Hepatic Arterial Infusion Chemotherapy Prior to Standard Systemic Chemotherapy in Patients with Highly Advanced Unresectable Liver Metastases from Colorectal Cancer: A Report of Three Patients

We administered hepatic arterial infusion chemotherapy (HAIC) prior to FOLFOX to three patients with unresectable liver metastases from colorectal cancer. The patients' disease state was found to be highly advanced based on both computed tomography findings and liver function tests. The treatment strategy included an initial administration of HAIC to control liver metastases and improve liver function in order to facilitate the subsequent safe administration of FOLFOX without drug loss. As the HAIC regimen, 1,000mg/m2 of 5-FU was administered weekly by continuous 5-h infusion after performing laboratory investigations through an implanted port-catheter system. After 3 HAIC cycles administered over 3 consecutive weeks, the mean alkaline phosphatase levels decreased from 969.3IU/l to 422IU/l due to shrinkage of the liver metastases. Thereafter, FOLFOX without drug loss could be safely initiated for all patients. Two patients succumbed 488 and 333 days after HAIC was initiated;the third patient is still alive and has been followed-up for 1215 days. The combined use of HAIC and standard systemic chemotherapy could be a feasible and efficacious treatment in highly advanced cases of liver dysfunction

Preoperative Graft Volume Assessment with 3D-CT Volumetry in Living-Donor Lobar Lung Transplantations

To determine the effectiveness of living-donor lobar lung transplantation (LDLLT), it is necessary to predict the recipient's postoperative lung function. Traditionally, Date's formula, also called the segmental ratio, has used the number of lung segments to estimate the forced vital capacity (FVC) of grafts in LDLLT. To provide a more precise estimate of graft FVC, we calculated the volumes of the lower lobe and total lung using three-dimensional computed tomography (3D-CT) and the volume ratio between them. We calculated the volume ratio in 52 donors and tested the difference between the segmental volume ratios with a one-tailed t-test. We also calculated the predicted graft FVC in 21 LDLLTs using the segmental ratio pFVC(c) and the volume ratio pFVC(v), and then found the Pearson's correlation coefficients for both pFVC(c) and pFVC(v) with the recipients' actual FVC (rFVC) measured spirometrically 6 months after surgery. Significant differences were found between the segmental ratio and the average volume ratio for both sides (right, p＝0.03;left, p＝0.0003). Both pFVC(c) and pFVC(v) correlated significantly with rFVC at 6 months after surgery (p＝0.007 and 0.006). Both the conventional and the volumetric methods provided FVC predictions that correlated significantly with measured postoperative FVC

Influence of Visual Stimulation-Induced Passive Reproduction of Motor Images in the Brain on Motor Paralysis After Stroke

Finger flexor spasticity, which is commonly observed among patients with stroke, disrupts finger extension movement, consequently influencing not only upper limb function in daily life but also the outcomes of upper limb therapeutic exercise. Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as a potential treatment for spasticity in patients with stroke. However, it remains unclear whether KINVIS intervention alone could improve finger flexor spasticity and finger extension movements without other intervention modalities. Therefore, the current study investigated the effects of a single KINVIS session on finger flexor spasticity, including its underlying neurophysiological mechanisms, and finger extension movements. To this end, 14 patients who experienced their first episode of stroke participated in this study. A computer screen placed over the patient’s forearm displayed a pre-recorded mirror image video of the patient’s non-paretic hand performing flexion–extension movements during KINVIS. The position and size of the artificial hand were adjusted appropriately to create a perception that the artificial hand was the patient’s own. Before and after the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range of finger extension movements of the paretic hand were determined. Accordingly, MAS scores and active metacarpophalangeal joint extension range of motion improved significantly after the intervention. Moreover, additional experimentation was performed using F-waves on eight patients whose spasticity was reduced by KINVIS to determine whether the same intervention also decreased spinal excitability. Our results showed no change in F-wave amplitude and persistence after the intervention. These results demonstrate the potential clinical significance of KINVIS as a novel intervention for improving finger flexor spasticity and extension movements, one of the most significant impairments among patients with stroke. The decrease in finger flexor spasticity following KINVIS may be attributed to neurophysiological changes not detectable by the F-wave, such as changes in presynaptic inhibition of Ia afferents. Further studies are certainly needed to determine the long-term effects of KINVIS on finger spasticity, as well as the neurophysiological mechanisms explaining the reduction in spasticity

Association between Histological Types and Enhancement of Dynamic CT for Primary Lung Cancer

The aim of this study was to explore enhancement patterns of different types of primary lung cancers on 2-phase dynamic computed tomography (CT). This study included 217 primary lung cancer patients (141 adenocarcinomas [ADs], 48 squamous cell carcinomas [SCCs], 20 small cell lung carcinomas [SCLCs], and 8 others) who were examined using a 2-phase dynamic scan. Regions of interest were identified and mean enhancement values were calculated. After excluding the 20 SCLCs because these lesions had different clinical stages from the other cancer types, the mean attenuation values and subtractions between phases were compared between types of non-small cell lung carcinomas (NSCLCs) using the Kruskal–Wallis test. Late phase attenuation and attenuation of the late minus unenhanced phase (LMU) of SCCs were significantly higher than those of ADs (p<0.05). To differentiate SCC and AD in the late phase, a threshold of 80.21 Hounsfield units (HU) gave 52.9% accuracy. In LMU, a threshold of 52.16 HU gave 59.3% accuracy. Dynamic lung CT has the potential to aid in differentiating among NSCLC types

The Diagnostic Capacity of Pre-treatment 18F-FDG PET/CT for Predicting the Extranodular Spread of Lymph Node Metastases in Patients with Oral Squamous Cell Carcinoma

