Risk factors for unsuccessful removal of central venous access ports implanted in the forearm of adult oncologic patients

Purpose: To evaluate the risk factors for unsuccessful removal of a central venous access port (CV port) implanted in the forearm of adult oncologic patients. Materials and methods: This study included 97 adult oncologic patients (51 males, 46 females; age range, 30–88 years; mean age, 63.7 years) in whom removal of a CV port implanted in the forearm was attempted at our hospital between January 2015 and May 2021. Gender, age at removal, body mass index, and diagnosis were examined as patient characteristics; and indwelling period, indwelling side, and indication for removal were examined as factors associated with removal of a CV port. These variables were compared between successful and unsuccessful cases using univariate analysis. Then, multivariate analysis was performed to identify independent risk factors for unsuccessful removal of a CV port using variables with a significant difference in the univariate analysis. A receiver-operating characteristics (ROC) curve was drawn for significant risk factors in the multivariate analysis and the Youden index was used to determine the optimum cut-off value for predicting unsuccessful removal of a CV port. Results: Removal of CV ports was successful in 79 cases (81.4%), but unsuccessful in 18 cases (18.6%) due to fixation of the catheter to the vessel wall. Multivariate logistic regression analysis showed that the indwelling period (odds ratio 1.048; 95% confidence interval 1.026–1.070; P  60 months had unsuccessful removal. Conclusion: The indwelling period is an independent risk factor for unsuccessful removal of a CV port implanted in the forearm of adult oncologic patients, with a cut-off of 41 months

Transient and permanent gene transfer into the brain of the teleost fish medaka (Oryzias latipes) using human adenovirus and the Cre-loxP system

AbstractIn this study, we demonstrated that human type-5 adenovirus infected the brain of the teleost fish, medaka (Oryzias latipes), in vivo. Injection of adenoviral vector into the mesencephalic ventricle of medaka larvae induced the expression of reporter genes in some parts of the telencephalon, the periventricular area of the mesencephalon and diencephalon, and the cerebellum. Additionally, the Cre-loxP system works in medaka brains using transgenic medaka carrying a vector containing DsRed2, flanked by loxP sites under control of the β-actin promoter and downstream promoterless enhanced green fluorescent protein (EGFP). We demonstrated that the presence of green fluorescence depended on injection of adenoviral vector expressing the Cre gene and confirmed that EGFP mRNA was transcribed in the virus-injected larvae

Mechanism of Voriconazole-Induced Transient Visual Disturbance: Reversible Dysfunction of Retinal ON-Bipolar Cells in Monkeys

PURPOSE. To investigate the mechanism of voriconazole-induced transient visual disturbance in humans. METHODS. Standard full-field electroretinograms (ERGs) were recorded from monkeys treated intravenously with voriconazole. In addition, photopic ERGs elicited by long-duration stimuli (ON-OFF response) were also recorded from monkeys receiving intravenous voriconazole or intravitreal 2-amino-4-phosphonobutyric acid (APB). RESULTS. Characteristic changes were observed in the waveform of the standard full-field ERGs obtained immediately after dosing of voriconazole as follows: electronegative combined rod-cone response (markedly attenuated b-wave and oscillatory potentials), undetectable rod response (eliminated b-wave); slightly abnormal single-flash cone response (flattened appearance in the bottom of the a-wave, mildly attenuated b-wave); and slightly abnormal 30 Hz flicker (mildly attenuated b-wave). The above changes fully recovered to baseline 24 hours after each dosing, along with a decrease in plasma voriconazole concentration. In addition, the change in the waveform of the ON-OFF response recorded in voriconazole-treated monkeys was quite similar to that recorded in APB-treated monkeys as follows: the b-wave was eliminated or prominently attenuated; and the a-and d-waves were not apparently attenuated. V oriconazole is a triazole antifungal agent with potent activity against a broad spectrum of clinically significant pathogens. 1-3 Voriconazole has been generally well tolerated in clinical trials 4 and postmarketing surveillances 5-7 with frequently reported adverse events of transient visual disturbances, which are described as enhanced/altered light perception, photopsia, photophobia, blurred vision, or color vision changes without any abnormality in the fundus oculi. Very few studies have focused on the detailed effect of voriconazole on retinal function, although the retina is generally considered to be the site of the visual disturbances because reversible decreases in the amplitude of the electroretinogram (ERG) were noted in voriconazole-treated humans. METHODS Animals A total of ten cynomolgus monkeys (Macaca fascicularis) between three and eight years of age were used in this study. The animals were housed individually in stainless steel cages in an animal study room where the environmental condition was set as follows: room temperature, 24°C; relative humidity, 60%; illumination, 12-hour lighting (7:00 to 19:00) at 150 to 300 luces. The animals were fed 100 g per animal per day of pellet food for monkeys (PS; Oriental Yeast Co., Ltd., Tokyo, Japan). Tap water from a feed-water nozzle was supplied ad libitum to the animals. All experimental procedures adhered to the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research, and were approved by the Institutional Animal Care Committee of DaiichiSankyo Co. Ltd. Drug Administration Voriconazole (VFEND for Intravenous Use; Pfizer Inc., New York, NY) was dissolved in physiologic saline. The dose formulation was administered intravenously at a rate of 0.2 mL/kg per minute for ten minutes to six animals with increasing doses of 0, 3, 6 and 12 mg/kg at intervals of one week or more, and the standard full-field ERGs were recorded as described below. Several months after the 12 mg/kg dosing, voriconazole was administered to three animals at 0 mg/kg and to another three animals at 6 mg/kg in the same manner, and the photopic ERG elicited by a long-duration stimulus (the ON-OFF response) was recorded as described below. Intravitreal injection of 2-amino-4-phosphonobutyric acid (APB) (Sigma-Aldrich; St. Louis, MO) was also conducted in two animals several weeks after the last dosing of voriconazole mentioned above. The techniques for intravitreal injection have been described in detail elsewhere

