[Spontaneous Renal Rupture of Acquired Cystic Kidney Disease after Coronary Artery Bypass Grafting:Report of a Case].

We described a hemodialysis patient with spontaneous renal rupture of acquired cystic kidney disease (ACKD) after off-pump coronary artery bypass grafting(OPCAB). A 53-year-old man was transfer to our hospital with a diagnosis of unstable angina pectoris. He became ventilated due to congestive heart failure 3 days and underwent OPCAB on schedule 6 days after hospitalization. He suddenly complainted of colicky frank pain 31 days after surgery. Computed tomography (CT) demonstrated bulky hematoma with swollen kidney. Treatment included blood transfusions, withdrawal of anticoagulation, administration of vitamin K, and bed rest. The patient's symptom disappeared. A month later CT showed that the hematoma had been absorbed.

High metabolic heterogeneity on baseline 18FDG-PET/CT scan as a poor prognostic factor for newly diagnosed diffuse large B-cell lymphoma.

Metabolic heterogeneity (MH) can be measured using 18F-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT), and it indicates an inhomogeneous tumor microenvironment. High MH has been shown to predict a worse prognosis for primary mediastinal B-cell lymphoma, whereas its prognostic value in diffuse large B-cell lymphoma (DLBCL) remains to be determined. In the current study, we investigated the prognostic values of MH evaluated in newly diagnosed DLBCL. In the training cohort, 86 patients treated with cyclophosphamide, doxorubicin, vincristine, and prednisone-like chemotherapies were divided into low-MH and high-MH groups using receiver operating characteristic analysis. MH was not correlated with metabolic tumor volume of the corresponding lesion, indicating that MH was independent of tumor burden. At 5 years, overall survivals were 89.5% vs 61.2% (P = .0122) and event-free survivals were 73.1% vs 51.1% (P = .0327) in the low- and high-MH groups, respectively. A multivariate Cox-regression analysis showed that MH was an independent predictive factor for overall survival. The adverse prognostic impacts of high MH were confirmed in an independent validation cohort with 64 patients. In conclusion, MH on baseline 18FDG-PET/CT scan predicts treatment outcomes for patients with newly diagnosed DLBCL.

[Coronary Artery Bypass Grafting to the Left Anterior Descending Artery via Anterior Minithoracotomy after Surgery for Acute Papillary Muscle Rupture;Report of a Case].

We presented a case with chronic occlusion of the left anterior descending artery(LAD) after mitral valve replacement (MVR). An 80-year-old man was transferred to our hospital with a diagnosis of acute myocardial infarction. Before coronary angiography, the patient suddenly fell in a state of cardiogenic shock. Echocardiography revealed acute mitral regurgitation due to anterior papillary muscle rupture. Although emergency MVR was performed, introduction of percutaneous cardiopulmonary support (PCPS) and intraaortic balloon pumping ( IABP) was needed to come off cardiopulmonary bypass. Postoperative coronary angiography revealed chronic occlusion of LAD. The left internal thoracic artery was anastomosed to LAD via anterior minithracotomy to avoid median re-sternotomy. The postoperative course was uneventful and the cardiac function improved.

Serum level of soluble interleukin-2 receptor is positively correlated with metabolic tumor volume on 18 F-FDG PET/CT in newly diagnosed patients with diffuse large B-cell lymphoma.

