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Background Metastatic lung tumor with a tumor thrombus in the peripheral pulmonary vein is very rare. We present a case of a metastatic lung tumor from hepatocellular carcinoma (HCC) with tumor thrombus invasion in the pulmonary vein that was diagnosed preoperatively and underwent complete resection by segmentectomy. Case presentation A 77-year-old man underwent laparoscopic lateral segment hepatectomy for HCC eight years ago. Protein induced by vitamin K absence or antagonist-II remained elevated from two years ago. Contrast-enhanced chest computed-tomography (CT) showed a 27 mm nodule in the right apical segment (S1). He was pathologically diagnosed with a metastatic lung tumor from HCC via transbronchoscopic biopsy. We planned to perform right S1 segmentectomy. Before surgery, contrast-enhanced CT in the pulmonary vessels phase for three-dimensional reconstruction showed that the tumor extended into the adjusting peripheral pulmonary vein, and we diagnosed tumor thrombus invasion in V1a. The surgery was conducted under 3-port video-assisted thoracic surgery. First, V1 was ligated and cut. A1 and B1 were cut. The intersegmental plane was cut with mechanical staplers. Pathological examination revealed moderately-differentiated metastatic HCC with tumor thrombus invasions in many pulmonary veins, including V1a. No additional postoperative treatments were performed. Conclusions As malignant tumors tend to develop a tumor thrombus in the primary tumor, it might be necessary to perform contrast-enhanced CT in the pulmonary vessel phase to check for a tumor thrombus before the operation for metastatic lung tumors.

Objectives: To identify ocular trauma trends and to analyze how initial uncorrected visual acuity (VA) is associated with mechanism of injury (MOI) in a referral hospital in Indonesia. Methods: A five-year medical chart review at the Ophthalmology Emergency Department (OED) Dr. Soetomo General Academic Hospital (DSGAH). The information retrieved included sex, age, laterality involvement, initial uncorrected VA, MOI and management. Sex- and age- adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between poor initial uncorrected VA and MOI, using multivariate logistic regression analysis. Results: A total of 953 patients consisted of 80.3% males and 19.9% females. Ocular trauma predominantly occurred in 21–30 years age group (20.9%). May and November were found to have the highest average number of monthly patients. Closed globe injuries (80.3%) were more prevalent than open globe injuries (17.7%). The most frequent MOIs were sharp objects (311; 32.6%), followed by blunt objects (236; 24.8%). Most cases (89.2%) displayed unilateral involvement and 54.3% cases showed an initial uncorrected VA of better than 6/18. Compared to road dust, blunt object, sharp object and traffic accident were significantly associated with poor initial VA, with adjusted ORs (95% CIs) of 5.24 (2.27-12.10), 4.03 (1.76-9.25) and 8.17 (3.31-20.15), respectively. Conclusions: Initial uncorrected VA and MOI provide earlier information regarding the prognosis. Traffic accident showed a greater tendency to cause a poor initial uncorrected VA. Most ocular trauma is preventable by educating people at risk to avoid common MOIs and to use protection.

To investigate the prevalence and factors associated with uncorrected presbyopia among rural community dwellers in Japan. A population-based cross-sectional study was conducted in 2011 among community dwellers aged 40–74 years who received specific health checkups in Minamiaizu and Tadami, Fukushima Prefecture, Japan. Uncorrected presbyopia was considered as when the distance-corrected visual acuity in the better eye was ≥0.5 and the near-presenting visual acuity in the better eye was

To assess the relationship between retinal vein occlusion (RVO) and the incidence of cardiovascular (CV) events. This was a single-institution, retrospective cohort study. We enrolled 57 patients diagnosed with RVO between January 2012 and December 2019, and 125 non-RVO patients who had undergone cataract surgery by a single surgeon between January and April 2012. We compared the relative risk and incidence rate ratio of CV events between the 2 groups. In addition, survival analysis was performed to calculate the hazard ratio (HR) using the Cox proportional hazards model. RVO, age, sex, blood pressure, body mass index, presence of diabetes, blood sample data, and smoking were considered confounders. The mean observation period (± standard deviation) for the RVO and non-RVO groups was 2.68 ± 2.04 and 2.81 ± 2.70 years, respectively. Seven CV events were observed in the RVO group and 2 in the non-RVO group. Relative risk and incidence rate ratio were 7.68 (95% confidence interval [CI]: 1.65–35.8) and 8.07 (95% CI: 1.54–79.6), respectively. Multivariate analysis revealed that the RVO group had a high HR for CV events (HR: 16.13 [95% CI: 2.29–113.74]) and older age (HR: 1.26 [95% CI: 1.06–1.49]). RVO can predict future CV events, especially in the elderly population. Fundus observations should be shared between ophthalmologists and internists to prevent future CV events.

