Impairment of DYRK2 augments stem-like traits by promoting KLF4 expression in breast cancer.

Whereas accumulating studies have supported the cancer stem cell theory, a specific therapy targeting a cancer stem cell subpopulation has not been established. Here, we show that dual-specificity tyrosine phosphorylation-kinase 2 (DYRK2) is a novel negative regulator for formation of breast cancer stem cells. Downregulation of DYRK2 promotes cancer stem-like traits in vitro, tumourigenesis in vivo and the proportion of the cancer stem cell population in human breast cancer tissues. We found that Krupple-like factor 4 (KLF4) serves as a key mediator of DYRK2's control over the cancer stem phenotype. Reduced DYRK2 expression increases KLF4 expression, which induces cancer stem-like properties. We identified androgen receptor (AR) as a transcription factor binding to the KLF4 promoter region; this process is dependent on DYRK2 kinase activity. Our findings delineate a mechanism of cancer stem cell regulation by the DYRK2-AR-KLF4 axis in breast cancer. Targeting of this pathway may be a promising strategy against breast cancer stem cells.

[Emergent endovascular stent-graft treatment for traumatic injury of descending aorta; report of a case].

A 71-year-old man was transfered to our hospital with acute aortic rupture due to a hit in the back by a log. Chest computed tomography (CT) demonstrated dissecting aneurysm of thoracic descending aorta, mediastinal hematoma, rib fracture and pulmonary contusion, We performed emergent endovascular stent-graft placement with local anesthesia successfully. The post operative course was uneventful. Chest CT scan after four months showed disappearance of aneurysm and hematoma.

Idiopathic gastric rupture in a 3-month-old girl.

UNLABELLED: This case reports on idiopathic gastric rupture in a 3-mo-old girl who had frequent episodes of vomiting and abdominal distension the day before admission to the clinic. Metabolic acidosis was detected and rotavirus antigen was identified in the stools. Abdominal X-rays and CT scans revealed free air and fluid in the abdominal cavity, leading to a diagnosis of gastrointestinal perforation. During surgery, idiopathic gastric rupture was detected and treated. The postoperative course was uneventful. CONCLUSION: Idiopathic gastric rupture is extremely rare in childhood beyond the neonatal period. Early diagnosis and surgery are mandatory if children with this condition are to be saved.

Late onset of right Bochdalek's hernia with strangulation of the omentum.

UNLABELLED: We report a case of bloody pleural effusion and infarction of the greater omentum caused by a non-traumatic diaphragmatic hernia with a late presentation. A 15-y-old boy with Down's syndrome developed abdominal pain and vomiting, as well as an elevated serum level of C-reactive protein. Chest roentgenograms showed a right-sided pleural effusion and computed tomography revealed a right diaphragmatic hernia. Barium enema confirmed the diagnosis. An operation revealed a right Bochdalek's hernia with strangulation of the greater omentum in the right pleural cavity. CONCLUSION: Diaphragmatic hernia should be considered in patients with pleural effusion, abdominal pain and vomiting.

Application of a drug delivery system in a novel rat model of chronic hyperendotoxemia.

There has not been an ideal reproducible small-animal model of chronic hyperendotoxemia to date. Our drug delivery system (DDS) is a new technology that can deliver a drug conveniently to a target organ at an optional rate. 2-Hydroxyethyl methacrylate (HEMA) was used as a carrier of lipopolysaccharide (LPS), and diethylene glycol and polyethylene glycol dimethacrylates (2G, 4G, 9G) were used as cross-linking agents. A mixed solution of HEMA and di(poly)ethylene glycol dimethacrylate was charged into a glass tube with or without LPS and polymerized by ultraviolet irradiation. This polymer was cut into DDS tablets of the same size with or without LPS. A mixture with HEMA:4G = 1:3 was the most suitable composition to release a constant concentration of LPS. We also developed a novel rat model of chronic hyperendotoxemia. Four DDS tablets, each containing 15 mg LPS, were implanted into the abdominal cavity of rats in the LPS group. The control group was implanted with four DDS tablets without LPS. Plasma levels of LPS in the study group were maintained at more than 2,000 pg/ml for 72 h after implantation. Weight gain was lower and body temperature was higher in the LPS group than in the control group. Plasma levels of inter leukin (IL)-6 in the LPS group were higher than in the control group only during the initial 12 h after implantation of DDS tablets. The white blood cell count at 24 h and platelet counts at 24, 48, and 72 h in the LPS group were lower than those in the control group. These results indicate that chronic hyperendotoxemia was maintained for 72 h by continuous release of LPS from the DDS. Moreover, the intensity of endotoxemia could be varied by varying the number of DDS tablets. It is concluded that our new rat model using LPS-DDS will be applicable and useful as a model of chronic hyperendotoxemia.

