Serial angiographic and endovascular documentation of peri-stent contrast stains after sirolimus-eluting stent implantation: Multiple cavity formations between entirely covered stent struts.

A 72-year-old woman with a history of treatment with a single sirolimus-eluting stent (SES) for right coronary artery stenosis 21 months previously, was hospitalized to undertake invasive coronary evaluation due to recurrence of symptoms of effort angina. At the time of 9 months of angiographic follow-up, no in-stent restenosis was detected, however, several contrast filled "dimples" were noticed outside the stent border. At this time, further increments in the numbers of dimple formation were documented, in addition to progression of stenosis at the distal non-stented portion. Intravascular ultrasound demonstrated multiple cavity formations between the stent struts, due to positive remodeling occurring at the previously relatively disease-free side of the vessel wall. Surprisingly, optical coherence tomography demonstrated all the stent struts, including those located adjacent to cavities, were exclusively covered with neointima or other tissue components, completely attaching to the vessel wall throughout the stented segment. No evident thrombus formation was detected in these cavities. Despite no exposed stent struts, a hypothetical concern remains because such cul-de-sac formations may produce local blood flow turbulence within stents, which may be potentially associated with activation of local platelet aggregation. Careful long-term follow-up may be necessary for these patients.

Modeling and evaluation of human motor skills in a virtual tennis task.

The present paper develops a virtual tennis system using robotic devices for the rehabilitation of upper arm movements, and discusses an evaluation method of human motor skills for natural stroke in the dynamic task. In the training, a trainee manipulates the handle of an impedance-controlled robot to hit a ball by a racket toward the center of a circular target on the wall with considerations of motion smoothness and timing. A reference hand motion for the target task is clarified through a set of training experiments with 6 health volunteers and computationally expressed in the framework of a minimum jerk model. The designed index based on the reference model will be effective to quantitatively evaluate the recovery of motor skills for natural stroke in the virtual tennis task.

[A patient with advanced gastric cancer surviving for more than 5 years after neoadjuvant chemotherapy and curative resection].

The patient was a 54-year-old female who was diagnosed as a Borrmann 4 type gastric cancer with invasion to the descending part of the duodenum and hepatic flexure of the colon. Curative resection was considered to be impossible from the clinical findings, so low-dose CDDP + 5-FU therapy and MTX/5-FU sequential therapy were given. After the chemotherapy, the primary lesion was decreased remarkably and the invasive foci disappeared. Therefore total gastrectomy with perigastric lymphadenectomy and splenic preservation was performed. The histological findings revealed that viable cancer cells remained only in the mucosal layer of the primary lesion. The patient has been alive without recurrence for 66 months after the curative resection. This case report suggests that patients who have good response to neoadjuvant chemotherapy with curative resection appear to have prolonged disease-free and overall survival.