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Background: Recent clinical studies suggest protective effects of SGLT2 inhibitors on kidney disease outcome. Chronic hypoxia has a critical role in kidney disease development, thus we speculated that canagliflozin, an SGLT2 inhibitor, can improve kidney oxygenation. Methods: A single-arm study was conducted to investigate the effects of canagliflozin on T2* value, which reflects oxygenation level, in patients with type 2 diabetes (T2D) using repeated blood oxygenation level-dependent MRI (BOLD MRI) examinations. Changes in cortical T2* frombefore (Day 0) to after single-dose treatment (Day 1) and after five consecutive treatments (Day 5) were evaluated using 12-layer concentric objects (TLCO) and region of interest (ROI) methods. Results: In the full analysis set (n=14 patients), the TLCO method showed no change of T2* with canagliflozin treatment, whereas the ROI method found that cortical T2* was significantly increased on Day 1 but not on Day 5. Sensitivity analysis using TLCO in 13 well-measured patients showed that canagliflozin significantly increased T2* on Day 1 with no change on Day 5, whereas a significant improvement in cortical T2* following canagliflozin treatment was found on both Day 1 and 5 using ROI. Conclusions: Short-term canagliflozin treatment may improve cortical oxygenation and lead to better kidney outcomes in patients with T2D. [ABSTRACT FROM AUTHOR]

Background/Aim: To evaluate the Spinal Instability Neoplastic Score (SINS) for prediction of survival in patients with spinal column metastasis of castration-resistant prostate cancer (CRPC). Patients and Methods: A retrospective study of spinal instability was performed in patients with CRPC using SINS. Overall survival was evaluated starting from the time of SINS evaluation. The subjects were 42 patients with CRPC among 261 cases diagnosed with metastatic spinal tumors by radiologists, among 42,152 cases that underwent a body computed tomography scan at Kawasaki Medical School Hospital within 32 months from December 2013 to July 2016. Results: The median age was 78 (range=55-91 years), the median prostate-specific antigen (PSA) level at SINS evaluation was 42.1 (0.1-3,121.6) ng/ml, and 11 patients had visceral metastasis. The median periods from diagnosis of bone metastasis and development of CRPC to SINS evaluation were 17 (0-158) and 20 (0-149) months, respectively. The spine was stable in 32 cases (group S) and potentially unstable or unstable in 10 (24%) (group U). The median observation period was 17.5 (0-83) months and 36 patients died. The median survival period after SINS evaluation was longer in group S than that in group U (20 vs. 10 months, p=0.0221). In multivariate analysis, PSA level, visceral metastasis, and spinal instability were significant prognostic factors. The hazard ratio for patients in group U was 2.60 (95%CI=1.07-5.93, p=0.0345). Conclusion: Spinal stability evaluated using SINS is a new prognostic factor for survival of patients with spinal metastasis of CRPC. [ABSTRACT FROM AUTHOR]

Highlights from the article: I met Dr Akira Yamamoto for the first time when I was a student at Shiga University of Medical Science, Graduate School. In addition, patients with FH, who have atherosclerotic cardiovascular disease at a young age, received tremendous benefit from statins by improving their prognosis dramatically. Dr Yamamoto's development of LDL apheresis enabled selective removal of LDL for the treatment of homozygous FH.

Highlights from the article: Professor Akira Yamamoto passed away on 7 January 2019. On the other hand, in Japan, the clinical studies and researches of the therapeutic apheresis had become popular because the late Professor Yukihiko Nosé and the late Dr Noboru Inoue applied membrane separation into apheresis treatments. Professor Yamamoto, Professor Horst Klinkmann, and Professor Nosé are in attendance.

