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A 71-year-old man with symptomatic severe aortic valve stenosis and stenosis of the proximal right coronary artery (RCA) underwent aortic valve replacement with Perceval (LivaNova, London, UK), a sutureless aortic bioprosthesis with a self-expanding open-cell designed nitinol frame (SL-AVR). Seven weeks after the SL-AVR, percutaneous coronary intervention (PCI) to the RCA was required. However, engagement of the guiding catheter (GC) was challenging because the RCA ostium was jailed by the strut of the Perceval. Therefore, the “Mother, Child, and Grandchild Technique” was used. A 4-Fr diagnostic catheter (DC) was partially engaged, and a support type 0.014-inch guidewire (GW) was inserted into the distal RCA. The DC was replaced by a 6-Fr GC. To fill the gap between the 0.014-inch GW and 6-Fr GC, a 5-Fr tapered inner sheath (IS, tip size was 3.0-Fr, used as Child catheter) was inserted into the 6-Fr GC (Mother catheter), and a 2.6-Fr microcatheter (Grandchild catheter) was inserted into the 5-Fr IS. Therefore, the gap between the 0.014-inch GW and 6-Fr GW was obliterated. Finally, we successfully inserted the PCI system and engaged the GC. RCA stenosis was treated using the conventional PCI technique. Herein, we report a case of successful PCI subsequent to SL-AVR.

A severely calcified lesion is the most challenging entity in endovascular therapy (EVT) for below-the-knee (BTK) arteries. In this report, we introduce a challenging plaque modification technique known as the inner PIERCE technique. A 65-year-old man on hemodialysis with multiple toe ulcerations underwent an EVT for his BTK artery diseases. During EVT, the guidewire passed through the severely calcified posterior tibial and plantar arteries; however, the other devices could not pass through the lesion. Therefore, a novel inner PIERCE technique was performed. After guidewire externalization, an 18G 20 cm needle was advanced from the retrograde approach site, following the guidewire, for percutaneous transhepatic cholangiodrainage (PTCD). The PTCD needle was advanced into the severely calcified plaque using a rotational motion. Finally, the needle could pass through the lesion. After the inner PIERCE technique, an angioplasty was performed with a 2.5 mm balloon. The final angiography showed sufficient blood flow. After the EVT, complete wound healing was achieved in 4 months. This challenging technique may be an additional option for EVT to treat severely calcified BTK arteries.

Background Sinus of Valsalva aneurysm (SVA) is a rare cardiac abnormality occurring in 0.09% of the general population, but few reports have examined its recurrence. Unruptured SVAs are usually asymptomatic. Case summary A 50-year-old woman presented with chest pain and a history of surgery for a ruptured right coronary SVA 32 years prior. Echocardiography showed the recurrence of an unruptured SVA of the non-coronary sinus with moderate aortic regurgitation, severe mitral regurgitation, and severe tricuspid regurgitation. Cardiac computed tomography (CT) revealed compression of the right coronary artery (RCA) between the SVA and sternum. Adenosine triphosphate stress myocardial perfusion imaging (MPI) identified reversible ischaemia of the inferior wall. The patient underwent patch closure of the SVA, aortic valve replacement, mitral valvuloplasty, and tricuspid annuloplasty. Post-operative MPI showed no residual ischaemia, and CT confirmed both successful repair of the SVA and intact RCA. Discussion This case provides two noteworthy findings. First, the SVA recurred after 32 years. Second, a non-coronary SVA causing myocardial ischaemia is extremely rare given the long anatomical distance between the non-coronary sinus and coronary arteries. In our patient, the non-coronary SVA grew large enough within the anterior mediastinum to cause RCA compression.

The change in twin-boundary mobility that is caused by twin-boundary segregation was investigated in pure magnesium and four binary solid-solution magnesium alloys (Mg-Ag, Mg-Sn, Mg-Y and Mg-Zn all...

