Two Cases of Nivolumab Re-Administration after Pneumonitis as Immune-Related Adverse Events

Nivolumab is a recently approved medication for the treatment of unresectable malignant melanoma. Many immune-related adverse events (irAEs) associated with nivolumab have been reported, such as pneumonitis, hepatitis, dermatitis, and thyroiditis. Prednisolone can effectively treat irAEs. However, it is unclear how or if nivolumab should be administered to patients after they have experienced an irAE. Herein, we show 2 patients who underwent pneumonitis as irAE. Case 1 demonstrated a cryptogenic organizing pneumonia pattern in the CT scan and case 2 had a diffuse alveolar damage (DAD) pattern. Oral corticosteroids improved chest shadow of CT scan in both cases. However, when nivolumab was re-administrated, case 1 demonstrated no symptoms, but case 2 demonstrated pneumonia again. From our cases, it is difficult to re-administrate nivolumab for the patients with pneumonitis which shows a DAD pattern in CT, even if oral corticosteroids improve their symptoms

Nanoscale Texture and Microstructure in a NdFeAs(O,F)/IBAD-MgO Superconducting Thin Film with Superior Critical Current Properties

This paper reports the nanoscale texture and microstructure of a high-performance NdFeAs(O,F) superconducting thin film grown by molecular beam epitaxy on a textured MgO/Y2O3/Hastelloy substrate. The NdFeAs(O,F) film forms a highly textured columnar grain structure by epitaxial growth on the MgO template. Although the film contains stacking faults along the ab-plane as well as grain boundaries perpendicular to the ab-plane, good superconducting properties are measured: a critical temperature, T-c, of 46 K and a self-field critical current density, J(c), of 2 x 10(6) A/cm(2) at 4.2 K. Automated crystal orientation mapping by scanning precession electron diffraction in transmission electron microscope is employed to analyze the misorientation angles between adjacent grains in a large ensemble (247 grains), and 99% of the grain boundaries show in-plane misorientation angles (Delta gamma) less than the critical angle theta(c), which satisfies one of the necessary conditions for the high J(c). Comparing the columnar grain size distribution with the mean distance of the flux line lattice, the triple junctions of low-angle grain boundaries are found to be effective pinning centers, even at high temperatures (>= 35 K) and/or low magnetic fields

New method to create a vascular arteriovenous fistula in the arm with an endoscopic technique

AbstractWe describe a new technique in which the basilic vein is transposed subcutaneously with endoscopic surgery to create a vascular access in the arm. The vein was harvested with the Endoscopic Vascular Surgery System (Olympus Co, Tokyo, Japan). We could harvest a vessel about 25 cm long with endoscopy. After vessel transposition, an arteriovenous fistula was created in the usual manner. In all 10 patients, we created an effective blood access as scheduled before surgery. We could use the arteriovenous fistula 6 days after surgery and get blood flow in all cases. (J Vasc Surg 2002;36:635-8.

High Jc_{c} and low anisotropy of hydrogen doped NdFeAsO superconducting thin film

The recent realisations of hydrogen doped LnFeAsO (Ln = Nd and Sm) superconducting epitaxial thin films call for further investigation of their structural and electrical transport properties. Here, we report on the microstructure of a NdFeAs(O,H) epitaxial thin film and its temperature, field, and orientation dependencies of the resistivity and the critical current density J$_{c}$. The superconducting transition temperature T$_{c}$ is comparable to NdFeAs(O,F). Transmission electron microscopy investigation supported that hydrogen is homogenously substituted for oxygen. A high self-field J$_{c}$ of over 10 MA/cm$^{2}$ was recorded at 5 K, which is likely to be caused by a short London penetration depth. The anisotropic Ginzburg–Landau scaling for the angle dependence of J$_{c}$ yielded temperature-dependent scaling parameters γ$_{J}$ that decreased from 1.6 at 30 K to 1.3 at 5 K. This is opposite to the behaviour of NdFeAs(O,F). Additionally, γ$_{J}$ of NdFeAs(O,H) is smaller than that of NdFeAs(O,F). Our results indicate that heavily electron doping by means of hydrogen substitution for oxygen in LnFeAsO is highly beneficial for achieving high J$_{c}$ with low anisotropy without compromising T$_{c}$, which is favourable for high-field magnet applications

Subcutaneous Nodule on the Right Palm of a Young Boy : A Quiz

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Gastric T-cell lymphoma associated with hemophagocytic syndrome

BACKGROUND: Lymphoma-associated hemophagocytic syndrome (LAHS) occurs in mostly extra nodal non-Hodgkin's lymphoma. LAHS arising from gastrointestinal lymphoma has never been reported. Here we report a case of gastric T-cell lymphoma-associated hemophagocytic syndrome. CASE PRESENTATION: A 51-year-old woman presented with pain, redness of breasts, fever and hematemesis. Hematological examination revealed anemia. Gastroscopy revealed small bleeding ulcers in the stomach and the computed tomography scan showed liver tumor. She underwent total gastrectomy for gastrointestinal bleeding and the histopathology revealed gastric T-cell lymphoma. She continued to bleed from the anastomosis and died on the 8th postoperative day. Autopsy revealed it to be a LAHS. CONCLUSIONS: If Hemophagocytic syndrome (HPS) occurs in lymphoma of the gastrointestinal tract, bleeding from the primary lesion might be uncontrollable. Early diagnosis and appropriate treatment are needed for long-term survival