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Background Studies suggest that fragmented QRS (fQRS) can predict arrhythmic events in various cardiac diseases. However, the association between fQRS recordings on intracardiac electrogram (EGM) and ventricular arrhythmic events remains unknown. Methods We enrolled 51 patients (age, 62 ± 12 years; 40 men) with an implantable cardioverter‐defibrillator (ICD) and structural heart disease and evaluated surface electrocardiogram (ECG) and EGM measurement of fQRS and the association between fQRS and arrhythmic events. Results fQRS was detected on surface ECG and ICD‐EGM in 12 (23.5%) and 15 (29.4%) patients, respectively. fQRS was detected more frequently on ICD‐EGM in patients with fQRS on surface ECG than in patients without fQRS (7/12 [58.3%] vs 8/39 patients [20.5%], P = .01). Appropriate ICD therapies were documented in 16 patients. Among these patients, fQRS was detected more frequently on surface ECG and ICD‐EGM in patients with appropriate ICD therapies (8/16, 50.0%; P = .001 and 11/16, 68.9%; P, We enrolled patients with implantable cardioverter defibrillator (ICD) and structural heart disease and evaluated the surface electrocardiogram (ECG) and intracardiac electrogram (EGM) measurement of fQRS and the association between fQRS and arrhythmic events.Appropriate ICD therapies were significantly higher in patients with fQRS on both surface ECG and ICD EGM than in those without.Surface ECG and ICD‐EGM measurement may help predict ventricular arrhythmic events.

Introduction Preoperative inguinal pain (painful inguinal hernia) is a well-known factor associated with chronic postoperative inguinal pain (CPIP). However, it remains unclear what preventive measures should be taken in such patients. Case presentation We report two patients with painful inguinal hernia who underwent pragmatic ilioinguinal nerve neurectomy during open anterior repair. The nerve was compressed by bulky spermatic cord lipoma in case 1 and by the hernia sac presenting over a few decades in case 2. Hematoxylin and eosin staining of the resected nerves revealed mucoid degeneration. Toluidine blue staining of resin-embedded nerve sections demonstrated that fully-myelinated axons had significantly decreased in case 1 and almost disappeared in case 2, indicating the development of massive demyelination of the ilioinguinal nerve in both cases. Discussion In cases where the injured nerve is left in situ, CPIP may occur since demyelinating neuropathy sometimes becomes irreversible. Conclusion Planned nerve resection via open anterior inguinal hernia repair may be an option to prevent CPIP in patients with painful inguinal hernia., Highlights • Painful inguinal hernia is a known risk factor for CPIP; however, preventive measures remains unclear. • Ilioinguinal nerves were massively demyelinated in two patients with painful inguinal hernia. • Severe neuropathy induced by chronic compression of the ilioinguinal nerve may be associated with painful inguinal hernia. • Planned nerve resection via anterior hernia repair is an option to prevent CPIP in patients with painful inguinal hernia.

Background The peri‐outflow tract region could be the origin of ventricular tachycardia (VT) after aortic valve replacement (AVR). However, the clinical characteristics of outflow tract ventricular tachycardias (OTVTs) after AVR are yet to be clarified. This study investigated the incidence, risk factors, and clinical characteristics of patients with OTVTs after AVR. Methods We retrospectively analyzed the clinical course of 120 patients who had undergone surgical AVR (SAVR) between April 1980 and October 2018. The patients had no ischemic or diagnosed cardiomyopathies other than primary aortic valve diseases. Results Six patients (5.0%) developed OTVTs after SAVR. The average onset was at 10.8 ± 5.7 years after SAVR. All cases of VT arose from the inferior axis and included left and right bundle branch block configuration. Two patients who underwent cardiac magnetic resonance imaging (MRI) had late gadolinium enhancement (LGE) in the midlayer of the left ventricle basal anteroseptal wall. Patients with periaortic VTs had significantly larger left ventricular (LV) diameter at systole, lower LV ejection fraction, higher positive rates of signal‐averaged electrocardiogram (SAECG), and nonsustained VTs on Holter monitoring. On ablation, local fragmented potentials with low voltage zones were observed in accordance with the LGE distribution. Multiple VTs originating from the periaortic region were provoked in the sessions. Conclusions Acute OTVT was found in 5% of patients after SAVR. Arrhythmia risk stratification by SAECG, Holter ECG, and cardiac MRI should be considered for a long period in patients after SAVR., Based on our results, acute onset of OTVT was found in 5% of patients who received SAVR. Therefore, we suggest that arrhythmic risk stratification should be considered for patients who have undergone SAVR for a long period.

