Spontaneous esophageal perforation within a hiatal hernia : A case report

Introduction: Spontaneous esophageal perforation, also commonly referred to as Boerhaave's syndrome, is one of the most lethal diseases causing an acute abdomen. Though rare, emergent surgical intervention is often required and management can be various based upon the site of the perforation. This literature has been written in line with the SCARE criteria (Agha et al., 2020) [1]. Presentation of case: A 76-year-old man presented with acute abdominal pain. Computed tomography (CT) revealed and an emergent esophagogastroduodenoscopy (EGD) was performed carefully, which revealed a 7 cm all-layer esophageal laceration in the left lower esophageal wall. In our case, a hiatal hernia was protruding into the mediastinum, and the perforation site was inside of it, but there was no invasion into the thoracic cavity, thus a transabdominal approach was performed without thoracotomy. Discussion: This type of esophageal perforation within a hiatal hernia is quite rare and provides a unique clinical challenge. In addition, A review reported the average length of spontaneous esophageal perforation to be around 2 cm while our case had a perforation with a length of 7 cm. We chose the combination of the simple suture with omental buttress and wide drainage, but a complete fundoplication was impossible due to its large size of perforation. Conclusion: We chose the open abdominal approach because the case had high inflammation, a hiatal hernia and possibility of retro-gastric perforation. However, MIS should have been considered first if a situation or human resources allow it

Searching for the most distant blazars with the Fermi Gamma-ray Space Telescope

We investigate the prospects for discovering blazars at very high-redshifts (z>3-6) with the Fermi Gamma-Ray Space Telescope (Fermi), employing a model for the evolving gamma-ray luminosity function (GLF) of the blazar population. Our previous GLF model is used as a basis, which features luminosity-dependent density evolution implied from X-ray data on active galactic nuclei, as well as the blazar sequence paradigm for their spectral energy distribution, and which is consistent with EGRET and current Fermi observations of blazars.Here we augment the high-redshift evolution of this model by utilizing the luminosity function of quasars from the Sloan Digital Sky Survey (SDSS), which is well-constrained up to z~5. We find that Fermi may discover a few blazars up to z~6 in the entire sky during its 5-year survey. We further discuss how such high-redshift blazar candidates may be efficiently selected in future Fermi data.Comment: 6 pages, 2 figures, accepted for publication in MNRA

Amphiregulin and Epiregulin mRNA expression in primary colorectal cancer and corresponding liver metastases

<p>Abstract</p> <p>Background</p> <p>Amphiregulin (AREG) and Epiregulin (EREG), ligands of EGFR, are reported to be predictive biomarkers of colorectal cancer patients treated with Cetuximab, an anti-EGFR antibody. The purpose of this study is to determine the correlation of AREG and EREG expression between primary colorectal cancer and corresponding liver metastases.</p> <p>Methods</p> <p>One hundred twenty colorectal cancer patients with liver metastases (100 with synchronous metastases, 20 with metachronous) were evaluated. No patients had ever received anti-EGFR antibody agents. AREG and EREG mRNA expression from both the primary tumor and liver metastases were measured using real-time RT-PCR. KRAS codon 12, 13 mutation status was analyzed by direct sequencing.</p> <p>Results</p> <p>Modest, but significant, correlations were observed between primary tumor and corresponding liver metastases in both AREG mRNA expression (Rs = 0.54, p < 0.0001) and EREG mRNA expression (Rs = 0.58, p < 0.0001). AREG and EREG mRNA expression was strongly correlated in both the primary tumor (Rs = 0.81, p < 0.0001) and the liver metastases (Rs = 0.87, p < 0.0001). No significant survival difference was observed between low and high AREG or EREG patients when all 120 patients were analyzed. However, when divided by KRAS status, KRAS wild-type patients with low EREG mRNA levels in the primary site showed significantly better overall survival rates than those with high levels (p = 0.018). In multivariate analysis, low EREG expression was significantly associated with better overall survival (p = 0.006).</p> <p>Conclusions</p> <p>AREG and EREG expression showed a modest correlation between primary tumor and liver metastases. As EREG mRNA expression was associated with decreased survival, it is appeared to be a useful prognostic marker in KRAS wild-type patients who never received anti-EGFR therapy.</p

Cast: a novel protein of the cytomatrix at the active zone of synapses that forms a ternary complex with RIM1 and munc13-1

The cytomatrix at the active zone (CAZ) has been implicated in defining the site of Ca2+-dependent exocytosis of neurotransmitter. We have identified here a novel CAZ protein of ∼120 kD from rat brain and named it CAST (CAZ-associated structural protein). CAST had no transmembrane segment, but had four coiled-coil domains and a putative COOH-terminal consensus motif for binding to PDZ domains. CAST was localized at the CAZ of conventional synapses of mouse brain. CAST bound directly RIM1 and indirectly Munc13-1, presumably through RIM1, forming a ternary complex. RIM1 and Munc13-1 are CAZ proteins implicated in Ca2+-dependent exocytosis of neurotansmitters. Bassoon, another CAZ protein, was also associated with this ternary complex. These results suggest that a network of protein–protein interactions among the CAZ proteins exists at the CAZ. At the early stages of synapse formation, CAST was expressed and partly colocalized with bassoon in the axon shaft and the growth cone. The vesicles immunoisolated by antibassoon antibody–coupled beads contained not only bassoon but also CAST and RIM1. These results suggest that these CAZ proteins are at least partly transported on the same vesicles during synapse formation

Revisiting the Cosmic Star Formation History: Caution on the Uncertainties in Dust Correction and Star Formation Rate Conversion

The cosmic star formation rate density (CSFRD) has been observationally investigated out to redshift z~10. However, most of theoretical models for galaxy formation underpredict the CSFRD at z>1. Since the theoretical models reproduce the observed luminosity functions (LFs), luminosity densities (LDs), and stellar mass density at each redshift, this inconsistency does not simply imply that theoretical models should incorporate some missing unknown physical processes in galaxy formation. Here, we examine the cause of this inconsistency in UV wavelengths by using a mock catalog of galaxies generated by a semi-analytic model of galaxy formation. We find that this inconsistency is due to two observational uncertainties: dust obscuration correction and conversion from UV luminosity to star formation rate (SFR). The methods for correction of obscuration and SFR conversion used in observational studies result in the overestimation of CSFRD by ~ 0.1-0.3 dex and ~ 0.1-0.2 dex, respectively, compared to the results obtained directly from our mock catalog. We present new empirical calibrations for dust attenuation and conversion from observed UV LFs and LDs into CSFRD.Comment: 12 pages including 11 figures. matches the published version (ApJ 2013 Jan. 20 issue

Schwannoma resembling metastatic lymph node

In this report, we describe a rare case of vagus nerve schwannoma associated with esophageal cancer. A 70-year-old man visited our hospital complaining of worsening dysphagia. His upper gastrointenstinal endoscopy revealed a mass in the esophagus. A contrast-enhanced chest computed tomography also detected a 15 mm nodule attached to the tracheal membrane. This nodule was diagnosed as a metastatic lymph node. Although the primary tumor reduced after neoadjuvant chemotherapy, the nodule remained intact ; it showed fluorodeoxyglucose accumulation on positron emission tomography. We had a clinical diagnosis of stage III after neoadjuvant chemotherapy and underwent surgery. Intraoperatively, the nodule could not be detached from the right vagus nerve ; therefore, we excised the nodule along with the adjacent vagus nerve. The nodule was pathologically diagnosed as a vagus schwannoma. The nodule was not a regional lymph node metastasis of esophageal cancer. His postoperative course was uneventful, and he is currently undergoing outpatient follow-up without recurrence