Intravitreal bevacizumab injection and carotid artery stent replacement for neovascular glaucoma in internal carotid artery occlusion

Neovascular glaucoma (NVG) secondary to internal carotid artery (ICA) occlusion is usually resistant to treatment. We report a case of NVG with ICA occlusion improved by intravitreal bevacizumab (IVB) injection and carotid artery stent replacement (CAS), even though we did not perform panretinal photocoagulation. A 67-year-old male with NVG noted visual loss in his left eye. Magnetic resonance angiography showed left ICA occlusion. He was diagnosed with NVG secondary to ICA occlusion. The next day, we carried out IVB injection in his left eye, following which the iris and angle neovascularization regressed, and the intraocular pressure decreased to normal within a day after the injection. CAS was performed on his left ICA at a month post injection. Two months later, we reinjected bevacizumab in his left eye. His condition remained stable with no recurrence over two years. This case indicates that IVB injection and CAS are useful for early-stage NVG secondary to ICA occlusion

A Case of Endoscopic Mucosal Resection of Carcinoma in Adenoma at the Minor Duodenal Papilla

Here, we describe a case of minor papillary adenocarcinoma in adenoma that was treated with endoscopic mucosal resection (EMR). In a 67-year-old woman, sigmoid colon cancer was incidentally detected on preoperative upper gastrointestinal endoscopy. Endoscopy revealed a slightly elevated lesion at the minor duodenal papilla. The findings of a histopathologic examination were suggestive of adenocarcinoma. Computed tomography and magnetic resonance images identified a minute tumor, whereas endoscopic ultrasonography revealed that the tumor did not spread to the pancreas. We performed EMR of this lesion. There were no complications, and relapse has not occurred in 3 years. Cases of minor papillary adenocarcinoma treated with EMR are quite rare

Assembly, assessment and availability of de novo generated transcriptomes

De novo assembly of a complete transcriptome without the need for a guiding reference genome is attractive, particularly where the cost and complexity of generating a eukaryote genome is prohibitive. The transcriptome should not however be seen as just a quick and cheap alternative to building a complete genome. Transcriptomics allows the understanding and comparison of spatial and temporal samples within an organism and allows surveying of multiple individuals or closely related species. De novo assembly in theory allows the building of a complete transcriptome without any prior knowledge of the genome it also allows the discovery of alternate splice forms of coding RNAs and also non-coding RNAs, which are often missed by proteomic approaches or are incompletely annotated in genome studies. The limitations of the method are that generation of a truly complete assembly is unlikely and so we require some method for assessment of the quality and appropriateness of a generated transcriptome. Whilst no single consensus pipeline or tools is agreed as optimal, various algorithms and easy to use software do exist making transcriptome generation a more common approach. With this expansion of data, questions still exist relating to how do we make these datasets fully discoverable, comparable and most useful to understand complex biological systems

Five doses of the mRNA vaccination potentially suppress ancestral-strain stimulated SARS-CoV2-specific cellular immunity: a cohort study from the Fukushima vaccination community survey, Japan

The bivalent mRNA vaccine is recommended to address coronavirus disease variants, with additional doses suggested for high-risk groups. However, the effectiveness, optimal frequency, and number of doses remain uncertain. In this study, we examined the long-term cellular and humoral immune responses following the fifth administration of the mRNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in patients undergoing hemodialysis. To our knowledge, this is the first study to monitor long-term data on humoral and cellular immunity dynamics in high-risk populations after five doses of mRNA vaccination, including the bivalent mRNA vaccine. Whereas most patients maintained humoral immunity throughout the observation period, we observed reduced cellular immune reactivity as measured by the ancestral-strain-stimulated ELISpot assay in a subset of patients. Half of the individuals (50%; 14/28) maintained cellular immunity three months after the fifth dose, despite acquiring humoral immunity. The absence of a relationship between positive controls and T-Spot reactivity suggests that these immune alterations were specific to SARS-CoV-2. In multivariable analysis, participants aged ≥70 years showed a marginally significant lower likelihood of having reactive results. Notably, among the 14 individuals who received heterologous vaccines, 13 successfully acquired cellular immunity, supporting the effectiveness of this administration strategy. These findings provide valuable insights for future vaccination strategies in vulnerable populations. However, further research is needed to evaluate the involvement of immune tolerance and exhaustion through repeated vaccination to optimize immunization strategies