Gastrointestinal stromal tumors of the duodenum are rare. For benign tumors, premalignant lesions, or malignant potential tumors located in the second portion of the duodenum close to the papilla of Vater, pancreaticoduodenectomy is sometimes performed. A case of laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor at the second portion of the duodenum is reported. The surgical procedure was performed as follows: first, the second portion of the duodenum was separated from the pancreatic head; second, the duodenum was cut off with the linear stapler after having confirmed preservation of the papilla by intraoperative endoscopy; and third, reconstruction was carried out by a side-to-side duodenojejunostomy. Laparoscopic segmental duodenectomy for duodenal gastrointestinal stromal tumors is thought to be advantageous compared with pancreaticoduodenectomy in terms of low burden and organ function preservation. The present procedure is feasible for benign or low-malignant tumors that do not infiltrate outside of the duodenal walls.

Both esophageal rupture and esophageal cancer are life-threatening diseases. We report a case of esophageal cancer that occurred after esophageal rupture was treated with thoracoscopic and laparoscopic surgery. A 76-year-old man presented with vomiting followed by epigastric pain and was diagnosed with spontaneous esophageal rupture. Laparoscopic and thoracoscopic surgery were performed. Primary closure was completed with a fundic patch, and thoracic lavage was performed. Ten months later, his condition was diagnosed as squamous cell carcinoma of the abdominal esophagus. He underwent thoracoscopic esophageal resection in the prone position, and a gastric conduit was created laparoscopically. The pathological finding was superficial esophageal carcinoma without lymph node metastasis. The patient's postoperative course was uneventful, and there was no recurrence at 21 months of follow-up.

Purpose To describe the relationship between retinal vascular calibre and cardiovascular risk factors in a Japanese population. Methods The Locomotive Syndrome and Health Outcome in Aizu Cohort Study is a population-based, cross-sectional survey that included 2346 persons (56.1% of the eligible population) aged 40 to 74 years old. Retinal vascular calibre was measured from digital retinal photographs using a validated standardized protocol. Data on major cardiovascular risk factors were collected from all participants. Results Of the 1787 participants with available retinal vascular calibre data, the mean retinal arteriolar calibre (CRAE) was 141.6 ± 18.6 μm, the mean venular calibre (CRVE) was 209.3 ± 26.1 μm, and the mean arteriole-to-venule ratio was 0.68 ± 0.08. A smaller CRAE was associated with male sex, increasing quartiles of systolic blood pressure and diastolic blood pressure, history of hypertension, current alcohol intake and higher quartiles of serum creatinine. A larger CRAE was associated with increasing quartiles of total cholesterol. A larger CRVE was associated with current cigarette smoking. Multivariate analyses showed that a smaller CRAE was associated with male sex, elevated mean arterial blood pressure and a history of hypertension; and a larger CRVE was associated with cigarette smoking. Conclusions The results of this study suggest that a narrowed diameter of the retinal arteriole in Japanese people is related to hypertension and sex (male) and that an enlarged retina venular diameter is related to a history of smoking. The pattern of these associations is similar to that in white populations and other Asian populations.

AIM The bisoprolol transdermal patch is a newly developed β-blocker designed to deliver its pharmaceutical ingredient through the skin surface. We aimed to compare the bisoprolol transdermal patch and bisoprolol fumarate tablet using the heart rate variability (HRV). METHOD Eligible hypertensive patients received a 2-week administration with a 2.5 mg bisoprolol fumarate tablet, followed by 24-hour Holter monitoring. The tablet was then switched to a 4 mg bisoprolol transdermal patch, and after 2 weeks of its administration, the Holter monitoring was repeated. Both drugs were given once daily. Endpoint was any alteration in the HRV caused by a change in the administration route for bisoprolol. RESULTS There was no difference in the 24-hour time-domain and frequency-domain HRV measurements before and after the drug switching among patients recruited (N = 30). However, the switching significantly altered the time-course curves of the hourly HRV measurements, including the mean normal-to-normal (NN) interval (P = .004), standard deviation of the NN index (P

