reduce its impacts. Specifically, the review covers the application of social science approaches, as well as advances in video camera and genetic methods for identifying depredating species. The practicalities and considerations for testing magnetic, electrical, and acoustic deterrent devices are discussed in light of recent research. Key concepts for the management of shark depredation are reviewed, with recommendations made to guide future research and policy development. Specific management responses to address shark depredation are lacking, and this review emphasizes that a "silver bullet" approach for mitigating depredation does not yet exist. Rather, future efforts to manage shark depredation must rely on a diverse range of integrated approaches involving those in the fishery (fishers, scientists and fishery managers), social scientists, educators, and other stakeholders.

Sensory systems in sawfishes. 1. The ampullae of Lorenzini.

The distribution and density of the ampullary electroreceptors in the skin of elasmobranchs are influenced by the phylogeny and ecology of a species. Sensory maps were created for 4 species of pristid sawfish. Their ampullary pores were separated into pore fields based on their innervation and cluster formation. Ventrally, ampullary pores are located in 6 areas (5 in Pristis microdon), covering the rostrum and head to the gills. Dorsally, pores are located in 4 areas (3 in P. microdon), which cover the rostrum, head and may extend slightly onto the pectoral fins. In all species, the highest number of pores is found on the dorsal and ventral sides of the rostrum. The high densities of pores along the rostrum combined with the low densities around the mouth could indicate that sawfish use their rostrum to stun their prey before ingesting it, but this hypothesis remains to be tested. The directions of ampullary canals on the ventral side of the rostrum are species specific. P. microdon possesses the highest number of ampullary pores, which indicates that amongst the study species this species is an electroreception specialist. As such, juvenile P. microdon inhabit low-visibility freshwater habitats.

Neck Location on the Outer Convexity is a Predictor of Incomplete Occlusion in Treatment with the Pipeline Embolization Device: Clinical and Angiographic Outcomes.

BACKGROUND AND PURPOSE: With the increasing use of the Pipeline Embolization Device for the treatment of aneurysms, predictors of clinical and angiographic outcomes are needed. This study aimed to identify predictors of incomplete occlusion at last angiographic follow-up. MATERIALS AND METHODS: In our retrospective, single-center cohort study, 105 ICA aneurysms in 89 subjects were treated with Pipeline Embolization Devices. Patients were followed per standardized protocol. Clinical and angiographic outcomes were analyzed. We introduced a new morphologic classification based on the included angle of the parent artery against the neck location: outer convexity type (included angle, <160°), inner convexity type (included angle, >200°), and lateral wall type (160° ≤ included angle ≤200°). This classification reflects the metal coverage rate and flow dynamics. RESULTS: Imaging data were acquired in 95.3% of aneurysms persistent at 6 months. Complete occlusion was achieved in 70.5%, and incomplete occlusion, in 29.5% at last follow-up. Multivariable regression analysis revealed that 60 years of age or older (OR, 5.70; P = .001), aneurysms with the branching artery from the dome (OR, 10.56; P = .002), fusiform aneurysms (OR, 10.2; P = .009), and outer convexity-type saccular aneurysms (versus inner convexity type: OR, 30.3; P < .001; versus lateral wall type: OR, 9.71; P = .001) were independently associated with a higher rate of incomplete occlusion at the last follow-up. No permanent neurologic deficits or rupture were observed in the follow-up period. CONCLUSIONS: The aneurysm neck located on the outer convexity is a new, incomplete occlusion predictor, joining older age, fusiform aneurysms, and aneurysms with the branching artery from the dome. No permanent neurologic deficits or rupture was observed in the follow-up, even with incomplete occlusion.

Electrosensory Impairment in the Atlantic Stingray, Hypanus sabinus, After Crude Oil Exposure.