Allogeneic transplantation of hematopoietic cells is the only curative therapy for several hematopoietic disease in which patients receive cytotoxic conditioning regimens followed by infusion of hematopoietic stem cells. Although the outcomes have improved over the past decades, graft-versus-host-disease (GVHD), the most common life-threatening complication, remains a major cause of non-relapse morbidity and mortality. Pathophysiology of acute GVHD characterized by host antigen-presenting cells after tissue damage and donor T-cells is well studied, and additionally the importance of recipient microbiota in the intestine is elucidated in the GVHD setting. Oral microbiota is the second most abundant bacterial flora in the body after the intestinal tract, and it is related to chronic inflammation and carcinogenesis. Recently, composition of the oral microbiome in GVHD related to transplantation has been characterized and several common patterns, dysbiosis and enrichment of the specific bacterial groups, have been reported. This review focuses on the role of the oral microbiota in the context of GVHD. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether readout-segmented echo-planar imaging (RS-EPI) diffusion-weighted imaging (DWI) can reduce image distortion and improve the lesion identification in parathyroid adenomas (PTAs) compared to single-shot EPI (SS-EPI) DWI, and to determine whether PTAs can be differentiated from other soft tissue structures of the head and neck region by using the apparent diffusion coefficient (ADC) value. Methods: We retrospectively analyzed the preoperative MR images including DWI of 24 patients with surgically confirmed PTA. RS-EPI and SS-EPI DWI were evaluated by two independent readers for the identification of the lesions and distortion. The ADC values of the PTAs were compared with those of thyroid glands and cervical lymph nodes. Results: RS-EPI provided significantly less distortion compared to SS-EPI. RS-EPI tended to have better lesion identification compared with SS-EPI without a statistically significant difference. On SS-EPI, the PTAs had significantly higher ADC values compared with the cervical lymph nodes. On RS-EPI, the PTAs had significantly higher ADC values compared with the thyroid glands and cervical lymph nodes. Conclusion: RS-EPI reduces the DWI distortion in PTAs. The ADC value obtained using RS-EPI enables the differentiation of PTAs from nearby structures, such as thyroid glands and cervical lymph nodes. [ABSTRACT FROM AUTHOR]

Objectives: Level of Care (LOC) determination is an important process of care planning for emotionally disturbed children and adolescents. As a tool of LOC determination, the Child and Adolescent Service Intensity Instrument (CASII) has been developed and tried to extend the usage out of the United States. As part of that effort, the CASII is currently being evaluated for its psychometric property in Japan. Methods: The CASII has been translated into Japanese, and then, 23 child psychiatrists and 70 nonpsychiatrist professionals who completed CASII training rated 7 vignettes to test inter-rater reliability. External validity was being evaluated by comparing the CASII ratings of 163 participants aged 6–17 against the Child Behavior Checklist (CBCL)/ Youth Self‑Report (YSR) and Child Global Assessment Scale (CGAS). Results: Inter-rater reliability among psychiatrists showed intra‑class correlation coefficients ranging from 0.63 to 0.91 and those by nonpsychiatrists from 0.42 to 0.80. Cronbach’s alpha was higher than 0.97 for both psychiatrists and nonpsychiatrists. The CASII ratings and LOC determination for 145 participants were significantly correlated with the Actual LOC and ratings of CBCL/YSR and CGAS except for the Internalizing Problem scores. There was no significant difference between LOC Recommended and Actual LOC. Conclusions: The Japanese version of the CASII showed fairly good inter-rater reliability and validity to use in the practice of mental health as well as child welfare in Japan. [ABSTRACT FROM AUTHOR]

In this study, we investigated the role of transient receptor potential melastatin 2 (TRPM2), a nonselective cation channel abundantly expressed in inflammatory cells such as macrophages, in the development of postoperative ileus, a complication of abdominal surgery characterized by gastrointestinal dysmotility. In wild-type mice, we found that intestinal manipulation, a maneuver that elicits symptoms typical of postoperative ileus, delays the transit of fluorescein-labeled dextran, promotes the infiltration of CD68+ macrophages, Ly6B.2+ neutrophils, and MPO+ cells into intestinal muscles, boosts expression of IL-1β, IL-6, TNF-α, iNOS, and CXCL2 in intestinal muscles and peritoneal macrophages, enhances phosphorylation of ERK and p38 MAPK in intestinal muscles, and amplifies IL-1β, IL-6, TNF-α, iNOS, and CXCL2 expression in resident and thioglycolate-elicited peritoneal macrophages following exposure to lipopolysaccharide. Remarkably, TRPM2 deficiency completely blocks or diminishes these effects. Indeed, intestinal manipulation appears to activate TRPM2 in resident muscularis macrophages and elicits release of inflammatory cytokines and chemokines, which, in turn, promote infiltration of macrophages and neutrophils into the muscle, ultimately resulting in dysmotility. NEW & NOTEWORTHY Activation of transient receptor potential melastatin 2 (TRPM2) releases inflammatory cytokines and chemokines, which, in turn, promote the infiltration of inflammatory cells and macrophages into intestinal muscles, ultimately resulting in dysmotility. Thus TRPM2 is a promising target in treating dysmotility due to postoperative ileus, a complication of abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: Malnutrition can adversely affect treatment responses and oncological outcomes in cancer patients. However, among patients with rectal cancer who undergo chemoradiotherapy (CRT), the significance of peri-treatment nutrition assessment as a predictor of treatment response and outcome remains unclear. Objective: The aim of this study was to determine whether the Prognostic Nutrition Index (PNI) based on peri-treatment serum can be used as a predictor of treatment response and outcome in patients with rectal cancer who undergo CRT. Design, Setting, and Patients: We analyzed 114 patients with rectal cancer who received preoperative CRT followed by total mesorectal excision at our institution. Results: Post-CRT PNI was significantly lower than pre-CRT PNI in rectal cancer patients. Although post-CRT PNI did not significantly correlate with either overall survival or disease-free survival, low pre-CRT PNI was significantly associated with shorter overall survival and disease-free survival in this population and was also an independent risk factor for ineffectiveness of long-course preoperative CRT. Finally, low pre-CRT PNIs were a stronger indicator of poor prognosis and early recurrence in patients with pathological lymph node metastasis (who generally need to receive postoperative chemotherapy), than in those with no pathological lymph node metastasis. Conclusion: Pretreatment PNI could be useful in evaluating and managing patients with rectal cancer who undergo CRT followed by curative resection. [ABSTRACT FROM AUTHOR]