ハンカイ シンケイ ドウテイ ニ NIMシステム オ モチイタ Zenkerケイシツ ノ 1レイ

　Zenker憩室はKillian’s間隙に発生した憩室であり，全消化管憩室の0.1%の頻度と稀である．今回われわれは，術中神経モニタリングシステムであるNIMシステム(NERVE INTEGRITY MONITORING SYSTEM；以下，NIMと略記)をZenker憩室の手術で使用し，反回神経を容易に同定することが可能であったので報告する．　症例は67歳，女性．数年前から咽頭部の違和感を自覚し，２カ月前から増悪したため当院外来を受診した．精査の結果，症状を認めるZenker憩室と診断し，手術を施行した．NIMを使用して反回神経の走行を確認しつつ憩室を同定した．憩室を切除後，二層縫合(Albert-Lembert吻合)して閉鎖した．術中内視鏡検査を施行し，食道に狭窄や漏れがないことを確認した．輪状咽頭筋切開を追加し，甲状腺を縫合部の前面で固定して縫合部を補強した．ドレーンを留置して手術を終了した．術後経過は良好で手術から14日目に退院とし，退院後１ヶ月の時点で症状は改善していることを確認した．　Zenker憩室の手術で反回神経損傷は回避すべき合併症のひとつである．甲状腺手術で使用するNIMはZenker憩室の手術においても反回神経の同定に使用することで，神経損傷のリスクを下げる可能性がある．　Zenker’s diverticulum is a diverticulum that develops in the Killian’s gap. The frequency of its occurrence is 0.1% of all digestive tract diverticulum. The present study reports that the NIM system can be useful during Zenker’s diverticulum surgery for easily identifying recurrent laryngeal nerve.　The present case is of a 67-year-old woman. She was aware of discomfort in her pharyngeal region for several years. She had been aggrieved for the past 2 months, and therefore was admitted to our hospital’s outpatient clinic. Following examination, we diagnosed Zenker’s diverticulum and performed surgery. We identified recurrent laryngeal nerve using NIM. We dissected the diverticulum and sutured in layers and closed. Intraoperative endoscopy was performed to confirm that there was no stenosis or leakage in the esophagus. We performed ring pharyngeal muscle incision. We fixed the thyroid gland in front of the suture to reinforce it. There was no untoward event postoperatively, and the patient was discharged from the hospital on day 14 after the surgery. We confirmed that the symptom had improved at 1 month after discharge.　NIM used in thyroid surgery is also useful in identifying the recurrent laryngeal nerve during Zenker’s diverticula surgery and may help reduce the risk of nerve damage

トウイン ニオケル セツジョ フノウ キョクショ シンコウ ショクドウガン ノ チリョウ セイセキ

【背景】遠隔転移のない切除不能局所進行食道癌に対する標準治療は根治的化学放射線療法(CRT)だが，近年Docetaxel/5-FU/ Cisplatin 療法をはじめとした導入化学療法（ICT）からの外科的切除の有用性が報告されている．今回，当院での切除不能局所進行食道癌に対する治療成績について検証した．【対象と方法】2016年から2019年の期間で，当院で治療した切除不能局所進行食道癌9例(リンパ節T4bも含む)を対象とした．【結果】男性：6例，女性：3例．年齢：中央値 64（41-78）歳．腫瘍主占居部位：Ut/Mt/Lt=1/7/1．浸潤臓器:気管/左主気管支/大動脈=2/4/3，cN0/1/2=1/3/5，初回治療: ICT/CRT=7/2であった．初回治療別に検証すると，奏効率:ICT/CRT=5(71.4%)/0(0%)であり，ICTにて奏効が得られた5例は根治切除可能と判断し，4例（80％）でR0切除が得られた．術後合併症は，縫合不全0例，肺炎1例(20%)，反回神経麻痺2例(40%)であった．術後在院日数中央値は16日(13-21)であった．R0切除4例は全例1年以上の生存が得られているが，2例で再発(リンパ節再発1例，肺・リンパ節再発1例)を認めた．R1切除例はCRTを追加し，術後2年無再発生存中である．根治切除を施行していない4例の初回治療からの1年生存率は25％と予後不良であった．【結語】切除不能局所進行食道癌であってもICTを組み入れることでconversion surgeryが安全に施行され，高いR0切除率が得られ，予後の延長に寄与する可能性がある．Background:Recently, the usefulness of surgical resection after induction chemotherapy (ICT) including Docetaxel / 5-FU / Cisplatin therapy for locally advanced esophageal cancer has been reported. Methods:Nine patients with locally advanced unresectable esophageal cancer who underwent multidisciplinary treatment in our hospital from 2016 to 2019 were eligible for this study. Results:The patients’ characteristics included a median age of 64 years; the male/female ratio of 6/3; Tumor main occupancy site Ut / Mt / Lt = 1/7/1; Invading adjacent organs: trachea / left main bronchus / aorta; 2/4/3, Lymph node metastasis (0/1/2); 1/3/5, and initial treatment ICT / CRT; 7/2. Response rate of ICT were 71.4% (5 cases) and that of CRT were 0%. Four patients (80%) of 5 patients who responded to ICT were underwent R0 resection. Postoperative complications were anastomotic leakage in 0 cases, pneumonia in 1 case (20%), and recurrent nerve paralysis in 2 cases (40%). The median length of hospital stay after surgery was 16 days. All 4 cases of R0 resection had survived for 1 year or more. The 1-year survival rate from the initial treatment of 4 patients who did not undergo radical resection was 25%. Conclusion:Conversion surgery after ICT for locally advanced unresectable esophageal cancer may contribute to a high R0 resection rate and better clinical outcomes