Objective To investigate the association between visual impairment and the risk of falls in hospitalized patients. Design Individually matched case–control study. Methods The medical records of patients who fell while hospitalized at Juntendo Tokyo Koto Geriatric Medical Center (JTKGMC) from January to December 2014 were reviewed retrospectively. Among them, 36 patients who were recorded as visiting the Ophthalmology Outpatient Clinic from 1 year before to 1 year after the fall were included as cases. As the control subjects, 36 individually matched patients were chosen who were hospitalized in the same beds in the same hospital wards. Visual impairment and blindness were defined according to U.S. criteria. Conditional logistic regression analysis was used for both univariate and multivariate analyses. Based on previous reports, multivariate analysis was performed with adjustment for age, sex, a history of falls, and use of walking aids. This study was approved by the institutional review board of JTKGMC and was performed according to the tenets of the Declaration of Helsinki. Results The crude odds ratio (OR) for visual impairment was 6.0 (95% confidence interval [CI]: 0.72–49.83). For a history of falls and use of walking aids, the crude OR (95% CI) was 2.5 (0.97–6.44) and 2.8 (0.88–8.64), respectively. After adjustment for age, sex, a history of falls, and use of walking aids, the association between falls and visual impairment was significant (OR: 13.9; 95% CI: 1.0004–194.41). Conclusion These findings suggest that visual impairment could be an independent risk factor for falls among hospitalized patients.

The aims of this study were to investigate the incidence of positive donor tissue cultures before transfer to preservation medium (Optisol™-GS) for penetrating keratoplasty, to verify the efficacy of antibiotics contained in Optisol™-GS by examining the drug susceptibility and to assess the relationship between the results of our microbial assessments as well as donor factors and the incidence of contamination. We conducted a retrospective, cross-sectional study using Juntendo Eye Bank records for all corneal transplantations. Two hundred donor conjunctiva harvestings and storage medium (EP-II®) cultures were performed between July 2008 and June 2011. We analyzed the associations between donor factors (age, gender, history of cataract surgery, death-to-preservation interval, cause of death) and contamination rates using multivariate analysis by the generalized estimating equation model. We obtained positive bacterial cultures from 154 of the 200 eyes (77.0%). The isolated bacteria were indigenous, such as coagulase-negative Staphylococci, Corynebacterium sp., and methicillin-resistant Staphylococcus aureus (MRSA). There was significant resistance to levofloxacin (18 eyes, 9.0%) and gentamicin (12 eyes, 6.0%), and no vancomycin-resistant bacteria were detected. The donor factors did not correlate with the prevalence of bacterial contamination in our criteria. Pre-banking microbial assessment allows for microbial detection, bacterial susceptibility and resistance testing. This is useful for developing preservation mediums containing effective spectrum antibiotic agents for high quality control of corneal banking.

The role of plasma levels of oxidized low density lipoprotein (OxLDL) in the development of coronary heart disease (CHD) has not been fully elucidated. We examined the relationship among plasma levels of OxLDL, measured by an enzyme immunoassay using an antibody against OxLDL (FOH1a/DLH3) and apolipoprotein B, CHD, and modalities at the onset of acute coronary syndrome (ACS). A total of 115 individuals who underwent coronary angiography were studied. Of these, 21 patients complicated with extracoronary cardiovascular diseases were excluded. Consequently, 94 patients (63 men) (ACS: 23, stable angina pectoris (SAP): 46, and normal coronary artery (NCA):25) were eligible for inclusion in the study. Elevated plasma levels of OxLDL were associated with CHD, especially with ACS. In patients with NCA, hypertension was associated with plasma OxLDL. Plasma levels of OxLDL were significantly higher in patients with new-onset type ACS than in those with worsening type ACS (2.98 versus 1.53 mg/dL, P = 0.002). In conclusion, plasma levels of OxLDL are associated with CHD and significantly higher in patients with new-onset ACS. The findings of the present study suggest that plasma OxLDL can be a marker of the development of CHD and modalities of ACS.