Keywords: CO2; Formate; Iridium; Redox Flow Battery; XAFSBatteries. In their Research Article (e202310976), Ryoichi Kanega, Akira Yamamoto et al. report an aqueous redox flow battery using CO2 as an active material with a homogeneous Ir catalyst...By Ryoichi Kanega; Erika Ishida; Takaaki Sakai; Naoya Onishi; Akira Yamamoto; Hiroki Yasumura; Hisao Yoshida; Hajime Kawanami; Yuichiro Himeda; Yukari Sato and Akihiro OhiraReported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

Keywords: CO2; Formate; Iridium; Redox Flow Battery; XAFSBatteries. In their Research Article (e202310976), Ryoichi Kanega, Akira Yamamoto et al. report an aqueous redox flow battery using CO2 as an active material with a homogeneous Ir catalyst...By Ryoichi Kanega; Erika Ishida; Takaaki Sakai; Naoya Onishi; Akira Yamamoto; Hiroki Yasumura; Hisao Yoshida; Hajime Kawanami; Yuichiro Himeda; Yukari Sato and Akihiro OhiraReported by Author; Author; Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

To improve the transdermal bioavailability and safety of alendronate (ALN), a nitrogencontaining bisphosphonate, we developed self-dissolving microneedle arrays (MNs), in which ALN is loaded only at the tip portion of micron-scale needles by a dip-coating method (ALN(TIP)-MN). We observed micron-scale pores in rat skin just after application of ALN(TIP)-MN, indicating that transdermal pathways for ALN were created by MN. ALN was rapidly released from the tip of MNs as observed in an in vitro release study. The tip portions of MNs completely dissolved in the rat skin within 5 min after application in vivo. After application of ALN(TIP)-MN in mice, the plasma concentration of ALN rapidly increased, and the bioavailability of ALN was approximately 96%. In addition, the decrease in growth plate was effectively suppressed by this efficient delivery of ALN in a rat model of osteoporosis. Furthermore, no skin irritation was observed after application of ALN(TIP)-MN and subcutaneous injection of ALN, while mild skin irritation was induced by whole-ALN-loaded MN (ALN-MN)--in which ALN is contained in the whole of the micron-scale needles fabricated from hyaluronic acid--and intradermal injection of ALN. These findings indicate that ALN(TIP)-MN is a promising transdermal formulation for the treatment of osteoporosis without skin irritation. [ABSTRACT FROM AUTHOR]

Prediction of the intestinal absorption of new chemical entities (NCEs) is still difficult, in part because drug efflux transporters, including breast cancer resistance protein (BCRP) and P-glycoprotein (P-gp), restrict their intestinal permeability. We have demonstrated that the absorptive quotient (AQ) obtained from the in vitro Caco-2 permeability study would be a valuable parameter for estimating the impact of BCRP on the intestinal absorption of drugs. In this study, in order to assess the correlation between the in vitro AQ for BCRP and in vivo contribution of BCRP on drug absorption, we evaluated the oral absorption of various compounds by portalsystemic blood concentration (P-S) difference method in wild-type (WT), Bcrp(-/-), and Mdr1a/1b(-/-) mice. In addition, we also calculated a rate of BCRP contribution (Rbcrp). Ciprofloxacin and nitrofurantoin showed the low Rbcrp value (0.05 and 0.15), and their apparent fractions of intestinal absorption in WT mice were 46.5% and 63.7%, respectively. These results suggest that BCRP hardly affects their intestinal absorption in mice. On the other hand, the apparent fraction of intestinal absorption of topotecan and sulfasalazine was significantly lower in WT mice than in Bcrp(-/-) mice. Moreover, their Rbcrp values were 0.42 and 0.79, respectively, indicating the high contribution of BCRP to their oral absorption. Furthermore, in vivo Rbcrp calculated in this study was almost comparable to in vitro AQ obtained from Caco-2 permeability study. This study provides useful concepts in assessing the contribution of BCRP on intestinal absorption in drug discovery and development process. [ABSTRACT FROM AUTHOR]

Background: The relationship between the signal from retrograde venous flow on magnetic resonance angiography (MRA) and retrograde upward flow from the left brachiocephalic vein has not been explored.Purpose: To reveal the frequency of jugular venous reflux using MRA and nuclear venography in patients being evaluated for cerebral volume and blood flow.Material and Methods: A total of 229 patients with cognitive disturbance who had undergone brain magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) on the same day to evaluate cerebral blood flow were evaluated. Jugular venous reflux was measured on MRA and nuclear venography, which was conducted just after injection of N-isopropyl-123I-p-iodoamphetamine for the SPECT study.Results: MRA showed jugular reflux in seven patients on the right side, and in 22 on the left. Nuclear venography showed jugular reflux in six patients on the right side, and in 20 on the left.Conclusion: Jugular venous reflux was observed mostly on the left side. Retrograde flow was observed on both MRA and nuclear venography in half of the cases, with the rest only on one of the modalities. [ABSTRACT FROM AUTHOR]

Objective: To compare renal cortical thicknesses between patients with and without cirrhosis with normal renal function based on serum creatinine using non-contrast-enhanced steady-state, free precession (SSFP) MRI with spatially selective inversion recovery (IR) pulses and to discuss the clinical implications of measuring renal cortical thickness in patients with cirrhosis. Methods: 40 patients with and without cirrhosis who had normal renal function based on serum creatinine and underwent non-contrast-enhanced SSFP imaging with spatially selective IR pulses were included. The renal cortical thickness, renal width, renal cortical width ratio, serum creatinine levels and estimated glomerular filtration rates (eGFRs) were compared between cirrhotic and non-cirrhotic groups. Results: The mean renal cortical thickness was significantly lower in the cirrhotic group (3.6 ± 0.9 mm) than in the non-cirrhotic group (4.9 ± 0.8 mm; p < 0.001). The mean renal cortical width ratio was significantly lower in the cirrhotic group (0.07 ± 0.02) than in the non-cirrhotic group (0.10 ± 0.02; p < 0.001). The mean serum creatinine and mean eGFR did not show significant differences between the two groups. Conclusion: Measurement of renal cortical thickness by means of non-contrast-enhanced SSFP MRI with spatially selective IR pulses may help evaluate renal function accurately in patients with cirrhosis, in whom it may be overestimated by serum creatinine and eGFR. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to retrospectively evaluate the effectiveness of the model for end-stage liver disease (MELD) score compared with the Child-Pugh classification in patients who received three-dimensional conformal radiotherapy (3D CRT) for hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) by analyzing toxicity and prognostic factors. Methods: 56 consecutive patients who had locally advanced HCC with PVTT treated by 3D CRT between September 2007 and April 2013 were retrospectively reviewed. Results: The median survival time of all patients was 6.4 months. Receiver-operating characteristic (ROC) analysis identified MELD score = 7.5 [area under the curve (AUC) 0.81] and Child-Pugh score = 6.5 (AUC 0.86) as the best cut-off values for predicting the incidence of complications over Common Terminology Criteria for Adverse Events grade 2. There was no significant difference in the discrimination power between the MELD score and the Child-Pugh score on comparison of the two ROC curves (p = 0.17). On multivariate analysis, age, MELD score and radiotherapy dose were significant prognostic factors for overall survival (p = 0.021, 0.038 and 0.006, respectively). In contrast, the Child-Pugh classification, tumour response, PVTT response and the number of prior interventional radiologic treatments were not significant on multivariate analysis. Conclusion: This study showed that the best MELD score cut-off value is 7.5 and that the MELD score is a better prognostic factor than the Child-Pugh classification in 3D CRT for HCC with PVTT. Advances in knowledge: The MELD score is useful for predicting the risk of severe toxicities and the prognosis of patients treated with 3D CRT for PVTT. [ABSTRACT FROM AUTHOR]