Elasmobranchs are renowned for their extremely sensitive electrosensory system, which is used to detect predators, prey, and mates, and is possibly used for navigation. The proper functioning of the electrosensory system is thus critical to fitness. The objective of this study was to test whether exposure to crude oil impairs the electroreceptive capabilities of elasmobranch fishes. Electrosensory function was quantified from six stingrays before and after exposure to a concentration of oil that mimicked empirically measured concentrations along the coast of Louisiana following the Deepwater Horizon spill. Orientation distance (cm), and angle with respect to the dipole axis of a prey-simulating electric field were used to derive the electric field intensity that elicited a response. Oil exposed stingrays continued to exhibit feeding behavior, but they initiated orientations to prey-simulating electric fields from a significantly closer orientation distance. The mean orientation distance after oil exposure was 5.29 ± 0.41 SE cm compared to a pre-exposure orientation distance of 7.16 ± 0.66 SE cm. Stingrays required a mean electric field intensity of 0.596 ± 0.21 SE µV cm-1 to initiate a response after oil exposure, compared to a mean of only 0.127 ± 0.03 SE µV cm-1 in uncontaminated seawater. Oil exposed stingrays thus exhibited a response to a stimulus approximately 4.7 times greater than controls. Stingrays impacted by an oil spill appear to experience reduced electrosensory capabilities, which could detrimentally impact fitness. This study is the first to quantify the effects of crude oil on behavioral electrosensory function.

Predictors of Cerebral Aneurysm Rupture after Coil Embolization: Single-Center Experience with Recanalized Aneurysms.

BACKGROUND AND PURPOSE: Recanalization after coil embolization is widely studied. However, there are limited data on how recanalized aneurysms rupture. Herein, we describe our experience with the rupture of recanalized aneurysms and discuss the type of recanalized aneurysms at greatest rupture risk. MATERIALS AND METHODS: A total of 426 unruptured aneurysms and 169 ruptured aneurysms underwent coil embolization in our institution between January 2009 and December 2017. Recanalization occurred in 38 (8.9%) of 426 unruptured aneurysms (unruptured group) and 37 (21.9%) of 169 ruptured aneurysms (ruptured group). The Modified Raymond-Roy classification on DSA was used to categorize the recanalization type. Follow-up DSA was scheduled until 6 months after treatment, and follow-up MRA was scheduled yearly. If recanalization was suspected on MRA, DSA was performed. RESULTS: In the unruptured group, the median follow-up term was 74.0 months. Retreatment for recanalization was performed in 18 aneurysms. Four of 20 untreated recanalized aneurysms (0.94% of total coiled aneurysms) ruptured. In untreated recanalized aneurysms, class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .025). In the ruptured group, the median follow-up term was 28.0 months. Retreatment for recanalization was performed in 16 aneurysms. Four of 21 untreated recanalized aneurysms (2.37% of total coiled aneurysms) ruptured. Class IIIb aneurysms ruptured significantly more frequently than class II and IIIa (P = .02). CONCLUSIONS: The types of recanalization after coil embolization may be predictors of rupture. Coiled aneurysms with class IIIb recanalization should undergo early retreatment because of an increased rupture risk.

Enhanced visual fields in hammerhead sharks.

Several factors that influence the evolution of the unusual head morphology of hammerhead sharks (family Sphyrnidae) are proposed but few are empirically tested. In this study we tested the 'enhanced binocular field' hypothesis (that proposes enhanced frontal binocularity) by comparison of the visual fields of three hammerhead species: the bonnethead shark, Sphyrna tiburo, the scalloped hammerhead shark, Sphyrna lewini, and the winghead shark, Eusphyra blochii, with that of two carcharhinid species: the lemon shark, Negaprion brevirostris, and the blacknose shark, Carcharhinus acronotus. Additionally, eye rotation and head yaw were quantified to determine if species compensate for large blind areas anterior to the head. The winghead shark possessed the largest anterior binocular overlap (48 deg.) and was nearly four times larger than that of the lemon (10 deg.) and blacknose (11 deg.) sharks. The binocular overlap in the scalloped hammerhead sharks (34 deg.) was greater than the bonnethead sharks (13 deg.) and carcharhinid species; however, the bonnethead shark did not differ from the carcharhinids. These results indicate that binocular overlap has increased with lateral head expansion in hammerhead sharks. The hammerhead species did not demonstrate greater eye rotation in the anterior or posterior direction. However, both the scalloped hammerhead and bonnethead sharks exhibited greater head yaw during swimming (16.9 deg. and 15.6 deg., respectively) than the lemon (15.1 deg.) and blacknose (15.0 deg.) sharks, indicating a behavioral compensation for the anterior blind area. This study illustrates the larger binocular overlap in hammerhead species relative to their carcharhinid sister taxa and is consistent with the 'enhanced binocular field' hypothesis.

