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• Pure ground-glass nodule with mediastinal lymph node metastases is rare. • Micropapillary component of lung adenocarcinoma is the risk of mediastinal lymph node metastases and poor prognosis. • The necessity of lymph node dissection of lung adenocarcinoma presenting as pure GGNs is unclear. Generally, lung cancer representing as Ground-glass nodules is associated with an early stage and good prognosis. However, we herein report a rare case of pure ground-glass nodules with mediastinal lymph node metastases. A 69-year-old man underwent video assisted thoracic surgery right upper lobectomy with mediastinal lymph node dissection due to multifocal Ground-glass nodules in the right upper lobe of the lung. Histopathologically, six lung adenocarcinomas were present simultaneously. Furthermore, we detected mediastinal lymph nodes metastases that contain micropapillary component. The lung lesion containing micropapillary component was a pure Ground-glass nodule that adjoining pulmonary bulla on CT findings. Generally, lung cancer presenting as pure ground-glass nodules is associated with an early stage and good prognosis. However, the necessity of evaluating the mediastinal lymph nodes in pure ground-glass nodules is controversial. It is reported that lung cancer adjoining the wall of a bulla tends to have a poor prognosis, even when small in size. Therefore, Ground-glass nodules with metastases might have a different pathogenesis than other nodules. Adenocarcinoma appearing as pure Ground-glass nodules is associated with early stage lung cancer and a good prognosis. However, the findings in our patient indicate the importance and necessity of evaluating the mediastinal lymph nodes for metastases intraoperatively. [ABSTRACT FROM AUTHOR]

Highlights • Block- and trial-based proactive inhibition can be two modes of slowing behavioral reaction according to contexts. • We established a novel stop-signal task to evaluate the block- and trial-based proactive inhibition separately in rats. • Neural activity in M1, M2, PPC and OFC neurons was differently modulated under the two types of proactive inhibition. • Therefore, different cortical mechanisms may underlie the two types of proactive inhibition in rodents. Abstract Animals can suppress their behavioral response in advance according to changes in environmental context (proactive inhibition: delaying the start of response), a process in which several cortical areas may participate. However, it remains unclear how this process is adaptively regulated according to contextual changes on different timescales. To address the issue, we used an improved stop-signal task paradigm to behaviorally and electrophysiologically characterize the temporal aspect of proactive inhibition in head-fixed rats. In the task, they must respond to a go cue as quickly as possible (go trial), but did not have to respond if a stop cue followed the go cue (stop trial). The task alternated between a block of only go trials (G-block) and a block of go-and-stop trials (GS-block). We observed block-based and trial-based proactive inhibition (emerging in GS-block and after stop trial, respectively) by behaviorally evaluating the delay in reaction time in correct go trials depending on contextual changes on different timescales. We electrophysiologically analyzed task-related neuronal activity in the primary and secondary motor, posterior parietal, and orbitofrontal cortices (M1, M2, PPC, and OFC, respectively). Under block-based proactive inhibition, spike activity of cue-preferring OFC neurons was attenuated continuously, while M1 and M2 activity was enhanced during motor preparation. Subsequently, M1 activity was attenuated during motor decision/execution. Under trial-based proactive inhibition, the OFC activity was continuously enhanced, and PPC and M1 activity was also enhanced shortly during motor decision/execution. These results suggest that different cortical mechanisms underlie the two types of proactive inhibition in rodents. [ABSTRACT FROM AUTHOR]

• Thymic papillary adenocarcinoma is extremely rare. • Further, thymic papillary adenocarcinoma coexisting with type A thymoma is extremely rare. • Surgery remains the only effective treatment for this disease. • We performed minimally invasive VATS approach. Thymic papillary adenocarcinoma is rare. Further, thymic papillary adenocarcinoma coexisting with type A thymoma is extremely rare. Surgery remains the only effective treatment for this disease. An 84-year-old Japanese woman presented to our institute due to abnormal chest computed tomography (CT) findings showing a 45 × 40 × 40-mm tumor located in the anterior mediastinum. A malignant tumor was suspected based on the CT findings and high serum levels of carcinoembryonic antigen. Mediastinal tumor resection was performed via video-assisted thoracic surgery through the left thoracic approach. This patient was discharged from our institute without any problems at six days post-operation. This report has three major implications. First, one of the tumors was papillary adenocarcinoma. Primary papillary adenocarcinoma of the thymus is exceedingly rare. Second, papillary adenocarcinoma and type A thymoma coexisted in this tumor. Third, epithelial thymic tumor should be resected completely, since complete resection has been reported to be associated with an improved prognosis. We encountered a rare case of thymic papillary adenocarcinoma coexisting with type A thymoma. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: Gallstone ileus (GI) results from the passage of a stone through a cholecystoenteric fistula, subsequently causing a bowel obstruction. The ideal treatment procedure for GI remains controversial. PRESENTATION OF CASE: A 63-year-old female was admitted to our hospital following persistent nausea and vomiting for 7 days. Computed tomography revealed a partially calcified 4-cm circular object in the jejunum, and the proximal intestine was dilated, with concomitant pneumobilia. Based on the preoperative diagnosis of GI, enterotomy with stone extraction by single-incision laparoscopic surgery (SILS) was performed. The patient's postoperative course was uneventful, and the cholecystoduodenal fistula closed spontaneously 4 months after the surgery. DISCUSSION: Recent studies have reported that enterotomy with stone extraction alone is associated with better outcomes than with more invasive techniques. This case also suggests that enterotomy with stone extraction alone and careful postoperative follow-up is feasible for the management of GI. Although the use of laparoscopy in the management of GI has been described previously, laparoscopic surgery has not been widely performed, and SILS is not generally performed. When only this less demanding procedure is required, laparoscopic surgery, including SILS, can be a viable option. CONCLUSION: SILS can be an alternative surgical procedure for the management of GI. [Copyright &y& Elsevier]