For many of the novel antiepileptics, immunoassays, used for routine therapeutic drug monitoring (TDM), cannot be used. We could monitor eight novel antiepileptics using an LC/MS method since July 2017. The purpose of this study was to evaluate the significant changes associated with the transition from outsourcing to in-hospital monitoring of novel antiepileptics. The number of measurements of novel antiepileptics was significantly increased during the first (p

Esophageal squamous cell carcinoma (ESCC) is one of the most fatal types of malignant tumors worldwide. Epitranscriptome, such as N6 -methyladenosine (m6 A) of mRNA, is an abundant post-transcriptional mRNA modification and has been recently implicated to play roles in several cancers, whereas the significance of m6 A modifications is virtually unknown in ESCC. Analysis of tissue microarray of the tumors in 177 ESCC patients showed that higher expression of m6 A demethylase ALKBH5 correlated with poor prognosis and that ALKBH5 was an independent prognostic factor of the survival of patients. There was no correlation between the other demethylase FTO and prognosis. siRNA knockdown of ALKBH5 but not FTO significantly suppressed proliferation and migration of human ESCC cells. ALKBH5 knockdown delayed progression of cell cycle and accumulated the cells to G0/G1 phase. Mechanistically, expression of CDKN1A (p21) was significantly up-regulated in ALKBH5-depleted cells, and m6 A modification and stability of CDKN1A mRNA were increased by ALKBH5 knockdown. Furthermore, depletion of ALKBH5 substantially suppressed tumor growth of ESCC cells subcutaneously transplanted in BALB/c nude mice. Collectively, we identify ALKBH5 as the first m6 A demethylase that accelerates cell cycle progression and promotes cell proliferation of ESCC cells, which is associated with poor prognosis of ESCC patients.

Objectives This study aimed to clarify the factors of successful inter-agency collaboration that affect multidisciplinary workers’ abilities to identify child maltreatment. A questionnaire-based survey was conducted; the contents of the questionnaire included the Collaboration Evaluation Scale we developed and the workers’ abilities to identify child maltreatment. In total, 277 individuals from various agencies in Japan participated in this study. To examine the factors of successful inter-agency collaboration affecting workers’ awareness of child maltreatment, we used hierarchical multiple regression analysis. Results The analysis showed the positive effect of “commitment with loyalty” on the workers’ awareness of child maltreatment-related information in all fields (β = .18–.31, p

Purpose To establish an automated pronuclei determination system by analysis using deep learning technology which is able to effectively learn with limited amount of supervised data. Methods An algorithm was developed by explicitly incorporating human observation where the outline around pronuclei is being observed in determining the number of pronuclei. Supervised data were selected from the time‐lapse images of 300 pronuclear stage embryos per class (total 900 embryos) clearly classified by embryologists as 0PN, 1PN, and 2PN. One‐hundred embryos per class (a total of 300 embryos) were used for verification data. The verification data were evaluated for the performance of detection in the number of pronuclei by regarding the results consistent with the judgment of the embryologists as correct answers. Results The sensitivity rates of 0PN, 1PN, and 2PN were 99%, 82%, and 99%, respectively, and the overlapping 2PN being difficult to determine by microscopic observation alone could also be appropriately assessed. Conclusions This study enabled the establishment of the automated pronuclei determination system with the precision almost equivalent to highly skilled embryologists.

A wind-and-react MgB 2 solenoid magnet for klystrons has been developed. While the current normal-conducting (Cu) magnet consumes 20 kW per magnet, this MgB$_2$ magnet consumes less than 3 kW in refrigerator power. The conduction-cooled half coil of the magnet is 337 mm in inner diameter; the winding pack, 19.4 mm wide × 136.6 mm high, uses 2.7 km of 10 filament circular conductor, which is insulated with glass 0.83 mm in diameter, and is reacted after being wound onto a stainless steel bobbin. The coil has Cu plates of 0.2 mm in thickness between each coil layer and on the inner and outer sides. The magnet has two coils and produces 0.8 T in the center and its stored energy is 11.8 kJ. Together with the above-mentioned coil structure, these coils can consume stored energy in itself at quench without a special quench protection system. A performance test of the magnet was successful.

The deposition of islet amyloid is associated with β-cell mass dysfunction in type 2 diabetes mellitus (T2DM). Since the amylin aggregate is the main component of islet amyloid, in vivo imaging of amylin may be useful for diagnosis and elucidation of the pathogenic mechanism of T2DM. In the present study, we newly designed, synthesized, and evaluated two 18F labeled compounds ([18F]DANIR-F 2b and [18F]DANIR-F 2c) as positron emission tomography (PET) probes targeting amylin aggregates. In an in vitro binding study, DANIR-F 2b and DANIR-F 2c showed binding affinity for amylin aggregates (Ki = 160 and 29 nM, respectively). In addition, [18F]DANIR-F 2b and [18F]DANIR-F 2c clearly labeled islet amyloids in in vitro autoradiography of T2DM pancreatic sections. In the biodistribution study using normal mice, [18F]DANIR-F 2b and [18F]DANIR-F 2c displayed favorable pharamacokinetics in the pancreas and some organs located near the pancreas. Furthermore, in an ex vivo autoradiographic study, [18F]DANIR-F 2c also bound to amylin aggregates in the pancreas of the amylin transplanted mice. The results of this study suggest that [18F]DANIR-F 2c shows fundamental properties as a PET imaging probe targeting amylin aggregates in the T2DM pancreas.

Endovascular therapy, an established first-line treatment for isolated iliac artery (IA) occlusion (IAO), may be of limited use in challenging lesions. We describe a novel percutaneous endoluminal anatomical bypass (PEApass) technique for uncrossable external IA (EIA) occlusion. A 70-year-old man on hemodialysis with a history of colostomy presented with chronic limb-threatening ischemia due to a left EIA with below-the-knee occlusions. During a previous colostomy, the left EIA was accidentally ligated. Conventional endovascular recanalization for the ligated EIA failed, and a femoral-femoral bypass and below-knee angioplasty were performed as alternative therapy. Two weeks later, surgical site infection developed at both anastomosis sites. PEApass was performed prior to removing the infected graft. An arteriovenous fistula (AVF) in the distal location was created using a re-entry device, and its proximal location was created using a 0.014-in. penetration guidewire, which was snared on the inside of the iliac vein (IV) using a retrograde snare. The proximal and distal sections of the IA were connected using an 8.0-mm × 100-mm stent graft implanted through the IV. A final angiogram indicated that flow to the occluded IA was completely restored without complications. Following the PEApass, the infected graft was removed. Complete wound healing was achieved within approximately 1 month. This innovative PEApass procedure is feasible and could be an alternative procedure for patients with uncrossable IAO.

Graphical abstract, Highlights • Congenital leaflet prolapse and absent chordae of tricuspid valve (TV) is rare. • Congenital TV abnormalities were difficult to evaluate with echocardiography. • Three-dimensional transesophageal echocardiography revealed this TV abnormality.

[Image: see text] Tau aggregate, which is the main component of the neurofibrillary tangle, is an attractive imaging target for diagnosing and monitoring the progression of Alzheimer’s disease (AD). In this study, we designed and synthesized six radioiodinated 6,5,6-tricyclic compounds to explore novel scaffolds for tau imaging probes. On in vitro autoradiography of AD brain sections, pyridoimidazopyridine and benzimidazopyrimidine derivatives ([(125)I]21 and [(125)I]22, respectively) showed selective binding affinity for tau aggregates, whereas carbazole, pyrrolodipyridine, and pyridoimidazopyrimidine derivatives ([(125)I]10, [(125)I]12, and [(125)I]23, respectively) bound β-amyloid aggregates. In a biodistribution study using normal mice, [(125)I]21 and [(125)I]22 showed high initial uptakes (5.73 and 5.66% ID/g, respectively, at 2 min postinjection) into and rapid washout (0.14 and 0.10% ID/g, respectively, at 60 min postinjection) from the brain. Taken together, two novel scaffolds including pyridoimidazopyridine and benzimidazopyrimidine may be applied to develop useful tau imaging probes.

Hemotropic mycoplasmas are common pathogens in animals, but it remains unclear what role these pathogens play in human infections. We report clinical and biologic characterization of Candidatus Mycoplasma haemohominis infection in a 42-year-old man in Japan. The patient had severe hemophagocytic syndrome 1 month after an accidental needlestick injury. Metagenomic deep sequencing identified Candidatus M. haemohominis and determined its draft genome for an isolate from serum of the patient. A high copy number of the Candidatus M. haemohominis genome was detected in serum and bone marrow samples. Electron microscopy examination showed morphologic characteristics of Candidatus M. haemohominis. Levofloxacin monotherapy induced resistance caused by a gyrase A gene mutation in the quinolone resistance–determining region, but a combination treatment with moxifloxacin and minocycline was effective. We identified Candidatus M. haemohominis in a patient who had life-threatening symptoms related to multiple organ infection. Human infection with this mycoplasma might occur more frequently than has been generally recognized.

Objective We started an information technology (IT) system that encodes the medical treatment status of hepatitis B virrus (HBV) with a 9-digit number, automatically checks for inappropriate situations occurring due to immunosuppression and chemotherapy that do not comply with the flowchart of the hepatitis B countermeasure guideline, and promotes correct HBV medical treatment in our hospital. We conducted a prospective study of HBV reactivation using this system. Methods Among 21,607 cases that were managed using this system, 1,206 patients who were HBs antigen-negative, HBc antibody- and/or HBs antibody-positive and in whom HBV DNA quantification was performed two times or more were examined for the occurrence of HBV reactivation. The study population included: malignant lymphoma patients using rituximab (n=40), patients with malignant tumors using anticancer agents (n=546), patients treated with steroids (n=274), rheumatoid arthritis (RA) patients (n=144), patients using immunosuppressants/biologics (n=26), and patients undergoing hepatitis C direct acting antiviral (DAA) treatment (n=176). Results HBV reactivation was observed in 27 cases undergoing treatment with the following agents: rituximab (n=6), anticancer agents (n=8), steroids (n=10), anti-RA agents (n=1), and hepatitis C DAA (n=2). Among the 40 patients who were using rituximab, 6 (18.2%) showed a high rate of reactivation. In 10 in which HBV reactivation occurred at a median of 10 (range, 4-32) months after steroid administration, 6 occurred after the 7th month, and 1 patient showed HBs antigen positivity and severe hepatitis. Conclusion Continuing of the operation of an automatic check system using coded medical information to check for the reactivation enabled this prospective study of HBV reactivation. Careful attention should be paid to patients using steroids, as well as malignant lymphoma patients who are treated with rituximab. The results of the present study suggest that the present IT encoding system would be useful for preventing HBV reactivation.

We recently reported evidence of transthyretin (TTR) familial amyloid polyneuropathy (TTR FAP) associated with TTR E61K, which is characterized by late-onset sensory dominant polyneuropathy, autonomic disturbances, and cardiomyopathy. In those TTR FAP patients, no amyloid deposits were observed in the endoneurium of examined sural nerves. Furthermore, the amyloidogenicity of E61K TTR was similar to that of wild-type TTR in vitro. Thus, we speculated that dorsal root ganglia (DRGs) may be the initial sites for the lesions in amyloid neuropathy because there is no blood-nerve barrier. In the present study, lumbar magnetic resonance imaging was performed to evaluate the DRGs in pre-symptomatic TTR E61K and V30M subjects. Magnetic resonance imaging (3 T) was used for three-dimensional T2-weighted imaging (coronal sections; slice thickness, 2 mm), and the DRG volumes were measured. The mean volumes of the bilateral L3, L4, and S1 DRGs in the pre-symptomatic TTR E61K subject were larger than those for the pre-symptomatic TTR V30M subject and five control patients. The mean volumes of the bilateral L4 to S1 DRGs in the pre-symptomatic TTR V30M subject were similar to those in control patients. A number of lumbar DRGs were enlarged in the pre-asymptomatic TTR E61K subject, suggesting that DRGs may be the sites of the initial lesions in the peripheral nervous system of this FAP.

Background: Previous studies have shown favorable clinical outcomes of polymer-based paclitaxel-eluting stents (PB-PESs) in patients with femoropopliteal artery (FPA) disease. However, the effectiveness of PB-PES in hemodialysis (HD) patients has not been reported. The aim of this study was to compare the clinical performance of PB-PESs between HD and non-HD patients with symptomatic FPA disease.Materials and Methods: Between January 2019 and February 2020, 52 consecutive patients (mean age: 75.5 years; 42 men) underwent PB-PES implantation for symptomatic FPA diseases. Of these, 29 patients received HD and were classified into the HD cohort. The remaining 23 patients were classified into the non-HD cohort. Clinical outcomes were compared between the two cohorts. The primary efficacy endpoint was the primary patency at 12 months, and the primary safety endpoint was the 12-month incidence of major adverse cardiovascular and limb events (MACLEs), which were defined as the composite of the incidence of all-cause death, major amputation, stent thrombosis, and clinically driven target lesion revascularization (CD-TLR).Results: The overall primary patency rate was 93.3%. No significant difference existed in primary patency between the HD and non-HD cohorts (91.7% vs. 95.0%, P=0.577). The overall incidence rate of MACLEs was 16.6%, and the incidence rate was not significantly different between the HD and non-HD cohorts (20.2% vs. 13.3%, P=0.954). The incidence of stent thrombosis was not different between the HD and non-HD cohorts (8.3% vs. 5.0%, P=0.956).Conclusion: PB-PESs have exceptional 1-year primary patency and acceptable safety in HD patients and non-HD patients.Level of Evidence: Level 3, nonrandomized, follow-up study

Insulinomas are neuroendocrine tumors that are mainly found in the pancreas. Surgical resection is currently the first-line treatment for insulinomas; thus, it is vital to preoperatively determine their locations. The marked expression of the glucagon-like peptide-1 receptor (GLP-1R) is seen in pancreatic β-cells and almost all insulinomas. Radiolabeled derivatives of exendin-4, a GLP-1R agonist, have been used with nuclear medicine imaging techniques for the

The current WHO classification proposed high-grade biliary intraepithelial neoplasm (BilIN) and intracholecystic papillary neoplasm (ICPN) as precursors of the gallbladder carcinoma (GBC). Herein, conventional GBCs (cGBCs) were pathologically examined with respect to these two precursors.Forty-seven cases of GBC with grossly visible invasions were collected from Fukui Saiseikai Hospital. The association of two precursors was analyzed referring to pathologic features of cGBCs and post-operative survival.20 cGBCa (42.6%) were associated with either of two precursors in the surrounding mucosa: high-grade BilIN in 15 cases (31.9%) or ICPN in 5 cases (10.6%). Association of precursors was not related to gross types of and histological differentiation of cGBC. cGBCs without precursors showed frequent vascular/perineural invasion and lymph node metastasis, though cGBCs with and without precursors presented a similar post-operative survival. High-grade BilIN and ICPN associated with cGBCs showed more complicated cytoarchitectural features compared with those with no or focal invasion.More than 40% of cGBCs were associated with high-grade BilIN or ICPN, and the former was a frequent precursor. cGBCs without precursors showed aggressive pathologic features. Clinical detection of these precursors may make early treatment of cGBCs possible.

The occurrence of chemotherapy-related serious adverse events (AEs) is associated with a poor prognosis of hematopoietic malignancies. We have developed a medication guidance sheet (MGS) for monitoring AEs occurring when combining chemotherapy with etoposide, methylprednisolone, cisplatin, cytarabine, and rituximab (ESHAP±R). In this study, the usefulness of MGS was investigated in non-Hodgkin's lymphoma patients.The MGS was used to monitor AEs in 48 adult patients receiving ESHAP±R. The prediction accuracy of the MGS was estimated before and after modification based on practical data.A total of 246 AEs developed, all of which were predicted by the MGS. Among them, 149 events (61%) occurred during the same period as those predicted by the MGS. After modification of MGS for the onset and duration of AEs, the accuracy increased to 84%.The accuracy of the original MGS for ESHAP±R was insufficient but greatly improved after the AEs duration modification.

Multiple sclerosis (MS) is an intractable disease of the central nervous system that results from destruction of the myelin sheath. Direct measurement of de- and remyelination is required for monitoring the disease stage of MS, but no useful method has been established. In this study, we characterized four diaryl oxadiazole derivatives as novel myelin-imaging probes for single photon emission computed tomography (SPECT). All the diaryl oxadiazole derivatives penetrated the blood-brain barrier in normal mice. Among them, the highest ratio of radioactivity accumulation in the white matter (myelin-rich region) against the gray matter (myelin-deficient region) was observed at 60 min postinjection of [

There are two distinct etiologies of esophago-gastric junctional adenocarcinomas (EGJACs): one associated with extensive gastric mucosal atrophy (GA), resembling non-cardiac gastric cancers; and the other related to gastro-esophageal reflux disease, resembling esophageal adenocarcinoma. In this study, we investigated the associations between the visceral fat area (VFA) and EGJACs separately in the two subtypes of EGJACs, depending on the extent of background GA. Sixty-four consecutive patients with EGJACs (Siewert type 2) were enrolled from a population-based database in Akita Prefecture, Japan, between 2014 and 2019. Two age- and sex-matched healthy controls were randomly assigned to each EGJAC case. The extents of GA were evaluated endoscopically, and the VFA values were measured based on computed tomography images. Logistic regression analyses were performed to investigate the associations between EGJACs and the VFA. Study subjects were classified into 2 subgroups depending on the extent of endoscopic GA: 29 (45.3%) without and 35 (54.7%) with extensive GA. Multivariable regression analyses revealed that a VFA of ≥100 cm2 was significantly associated with EGJACs in subjects without extensive GA [odds ratio (95% confidence interval): 2.65 (1.08–6.54)], while there was no such association in subjects with extensive GA [odds ratio (95% confidence interval): 1.52 (0.60–3.83)]. The contribution of the VFA to the etiology of EGJACs seems to differ depending on the extent of background GA, with the VFA more prominently associated with EGJACs in subjects without extensive GA than in those with it, providing further rationale concerning the heterogeneous nature of EGJAC etiology.

Background Mitral stenosis (MS) is often concomitant with aortic stenosis (AS). However, little is known about the functional status following transcatheter aortic valve replacement (TAVR) alone in patients with severe AS and MS and the impact of TAVR for AS on MS hemodynamics. Methods We enrolled 11 patients (age 83.6 ± 4.7 years, eight women) with severe AS and MS who underwent TAVR. We compared New York Heart Association (NYHA) functional class and mean transmitral pressure gradient (MPG), mitral valve area (MVA), and stroke volume (SV) measured by transthoracic Doppler echocardiography between baseline and after TAVR. We also examined the calcification of the mitral annulus and mitral leaflet opening. Results NYHA functional class improved after TAVR in all 11 patients. As SV increased after TAVR (52 ± 12 mL to 63 ± 18 mL, p = 0.041), MPG decreased and MVA increased (6.9 ± 3.8 mmHg to 5.1 ± 2.5 mmHg, p = 0.011 for MPG and 1.12 ± 0.25 cm2 to 1.49 ± 0.43 cm2, p = 0.035 for MVA). However, MPG increased in one patient in whom calcification extended into the entire anterior mitral leaflet (AML) and AML mobility was severely reduced. Conclusions NYHA functional class and hemodynamic status of MS improved after TAVR in patients with severe AS and MS. TAVR might provide therapeutic efficacy for selected symptomatic severe AS patients with MS.