Seasonal dynamics of dental sexual dimorphism in the Atlantic stingray Dasyatis sabina

Cartilaginous fishes continuously replace their teeth throughout their life (polyphyodonty) and often show a sexually dimorphic dentition that was previously thought to be an invariant sex character. Radial vector analysis of tooth shape in the polyphyodontic stingray Dasyatis sabina across a consecutive 24 month period shows a stable molariform morphology for females but a periodic shift in male dentition from a female-like molariform to a recurved cuspidate form during the reproductive season. The grip tenacity of the male dentition is greater for the cuspidate form that occurs during the mating season than for the molariform dentition that occurs during the non-mating season. Dental sexual dimorphism and its sex-dependent temporal plasticity probably evolved via polyphyodontic preadaptation under selective pressures on both sexes for increased feeding efficiency and sexual selection in males to maximize mating success. These phenomena are important considerations for the identification and classification of cartilaginous fishes and possibly other polyphyodontic vertebrates in the fossil record.

Are serum progesterone levels predictive of recurrent miscarriage in future pregnancies?

OBJECTIVE: To examine the predictive value of midluteal serum P as a marker of a luteal phase defect (LPD) in future pregnancies of recurrent aborters. DESIGN: Prospective analysis. SETTING: Nagoya City University Hospital. PATIENT(S): One hundred ninety-seven women with a history of two consecutive first trimester abortions, none of whom had any other medical problems or an identifiable cause of recurrent miscarriages, such as uterine anomalies or evidence of antiphospholipid antibodies. None of the study subjects received any medication for miscarriage or infertility. MAIN OUTCOME MEASURE(S): A midluteal phase single serum P level < 10 ng/mL was used as the criterion for a potential LPD: those whose subsequent pregnancy was successful and those in which failure was the end result. RESULT(S): Of the 197 patients, 46 (23.4%) demonstrated LPD without other endocrine abnormalities and 38 (19.3%) recurrent aborters suffered another abortion, with figures for LPD-negative and LPD-positive patients of 20.5% (31/151) and 15.2% (7/46), respectively. There was no statistically significant difference between the two groups. CONCLUSION(S): Progesterone, E2, and the P/E2 ratio may not predict future pregnancy loss in recurrent aborters.

Successful management of congenital protein C deficiency with recurrent pregnancy loss.

A 29-year-old woman experienced unexplained intrauterine fetal death (IUFD) three times, at 16, 27 and 27 gestational weeks. She was found to be protein C-deficient and the existence of infarction in the placenta was suspected at 20 weeks' gestation during her fourth pregnancy. Both heparin and antithrombin III were administered until delivery of a small-for-dates but live baby. Massive infarction in the placenta was evident at term. Anticoagulation with heparin is a useful treatment approach for cases of recurrent IUFD with protein C deficiency.

Electroreception in the euryhaline stingray, Dasyatis sabina.

This study quantified the electrosensitivity of a euryhaline elasmobranch, the Atlantic stingray (Dasyatis sabina) across a range of salinities. Specimens from a permanent freshwater (FW) population in the St Johns River system, FL, USA, were compared with stingrays from the tidally dynamic Indian River Lagoon in east Florida, USA. Behavioral responses of stingrays to prey-simulating electric stimuli were quantified in FW (0 p.p.t., rho=2026 Omega cm), brackish (15 p.p.t., rho=41 Omega cm) and full strength seawater (35 p.p.t., rho=19 Omega cm). This study demonstrated that the electrosensitivity of D. sabina is significantly reduced in FW. In order to elicit a feeding response, stingrays tested in FW required an electric field 200-300x greater than stingrays tested in brackish and saltwater (median FW treatments=1.4 microV cm(-1), median brackish-saltwater treatments=6 nV cm(-1)), and the maximum orientation distance was reduced by 35.2%, from 44.0 cm in the brackish and saltwater treatments to 28.5 cm in FW. The St Johns River stingrays did not demonstrate an enhanced electrosensitivity in FW, nor did they exhibit reduced sensitivity when introduced to higher salinities. Stingrays from both populations responded similarly to the prey-simulating stimulus when tested at similar salinities, regardless of their native environment. The reduction in electrosensitivity and detection range in FW is attributed to both an environmental factor (electrical resistivity of the water) and the physiological function of the ampullary canals. The plasticity of this sensory system to function across such a wide environmental range demonstrates its adaptive significance.

Clinical evaluation of immunotherapy in early pregnancy with x-irradiated paternal mononuclear cells for primary recurrent aborters.

OBJECTIVE: The purpose of this study was to evaluate the beneficial effect of immunotherapy for the treatment of recurrent abortion. STUDY DESIGN: We immunized 106 primary recurrent aborters, twice at around 5 and 7 weeks of gestation, with intradermal injection of approximately 100 to 200 million x-irradiated (50 Gy) paternal mononuclear cells. We injected another 38 primary recurrent aborters in the same manner with only 1 million such paternal cells, to examine the relationship between the paternal cell dose used for immunization and pregnancy outcome. RESULTS: The pregnancy success rate (83.0%) in patients immunized with a large number of cells was significantly higher than that (55.3%) in those immunized with a small number of cells (p < 0.001). Furthermore, the frequency of twins in the former group was high (5.7%, five of 88). CONCLUSION: This positive relationship between the paternal cell dose used for immunization in early pregnancy and the pregnancy outcome reflects the efficacy of this mode of immunotherapy for recurrent aborters.

Capnocytophaga haemolytica sp. nov. and Capnocytophaga granulosa sp. nov., from human dental plaque.

Two new Capnocytophaga species, for which we propose the names Capnocytophaga haemolytica and Capnocytophaga granulosa, were isolated from supragingival dental plaque of adults. The phenotypic characteristics of these organisms were the same as those of the genus Capnocytophaga: gram-negative rods; CO2 requirement; gliding motility; catalase negative; oxidase negative; acids produced from D-glucose, D-maltose, D-mannose, and D-sucrose; and acetate and succinate are the major end products of glucose fermentation. In addition, the cellular fatty acid contents and menaquinones of both species were similar to the cellular fatty acid contents and menaquinones of other Capnocytophaga species. Nevertheless, the levels of DNA-DNA relatedness of the two new species to each other and to other Capnocytophaga species were less than 20%. Two notable characteristics of C. haemolytica are the presence of hemolytic activity and the lack of aminopeptidase activity. C. granulosa has granular inclusions in its cells and grows aerobically. The type strains of C. haemolytica and C. granulosa are A0404 (= JCM 8565) and B0611 (= JCM 8566), respectively.

Congenital angiotropic lymphoma (intravascular lymphomatosis) of the T-cell type.

The autopsy of a stillborn infant showed an extensive intravascular proliferation of atypical cells throughout the body. There was no infiltration by these cells of the parenchyma of the bone marrow, lymph nodes, or thymus. By histochemistry, these cells were negative for naphthol-ASD-chloroacetate esterase, a marker of granulocytes. By immunohistochemistry, they were reactive with MT-1 and anti-Leu-22, but unreactive with MB-1, L26, anti-Leu-M1, Tü-9, and antihemoglobin antibodies. A few cells reacted with antileukocyte common antigen and UCHL-1. Based on these findings, the lesion was diagnosed as angiotropic lymphoma (intravascular lymphomatosis) of the T-cell type, which occurred congenitally. Most angiotropic lymphomas in the literature are of the B-cell type, and no leukemia virus type I antibody was negative in the mother.

Preconceptional natural-killer-cell activity as a predictor of miscarriage.

There is no immunological test for the prospective identification of alloimmune causes of miscarriage. We investigated whether activity of natural killer cells was predictive of subsequent abortion in women who had had unexplained recurrent abortions and had received no treatment. 24 women with high preconceptional NK activity, defined as mean plus 1 SD of NK activity of 47 controls, had a significantly higher abortion rate in the next pregnancy than 44 women with normal levels of NK activity (71 vs 20%; relative risk 3.5; 95% CI 1.8-6.5). The preconceptional evaluation of NK activity in women with recurrent miscarriages may thus be predictive of the risk of pregnancy loss at the next conception.

Prevalence of autoantibodies in patients with recurrent miscarriages.

PROBLEM: It is well known that the prevalence of several autoantibodies is higher in patients with recurrent miscarriages than in normal women. However, links between individual autoantibodies are unclear. The present study focuses on the possible association between beta 2-glycoprotein I (beta 2-GPI)-dependent anticardiolipin antibody (aCL), lupus anticoagulant (LA), and antinuclear antibody (ANA) in patients with recurrent miscarriages. METHOD OF STUDY: Three hundred and one patients, with a history of two or more unexplained miscarriages, were studied. The titers of beta 2-GPI-dependent aCL and LA were then compared between single-antibody-positive and three-antibody-positive groups. RESULTS: The prevalences of beta 2-GPI-dependent aCL, LA, and ANA were 3.3, 10.0, and 25.2%, respectively. Four of the 301 patients had all three antibodies. The LA titers in patients with positive values for three antibodies was significantly higher than in cases with only LA. CONCLUSION: beta 2-GPI-dependent aCL, LA, and ANA define three distinct, but partly related populations in patients with recurrent miscarriage. We should test at least two kinds of autoantibodies in recurrent aborters, because it has been found that, e.g., beta 2-GPI-dependent aCL and LA are predictors for miscarriages.