Diffuse large B-cell lymphoma (DLBCL) is the most frequent subtype of non-Hodgkin lymphoma. High total metabolic tumor volume (TMTV) calculated using 18 F-FDG PET/CT images at diagnosis predicts poor prognosis of patients with DLBCL. However, high cost and poor access to the imaging facilities hamper wider use of 18 F-FDG PET/CT. In order to explore a surrogate marker for TMTV, we evaluated the correlation between the serum levels of soluble interleukin-2 receptor (sIL-2R) and TMTV in 64 patients with DLBCL, and the results were verified in an independent validation cohort of 86 patients. Serum levels of sIL-2R were significantly correlated with TMTV. ROC analysis revealed that the cutoff value of TMTV ≥150 cm3 or sIL-2R ≥ 1300 U/mL could predict failure to achieve EFS24 with areas under the curve (AUC) 0.706 and 0.758, respectively. Each of TMTV ≥150 cm3 and sIL-2R ≥1300 U/mL was significantly associated with worse 5-year overall survival and event-free survival. Importantly, each of sIL-2R <1300 U/mL or TMTV <150 cm3 identified patients with favorable prognosis among NCCN-IPI high-intermediate and high-risk group. Serum level of sIL-2R represents a convenient surrogate marker to estimate metabolic tumor burden measured by 18 F-FDG PET/CT that can predict treatment outcomes of patients with DLBCL.

Diagnostic value of ¹8F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma.

PURPOSE: This study investigated the diagnostic accuracy of hybrid positron-emission tomography/computed tomography (PET/CT) for lymph node (LN) metastasis of esophageal cancer. We also investigated the correlation between the size of metastatic nests and the detection by PET/CT. METHODS: Two hundred and fifty-eight patients with esophageal squamous cell carcinoma who underwent esophagectomy with two- or three-field radical lymphadenectomy were analyzed retrospectively. We compared the diagnosis of preoperative PET/CT to the postoperative histopathological examination by each anatomical field (n = 1,231) in all 258 patients. The metastatic LNs resected from PET/CT positive fields were classified as belonging to the PET/CT-N-positive group (n = 229) and those from negative fields as belonging to the PET/CT-N-negative group (n = 352). The cross-sectional areas of metastatic nests were measured in each metastatic LN. RESULTS: Of the 1,231 fields, 275 (22 %) were positive for metastasis, including 581 LNs from 408 regional LN stations. The sensitivity and specificity of PET/CT examined by each anatomical field were 25.8 and 97.8 %, respectively. The median area of metastatic nests was 17.7 mm2 in the PET/CT-N-positive group, and 7.7 mm2 in the PET/CT-N-negative group (p < 0.001). CONCLUSIONS: A significant correlation was suggested between the nest size and detection by PET/CT. Because of its low sensitivity, PET/CT alone is insufficient to determine the surgical procedures, especially when considering reduction surgery.

One-bottle silane coupling agent containing 4-META.

The effectiveness of commercial and experimental silane coupling agents was evaluated by measuring their shear bond strengths to a ceramic disk. Experimental one-bottle silane coupling agents were prepared using 3-MPTS, 4-META, and resin monomers. The surfaces of two ceramic disks (IPS e-max, Ivoclar Vivadent AG, Schaan, Lichtenstein) were treated by a silane coupling agent to bond them to each other; this bonding was mediated by a commercial flowable resin composite (Clearfil Majesty LV, Kuraray, Tokyo, Japan). A commercial silane coupling agent (Clearfil Porcelain Bond Activator, Kuraray, Tokyo, Japan) modified by adding 4-META exhibited a significantly higher bond strength than the unmodified commercial one-bottle silane coupling agent. Among the tested materials, two experimental one-bottle silane coupling agents composed of 5% 4-META, 45% 3-MPTS, and 50% resin monomers exhibited statistically highest bond strengths.

Diagnostic accuracy of lymph node metastasis depends on metabolic activity of the primary lesion in thoracic squamous esophageal cancer.

