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Pediatric Living Donor Liver Transplantation for Congenital Absence of the Portal Vein With Pulmonary Hypertension: A Case Report

Few reports of liver transplantation exist in patients with congenital absence of the portal vein and pulmonary hypertension. Living donor liver transplantation is usually performed before exacerbation of pulmonary hypertension. A 7-year-old girl (height: 131.5 cm; weight: 27.4 kg) with congenital absence of the portal vein was diagnosed with pulmonary hypertension (mean pulmonary artery pressure 35 mm Hg), and liver transplantation was planned before exacerbation of pulmonary hypertension. We successfully managed her hemodynamic parameters using low-dose dopamine and noradrenaline under monitoring of arterial blood pressure, central venous pressure, cardiac output, and stroke volume variation. Anesthesia was maintained using air-oxygen-sevoflurane and remifentanil 0.1 to 0.6 μg∙kg-1∙min-1. It is necessary to understand the potential perioperative complications in such cases and to adopt a multidisciplinary team approach in terms of the timing of transplantation and readiness to deal with exacerbation of pulmonary hypertension

X-Ray Diffuse Scattering Study on Ionic-Pair Displacement Correlations in Relaxor Lead Magnesium Niobate

Ionic-pair equal-time displacement correlations in relaxor lead magnesium niobate, $Pb(Mg_{1/3}Nb_{2/3})O_{3}$, have been investigated at room temperature in terms of an x-ray diffuse scattering technique. Functions of the distinct correlations have been determined quantitatively. The results show the significantly strong rhombohedral-polar correlations regarding Pb-O, Mg/Nb-O, and O-O' pairs. Their spatial distribution forms an ellipse or a sphere with the radii of 30-80$\AA$. This observation of local structure in the system proves precursory presence of the polar microregions in the paraelectric state which leads to the dielectric dispersion.Comment: 11 pages, 3 figure

Peculiar mechanisms of graft recovery through anti-inflammatory responses after rat lung transplantation from donation after cardiac death

Background: Although lung transplantation from donation after cardiac death (DCD), especially uncontrolled DCD, is limited by warm ischemic periods, the molecular mechanism of warm ischemia-reperfusion-injury (IRI) has not been well elucidated. The purpose of this study was to clarify the particular longitudinal mechanisms of molecular factors involved in warm IRI. Methods: Cold ischemic-time (CIT)-group lungs were retrieved and subjected to 3-h of cold preservation, whereas warm ischemic-time (WIT)-group lungs were retrieved after 3-h of warm ischemia. Orthotopic rat lung transplantation was performed and the grafts were reperfused for 1 or 4-h. The graft functions, gene expression, and activation of inflammatory molecules in the grafts were analyzed. Exhaled-carbon-monoxide-concentration (ExCO-C) was measured during reperfusion. Results: Only the WIT-group showed obvious primary graft dysfunction at 1-h reperfusion, but the graft function was recovered during 4-h reperfusion. Most of pro-inflammatory cytokines and stress-induced molecules showed different expression and activation patterns between CIT and WIT groups. In the WIT-group, the expressions of anti-inflammatory molecules, IL-10 and HO-1, were significantly increased at 1-h reperfusion compared to the CIT-group, and these high levels were maintained through 4-h reperfusion. Furthermore, ExCO-C levels in the WIT-group increased immediately after reperfusion compared to the CIT-group. Conclusions: This study indicates that warm IRI may involve a different mechanism than cold IRI and anti-inflammatory pathways may play important roles in the graft recovery after lung transplantation from uncontrolled DCD

Development Conditions for Tropical Storms over the Western North Pacific Stratified by Large-Scale Flow Patterns

