Endoscopic ultrasonography-guided transmural drainage of an infected hepatic cyst due to Edwardsiella tarda: a case report

Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 77-year-old man with an infected hepatic cyst in the lateral segment caused by Edwardsiella tarda, which has not been previously reported as a pathogenic organism associated with infected hepatic cysts. Percutaneous drainage was temporarily effective, but infection recurred after the drainage tube was removed. We then inserted two drainage tubes into the cyst using an endoscopic ultrasonography (EUS)-guided technique, which was developed from EUS-guided fine needle aspiration (EUS-FNA). The internal drainage tube was a 7 Fr double pigtail stent, and the external tube was a 6 Fr nasobiliary drainage tube. Lavage through the external drainage tube was carried out for one week. The external drainage tube was discontinued when the patient’s condition improved significantly. Sixteen days after tube insertion, he was discharged with the internal tube draining the hepatic cyst into the stomach. Fifteen months after EUS-guided drainage, CT examination showed no recurrence of the hepatic cyst. EUS-guided drainage is an effective treatment for infected hepatic cysts.     

Intra-articular nodular fasciitis of the knee: a rare cause of recurrent hemarthrosis

A 20-year-old man presented with pain and recurrent hemarthrosis in the right knee. Magnetic resonance imaging of the knee showed a lesion with homogeneous low signal intensity on T1-weighted images and a heterogeneous, low to high signal intensity on T2-weighted images. At arthroscopy, the mass was located between the posterior cruciate ligament and the posterior knee joint capsule. The tumor was excised through a posterior approach and histologically diagnosed as a nodular fasciitis. Intra-articular nodular fasciitis is a very rare clinicopathologic entity. The current case showed the unique clinical feature of recurrent hemarthrosis at initial presentation, which has not been previously reported.     

Prostaglandin E2 type 1 receptors contribute to neuronal apoptosis after transient forebrain ischemia

Cyclooxygenase-2-derived prostaglandin E₂ (PGE₂) contributes to excitotoxic and ischemic neuronal cell death by engaging neuronal PGE₂ type 1 receptors (EP1R). Our previous studies have shown that EP1R signaling resulted in disturbances of intracellular Ca²⁺ homeostasis and suppression of the pro-survival protein kinase AKT. The aim of this study was to investigate whether these pathophysiological mechanism have a role in the neuronal cell death after transient forebrain ischemia. Mice were subjected to ischemia/reperfusion by bilateral common carotid artery occlusion. Hippocampal cornu ammonis area 1 (CA1) neuronal cell death was determined 5 days after reperfusion. Animals treated with the EP1R antagonist SC51089 or EP1R-deficient mice (EP1^−/−) showed significantly less neuronal injury as compared to vehicle-treated wild-type controls. Benefits of EP1R blockage were still evident 14 days after injury. Better neuronal survival was correlated with reduced neuronal caspase-3 activity and decreased nuclear translocation of the apoptosis-inducing factor . Neuroprotection could be reverted by intracerebroventricular administration of the phosphoinositide 3-kinase inhibitor {"type":"entrez-nucleotide","attrs":{"text":"LY294002","term_id":"1257998346","term_text":"LY294002"}}LY294002 and was not further increased by the calcineurin inhibitor FK506. These data implicate EP1R in postischemic neuronal apoptosis possibly by facilitating AKT inhibition.     

Revisiting Low-Risk Thyroid Papillary Microcarcinomas Resected Without Observation: Was Immediate Surgery Necessary?

Introduction

Low-risk thyroid papillary microcarcinomas (PMCs) without evidence of metastasis grow slowly if at all. However, we recommended surgery for tumors touching the trachea (TR) or located in the course of the recurrent laryngeal nerve (RN). Here we compared the cases of low-risk PMC patients who underwent immediate surgery to cases of TR- and RN-involved PMCs.

Materials and methods

We enrolled 1143 low-risk PMC patients who underwent immediate surgery in the years 2006–2014. The PMCs of 437 patients touched the TR on imaging studies: 270, 104, and 63 were graded as low, intermediate, and high risk, respectively, for TR invasion based on the angles between the tumor and the TR surface. The tumor was in the course of the RN in 144 patients, with 35 graded low risk and 109 high risk for RN invasion based on the normal rim of the thyroid in the direction of the RN.