UNLABELLED: The metabolic activity of the primary tumor is an important variable in (18)F-FDG PET interpretation for presurgical staging, because this activity is likely to affect the possibility of detection of malignant involvement in lymph nodes (LNs). The purpose of this study was to reevaluate the diagnostic accuracy of (18)F-FDG PET/CT for the presurgical staging of esophageal squamous cell carcinoma (SCC) in correlation with the (18)F-FDG avidity of the primary lesions. METHODS: One hundred fifty-six patients (mean age ± SD, 61.4 ± 8.0 y) underwent (18)F-FDG PET/CT before surgical esophagectomy and LN dissection. LN metastasis was identified using the fusion of PET and CT images with increased (18)F-FDG uptake greater than the background activity of the adjacent structures. The results of the patients' (18)F-FDG PET/CT examinations for LN involvement were compared with the histopathologic results to investigate the diagnostic accuracy of (18)F-FDG PET/CT for tumor staging. In addition, we examined the correlation between the diagnostic accuracy of (18)F-FDG PET/CT for LN involvement and the (18)F-FDG avidity of the primary lesions, to investigate the effect of tumor aggressiveness on the diagnosis of LN metastasis. RESULTS: The diagnostic accuracy of (18)F-FDG PET/CT for LN metastasis showed a low sensitivity, ranging from 29.3% to 53.3%, whereas the specificity was higher than 89.8% in regional thoracic nodes and in remote areas of the cervical and abdominal regions. The (18)F-FDG uptake of the primary lesions positively correlated with that of the metastatic LNs in the thoracic field (R = 0.52, P < 0.05). As a result, our receiver-operating-characteristic analyses demonstrated an area under the curve value of 0.73, with the optimal cutoff value at a maximum standardized uptake value of 3.3 in patients with mid to high (18)F-FDG avidity in the primary lesions (maximum standardized uptake value ≥ 5). CONCLUSION: This study showed that the avidity of the primary esophageal SCCs affected the detectability of lymph nodal metastases. If primary lesions of esophageal SCC present with a low (18)F-FDG uptake, PET/CT may have a limited role for initial staging because of low sensitivity to detect lymph node metastases.

Multimodality evaluation of cardiac paraganglioma.

We report 2 rare cases of primary cardiac paraganglioma demonstrated with multimodality imaging. Both a 46-year-old woman who presented with hypertension (case 1) and a 46-year-old woman without any symptoms (case 2) had mediastinal tumors depicted by CT and MRI. Both cases showed intense focal uptakes in the tumors with iodine-123-meta-iodobenzylguanidine SPECT. Case 2 also underwent 18F-FDG PET/CT and revealed a focal uptake. CT angiography detected the arterial feeder and venous drainages, information that was useful for the operation. After surgical removal, pathology confirmed primary cardiac paraganglioma in both cases. 18F-FDG PET/CT was also useful in ruling out residual or recurrent tumors.

Direct projections from the central amygdaloid nucleus to the mesencephalic trigeminal nucleus in rats.

The amygdala is activated by fear and plays an important role in the emotional response to life-threatening situations. When rats feel threatened, they respond by biting fiercely. Bite strength is regulated by the trigeminal motor nucleus and the mesencephalic trigeminal nucleus (Me5). The Me5 relays proprioceptive signals from the masticatory muscles and the periodontal ligaments to the trigeminal motor and premotor nuclei. The amygdala projects to the trigeminal motor nucleus and the premotor reticular formation. However, it is unknown whether the amygdala projects directly to the Me5. In the present study, neurons of the central amygdaloid nucleus (ACe) were labeled following injection of a retrograde tracer, Fast Blue, into the caudal Me5, and fibers and terminal buttons from the ACe to the Me5 were examined after injections of an anterograde neuronal tracer, biotinylated dextran amine into the ACe. Furthermore, wheat germ agglutinin-conjugated to horseradish peroxidase was injected into the ACe, and labeled fibers and terminal buttons in the Me5 were examined by electron microscopy. Labeled terminal buttons on Me5 somata were more abundant in the caudal than the rostral Me5. Electron microscopic observation revealed that a part of these terminal buttons formed axo-somatic synapses. These results indicate that the ACe sends direct projections to the Me5, and suggest that the amygdala regulates bite strength by modifying neuronal activity in the Me5.

Water evaporation from substrate tooth surface during dentin treatments.

