Brachial‐ankle pulse wave velocity and cardio‐ankle vascular index are associated with future cardiovascular events in a general population: The Nagahama Study

Faster pulse wave velocity (PWV) is known to be associated with the incidence of cardiovascular diseases (CVD). The aim of this study was to clarify the hypothesis that PWV may be associated with future CVD events even when its time‐dependent changes were adjusted. We also investigated a prognostic significance of cardio‐ankle vascular index, another index of arterial stiffness. Study participants included 8850 community residents. The repeated measures of the clinical parameters at 5.0 years after the baseline were available for 7249 of the participants. PWV was calculated using the arterial waveforms measured at the brachia and ankles (baPWV). The cardio‐ankle vascular index was calculated by estimated pulse transit time from aortic valve to tibial artery. During the 8.53 years follow‐up period, we observed 215 cases of CVD. The incidence rate increased linearly with baPWV quartiles (per 10 000 person‐years: Q1, 2.7; Q2, 12.6; Q3, 22.5; Q4, 76.2), and the highest quartile was identified as an independent determinant of incident CVD by conventional Cox proportional hazard analysis adjusted for known risk factors [hazard ratio (HR), 4.00; p = .007]. Per unit HR of baPWV (HR, 1.15; p < .001) remained significant in the time‐dependent Cox regression analysis including baPWV and other clinical values measured at 5‐year after the baseline as time‐varying variables (HR, 1.14; p < .001). The cardio‐ankle vascular index was also associated with CVD with similar manner though the associations were less clear than that of baPWV. baPWV is a good risk marker for the incidence of CVD.     

Ce3+-enriched spherical porous ceria with an enhanced oxygen storage capacity

Porous ceria was obtained using a unique solvothermal reaction in acetonitrile, applying high temperature and pressure. The resulting material comprised homogeneous and monodisperse spheres and exhibited an extremely large surface area of 152 m² g⁻¹. From catalytic performance evaluation by vapor- and liquid-phase reactions, the synthesized porous ceria showed superior and different reaction activity compared with commercial CeO₂. To examine the origin of the reaction activity of the present porous ceria, synchrotron hard X-ray photoelectron spectroscopy (HAXPES) measurements were carried out. The systematic study of HAXPES measurements revealed that the obtained porous ceria with the present solvothermal method contained a very high concentration of Ce³⁺. Moreover, O₂-pulse adsorption analyses demonstrated a significant oxygen adsorption capacity exceeding 268 μmol-O g⁻¹ at 400 °C owing to its high contents of Ce³⁺ species.

Spherical porous ceria having high content of Ce³⁺ species was synthesized by the solvothermal method using acetonitrile as a solvent. The spherical porous ceria possesses superior oxygen storage capacity owing to its high Ce³⁺ contents.     

TAFRO syndrome successfully treated with tocilizumab: A case report and systematic review

Thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly (TAFRO) syndrome is considered as a unique clinicopathologic variant of multicentric Castleman’s disease and is recently reported in Japan. This entity represents a severe inflammatory state leading to organ failures such as severe liver dysfunction seen in our case, and can be treated by immunosuppressive agents, steroids, and cyclosporine shown in several case reports. A systematic review and our case suggest the potential utility of tocilizumab as a treatment for TAFRO syndrome.     

Leiomyosarcoma of the stomach treated by endoscopic submucosal dissection

There have been no reports of primary leiomyosarcoma of the stomach treated by endoscopic submucosal dissection (ESD). We report an extremely rare case of gastric leiomyosarcoma that was successfully treated by ESD. An asymptomatic 74-year-old female underwent esophagogastroduodenoscopy for screening in December 2013. A centrally depressed submucosal tumor 10 mm in diameter was detected at the posterior wall of the upper gastric body. Follow-up esophagogastroduodenoscopy conducted 5 months later showed that the tumor diameter had increased to 15 mm. Endoscopic ultrasound revealed a hypoechoic mass located in the second to the middle of the third layer. Endoscopic ultrasound-guided fine-needle aspiration demonstrated a myogenic tumor. The tumor was completely resected by ESD without complications. Immunohistopathological diagnosis of the resected specimen was gastric leiomyosarcoma derived from the muscularis mucosae, with negative lateral and vertical margins. No local recurrence or metastasis has been detected at 36 months after ESD. This is the first report of gastric leiomyosarcoma treated by ESD in the English language literature.     

Endoscopic ultrasound-guided fine-needle aspiration biopsy - Recent topics and technical tips

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a useful procedure that enables reliable pathological diagnoses of pancreatobiliary diseases, subepithelial lesions, and swollen lymph nodes. In recent years, a pathological diagnosis based on EUS-FNA has made it possible to provide accurate treatment methods not only in these fields, but also in respiratory organs and otorhinolaryngology. This review discusses the latest topics pertaining to EUS-FNA as well as procedural tips.     

Artificial intelligence for endoscopy

In recent times, there has been progressive development in artificial intelligence (AI) following the introduction of deep learning in the medical field including gastroenterology and endoscopy. Most of the reported studies were based on retrospective data. Several prospective studies of real-time diagnosis of moving images using the AI system are expected to match the real clinical situation and to aid the endoscopists in the detection and diagnosis of neoplasms without missing any lesion. AI can read a large number of endoscopic images in a few minutes and make a diagnosis; therefore, it is expected to cover the lack of support for the screening esophagogastroduodenoscopy in the health check-up and a large number of capsule images, thereby freeing the endoscopists from this burden. AI can help make the diagnosis during the endoscopic procedure and thereby prevent an unnecessary biopsy for patients taking antithrombotic drugs. AI can also be useful for education and training in endoscopy. Trainees can learn to perform endoscopy and the detection and diagnosis of lesions by the support of AI. In the near future, real-time endoscopic diagnosis using AI is expected to lessen the burden of endoscopists, to enhance the quality level of endoscopists, to overcome the miss of lesions and to make optimal diagnosis.     

Characterization of influenza A(H1N1)pdm09 viruses isolated from Nepalese and Indian outbreak patients in early 2015

We characterized influenza A(H1N1)pdm09 isolates from large‐scale outbreaks that occurred in Nepal and India in early 2015. Although no specific viral features, which may have caused the outbreaks, were identified, an S84N substitution in hemagglutinin was frequently observed. Chronological phylogenetic analysis revealed that these Nepalese and Indian viruses possessing the S84N substitution constitute potential ancestors of the novel genetic subclade 6B.1 virus that spread globally in the following (2015/16) influenza season. Thus, active surveillance of circulating influenza viruses in the Southern Asia region, including Nepal and India, would be beneficial for detecting novel variant viruses prior to their worldwide spread.