Background Coronary computed tomography angiography (CCTA) may be useful for noninvasive follow-up; however, evaluation of coronary stenosis and CT number of plaque may be inaccurate under different vessel enhancement of contrast media. We examined the reproducibility of the CT number of repeat CCTA using our original CT number-controlling system (CTN-CS), which selects contrast level by a multiple regression equation using body surface area and peak CT number and peak time on timing bolus and during CCTA. Methods and results One hundred seventy-two patients who underwent serial CCTA were prospectively and randomly assigned to 3 groups. In the first group, Group A, the amount of contrast for the second CCTA was determined by CTN-CS to match the intracoronary CT number of the first CCTA. In Group B, each patient received the same amount of intravenous contrast in both CCTA examinations. In Group C, 0.7 mL/mg body weight (BW) of contrast medium (350 mgI/mL) was used for baseline and follow-up CCTAs. The regression of repeated CCTAs was the best in Group A ( r = 0.85, p < 0.001) vs. Group B ( r = 0.52, p < 0.001), and Group C ( r = 0.61, p < 0.001). The absolute difference between intracoronary CT numbers of the second and first CCTA was the lowest in Group A (24.8 ± 21.8 HU), followed by Group B (37.6 ± 26.2 HU; p < 0.05) and Group C (46.5 ± 34.4 HU; p < 0.001). Conclusions Using CTN-CS, the difference of intracoronary CT numbers of the second and first CCTA was the smallest when compared to CCTAs using the same contrast volumes or constant volumes per body weight. [ABSTRACT FROM AUTHOR]

Background: Controlling intracoronary computed tomography (CT) number for coronary CT angiography (CCTA) has been difficult. Objective: The study assessed whether intracoronary CT number of CCTA could be estimated. Methods: One hundred twenty six patients were randomly assigned to either CCTA with 30 rnL of contrast media (CM) following 5 mL of CM at timing bolus or CCTA with 50 mL of CM following lOmL of CM at timing bolus. The relationships between intracoronary CT number and patients' characteristics and peak time and peak CT number at timing bolus in patients who showed valid time-density curve were analyzed in both groups. Then, the multiple regression equation best described was made. The prediction system was validated by 112 patients randomly targeted between 250 HU and 430 HU of CT number. Results: In group 5/30, intracoronary CT number was positively correlated with peak CT number at timing bolus (correlation coefficient, 1.42, p<0.001), negatively correlated with body surface area (-109.19, p< 0.001 ) and peak time (-6.93, p <0.001). Whereas, intracoronary CT number was positively correlated with only peak CT number at timing bolus ( 1.33, p< 0.001 ) in group 10/50. Then, CT number-controlling system using the simple equation best described CT number was established for CCTA following 5 mL of CM at timing bolus. Of 112 patients, there was good correlation between target CT number and measured CT number (r=0.85, p < 0.0001 ) in 96 patients (85.7%), having valid time-density curve at timing bolus. Conclusions: Controlling CT number may be enabled by CT number-controlling system following 5 mL of CM at timing bolus. [ABSTRACT FROM AUTHOR]

