Total humerus replacement for osteosarcoma with proximal part of humerus: a case report

Incisional biopsy and intramedullary pinning were performed for pathological fracture associated with a malignant bone tumor of the proximal humerus. Osteosarcoma, for which preoperative chemotherapy had been performed, was confirmed by postoperative pathological examination. To achieve wide resection and acquire a safe resected margin, total humerus replacement was performed, and the whole humerus was reconstructed using the Howmedica Modular Reconstruction system. The patient resumed normal activities, although mild contracture of the elbow joint remains 8 years after surgery

Real-world treatment patterns of subsequent therapy after palbociclib in patients with advanced breast cancer in Japan

Purpose: The optimal treatment following endocrine therapy (ET) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) has not been established. We aimed to investigate treatment patterns and time to treatment failure (TTF) of subsequent therapy after palbociclib in a Japanese real-world setting. Methds: This retrospective observational study used de-identified data of patients with advanced breast cancer treated with palbociclib, using a nationwide claims database (April 2008 to June 2021). Measures included the type of subsequent therapies after palbociclib (endocrine-based therapy: ET alone, ET + CDK4/6i, and ET + mammalian target of rapamycin inhibitor [mTORi]; chemotherapy; chemotherapy + ET; and others) and their TTFs. The median TTF and 95% confidence interval (CI) were estimated using the Kaplan-Meier method. Results: Of 1170 patients treated with palbociclib, 224 and 235 received subsequent therapies after first- and second-line palbociclib treatment, respectively. Among them, 60.7% and 52.8% were treated with endocrine-based therapies as first subsequent therapy, including ET + CDK4/6i (31.2% and 29.8%, respectively). The median TTF (95% CI) of ET alone, ET + CDK4/6i, and ET + mTORi as first subsequent therapy after first-line palbociclib were 4.4 (2.8–13.7), 10.9 (6.5–15.6), and 6.1 (5.1–7.2) months, respectively. No apparent relationship between the treatment duration of prior ET + palbociclib and subsequent abemaciclib was observed. Conclusion: This real-world study revealed that one-third of the patients received sequential CDK4/6i after ET + palbociclib, and treatment duration of ET + CDK4/6i following ET + palbociclib was the longest among the treatment options. Further data are awaited to determine whether ET + targeted therapy with CDK4/6i and mTORi provides acceptable treatment options following ET + palbociclib

The Functional Severity Assessment of Coronary Stenosis Using Coronary Computed Tomography Angiography-Based Myocardial Mass at Risk and Minimal Lumen Diameter

Background. We investigated whether or not the addition of myocardial mass at risk (MMAR) to quantitative coronary angiography was useful for diagnosing functionally significant coronary stenosis in the daily practice. Methods. We retrospectively enrolled 111 consecutive patients with 149 lesions who underwent clinically indicated coronary computed tomography angiography and subsequent elective coronary angiography with fractional flow reserve (FFR) measurement. MMAR was calculated using a workstation-based software program with ordinary thin slice images acquired for the computed tomography, and the minimal lumen diameter (MLD) and the diameter stenosis were measured with quantitative coronary angiography. Results. The MLD and MMAR were significantly correlated with the FFR, and the MMAR-to-MLD ratio (MMAR/MLD) showed a good correlation. The area under the receiver operating characteristic curve (AUC) of MMAR/MLD for FFR ≤ 0.8 was 0.746, and the sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 83%, 68%, and 77%, respectively, at a cut-off value of 29.5 ml/mm. The addition of MMAR/MLD to diameter stenosis thus made it possible to further discriminate lesions with FFR ≤ 0.8 (AUC = 0.750). For the proximal left coronary artery lesions, in particular, MMAR/MLD showed a better correlation with the FFR, and the AUC of MMAR/MLD for FFR ≤ 0.8 was 0.919 at a cut-off value of 31.7 ml/mm. Conclusions. The index of MMAR/MLD correlated well with the physiological severity of coronary stenosis and showed good accuracy for detecting functional significance. The MMAR/MLD might be a useful parameter to consider when deciding the indication for revascularization

A case of broncholithiasis complicating hemoptysis

A 62-year-old male was admitted because of hemoptysis. The chest X-ray showed an infiltrative shadow in the right upper lung field. Tomograms and CT scans also showed an infiltrative shadow and small calcifications in the same field. Examination by bronchoscopy revealed bronchial bleeding from the depth of the right B1b. Although the detailed view was unclear due to bleeding, we did not find any growth or any mucosal abnormality. We examined only the bronchial washing cytology. The result was Papanicolaou class Ⅱ. However, we could not rule out malignancy, so we decided to perform a right upper lobectomy. A bron-cholith was seen in the B1b and a hematoma was also seen on its periphery. The stone components were calcium carbonate (74%) and calcium phosphate (26%), suggesting that the stone was caused by mucus retention

Method for Enhancing Cell Penetration of Gd³⁺-based MRI Contrast Agents by Conjugation with Hydrophobic Fluorescent Dyes

Gadolinium ion (Gd³⁺) complexes are commonly used as magnetic resonance imaging (MRI) contrast agents to enhance signals in <i>T</i>₁-weighted MR images. Recently, several methods to achieve cell-permeation of Gd³⁺ complexes have been reported, but more general and efficient methodology is needed. In this report, we describe a novel method to achieve cell permeation of Gd³⁺ complexes by using hydrophobic fluorescent dyes as a cell-permeability-enhancing unit. We synthesized Gd³⁺ complexes conjugated with boron dipyrromethene (<b>BDP-Gd</b>) and Cy7 dye (<b>Cy7-Gd</b>), and showed that these conjugates can be introduced efficiently into cells. To examine the relationship between cell permeability and dye structure, we further synthesized a series of <b>Cy7-Gd</b> derivatives. On the basis of MR imaging, flow cytometry, and ICP-MS analysis of cells loaded with <b>Cy7-Gd</b> derivatives, highly hydrophobic and nonanionic dyes were effective for enhancing cell permeation of Gd³⁺ complexes. Furthermore, the behavior of these <b>Cy7-Gd</b> derivatives was examined in mice. Thus, conjugation of hydrophobic fluorescent dyes appears to be an effective approach to improve the cell permeability of Gd³⁺ complexes, and should be applicable for further development of Gd³⁺-based MRI contrast agents

State-of-the-Art of Computer-Aided Detection/Diagnosis

New Yor