トウイン ニオケル キョウクウ キョウカ ショクドウ セツジョ ノ ドウニュウ ト タンキ チリョウ セイセキ ノ ケントウ

【背景】食道癌に対する胸腔鏡手術は本邦で広く行われており、施設ごとに手術手技の定型化がなされている.胸腔鏡下手術の利点として拡大視効果や緻密な手術操作が可能となることが挙げられるが、当院でも2016年より腹臥位胸腔鏡下食道手術を導入し、出血の少ない安全かつ確実な郭清を目指し、定型化に向けてその手技を刷新している.【対象と方法】】2016年4月から2019年4月までに当院で施行した胸腔鏡下食道切除38例につき、その短期成績を検討した.【結果】男:女＝32:6、年齢中央値 66歳(41-76)、cStage I / II / III / IVa: 17 / 6 / 13 / 2であった.胸腔内出血量中央値は10ml(0-53)、胸部操作時間中央値は192分(97-478)、胸腔内郭清リンパ節個数中央値は17個(1-42)であった.術後合併症は、縫合不全3例(7.9％)、反回神経麻痺7例(18.4％)、肺炎12例(31.6％)であった.術後在院日数中央値は19日(11-38)であった.導入期からの前半19例では反回神経麻痺を6例(31.6％)に認めたが、後半19例では１例(5.2％)であった(p=0.036).【結語】当院における胸腔鏡下食道切除術は安全に導入、施行可能であった.手術手技が定型化されることで反回神経麻痺を少なくする郭清が可能になると考えられた.Background: Thoracoscopic esophagectomy (TE) is increasingly being used worldwide in patients with esophageal cancer. In this study, we investigated the clinical short-term outcomes of TE performed in patients placed in the prone position. Method: We investigated the surgical and clinical outcomes in 38 patients with esophageal cancer who underwent TE at our hospital between April 2016 and April 2019. Results: Of the 39 patients investigated, 32 were men. Median patient age was 66 (range 41–76) years, the median intraoperative blood loss was 10 (0–53) mL, and the median operation time for thoracoscopy was 192 (97–478) min. The mean operation time for thoracoscopy in the latter group was significantly shorter than that in the former group (188 min vs. 232 min, p=0.013). The following postoperative complications were observed: 7 (18.4%) cases of recurrent nerve palsy, 3 (7.9%) cases of anastomotic leakage, 12 (31.6%) cases of pneumonia, and 0 (0%) cases of chylothorax. The incidence of recurrent nerve palsy was lower in the latter group than in the former group (5.2% vs. 31.6%, p=0.036). Conclusions: TE in the prone position is safe and feasible. As experience performing the procedure increases, the performance of the procedure stabilizes

The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force

「コロナ制圧タスクフォース」COVID-19患者由来の血液細胞における遺伝子発現の網羅的解析 --重症度に応じた遺伝子発現の変化には、ヒトゲノム配列の個人差が影響する--. 京都大学プレスリリース. 2022-08-23.Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection