Study of gradient echo (GRE) Dixon image using low-field MRI scanner for examination of metastatic bone marrow tumors: comparison of double and single echo sequences

We evaluated the gradient echo (GRE) Dixon method in metastatic bone tumors using a low-field MRI scanner (0.2 Tesla). This method is characterized by the double echo sequence of in-phase and opposed-phase. Studies were carried out on a phantom, 14 healthy volunteers, and clinical examples (33 vertebral bodies) using the T(1)-weighted spin echo, T(2)-weighted turbo spin echo, and GRE Dixon methods. Further, we obtained addition and subtraction images from the double echo sequence. In the clinical examples, the contrast-to-noise ratio (CNR) of the subtraction images (51.3+/-24.1) was significantly better than that of the T(1)-SE images (6.7+/-3.1, p<0.0001). For the examination of metastatic bone marrow tumors using a low-field MRI scanner (0.2 Tesla), subtraction images are thought to be the most effective.     

Phase II study of oral S-1 and cisplatin with concurrent radiotherapy for locally advanced non-small-cell lung cancer

Purpose

To determine the efficacy and safety of oral S-1 in combination with cisplatin and thoracic radiotherapy in patients with unresectable stage III non-small-cell lung cancer (NSCLC).

Methods and materials

S-1 (50 mg/m²) was administered orally twice daily for 14 days, with cisplatin (40 mg/m²) on days 1 and 8 of each cycle every 3 weeks, for 2–4 cycles. Thoracic radiation therapy was administered in 2 Gy fractions five times weekly for a total dose of 60 Gy. The primary endpoint was the response rate, and secondary endpoints included progression-free survival, overall survival and safety.

Results

Forty-one patients were enrolled in this study. The objective response rate was 87.8% (98% CI: 77.8–97.8%). The median progression-free survival was 467 days (15.4 months), and the median survival time was 904 days (29.7 months). The overall survival rates at 1- and 2-years were 85.7% and 52.9%, respectively. Hematological toxicities included grade 3/4 neutropenia (17%) and grade 3/4 leukopenia (27%). No grade 3 febrile neutropenia was detected, and grade 3/4 non-hematological toxicities were also mild. A grade 3 gastrointestinal hemorrhage was observed in one patient.

Conclusions

The combination of oral S-1 plus cisplatin with concurrent radiotherapy is a promising treatment with a high efficacy and lower toxicity in patients with locally advanced NSCLC.     

Striking crosstalk of ROCK signaling with endothelial function

Rho-associated coiled-coil forming protein kinases (ROCKs), the downstream target proteins of RhoA, are ubiquitously expressed serine-threonine protein kinases. ROCKs have diverse cellular functions, e.g. smooth muscle contraction, actin cytoskeleton organization, cell adhesion, and gene expression. Accumulating evidence has revealed that ROCKs are substantially involved in cardiovascular disorders such as angina, cerebral ischemia, myocardial ischemia, and cardiac hypertrophy. So far, the significant relationship of ROCKs with endothelial function has been reported. ROCKs inhibition by statins or other selective inhibitors leads to the upregulation and activation of endothelial nitric oxide synthase, resulting in the reduction of vascular inflammation and atherosclerosis. Meanwhile, it has been also demonstrated that endogenous nitric oxide could inhibit RhoA/ROCK signaling pathway. Taken together, there might be critical crosstalk of ROCKs with endothelial function. In addition, we further focus on leukocyte ROCK activity as a surrogate marker in patients with atherosclerosis-related diseases. Indeed, leukocyte ROCK activity has been shown to be increased in atherosclerotic patients, indicating the possible usage of leukocyte ROCK activity as a surrogate marker similar to endothelial function evaluated by flow-mediated dilation. Here, we review concerning ROCK signaling pathway, especially focusing on the crosstalk of ROCKs with endothelial function.     

Atrioventricular conduction properties in patients with prolonged pauses undergoing ablation of longstanding persistent atrial fibrillation: do pauses during atrial fibrillation matter?

Background

Atrioventricular (AV) conduction disturbances have often been considered as an etiology of prolonged pauses during atrial fibrillation (AF). We aimed to test whether there was a significant difference in the AV conduction properties between patients with and without clinically significant pauses who underwent ablation of longstanding persistent AF.

Methods

Ninety-nine patients undergoing ablation of longstanding persistent AF were divided into three groups according to the extent of pauses documented on the ambulatory electrocardiogram during AF; patients without pauses (n?=?25), with pauses of <3?s (n?=?52), and with pauses of ??3?s (n?=?22). The AV conduction properties, heart rate variability, and bradycardia-related symptoms after conversion to sinus rhythm were compared across the three groups plus a control group (n?=?35).

Results

Sinus conversion was achieved in all patients after ablation. No differences were found across the groups in the AV conduction properties including the AH and HV intervals, AV nodal effective refractory period, or Wenckebach point. A male gender (???=?0.32; p?=?0.0016), structural heart disease (???=?0.24; p?=?0.02), and the AA interval right after ablation (???=?0.35; p?=?0.0014), rather than the AV conduction properties, were independent determinants of the longest normal RR interval during AF. No patients experienced any bradycardia-related symptoms after ablation.

Conclusions

No AV conduction abnormalities were necessarily identified after the ablation even among the patients suspected of having an AV conduction disturbance during AF.     

Broad ligament hernia successfully repaired by single‐incision laparoscopy: A case report

A 52‐year‐old woman with a history of two parturitions presented with lower abdominal pain. Multi‐detector CT of the abdomen showed discontinuity of the sigmoid colon near the broad ligament on the left side. We assigned a provisional diagnosis of an internal hernia progressing through a defect in the broad ligament. SILS revealed a total broad ligament defect on the left side but no signs of ischemic, necrotic bowel. We successfully repaired the broad ligament defect with suturing. At the 2‐month follow‐up, the patient remained well with no signs of recurrence. This case appears to be the first report of a broad ligament hernia successfully diagnosed and repaired by SILS.