Surgical intervention for emphysematous pulmonary regions in a postoperative infant with congenital diaphragmatic hernia.

A postoperative infant with congenital diaphragmatic hernia (CDH) developed extrinsic obstruction of the trachea by the innominate artery that ensued from unequal expansion of the lungs followed by left mediastinal shift. Septation of the anterior mediastinum prevented unequal expansion of the lungs, and elongation of the innominate artery improved proximal airway obstruction. Prolonged artificial ventilation, however, resulted in the emphysematous bullae in the left lung. Lung volume reduction surgery (LVRS), at 3 years of age, ameliorated the respiratory distress and resulted in good weight gain. Surgical intervention, including LVRS, should be considered to improve respiratory disturbance caused by difference in compliance of the lungs in children.

Handlebar hernia: case report and review of pediatric cases.

The authors describe a rare case of handlebar hernia in a 9-year-old-boy. All layers of his abdominal wall were disrupted by a fall on a bicycle; however, his skin and intra-abdominal organs were completely intact. Computed tomography demonstrated subcutaneous intestinal loops protruding through the rent. Surgical repair was performed, and his postoperative course was uneventful.

Subcapsular hemorrhage of the liver in a very-low-birth-weight neonate: survival after decompression laparotomy.

Subcapsular hemorrhage of the liver in a very-low-birth-weight neonate was successfully treated by decompression laparotomy. This may be the second smallest survivor after surgery in the literature.

Infantile myofibromatosis of the triceps detected by prenatal sonography.

A routine prenatal sonographic examination at 36 weeks' menstrual age revealed a solid and slightly inhomogeneous soft-tissue tumor on a fetus's left upper arm. The mass in the left triceps brachii muscle measured 8 x 7 x 5 cm at birth. Because of progressive flexion contracture of the left elbow joint, at 2 months of age the infant underwent radical resection of the tumor, sparing some muscle fibers. Light microscopic and immunohistochemical studies revealed myofibromatosis. Neither tumor nor functional disorder of the arm was evident 3 years after surgery.

An unusual presentation of congenital infantile myofibromatosis arising from the interspinous ligament.

The authors describe an extremely rare presentation of congenital infantile myofibromatosis. A full-term newborn boy presented with a thumb-sized subcutaneous mass on the mid-spinal line between the 2nd and 3rd lumbar spinous processes. A solid tumor arising from the interspinous ligament was resected. Microscopic and immunohistochemical studies revealed myofibromatosis.

[A case of tricuspid atresia treated with fenestrated total cavopulmonary connection at late infantile stage].

A one-year-old girl with tricuspid atresia (TA) underwent fenestrated totalcavopulmonary connection (TCPC) after pulmonary artery banding. Under cardiopulmonary bypass, an fenestrated intraatrial cavocaval channel was constructed with a prosthetic graft of polytrafluorothylene. The SVC was transsected and each end of SVC was anastomosed to the pulmonary artery in a end-to-side fashion. She did not need "high CVP management" nor "low HR management" in the post operative course. We suggest that fenestrated TCPC may be indicated for the patients of TA at late infantile stage.

[A case of pentalogy of Cantrell with tetralogy of Fallot and left ventricular diverticulum].