Objective: To investigate the incidence, risk factors and clinical characteristics of periaortic VTs after AVR. Background: The periaortic region is the origin of some ventricular tachycardias (VTs) after aortic valve replacement (AVR). However, the clinical characteristics of periaortic VTs after AVR are yet to be clarified. Methods: We retrospectively analyzed clinical courses of 109 patients who had undergone surgical AVR (SAVR) without other structural heart diseases between April 2009 and Jun 2019 and evaluated the incidence and characteristics of periaortic VTs after SAVR. Results: Three patients (2.8%) developed periaortic VTs after SAVR. The average duration of onset was 12.3±6.6 years. All VTs arose from the inferior axis; they included both left and right bundle branch block configuration (LBBB and RBBB). Two patients underwent cardiac magnetic resonance imaging; late gadolinium enhancement (LGE) was observed in the mid-layer of the left ventricle basal anteroseptal wall in both cases. Patients with periaortic VTs had significantly wider interventricular septum, lower left ventricular ejection fraction (LVEF), larger LV diameter at systole, and higher positive rates of signal-averaged ECG and non-sustained VTs on Holter. On ablation, local fragmented potentials with low voltage zones were observed in accordance with the distribution of LGE. Multiple VTs originating from the periaortic region were provoked in the sessions. Conclusions: Periaortic VTs long after surgical AVR are not rare, and arrhythmia risk stratification, including that by signal averaged electrocardiogram (SAECG), Holter, and cardiac magnetic resonance imaging (MRI) should be considered.

(Objective) The prostate cancer detection rates on initial transrectal ultrasound guided prostate biopsies were investigated and the clinicopathological features of prostate cancer patients were examined. (Methods) A retrospective review was performed. From 2003 to 2015, 2,246 patients received initial prostate biopsy in Tochigi Cancer Center. Prostate cancer detection rates and clinicopathological features of the prostate cancer patients in relation to prostate-specific antigen levels were evaluated. (Results) Of the biopsies, 1,294 cases (57.6%) were diagnosed as prostate cancer. The prostate cancer detection rates were 27.8%, 39.8%, 53.6%, 67.4%, 88.4%, 100% in the groups with PSA levels 0.0-3.0, 3.1-4.0, 4.1-10.0, 10.1-20.0, 20.1-100.0, >100.0 ng/ml, respectively. Of all 1,294 cases in prostate cancer, patients rates with the low risk were 0%, 30%, 22%, 0%, 0%, 0% in the groups with PSA levels 0.0-3.0, 3.1-4.0, 4.1-10.0, 10.1-20.0, 20.1-100.0, >100.0 ng/ml, respectively. (Conclusions) From the results of the prostate cancer detection rates and the low risk rates, it seems difficult to determine diagnosis and treatment of prostate cancer only with PSA values.

A case of small bowel obstruction caused by Bolbosoma sp. infection is reported. A 27-year-old woman admitted with abdominal pain was diagnosed as small bowel obstruction. Laparoscopic surgery revealed induration in jejunum at ca. 120 cm distal to the ligament of Treiz, attributed to a band connecting the serosa to the ascending mesocolon. Resected band contained an acanthocephalan accompanying foreign body reaction with abscess formation. The parasite belonged to the genus Bolbosoma, of which identification was made by DNA sequence analysis. This is the eighth case of Bolbosoma infection in humans, and the first one causing an ileus.

Highlights • Laparoscopic IPOM repair for inguinal hernia may cause chronic neuropathic pain. • Laparoscopic IPOM repair for inguinal hernia should be avoided as much as possible. • Laparoscopic selective neurectomy is an option for chronic neuropathic pain., Introduction Laparoscopic intraperitoneal onlay mesh (IPOM) repair is occasionally used for inguinal hernia repair. Here, we report a case of chronic neuropathic pain after laparoscopic IPOM repair for inguinal hernia, which was treated successfully with laparoscopic selective neurectomy. Presentation of case A 59-year-old man with bilateral inguinal hernia underwent laparoscopic repair. Transabdominal preperitoneal repair was performed on the left side, whereas IPOM repair was performed on the right side due to a peritoneal defect. At postoperative month 1, he presented with severe pain and numbness distributed from the right inguinal region to the inner thigh region. The symptoms had persisted for 1 year despite medical treatment. We diagnosed that the symptoms might be due to the entrapment of nerves in the contracted mesh, and performed a second surgery via laparoscopic approach 13 months after the first surgery. On laparoscopic exploration, the lateral side of the mesh was contracted and involved nerve branches. We ligated and cut off these nerve branches. His symptoms resolved immediately after the surgery. At postoperative month 12, he has passed without any pain, numbness, and hernia recurrence. Discussion Laparoscopic exploration would be useful to figure out chronic neuropathic pain after laparoscopic inguinal hernia repair. Conclusion Laparoscopic IPOM repair for inguinal hernia should be avoided as much as possible because it may cause chronic neuropathic pain. Laparoscopic selective neurectomy is an option for patients with chronic neuropathic pain after laparoscopic hernia repair.

An optimal periprocedural anticoagulation strategy is essential for minimizing bleeding and thromboembolic complications during atrial fibrillation (AF) ablation. Limited data are available on the uninterrupted use of apixaban in patients with AF undergoing catheter ablation. This study aimed to evaluate the safety and efficacy of uninterrupted apixaban in patients undergoing radiofrequency ablation for AF. In particular, we evaluated silent cerebral infarction (CI) during radiofrequency catheter ablation of AF. This was a prospective and nonrandomized cohort study. A total of 259 consecutive patients who underwent AF ablation were evaluated; 157 patients received apixaban (Api group), and 102 patients received dose-adjusted (PT-INR 2.0-3.0) warfarin (Wf group). All oral anticoagulants were continued throughout the periprocedural period, including the morning of the procedure. Intravenous heparin was administered during the procedure and neutralized by protamine at the end of the procedure. Sixty-one patients underwent magnetic resonance imaging (MRI) after the procedure to evaluate for silent CI. Mean age was 66 ± 11 years; there were 91 men (73.7%) and 148 cases of paroxysmal AF (57.1%). No symptomatic CI was observed. Silent CI occurred in 6/61 patients (9.8%). No significant difference was observed between the Api group (4/30 patients, 13.3%) and the Wf group (2/31 patients, 6.5%). There was no significant difference regarding major bleeding events between the Api group (1/157 patients, 0.6%) and the Wf group (2/102 patients, 2.0%). The safety and efficacy of uninterrupted apixaban for patients undergoing AF ablation were equivalent to warfarin for preventing bleeding and thromboembolic complications.

Gonadotropin-releasing hormone analog depots have been widely used for a variety of diseases including prostate cancer, breast cancer, endometriosis, uterine leiomyomas, and central precocious puberty. Most of the side/adverse effects of gonadotropin-releasing hormone analog depots, such as leuprorelin acetate depot, are related to hypotestosteronism in males. Anaphylaxis to gonadotropin-releasing hormone analog depot is extremely rare. We present the first case report of a Japanese man who developed anaphylaxis to leuprorelin acetate depot during the treatment of metastatic prostate cancer and recovered successfully by conservative treatment. A drug-lymphocyte stimulation test showed that not only leuprorelin acetate itself, but also its vehicle polylactic and glycolic acids, might be responsible for the anaphylaxis to leuprorelin acetate depot. Because anaphylaxis can be lethal, the present case suggests that one should bear in mind the possibility of anaphylaxis in all patients who receive gonadotropin-releasing hormone analog depot and monitor such patients carefully.

