Intestinal adhesion due to previous uterine surgery as a risk factor for delayed diagnosis of uterine rupture: a case report

<p>Abstract</p> <p>Introduction</p> <p>Uterine rupture is a life-threatening condition both to mothers and fetuses. Its early diagnosis and treatment may save their lives. Previous myomectomy is a high risk factor for uterine rupture. Intestinal adhesion due to previous myomectomy may also prevent early diagnosis of uterine rupture.</p> <p>Case presentation</p> <p>A 38-year-old primiparous non-laboring Japanese woman with a history of myomectomy was admitted in her 34^thweek due to lower abdominal pain. Although the pain was slight and her vital signs were stable, computed tomography revealed massive fluid collection in her abdominal cavity, which led us to perform a laparotomy. Uterine rupture had occurred at the site of the previous myomectomy; however, the small intestine was adhered tightly to the rupture, thus masking it. The baby was delivered through a low uterine segment transverse incision. The ruptured uterine wall was reconstructed.</p> <p>Conclusion</p> <p>Intestinal adhesion due to a prior myomectomy occluded a uterine rupture, possibly masking its symptoms and signs, which may have prevented early diagnosis.</p

Management of Multiple Primary Lung Cancer in Patients with Centrally Located Early Cancer Lesions

BackgroundPatients with centrally located early lung cancer (CLELC) are often heavy smokers with a considerably high risk of multiple primary lung cancer (MPLC) lesions; treatment strategies for such patients must preserve the cardiopulmonary function.MethodsBetween July 2004 and July 2008, patients with CLELC underwent photodynamic therapy (PDT) using NPe6, second-generation photosensitizer at Tokyo Medical University Hospital. Among these patients, we retrospectively analyzed MPLC, which was treated by surgery plus PDT or PDT alone and examined the effectiveness of PDT, and we propose a treatment strategy for patients with MPLC.ResultsA total of 64 patients with CLECL received NPe6-PDT, and MPLCs were found in 22 patients (34.4%) using sputum cytology and a bronchoscopical examination using autofluorescence bronchoscopy. Among these 22 patients, 10 patients underwent surgery for primary lung cancer and underwent NPe6-PDT for the treatment of secondary primary CLELC, one patient underwent PDT for CLELC as a primary lesion followed by an operation for peripheral-type lung cancer as a secondary primary lesion, and 11 patients underwent PDT alone for MPLC lesions (28 lesions) that were roentgenographically occult lung cancers. Among these 22 patients with MPLC including peripheral-type lung cancers, which were resected by surgery, all 39 CLELC lesions exhibited a complete response after PDT, and all patients were alive.ConclusionsFor patients with lung cancer with a long-term history of smoking, careful follow-up examinations after surgical resection are needed considering the incidence of metachronous primary lung cancers. PDT can play an important role for the treatment strategy for MPLC

表層海水中溶存酸素の高精度連続観測

大気・海洋間の二酸化炭素や酸素の交換量と，その時空間変動要因や，大気中の温室効果ガスの動態を解明するための一環として，表層海水中溶存酸素の高精度連続観測に取り組んでいる．海洋地球研究船「みらい」では，表層海水連続測定装置により，水温・塩分の測定に加え，世界中で広く利用されているAADI社製OPTODEによる溶存酸素，および，蛍光光度計によるクロロフィルaの測定が行われてきた．OPTODEは時間安定性が優れており，連続観測に適していると考えられているが，応答時間が遅い（カタログによれば67%応答時間は20℃で23秒）という問題があった．そこで，船舶CTDO観測で培った高精度溶存酸素測定技術に基づき，2012年度から表層海水連続測定装置に応答時間が早いJFE Advantech社製RINKOを追加した．溶存酸素検出膜の適切なエイジングと標準ガスを用いたセンサー出力値の線形化，および，時間ドリフト補正用の溶存酸素の分析値を取得することで，溶存酸素の高精度連続観測を実現し，北極海，ベーリング海，西部太平洋，南大洋の広範囲でデータを蓄積した．従来のOPTODEと新たに導入したRINKOの比較から，RINKOに比べてOPTODEは約8分遅れて応答していることや，北極海などでの塩分の短時間での大きな変化に対応してOPTODEが不自然に大きく応答することが明らかになった．さらに，RINKOの技術を応用し，センサーを用いた酸素法による基礎生産量の測定を試みている．これらのデータを総合的に解析し，表層海水中の溶存酸素の時空間変動特性を把握し，変動要因の解明を目指す．BE13-19講演要旨 / ブルーアース2013（2013年3月14日～15日, 東京海洋大学品川キャンパス）http://www.godac.jamstec.go.jp/darwin/cruise/mirai/mr12-e03/

