The potential hazard of a non-slip element balloon causing distal longitudinal stent deformation: the first clinical experience and in vitro assessment

Background: A new complication, longitudinal stent deformation (LSD), is increasingly reported withrecent intracoronary stent designs. There have been experiences of unusual cases of distal LSD causedby entrapment of a Lacrosse® non-slip element (NSE) balloon (Goodman Co., Ltd., Nagoya, Japan),which has three flexible nylon elements to prevent slippage. Accordingly, the aim of this study is to reportthe clinical experience of distal LSD caused by the NSE in the documented center and to investigate theincidence and mechanisms involved.Methods: Coronary intervention cases were retrospectively reviewed using the NSE balloon in hospitalbetween May 2014 and June 2017. In bench testing, distal LSD was reproduced in a silicon tube modelto identify its mechanism.Results: A total of 95 patients with 107 lesions underwent coronary interventions with NSE. Of these,72 lesions (12 de-novo lesions and 60 in-stent restenosis) were treated using in-stent dilatation. Twodistal LSD cases occurred, representing an incidence of 2.78% (2/72) among all procedures; 16.7%(2/12) of the de-novo lesions developed LSD. In vitro experimentation allowed indentification of themechanisms involved and bailout strategies.Conclusions: This is the first study to evaluate NSE balloon catheter entrapment complicated by distalLSD in which reconstruction of the deformed stent and retrieval of the NSE could be achieved successfully.There is a potential hazard for distal LSD during post-dilatation using the NSE balloon due to itsstructural characteristics. Careful assessment is needed to prevent this complication

A treatment case of Sotos syndrome

Sotos syndrome is a genetic disorder characterized by overgrowth in childhood, specific facial manifestations, advanced bone age, and mental retardation. Although only one case report of Sotos syndrome treated with surgical orthodontics has thus far been published, there have also been a few detailed reports of long-term observation of Sotos syndrome through total orthodontic treatment. This article aimed to present the case of a growing patient with skeletal mandibular protrusion and unilateral posterior crossbite as present in Sotos syndrome treated with a non-surgical orthodontic technique. A 10-year-old boy was diagnosed with skeletal mandibular protrusion and posterior crossbite associated with Sotos syndrome. After maxillary lateral expansion, the skeletal Class III relationship with an anterior crossbite improved owing to mandibular clockwise rotation, while the facemask had a marginal effect. At the completion of growth at 16 years, he had a skeletal Class I relationship, and thus, conventional orthodontic treatment with preadjusted edgewise appliances was initiated. After 41 months of multibracket treatment, acceptable occlusion with a functional Class I relationship was obtained. At 12 months postretention, no or few changes in occlusion and facial features were observed. Our results demonstrate that considering the maxillofacial vertical growth during peripubertal period associated with Sotos syndrome, much attention should be paid to the early orthopedic treatment with the facemask and/or chin cap

Paclitaxel-Based Chemotherapy for Advanced Pancreatic Cancer after Gemcitabine-Based Therapy Failure: A Case Series of 5 Patients

Background/Objectives: Gemcitabine (GEM) is a gold-standard chemotherapy agent for advanced pancreatic cancer. Because of the malignant character of the disease, nearly all patients show disease progression despite treatment with GEM-based chemotherapy; therefore, second-line chemotherapy may be beneficial for these patients. We report a retrospective analysis of 5 patients with advanced pancreatic cancer, treated with a paclitaxel-containing regimen as second-, third- or fourth-line chemotherapy after various therapies, such as a GEM-based regimen, S-1 regimen, and chemoradiation. We retrospectively analyzed the efficacy and adverse events, and evaluated the paclitaxel-containing regimens. A review of the literature is also discussed. Results: The median overall survival from the start of salvage therapy was 10.7 months. The disease control rate of the paclitaxel-containing regimen according to RECIST criteria was 60%, including complete response in 0 patients, partial response in 3, and stable disease in 2. Two patients had malignant ascites at the start of this salvage therapy, and in both of them the ascites and clinical complaints improved. Grade 3 and 4 hematological adverse events were observed in 2 patients and 1 patient, respectively. Conclusion: Salvage paclitaxel-based therapy could be beneficial to advanced pancreatic cancer patients who maintain good performance status after several chemotherapy failures

Accretion of Terrestrial Planets from Oligarchs in a Turbulent Disk

We have investigated the final accretion stage of terrestrial planets from Mars-mass protoplanets that formed through oligarchic growth in a disk comparable to the minimum mass solar nebula (MMSN), through N-body simulation including random torques exerted by disk turbulence due to Magneto-Rotational-Instability. For the torques, we used the semi-analytical formula developed by Laughlin et al.(2004). The damping of orbital eccentricities (in all runs) and type-I migration (in some runs) due to the tidal interactions with disk gas are also included. We found that the orbital eccentricities pumped up by the turbulent torques and associated random walks in semimajor axes tend to delay isolation of planets, resulting in more coagulation of planets than in the case without turbulence. The eccentricities are still damped after planets become isolated. As a result, the number of final planets decreases with increase in strength of the turbulence, while Earth-mass planets with small eccentricities are still formed. In the case of relatively strong turbulence, the number of final planets are 4-5 at 0.5-2AU, which is consistent with Solar system, for relatively wide range of disk surface density (~10^{-4}-10^{-2} times MMSN).Comment: accepted for publication in Icarus; 19 pages, 8 figures, 1 tabl

Seismicity controlled by resistivity structure : the 2016 Kumamoto earthquakes, Kyushu Island, Japan

The M JMA 7.3 Kumamoto earthquake that occurred at 1:25 JST on April 16, 2016, not only triggered aftershocks in the vicinity of the epicenter, but also triggered earthquakes that were 50–100 km away from the epicenter of the main shock. The active seismicity can be divided into three regions: (1) the vicinity of the main faults, (2) the northern region of Aso volcano (50 km northeast of the mainshock epicenter), and (3) the regions around three volcanoes, Yufu, Tsurumi, and Garan (100 km northeast of the mainshock epicenter). Notably, the zones between these regions are distinctively seismically inactive. The electric resistivity structure estimated from one-dimensional analysis of the 247 broadband (0.005–3000 s) magnetotelluric and telluric observation sites clearly shows that the earthquakes occurred in resistive regions adjacent to conductive zones or resistive-conductive transition zones. In contrast, seismicity is quite low in electrically conductive zones, which are interpreted as regions of connected fluids. We suggest that the series of the earthquakes was induced by a local accumulated stress and/or fluid supply from conductive zones. Because the relationship between the earthquakes and the resistivity structure is consistent with previous studies, seismic hazard assessment generally can be improved by taking into account the resistivity structure. Following on from the 2016 Kumamoto earthquake series, we suggest that there are two zones that have a relatively high potential of earthquake generation along the western extension of the MTL

Transoral surgery for superficial head and neck cancer: National Multi‐Center Survey in Japan

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real-world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1–75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2–357). Adverse events occurred in 12.7%. Life-threatening complications occurred in 0.5%, but there were no treatment-related deaths. During a median follow-up period of 46.1 months (range 1–113), the 3-year overall survival rate, relapse-free survival rate, cause-specific survival rate, and larynx-preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment