To clarify the safety margin in excision of bone and soft tissue sarcomas, a new evaluation method for surgical margins was drafted by the Bone and Soft Tissue Committee of the Japanese Orthopaedic Association in 1989. This new evaluation system was applied to 1329 patients with bone and soft tissue sarcomas, of whom 492 were excluded because of insufficient details, leaving 837 patients (901 surgeries) for the current study. Based on the results derived from analyzing these registered surgical margins, predictable safety margins under different conditions could be determined. When preoperative treatment is not done or is ineffective in high-grade sarcoma, a margin greater than 3 cm wide is necessary. When the preoperative modality is effective, a 2-cm wide margin is permissible. However, for recurrent sarcoma, whether low-grade or high-grade, a curative procedure is necessary. For low-grade sarcoma, obtaining an adequate wide margin is essential but partial marginal margins are acceptable at sites where barriers exist. When the margin is insufficient, radiotherapy should be used regardless of the tumor grade. Making a safety margin definitive through this system, an optimum treatment can be obtained and unnecessary adjunctive modalities can be avoided.
Abstract Funding Acknowledgements Type of funding sources: None. Background Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation. Purpose We aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19). Methods We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study. Results A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1% – 98.1%), sensitivity of 92.3% (79.7% – 97.3%), specificity of 100% (80.6% – 100%), positive predictive value of 95.0% (89.6% − 97.7%), and Kappa of 0.33 (0.27 – 0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2% – 91.3%), 77.5% (62.5% – 87.7%), and 100% (80.6% – 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4% – 69.1%), 37.2% (32.0% – 42.7%), and 97.8 % (95.2% – 99.0%), respectively. Conclusion AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.
We report a case of a 31-year-old man with extrarenal angiomyolipoma of the perinephric space. He presented with asymptomatic macrohematuria. Computed tomography of the abdomen revealed a large perinephric mass which was separated from the right kidney and its unique growth appeared to have surrounded the kidney. Extrarenal angiomyolipomas of the perinephric fat are rare and they should be considered in the differential diagnosis of a retroperitoneal mass where asymptomatic macrohematuria was presented at the onset.
Experimental studies have demonstrated that adrenomedullin (AM) has a positive inotropic action and exerts inhibitory effects against ventricular remodelling as an autocrine and paracrine factor. However, there is no clinical evidence for AM acting as a local regulator in the human heart. We measured the levels of various molecular forms of AM, i.e. an active form of mature AM (AM-m), an intermediate inactive form of glycine-extended AM (AM-Gly) and total AM (AM-T = AM-m+AM-Gly), in plasma and pericardial fluid using our newly developed immunoradiometric assay in consecutive 67 patients undergoing coronary artery bypass graft surgery. Pericardial fluid and plasma cAMP, atrial natriuretic peptide and brain natriuretic peptide levels were also measured. The relationships between pericardial fluid AM levels and ventricular functions and other hormone levels were analysed. The level of each molecular form of AM in pericardial fluid was closely correlated with that of the other molecular forms of AM in the fluid. However, levels were not correlated with those in plasma. AM-T levels were slightly higher in pericardial fluid than in plasma (+72%; P<0.05), whereas AM-m levels and AM-m/AM-T ratios were markedly higher in pericardial fluid than in plasma (AM-m, +994%; AM-m/AM-T ratio, +443%; both P<0.01). AM-m, AM-Gly and AM-T levels in pericardial fluid were correlated with indices of left ventricular function, and with atrial natriuretic peptide and brain natriuretic peptide levels. Interestingly, AM and cAMP levels were positively correlated in plasma, but negatively correlated in pericardial fluid. In addition, AM-m, AM-Gly and AM-T levels in pericardial fluid were higher in patients with acute coronary syndrome than in those with stable ischaemic heart disease (AM-m, +80%; AM-Gly, +96%; AM-T, +83%; all P<0.01). These results suggest that AM in pericardial fluid reflects cardiac synthesis, and that enhanced cardiac secretion of AM is associated with left ventricular dysfunction, ventricular overload and myocardial ischaemia. Considering that AM has positive inotropic, coronary vasodilatory and anti-remodelling actions, increased cardiac AM may play a compensatory role in the ischaemic and failing myocardium.
Background: Although Japanese guideline recommends to reduce salt intake to less than 6 g per day for patients with hypertension, dietary salt intake is still high, being around 10–11 g. Cereal food contains much less salt compared to a Japanese breakfast (4–5 g of salt in general), predicting the effect to reduce the blood pressure. Patients and Methods: Patients who have a risk for atherosclerotic disease w eligible for enrollment in this study. The participants took a 50 g package of Frugura∨ (cereal meal, contains 0.2 g of salt) with milk or yogurt as a breakfast at least 4 days per week. Blood pressure (BP), body composition data, estimate dietary salt intake, and serum blood data were compared between before and 4 weeks after taking the meal. Result: Sixteen patients (9 male and 7 female) were enrolled in this study. The mean age was 68.2 years-old. BP in the morning was reduced from 128.7 to 127.8 [mmHg] (p = 0.635) in systolic, and from 79.8 to 77.3 [mmHg] (p = 0.124) in diastolic. Furthermore, BP in the night was reduced from 123.5 to 122.6 [mmHg] (p = 0.606) in systolic, and from 75.1 to 71.8 [mmHg] (p < 0.05) in diastolic. The estimate dietary salt intake was reduced from 9.3 g to 8.6 g, although there was no significant difference (p = 0.370). There was also no significant difference in body weight (62.0 vs 62.0, p = 0.914 [kg]) and body fat ratio (30.2 vs 31.5, p = 0.330 [%]). Serum interleukin-6 significantly decreased after 4 weeks (2.1 vs 1.5, p < 0.05 [pg/dL]). In note, there was no significant difference in liver, kidney, and diabetes marker (HbA1c) between groups. Moreover, 13 patients out of 16 claimed improvement of bowel movement. Conclusion: There could be a potential in Frugura∨ reducing blood pressure via low salt contents.