Purpose: An amino acid-containing elemental diet (ED) does not require digestion for nutritional absorption, making it a good option for patients with gastrointestinal malabsorption. We conducted a randomized trial to confirm that perioperative ED enhanced the recovery of patients undergoing laparoscopic colectomy. Methods: Patients in the intervention arm received commercially available ED from the day prior to surgery until postoperative day (POD) 3, whereas patients in the control group received a conventional perioperative diet program. To verify the endpoints, "estimated minimum length of stay in hospital after surgery" (emLOS) was defined as the number of days necessary to reach all the five criteria; namely, "sufficient oral intake", "sufficient pain control", "withdrawal of intravenous alimentation", "no abnormal findings in routine examinations", and "no rise in fever". Results: A total of 102 patients were randomized, 94 of whom were analyzed (ED 45, control 49). There was no morbidity or mortality. Shorter emLOS (POD 4 vs. POD 7; p = 0.018), earlier resumption of sufficient oral intake (POD 3 vs. POD 4; p = 0.034) and faster recovery to defecation (2.2 vs. 3.1 days; p = 0.005) were observed in the ED group vs. the control group. Conclusions: The perioperative ingestion of ED by patients undergoing laparoscopic colectomy is safe and can reduce the postoperative hospital stay by supporting the acceleration of oral intake.

This study examines the relationship between quality of life (QOL) and the legal Japanese grade of visual impairment as defined by the Physically Disabled Persons Welfare Act. Participants of this cross-sectional study were 98 Japanese patients legally classified as visually impaired, from six ophthalmology departments. Vision-related QOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25). The short Japanese version of this questionnaire (VFQ-J11) score was calculated from the VFQ-25 results for each participant. Health utility was measured using the EuroQoL Index (EQ-5D). Data were collected for age, gender, vision-disability level, the corrected visual acuity of each eye, and disease type. The mean age was 66.8 years (SD = 17.8). Visual impairment grade was significantly associated with VFQ-J11 score and the composite score developed from the VFQ-25 (p

The present study proposes a novel experimental approach to examine the effect of previous schedule history on subsequent responses. College students used a three-button device to indicate their choice of response. We performed two experiments. Each experiment consisted of three phases. In experiment I, fixed-ratio 10 (FR 10) reinforcement schedule was employed in phases 1 and 3. Phase 2 employed “Rotary-FR 10” schedule: after obtaining a point produced by pressing one of three specified buttons in a triangular array 10 times, the effective button changed to another in a clockwise direction. Optimal response pattern for Rotary-FR 10 was analyzed. Two types of behavior, referred to as “consecutive” and “scatter” were observed in phase 1. The mean number of optimal responses in consecutive type was significantly higher than scatter type in phases 2 and 3. In experiment II, two schedules were used in phase 1, and the same protocol used in experiment I was followed. We found that the reinforcement schedule used in phase 1 affected acquisition of the optimal response in phase 2. These results suggest that the earlier behavioral tendencies play an important role in determining subsequent behavior and that such behavioral tendency can be modified by specifically designed protocols.

An 88-year-old Japanese woman was admitted to our hospital for abdominal pain with a raised inflammatory reaction. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) showed a duodenal ulcer punching a liver cyst. Since neither ascites nor free air were detected on CT and her family did not wish for aggressive medical treatment, the patient received clinical observation and conservative management. Antibiotic and proton-pump inhibitor therapy was effective, and she exhibited an uneventful recovery. A reexamination of EGD and CT confirmed that the fistulous tract between the liver cyst and duodenum was blockaded.

