Clinical Utility of 4C Mortality Scores among Japanese COVID-19 Patients: A Multicenter Study.

BACKGROUND: We analyzed data from COVID-19 patients in Japan to assess the utility of the 4C mortality score as compared with conventional scorings. METHODS: In this multicenter study, COVID-19 patients hospitalized between March 2020 and June 2021, over 16 years old, were recruited. The superiority for correctly predicting mortality and severity by applying the receiver operating characteristic (ROC) curve was compared. A Cox regression model was used to compare the length of hospitalization for each risk group of 4C mortality score. RESULTS: Among 206 patients, 21 patients died. The area under the curve (AUC) (95% confidential interval (CI)) of the ROC curve for mortality and severity, respectively, of 4C mortality scores (0.84 (95% CI 0.76-0.92) and 0.85 (95% CI 0.80-0.91)) were higher than those of qSOFA (0.66 (95% CI 0.53-0.78) and 0.67 (95% CI 0.59-0.75)), SOFA (0.70 (95% CI 0.55-0.84) and 0.81 (95% CI 0.74-0.89)), A-DROP (0.78 (95% CI 0.69-0.88) and 0.81 (95% CI 0.74-0.88)), and CURB-65 (0.82 (95% CI 0.74-0.90) and 0.82 (95% CI 0.76-0.88)). For length of hospitalization among survivors, the intermediate- and high- or very high-risk groups had significantly lower hazard ratios, i.e., 0.48 (95% CI 0.30-0.76)) and 0.23 (95% CI 0.13-0.43) for discharge. CONCLUSIONS: The 4C mortality score is better for estimating mortality and severity in COVID-19 Japanese patients than other scoring systems.

Endoscopic Submucosal Dissection for Neoplasia of the Greater Curvature of the Upper and Middle Stomach: J-shaped Superficial Cutting and Splashed Dissection.

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric neoplasia. However, as the upper and middle body of the greater curvature has a rich vasculature and submucosal fibrosis, ESD of neoplasia in these locations requires a specific strategy. We aimed to investigate the efficacy and safety of the J-shaped superficial cutting and splashed submucosal dissection (JSCS) technique for neoplasia of the greater curvature by comparing ESD using JSCS with conventional ESD. METHODS: Twenty-two patients who underwent ESD for gastric neoplasia affecting the upper and middle body of the greater curvature were divided into two groups for retrospective analysis. Nine patients underwent conventional ESD (c-Group), while 13 underwent ESD with JSCS (j-Group). Primary outcome was the en bloc resection rate. Secondary outcomes included complete resection (R0) rate, procedure time, perforation rate, total bleeding time, and the total number of massive bleeding events and of hemostatic forceps times applied during ESD. RESULTS: There were no significant differences between both groups (c-Group vs j-Group) in en bloc resection rate, or R0 resection rate. Compared with the c-Group, the j-Group tended to have a decreased mean procedure time (mean 133 minutes vs 74 minutes, p=0.11) and perforation rate (11% vs 0%, p=0.41). Compared with the c-Group, the j-Group had significantly fewer bleeding incidents (13.4 times vs 6.6 times, p=0.0095), shorter total bleeding time (17.6 min vs 7.4 min, p=0.036), and fewer usages of hemostatic forceps (6.3 times vs 2.4 times, p=0.026) during ESD. CONCLUSION: Endoscopic submucosal dissection with JSCS is superior to conventional ESD, as it reduces intraprocedural bleeding. This technique has the potential to become the standard strategy for neoplasia affecting the upper and middle body of the greater curvature.

Huge Pseudoaneurysm of the Femoral Artery after Internal Fixation of Femoral Trochanteric Fracture.

Pseudoaneurysm is one of the most serious complications of femoral trochanteric fracture surgery. Since the rupture of pseudoaneurysm may lead to death, early detection is important. We report the case of an 80-year-old male who developed pain in the proximal thigh and severe swelling after internal fixation of a femoral trochanteric fracture with a hip nail. Angiography revealed a pseudoaneurysm of a branch of the deep femoral artery near the interlocking screw. The vascular lesion was immediately treated by transcatheter embolization, and the vascular leakage was completely resolved with catheter embolization. After embolization, the patient's clinical state improved rapidly, and the laboratory values improved to normal after several weeks. The current case study reminds us that pseudoaneurysm can occur after intramedullary nail placement to treat a femoral trochanteric fracture.

[Contribution of clinical laboratory to the diabetes care team: efforts in physiological laboratory].

A large number of clinical laboratory technologists are qualified as diabetes educators; however, few of them actually participate in teaching patients. This is partially because it is difficult to balance their routine laboratory tasks and the work of a diabetes educator. We have introduced ultrasonic examinations of the ophthalmic artery, inspection of the R-R interval and current perceptual-threshold inspection for the early diagnosis of diabetic complications, and we have been contributing to the good medical care for diabetes. Furthermore, to care for diabetic foot lesions, clinical laboratory technologists have participated in checking diabetic patients' feet since 2007. In concrete terms, we examine the feet of diabetic patients, take digital pictures of the feet, and write a report, while preparing for thermographic examination of the patient. At the same time, we give simple guidance about foot care. Technologists cannot perform medical treatment; however, this has been accepted by medical staff because we only check foot lesions. We make use of existing medical imaging and reporting systems in the physiological laboratory, so doctors and nurses on the diabetic care team can always obtain information about the patients. Such actions have a good reputation not only among medical staff but also among diabetic patients.

Visual functional and histopathological correlation in experimental autoimmune optic neuritis.

PURPOSE: To elucidate the correlation between visual threshold of optokinetic tracking (OKT), visual evoked potential (VEP), and histopathology at different time points after induction of experimental autoimmune optic neuritis (EAON). METHODS: EAON was induced in C57BL/6 mice by subcutaneous immunization with an emulsified mixture of myelin oligodendrocyte glycoprotein (MOG)(35-55) peptide. OKT and VEP were measured on days 7, 14, 21, 28, and 42 postimmunization. After VEP measurements, the mice were killed and their eyes were enucleated for histopathological studies. Immunohistochemical staining was performed using cell-specific markers for characterization of cells in the optic nerve: CD3 (T cells), Iba-1 (microglia), MBP (myelin basic protein), and neurofilament (axons). RESULTS: Functionally, OKT threshold decreased as early as day 7, and VEP latency was significantly prolonged on day 21. Axon degeneration was observed as early as day 14. Activated microglia infiltration was also observed on day 14, before T cell infiltration, which peaked on day 21. Demyelination, confirmed by MBP staining, was observed on day 21. CONCLUSIONS: Microglial infiltration in the optic nerve coincided with decline in OKT threshold and preceded VEP latency prolongation, while VEP latency prolongation coincided with T cell infiltration and demyelination of the optic nerve. These findings may contribute to understanding of the pathophysiology of optic neuritis and future development of more effective therapeutic strategy for refractory optic neuritis.

Kinetics of polymorphonuclear leukocytes in an experimental hypopyon model.

Regarding the process of uveitis development, many past studies have used the experimental autoimmune uveoretinitis (EAU) and other animal models to observe histologically the infiltration of inflammatory cells and the process of lesion progression. However, no detailed study of the process of clearance of infiltrated inflammatory cells from the eye has been reported. The purpose of this study was to investigate the process of clearance of polymorphonuclear leukocytes (PMNs) using an experimental hypopyon model. PMNs obtained from ascites of SD rat were injected into the anterior chamber of SD rats. The process of PMNs clearance was evaluated by serial photography and 3D optical coherence tomography (3D-OCT), and histological changes were observed simultaneously. The hypopyon heights regressed from 1.04±0.06 mm at 1h (day 0) to 0.45±0.07 mm at day 1, and 0 mm at day 3 after PMNs injection. When the hypopyon heights at the three time points were compared, significant differences were found between groups (P<0.05). The hypopyon volumes also decreased from 1.46±0.07 mm(3) at 1h to 1.16±0.09 mm(3) at 2h, and 0.83±0.04 mm(3) at 3h after PMN injection. When the hypopyon volumes at the three time points were compared, significant differences were found between groups (P<0.05). Light micrographs of inferior segment of the eyeball revealed dense PMNs in the chamber angle at 1h after PMNs injection and many PMNs in the iris stroma and vessels, as well as at the episcleral and subconjunctival tissues around limbus at 3h and day 1 after PMNs injection. Light micrographs of superior segment of the eyeball at 3h after injection revealed PMNs in the episcleral and subconjunctival vessels. Electron micrographs of inferior segment of the eyeball at 3h after PMNs injection revealed dense PMNs with slightly condensed nuclei in the anterior chamber, as well as in the iris stroma and vessels. In conclusion, in the experimental hypopyon model, PMNs injected into the anterior chamber were cleared from the eye mainly through the iris stroma and vessels, as well as the episcleral and subconjunctival tissues around limbus.

Inhibition of peroxisome proliferator-activated receptor gamma activity in esophageal carcinoma cells results in a drastic decrease of invasive properties.

Esophageal cancer is difficult to treat because of its rapid progression, and more effective therapeutic approaches are needed. The PPARgamma is a nuclear receptor superfamily member that is expressed in many cancers. PPARgamma expression is a feature of esophageal cancer cell lines, and in the present investigation, the PPARgamma antagonists T0070907 and GW9662 could induce loss of invasion but could not induce growth reduction or apoptosis at low concentrations (< 10 mM). A high concentration of antagonists (50 microM) inhibited cell growth and induced apoptosis, but these effects did not explain our result at the low concentration. Morphological change, decreased expression of the cell signaling pathway and inhibition of cancer cell invasion were observed in the low concentration. This suggested that PPARgamma antagonists inhibited esophageal cancer cell invasion as well as cell adherence, most likely due to alteration in the FAK-MAPK pathway, and this was independent of apoptosis. These results suggested that PPARgamma plays an important role in cancer cell invasion and that it might be a novel target for therapy of esophageal cancer.

