Brain perfusion asymmetry in patients with oral somatic delusions

Oral cenesthopathy is a somatic delusion or hallucination involving the oral area and is categorized as a delusional disorder, somatic type. The pathophysiology of this intractable condition remains obscure. In this study, we clarified the pathophysiology of oral cenesthopathy by evaluating regional brain perfusion. We performed single photon emission computed tomography (SPECT) using ^99mTc-ethylcysteinate dimer in 16 subjects (cenesthopathy:control = 8:8). The SPECT images were visually assessed qualitatively, and quantitative analyses were also performed using a three-dimensional stereotactic region-of-interest template. The visual assessment revealed a right > left perfusion asymmetry in broad areas of the brain among the patients. The quantitative analysis confirmed that the regional cerebral blood flow values on the right side were significantly larger than those on the left side for most areas of the brain in the patients. A comparison of the R/(R + L) ratios in both groups confirmed the significant brain perfusion asymmetry between the two sides in the callosomarginal, precentral, and temporal regions in the patients. Qualitative evaluation of the SPECT images revealed right > left brain perfusion asymmetry in broad regions of the brain. Moreover, the quantitative analyses confirmed the perfusion asymmetry between the two sides in the frontal and temporal areas. Those may provide the key for elucidation of the pathophysiology of oral cenesthopathy.     

Trials of vaccines for pancreatic ductal adenocarcinoma: Is there any hope of an improved prognosis?

Pancreatic tumors are chemoresistant and malignant, and there are very few therapeutic options for pancreatic cancer, as the disease is normally diagnosed at an advanced stage. Although attempts have been made to develop vaccine therapies for pancreatic cancer for a couple of decades, none of the resultant protocols or regimens have succeeded in improving the clinical outcomes of patients. We herein review vaccines tested within the past few years, including peptide, biological and multiple vaccines, and describe the three sets of criteria used to evaluate the therapeutic activity of vaccines in solid tumors.     

Chronic active EBV infection with features of granulomatosis with polyangiitis

Herein, we report the case of a 13‐year‐old boy with multiple recurrent ulcers on his legs. He developed severe sinusitis at 10 years of age and had significant weight loss (6 kg) in the 2 months prior to admission. Histology of tissue biopsied from the ulcer indicated small vessel vasculitis and granulomatous inflammation. Given that these findings met the diagnostic criteria for granulomatosis with polyangiitis (GPA), he was treated with immunosuppressive agents. Further pathology, however, indicated Epstein–Barr virus (EBV)‐encoded RNA (EBER) in most lymphocytes in the same sample. The EBER‐positive lymphocytes were mainly CD4‐positive T cells. The EBV‐DNA load in the peripheral blood was also abnormally increased (1.0 × 10⁴ copies/μg DNA). Thus, the diagnosis was established as chronic active EBV infection (CAEBV). This case illustrates the necessity of careful differential diagnosis of CAEBV owing to its clinical resemblance and pathological overlap with GPA.     

Education concerning pathological/cytological diagnosis at 4-year colleges

Recent students of clinical technologist training courses at 4-year colleges aiming to qualify as medical technologists or cytotechnologists have diverse future prospects, for the following reasons: (1) Abundant information can be easily obtained due to the advancement of IT, (2) 4-year college education is increasing available professions, and (3) graduate schools for laboratory medicine have been established, enabling acquisition of a degree. For departments of pathological/cytological diagnosis, cooperation with pathologists and clinicians based on a reliable relationship is important, and medical technologists, cytotechnologists, and pathologists are organically linked in performing tests. To strengthen this reliable relationship and broaden professions as medical care staff, not only students but also instructors have to consistently increase their level of consciousness and energy. In addition to the establishment of the current cytotechnologist education system, introduction of the 'qualification of senior cytotechnologist' established in other countries or 'pathologist's assistant (tentative name)' as a pathological specialist should be seriously considered. The established graduate schools in the field of laboratory medicine started to produce human resources capable of performing basic research based on the knowledge and techniques of laboratory and cytology tests, and were granted a degree. Many universities have established graduate courses combined with employment, and an increasing number of cytotechnologists have acquired specialized knowledge and perform research activities based on knowledge from their routine work.     

Synchrotron-based intravenous cerebral angiography in a small animal model

K-edge digital subtraction angiography (KEDSA), a recently developed synchrotron-based technique, utilizes monochromatic radiation and allows acquisition of high-quality angiography images after intravenous administration of contrast agent. We tested KEDSA for its suitability for intravenous cerebral angiography in an animal model. Adult male New Zealand rabbits were subjected to either angiography with conventional x-ray equipment or synchrotron-based intravenous KEDSA, using an iodine-based contrast agent. Angiography with conventional x-ray equipment after intra-arterial administration of contrast agent demonstrated the major intracranial vessels but no smaller branches. KEDSA was able to visualize the major intracranial vessels as well as smaller branches in both radiography mode (planar images) and tomography mode. Visualization was achieved with as little as 0.5 ml kg-1 of iodinated contrast material. We were able to obtain excellent visualization of the cerebral vasculature in an animal model using intravenous injection of contrast material, using synchrotron-based KEDSA.     

Retention and load transfer characteristics of implant-retained auricular prostheses

PURPOSE: The use of osseointegrated implants for maxillofacial prostheses reduces the need for adhesives, provides for a more stable and more esthetic prosthesis with thinner margins, and results in increased patient acceptance and confidence. The purpose of this study was to compare the retention and load transfer characteristics of differently designed implant-retained auricular prostheses. MATERIALS AND METHODS: A photoelastic model was fabricated of the auricular-temporal region of a human skull. Craniofacial implants 3.75 mm in diameter and 4 mm long were embedded in locations typically selected to retain auricular prostheses. Two retention mechanisms were evaluated on the implants: a Hader bar with 3 clips and the use of 3 Locator attachments. The retentive capacity of the prostheses was determined on an Instron test machine. Initial retention and changes with multiple removals were examined. Dislodgment forces were applied to each retentive device in the field of a circular polariscope. Resulting stresses were monitored and recorded photographically. RESULTS: The highest initial retention demonstrated by the Locator device was 12.4 +/- 0.9 lb, and the highest retention value for the Hader bar with clips was 7.5 +/- 1.1 lb. All attachments decreased in retention after multiple removals. The Locator devices produced higher peri-implant stresses compared to the Hader bar-with-clips design. CONCLUSIONS: Since higher retention is associated with higher stresses, results of this study suggest that a balance between retention and stress production is necessary in selecting a retention mechanism for the specific requirements of the patient being treated. The Locator attachment was correlated with higher retention values as well as with higher peri-implant stress compared to the Hader bar-and-clip attachment design. Retention decreased and then stabilized after multiple