Difference in the expression of CIRBP, RBM3 and HSP70 in the myocardium and cerebellum after death by hypothermia and carbon monoxide poisoning

Abstract: We studied the expression of hypoxia-related antigens (e.g., cold-inducible antigens and apoptotic antigens) in the myocardium and the cerebellumthat were obtained from individuals after death by carbon monoxide or hypothermia. The immunohistochemistry results revealed that expression of cold-inducible RNA binding protein (CIRBP) and RNA-binding protein 3 (RBM3) may be associated with hpyothermic and the hypoxic conditions. The expression of CIRBP and RBM3 in the myocardium was different from their expression in the cerebellum, especially in the Purkinje cells. The results indicate that agonal duration influences antigen expression. In the hypothermic condition, the myocardium uses more ATP since the force of the excitation-contraction coupling of the myocardium increases by more than 400% when the experimental temperature is reduced from 35°C to 25°C. The results obtained in this study indicate that physicians should pay attention to the myocardium when cooling the patient's body to protect the brain

The importance of collecting live fly larvae from a severely decomposed human cadaver in winter. Case report

Abstract: A severely decomposed cadaver was found in a snow-covered mountain forest on January 31, 2010. The cadaver, later identified as a 24-year-old Japanese man, was hanging from under a tree and consisted mainly of skeletal remains. At autopsy, dozens of larvae were observed around the inner cavity of the knee joint, and entomologically they were identified as the third instar larvae of the family Piophilidae (Diptera). It is interesting that the larvae were found alive at the autopsy in January when snow is present. The entomological information supports the information that the man had died around September 8 with the following reason: the location where the victim was found was too cold for the flies to have deposited their eggs; at the man's death, the ambient temperature was enough high for flies to deposit their eggs; according to the gradual decrease of the ambient temperature, the larvae penetrated into deep lesion with feeding. This is a valuable case demonstrating that live larvae can be obtained from a severely decomposed cadaver found in winter and can support the information about the time of death. This report also validated the importance of collecting Piophilidae flies of severely decomposed cadavers in winter. Key Words: fly larvae, winter, severely decomposed cadaver, forensic entomology, postmortem interval, autopsy. E ntomological information can often be useful in determining both the manner of death (insect activity can sometimes be concentrated around wound sites) and the post mortem interval (PMI) when medical parameters are no longer of value 1) Department of Legal For cadavers with short PMI, detailed information about the species and instars of collected larvae may provide entomological evidence for PMI estimation. Even if the cadavers had been restored for the long time, flies are often observed and provide useful information We report a case in which a victim was found in a snow-covered forest. Although the cadaver consisted mostly of skeletal remains due to postmortem changes, live fly larvae could be collected. As this entomological evidence was well accordance with the information obtained from police investigation, we suggest the importance of collecting live insects even in the severely decomposed cadavers in winter

Successful retreatment with osimertinib after osimertinib-induced acute pulmonary embolism in a patient with lung adenocarcinoma: A case report

AbstractPulmonary embolism (PE) can be life-threatening, and it is challenging to diagnose because of its nonspecific signs and symptoms. PE is also an important potential risk of osimertinib treatment, however, clinical courses regarding retreatment after osimertinib-induced acute pulmonary embolism remain unclear. We described a 77-year-old woman with postoperative recurrent lung adenocarcinoma who developed osimertinib-induced acute PE. She received apixaban and was later successfully retreated with osimertinib. This case suggests that retreatment with osimertinib after osimertinib-induced acute PE may be a treatment option when alternative therapeutic options are limited

Successful osimertinib rechallenge after osimertinib-induced pneumonitis in a patient with lung adenocarcinoma

Pneumonitis is a serious adverse event of EGFR-TKI treatment. Although several cases of EGFR-TKI rechallenge after EGFR-TKI-induced pneumonitis have been reported, little is known about post-pneumonitis osimertinib rechallenge. We describe a 69-year-old never-smoking Japanese woman with postoperative recurrent lung adenocarcinoma retreated with osimertinib after osimertinib-induced pneumonitis. Although osimertinib rechallenge must be carefully chosen based on risk/benefit analysis, osimertinib rechallenge after osimertinib-induced pneumonitis may be an option, with limited alternative therapeutic options. Keywords: Osimertinib, Pneumonitis, Rechallenge, Corticosteroi

Transformation to small cell lung cancer after first-line afatinib treatment

Acquiring resistance to epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) is inevitable. Transformation to small cell lung cancer (SCLC) is reported as a possible mechanism of this acquired resistance. We describe the case of a 35-year-old man with lung adenocarcinoma harboring EGFR exon 19 deletion. After 7 months of successful treatment with afatinib, he experienced relapse and rebiopsy revealed SCLC with EGFR exon 19 deletion. Tumor marker tests at this point showed normal levels of serum neuron-specific enolase and pro-gastrin releasing peptide. Our case highlights the importance of rebiopsy for revealing SCLC transformation, a potential mechanism of acquired resistance to afatinib as with other EGFR-TKIs, and normal-range values of tumor markers for SCLC cannot exclude the possibility of SCLC transformation. Keywords: Transformation, Small cell lung cancer, Adenocarcinoma, Rebiopsy, Acquired resistance, Afatini

Usefulness of high suction pressure for sufficient tissue collection during endobronchial ultrasound guided transbronchial needle aspiration.

INTRODUCTION: The optimal suction pressure during endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) remains to be determined. The aim of this study was to compare suction pressures for performance in collecting sufficient tissue specimens from mediastinal and hilar lymph nodes during EBUS-TBNA. METHODS: Retrospective analysis of consecutive patients with mediastinal and hilar lymphadenopathy who underwent EBUS-TBNA over a 3-year period. Results from patients who underwent EBUS-TBNA using a dedicated 20-mL VacLoc (Merit Medical Systems, Inc, South Jordan, UT) syringe (conventional method, group C) were compared with results from patients in whom a disposable 30-mL syringe (high pressure group, group H) was used. The yield for sufficient histologic specimen retrieval and amount of tissue obtained were compared between the 2 groups. RESULTS: Of 178 patients who underwent EBUS-TBNA, 131 had lung cancer confirmed by EBUS-TBNA: 35 in group C and 96 in group H. There were 7 patients in group C and 6 in group H who received final diagnoses by cytology alone. There were 28 in group C and 90 in group H who were diagnosed by both cytology and histology. There was a statistically significant difference between the groups in terms of the rate of sufficient sampling for histological specimens (p = 0.04). The H group revealed a tissue area approximately twice that of the C group (p = 0.003). There were no major procedure-related complications in either group. CONCLUSION: Higher suction pressures with larger syringe volumes during EBUS-TBNA may be useful for safely collecting sufficient tissue specimens