Aberrant activation of T cells has been considered to play important roles for pathogenesis of SLE. In T cells activation, calcium signalling is essential for the process. Interestingly, T cells of SLE patients have been reported to show several abnormalities of calcium signalling. In the present study, we postulated that patients with SLE may target calcium signaling-related molecules as autoantigen as autoantibodies to these molecules are potentially capable of interfering with calcium signalling through binding to these molecules localised at the plasma membrane eventually resulting in abnormal T cells activation in SLE. Regarding to the calcium signaling-related molecules, recent studies have shown that AHNAK1 is predominantly expressed in CD4 +T cells of cell membrane and cytoplasm. Moreover, AHNAK1 is known to play significant roles for regulating of calcium signalling at T cells activation through its ability to localise calcium channels properly at the plasma membrane as scaffold protein. Therefore, we verify whether autoimmune response to AHNAK1 is elicited in SLE.
Objectives
The present study was conducted to clarify whether autoantibodies to AHNAK-1 are produced in SLE compared with other connective tissue diseases and normal healthy controls (NHCs).
Methods
The Patients sera consisting of SLE (n=59), other connective tissue diseases (PM/DM; n=40, SSc; n=40, SS; n=30, MCTD; n=30, and RA; n=30) and NHCs (n=115) were used in the present study. Immunoreactivitiy against AHNAK1 recombinant antigens was evaluated by ELISA. AHNAK1 mRNA expression in peripheral blood mononuclear cells (PBMCs) was evaluated by quantitative RT-PCR. Indirect immunofluorescence (IIF) staining using monoclonal anti-AHNAK1 antibodies in combination with the patient's sera containing anti-AHNAK1 antibodies was evaluated using HEp-2 substrate. The experimental data were statistically analysed using the Mann–Whitney U-test or Chi-square test, and differences with P-values<0.05 were considered to be significant.
Results
Immunoreactivity against AHNAK1 was significantly elevated in SLE patients compared to both NHCs and other connective tissue diseases. Significant elevation of AHNAK1 mRNA expression was observed in PBMC of SLE patients compared to NHCs. Among 17 SLE patients with anti AHNAK1 antibodies positive sera, 4 patients revealed reduction of anti- AHNAK1 antibodies level after the treatment like glucocorticoid or immune suppressive reagents, however, the remaining 13 patients did not show the reduction of serum level pf anti-AHNAK1 antibodies. In clinical profile, lymphopenia was frequently observed in these SLE patients.IIF analysis showed that AHNAK-1 is localised at cell membrane and cytoplasm rather than nucleus.
Conclusions
In the present study, we found that autoantibodies to AHNAK1 were significantly observed in sera with SLE compared to both NHCs and other connective tissue diseases. Furthermore, AHNAK1 were enriched in PBMC of SLE patients suggesting antigen driven system may play an important role for this autoantibodies production. Anti-AHNAK1 antibodies may be pathological and play an important role for pathogenesis of SLE because it may possibly alter physiological calcium signalling of T cells through binding to AHNAK1 on cell membrane eventually resulting in aberrant T cells activation in SLE.
A right-sided aortic arch is normally asymptomatic. We report the case of an 84-year-old man with right internal jugular vein thrombosis caused by an aneurysm in a right-sided aortic arch. The patient had undergone open repair of an abdominal aortic aneurysm and had an uneventful postoperative course. However, a routine postoperative contrast-enhanced thoracic and abdominal computed tomography scan showed right internal jugular vein thrombosis. The patient had no history of catheter insertion in the right jugular veins and had no hereditary coagulopathy. It was presumed that the cause of this thrombosis was compression of the right brachiocephalic vein by an aneurysm of the right-sided ascending aorta that was considered too small to require surgical repair. The right internal jugular vein thrombosis was successfully treated with edoxaban. .
We reported three cases (42, 20 and 18-year-old men) of advanced nonseminomatous testicular germ cell cancer treated by salvage high-dose chemotherapy (HDC) supported by peripheral blood stem cell autotransplantation. Two cases which had been refractory to (B) EP (bleomycin, etoposide, cisplatin) and VIP (etoposide, ifosfmide, cisplatin) chemotherapies received one course of high-dose CEI (carboplatin 1,250 mg/m2, etoposide 1,500 mg/m2 and ifosfamide 7.5 g/m2), and the other case had been refractory to PVB (cisplatin, vinblastine, bleomycin) and VIP chemotherapies received one course of high-dose CEI and high-dose CCT (carboplatin 800 mg/m2, cyclophosphamide 6 g/m2 and thiotepa 720 mg/m2). Only one case achieved an incomplete remission by HDC, which was verified as a pathological complete response at the following salvage surgery, and has been alive with no evidence of disease for 68 months. The others achieved no change of disease following HDC and died from cancer progression. Hepatotoxicity, neurotoxicity and severe depression occurred, but not fatal in 2 cases.