Background Elderly adults undergoing hemodialysis (HD) have multiple comorbidities, physical frailty, and functional dependence with activities of daily living (ADL). ADL difficulty is an early predictor of ADL dependency in community-dwelling elderly adults. However, the characteristics of ADL difficulty in patients undergoing HD have not yet been reported. The present study aimed to examine the current status and characteristics of physical function and ADL difficulty in ambulatory elderly patients undergoing HD. Methods In all, 136 elderly outpatients undergoing HD and 40 community-dwelling controls participated in the present study. The characteristics, physical function (SARC-F score, grip strength, five-times sit-to-stand test time, usual gait speed, maximum gait speed, and short physical performance battery score), and scores from the ADL difficulty questionnaires [difficulty related to upper limb (U/L) and lower limb (L/L) functions] were compared between the HD and control groups. Multiple regression analysis was performed to examine whether the characteristics of physical function were able to discriminate ADL difficulty in the HD group. Results The HD group had a significantly greater SARC-F score, lower grip strength, longer five-times sit-to-stand test time, slower usual gait speed, slower maximum gait speed, lower short physical performance battery score, and lower U/L and L/L ADL difficulty scores compared to the control group (all P < 0.001). The distribution of U/L and L/L ADL difficulty scores showed a wider variation in the HD group than in the control group. The U/L ADL difficulty score was independently associated with the SARC-F score (β = −0.52, P < 0.001) and grip strength (β = 0.21, P = 0.02). The L/L ADL difficulty score was independently associated with the SARC-F score (β = −0.56, P < 0.001) and usual gait speed (β = 0.35, P < 0.001). Conclusions The elderly HD group had a poorer physical function and experienced stronger ADL difficulty than the control group. There was an association between ADL difficulty and sarcopenia or poor physical function among patients undergoing HD. These findings provide useful data for effective clinical management to prevent decline of ADL in ambulatory elderly patients undergoing HD.

Recently, "polypoid invasive carcinoma (PICA)" showing grossly visible polypoid, invasive carcinoma with no adenoma component was proposed as a neoplastic polyp of the gallbladder. Herein, we report four cases of PICA of the bile duct. PICA cases of bile duct showed single, sessile polypoid growth grossly, and polypoid components were composed of invasive carcinoma of papillary/tubular patterns with active desmoplasia, and invaded directly and continuously into the bile duct wall and periductal tissue. While PICA and other intraductal papillary neoplasm of bile duct (IPNB) shared several features, PICA showed an invasive carcinoma growing in the duct lumen and also invading into the bile duct wall, thus different from IPNB which is the intraluminal polypoid, preinvasive epithelial neoplasia with back-to-back epithelial units. Taken together, PICA and IPNB could be differentiated from each other.

Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging.A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported.In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death.An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.

We investigated the development of hepatits B virus (HBV) reactivation in patients receiving immunosuppressive therapy or chemotherapy at our hospital for 8 years. Using the automatic checking system for HBV reactivation coded using medical information that has been in operation in our hospital since October 2012, we prospectively observed the occurrence status of HBV reactivation in immunosuppressive/chemotherapy cases for 8 years. HBV reactivation occurred in 31 of 1516 patients with HBV infection. It occurred annually between 1 and 7 cases in multiple clinical departments, and in 8 of 59 patients treated with rituximab, 10 of 653 patients treated with antineoplastic agents, 10 of 399 patients treated with steroids, and 3 of 212 patients treated with direct-acting antivirals. The cumulative incidence of HBV reactivation was 1.2%, 2.3%, and 3.4% at 1, 2, and 3 years, respectively. The results of Cox regression analysis showed that the incidence of HBV reactivation was significantly higher in patients who received rituximab (odds ratio:12.841) or steroid (hazard ratio:4.264) or those who tested positive for HBc antibody alone (hazard ratio:11.005). We observed the occurrence of HBV reactivation in HBV-infected patients treated with immunosuppressive therapy or chemotherapy. HBV reactivation by immunosuppressive therapy or chemotherapy still occurs, and further safety management and caution are required in the hospital.