In free choice, two or more responses eligible for reinforcement are concurrently available, as when a pigeon’s pecks on either of two keys can produce fixed-interval (FI) reinforcers. In forced choice, only one eligible response is available, as when pecks on one key can produce FI reinforcers but extinction (EXT) is arranged for pecks on a second key. Free choice is typically preferred when pitted against forced choice in terminal links of concurrent-chain or multiple concurrent-chain schedules. When multiple concurrent-chain schedules arrange conditions A and B respectively for left and right terminal links during one initial-link stimulus but their reversal during a second initiallink stimulus, preferences can be determined within sessions as differences between relative initial-link rates. The experimental question was whether free-choice preference is demonstrable even with one free-choice alternative rarely or never chosen. A history of multiple concurrent-chains with equal single-FI terminal links was followed by training,independent of initial links, of FI 20-s (green key), FI 40-s (yellow key), and EXT (red key). Multiple concurrentchain schedules then pitted free-choice terminal links with green (FI 20-s) and yellow (FI 40-s) keys against forcedchoice terminal links with green (FI 20-s) and red (EXT) keys. These terminal links maintained responding almost exclusively on the green key whether the other key was yellow or red, and all reinforcers were produced by green-keyresponding. Even with reinforcers equal and with the yellow alternative rarely or never chosen, the green-yellow erminal link (free choice) was preferred to the green-red (forced choice) terminal link.Key words: free choice, forced choice, preference, concurrent-chain schedules, initial links, terminal links, iscriminated operants, Em uma situação de liberdade de escolha (escolha livre), duas ou mais respostas elegíveis para reforço estão concorrentemente disponíveis, como quando as bicadas de um pombo em qualquer um de dois discos pode produzir reforços em intervalo-fixo (FI). Em escolha forçada, uma única resposta é elegível para reforço, como quando as bicadas em um disco podem produzir reforços em FI, mas as bicadas em um segundo disco são colocadas em extinção (EXT).A liberdade de escolha tem sido tipicamente preferida à escolha forçada, quando ambas constituem os elos terminais de esquemas encadeados concorrentes ou de esquemas múltiplos encadeados concorrentes. Quando esquemas múltiplos encadeados concorrentes programam as condições A e B para os elos terminais à esquerda e à direita, respectivamente, na presença de um dos estímulos do elo inicial, mas programam as posições inversas para A e B nos elos terminais na presença do outro estímulo do elo inicial, as preferências podem ser determinadas, ao longo das sessões, como diferenças nas taxas relativas nos elos iniciais. A questão neste experimento era se a preferência por escolha livre é demonstrável mesmo quando uma das alternativas quase nunca é escolhida ou é escolhida raramente. Uma história experimental sob esquemas múltiplos cujos componentes eram cadeias concorrentes, nas quais os elos terminais eram um mesmo esquema de FI, foi seguida pelo treino, independente dos elos iniciais, de FI 20-s (disco verde), FI 40-s (disco amarelo), e EXT (disco vermelho) nos elos terminais. Então, os esquemas múltiplos de cadeias concorrentes programaram os elos terminais de escolha livre com dois discos, verde (FI 20-s) e amarelo (FI 40-s), concorrentemente com elos terminais de scolha forçada, também com dois discos, um verde (FI 20-s) e outro vermelho (EXT). Esses elos terminais mantiveram o responder quase que exclusivamente no disco verde, quer o outro fosse amarelo ou vermelho, e todos os reforços foram produzidos por respostas no disco verde. Embora os reforços fossem iguais e a alternativa com o disco amarelo nunca ou quase nunca tivesse sido escolhida, o elo terminal com os discos verde e amarelo (escolha livre) foi preferido ao elo terminal com os discos verde e vermelho (escolha forçada).Palavras-chave: escolha livre, escolha forçada, preferência, esquemas encadeados concorrentes, elos iniciais, elosterminais, operantes discriminados

In this paper, a rapid and simple method to determine the optimal temperature conditions for denaturant electrophoresis using a temperature-controlled on-chip capillary electrophoresis (CE) device is presented. Since on-chip CE operations including sample loading, injection and separation are carried out just by switching the electric field, we can repeat consecutive run-to-run CE operations on a single on-chip CE device by programming the voltage sequences. By utilizing the high-speed separation and the repeatability of the on-chip CE, a series of electrophoretic operations with different running temperatures can be implemented. Using separations of reaction products of single-stranded DNA (ssDNA) with a peptide nucleic acid (PNA) oligomer, the effectiveness of the presented method to determine the optimal temperature conditions required to discriminate a single-base substitution (SBS) between two different ssDNAs is demonstrated. It is shown that a single run for one temperature condition can be executed within 4 min, and the optimal temperature to discriminate the SBS could be successfully found using the present method.

The present experiment examined whether, in a matching-to-sample (MTS) procedure, a relation between two stimuli, a sample and a comparison, could be established as a result of just stimulus-stimulus pairing, even if back up reinforcers were never provided for the conditional relation between the sample and comparison stimuli, but rather only for the comparison stimulus. A procedure called "pseudo matching-to-sample" was used in which, when S1 was presented as a sample stimulus, two comparison stimuli (C1 and C2) were presented, and only responses to C1 were reinforced. Conversely, when S2 was presented, only responses to C3 (and not C4) were reinforced. In other words, organisms experiencing this procedure could discriminate C1 from C2, and C3 from C4, by simple discrimination without regard to the conditional sample stimuli. In order to examine cross-species differences, responding by humans in this procedure was compared to that by pigeons. Although the humans developed a discriminative function for the sample stimuli, that is, the humans' responding was affected by both the sample stimuli and the reinforcers, responding by the pigeons was affected solely by the reinforcers. These data suggest that, in this procedure, humans (but not pigeons) are able to learn relations among stimuli simply as a result of stimulus-stimulus pairing.

