Ultrasonographically-guided stent placement at the vertebral artery origin without contrast medium: A case report

Although ultrasonographically-guided carotid interventions without contrast medium have been reported in the literature, we found no report regarding stenting of the vertebral artery origin for treatment of stenosis. Here, we report the case of an iodine-allergic patient in whom a stenosis at the origin of the vertebral artery was successfully treated with ultrasonographically-guided stent placement without contrast medium. B-mode longitudinal images were monitored during the insertion of the embolism-protection device, when positioning the stent, and for the evaluation of the stent opening. This technique can be an alternative option in selected patients, especially those allergic to the contrast medium.     

Assessment of Daily Needle Applicator Displacement during High-Dose-Rate Interstitial Brachytherapy for Prostate Cancer using Daily CT Examinations

To improve treatment conformity for prostate cancer, we investigated daily applicator displacement during high-dose-rate interstitial brachytherapy (HDR-ISBT). Thirty patients treated with HDR-ISBT as monotherapy were examined. All patients received a treatment dosage of 49 Gy per 7 fractions over 4 days. For dose administration, we examined 376 flexible applicators (1128 points) using our unique ambulatory implant technique. Using CT images with a 3-mm slice thickness, we calculated the relative coordinates of the titanium markers and the tips of the applicators. We calculated the distance between the center of gravity of the markers and the tips of the catheters, and compared the distances measured on the day of implantation and the second, third, and fourth treatment days. The mean displacement distance for all applicators was 4.3 ± 3.4 mm, 4.6 ± 4.1 mm, and 5.8 ± 4.5 mm at 21, 45, and 69 hours after initial planning CT. We used a 15-mm margin for needle displacement and only 2 points of 2 patients (16 mm and 18 mm at 69 hours, 2/1128 = 0.2%) exceeded this range. Almost patients (87%) showed the largest displacement within the first 21 hours. The relative doses that covered 100% of CTV (D100(CTV)) values compared with the initial treatment plan were reduced to 0.96 ± 0.08, 0.96 ± 0.08 and 0.94 ± 0.1 at 21, 45 and 69 hours. However, the relative D90(CTV) values kept acceptable levels (1.01 ± 0.02, 1.01 ± 0.03 and 1.01 ± 0.03). Cranial margin of 15 mm seems to be effective to keep D90(CTV) level if we do not do corrective action.     

Treatment results of laparoscopic surgery in Japanese patients with upside-down stomach

Introduction

Upside-down stomach, an atypical form of esophageal hiatal hernia, is a rare pathology. Due to its anomalous anatomical characteristics, the level of difficulty of laparoscopic surgery is considered to be high. However, as the number of patients is very small in Japan, surgical results have not been fully investigated. We examined the results of surgical treatment for Japanese patients with upside-down stomach.

Materials and methods

The subjects were 11 patients given a diagnosis of upside-down stomach based on upper gastrointestinal tract radiographic imaging and who had undergone laparoscopic surgery at least 6 months prior to this study. Surgical results, postoperative recurrence, and postoperative oral intake of gastric acid-suppressive medications were examined.

Results

The subjects consisted of one man and ten women (91 %). The mean age was 73.0 ± 9.2 years and the mean disease period was 38.7 months. The operation time was 175.5 ± 49.1 min (range 110–280) and the intraoperative blood loss was 122.7 ± 214.9 mL (range 0–550). None of the patients had required conversion to laparotomy. The mean postoperative hospital stay was 8.9 ± 3.4 days (range 7–18) and two patients had persistent dysphagia after surgery, which improved with endoscopic dilatation. While two patients (18 %) had a postoperative recurrence of hiatal hernia, none required reoperation. Two patients (18 %) needed oral gastric acid-suppressive medications postoperatively.

Conclusions

Laparoscopic surgery could be performed in all patients with upside-down stomach. Because of the significant recurrence rate of postoperative esophageal hiatal hernia, the use of a mesh may be required.     

Influence of sintering conditions on low-temperature degradation of dental zirconia

The effect of sintering conditions and concomitant microstructure of dental zirconia (ZrO₂) ceramics on their low-temperature degradation (LTD) behavior remains unclear.     

Orexin 2 receptor is involved in orexin A-induced hyperlocomotion in rats

BackgroundThe orexin system regulates various functions, including sleep/wake cycles, feeding, and cognition. Orexin A and orexin B are endogenous neuropeptides for both orexin 1 (OX₁) and orexin 2 (OX₂) receptors. Orexin A has a potent agonistic activity for both the receptors and is known to increase locomotor activity in rats. However, it has not been elucidated how each receptor contributes to orexin A-induced hyperlocomotion.MethodsWe examined the effects of an OX₁ receptor antagonist, SB 334867, and an OX₂ receptor antagonist, EMPA, as well as an OX₁ and OX₂ receptor antagonist on hyperlocomotion caused by intracerebroventricular administration of orexin A or an OX₂ receptor agonist, ADL-OXB ([Ala¹¹,d-Leu¹⁵]-orexin B), in rats.ResultsEMPA (100 mg/kg, ip) but not SB 334867 (3–10 mg/kg, ip) showed antagonistic effects on ADL-OXB-induced hyperlocomotion without affecting the spontaneous locomotor activity. Both EMPA (100 mg/kg, ip) and the OX₁ and OX₂ receptor antagonist (3–30 mg/kg, po) antagonized orexin A-induced hyperlocomotion, while SB 334867 (3?–10 mg/kg, ip) showed no effects.ConclusionsOur results suggest that orexin A-induced hyperlocomotion is mainly mediated by the activation of the OX₂ receptor.     

Regulation of osteoclast function via Rho-Pkn3-c-Src pathways

BackgroundWnt signaling pathways are largely divided into the β-catenin-dependent canonical pathway and β-catenin-independent non-canonical pathways. The roles of Wnt signaling in bone metabolism have been extensively investigated.We previously attempted to clarify the roles of Wnt-non-canonical signaling in bone resorption and demonstrated that Wnt5a-receptor tyrosine kinase-like orphan receptor 2 (Ror2) signaling promoted osteoclast differentiation by enhancing RANK expression in osteoclast precursor cells. However, the roles of Wnt5a-Ror2 signaling in osteoclast function remain unclear.HighlightTrabecular bone mass was significantly greater in osteoclast-specific Ror2-deficient (Ror2^ΔOCL/ΔOCL) mice than in control mice due to the decreased bone-resorbing activity of osteoclasts. Wnt5a-Ror2 signaling activated Rho in osteoclasts via dishevelled-associated activator of morphogenesis 2 (Daam2). The expression of protein kinase N3 (Pkn3), a Rho effector, increased during osteoclast differentiation. Trabecular bone mass was significantly greater in Pkn3-deficient mice than in wild-type mice due to the decreased bone-resorbing activity of osteoclasts. Pkn3 bound to c-Src and Pyk2 in a Wnt5a-Ror2 signaling-dependent manner, thereby enhancing the kinase activity of c-Src in osteoclasts. The binding of Pkn3 to c-Src was essential for the bone-resorbing activity of osteoclasts.ConclusionWnt5a-Ror2 signaling promotes the bone-resorbing activity of osteoclasts by activating the Daam2-Rho-Pkn3-c-Src pathways. Pkn3 inhibitors, therefore, have potential as therapeutic agents for osteoporosis and bone destruction in inflammatory diseases.