We report a successful repair of tetralogy of Fallot and left ventricular diverticulum associated with pentaology of Cantrell. The repair consisted of partial infundibular septectomy, closure of ventricular septum, reconstruction of right ventricular outlet using monocuspid transjunctional patch, and resection of left ventricular diverticulum. The infundibulum was extremely elongated, caused by ventricular dextroversion, and the hypoplasia of pulmonary trunk was absent. Therefore, transjunctional patch was longer, even after infundibular septectomy. This report discuss the pathogenesis of these cardiac anomalies and surgical imlication.

[Oozing type left ventricular rupture: report of three cases].

Two cases of postinfarction oozing type left ventricular rupture and a case of oozing type left ventricular rupture due to catheter perforation for left ventriculography are reported. The technique used to repair the rupture is fibrin glue-oxycellulose fixation method. The post operative course of three cases were uneventful. But left ventricular aneurysm remained in two cases.

[Rastelli operation for congenital heart disease complicated with peripheral pulmonary artery stenosis].

Peripheral pulmonary artery stenosis following the occlusion of ductus arteriosus is not rare in patients with pulmonary atresia. It is also seen after the creation of Blalock-Taussig shunt for various types of cyanotic congenital heart disease. Although pericardial patch enlargement for the pulmonary artery stenosis has been done at corrective surgery, the results were unsatisfactory because of restenosis. So, we proposed and performed a new method of pulmonary artery plasty using large rectangular heterogeneous pericardium, by which pulmonary artery could be widely enlarged from the pulmonary trunk to periphery of the stenosis. A 3-year-old female (case 1) was diagnosed with pulmonary atresia, ventricular septal defect, patent ductus arteriosus and coronary anomaly associated with left pulmonary artery stenosis. She previously received left Blalock-Taussig shunt. Another patient was a 4-year-old male (case 2) diagnosed with double-outlet right ventricle, pulmonary stenosis and patent ductus arteriosus. He also received right Blalock-Taussig shunt and had left pulmonary artery stenosis. Both patients received Rastelli operation with pulmonary artery plasty simultaneously. Rastelli operation was performed using composite graft consisted of valved heterogeneous pericardial roll and knitted Dacron graft. Post operative courses were uneventful and they were doing well one year after operation. We consider that the pulmonary artery plasty with rectangular heterogeneous pericardial patch is an effective surgical procedure to avoid restenosis compared with conventional pericardial patch enlargement or balloon pulmonary artery plasty.

[Mass-screenings for osteoporosis using computed X-ray densitometry (CXD): in a mobile unit].

The early diagnosis and treatment of osteoporosis is considered to be important for the prevention of fractures which often cause elderly to become bed-ridden. Computed X-ray densitometry (CXD), a method to measure bone mineral content in the metacarpus II utilizing a simple X-ray image, has been used for mass-screening of osteoporosis, because of its utility and reliability. However, due to its requiring adequate X-ray equipment, this method is often unsuitable for use in small facilities in a remote mountain areas. The use of CXD for osteoporosis screening, was attempted in a mobile unit for tuberculosis screening, by our public health center. The results showed that it is possible to use CXD in combination with a mobile unit, correcting the obtained values according to the radiographic conditions. With this set-up, CXD was used for mass-screening of osteoporosis in a total of 1150 subjects living in mountainous areas of Yoshino-gun, Nara prefecture, and CXD was found to be convenient and effective for mass-screening. The use of CXD in a mobile chest X-ray unit can be expected to be useful for mass-screening of osteoporosis especially in remote mountainous areas having inadequate X-ray equipment.

[Limited skin incision and partial median sternotomy for the repair of atrial septal defects in children].

Eight patients underwent the repair of atrial septal defect using the limited skin incision and partial median sternotomy. The average length of skin incision was 55% of the longitudinal size of the sternum. Our approach did not prolong the operation time and decreased the bloodloss. Moreover, postoperative events, such as hematoma, sternal instability, and wound infection, were not observed, and the cosmetic result was excellent. We think this method is safe and effective especially for children with atrial septal defect.

[A left subclavian arterial aneurysm caused by fibromuscular dysplasia: a case report].