Effective delivery of drug carriers selectively to the kidney is challenging because of their uptake by the reticuloendothelial system in the liver and spleen, which limits effective treatment of kidney diseases and results in side effects. To address this issue, we synthesized L-serine (Ser)-modified polyamidoamine dendrimer (PAMAM) as a potent renal targeting drug carrier. Approximately 82% of the dose was accumulated in the kidney at 3 h after i.v. injection of 111In-labeled Ser-PAMAM in mice, while i.v. injection of 111In-labeled unmodified PAMAM, L-threonine modified PAMAM, and L-tyrosine modified PAMAM resulted in kidney accumulations of 28%, 35%, and 31%, respectively. Single-photon emission computed tomography/computed tomography (SPECT/CT) images also indicated that 111In-labeled Ser-PAMAM specifically accumulated in the kidneys. An intrakidney distribution study showed that fluorescein isothiocyanate-labeled Ser-PAMAM accumulated predominantly in renal proximal tubules. Results of a cellular uptake study of Ser-PAMAM in LLC-PK1 cells in the presence of inhibitors [genistein, 5-(N-ethyl-N-isopropyl)amiloride, and lysozyme] revealed that caveolae-mediated endocytosis, micropinocytosis, and megalin were associated with the renal accumulation of Ser-PAMAM. The efficient renal distribution and angiotensin-converting enzyme (ACE) inhibition effect of captopril (CAP), an ACE inhibitor, was observed after i.v. injection of the Ser-PAMAM-CAP conjugate. These findings indicate that Ser-PAMAM is a promising renal targeting drug carrier for the treatment of kidney diseases. Thus, the results of this study demonstrate efficient renal targeting of a drug carrier via Ser modification. [ABSTRACT FROM AUTHOR]

Nora Trebesch, Christoph Tremblay, Mark Troya, Martinez, Marta Tsai, Tsung-Sheng Tsujiyama, Hitoshi Tukiainen, Janne Turhan, Bertan Tuzemen, Didem Ui, Takashi Ulyssea, Gabriel Uribe, Martin Ursino, Giovanni Ushchev, Philip Valentinyi, Akos Van Biesebroeck, Johannes van den Berg, Vincent A.C. van Rens, Thijs van Vuuren, Aico Van Zandt, Timothy Vardishvili, Oliko Vasey, Gabrielle Verbrugge, Randal Vidangos, Ivan Vohra, Akhil Voigtlaender, Nico Volosovych, Vadym Vuillemey, Guillaume Wan, Yuanyuan Wang, Erik H. Wang, Mengjie Wang, Wendun Wang, Xiao Yu Wang, Yikai Wang, Yu Wangner, Philipp Wasser, Cédric Watanabe, Makoto Watson, Mark Waugh, Mike Weber, Joerg Weber, Matthias Weber, Simon Wee, Shu Lin Weil, David Weinberger, Ariel Weiss, David Wen, Yi Weng, Xi Werner, Jan Werquin, Nicolas Wey, Christian White, Alexander Whitmeyer, Mark Wiczer, David Williams, Steven Winberry, Thomas Wiswall, Matthew Wolff, Jonathan Wolthoff, Ronald Woods, Daniel Wozniak, Abigail Wu, Jing Cynthia Xi, Xican Xiao, Erte Xing, Yiqing Xu, Haiqing Xu, Zhiwei Yakita, Akira Yamamoto, Yuichi Yang, Huanxing Yazici, Hakki Yeaple. Stephen Yedid-Levi, Yaniv Yehezkel, Yaron Yi, Kei-Mu Yildirim, Huseyin You, Wei Young, Eric Yue, Vivian Zabczyk, Pawel Zafar, Basit Zanetti, Francesco Zapal, Jan Zapechelnyuk, Andy Zecchetto, Franco Zennyo, Yusuke Zenou, Yves Zetlin-Jones, Ariel Zhang, Donghai Zhang, Jing Zhang, Junfu Zhang, Xingtan Zhong, Molin Zhou, Alex Zhou, Zhen Zhu, Shenghao Zhu Xiaodong Ziliak, James. [Extracted from the article]

