Osteology of Hemigrammocypris neglecta (Teleostei: Cypriniformes) with comments on its systematic position.

Hemigrammocypris neglecta is a small-sized cyprinid fish that is endemic to Japan and the sole member of the genus Hemigrammocypris. We examined the osteological features of the species, and its relationships with related genera are discussed. The present data suggest that H. neglecta is most likely the sister taxon of Metzia lineata. This relationship is supported by one possible synapomorphy: the presence of a postepiphysial fontanelle, which is absent in all other Xenocypridinae.

Possible mechanisms of action of clarithromycin and its clinical application as a repurposing drug for treating multiple myeloma.

Clarithromycin (CAM), a semisynthetic macrolide antibiotic, is a widely used antibacterial drug. Recently, the efficacy of CAM as an add-on drug for treating multiple myeloma (MM) has been noted. Its effect on treating MM has been confirmed in combination chemotherapies that include CAM. However, a single treatment of CAM has no efficacy for treating MM. Many myeloma growth factors (MGFs) including interleukin (IL)-6 are known to be closely involved in the development of MM. CAM has been shown to suppress many MGFs, particularly IL-6. The possible mechanisms of action of CAM in treating MM have been suggested to include its immunomodulatory effect, autophagy inhibition, reversibility of drug resistance, steroid-sparing/enhancing effect and suppression of MGFs. In addition, MM is characterised by uncontrolled cell growth of monoclonal immunoglobulin (Ig)-producing neoplastic plasma cells. Large quantities of unfolded or misfolded Ig production may trigger considerable endoplasmic reticulum stress. Thus, MM is originally a fragile neoplasm particularly susceptible to autophagy-, proteasome- and histone deacetylase 6-inhibitors. Taken together, CAM plays an important role in MM treatments through its synergistic mechanisms. In addition, CAM with its pleiotropic effects on cytokines including IL-6 and indirect antiviral effects might be worth a try for treating COVID-19.

A novel combination of bortezomib, lenalidomide, and clarithromycin produced stringent complete response in refractory multiple myeloma complicated with diabetes mellitus - clinical significance and possible mechanisms: a case report.

BACKGROUND: In general, dexamethasone is a required component drug in various combination chemotherapies for treating multiple myeloma, and its efficacy has been widely recognized. However, administration of dexamethasone is known to cause various adverse effects including hyperglycemia which requires insulin therapy. During the course of treatment, we developed a novel effective dexamethasone-free combination regimen and evaluated it for its effect in multiple myeloma. CASE PRESENTATION: We report a case of 68-year-old Japanese woman with refractory advanced Bence-Jones-λ type multiple myeloma associated with diabetes mellitus. Various combination regimens were carried out, but the response to some regimens was insufficient or others containing dexamethasone, although effective, were inappropriate to continue due to aggravation of diabetes mellitus. Thus, we developed a dexamethasone-free, short dosing-period regimen consisting of bortezomib, lenalidomide, and clarithromycin. This regimen was found to be highly effective and succeeded in achieving stringent complete response. CONCLUSIONS: The successful dexamethasone-free regimen clearly shows that dexamethasone is not a requisite component in treating multiple myeloma, and it can be substituted with clarithromycin. This regimen is particularly useful for treating patients with multiple myeloma associated with diabetes mellitus.

Development of bolometric tomography technique for high-contrast radiation distribution in toroidal devices.

An extended Computed Tomography (CT) technique with a priori information based on Phillips-Tikhonov regularization has been developed to handle a high-contrast radiation distribution, which can result in large reconstruction errors in the region where radiation intensity is low, with few line of sight (LOS) data. Reference profiles generated from LOS data for every time slice are employed as the a priori information. In the extended technique, the weighting parameter for the reference profile is automatically determined from the LOS data, to avoid an inappropriate reference. The extended technique has been examined with a reconstruction test with the previously designed CT system using an infrared imaging video bolometer in JT-60SA. In the reconstructed profile of the high-contrast radiation distribution, the extended technique shows improvement of the weak radiation region, such as the scrape-off layer, without the deterioration of the strong radiation region, such as around the divertor. The results indicate that the extended CT technique can help to handle a high-contrast radiation distribution with few LOS data.

Conceptual design of imaging bolometer for use of computed tomography in JT-60SA.

An InfraRed imaging Video Bolometer (IRVB) system in JT-60SA has been designed for the two-dimensional (2D) Computed Tomography (CT) analysis of radiation. To achieve complete viewing of the whole poloidal cross section for plasmas having a low aspect ratio, a new IRVB concept, which has two sets of pin-hole camera systems viewing two different directions, has been introduced. Fields of view of the IRVB have been successfully designed by moving apertures to be sufficient for CT use without installation in tangential ports. The size of the aperture, which determines the width of the sightline of the IRVB channels, has also been optimized with respect to the reconstruction error with well-established solvers of tomography. The optimization indicates that the 7 mm square aperture is the best for this system, and the CT measurement without this optimization can become degraded. A synthetic image using an estimated radiation profile shows that the signal to noise (S/N) ratio of the designed IRVB is large enough to identify the incident radiation power. The result indicates that the designed IRVB can be used for the 2D CT measurement of radiation in JT-60SA.

[A case of pathological complete response of advanced rectal cancer with liver metastasis accompanied by tumor thrombus following treatment with bevacizumab/FOLFOX4 chemotherapy].

A 58-year-old man underwent low anterior resection for type 2 rectal cancer with liver metastasis. An abdominal computed tomography (CT) scan showed multiple hepatic tumors (in S2, S3, S4, and S6) and a filling defect in the left portal vein. Pathological examination revealed a moderately differentiated adenocarcinoma, pSS, pN0, ly0, v3, with a tumor thrombus in the portal vein. After surgery, the patient was treated with combined chemotherapy of bevacizumab/Leucovorin and fluorouracil with oxaliplatin (FOLFOX4). After 11 courses of chemotherapy, tumor marker levels normalized, and the sizes of the liver metastases and thrombus in the left portal vein remarkably decreased. Resection of the left hepatic lobe and a partial resection of S6 were performed. Pathological examination revealed no residual cancer cells and indicated that the histological classification due to the chemotherapy regimen was Grade 3. The patient was alive for 5 years after the initial surgery, without recurrence.

Coronary artery bypass grafting for acute myocardial infarction in stent ERA.

PURPOSE: We evaluated a treatment strategy for acute myocardial infarction (AMI) that percutaneous coronary intervention (PCI) is performed on a culprit lesion unless the culprit is an unprotected left main trunk. Emergent coronary artery bypass grafting (CABG) is done when the culprit is a left main trunk and a mechanical complication exists. METHODS: From 1997 to 2008, 22 and 232 patients underwent CABG for AMI and non-AMI, respectively. Of the 22 patients of AMI, PCI was performed in 12 patients and not performed in 10 patients before surgery. We investigated complication, intubation period, in-hospital mortality and hospitalization period. RESULTS: No in-hospital mortality was observed in all 22 AMI patients. There was no difference in in-hospital mortality and complication between the AMI and the non-AMI patients. No significant difference was found in hospital stay, complication, intubation period, in-hospital mortality and hospitalization period between patients who received preceding PCI and not. CONCLUSIONS: These results suggest that our treatment strategy is reasonable. Further studies will be warranted to clarify the role of preceding PCI.

Spontaneous rupture of a giant coronary artery aneurysm causing cardiac tamponade: A case report.

A 62-year-old woman with a history of dyslipidemia and hypothyroidism was referred to our institution with syncope. Cardiac tamponade due to spontaneous rupture of a 50-mm aneurysm of the coronary artery was diagnosed by transthoracic echocardiography, enhanced computed tomography, and coronary angiography. Emergency surgery was performed, and despite developing postoperative complications such as acute renal insufficiency, the patient was discharged from hospital without sequelae 89 days later. Histological findings revealed cystic media degeneration, but neither significant atherosclerotic changes nor inflammatory cell infiltration. Although coronary artery aneurysms are comparatively rare and generally asymptomatic, those over 30 mm in diameter are considered to be at increased risk of rupture. A coronary artery aneurysm of about 50 mm ruptured in our patient, supporting this view.

Dramatic improvement of rapidly progressing acute renal failure and severe hypertension after bilateral renal artery stenting.

In this case report, we describe an 83-year-old man with bilateral renal artery stenosis who had rapidly progressing acute renal failure and severe hypertension. These conditions improved dramatically after bilateral renal artery stenting. Renal artery stenosis can cause renal failure, hypertension, and heart failure, leading to a poorer life prognosis. If renal artery stenosis is found as a cause of acute renal failure, severe hypertension, or heart failure, it is useful to perform revascularization as soon as possible. Revascularization by stenting has a high success rate and is expected to improve the condition remarkably.

Selective intracoronary administration of nitroprusside before balloon dilatation prevents slow reflow during percutaneous coronary intervention in patients with acute myocardial infarction.

BACKGROUND: Previous studies have shown that intracoronary nitroprusside injection is safe and effective after slow reflow complicates percutaneous coronary intervention (PCI). OBJECTIVES: We sought to determine the safety and efficacy of selective intracoronary administration of nitroprusside through the drug delivery catheter before balloon dilatation to prevent no or slow reflow during PCI for acute myocardial infarction (AMI). METHODS: We studied 120 consecutive patients with AMI treated by PCI. In 60 patients (nitroprusside group), nitroprusside (120 mug) was selectively administered through the drug delivery catheter into the distal coronary artery to reach the target lesion before balloon dilatation. Clinical and angiographic data, as well as in-hospital outcomes, of the nitroprusside group were retrospectively compared with 60 patients who had conventional PCI without nitroprusside (control group). RESULTS: There were no significant differences in the baseline clinical and angiographic characteristics between the 2 groups. Compared to the control group, the nitroprusside group had 1) less slow reflow during the procedure (12% versus 35%, P = 0.0025), 2) a shorter fluoroscopic time (14.4 +/- 7.9 versus 18.7 +/- 9.1 minutes, P = 0.0093), 3) a shorter procedure time (57.6 +/- 20.6 versus 78.1 +/- 26.4, P < minutes, P < 0.0001), 4) a better final TIMI flow grade (III:II:I:0 = 59:1:0:0 versus 53:6:1:0, P = 0.0284), 5) a better blush grade (III:II:I:0 = 49:10:1:0 versus 33:15:8:4, P = 0.0006), and 6) a better corrected TIMI coronary flame count (30.8 +/- 13.7 versus 46.5 +/- 44.7, P = 0.0102). There were no particular complications with nitroprusside use. CONCLUSIONS: The selective intracoronary administration of nitroprusside prior to PCI is safe and well tolerated, prevents no or slow reflows, and improves reperfusion of the infarcted myocardium.

[Percutaneous transluminal angioplasty via dorsalis pedis artery for chronic total occlusion of superficial femoral artery: a case report].

A 60-year-old woman with intermittent claudication underwent angiography, which showed total occlusion of the left superficial femoral artery and no distal flow. Computed tomography with contrast medium revealed that the occlusion extended to the popliteal artery but distal flow was maintained to the dorsalis pedis artery. Percutaneous transluminal angioplasty was attempted via the right femoral artery, but the guidewire could not be advanced. Therefore, a 4F sheath was inserted into the dorsalis pedis artery and the guidewire was passed through the occluded lesion. After pre-dilation, the guidewire was re-crossed from the right femoral artery and two stents were successfully implanted. Finally sufficient antegrade blood flow was achieved after the procedure. The trans-dorsalis pedis artery approach is a valuable option for the percutaneous transluminal angioplasty of long superficial femoral artery occlusion if the antegrade approach is impossible.