Intracranial extension of meibomian gland carcinoma with pagetoid changes

金沢大学附属病院脳神経外科A 41-year-old man presented with exophthalmos and loss of visual acuity. Neuroradiological studies showed a large mass extending from the intraorbital region to the frontal lobe. In addition, it also involved the middle cranial and infratemporal fossae with accompanying skull destruction. The tumor was almost totally removed. The histological diagnosis was sebaceous carcinoma with pagetoid changes. Despite surgery and local irradiation, intracranial metastases were recognized one year later, and the patient underwent total tumor removal and whole-brain irradiation. Although multiple lung metastases were detected one year after the second operation, three years post-surgery he remains free of intracranial tumor recurrence. Sebaceous carcinoma of meibomian gland origin with pagetoid changes is a distinct, highly aggressive clinical entity. Early diagnosis and appropriate treatment are essential to improve the prognosis of patients with meibomian gland carcinoma with intracranial extension. © 2008 Elsevier Ltd. All rights reserved

PTBDにおけるVirtual Fluoroscopic Preprocedural Planningの有用性の検討

Purpose: To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage (PTBD) procedure. Materials and Methods: Twenty-two patients who were treated by PTBD were included in this study. Twelve patients were treated using PTBD intraoperative referencing coronal computed tomography (CT) images (i.e., coronal CT group), and 10 patients were treated using PTBD intraoperative referencing VFPP images (i.e., VFPP group). To analyze the effect of the intraoperative referencing VFPP image, the VFPP group was retrospectively compared with the coronal CT group. Results: The characteristics of both patient groups were not statistically significantly different. There were no significant differences in the targeted bile duct, diameter and depth of the target bile, breath-holding ability, number of targeted bile duct puncture attempts, change in the targeted bile duct, and exchange of the drainage catheter. However, the X-ray fluoroscopy time and the procedure time were significantly shorter in the VFPP group than in the coronal CT group (196 vs. 334 seconds, P < 0.05; and 16.0 vs. 27.2 minutes, P < 0.05). Conclusion: Intraoperative referencing using the VFPP imaging in PTBD intuitively can be a useful tool for better localization of the guidewire in the bile duct, and therebyshorten the X-ray fluoroscopy time and procedure 1 time while minimizing radiation exposure and complications

Antiphospholipid Antibodies in Patients with Myasthenia Gravis

We measured antiphospholipid antibodies in sera from 94 patients with myasthenia gravis (MG). We found lgG aCL in 14/94 (14.9 % )lgM aCL in 6/94 (6.4 %) and LA in 4/56 (7.1 %) patients with MG. As a whole 21 of 94 (22.3 % ) patients with MG had some aPL. There was no correlation between the presence of aPL and the severity of MGthe presence of hyperplasia of thymustiter of the antiacetylcholine receptor antibodies or anti-single stranded DNA antibodies. Though the percentage of malignant thymoma with aPL were higher than that of malignant thymoma without aPLwe thought that aPL were not the specific antibody in malignant thymoma. In MGaPL did not play as the aCL syndrome and seemed to be non-specific antibodies

Percutaneous drainage of psoas and iliopsoas muscle abscesses with a one-step technique under real-time computed tomography fluoroscopic guidance

PURPOSE : To evaluate the utility and safety of drainage catheter installation for psoas/iliopsoas muscle abscesses using a one-step technique under the guidance of real-time computed tomography (CT) fluoroscopy. MATERIALS and METHODS : Ten psoas or iliopsoas muscle abscesses in 7 patients that were treated with percutaneous drainage were included in this study. All drainage procedures were carried out using a one-step technique under real-time CT fluoroscopic guidance. RESULTS : The drainage catheter insertion was performed successfully with the one-step technique in all lesions. Improvements in the patients’ symptoms and blood test results were seen after the drainage procedure in all cases. In addition, postoperative CT scans demonstrated that the abscesses had reduced in size or disappeared in all but one patient, who was transferred to another institution while the drainage catheter was still in place. No major complications were seen in any case. CONCLUSION : The one-step procedure is simple to perform. The percutaneous drainage of psoas or iliopsoas muscle abscesses with the one-step technique under real-time CT fluoroscopic guidance is accurate and safe. Moreover, compared with the two-step technique the one-step procedure results in a shorter drainage procedure and exposes the patient and operator to lower amounts of radiation

Raft-based sphingomyelin interactions revealed by new fluorescent sphingomyelin analogs

Sphingomyelin (SM) has been proposed to form cholesterol-dependent raft domains and sphingolipid domains in the plasma membrane (PM). How SM contributes to the formation and function of these domains remains unknown, primarily because of the scarcity of suitable fluorescent SM analogs. We developed new fluorescent SM analogs by conjugating a hydrophilic fluorophore to the SM choline headgroup without eliminating its positive charge, via a hydrophilic nonaethylene glycol linker. The new analogs behaved similarly to the native SM in terms of their partitioning behaviors in artificial liquid order-disorder phase-separated membranes and detergent-resistant PM preparations. Single fluorescent molecule tracking in the live-cell PM revealed that they indirectly interact with each other in cholesterol- and sphingosine backbone–dependent manners, and that, for ∼10–50 ms, they undergo transient colocalization-codiffusion with a glycosylphosphatidylinositol (GPI)-anchored protein, CD59 (in monomers, transient-dimer rafts, and clusters), in CD59-oligomer size–, cholesterol-, and GPI anchoring–dependent manners. These results suggest that SM continually and rapidly exchanges between CD59-associated raft domains and the bulk PM