The International Society for Apheresis (ISFA) and the Japanese Society for Apheresis (JSFA) joint meeting was held October 17-20, 2019, at the Kyoto International Conference Center. Breaking Event, Kagamiwari: Prof. Ken Yamaji (New Congress President of JSFA 2020), Prof. Andre Kaplan (New ISFA President), Prof. Yoshihiro Endo, Prof. Hidenori Matsuo (JSFA President), Prof. Hiroshi Tsuda (JSFA Adviser) Memorial Session for Prof. Akira Yamamoto: Prof. Hidenori Matsuo and Prof. Tadao Akizawa (Chairs). [Extracted from the article]

The article presents a study which aims to investigate the impact of trypsin on macromolecule transdermal delivery through the application of biochemical properties to the skin's stratum corneum. The study used various methods such as fluorescence spectrometry, high performance liquid chromatography (HPLC), and analysis of variance. It concludes that trypsin has a biochemical enhancer potential for the transdermal delivery of peptide and protein drugs.

The effects of polyethylene glycol 20000 (PEG 20000) on the intestinal absorption of prednisolone, methylprednisolone and quinidine, three P-glycoprotein (P-gp) substrates, across the isolated rat intestinal membranes were examined by an in-vitro diffusion chamber system. The serosal-to-mucosal (secretory) transport of these P-gp substrates was greater than their mucosal-to-serosal (absorptive) transport, indicating that their net movement across the intestinal membranes was preferentially in the secretory direction. The polarized secretory transport of these drugs was remarkably diminished and their efflux ratios decreased in the presence of PEG 20000. In addition, PEG 20000 did not affect the transport of Lucifer yellow, a non-P-gp substrate. The intestinal membrane toxicity of PEG 20000 was evaluated by measuring the release of alkaline phosphatase (ALP) and protein from the intestinal membranes. The release of ALP and protein was enhanced in the presence of 20 mM sodium deoxycholate (NaDC), a positive control, while these biological parameters did not change in the presence of 0.1–5% (w/v) PEG 20000. These findings indicated that the intestinal membrane damage caused by PEG 20000 was not a main reason for the enhanced absorptive transport of these P-gp substrates in the presence of PEG 20000. Furthermore, the transepithelial electrical resistance (TEER) of rat jejunal membranes in the presence or absence of PEG 20000 was measured by a diffusion chamber method. PEG 20000 (0.1–5.0 % w/v) did not change the TEER values of the rat jejunal membranes, indicating that the increase in the absorptive transport of these P-gp substrates might not be due to the increased transport of these P-gp substrates via a paracellular pathway caused by PEG 20000. Finally, the effect of PEG 20000 on the intestinal absorption of quinidine was examined by an in-situ closed-loop method. The intestinal absorption of quinidine was significantly enhanced in the presence of 0.1–1.0% (w/v) PEG 20000. These findings suggest that PEG 20000 might be a useful excipient to improve the intestinal absorption of quinidine, which is mainly secreted by a P-gp-mediated efflux system in the intestine. [ABSTRACT FROM AUTHOR]

Background: Chylous leakage is a well-known complication after esophagectomy, but cervical chylous leakage is relatively rare, and considerable controversy remains regarding the appropriate management strategies. We herein report a case of cervical chylous leakage treated successfully by lipiodol lymphangiography.Case Presentation: The patient, a 70-year-old man with middle thoracic esophageal cancer, underwent radical esophagectomy with 3-field lymph node dissection and subsequently developed cervical chylous leakage. From the second postoperative day (POD2), the amount of fluid in the cervical drainage tube increased by 200-300 ml/day. We started octreotide (300 μg/day) on POD5 and etilefrine (120 mg/day) on the POD6. However, the amount of cervical discharge did not decrease. We performed lipiodol lymphangiography on POD8. Thereafter, the amount of cervical discharge finally began to decrease. We removed the drainage tube on POD13, and the patient was discharged from the hospital on POD23.Conclusions: Our case suggests the clinical efficacy of lipiodol lymphangiography for cervical chylous leakage after esophagectomy. [ABSTRACT FROM AUTHOR]