[The evaluation of preoperative and postoperative frontal lobe functions in three operative cases of meningioma].

We report three cases of frontal meningioma with their pre- and post-operative evaluations of higher brain functions, especially of frontal lobe functions. All of the cases showed the improvement of the frontal lobe functions after the tumor removal. The evaluations of frontal lobe functions in benign brain tumors such as a meningioma are reported only in a few cases. The evaluations of frontal lobe functions in the operative cases of benign brain tumors provide many interesting and valuable informations about frontal lobe functions. So we must be more interest in evaluations in higher brain functions and accumulate cases for the further analysis of higher brain functions.

Parry-Romberg syndrome with a giant internal carotid artery aneurysm.

BACKGROUND: Parry-Romberg syndrome or progressive facial hemiatrophy is a rare clinical entity of an unknown etiology. We present the case of a 56-year-old woman with Parry-Romberg syndrome and a giant internal carotid artery aneurysm. CASE DESCRIPTION: The case was a 56-year-old woman with Parry-Romberg syndrome and a giant internal carotid artery aneurysm. Its association was extremely rare. Our report and some other reports of Parry-Romberg syndrome with cerebral aneurysms suggest the hypothesis that Parry-Romberg syndrome could be related to some inflammatory causes such as an autoimmune disease. CONCLUSION: We present the case of a 56-year-old woman with Parry-Romberg syndrome and a giant internal carotid artery aneurysm. Its association is extremely rare and will support the hypothesis that Parry-Romberg syndrome could be related to some inflammatory causes such as an autoimmune disease.

[A case report of the chondroma arising from the falx cerebri].

We have reported a case of chondroma arising from the falx cerebri in a 60-year-old female with no neurological symptom. The tumor was revealed as a round mass, attached to the falx cerebri, with marginally scattered calcification on CT scan and with slight enhancement on MRI images. And cerebral angiogram presented a mass with no tumor stain on the external carotid angiography against our preoperative diagnosis of falx meningioma. A subtotal removal of the mass was performed with the diagnosis of chondroma on pathological examination. The chondroma arising from the falx cerebri is extremely rare with only 15 reported cases in the literature. We have presented the first case in Japan and reviewed the previous reports.

[Coil embolization with a hyperform occlusion balloon for an acutely ruptured wide-necked basilar tip aneurysm: case report].

A 54-year-old woman was admitted to our hospital because of severe headache. CT scan demonstrated subarachnoid hemorrhage (SAH), and cerebral angiography revealed a wide-necked basilar tip aneurysm with a bleb and a small basilar artery-left superior cerebellar artery aneurysm. She was treated with coil embolization using a neck remodeling technique one day after SAH. Guiding catheters were introduced into the bilateral vertebral artery via the transfemoral route. A Hyperform occlusion balloon catheter was introduced into the left posterior cerebral artery (PCA) through the left vertebral artery, and was placed at the neck of the basilar tip aneurysm for neck remodeling. Then, the microcatheter for coil deployment was placed in the dome of the aneurysm through the right vertebral artery. The coil was deployed in the aneurysm while the balloon was inflated across the neck. The inflated Hyperform occlusion balloon was partially herniated into the dome of the aneurysm. The distal part of the balloon was positioned in the left PCA segment, and its proximal part was positioned in the basilar artery. The balloon conformed easily to the aneurysmal neck and its surrounding vessel structure. When the balloon was deflated, the coil did not protrude into the parent artery, and was stable in the aneurysm. Angiography immediately after the procedure showed complete occlusion of the aneurysm with patency of both PCAs. The Hyperform occlusion balloon is very compliant and supple, so it easily changes from its cylindrical shape when inflated to expand into the origin of the arterial branches emerging from the aneurysm neck. We think this balloon is a useful device for treating wide-necked aneurysms located at arterial bifurcation.

[Direct carotid approach for carotid angioplasty and stenting with a small incision: a technical case report].

Direct carotid puncture is an important option in endovascular surgery when a guiding catheter is not advanced into the common carotid artery because of arterial tortuosity. However, hemostasis after the procedure is not easy and hematoma formation from the puncture site sometimes causes serious complications. We present our carotid angioplasty and stenting (CAS) method with a direct carotid puncture and a small incision. An 85-year-old male with transient ischemic attack had severe left carotid artery stenosis. CAS was planned considering his age, but arterial tortuosity prevented a guiding catheter from being introduced into the left common carotid artery. Following this, the left common carotid artery was exposed with a small skin incision under local anesthesia, and a direct carotid puncture was made. A 7-French short sheath was carefully advanced and positioned into the left common carotid artery and a self-expandable stent was delivered through it. Upon completion of the procedure, the puncture point of the vascular wall was sutured with 6-0 proline immediately after withdrawing the sheath, and the skin was closed. A direct carotid puncture with a small incision can be performed safely. This method can reliably stop bleeding from the puncture site and also avoid the need for prolonged manual compression of the carotid artery under systemic anticoagulation and antiplatelet therapy. We think our method is useful for accessing corotid artery stenosis when the transfemoral approach is difficult.