Background Bucolome is a non-steroidal anti-inflammatory drug and uricosuric agent, currently used only in Japan. It is known to induce drug interactions by inhibiting cytochrome P450 (CYP) 2C9. It is often used to enhance the anticoagulant effect of warfarin by utilizing its drug interactions. There are only a few reports on drug interactions of bucolome and the mechanism remain poorly understood. Case presentation An 81-year-old woman with a history of type 2 diabetes mellitus was taking glimepiride 2 mg/day and voglibose 0.6 mg/day. After hospitalization, the patient underwent surgical aortic valve replacement surgery (day 0). Glimepiride and voglibose were resumed on the second postoperative day (day 2), and warfarin was started to prevent thromboembolism. Since the prothrombin time-international normalized ratio on day 9 was low at 1.24, 300 mg/day of bucolome was added to enhance the effect of warfarin. A gradual decrease in blood glucose levels was observed from the day after bucolome administration was initiated. Hypoglycemia in the 56–57 mg/dL range occurred before lunch and dinner on the 6th day (day 14) of bucolome administration, due to which voglibose was discontinued. Hypoglycemia below 70 mg/dL was not observed thereafter, and the general condition of the patient was stable. Conclusions Based on the clinical course and literature review, we believe that hypoglycemia in the present case was due to a drug interaction, caused by inhibition of CYP2C9 by bucolome and competitive inhibition of CYP2C9 by warfarin, which affected the pharmacokinetics of glimepiride. The possibility of hypoglycemia due to drug interactions should be considered by physicians, when bucolome is included to enhance the effect of warfarin, in patients taking glimepiride.

Type 2 diabetes mellitus (T2DM) accounts for the majority of diabetes mellitus cases, and β-cell function and mass may be involved in its pathophysiology. The deposition of islet amyloid in pancreas islets is one of the mechanisms of progression of T2DM. Therefore, the development of imaging techniques for islet amyloid deposition contributes to the early-phase diagnosis and elucidation of the pathogenic mechanism of T2DM. We have reported that pyridyl benzofuran (PBF) is a promising scaffold for islet amyloid imaging probes. In this study, we designed [We synthesized dedpa-PBF and dedpa-(PBF)In the in vitro saturation binding assay, the affinity of [[

While an association between esophago-gastric junctional adenocarcinomas (EGJACs) and obesity, especially visceral obesity, has been suggested in Western countries, the association remains unclear in Asia, including Japan. In this population-based case-control study, we investigated the association between EGJACs and obesity.To perform near-population-based data collection for all early-stage EGJACs occurring in Akita Prefecture from 2014 to 2019, clinical data, including endoscopic and computed tomography (CT) findings, were collected from 11 cancer treatment base hospitals in the area. Age- and gender-matched controls were extracted at a case-to-control ratio of 1:2 from healthy subjects who received health checkups in the same area. The visceral fat area (VFA) was calculated using CT images. Logistic regression analyses were performed to investigate the associations between EGJACs and obesity-related parameters.In total, 74 EGJAC cases (62 males, median age of 70 years old) and 148 controls were extracted. Multivariable analyses showed a significantly negative association between the BMI and EGJACs and a significantly positive association between the VFA and EGJACs with odds ratios (ORs) (95% confidence intervals [CIs]) of 0.65 (0.53-0.80) and 1.01 (1.01-1.02), respectively. These findings were confirmed in another dataset (40 EGJACs and 80 controls). In addition, as a categorical variable, VFA ≥ 100 cmWe found paradoxical associations between EGJACs and obesity-related parameters (BMI vs. VFA) in a Japanese population, suggesting a potentially pivotal role of the VFA rather than the BMI as a risk factor for EGJACs.

We report a case of a 63-year-old man without a history of atrial fibrillation or mitral valve disease who was admitted to our hospital. Echocardiography revealed a large left atrial mass attached to the atrial septum. We suspected the mass to be a myxoma, but it turned out to be a large thrombus after the surgery. Left atrial thrombus without mitral valve disease or atrial fibrillation is rare. Although the degree of urgency varies based on the case, early surgical resection is recommended for a large left atrial thrombus to prevent embolism.