The added value of non-contrast 3-Tesla MRI for the pre-operative localization of hyperparathyroidism

OBJECTIVE: We investigated the efficacy of non-contrast 3-Tesla MR imaging added to the combination of sestamibi with99mTc (MIBI) scintigraphy and Ultrasonography (US) for the pre-operative localization of Primary Hyperparathyroidism (PHPT) lesions. METHODS: A total of 34 parathyroid glands, including nine normal glands, were examined with MIBI, US, and non-contrast 3-Tesla MRI. MRI was performed with the acquisition of T1- and T2-weighted images and fat-suppressed T2-weighted images. We calculated the sensitivities of MIBI, US, and the 'additional' MRI, with knowledge of the former two modalities' results. RESULTS: For the diagnosis of PHPT lesions, the sensitivity values of MIBI, US, and additional MRI were 88.0% (22/25), 84.0% (21/25), and 92.0% (23/25), respectively. Normal glands were not visualized with any modality (0/9). One lesion was detected neither with US nor MRI, but only with MIBI, with the limitation that MIBI represented no more than laterality. The two glands not identified in MRI were 4 mm and 6 mm in their size, which are within the range of normal gland's size. Two lesions were not detected with US or MIBI but were visualized with the additional MRI, which indicated that the MRI contributed an 8.0% (2/25) improvement of sensitivity, compared from that of US. Fat-suppressed T2-weighted images were useful in the identification of parathyroid lesions, as these images helped to differentiate between the lesion and the adjacent tissue. CONCLUSION: Additional non-contrast 3-Tesla MRI was a useful adjunctive tool for localization of PHPT, which improved the sensitivity of the pre-operative localization of PHPT lesions. Fat-suppressed T2-weighted images contributed to their identification. LEVEL VI: Evidence from a single descriptive or qualitative study

Field Effect of Alcohol, Cigarette Smoking, and Their Cessation on the Development of Multiple Dysplastic Lesions and Squamous Cell Carcinoma: A Long-term Multicenter Cohort Study

[Background and Aims] Multiple developments of squamous dysplasia and squamous cell carcinoma (SCC) in the upper aerodigestive tract have been explained by field cancerization phenomenon and were associated with alcohol and cigarette use. Second primary SCC development after curative treatment impairs patients’ quality of life and survival; however, how these consumption and cessation affect field cancerization is still unknown. [Methods] This is a multicenter cohort study including 331 patients with superficial esophageal SCC (ESCC) treated endoscopically and pooled data from 1022 healthy subjects for comparison. Physiological condition in the background esophageal mucosa was classified into 3 groups based on the number of Lugol-voiding lesions (LVLs) per endoscopic view: grade A, 0; grade B, 1–9; or grade C, ≥10 LVLs. Lifestyle surveys were conducted using a self-administered questionnaire. Patients were counseled on the need for alcohol and smoking cessation by physicians and were endoscopically surveyed every 6 months. [Results] LVL grades were positively associated with alcohol drinking intensity, flushing reactions, smoking, and high-temperature food and were negatively associated with eating green and yellow vegetables and fruit. Second primary ESCC and head/neck SCC were significantly more prevalent in the grade C LVL (cumulative 5-y incidences 47.1%, 95% confidence interval [CI] = 38.0–57.2 and 13.3%, 95% CI = 8.1–21.5, respectively). Alcohol and smoking cessation significantly reduced the development of second primary ESCC (adjusted hazard ratios 0.47, 95% = CI 0.26–0.85 and 0.49, 95% CI = 0.26–0.91, respectively). [Conclusion] Alcohol drinking, smoking, flushing reaction, and high-temperature food were closely associated with field cancerization, and cessation of alcohol and smoking significantly reduced the risk of development of second primary cancer. UMIN Clinical Trials Registry ID:UMIN000001676

日本人糖尿病母体から出生した児の糖代謝異常にHNF-1α遺伝子変異は関与しない

糖尿病母体から出生した児における糖代謝異常出現へのHNF(hepatocyte nuclear factor)-1α遺伝子,および環境因子の関与を検討した. 1989～1999年の追跡発育発達検診を受診し,遺伝子検索の同意が得られた134名(1型糖尿病母体出生児50名, 2型糖尿病母体出生児84名)を対象とした.対象を経口糖負荷試験で判定し,正常結果のみを正常群(N),糖尿病と診断した糖尿病群(D),その他を境界群(B)とした. HNF-1α遺伝子はPCR直接シークエンス法で変異を検索した.結果は, (1) 1型糖尿病母体出生児ではD1名(2%), B12名(24%), N37名(74%)であり, 2型糖尿病母体出生児ではD3名(3.8%), B31名(36.9%), N50名(59.5%)であり,糖尿病児の病型は全例が母の病型と一致していた. (2) 糖代謝異常は若年で出現していた. (3) 母体妊娠中平均血糖は, D>B>N群の順に高値であった. (4) 母の妊娠前のBMIと児の最大肥満度は正相関を示した. (5) 2型糖尿病母体出生児のうちの肥満児では,母が非肥満の群で糖代謝異常出現率が高値であった. (6) HNF-1α遺伝子変異は認めなかったが,既知の遺伝子多型が非糖尿病者における頻度に比し高率の傾向にあった.糖尿病母体出生児の糖代謝異常にHNF-1α遺伝子の関与は示されなかった.今後も対象を増やし,父方の関与についてもさらに検討する必要がある.A study on genetic and environmental factors has been carried out in the 134 offspring of diabetic mothers (50 from type 1 and 84 from type 2), who had been followed up for 1 to 10 years. Offspring were judged to be normal (N), diabetic (D), and borderline (B) by results of glucose torelance test. A search for mutations in the hepatocyte nuclear factor (HNF)-1α gene was conducted using the PCR direct sequencing method. (1) Diabetes and abnormal glucose tolerance was found 3.0% and 32.1% in offspring, respectively. (2) The mean age abnormal glucose tolerance discovered in the offspring was 11.4 to 14.4 years. (3) The rank of mean plasma glucose values during pregnancy in both mothers with type 1 and type 2 diabetes, in descending order, by offspring group was D>B >N. (4) There was a significant positive correlation between maternal body mass index in the pre-pregnant state and the maximum degree of obesity of the offspring. (5) Among the obese offspring, development of abnormal glucose tolerance was significantly more common in the offspring of non-obese mothers than in those of obese mothers. (6) No HNF-1α gene abnormalities were observed in any of the patients

