Safe techniques in surgery for hysteroscopic myomectomy

Hysteroscopic myomectomy is regarded as the best treatment for patients with submucous myomata. However, this procedure has a number of associated complications, including uterine perforation, cervical laceration, hyponatremia and hemorrhage, especially in cases of sessile submucous myomata. To avoid these problems, it is important to make well-advised preparations and manipulations both pre- and intraoperatively. The main surgical considerations for safe hysteroscopic myomectomy are shortening the operating time and avoiding cutting too deeply into the myometrium. With these requirements in mind, a combination of techniques using vaporization and a powerful oxytocic agent, such as prostaglandin F-2alpha, appears to be the safest method of carrying out hysteroresectoscopy for unpedunculated sessile submucous myomata.     

The N-terminus of the Montano virus nucleocapsid protein possesses broadly cross-reactive conformation-dependent epitopes conserved in rodent-borne hantaviruses

The hantavirus nucleocapsid (N) protein is an important immunogen that stimulates a strong and cross-reactive immune response in humans and rodents. A large proportion of the response to N protein has been found to target its N-terminus. However, the exact nature of this bias towards the N-terminus is not yet fully understood. We characterized six monoclonal antibodies (mAbs) against the N protein of Montano virus (MTNV), a Mexican hantavirus. Five of these mAbs recognized eight American hantaviruses and six European and Asian hantaviruses, but not the Soricomorpha-borne Thottapalayam hantavirus. The N protein-reactive binding regions of the five mAbs were mapped to discontinuous epitopes within the N-terminal 13-51 amino acid residues, while a single serotype-specific mAb was mapped to residues 1-25 and 49-75. Our findings suggest that discontinuous epitopes at the N-terminus are conserved, at least in rodent-borne hantaviruses, and that they contribute considerably to N protein cross-reactivity.     

Liquid crystal display screens as stimulators for visually evoked potentials: flash effect due to delay in luminance changes

Purpose

The cathode-ray tube (CRT) screen has recently been replaced by liquid crystal display (LCD) screens as visual stimulators for pattern-reversal visually evoked potentials (p-VEPs). The aim of the study was to evaluate the usefulness of LCD screen to elicit p-VEPs.

Methods

The waveforms of the p-VEPs elicited by a LCD panel were compared with those elicited by a conventional CRT screen. The changes in the luminance of each screen were measured with a photodiode, and the mean luminance change was measured with a luminance meter. VEPs and electroretinograms (ERGs) were also recorded when the monitor was covered by a diffuser.

Results

The p-VEPs elicited by the LCD consisted of the N75 and P100 components of the conventional VEPs and had good reproducibility. The average latency of these components was significantly delayed by 9.8 ms for N75 and 10.2 ms for P100, and the N75-P100 amplitude was significantly larger than the conventional p-VEP elicited by the CRT screen. During the reversal phase, especially from black-to-white, the luminance of the LCD screen was transiently reduced, and it elicited a flash VEP and ERG. A reduction in the contrast of the checks minimized the transient change in the luminance, and the VEP waveform was more similar to that elicited by the CRT screen.

Conclusions

The results suggest that when an LCD monitor is used as an alternative visual stimulator to elicit p-VEPs, the delay in the luminance change and the flash effect needs to be taken into account.     

Correlations between both the expression levels of inflammatory mediators and growth factor in medial perimeniscal synovial tissue and the severity of medial knee osteoarthritis

An enhanced expression of the inflammatory mediators in the perimeniscal synovium in knee osteoarthritis (OA) has been suggested to contribute to progressive cartilage degeneration. However, whether the expression levels of these molecules correlated with the severity of OA still remained unclear. Medial perimeniscal synovial samples were obtained from 23 patients with Kellgren-Lawrence (K/L) grades 2 to 4 of medial knee OA. Immunohistochemical analysis of the synovium revealed that the MMP-1, COX-2 and IL-1β expression of the patients with K/L 4 to be significantly reduced in comparison to those with either K/L 2 or 3, while the TGF-β expression showed the opposite. The synovial expression of MMP-1 and IL-1β showed a significant negative correlation with the severity of OA, while that of TGF-β again showed the opposite. In conclusion, although synovial inflammation remained active, the MMP-1, COX-2 and IL-1β expression in synovium decreased depending upon the severity of OA, while the TGF-β expression increased.     

