Prognosis Prediction Using Magnetic Resonance Spectroscopy and Oligoclonal Bands in Central Nervous System Methotrexate-associated Lymphoproliferative Disorder

Central nervous system methotrexate-associated lymphoproliferative disorder (CNS-MTX-LPD) is rare, but its spontaneous regression has been observed in some patients after withdrawal of agents. We herein report three cases of primary CNS-MTX-LPD that received oral MTX for rheumatoid arthritis. Epstein-Barr virus and oligoclonal bands (OCBs) were positive, while proton magnetic resonance spectroscopy (¹H-MRS) showed an elevated lipid peak and slightly elevated choline/N-acetylaspartate ratio in common. After MTX withdrawal, brain lesions showed spontaneous regression in all cases. Our patient''s ¹H-MRS findings and OCBs may reflect a non-monoclonal lymphoproliferative histology as benign-type lesions in CNS-MTX-LPD.     

Label‐free multiphoton excitation imaging as a promising diagnostic tool for breast cancer

Histopathological diagnosis is the ultimate method of attaining the final diagnosis; however, the observation range is limited to the two‐dimensional plane, and it requires thin slicing of the tissue, which limits diagnostic information. To seek solutions for these problems, we proposed a novel imaging‐based histopathological examination. We used the multiphoton excitation microscopy (MPM) technique to establish a method for visualizing unfixed/unstained human breast tissues. Under near‐infrared ray excitation, fresh human breast tissues emitted fluorescent signals with three major peaks, which enabled visualizing the breast tissue morphology without any fixation or dye staining. Our study using human breast tissue samples from 32 patients indicated that experienced pathologists can estimate normal or cancerous lesions using only these MPM images with a kappa coefficient of 1.0. Moreover, we developed an image classification algorithm with artificial intelligence that enabled us to automatically define cancer cells in small areas with a high sensitivity of ≥0.942. Taken together, label‐free MPM imaging is a promising method for the real‐time automatic diagnosis of breast cancer.     

Radiation-induced angiosarcoma of the parotid gland after postoperative radiotherapy for hypopharyngeal carcinoma

Secondary carcinogenesis within the irradiation range is one of the most severe problems in cancer survivors. A 60-year-old woman developed hypopharyngeal carcinoma, and she received radical surgery and postoperative radiotherapy. Eight years later, brown pigmentation and induration were observed in the left subaural region. Fine-needle aspiration biopsy revealed malignancy and the parotid tumor was diagnosed as recurrence of hypopharyngeal carcinoma. Neoadjuvant chemotherapy followed by radical parotidectomy was performed. The pathological diagnosis was angiosarcoma, which was most likely induced by past irradiation. About two months after surgery, lung metastases were detected. Docetaxel did not affect to lung metastases, but paclitaxel therapy was partially effective. The lung tumors increased in size, and brain metastases developed, resulting in death. Both neoadjuvant chemotherapy and radical surgery played important roles in the local disease control. Administration of newer agents as adjuvant chemotherapeutic agent should also be considered for improving the prognosis.     

The effects of breaking sedentary time with different intensity exercise bouts on energy metabolism: A randomized cross-over controlled trial

Background and aimsBreaking up sedentary periods, particularly with light activity, increases total energy expenditure (EE), and helps provide better glycemic control. However, the effects of activities of various intensities to interrupt prolonged sedentary time are unclear. The purpose of the present study was to examine potential differences in glycemic control and EE from breaking up sedentary time with short exercise bouts of different intensities.Methods and resultsNine overweight/obesity young men underwent whole body indirect calorimetry at 19:00 on day 1 and stayed overnight. After awakening on day 2, they performed short duration jogging every 30 min over 8 h (16-time bouts in total) under 3 different conditions with the same running distance: (1) lactate threshold (LT) for 2 min, (2) 60% LT for 200 s, and (3) onset of blood lactate accumulation (OBLA) for 75 s. The 24-h EE and interstitial glucose concentration (from 8:00 to 19:00 on day 2) was continuously measured throughout the trials. The standard deviation during intervention and indexes of postprandial of the interstitial glucose concentration was significantly lower at LT and OBLA than at 60% LT (p < 0.05). The 24-h EE was not significantly different among conditions, but EE at OBLA during intervention was slightly but significantly higher than at 60% LT and LT.ConclusionBreaking up sedentary time with short-duration jogging at LT and with OBLA intensities may have better glycemic control and increased use of carbohydrate as a fuel, while short-duration a jogging at OBLA intensity may increase EE.Trial registrationUMIN000041361.     

Ontogenic studies on the rat brain capillaries in relation to the human brain tumor vessels

Summary One of the major morphological disparities of brain capillaries between newborn or young and adult rats might be reflected in the aspect of development of the basement membrane. The basement membrane in young animals is clearly evident to be poorly developed up to 15 days of age, and then better developed to possess some similarity to that in adult animals. In addition, it also should be emphasized that slightly distended extracellular space is evident in the nervous tissue of newborn animals.Although in malignant astrocytoma some small blood vessels do not possess any perivascular space around them, others evidently have narrow or relatively wide perivascular spaces where some fibrils of mesodermal origin and fibrocytes can be clearly seen. Also, in some astrocytomas, wide extracellular space is distributed extensively all over the tumor tissue.However, in this context the immaturity of endothelial and glial cells in both young animals and brain tumors should be duly considered.The permeability of the brain capillaries in both young animals and brain tumors has been very well known to be higher than that of the adult brain tissue. However, the higher permeability has another significance, from the morphological point of view, in young animals than it has in brain tumors.

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Zusammenfassung Einer der hervorstechendsten morphologischen Unterschiede zwischen den Hirncapillaren neugeborener und junger oder erwachsener Ratten kommt in der Entwicklung der Basalmembran zum Ausdruck. Bei jungen Tieren bis zu einem Alter von 15 Tagen ist die Basalmembran wenig ausgebildet, mit fortschreitendem Alter der Tiere tritt die Ähnlichkeit mit der Basalmembran von erwachsenen Tieren ausgeprägter in Erscheinung. Außerdem ist zu betonen, daß im Nervengewebe neugeborener Tiere etwas erweiterte extracelluläre Räume zu beobachten sind.Im maligen Astrocytom gibt es kleine Blutgefäße, die keine perivasculären Räume besitzen, andere dagegen haben deutliche engere oder verhältnismäßig weite perivasculäre Räume, in denen mesodermale Fibrillen und Fibrocyten zu finden sind. In manchen Astrocytomen sind im gesamten Tumorgewebe weite extracelluläre Räume vorhanden.Allerdings müßte hier die Unreife der Endothelzellen und der Gliazellen bei jungen Tieren wie auch bei Hirntumoren in Rechnung gestellt werden.Es ist bekannt, daß sowohl bei jungen Tieren wie auch bei Hirntumoren die Permeabilität der Hirncapillaren höher ist als bei erwachsenen Tieren. Vom morphologischen Standpunkt jedoch bestehen in den Voraussetzungen der erhöhten Permeabilität bei jungen Tieren einerseits und bei Hirntumoren andererseits deutliche Unterschiede.

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With 11 Figures in the Text

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This study was made possible by a grant from the Rockfeller Foundation GAMNS 59117.     

Comparison of the Central Adrenal Vein and the Common Trunk of the Left Adrenal Vein for Adrenal Venous Sampling

PurposeTo compare left adrenal venous sampling (AVS) in two locations: the central adrenal vein and the common trunk.Materials and MethodsA total of 22 patients (12 men and 10 women; mean age, 50 y; range, 26–65 y) who were suspected of having primary aldosteronism (PA) and underwent successful AVS with cortisol concentration measurement and/or venography between November 2010 and August 2011 were retrospectively analyzed. In regard to the left adrenal vein, collections were done at two locations: at the common trunk below the confluence of the inferior phrenic vein and at the central adrenal vein, which was above the confluence. The effects of the inflow from the inferior phrenic vein on plasma aldosterone and cortisol levels were analyzed.ResultsEight patients had bilateral hypersecreting lesions and 13 had a unilateral lesion. One was diagnosed as having secondary hypertension other than PA. The median cortisol levels below and above the confluence were 129 μg/dL (range, 21–400 μg/dL) and 215 μg/dL (range, 21–690 μg/dL), respectively. The median aldosterone levels were 2,120 pg/mL (range, 164–42,700 pg/mL) and 4,275 pg/mL (range, 119–59,000 pg/mL), respectively. The median aldosterone/cortisol (A/C) ratios were 244 (range, 34–2,401) and 278 (range, 25–2,251), respectively. Cortisol and aldosterone levels were significantly higher above the confluence (P = .0050 and P = .0003, respectively), whereas the A/C ratio showed no significant difference (P = .12).ConclusionsAlthough higher levels of cortisol and aldosterone were obtained upstream, A/C ratio was not significantly different between the central adrenal vein and the common trunk.     

Leaflet escape in an Edwards TEKNA mitral prosthesis

In almost every type of artificial valve, structural failure has been described. We are reporting on a case of a sudden leaflet escape of an Edwards TEKNA mitral valve prosthesis 12 years after implantation. The patient had a sudden onset of dyspnea and severe pulmonary edema with subsequent cardiogenic shock. An emergency mitral replacement was successfully performed. A multi-detector computed tomography scanning and three-dimensional imaging showed two fragments that had embolized in the terminal aorta and the left common iliac artery. The patient presented visual field abnormality, and postoperative head computed tomography showed watershed cerebral infarction. The escaped leaflet that fractured transversely was removed, following the patient’s recovery, during cardiac surgery.