Background: Recent technological advances have enabled the reliable detection and characterization of circulating tumor cells (CTCs) in the blood of cancer patients. To quantify the amount of CTCs, various assays have been developed to facilitate the detection of epithelial cells in the blood by using cellular surface markers such as EpCAM and cytokeratins. However, recent studies have revealed the importance of CTCs undergoing epithelial-mesenchymal transition (EMT), which are difficult to detect by the conventional surface marker-based methods because those CTCs express low expression of epithelial markers. We previously reported a novel method for the identification of CTCs by removing WBCs from mononuclear cells in the blood, based on the features of Quantitative Phase Microscope Images (QPIs) of the cells obtained from machine-learning (AACR Annual Meeting 2015). Here, we report some progress of our study. Methods: We analyzed WBCs and cancer cell lines using Quantitative Phase Microscope (QPM) that can image optical path-length of living cells with a high resolution of 1nm without staining in non-cytotoxic way. At this time, QPIs were reconstructed from line scanned images of the cells flowing in a chamber. Obtained QPIs were analyzed by a computer vision application which automatically identifies an object in digital images based on the features extracted from the dataset we had developed by machine learning. Results: We imaged 325 WBCs obtained from healthy donors and 325 cell-line cells (from 5 cancer cell lines) with QPM. Then, we extracted certain features from the QPIs and used them as training images for machine learning. We employed 5-fold cross validation to create an algorithm to detect WBCs circulating in the blood. The algorithm successfully recognized WBCs among QPIs mixed in with WBCs and cancer cell lines. The ROC AUC value was 0.98, indicating that the algorithm was not a random selection. Furthermore, we successfully captured QPIs of the flowing cells, which makes it possible to sort living cells based on the algorithm we developed. Conclusions: We successfully differentiated WBCs from cancer cell lines based on the features of QPIs. The object recognition method applying to QPIs of the cell is expected as a useful, non-cytotoxic, marker-free isolation of CTCs. Citation Format: Yusuke Ozaki, Hidenao Yamada, Hirotoshi Kikuchi, Tomohiro Murakami, Tomhiro Matsumoto, Toshiki Kawabata, Yoshihiro Hiramatsu, Manabu Ohta, Kinji Kamiya, Megumi Baba, Toyohiko Yamauchi, Kentaro Goto, Yukio Ueda, Shigetoshi Okazaki, Hiroyuki Konno. Label-free imaging identification of WBCs based on the features of quantitative phase microscope images for negative selection of CTCs. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3952.

In order to evaluate the clinical significance of S100ao protein, we measured serum S100ao protein in 36 patients with renal cell carcinoma by EIA developed by Kimura et al. In addition, the distribution of S100ao protein was studied by the immunohistochemical method. Previous study demonstrated that mean level of serum S100ao protein in healthy volunteers was 203 +/- 107 pg/ml, therefore the cut off level was set to 524 pg/ml. The results obtained in this study were as follows: 1) The mean level of serum S100ao protein was 1162 +/- 2056 pg/ml, and its positive rate was 44% in 36 patients with renal cell carcinoma. When the patients were divided into 2 groups according to tumor stage, the mean level of serum S100ao protein in the high stage group was significantly higher than that in the low stage group (p less than 0.01). 2) In the sequential study of serum S100ao protein, patients with progressive disease showed a gradual increase in the level of serum S100ao protein while patients with no evidence of tumor showed a normal level of serum S100ao protein. 3) There was no correlation between the level of serum S100ao protein and the histological grade of renal cell carcinoma. 4) Immunohistochemical analysis (10 cases) showed that S100ao protein was observed in all of 10 renal cell carcinomas. Thus, the present study suggests that serum S100ao protein might be a useful clinical marker especially in monitoring patients with renal cell carcinoma.