Gastrointestinal stromal tumors of the small intestine in pediatric populations: a case report and literature review

An 18-year-old girl presented with abdominal pain and a tumor was subsequently detected in the jejunum. We therefore carried out a wedge resection of the jejunum. The diagnosis of GIST was confirmed histologically, and a mutation in exon 9 of the c-kit gene was observed. GISTs are rare in pediatric populations and pediatric GISTs occur predominantly in females and are characterized by a multifocal gastric location and a wild-type phenotype for the c-kit genes. The features of pediatric GISTs of the small intestine have not yet been categorized, and to date, only 11 cases in patients younger than 18 years have been reported. These cases did not occur primarily in females and tended to present as single tumors with mutations in the c-kit gene. This suggests that these cases do not have the same features as pediatric gastric GISTs, but instead are similar to adult GISTs. In pediatric populations, GISTs of the small intestine were expected to show a better response to imatinib treatment than gastric GISTs because of the alterations in the c-kit gene.     

Establishment of Long‐Term Model throughout Regular Menstrual Cycles in Immunodeficient Mice

Citation Kikuchi‐Arai M, Murakami T, Utsunomiya H, Akahira J, Suzuki‐Kakisaka H, Terada Y, Tachibana M, Hayasaka S, Ugajin T, Yaegashi N. Establishment of long‐term model throughout regular menstrual cycles in immunodeficient mice. Am J Reprod Immunol 2010 Problem The number of uterus natural killer (NK) cells change through the menstrual cycle, but the origin of uterus NK cell was not unclear. Our aims are to study whether we can reproduce repetition of menstrual cycle and to reveal the origin of uterus NK cells. Method of study Endometrial samples were obtained from fertile women, and the tissues were transplanted into ovariectomized non‐obese diabetic (NOD)/severe combined immunodeficiency (SCID)/γCnull (NOG) mice. Mice were treated with sex hormones which were in accord with human menstrual cycle. Results The replants showed similar histological changes as in eutopic endometrium repeatedly. CD56‐positive, CD16‐negative NK cells increased significantly during the treatment with estradiol and progesterone combination. Conclusion Histological assessment demonstrated that this model of NOG mice repeatedly exhibited regular menstrual cycles, and this model mimicked not ‘ectopic endometrium’, but ‘eutopic endometrium’ in humans. Change in number of NK cells suggested that NK cell might be derived from the endometrium.     

Cancer cachexia—pathophysiology and management

About half of all cancer patients show a syndrome of cachexia, characterized by anorexia and loss of adipose tissue and skeletal muscle mass. Cachexia can have a profound impact on quality of life, symptom burden, and a patient’s sense of dignity. It is a very serious complication, as weight loss during cancer treatment is associated with more chemotherapy-related side effects, fewer completed cycles of chemotherapy, and decreased survival rates. Numerous cytokines have been postulated to play a role in the etiology of cancer cachexia. Cytokines can elicit effects that mimic leptin signaling and suppress orexigenic ghrelin and neuropeptide Y (NPY) signaling, inducing sustained anorexia and cachexia not accompanied by the usual compensatory response. Furthermore, cytokines have been implicated in the induction of cancer-related muscle wasting. Cytokine-induced skeletal muscle wasting is probably a multifactorial process, which involves a protein synthesis inhibition, an increase in protein degradation, or a combination of both. The best treatment of the cachectic syndrome is a multifactorial approach. Many drugs including appetite stimulants, thalidomide, cytokine inhibitors, steroids, nonsteroidal anti-inflammatory drugs, branched-chain amino acids, eicosapentaenoic acid, and antiserotoninergic drugs have been proposed and used in clinical trials, while others are still under investigation using experimental animals. There is a growing awareness of the positive impact of supportive care measures and development of promising novel pharmaceutical agents for cachexia. While there has been great progress in understanding the underlying biological mechanisms of cachexia, health care providers must also recognize the psychosocial and biomedical impact cachexia can have.     

Re-evaluation of detectability of liver metastases by contrast-enhanced CT: added value of hepatic arterial phase imaging

Purpose

We compared the detectability of liver metastases on 2- and 3-phase images using robust statistical methods. Nine radiologists evaluated unenhanced CT plus portal venous phase (2-phase) images and 2-phase plus hepatic arterial phase (HAP) (3-phase) images.

Materials and methods

Our study included 54 patients with primary malignant tumors who underwent 3-phase hepatic dynamic CT more than twice to screen for liver metastases; 24 had 1–6 liver metastases measuring 4–27 mm in diameter (median 13 mm). The other 30 had no metastases. Nine board-certified radiologists participated in our observer performance study. They specified the location of the metastatic lesions and rated the probability of metastatic nodules on 2-phase images acquired with and without HAP imaging. We used jackknife alternative free-response receiver operating characteristic (JAFROC) analysis to compare their performances.

Results

For all radiologists the area under the curve without and with HAP imaging was 0.86 and 0.88, respectively; the difference was significant (p = 0.04). For metastases smaller than 10 mm the averaged lesion localization fraction without and with HAP imaging was 0.17 and 0.26 (p < 0.01).

Conclusion

Adding HAP to 2-phase imaging improved the detectability of liver metastases, especially of lesions smaller than 10 mm.