Background Small bowel obstruction (SBO) after abdominal surgery is usually treated successfully with intestinal decompression using a long nasointestinal tube (LT), but some cases fail to respond. Methods Clinical background and laboratory data on admission were evaluated retrospectively for 53 patients with adhesive SBO to determine predictive factors for failure of LT decompression, and the appropriate timing of laparotomy was investigated. Results Complete SBO (no evidence of air within the large bowel) and increased serum creatine phosphokinase (≥130 IU/L) were independent predictive factors for LT decompression failure. Laparotomy was indicated in 14 patients (9 and 5 with complete and partial SBO, respectively), whereas successful LT decompression occurred in 39 patients (9 and 30, respectively). Resolution of SBO took significantly longer for complete SBO (6.3 days) than for partial SBO (2.6 days). Conclusions Patients with complete SBO or high serum creatine phosphokinase (CPK) may not respond to LT decompression. Laparotomy is appropriate after non-response for 7 and 3 days for complete and partial SBO, respectively.

A behavioral-history procedure was used to study the function of terminal-link stimuli as conditioned reinforcers in multiple concurrent-chain schedules of reinforcement. First, three pigeons were exposed to multiple concurrent-chain schedules in which the two multiple-schedule components were correlated with a blue and a white stimulus, respectively. In each component the initial links were equal independent variable-interval (VI) 15 s schedules. A fixed-interval (FI) 10 s schedule operated on the red key in one terminal link while extinction operated on the green key in the alternative terminal link. When large preferences for the red stimulus had been established, two tests were conducted. In the terminal-link test, under new initial-link stimuli--purple and brown--an FI 10 s schedule operated for both the red and green terminal-link stimuli. In the subsequent initial-link test, the blue and white initial-link stimuli were reintroduced, and, as in the terminal-link test, FI 10s operated for both the red and the green terminal-link stimuli. In the terminal-link test, the three pigeons showed no preference for the terminal links with the red stimulus, but showed clear and consistent preferences for the red stimulus when blue and white stimuli were reintroduced as initial-link stimuli in the initial-link test. This suggests that there are multiple sources of control over initial-link response allocation in concurrent-chains, including control by both terminal- and initial-link stimuli.

Objective: Increased low-density lipoprotein (LDL) glycation in diabetics could facilitate LDL oxidation, which is proatherogenic. I studied plasma oxidized LDL (OxLDL) levels in diabetics and non-diabetics, their relation to glycemic control, and their circadian variations. Methods: OxLDL in diabetics (n=32) and in non-diabetics without coronary artery diseases (n=20) were compared. OxLDL in diabetics (n=24) was measured on Days 2, 3, 4, 8 and the last day of hospitalization. Circadian variation in OxLDL in diabetics (n=18) was also examined. Glycemic control was implemented during hospitalization. Patients: The diabetics were divided into two groups; moderately-controlled (MC) group (HbA1c < 9.0% at admission, n = 15) and poorly-controlled (PC) group (HbA1c ≧ 9.0% at admission, n = 9). Results： In the MC group, OxLDL decreased by 20.8% after glycemic control (p = 0.0139), but not in the PC group. OxLDL is correlated with LDL on Days 3, 4, 8 (r = 0.837, 0.864, 0.801, respectively), TG on Day 8(r = 0.932), and Lp(a) at discharge (r = 0.871). In the PC group, OxLDL was 15.8% higher on the average in the daytime than at night (p = 0.0024). Conclusion： Plasma OxLDL is decreased by glycemic control, particularly in moderately glycemic controlled patients. OxLDL has a circadian variation, particularly in poorly glycemic controlled patients. Long-term glycemic control could reduce the progression of atherosclerosis, by reducing OxLDL levels.