The purpose of this study was to evaluate changes in the quantity of water evaporation from tooth surfaces. The amount of water evaporation was measured using Multi probe adapter MPA5 and Tewameter TM300 (Courage+Khazaka Electric GmbH, Köln, Germany) after acid etching and GM priming of enamel; and after EDTA conditioning and GM priming of dentin. The results indicated that the amount of water evaporation from the enamel surface was significantly less than that from the dentin. Acid etching did not affect the water evaporation from enamel, though GM priming significantly decreased the evaporation (83.48 ± 15.14% of that before priming). The evaporation from dentin was significantly increased by EDTA conditioning (131.38 ± 42.08% of that before conditioning) and significantly reduced by GM priming (80.26 ± 7.43% of that before priming). It was concluded that dentin priming reduced water evaporation from the dentin surface.

Diffusion of GM primer and dentin adhesive into EDTA-conditioned dentin.

The aim of this study was to investigate the diffusion of red-stained experimental GM primer and blue-stained dentin bonding agent into EDTA-conditioned dentin and the effect of GM priming on contraction gap formation. After GM priming at 0, 35, 70, or 100 vol%, marginal adaptation was evaluated by measuring the wall-to-wall contraction gap width of a light-activated resin composite (Palfique Estelite, Tokuyama Dental, Japan) mediated with a commercial dentin bonding agent (Clearfil Photo Bond, Kuraray Medical, Japan). Contraction gap formation was completely prevented when treated with 35 vol% GM primer. Moreover, after treatment with 35 vol% GM, the red and blue dyes of stained GM primer and dentin bonding agent diffused up to a depth of 40 µm into the dentin surface. The diffusion of primer and bonding agent into EDTA-conditioned dentin was essential for bonding efficacy although SEM observation revealed an absence of hybrid layer formation.

The locus coeruleus projects to the mesencephalic trigeminal nucleus in rats.

The ganglion-cells in the mesencephalic trigeminal nucleus (Me5) process proprioceptive signals from the masticatory muscles and the periodontal ligaments, and are considered to regulate the rhythm of biting and bite strength. The locus coeruleus (LC) is the major source of noradrenergic projections in the brain and plays an important role in stressful situations and aggressive behavior. The two nuclei are adjacently located to each other in the lateral part of the periaqueductal gray matter of the fourth ventricle. In the present study, a small number of neurons were labeled in the LC with a neuronal tracer biotinylated dextran amine. The labeled single axons were traced from the labeled LC neuronal somata to the ipsilateral Me5 region where they produced terminal-like swellings. Some of the swellings appeared to make contact with the ganglion-cells of the Me5. These results suggest that the LC regulates the bite strength by modifying the ganglion-cell activity in the Me5. Additionally, these findings shed light on the enigma of why the main part of the Me5 at the level of pons is located at the lateral end of the gray matter ventral to the fourth ventricle, instead of at the trigeminal ganglion.

Production of polyselenodipenicillamines, unique selenium compounds.

Selenite (H(2)SeO(3)) reacts with thiol compounds (RSH) under acidic conditions to form selenotrisulfides (RSSeSR, i.e. monoselenodithiols). The stoichiometry of the reaction is proposed as 4RSH+H(2)SeO(3)-->RSSeSR+RSSR+3H(2)O. Surprisingly, we found novel polynuclear selenium-containing compounds, i.e. polyselenodipenicillamines (PenSSe(2-4)SPen), in the reaction of D-penicillamine (PenSH) with H(2)SeO(3). The selenium-centered features of PenSSe(2-4)SPen were determined by (1)H-NMR and LC-MS/MS analyses, showing that the selenium isotope abundance patterns of the compounds were in good agreement with the theoretically-calculated ones. In order to better understand the mechanisms for PenSSe(2-4)SPen production, various molar ratio of H(2)SeO(3) (1/8 to 4 times of PenSH) was reacted with PenSH, and the concentration of the products was calculated from integral values of dimethyl proton signals for PenSSe(1-2)SPen as compared with methyl proton signals for acetic acid (an internal standard). Total PenSSe(1-2)SPen concentration was increased with increasing of H(2)SeO(3), in which concomitant decrease of PenSSPen (disulfide form of PenSH) was observed. Based on these results, we proposed the PenSSe(2-4)SPen production mechanisms being involved in penicillamine selenopersulfides (PenSSe(1-2)H).