Background: We present a case series of a palliative radiofrequency ablation (RFA) for the tumors that lead to the resolution of pain and motor function disorders. RFA is widely used on tumors in various organs and often reported in good outcome. There are some reports that RFA was performed as a palliative treatment but a few reports of RFA that performed for lung tumor as a palliative treatment. This case series includes two cases, palliative RFA for a sacrum and a lung tumor. The results of this case series presented that a palliative RFA is effective in improving the symptoms of patients. Case presentation: Case 1. A 64-year-old Japanese woman with a chordoma at her sacrum presented with pain in her left leg and claudication. Though operations, radiation therapy and GS-TAE (gelatin sponge-transarterial embolization, via the L5 lumbar artery) were performed, the size of the tumor leading pain and claudication increased. RFA was performed for the sacral tumor, and these symptoms resolved one year after the procedure. Case 2. A 68-year-old Japanese man with a leiomyosarcoma at the apex of left lung presented with pain and motor function disorders of the left upper limb. Dissemination in the pleura was appeared after the operation for a leiomyosarcoma at the mediastinum. Though radiation therapy and a second operation were performed, the tumor at the apex of the left lung increased and pain and numbness of the left upper limb were appeared after the second operation. RFA was performed for the left lung tumor, and the symptoms resolved 3 months after RFA. Conclusion: RFA is effective as a palliative treatment and has a potential to salvage the patients from the symptoms of the tumors when conventional palliative treatments such as surgery, radiation therapy, and chemotherapy are difficult or contraindicated. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the process of biliary excretion of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) into the biliary tract and to assess the accumulation patterns in the gallbladder using MR cholangiography obtained with Gd-EOB-DTPA which is a liver-specific hepatobiliary contrast agent. Seventy-five patients underwent Gd-EOB-DTPA enhanced MR imaging. Serial multiphasic hepatobiliary phase imaging was qualitatively reviewed to evaluate the process of the biliary excretion of contrast agent into the bile duct and the gallbladder. The accumulation pattern of contrast agent into gallbladder was classified into two groups (group 1 = orthodromic type and group 2 = delayed type). Furthermore, the results in differences of the presence of T1 hyperintense bile or sludge of gallbladder, gall stones, wall thickening of gallbladder, chronic liver disease, and liver cirrhosis between two groups were compared. Forty-eight of 75 patients (64%) were included in group 1, and remaining 27 (36%) were in group 2. The frequency of the presence of T1 hyperintense bile or sludge of gallbladder was significantly higher in patients with group 2 than that in patients with group 1(P = 0.041). MR cholangiography obtained with Gd-EOB-DTPA showed that there may be an association between the biliary accumulation pattern in the gallbladder and the pathological condition. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this study was to characterize the in vivo pharmacokinetics with the enterohepatic circulation (EHC) and identify the role of multidrug resistance-associated protein 2 (MRP2/Mrp2) in biliary excretion and absorption of ramatroban, a thromboxane A2 antagonist using a recirculatory model.Methods. Ramatroban was intravenously or orally administered to Sprague-Dawley rats (SDR) and Eisai hyperbilirubinemic rats (EHBR). Portal and systemic blood and bile samples were collected, and the drug concentrations were analyzed by high-performance liquid chromatography (HPLC) to estimate various global and local moments.Results. The bioavailability (BA) of ramatroban was estimated at 21.0% in SDR and 61.9% in EHBR. The local absorption ratio for the dosage after oral administration (Fdosagea) and the single-pass local absorption ratio for EHC (Fa`) in the rats were similar and nearly 100%. The hepatic recovery ratio (Fh) and the single-pass biliary excretion ratio through the liver for the sum of ramatroban and its glucuronides (Fb) in EHBR were 61.4% and 8.88%, respectively, which differed considerably from those in SDR (15.0% and 22.4%). The difference in hepatic elimination between these strains would be caused, at least in part, by the reduced biliary excretion in EHBR, although the biliary excretion was not completely impaired.Conclusions. Ramatroban may be excreted by multiple transport systems, followed by efficient enterohepatic reabsorption in both strains. The results suggest that ramatroban may not be susceptible to drug-drug interaction involving MRP2/Mrp2 in biliary excretion and absorption. [ABSTRACT FROM AUTHOR]