The aim of this study was to evaluate the ability of pretreatment 90-min 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict the extranodular spread of lymph node metastases in oral squamous cell carcinoma. We retrospectively reviewed the cases of 56 patients who underwent pretreatment 18F-FDG PET/CT and surgery with neck dissection. Maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis were measured for the 56 primary sites and maximum standardized uptake value was measured for 115 lymph node levels. Extranodular spread was present at 9 lymph node levels in 7 patients. Significant differences were found in metabolic tumor volume and total lesion glycolysis of the primary site, and in lymph node maximum standardized uptake value, between patients with and without extranodular spread (p<0.05). Combining primary site total lesion glycolysis and lymph node maximum standardized uptake volume at their respective optimal cutoffs, the sensitivity, specificity, and accuracy for predicting extranodular spread were 89%, 92%, and 92%, respectively. Pretreatment 18F-FDG PET/CT is useful for predicting extranodular spread in patients with oral squamous cell carcinoma. The combined use of primary site total lesion glycolysis and lymph node maximum standardized uptake value showed greater predictive value than either predictor singly

ACC patterns on multiphasic dynamic CT

Tracheobronchial adenoid cystic carcinoma is a rare malignancy. To the best of our knowledge, its enhancement pattern on multiphasic contrast-enhanced multidetector computed tomography has not been reported. Herein, we report the computed tomography findings of three consecutive cases of tracheobronchial adenoid cystic carcinoma. All lesions presented a gradual enhancement pattern on multiphasic contrast-enhanced computed tomography. We speculate that the gradual enhancement pattern on multiphasic contrast-enhanced computed tomography could potentially serve as a characteristic imaging feature and may therefore be a clue to diagnose tracheobronchial adenoid cystic carcinoma

The Maximum Standardized Uptake Value Is More Reliable Than Size Measurement in Early Follow-up to Evaluate Potential Pulmonary Malignancies Following Radiofrequency Ablation

We retrospectively evaluated the accumulation of fluorodeoxy glucose (FDG) in pulmonary malignancies without local recurrence during 2-year follow-up on positron emission tomography (PET)/computed tomography (CT) after radiofrequency ablation (RFA). Thirty tumors in 25 patients were studied (10 non-small cell lung cancers;20 pulmonary metastatic tumors). PET/CT was performed before RFA, 3 months after RFA, and 6 months after RFA. We assessed the FDG accumulation with the maximum standardized uptake value (SUVmax) compared with the diameters of the lesions. The SUVmax had a decreasing tendency in the first 6 months and, at 6 months post-ablation, FDG accumulation was less affected by inflammatory changes than at 3 months post-RFA. The diameter of the ablated lesion exceeded that of the initial tumor at 3 months post-RFA and shrank to pre-ablation dimensions by 6 months post-RFA. SUVmax was more reliable than the size measurements by CT in the first 6 months after RFA, and PET/CT at 6 months post-RFA may be more appropriate for the assessment of FDG accumulation than that at 3 months post-RFA

Diagnostic Value of Dual-time-point F-18 FDG PET/CT and Chest CT for the Prediction of Thymic Epithelial Neoplasms

We retrospectively assessed the dual-time-point (DTP) F-18 FDG PET/CT findings of thymic epithelial neoplasms (TENs) and investigated the diagnostic capacity of PET/CT compared to that of CT for predicting carcinoma. We calculated the ratio of the standardized uptake value of the tumor and that of the aortic arch (T/M ratio) for both the 90-min early scan and the 2-h delayed scan in 56 TEN patients. We used a multivariate logistic regression (MLR) analysis to estimate the CT features of carcinoma. We compared the diagnostic capacities of PET/CT and chest CT using receiver operating characteristic (ROC) analyses. The ROC curve revealed that the appropriate cut-off T/M ratio value for the highest accuracy was 2.39 with 75.0% accuracy. The area under the curve (AUC) was 0.855. The statistical analyses for DTP scans of 35 TEN patients demonstrated 74.3% accuracy and 0.838 AUC for the early scan versus 82.9% and 0.825 for the delayed scan. The MLR analysis indicated that mediastinal fat infiltration was a predictor of carcinoma. The ROC curve obtained for the model yielded an AUC of 0.853. Delayed scanning could improve the diagnostic capacity for carcinoma. The T/M ratio and mediastinal fat infiltration are predictive of carcinoma with moderate diagnostic accuracy

Correlation between frontal lobe oxy-hemoglobin and severity of depression assessed using near-infrared spectroscopy

AbstractIntroductionThe search for objective biomarkers of psychiatric disorders has a long history. Despite this, no universally accepted instruments or methods to detect biomarkers have been developed. One potential exception is near-infrared spectroscopy, although interpreting the measures of blood flow recorded with this technique remains controversial. In this study, we aimed to investigate the relationship between recorded blood flow and depression severity assessed using the Hamilton depression scale in patients with various psychiatric disorders.MethodsEnrolled patients (n=43) had DSM-IV diagnoses of major depressive disorder (n=25), bipolar disorder I (n=5), schizophrenia (n=3), dysthymic disorder (n=3), psychotic disorder (n=3), panic disorder (n=2), and Obsessive Compulsive Disorder (n=2). The verbal fluency task was administered during blood flow recording from the frontal and temporal lobes.ResultsWe found that severity of depression was negatively correlated with the integral value of blood flow in the frontal lobe, irrespective of psychiatric diagnosis (F=5.94, p=0.02).DiscussionOur results support blood flow in the frontal lobe as a potential biomarker of depression severity across various psychiatric disorders.LimitationLimited sample size, no replication in the second set