The effect of lifestyle factors on osteoporotic fractures

Osteoporotic fracture is one of the biggest causes of bed-ridden conditions. Lifestyle factors such as dietary habits, smoking habits, alcohol consumption, and exercise habit are well associated with bone mineral densities. This review summarized the improved custom behavior is beneficial to prevent osteoporotic fractures in elderly.     

Two distinct activity patterns of fast-spiking interneurons during neocortical UP states

During sleep, neocortical neuronal networks oscillate slowly (<1 Hz) between periods of activity (UP states) and silence (DOWN states). UP states favor the interaction between thalamic-generated spindles (7-14 Hz) and cortically generated gamma (30-80 Hz) waves. We studied how these three nested oscillations modulate fast-spiking interneuron (FSi) activity in vivo in VGAT-Venus transgenic rats. Our data describe a population of FSi that discharge "early" within UP states and another population that discharge "late." Early FSi tended to be silent during epochs of desynchronization, whereas late FSi were active. We hypothesize that late FSi may be responsible for generating the gamma oscillations associated with cognitive processing during wakefulness. Remarkably, FSi populations were differently modulated by spindle and gamma rhythms. Early FSi were robustly coupled to spindles and always discharged earlier than late FSi within spindle and gamma cycles. The preferred firing phase during spindle and gamma waves was strongly correlated in each cell, suggesting a cross-frequency coupling between oscillations. Our results suggest a precise spatiotemporal pattern of FSi activity during UP states, whereby information rapidly flows between early and late cells, initially promoted by spindles and efficiently extended by local gamma oscillations.     

Histological diagnosis of spinal chondrosarcoma by endobronchial ultrasound-guided transbronchial needle aspiration

Rare neoplastic diseases including sarcomas can occur in the middle mediastinum. Obtaining a histological specimen is crucial for diagnosis and for establishing a treatment plan. Our research group has recently reported a minimal invasive method of tissue sampling of the mediastinum using direct real-time endobronchial ultrasound-guided transbronchial needle aspiration. By the use of this new modality, histological cores can be obtained for pathological diagnosis that can be used for immunohistochemistry as well as genetic analysis. A very rare case of spinal chondrosarcoma due to hereditary multiple exostoses successfully diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration and by immunohistochemistry with genetic analysis is reported.     

Hepatic veno-occlusive disease after tranexamic acid administration in patients undergoing allogeneic hematopoietic stem cell transplantation

Tranexamic acid is one of the widely used antifibrinolytic agents. In spite of its effective inhibitory activity against plasminogen, thromboembolic adverse events caused by tranexamic acid are rare. We encountered three recipients of allogeneic hematopoietic stem cell transplantation (HSCT) who developed hepatic veno-occlusive disease (VOD) shortly after the administration of tranexamic acid. Hepatic VOD was resolved completely in all patients with the discontinuation of the drug, and with supportive measures with or without intravenous tissue plasminogen activator administration. These findings suggest that administration of tranexamic acid could be one of the possible risk factors for developing hepatic VOD in HSCT recipients.     

Does hypoplasia of one pulmonary artery preclude a definitive repair in pulmonary atresia,intact ventricular septum,and hypoplastic right ventricle?

Summary Twins with pulmonary atresia, intact ventricular septum, and hypoplastic right ventricle associated with underdeveloped and discontinuous left pulmonary artery are described. Operations to connect the left pulmonary artery to the main pulmonary trunk, with subsequent biventricular repair assisted by bidirectional cavopulmonary anastomosis and atrial fenestration were performed. Follow-up catheterization proved spontaneous closure of the fenestration in one patient. Both patients have been in a satisfactory condition for 3 years since operation.     

Mesenteric fibromatosis successfully resected with duodeno-jejunectomy and nephrectomy

We report a rare case of intra-abdominal fibromatosis of the jejunal mesentery. A 71-year-old man, who was incidentally diagnosed with left hydronephrosis, was found to have a tumor near the duodeno-jejunal junction. The tumor appeared to invade the intestinal wall and was obstructing the left ureter. The tumor was indefinite in diagnosis preoperatively. The patient underwent an en-bloc excision of the tumor by a partial duodeno-jejunectomy combined with a left nephrectomy. Microscopic examination of the tumor showed that non-dysplastic fibroblasts proliferating in the jejunal mesentery had infiltrated into the adjacent small intestines and ureter, resulting in a diagnosis of intra-abdominal fibromatosis. This diagnosis was supported by findings of immunohistochemical analyses showing positive staining for vimentin and smooth muscle actin and negativity for keratin, CD34, C-kit and S-100. To our knowledge, this is the first documented case of intra-abdominal fibromatosis of the jejunal mesentery completely resected with the operative procedure described herein. In cases of a preoperatively undiagnosed retroperitoneal or mesenteric tumor that invades adjacent structures, it is important to consider intra-abdominal fibromatosis as a possible differential diagnosis. This may be helpful in planning the appropriate therapeutic strategies including extended multi-organ resection in selected patients.     

Intraoperative massive pulmonary tumor embolism from clear cell sarcoma in the retroperitoneum: successful treatment using cardiopulmonary bypass

Malignant neoplasms rarely extend into the inferior vena cava and up to the right side of the heart. Although massive pulmonary tumor embolism occurs relatively rarely, it can be a catastrophic problem. Intraoperative pulmonary tumor embolism and cardiac arrest occurred in a 68-year-old woman while dissecting the inferior vena cava to resect a pararenal tumor extending into the retrohepatic inferior vena cava. Abrupt arterial hypotension, tachycardia, and increased central venous pressure lead to the diagnosis of massive pulmonary tumor embolism. Emergency cardiopulmonary bypass was commenced under profound hypothermia and cardiac arrest. The tumors in the main pulmonary artery were extracted, and fragments of remnant tumor were retrieved by a vascular endoscope, a Fogarty catheter, and milking of the lung. Following embolectomy, the tumor in the retrohepatic to infrarenal inferior vena cava was removed and the primary tumor together with the infrarenal inferior vena cava was resected under hepatic vascular exclusion and partial cardiopulmonary bypass. The inferior vena cava below the renal veins was not reconstructed. The patient recovered with slight retrograde amnesia. A postoperative pulmonary perfusion scintigram showed no defect in the pulmonary circulation. She is well now 8 months after surgery. Safe prevention measures should be accomplished as a part of the perioperative management of patients with inferior vena cava tumor thrombus that may be fragile, and cardiopulmonary bypass should always be stand-by on surgery.