This study investigated the characteristics and environmental conditions of tropical cyclones (TCs) over the western North Pacific from 2009 to 2017 that dissipated before reaching tropical storm strength (TDs) under unfavorable environmental conditions; we compared TDs with TCs that reached tropical storm strength (TSs) in terms of modulations of relevant large-scale flow patterns. The flow patterns were categorized based on five factors: shear line, confluence region, monsoon gyre, easterly waves, and Rossby wave energy dispersion from a preexisting cyclone. Among 476 cases, 263 TDs were detected using best-track data and early stage Dvorak analysis. The TCs in the environments associated with the confluence region or Rossby wave energy dispersion (easterly waves) tended to reach tropical storm strength (remain weak) compared with the other factors. The average locations of TDs at the time of cyclogenesis in the confluence region, monsoon gyre, and easterly waves (Rossby wave energy dispersion) in the summer and autumn were farther to the west (east and north) than those of TSs that exhibited the same factors. The environments around TDs were less favorable for development than those around TSs, as there were significant differences in atmospheric (oceanic) environmental parameters between TDs and TSs in the factors of confluence region, easterly waves, and Rossby wave energy dispersion (shear line, monsoon gyre, and Rossby wave energy dispersion). The environmental conditions for reaching tropical storm strength over their developing stage, using five factors, can be summarized as follows: higher tropical cyclone heat potential in the shear line and monsoon gyre, weak vertical shear in the confluence region, wet conditions in the easterly waves, and higher sea surface temperatures and an intense preexisting cyclone in Rossby wave energy dispersion from a preexisting cyclone.</p

Efficacy of a Novel Narrow Knife with Water Jet Function for Colorectal Endoscopic Submucosal Dissection

Backgrounds. With respect to the knife’s design in colorectal endoscopic submucosal dissection (ESD), diameter, water jet function, and electric power are important because these relate to efficient dissection. In this study, we analyzed a novel, narrow ball tip-typed ESD knife with water jet function (Flush knife BT-S, diameter: 2.2 mm, length: 2000 mm, Fujifilm Co., Tokyo, Japan) compared to a regular diameter knife (Flush knife BT, diameter: 2.6 mm, length: 1800 mm). Methods. In laboratory and clinical research, electric power, knife insertion time, vacuum/suction amount with knife in the endoscopic channel, and water jet function were analyzed. We used a knife 2.0 mm long for BT-S and BT knives. Results. The BT-S showed faster mean knife insertion time (sec) and better vacuum amount (ml/min) compared to the BT (insertion time: 16.7 versus 21.6, p<0.001, vacuum amount: 38.0 versus 14.0, p<0.01). Additionally, the water jet function of the BT-S was not inferior. In 39 colorectal ESD cases in two institutions, there were mean 4.7 times (range: 1–28) of knife insertion. Suction under knife happened 59% (23/39) and suction of fluid could be done in 100%. Conclusions. Our study showed that the narrow knife allows significantly faster knife insertion, better vacuum function, and effective clinical results

Magnifying Endoscopy with Blue Laser Imaging Improves the Microstructure Visualization in Early Gastric Cancer: Comparison of Magnifying Endoscopy with Narrow-Band Imaging

Backgrounds. Magnifying endoscopy with blue laser imaging (ME-BLI) for diagnosis of early gastric cancer (EGC) is as effective as magnifying endoscopy with narrow-band imaging (ME-NBI). However, there are different EGCs in microstructure visualization between ME-BLI and ME-NBI. This study aimed to clarify the pathological features of the EGCs, in which microstructure visualization was different between ME-NBI and ME-BLI. Methods. EGCs were classified into groups A (irregular microsurface pattern (MSP) in ME-BLI and absent MSP in ME-NBI), B (irregular MSP in two modalities), or C (absent MSP in two modalities), according to the vessel plus surface classification. We compared the pathological features of EGCs between the three groups. Results. 17, four, and five lesions could be evaluated in detail in groups A, B and C, respectively. Well-differentiated adenocarcinomas with shallow crypts were more frequent in group A than in group B (58.8 and 0%, resp.). The mean crypt depth of group A was significantly shallower than that of group B (56 ± 20, 265 ± 64 μm, resp., P=0.0002). Conclusions. ME-BLI could better visualize the microstructures of the EGCs with shallow crypts compared with ME-NBI. Therefore, ME-BLI could enable a more accurate diagnosis of EGC with shallow crypts