A 70-year-old man complained left supraclavicular pulsatile tumor. Angiography and CT revealed the left subclavian arterial aneurysm that was just behind the clavicle. The aneurysm was resected through a cross-clavicle incision and an 8 mm Hemashield graft was implanted. The pathological study showed change of fibromuscular dysplasia. The post-operative course was uneventful.

In vitro evaluation of nicorandil, diltiazem, and prostaglandin E1 on hypothermic injury to immature myocytes.

The purpose of the present study was to evaluate the functional and biochemical effects of nicorandil (NRD), diltiazem (DTZ), or prostaglandin E1 (PGE) on cardiac myocytes incubated under hypothermic conditions. Cardiac myocytes were isolated from neonatal rat ventricles and cultured for 4 days with MCDB 107 medium. Myocytes (12.5 x 10(5) myocytes/flask) were then incubated at 4 degrees C for 24 hr in media containing various concentrations of NRD, DTZ, or PGE. After hypothermic incubation, creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) were measured. The myocytes were then cultured for an additional 24 hr at 37 degrees C to evaluate the recovery of myocyte beating rate. In the nicorandil groups, 10(-4) M NRD showed significantly increased beating rate recovery compared to control (44.2% vs 24.6%, respectively, as a percentage of control, i.e., beating rate prior to hypothermic incubation). Treatment with 10(-6) M diltiazem showed no beneficial effects (10(-6) M: 25.2%; control: 29.8%); however, beating was not observed at 10(-4) or 10(-5) M. There were no significant changes among the PGE groups. The release of CPK and LDH was significantly suppressed with 10(-4) M NRD (10(-4) M: 24.1, 257.2 MIU/flask; control: 125.4, 459.5 mIU/flask, respectively). However, 10(-4) M DTZ showed significantly increased CPK and LDH levels compared to the control (10(-4) M: 203.3, 883.4 mIU/flask; control: 112.3, 457.4 mIU/flask, respectively). There were no significant differences for CPK and LDH levels among the PGE groups. In conclusion, nicorandil has protective characteristics for immature myocytes that may be suitable for cardiac preservation in the neonatal period.

In vitro evaluation of phosphate, bicarbonate, and Hepes buffered storage solutions on hypothermic injury to immature myocytes.

In this study we evaluated cardiac myocyte viability and function under hypothermic conditions using three types of buffer solutions: phosphate buffer solution (PBS), Krebs-Henseleit bicarbonate buffer solution (KHB), and Hepes buffered minimum salt solution (MSS). As a control, normal saline solution (NSS) was used. Cardiac myocytes were isolated from neonatal rat ventricles. Myocytes (12.5 x 10(5) myocytes/culture flask) were then incubated at 4 degrees C for 6, 12, 18, and 24 hours in various buffer solutions. After each incubation time, CPK and LDH were measured. The myocytes were then incubated for an additional 24 hours at 37 degrees C to evaluate the recovery of the myocyte beating rate. Group MSS had a significantly better beating rate recovery than group NSS (control) after 18 hours (MSS, 32.7%, NSS, 0.0% of control; i.e., beating rate prior to hypothermic incubation). In contrast, group KHB showed a significantly lower recovery ratio than group NSS at 12 hours (41.0%, 78.8%, respectively), and the lowest recovery was observed in group PBS beginning at 6 hours of hypothermic incubation (27.6%). Group MSS significantly suppressed the release of CPK and LDH compared to group NSS at 24 hours (MSS, 246.7 and 440.2 mIU/flask; NSS, 369.7 and 821.3 mIU/flask, respectively). In contrast, groups PBS and KHB showed significantly increased CPK and LDH levels compared to group NSS after 12 hours (PBS, 388.6 and 721.4 mIU/flask; KHB, 340.5 and 540.5 mIU/flask; NSS, 91.5 and 222.7 mIU/flask, respectively). In conclusion, Hepes buffer has cytoprotective characteristics that may be suitable for long-term hypothermic preservation of immature myocardium compared to phosphate or bicarbonate buffer.