Results

Invasion of the TR cartilage was observed only in high-risk patients. Peritracheal connective tissue was resected in 21, 15, and 6 of the high-, intermediate- and low-risk patients, respectively. Significant invasion of the RN requiring complete resection was observed in only nine patients at high risk for RN invasion. The incidence of TR invasion in high- and intermediate patients and the incidence of RN invasion in the high-risk patients were significantly higher than those of the low-risk patients. Tumors <7 mm did not show TR or RN invasion.

Conclusion

Among PMCs that touched the TR or were located in the course of the RN, observation could be the first choice for tumors <?7 mm and those ≥?7 mm judged as low risk for TR or RN invasion. However, for PMCs with high-risk features, immediate surgery after cytological diagnosis by a needle aspiration biopsy is recommended.

     

Preheparin lipoprotein lipase mass and apolipoproteinC-III ratio helps identify postprandial triglyceride metabolic marker

Serum lipid profiles have usually been evaluated using blood specimen in fasting state. However, postprandial hypertriglyceridemia is important risk factor for atherosclerosis. In the present study, we determined several parameters of triglyceride (TG) metabolism in healthy volunteers. Serum concentrations of TG in fasting state correlated negative the ratio of preheparin serum lipoprotein lipase mass (pLPL) and apoC-III (pLPL/apoC-III) in both fasting (r = -0.771, p < 0.0001) and postprandial (r = -0.640, p < 0.0001) state. To exclude the effect of high density lipoprotein (HDL) in serum, we purified the fraction of TG rich lipoprotein (TRL) using ultracentrifugation method 3 healthy volunteers with postprandial state. The pLPL/apoC-III was reduced constantly during postprandial state in all volunteers. These findings suggest that pLPL/apoC-III may be a useful marker for evaluation of TG metabolism using postprandial blood specimens.     

Association of CD22 gene polymorphism with susceptibility to limited cutaneous systemic sclerosis

Activating and inhibitory signal transducers, CD19 and CD22, have been substantially implicated both in human systemic sclerosis (SSc) and tight-skin mouse, a model for SSc. We previously showed that a single nucleotide polymorphism (SNP) in CD19 promoter region was significantly associated with increased CD19 expression level and with susceptibility to SSc. In the present study, we examined whether CD22 polymorphisms were associated with susceptibility to SSc. CD22 variations were genotyped in 126 Japanese patients with SSc [47 diffuse cutaneous SSc and 79 limited cutaneous SSc (lcSSc)] and 93 unrelated healthy controls. At the c.2304C > A SNP coding for a synonymous substitution in exon 13, A/A genotype was observed in six patients with SSc (4.8 %) but none in the controls (P=0.040). All six patients with A/A genotype belonged to the lcSSc subgroup (7.6%, P=0.008 vs controls). Surface expression level of CD22 tended to be lower in B cells from the patients with A/A genotype (n=5) as compared with C/A (n=7) or C/C (n=14) genotype (17% decrease, P=0.0032). Taken together with our previous observation on CD19 polymorphism, intrinsic difference in the expression level of CD19 and CD22 was suggested to play a causative role in a proportion of patients with lcSSc.     

Soy isoflavone intake and prevalence of depressive symptoms during pregnancy in Japan: baseline data from the Kyushu Okinawa Maternal and Child Health Study

Objective

Several observational studies and trials examined the relationship between isoflavones or soybeans and depressive symptoms among peri- and postmenopausal women. We cross-sectionally evaluated the associations between intake of soy products and isoflavones and depressive symptoms during pregnancy in Japan.

Methods

Study subjects were 1745 pregnant women. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Depressive symptoms were defined by a score of 16 or over in the Center for Epidemiologic Studies Depression Scale.

Results

Higher intake of total soy products, tofu, tofu products, fermented soybeans, boiled soybeans, miso soup, and isoflavones was independently related to a lower prevalence of depressive symptoms during pregnancy: The adjusted prevalence ratios (95 % confidence intervals, P for trend) between extreme quartiles were 0.63 (0.47–0.85, 0.002), 0.72 (0.54–0.96, 0.007), 0.74 (0.56–0.98, 0.04), 0.57 (0.42–0.76, <0.0001), 0.73 (0.55–0.98, 0.03), 0.65 (0.49–0.87, 0.003), and 0.63 (0.46–0.86, 0.002), respectively. A significant positive exposure–response relationship was found between miso intake and depressive symptoms during pregnancy. No material relationship was observed between soymilk intake and depressive symptoms during pregnancy.

Conclusions

Our study is the first to show independent inverse relationships between intake of total soy products, tofu, tofu products, fermented soybeans, boiled soybeans, miso soup, and isoflavones and depressive symptoms during pregnancy.