Spatial distribution of pCO2 and pCH4 in the surface sea water and overlying air in the Arctic Ocean

第3回極域科学シンポジウム/特別セッション「これからの北極研究」11月28日（水） 国立極地研究所 2階大会議

Acute Insulin Stimulation Induces Phosphorylation of the Na-Cl Cotransporter in Cultured Distal mpkDCT Cells and Mouse Kidney

The NaCl cotransporter (NCC) is essential for sodium reabsorption at the distal convoluted tubules (DCT), and its phosphorylation increases its transport activity and apical membrane localization. Although insulin has been reported to increase sodium reabsorption in the kidney, the linkage between insulin and NCC phosphorylation has not yet been investigated. This study examined whether insulin regulates NCC phosphorylation. In cultured mpkDCT cells, insulin increased phosphorylation of STE20/SPS1-related proline-alanine-rich kinase (SPAK) and NCC in a dose-dependent manner. This insulin-induced phosphorylation of NCC was suppressed in WNK4 and SPAK knockdown cells. In addition, Ly294002, a PI3K inhibitor, decreased the insulin effect on SPAK and NCC phosphorylation, indicating that insulin induces phosphorylation of SPAK and NCC through PI3K and WNK4 in mpkDCT cells. Moreover, acute insulin administration to mice increased phosphorylation of oxidative stress-responsive kinase-1 (OSR1), SPAK and NCC in the kidney. Time-course experiments in mpkDCT cells and mice suggested that SPAK is upstream of NCC in this insulin-induced NCC phosphorylation mechanism, which was confirmed by the lack of insulin-induced NCC phosphorylation in SPAK knockout mice. Moreover, insulin administration to WNK4 hypomorphic mice did not increase phosphorylation of OSR1, SPAK and NCC in the kidney, suggesting that WNK4 is also involved in the insulin-induced OSR1, SPAK and NCC phosphorylation mechanism in vivo. The present results demonstrated that insulin is a potent regulator of NCC phosphorylation in the kidney, and that WNK4 and SPAK are involved in this mechanism of NCC phosphorylation by insulin

The clinical benefits of immune checkpoint inhibitor for thymic carcinomas ∼experience of single public hospital in Japan∼

Thymic carcinomas is rare and highly aggressive carcinoma. Most patients with them are diagnosed as being at surgically unresectable stages due to it. There are several reports which showed the effect of chemotherapy, however, it is controversial. Recently, immune checkpoint inhibitors have changed conventional chemotherapy due to their effect against various types of cancers. We administered nivolumab, anti-Programmed Cell Death (PD)-1 antibody, to four patients with unresectable thymic carcinomas who had previously undergone conventional chemotherapy. A histopathology on tumors from these patients revealed the presence of squamous cell carcinoma and PD-L1 high expression. After treatment with nivolumab, it seemed to be beneficial to all patients; The best clinical responses of 3 patients were partial response and that of the other one was stable disease. None of them experienced severe immune-related adverse events. Our results suggest the potential benefits of using these inhibitors to treat thymic carcinomas in real world clinical setting as is the cases in recent clinical trials for the evaluation of immune checkpoint inhibitors for the treatment of thymic carcinoma