Background: Circulating tumor cells (CTCs) are cancer cells which are shed from primary tumors and circulating in the bloodstream, and thought to play a key role in metastasis. Existing CTC capture methods are largely based on surface markers such as cytokeratins. However, invasive tumor cells tend to lose their epithelial markers and change into mesenchymal phenotype by the epithelial mesenchymal transition (EMT). It seems that conventional CTC capture methods miss the mesenchymal CTCs which are supposed to have highly malignant potentials. Because the features of CTCs are not fully understood, it is difficult to retrieve all CTCs by positive selection using CTC-surface markers. Considering the fact that vast majority of nucleated cells circulating in the blood stream are WBCs, eliminating WBCs from circulation is an efficient way to purify CTCs. In this study, we attempted to develop a novel method for the identification of WBCs in the blood using Quantitative Phase Imaging Microscopy (QPM). Methods: We analyzed WBCs and cancer cell lines using QPM that can image optical path-length of living cells with a high resolution of 1nm without staining in non-cytotoxic way. Obtained images, quantitative phase images (QPIs), were analyzed by a computer vision application which automatically identifies an object in digital images based on features extracted from the dataset we had developed by machine learning. Results: We imaged 325 WBCs obtained from healthy donors and 325 cell-line cells (including 5 different cell lines) with QPM. Then, we extracted certain features from the QPIs and used them as training images for machine learning. We employed 5-fold cross validation to create an algorithm to detect WBCs circulating in the blood. The algorithm successfully recognized WBCs among QPIs mixed in with WBCs and cancer cell lines. The ROC AUC value was 0.98, indicating that the algorithm was not random selection. Conclusions: We successfully differentiated WBCs from cancer cell lines based on the features of QPIs. The object recognition method applying to QPIs of the cell is expected as a useful, non-cytotoxic, marker free isolation of CTCs. Citation Format: Yusuke Ozaki, Hidenao Iwai, Hirotoshi Kikuchi, Tomohiro Matsumoto, Shinichiro Miyazaki, Toshiki Kawabata, Yoshihiro Hiramatsu, Manabu Ohta, Kinji Kamiya, Megumi Baba, Kentaro Goto, Toyohiko Yamauchi, Yukio Ueda, Shigetoshi Okazaki, Hiroyuki Konno. Label-free imaging identification of white blood cells using quantitative phase microscopy for negative selection of circulating tumor cells. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5186. doi:10.1158/1538-7445.AM2015-5186

BACKGROUND The neuroendocrine (NE) pathway has been attracting attention as a mechanism for the androgen-independent progression because the neuropeptide provokes tumor growth and inhibits apoptosis under androgen-deprived milieu in prostate cancer cells. On the basis that serum progastrin-releasing peptide (ProGRP) is elevated in patients with advanced disease stage, we examined the prognostic value of the neuropeptide. METHODS Serum ProGRP status was determined with an enzyme-linked immunosorbent assay (ELISA) in 460 men with benign and malignant prostatic diseases, chronic renal failure, and healthy controls. Seventy patients with metastatic prostate cancer including four patients (5.7%) with NE carcinoma who underwent hormonal therapy were enrolled in the prognostic analyses by Cox proportional hazards model. RESULTS The serum status steadily shifted toward predominant expression of ProGRP with the progression of prostate cancer into metastatic and androgen-independent stages. Univariate analysis revealed that the deteriorated performance status (PS) and extent of bony disease (EOD), and high serum alkaline phosphatase (ALP), serum ProGRP, and nadir prostate-specific antigen (PSA) levels were associated with a lower progression-free survival (PFS) rate (P

We describe a patient with tuberous sclerosis complex and massive bilateral renal angiomyolipomas (AMLs) in association with pulmonary lymphangioleiomatosis, who experienced hemorrhagic shock because of rupture of the left renal AML. She was treated with transarterial embolization, followed by bilateral nephrectomy. The total tumor burden weighed 5800 g, making it the largest AML by weight in published reports. The histopathologic examination revealed concurrent oncocytomas with AMLs in the right kidney, indicating a possible shared mechanism in the pathogenesis of these two disorders. This case also represents a rare, but significant, overlap between renal AML, pulmonary lymphangioleiomatosis, and tuberous sclerosis complex.

We report a case of primary malignant melanoma of the male urethra in whom fistula formation was observed in the fossa navicularis.