Measurement of shear bond strength to intact dentin.

Previously, we reported that the integrity of a resin composite restoration deteriorated when the dentin cavity wall was decalcified by conditioning. In this study, to evaluate the bonding between dentin adhesive and non-decalcified dentin surface, we experimented with a novel method of using a high-pressure water spray device to prepare smear layer-free dentin surfaces. When the smear layer was removed, shear bond strength significantly increased regardless of the removal method employed. Further, with glyceryl monomethacrylate (GM) priming, no significant differences in bond strength were observed among these smear layer removal methods: ethylenediamine tetraacetic acid (EDTA) conditioning, phosphoric acid conditioning, and removal by water spray. It was also found that GM priming was key to achieving marginal integrity, whereas contraction gap width increased with phosphoric acid conditioning. It was thus concluded that the efficacy of a dentin adhesive should be evaluated by consistently observing the contraction gap in three-dimensional cavities rather than by mere measurement of bond strength to a flat dentin surface.

Can hybrid FDG-PET/CT detect subclinical lymph node metastasis of esophageal cancer appropriately and contribute to radiation treatment planning? A comparison of image-based and pathological findings.

BACKGROUND: We aimed to determine the appropriateness of adding 18F-fluorodeoxyglucose (FDG)-positronemission tomography (PET) to computed tomography (CT) and other pre-existing diagnostic imaging modalities for detecting subclinical lymph node metastasis of esophageal cancer, by comparing images from these modalities with the results of histopathological analysis. METHODS: Twenty patients who received radical surgery for squamous cell carcinoma of the esophagus were examined by PET-CT, and endoscopic ultrasound (EUS) examination before surgery. Based on these diagnostic modalities, the clinical target volume (CTV) was set as the gross tumor volume (GTV) plus a 1-cm margin. Histopathological diagnosis was performed in all patients immediately after resection. RESULTS: Fifty-three (3.0%) of 1764 nodes in the 20 patients were histopathologically positive for cancer cells. The CTV was not adequate to cover these histopathologically detected positive lymph nodes in 8 of 20 patients on CT, 5 of 20 on CT+EUS, 7 of 20 on PET-CT, and 5 of 20 on PET-CT+EUS. CONCLUSION: The detection rate of subclinical lymph node metastasis did not improve with the use of PET-CT, for either the cervical and supraclavicular, mediastinal, or abdominal regions. It is not recommended to use FDG-PET or PET-CT alone as a diagnostic tool to determine CTV if pathologically involved lymphatic regions are to be included in the CTV in the treatment protocol. The accuracy of PET-CT must be further improved in order to better detect positive nodes and improve the definition of the CTV.

In vitro comparison of three caries dyes.

PURPOSE: To evaluate the efficacy of a conventional and newly-developed caries detector (Caries Check) by measuring the Vickers microhardness (VMH) and DIAGNOdent value of the dentin cavity wall of extracted human teeth after removing carious dentin that was stained by the caries detector. METHODS: 30 human teeth with coronal dentin caries extending halfway through the dentin were sectioned and extracted for use in this study. As a control, the longitudinal section of a caries-free extracted human tooth was prepared. The VMH and DIAGNOdent values were measured and the microstructure of the dentin cavity wall was examined using a scanning electron microscope (SEM). RESULTS: When Caries Check was employed as a guide for carious dentin removal, the microhardness of the cavity wall was significantly lower than the normal dentin and the DIAGNOdent value indicated that the dentin may have recalcified. SEM observations of the stained regions revealed that Caries Check did not stain the sclerotic dentin. Based on these findings, Caries Check may be a useful modality because the excavation of the dentin structure was shallower and the sclerotic dentin was preserved.

Role of oxidative stress in hypertrophied myoblasts stimulated by isoproterenol.