Successful pregnancy in a Churg-Strauss syndrome patient with a history of intrauterine fetal death.

Allergic granulomatosis and angiitis was first reported as a disease entity separate from polyarteritis nodosa in 1951 by Churg and Strauss. It is characterized by bronchial asthma, eosinophilia, and vasculitis and is especially rare in women of reproductive age, though, when present, may be associated with fetal mortality in pregnancy. We report a successful pregnancy in a patient who previously experienced intrauterine fetal death at 30 weeks of gestation.

Clinical trial of immunostimulation with a biological response modifier in unexplained recurrent spontaneous abortion patients.

We determined clinically whether a killed streptococcal preparation (KSP), a biological response modifier, is as effective as paternal lymphocyte immunotherapy for unexplained recurrent pregnancy abortion (RSA) therapy. The success rate of adverse pregnancy in the study group of 23 RSA cases, who were administered low doses of KSP before and during early pregnancy, was statistically compared with that in a control group of 205 women who received paternal lymphocyte immunotherapy. The association of natural killer (NK) cell activity in the peripheral blood with pregnancy outcome was also assessed. The success rate in the study group was 73.9% (17/23), compared to 75.1% (154/ 205) observed for the controls (not significant). Most of the successful cases exhibited low levels of NK cell activity in the peripheral blood. Immunotherapy with low doses of KSP is as effective as that with paternal lymphocytes, providing a simple and safe alternative therapy for unexplained RSA. Suppression of NK cell activity by some immunoregulatory mechanism was also found to have potential benefit in terms of a successful pregnancy outcome.

Biochemical examination of mother's urine is useful for prenatal diagnosis of Bartter syndrome.

Bartter syndrome is characterized by renal potassium and chloride loss, hypokalaemia, hypochloraemic metabolic alkalosis and increased plasma renin activity along with elevated angiotensin II and hyperaldosteronism. For diagnosis we conducted biochemical examinations of both amniotic fluid and the mother's urine. Except for potassium, amniotic fluid electrolytes in a mother with a fetus with Bartter syndrome were high. Urinary chloride, sodium and calcium were very low. Thus, the latter parameters may allow prediction of fetal Bartter syndrome during the prenatal period.

Low serum M-CSF levels are associated with unexplained recurrent abortion.

PROBLEM: The purpose of this study was to determine whether the serum macrophage-colony stimulating factor (M-CSF) level is associated with early pregnancy loss in unexplained recurrent spontaneous abortion (RSA) patients. METHOD: We therefore compared preconceptional serum M-CSF levels between unexplained RSA patients and controls. The former comprised 44 bed-rest therapy patients and 43 intradermal immunization (IDI) patients receiving paternal lymphocyte therapy, who had experienced two and three or more consecutive first-trimester pregnancy losses, respectively. The controls were 46 healthy non-pregnant women. We also prospectively studied the association between M-CSF levels during pregnancy and adverse pregnancy outcomes. Sera from a total of 31 pregnant women, including 16 of the bed-rest therapy group and 15 of the IDI therapy group, were collected at the 4th, 6th, and 8th gestational weeks and were measured for M-CSF levels, using the enzyme-linked immunoadsorbent assay (ELISA) method established by Hanamura et al. RESULTS: Serum M-CSF levels were significantly lower in the non-pregnant RSA patients (460.0 +/- 185.6 U/ml; mean +/- SD) than in the control group (726.5 +/- 134.0 U/ml) and also were lower at the 8th, but not the 4th or 6th gestational week in those patients of both the bed-rest and IDI therapy groups whose outcome was pregnancy failure. CONCLUSION: Thus a low level of serum M-CSF was found to be associated with unexplained recurrent pregnancy loss in both the preconceptional and conceptional phases. These results raise the possibility that M-CSF may play an important role in the maintenance of pregnancy and that it can be used as a parameter for determining individuals at risk.