miR-124 dosage regulates prefrontal cortex function by dopaminergic modulation

MicroRNA-124 (miR-124) is evolutionarily highly conserved among species and one of the most abundantly expressed miRNAs in the developing and mature central nervous system (CNS). Previous studies reported that miR-124 plays a role in CNS development, such as neuronal differentiation, maturation, and survival. However, the role of miR-124 in normal brain function has not yet been revealed. Here, we subjected miR-124-1⁺/⁻ mice, to a comprehensive behavioral battery. We found that miR-124-1⁺/⁻ mice showed impaired prepulse inhibition (PPI), methamphetamine-induced hyperactivity, and social deficits. Whole cell recordings using prefrontal cortex (PFC) slices showed enhanced synaptic transmission in layer 5 pyramidal cells in the miR-124-1⁺/⁻ PFC. Based on the results of behavioral and electrophysiological analysis, we focused on genes involved in the dopaminergic system and identified a significant increase of Drd2 expression level in the miR-124-1⁺/⁻ PFC. Overexpression or knockdown of Drd2 in the control or miR-124-1⁺/⁻ PFC demonstrates that aberrant Drd2 signaling leads to impaired PPI. Furthermore, we identified that expression of glucocorticoid receptor gene Nr3c1, which enhances Drd2 expression, increased in the miR-124-1⁺/⁻ PFC. Taken together, the current study suggests that miR-124 dosage modulates PFC function through repressing the Drd2 pathway, suggesting a critical role of miR-124 in normal PFC function

Utility of imaging modalities for predicting carcinogenesis in lobular endocervical glandular hyperplasia.

ObjectivesTo investigate the use of imaging methods for predicting carcinogenesis in lobular endocervical glandular hyperplasia (LEGH).MethodsWe retrospectively analyzed preoperative images on transvaginal sonography and magnetic resonance imaging (MRI) in 23 cases with histologically diagnosed LEGH.ResultsShape of cervical multicystic lesions on MR images could be divided into two types the flower-type with many small cysts surrounded by larger cysts, and the raspberry-type with many tiny, closely aggregated cysts. Six (46%) of 13 cases had raspberry-type lesions that were not detected on transvaginal sonography but were seen on MRI. Adenocarcinoma in situ (AIS) was identified in 4 postmenopausal women with raspberry-type lesions during the follow-up periods. In these cases, cytologic examination by targeted endocervical sampling using sonography enabled early detection of AIS.ConclusionsMRI and cytologic examination by targeted endocervical sampling may be very useful for predicting carcinogenesis in LEGH

Endovascular treatment for hemothorax via contralateral internal thoracic artery branch after Nuss procedure – A case report

The Nuss procedure is performed widely as a standard surgical treatment for pectus excavatum. Compared to conventional methods, the Nuss procedure excels in cosmetic terms and involves fewer complications. A 14-year-old boy developed right hemothorax with a sudden shock one month after the Nuss procedure. We identified the bleeding from left internal thoracic artery (ITA) branch and achieved hemostasis by endovascular coil embolization. To the best of our knowledge, this is the first to report that the ITA on the contralateral side of the hemothorax was responsible for the bleeding

Patients with MAC Lung Disease Have a Low Visceral Fat Area and Low Nutrient Intake

Objective. This study aimed to examine the nutritional status and nutrient intake of patients with MAC lung disease with a focus on visceral fat area. Patients and Methods. Among 116 patients of our hospital with nontuberculous mycobacteriosis who were registered between May 2010 and August 2011, 103 patients with MAC lung disease were included in this study. In all patients, nutritional status and nutrient intake were prospectively examined. Results. Patients were 23 men and 80 women (mean age, 72.3±10.9 years). BMI (kg/m2) at the time of registration was 20.4±2.7 in men and 19.2±2.9 in women. Visceral fat area (cm2) was significantly lower in women (35.7±26.6) than in men (57.5±47.4) (p=0.0111). The comparison with general healthy adults according to age revealed a markedly reduced visceral fat area among patients with MAC lung disease. With respect to nutrient intake, energy adequacy (86.1±15.7%), protein adequacy (82.4±18.2%), lipid adequacy (78.1±21.8%), and carbohydrate adequacy (89.6±19.2%) ratios were all low at the time of registration. BMI was significantly correlated with protein adequacy (p=0.0397) and lipid adequacy (p=0.0214) ratios, while no association was found between visceral fat area and nutrient intake. Conclusion. Patients with MAC lung disease had a low visceral fat area and low nutrient intake