Prospective randomized efficacy of ultrasound-guided foam sclerotherapy compared with ultrasound-guided liquid sclerotherapy in the treatment of symptomatic venous malformations

ObjectiveTo compare the clinical outcome between ultrasound-guided foam sclerotherapy (UGFS) and ultrasound-guided liquid form sclerotherapy (UGLS) in patients with venous malformations (VM).MethodsEighty-nine patients with symptomatic VM were treated with ultrasound-guided sclerotherapy. There were 22 males and 67 females with mean age of 14.5 years. The sclerosing agents used were 1% polidocanol (POL) or 10% ethanolamine oleate (EO). POL was injected predominantly into smaller, superficial lesions, whereas EO was used for large, deeper lesions. Foam sclerosing solution was provided using Tessari’s method. Patients were randomized to receive either UGFS or UGLS. Post-sclerotherapy surveillance was done at 6 months after last session using duplex ultrasound. Findings obtained by duplex scanning were divided into four groups: (1) disappeared group: the venous space was occluded and was totally shrunk; (2) partially recanalized group: the venous space was partially recanalized and was partially shrunk; (3) totally recanalized group: the venous space was totally recanalized and returned at the same size; and (4) worsened group: the venous space was totally recanalized and became worse.ResultsForty-nine patients were treated with UGFS and the remaining 40 were treated with UGLS. There were no significant differences in age and men:women ratio. There was no significant difference in the anatomic distribution of VMs between the two groups. The amount of POL was significantly smaller in patients who were treated with UGFS (P = .022). Similarly, there was a significant reduction in the use of EO in patients treated with UGFS (P = .005). The proportion of VM with total disappearance and partial recanalization was significantly higher in patients treated with UGFS (P = .002). No major complications related to sclerotherapy were encountered in both groups.ConclusionsThese findings suggest that UGFS could have greater promise compared with UGLS in the treatment of VMs

Leiomyoma of the Round Ligament Presenting as a Large Inguinal Mass

A 42-year-old woman was admitted to Kochi Prefectural Seinan Hospital complaining gradual enlargement of painless mass in the left lower quadrant. Physical examination revealed a 15×13 cm, immobile, elastic firm mass protruding from the abdominal wall in the left inguinal region. No bowel or urinary symptoms were present. Gynecological examination was negative. Tumor markers for ovarian carcinomas such as carcinoembryonic antigen, cancer antigen (CA) 125, CA 130 and CA72-4 were within normal limits. Ultrasonography revealed a well-defined tumor consisted of cystic and solid components in the inguinal canal. A plain CT scan demonstrated a large, wellcircumscribed, heterogeneous mass present in the pelvic cavity and inguinal canal consecutively. Barium enema and DIP were normal. Preoperative diagnosis was a soft tissue tumor with cystic degeneration of unknown origin, situated in the intra-and extra-pelvic cavity. Operative finding revealed a large tumor arising from the left intra-abdominal round ligament and grown into the inguinal canal through the internal inguinal ring. The tumor was macroscopically benign neoplasm and easily removed from the round ligament. Resected tumor with various-sized spongy lesions, measured 12×14×5 cm and weighed 665g, was histologically diagnosed as typical leiomyoma with myxoid degeneration

A Clinical Study on Serum Pepsinogen in 81 Patients Undergoing Gastric Examination

The serum pepsinogen (PG) level was determined in 81 patients undergoing gastric examination, and the results were clinically compared with the results of the conventional primary screening for gastric cancer based on the inquiry and radiography of the upper digestive tract. The values of PG I and PG II in patients whose stomach was found to be normal (normal group) were almost the same as the reported values, but their PG I /PG II ratio was somewhat smaller than the reported value. The PG levels in the gastric ulcer, erosive gastritis and gastric polyp groups did not significantly differ from those in the normal group, while the screening based on the PG level was suggested to be potentially useful for discovery of atrophic gastritis, post-gastrectomy abnormality and duodenal ulcer. Gastric cancer was discovered in four of the 81 cases (early cancer in one case and advanced cancer in three cases), and all were poorly-differentiated adenocarcinoma. When compared with the normal group, only the PG III ratio was smaller in this group. If this PG method is employed for the primary screening, the false-positive rate is 35.5% (falsenegative rate:75% ), an 46.9% of subjects undergoing this screening will require a second examination. The discrepancy between the results of this study and those reported earlier was surmised to be partly attributable to the facts that histological type was poorly-differentiated adenocarcinoma in all the patients with gastric cancer in this study and the mean age of all subjects was more than 10 year higher than that in the earlier report. Compared with the conventional screening method, the percentage of subjects requiring a second examination was higher by more than 20%. It was concluded that further studies are necessary, including review of the criteria for judgment of gastric cancer

Visualizing and manipulating chiral interface states in a moir\'e quantum anomalous Hall insulator

Moir\'e systems made from stacked two-dimensional materials host novel correlated and topological states that can be electrically controlled via applied gate voltages. We have used this technique to manipulate Chern domains in an interaction-driven quantum anomalous Hall insulator made from twisted monolayer-bilayer graphene (tMBLG). This has allowed the wavefunction of chiral interface states to be directly imaged using a scanning tunneling microscope (STM). To accomplish this tMBLG carrier concentration was tuned to stabilize neighboring domains of opposite Chern number, thus providing topological interfaces completely devoid of any structural boundaries. STM tip pulse-induced quantum dots were utilized to induce new Chern domains and thereby create new chiral interface states with tunable chirality at predetermined locations. Theoretical analysis confirms the chiral nature of observed interface states and enables the determination of the characteristic length scale of valley polarization reversal across neighboring tMBLG Chern domains. tMBLG is shown to be a useful platform for imaging the exotic topological properties of correlated moir\'e systems.Comment: 30 pages, 13 figures, 1 tabl

Sleep status of older adults with sleep apnoea syndrome may vary by body mass index

Obesity and ageing are the most important risk factors for sleep apnoea syndrome (SAS); however, the role of body mass index (BMI) on sleep status in healthy older adults is unclear. To explore sleep parameters according to BMI among active older adults, we cross-sectionally examined the relationship between sleep-related parameters and BMI in 32 Japanese adults aged from 83 to 95 years without long-term care who were unaware of having SAS. Correlation and linear regression analyses were performed. Moderate or severe SAS prevalence was high in both those with low (68.8%) and high (68.8%) BMI. A higher increase in apnoea-hypopnoea index (AHI) was negatively correlated with sleep depth in the high-BMI group. In the low-BMI group, the number of awakenings and age were positively correlated with AHI. Older adults may have SAS regardless of their BMI, and the sleep status of patients with SAS may vary by BMI

Spectroscopic Observations of the WZ Sge-Type Dwarf Nova GW Librae during the 2007 Superoutburst

We carried out an international spectroscopic observation campaign of the dwarf nova GW Librae (GW Lib) during the 2007 superoutburst. Our observation period covered the rising phase of the superoutburst, maximum, slowly decaying phase (plateau), and long fading tail after the rapid decline from the plateau. The spectral features dramatically changed during the observations. In the rising phase, only absorption lines of H$\alpha$, H$\beta$, and H$\gamma$ were present. Around the maximum, the spectrum showed singly-peaked emission lines of H$\alpha$, He I 5876, He I 6678, He II 4686, and C III/N III as well as absorption lines of Balmer components and He I. These emission lines significantly weakened in the latter part of the plateau phase. In the fading tail, all the Balmer lines and He I 6678 were in emission, as observed in quiescence. We find that the center of the H$\alpha$ emission component was mostly stable over the whole orbital phase, being consistent with the low inclination of the system. Comparing with the observational results of WZ Sge during the 2001 superoutburst, the same type of stars as GW Lib seen with a high inclination angle, we interpret that the change of the H$\alpha$ profile before the fading tail phase is attributed to a photoionized region formed at the outer edge of the accretion disk, irradiated from the white dwarf and inner disk.Comment: 10 pages, 9 figures, accepted for publication in PAS

Quantum textures of the many-body wavefunctions in magic-angle graphene

Interactions among electrons create novel many-body quantum phases of matter with wavefunctions that often reflect electronic correlation effects, broken symmetries, and novel collective excitations. A wide range of quantum phases has been discovered in MATBG, including correlated insulating, unconventional superconducting, and magnetic topological phases. The lack of microscopic information, including precise knowledge of possible broken symmetries, has thus far hampered our understanding of MATBG's correlated phases. Here we use high-resolution scanning tunneling microscopy to directly probe the wavefunctions of the correlated phases in MATBG. The squares of the wavefunctions of gapped phases, including those of the correlated insulators, pseudogap, and superconducting phases, show distinct patterns of broken symmetry with a $\sqrt{3}$ x $\sqrt{3}$ super-periodicity on the graphene atomic lattice that has a complex spatial dependence on the moir\'e superlattice scale. We introduce a symmetry-based analysis to describe our measurements of the wavefunctions of MATBG's correlated phases with a set of complex-valued local order parameters. For the correlated insulators in MATBG, at fillings of $\nu$ = $\pm$ 2 electrons per moir\'e unit cell relative to charge neutrality, we compare the observed quantum textures to those expected for proposed theoretical ground states. In typical MATBG devices, the textures of correlated insulators' wavefunctions closely match those of the theoretically proposed IKS order, while in ultra-low-strain samples our data has local symmetries like those of a T-IVC phase. We also study the wavefunction of MATBG's superconducting state, revealing strong signatures of intervalley coherence that can only be distinguished from those of the insulator with our phase-sensitive measurements.Comment: 5 figure

Safety of Postoperative Administration of Human Urinary Trypsin Inhibitor in Lung Cancer Patients with Idiopathic Pulmonary Fibrosis

Patients with idiopathic pulmonary fibrosis (IPF) undergoing pulmonary resection for lung cancer carry risks of acute exacerbations of IPF (AE) postoperatively. Currently, agents which may attenuate AE are actively sought. Urinary trypsin inhibitor, ulinastatin, is a synthetic glycoprotein which may potentially inhibit various inflammatory factors associated with the development and progression of IPF. The present study was done to evaluate the effects of administration of high dose ulinastatin in lung cancer patients with IPF immediately following lung resection.Patients with IPFs radiologically diagnosed on high resolution CT, and histologically diagnosed resectable lung cancers, were eligible for the study. The effects of escalating doses of ulinastatin 3×10(5), 6×10(5), and 9×10(5) units/body/day, administered postoperatively for 3 days were evaluated. The endpoints were safety and feasibility.Nine patients were evaluated, in cohorts of 3 patients per dosage. Postoperative follow up ranged from 3 to 12 months (median 9 months). The postoperative courses were uneventful in all patients. No subjective adverse events such as abdominal symptoms or skin rashes, or objective adverse events as per serum laboratory tests, such as liver or kidney dysfunctions potentially attributable to ulinastatin administration were observed. AE was seen in one patient at 3 months after surgery, but since this occurred shortly after administration of chemotherapy, it was considered to be attributable to the chemotherapy rather than surgery.Ulinastatin administration after lung resection in lung cancer patients with IPF was considered to be safe and feasible. Further study is planned at the highest dose of this study to evaluate efficacy.UMIN.ac.jp/ctr/UMIN000002410