Background: Cytochrome P450 (CYP450) activity is an important indicator of liver graft function. CYP450 activity is altered by pro-inflammatory cytokines, which are associated with ischemia-reperfusion (I/R) injury during orthotopic liver transplantation (OLT). Treprostinil, an FDA-approved prostacyclin analog, ameliorated cold I/R injury during rat OLT. We hypothesized that treprostinil would improve CYP450 activity in liver graft during cold I/R injury post-OLT. Methods: OLT was performed in syngeneic male Lewis rats with 18 h graft preservation in cold UW solution. Donor and recipients received treprostinil (100 ng/kg/min) or matching placebo for 24 h before and up to 48 h post-OLT. Liver graft mRNA and protein expression of CYP450 isoforms were analyzed by qRT-PCR and Western blot analysis, respectively. The formation rates of 1-hydroxymidazolam and 6β-hydroxytestosterone, 6-hydroxychlorzoxazone, 2α- and 16α-hydroxytestosterone in liver graft microsomes served as markers for CYP3A, CYP2E1, and CYP2C11 activity, respectively, and were measured by LC–MS. Results: Treprostinil significantly decreased serum ALT and AST levels at 6–48 h after OLT, compared to placebo. The expressions of TNFα and IFNγ mRNA in the liver graft were significantly inhibited in the treprostinil-treated group at 1 h post-reperfusion. Treprostinil restored CYP2E1 protein expression to that of normal liver and significantly improved CYP3A activity to more than two-fold of placebo early post-OLT. Conclusions: Treprostinil significantly ameliorated hepatic injury, reduced expression of pro-inflammatory cytokines, and improved CYP450 activity in liver graft early post-OLT. These findings suggest that treprostinil has the potential to serve as a therapeutic option to protect liver graft function against I/R injury during clinical OLT. [ABSTRACT FROM AUTHOR]

: ObjectivesWe tested a hypothesis that elevation of the plasma level of brain natriuretic peptide (BNP) is one of the characteristics of patients with diastolic heart failure (DHF) independent of left ventricular (LV) hypertrophy.: BackgroundThe clinical characteristics of DHF are not well acknowledged, although DHF has become a great social burden. Such a lack of clinical information leads to inaccuracy in the diagnosis of DHF. We have demonstrated enhancement of ventricular production of BNP with progression of maladaptive ventricular hypertrophy, but not with development of compensatory hypertrophy in an animal DHF model.: MethodsOf 372 patients who presented to the emergency department because of acute pulmonary congestion without acute coronary syndrome between January 1996 and May 2002, those with an ejection fraction ≥45% upon admission, who were stably controlled at least for a year in our outpatient clinics, comprised the DHF group (n = 19). A control group consisted of 22 hypertensive patients with a LV mass index greater than or equal to its minimum value of the DHF group and an ejection fraction ≥45%, in whom cardiac symptoms had not occurred.: ResultsDespite a similar distribution of LV mass index, the BNP level was higher in the DHF group than in the control group (149 ± 38 vs. 31 ± 5 pg/ml, p < 0.01). There was no difference in LV cavity size or parameters derived from pulsed Doppler transmitral flow velocity curves.: ConclusionsAn elevation of BNP may be a hallmark of patients with or at risk of DHF among subjects with preserved systolic function independent of LV hypertrophy. [Copyright &y& Elsevier]

Objective: To evaluate the typing power of cluster analysis of antimicrobial susceptibility. Methods: Results of pulsed-field gel electrophoresis in 71 strains of methicillin-resistant Staphylococcus aureus were compared with cluster analysis of the diameter of growth inhibition in 11 drugs. Subjects were a consecutive series of patients (n = 71) from the wards and outpatient units of a community teaching hospital. Results: The cluster analysis took 2 to 3 seconds once the data were entered into a computer. The sensitivity, specificity, and accuracy of the cluster analysis were 76.3%, 58.3%, and 73.2%, respectively, using genotyping as the reference. Conclusions: The cluster analysis offered real-time epidemiologic data at minimal cost and labor, warranting its cost-effective role. [ABSTRACT FROM AUTHOR]

Highlights • Effects of discretion for behavioral selection on habit formation were examined in freely behaving male rats. • Rats were trained in the two-alternative forced-choice visual association/nonassociation tasks. • Overtrained group in the visual nonassociation task showed less sensitivity to contingency manipulation than other groups. • Overtrained group in the visual association task was more sensitive to changes in relative value than the nonassociation one. • Therefore, habit formation would be influenced by discretion for behavioral selection. Abstract As training progresses, animals show a transition from goal-dependent behavior to goal-independent behavior (habitual responses). Habit formation is influenced by several factors, including the amount of training and action-outcome contingency. However, it remains unknown whether and how discretion for behavioral selection influences habit formation. To this end, we trained male rats in two types of two-alternative forced-choice task: visual association and nonvisual association tasks. In the first type of task, rats learned the association between reward and a visual cue, the position of which was randomly changed per trial so that rats had to make a judgmental decision about which choice delivered the reward in each trial (discreet judgment group); in the second type of task, the rats learned that a reward was delivered after either choice following task initiation (uncontrolled judgment group). To test the sensitivity to contingency manipulation, the extinction tests were conducted in short- and long-term trained groups, with the result that the overtrained rats in the uncontrolled judgment group, but not the other three groups, showed less sensitivity. To further investigate the reward sensitivity in the long-term trained groups from another perspective, we continuously and periodically altered the reward size for each trial. The rats of the discreet judgment group changed intertrial intervals depending on reward size, while this tendency was weaker in the uncontrolled judgment group. These results suggest that discreet judgment maintained goal-directed rat behavior, whereas uncontrolled judgment led to the development of habit-like behavior. [ABSTRACT FROM AUTHOR]

