99m-Technetium galactosyl human serum albumin scanning to evaluate liver function after stereotactic body radiotherapy for hepatocellular carcinoma: A case report

The primary choice among treatment options for liver malignancies is surgery. However, if surgery cannot be performed, Stereotactic body radiotherapy (SBRT) may be effective. 99m-technetium galactosyl human serum albumin (GSA) single-photon emission computed tomography (SPECT) imaging is useful for the assessment of liver function before surgery. We report the case of a 77-year-old man who had undergone SBRT for hepatocellular carcinoma of the left lobe of the liver 2 years previously. Follow-up revealed a 15-mm hepatocellular carcinoma at the edge of the right lobe of the liver. 99m-technetium GSA SPECT was performed before SBRT to confirm that there was no accumulation in the left lobe and to ensure that there was good function of the right lobe. Three months after SBRT, the tumor had responded, and decreases in GSA accumulation were observed in line with the radiation beam. Because hepatocellular carcinoma often relapses, it is important to assess the anatomic site of liver dysfunction before and after radiation. This case demonstrates that 99m-technetium GSA SPECT is useful for this purpose

HumanMimic: Learning Natural Locomotion and Transitions for Humanoid Robot via Wasserstein Adversarial Imitation

Transferring human motion skills to humanoid robots remains a significant challenge. In this study, we introduce a Wasserstein adversarial imitation learning system, allowing humanoid robots to replicate natural whole-body locomotion patterns and execute seamless transitions by mimicking human motions. First, we present a unified primitive-skeleton motion retargeting to mitigate morphological differences between arbitrary human demonstrators and humanoid robots. An adversarial critic component is integrated with Reinforcement Learning (RL) to guide the control policy to produce behaviors aligned with the data distribution of mixed reference motions. Additionally, we employ a specific Integral Probabilistic Metric (IPM), namely the Wasserstein-1 distance with a novel soft boundary constraint to stabilize the training process and prevent model collapse. Our system is evaluated on a full-sized humanoid JAXON in the simulator. The resulting control policy demonstrates a wide range of locomotion patterns, including standing, push-recovery, squat walking, human-like straight-leg walking, and dynamic running. Notably, even in the absence of transition motions in the demonstration dataset, robots showcase an emerging ability to transit naturally between distinct locomotion patterns as desired speed changes

Gastric Carcinoid with Hypergastrinemia: Report of Three Cases

We report 3 cases of gastric carcinoids with hypergastrinemia. Case 1: A 60-year-old man had a 2 cm carcinoid of the stomach and underwent partial resection. Involvement of the muscularis propria and lymph nodes metastasis were observed microscopically. Follow-up gastroscopy revealed another carcinoid lesion and total gastrectomy was performed. Case 2: A 67-year-old woman with multiple carcinoids of the entire stomach underwent antrectomy. No growth of residual tumors has been detected so far. Case 3: A 61-year-old man had a tumor near the esophagogastric junction and underwent total gastrectomy. Carcinoid component was diffusely intermingled with adenocarcinoma in the tumor and invaded into the subserosa. In all 3 cases, the serum gastrin level was high and atrophic gastritis was microscopically observed. Carcinoid tumor in Case 3 was different from those in Cases 1 and 2 and interestingly, gastric carcinoid with hypergastrinemia showed various types of appearance

Ectopic varices in a right diaphragm that ruptured into the pleural cavity.

The term ectopic varices is used to describe dilated portosystemic collateral veins in unusual locations other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the right diaphragm and ruptured into the pleural cavity. A 68-year-old female with hepatocellular carcinoma complicated with liver cirrhosis was admitted due to an acute onset of dyspnea and right bloody pleural effusion. Because of the patient's advanced hepatocellular carcinoma and poor condition, conservative therapies such as hemostats and blood transfusion were selected. Even though the bleeding to the pleural cavity stopped spontaneously, the patient died due to a progression of liver failure. Autopsy revealed a huge collateral vein in the right diaphragm. The etiology, prevalence, relationship with portal hypertension, and treatment of ectopic varices are discussed herein

Scores of Child–Pugh Classification Impact Overall Survival After Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors

BackgroundStereotactic body radiotherapy (SBRT) delivers high-dose radiation to tumor tissues in few fractions, thereby reducing radiation damage to at-risk organs. There are more potential effects of SBRT owing to the higher biological equivalent dose delivered. Herein, we retrospectively analyzed its effectiveness and toxicity at our institution.MethodsData from patients with hepatocellular carcinoma (HCC; n = 10) and liver metastases (n = 10) who underwent SBRT (total dose of 30–50 Gy in 5–10 fractions) between 2013 and 2016 were analyzed. Adverse events were recorded at the end of RT, 6 months after treatment, or upon death. Overall survival (OS) was calculated according to the biological effective dose (BED α/β = 10) and liver function (Child–Pugh [CP] classification 5 or 6 vs. 7 or 8) after SBRT, using Kaplan–Meier analyses.ResultsOf the 20 patients, 6 declined the CP classification score after SBRT; grade 3 adverse events were not seen in any patient. A higher OS rate was seen in patients receiving a higher BED and in those with better CP classification after SBRT. Kaplan–Meier survival analysis yielded a median OS of 401 days and 1- and 2-year OS of 45% and 15%, respectively.ConclusionThe higher BED was significantly associated with tumor control, and there were no differences in the tumor control rate between HCC and metastatic tumors. Changes in CP scores after SBRT also affected the survival rate. Good liver function may permit multiple rounds of SBRT

Expression of Cyclooxygenase Enhances Tumor Invasion and Metastasis in Human Gastric Carcinoma

Background: Expression of COX-2 in vitro has been shown to have a number of cellular effects including increasing proliferation, reducing apoptosis promoting angiogenesis, decreasing E-cadherin expression and increasing invasive/metastatic potential. Aims: To determine the role of COX-2 in the development and metastasis potential of gastric carcinoma in human subjects. Methods: Tissue samples were obtained from surgically removed specimens of 48 patients with primary gastric adenocarcinoma who underwent gastrectomy from January 1998 to December 1999. The specimens were stained for HE while COX-2 expressions in cancer fold and antrum site were evaluated immunohistochemically. Expression of COX-2 was defined as positive when either one of cancer lesion or antrum site showed immunoreactivity. Results: Preliminary result from 12 out of 48 cases, COX-2 immunoreactivity was detected in 50% (6 of 12 specimens). Expression of COX-2 were more frequent in tumor with serosal invasion (5 of 6 specimens), lymph node metastases (3 of 3 specimens), tumor size more than 4 cm and were significant, statistically (p<0.05). The expression of COX-2 in well differential carcinoma type was similar with in poorly differentiated carcinoma type. Conclusion: COX-2 expression in gastric carcinoma tissue is correlated closely with tumor size, serosal invasion and lymph node metastases, indicating that COX-2 is involved in the growth and metastases of gastric carcinoma

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for the Diagnosis of Intrathoracic Lesions : Experience of a Single Academic Medical Center

Article信州医学雑誌 60(5): 249-255(2012)journal articl