OBJECTIVE: Hydrogen peroxide (H(2)O(2)), one of the oxyradical members, has been shown to have insulin-like effects, and endogenous H(2)O(2) may have the ability to improve impaired glucose metabolism. As a mechanism contributing to progression of hypertrophy, we hypothesized that the formation of H(2)O(2) to improve glucose uptake could be an oxidative stress resulting in apoptotic cell death. METHODS: We used cultured myoblasts (H9c2) stimulated by isoproterenol as a model to focus on glucose metabolism, oxidative stress, apoptosis, and extracellular signal-regulated protein kinases (ERKs) expression. RESULTS: In hypertrophied myoblasts, anaerobic glycolysis became prominent at day 7 of isoproterenol stimulation (ISO7; isoproterenol was administered for 7 days). Hydroperoxides production started to increase at day 5 of isoproterenol stimulation (ISO5) and peaked at ISO7. Apoptotic cell death was significantly increased in ISO5 and ISO7. Temporary ERKs suppression was also found at ISO5 and ISO7. Change in glucose metabolism led to stimulation of hydroperoxides production, apoptotic cell death and suppression of ERKs. CONCLUSION: We concluded that oxidative stress was increased during the progression of hypertrophied myoblasts in association with impaired glucose metabolism and increased apoptotic cell death. Suppression of ERKs may be involved in signal transduction of apoptotic cell death.

Priming effects of triethylene glycol and triethylene glycol monomethacrylate on dentin bonding.

The objective of this study was to evaluate the effects of triethylene glycol (TEG) and triethylene glycol monomethacrylate (TEGMA) solutions as dentin primers on dentin bonding. To this end, wall-to-wall polymerization contraction gap width of a resin composite in a cylindrical dentin cavity and shear bond strength to a flat dentin surface were measured. Dentin was pretreated with an experimental dentin bonding system - consisting of 0.5 M ethylenediaminetetraacetic acid conditioner, TEG or TEGMA primer, and Clearfil Photo Bond bonding agent - prior to resin composite filling. When the cavity was primed with an aqueous solution of 35 vol% TEG, 35 or 45 vol% TEGMA for a few seconds, contraction gap formation was prevented completely. Then, among these three gap-free groups, there were no significant differences in shear bond strength. It was thus shown that both TEG and TEGMA were highly effective dentin primers, completely preventing contraction gap formation even when they were applied for only a few seconds.

Light intensity evaluation of laser-induced fluorescence after caries removal using an experimental caries staining agent.

OBJECTIVE: The purpose of this study was to evaluate the intensity of fluorescent light reflected from cavity wall dentin, after dentin stained by an experimental caries detecting liquid was removed. BACKGROUND DATA: The conventional caries detecting liquid tends to penetrate dentin too deeply. On the other hand, DIAGNOdent has gradually gained recognition and established itself as a caries detection device using a laser beam. METHOD: An experimental caries staining liquid or the conventional caries staining liquid was applied in the same cavity to observe for differences in dye penetration. Intensity of fluorescence reflected from treated dentin was measured by DIAGNOdent. RESULTS: The mean DIAGNOdent value after removing the tooth substance stained by the experimental liquid was 17.9+/-4.1, compared with 7.7+/-2.7 by conventional one. CONCLUSION: Light intensity evaluation of laser-induced fluorescence suggested that the experimental caries detecting liquid did not penetrate the dentin which should be preserved, hence avoiding overtreatment.

Guinea Pig Maximization Test of tri-ethylene glycol mono-methacrylate.

The aim of this study was to evaluate tri-ethylene glycol mono-methacrylate (TEGMA) in terms of dermatological allergic reaction using a Guinea Pig Maximization Test. Skin reaction was evaluated according to the criteria of International Contact Dermatitis Research Group. TEGMA, as a constituent in new primers, has been reported to contribute to a priming ability similar to that of highly purified glyceryl mono-methacrylate (GM). In this study, it was found that its adverse effect was less than that of 2-hydroxy ethyl methacrylate (2-HEMA), but similar to that of highly purified GM. In conclusion, it was anticipated that TEGMA would hereafter replace 2-HEMA as a primer, as it posed a lower risk of triggering dermatological allergic reaction.