We report herein the rare case of a 33-year-old man found to have a multiple endocrine neoplasia type 1 (MEN1)-associated carcinoid tumor in the thymus. A chest roentgenogram demonstrated an asymptomatic anterior mediastinal mass, 7 cm in diameter, and ultrasound-guided percutaneous Tru-Cut biopsy revealed a carcinoid tumor of the thymus. An extended thymectomy was performed through a median sternotomy and pathological examination confirmed the diagnosis of a thymic carcinoid tumor, which was mainly encapsulated with locally invasive growth into the pleura. Despite the absence of a family history of MEN1, he was treated for two pancreatic islet cell tumors, hyperparathyroidism, an adrenal tumor, and a retroperitoneal lipoma. MEN1 mutations were detected both in blood samples and pancreatic tumor tissues. He is now well without any evidence of tumor recurrence 27 months after the operation for the thymic carcinoid. MEN1 mutations were screened by direct nucleotide sequencing of all protein-coding regions of exons 2–10 of the MEN1 gene. Heterozygous germline mutation was detected in the blood sample analyses. Moreover, fresh-frozen pancreatic tumor tissues showed a loss of heterozygosity in the MEN1 region.

Chick embryo fibroblasts and chorioallantoic membranes infected with fowlpox virus (FWPV) or pigeonpox virus (PPV) were examined by transmission and scanning electron microscopy. Immature virus particles were observed in finely granular areas, i.e. virus factories, of the cytoplasm. These particles had various forms depending on their stages of development. Many tubular structures were also seen in these regions. Mature virus particles with ellipsoidal or brick-shaped forms enclosing electron-dense cores were detected throughout the cytoplasm. Notably, there was a high frequency of virus budding at the cell surface, but only occasional virus wrapping in the cytoplasm. Another remarkable feature of the infected cells was accumulation of many virions just beneath the plasma membrane, indicating that this phenomenon is closely related to virus budding. Based on the observed frequency of budding, this mechanism seems to be the predominant way for FWPV and PPV to exit the cell.

Preferences in pigeons for free choice over forced choice under uncertain contingencies were compared with the one under certain contingencies in multiple concurrent-chain schedules of reinforcement. The uncertain condition examined the preference for two alternatives over one alternative when reinforcement probability at the end of the terminal link equalled 0.5, and with all keys in each terminal link lit green (two mixed fixed-interval extinction keys versus one mixed fixed-interval extinction key). Key and schedule arrangement in the certain condition was the same except that a peck on any terminal-link key after the FI interval always produced food. When naive pigeons were first exposed to uncertain contingencies, preference for two lit keys over one lit key was observed, and the preference was confirmed by sequential reversals of the terminal-link contingencies. However, no consistent preference was observed when uncertain condition followed the certain condition. Under certain contingencies, unlike the earlier experiments, very small and inconsistent preferences for free choice were demonstrated. A possible reason for the different preferences in the uncertain conditions was that pigeons may lessen their sensitivity to the circumstances with uncertainty by any history or carry-over effect of the prior contingency.

BACKGROUND Directional coronary atherectomy (DCA) and balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) differ in their method of dilating stenotic vessels. It is not known whether there is any morphologic difference between restenotic lesions that occur after DCA and those occurring after PTCA. METHODS To evaluate histopathologic differences between restenotic lesions after DCA or PTCA, we reviewed coronary atherectomy specimens excised from 37 patients with stable angina. Patients were classified into three groups: those with restenotic lesions after DCA (n = 8), those with restenotic lesions after PTCA (n = 14), and those with primary lesions (n = 15). Specimens were analyzed immunohistochemically using monoclonal antibodies specific for smooth muscle cells (HHF35), endothelial cells (CD31), macrophage-derived foam cells (CD6B) and cell replication activity (Ki-67). In seven patients undergoing repeat DCA, de novo plaques and restenotic plaques were compared. RESULTS Stellate smooth muscle cell (S-SMC) content in restenotic lesions after DCA (87%) was significantly greater than that in primary lesions (40%; P = 0.032) and that in restenotic lesions after PTCA (43%; P = 0.045). Foam cells tended to be more prevalent in primary lesions (67%) than in restenotic lesions after DCA (25%; P = 0.062) or after PTCA (36%; P = 0.10). Restenotic lesions after DCA had more S-SMC proliferation and fewer foam cells than did primary lesions. There were no differences in the presence of thrombus, calcification, cholesterin, hemosiderin, the percentage of HHF35-positive cells or Ki-67-positive cells, or neovascularization among the three groups. CONCLUSIONS Smooth muscle cell proliferation may have an important role in the development of restenosis after DCA. Fewer foam cells are present in restenotic lesions after DCA or PTCA than are present in primary lesions.