Background: Prolonged use of totally implantable access ports (APs) and central lines (CLs) has been known to carry a risk of bloodstream infection (BSI), but the safe cutoff day for discontinuing use remains unknown. We performed a receiver operating characteristic (ROC) curve analysis to determine this cutoff. Methods: A retrospective 24-month study covered a total of 22,481 days of device use. For each day of use, the following findings were recorded: patient age and sex; presence or absence of diabetes mellitus, preexisting sepsis, and renal disease; and occurrence of device-associated BSI. BSI was defined in accordance with the Centers for Disease Control and Prevention’s definition of catheter-related infection. Results: BSIs occurred in 81 patients with an AP, for a BSI rate of 2.81 cases per 1,000 days of use. Among the 896 patients with a CL, the BSI rate was 5.60 cases per 1,000 days of use. The ROC analysis found a cutoff time of 33 days for APs (median days of use, 48) and 10 days for CLs (median days of use, 20.5). For the total 22,481 days of use, the odds ratio between APs and CLs with respect to BSI was 0.556 (95% confidence interval [CI], 0.256-1.208; P = .138). Days of use beyond the cutoff had an odds ratio of 2.867 (95% CI, 1.823-4.507; P < .001). Among the risk factors, preexisting sepsis had an odds ratio of 7.843 (95% CI, 4.666-13.184; P < .001). Conclusion: Use of an AP for more than 33 days and a CL for more than 10 days may carry an increased risk of device-associated BSI. These cutoff periods are longer than those expected at the time of device placement and indicate the importance of postplacement care. [Copyright &y& Elsevier]

• A precise experimental approach to capture solidification of PCMs at multiple scales. • A multi-scale solidification mathematical model solved analytically and numerically. • 2D crystal growth is measured by image analysis and predicted by phase field method. • Temperature transition, freezing time, nucleation state, and crystal growth are validated. • Various cooling rates are studied for the effect of surrounding environments on PCMs. We present a multi-scale solidification framework for pure substances using laboratory experiments and mathematical modeling. The multi-scale phenomena of solidification are experimentally captured by the state-of-the-art thermal control chamber and optical devices. In particular, the transient temperature over five solidification stages is observed under various cooling rates, while the nucleation site and crystal evolution are photographed and further processed via image analysis. A unified mathematical model is also developed to quantitatively examine the solidification process at three scales: (i) the supercooling, freezing, and subcooling stages with a time-dependent boundary at the macroscale are analytically solved by Duhamel's theorem and perturbation method; (ii) the two-dimensional (2D) dendritic growth at the mesoscale is computed by the Allen-Cahn equation through phase field modeling; and (iii) the heterogeneous nucleation at the microscale is numerically simulated. The results demonstrated that the experimental data and modeling were in close agreement with the freezing curve, nucleation temperature, nucleation time, 2D crystal evolution, and freezing time. [ABSTRACT FROM AUTHOR]

l-leucine, an essential amino acid, is one of the most popular ingredients in dietary supplements. To investigate a possibility of its embryo-fetal toxicity in rats, 11- to 12-week old dams were orally administered an aqueous solution of l-leucine at doses of 300 or 1000 mg/kg body weight on gestational days 7–17. Body weight and feed intake was evaluated throughout the whole course of pregnancy (days 0–20). l-Leucine did not influence body weight, but at a dose of 1000 mg/kg, slightly enhanced feed intake on days 14 and 18 of pregnancy. Caesarean section (day 20) revealed no influences on the litter size and weight of live-born fetuses, the number of corpora lutea, implantation index or the quality of placenta, and the minor increase in feed intake was considered irrelevant to the pregnancy outcomes. Fetuses were evaluated in a battery of external, visceral and skeletal examinations. No effects of l-leucine on gender ratio and external abnormalities, and no significant treatment-related variations in visceral and skeletal pathologies were observed. These results suggested that l-leucine, administered orally during organogenesis at doses up to 1000 mg/kg body weight, did not affect the outcome of pregnancy and did not cause fetotoxicity in rats. [Copyright &y& Elsevier]