Lethal Bleeding from a Duodenal Cancerous Ulcer Communicating with the Superior Mesenteric Artery in a Patient with Pancreatic Head Cancer

Pancreatic cancer often invades the duodenum and causes obstruction, but rarely causes massive duodenal bleeding. A 68-year-old male was admitted to our hospital because of vomiting. Enhanced abdominal CT showed a hypovascular tumor with air bubbles in the uncinate process of the pancreas. The tumor invaded the duodenum and metastasized to the liver and peritoneum. The main trunk of the superior mesenteric artery (SMA) was circumferentially involved. After admission, he had hematemesis and melena. Emergency gastroduodenoscopy revealed pulsating vessels in the third portion of the duodenum and he eventually experienced hemorrhagic shock. Severe bleeding occurred from his mouth and anus like a catastrophic flood. It was difficult to sustain blood pressure even with massive blood transfusion with pumping. After insertion of an intra-aortic balloon occlusion catheter, the massive bleeding was eventually stopped. Although we attempted interventional radiography, aortography revealed direct communication between the main SMA trunk and the duodenal lumen. The tumor was considered anatomically and oncologically unresectable. Thus, we did not perform further intervention. The patient died 2 h after angiography. Herein, we report the case of pancreatic head cancer causing lethal bleeding associated with tumor-involved SMA. Duodenal bleeding associated with pancreatic cancer invasion should be considered as an oncogenic emergency

Significance of Coronary Artery Calcium Score in the Target Lesion Evaluated by Multi-detector Computed Tomography for Selecting Treatment of Rotational Atherectomy in Patients with Coronary Artery Disease

We investigated whether coronary artery calcium score (CAC) in the target lesion on the multidetector computed tomography angiography (CTA) predicts the addition of the Rotational atherectomy (Rota) during percutaneous coronary intervention (PCI). Lesion CAC on CTA were evaluated with quantitative coronary analysis (QCA) on coronary angiography for predicting the Rota treatment in 114 consecutive patients (165 target lesions) with first PCI (68 ± 9 years old, females: 17.6%). Rota was added in 8 patients (11 lesions). The lesion length and diameter stenosis on QCA, and lesion length and lesion CAC on CTA were the primary factors associated with the addition of Rota. Using the cut-off value based on receiver operating characteristic analysis, the sensitivity and specificity for predicting the Rota based on QCA was 72.7% in 8 of 11 lesions (vessels) with Rota and the specificity was 74% in 114 of 154 without Rota in the lesion length of ≥ 23mm (χ2=10.9, p=0.001), and 54.5% in 6 of 11 lesions with Rota and the specificity was 79.2% in 122 of 154 without Rota in the diameter stenosis of ≥ 83% (χ2=6.6, p=0.01). Those based on CTA were 90.9% in 10 of 11 lesions with Rota and 77.3% in 119 of 154 without Rota in the lesion length of ≥ 34mm (χ2=24.1, p<0.001), and 90.9% in 10 of 11 with Rota and 88.3% in 136 of 154 without Rota in the lesions with CAC ≥453 (χ2=45.7, p<0.001). Lesion CAC on CTA is most predictive of addition of Rota during PCI

The Japanese Clinical Practice Guideline for acute kidney injury 2016

Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search

The characterization of low pathogenic avian influenza viruses isolated from wild birds in northern Vietnam from 2006 to 2009

Due to concerns that wild birds could possibly spread H5N1 viruses, surveillance was conducted to monitor the types of avian influenza viruses circulating among the wild birds migrating to or inhabiting in northern Vietnam from 2006 to 2009. An H5N2 virus isolated from a Eurasian woodcock had a close phylogenetic relationship to H5 viruses recently isolated in South Korea and Japan, suggesting that H5N2 has been shared between Vietnam, South Korea, and Japan. An H9N2 virus isolated from a Chinese Hwamei was closely related to two H9N2 viruses that were isolated from humans in Hong Kong in 2009, suggesting that an H9N2 strain relevant to the human isolates had been transmitted to and maintained among the wild bird population in Vietnam and South China. The results support the idea that wild bird species play a significant role in the spread and maintenance of avian influenza and that this also occurs in Vietnam

Mutations conferring SO42- pumping ability on the cyanobacterial anion pump rhodopsin and the resultant unique features of the mutant

Membrane transport proteins can be divided into two types: those that bind substrates in a resting state and those that do not. In this study, we demonstrate that these types can be converted by mutations through a study of two cyanobacterial anion-pumping rhodopsins, Mastigocladopsis repens halorhodopsin (MrHR) and Synechocystis halorhodopsin (SyHR). Anion pump rhodopsins, including MrHR and SyHR, initially bind substrate anions to the protein center and transport them upon illumination. MrHR transports only smaller halide ions, Cl- and Br-, but SyHR also transports SO42-, despite the close sequence similarity to MrHR. We sought a determinant that could confer SO42- pumping ability on MrHR and found that the removal of a negative charge at the anion entrance is a prerequisite for SO42- transport by MrHR. Consistently, the reverse mutation in SyHR significantly weakened SO42- pump activity. Notably, the MrHR and SyHR mutants did not show SO42- induced absorption spectral shifts or changes in the photoreactions, suggesting no bindings of SO42- in their initial states or the bindings to the sites far from the protein centers. In other words, unlike wild-type SyHR, these mutants take up SO42- into their centers after illumination and release it before the ends of the photoreactions

Effect of PEGylation on Controllably Spaced Adsorption of Ferritin Molecules

The interparticle distance between nanoparticles (NPs) dispersed on on SiO₂ was shown to be controlled by PEGylation. Ferritins with nanoparticle cores were prepared and PEGylated with poly­(ethylene glycol)­s (PEGs) of two different molecular weights. It was shown that the thickness of the PEG layer on the ferritin surface determines the interparticle distance under short Debye lengths. Under conditions where the Debye length was greater than the PEG layer thickness, distance between ferritins increased due to the electrostatic repulsive force. Results suggest that the PEG layer accommodated a small amount of counterions insufficient to cancel the ferritin outer surface charges. Simulation showed that ferritins adsorbed randomly and interparticle distance can be predicted theoretically. We demonstrate that PEGylated ferritins, that is, NP cores, can be dispersed on a surface with interval distances between particles determined by the combination of the ionic strength of the solution and the molecular weight of the PEG

Thrombomodulin can Predict the Incidence of Second Events in Patients with Acute Myocardial Infarction

Biomarkers of atherothrombosis can predict the risk of cardiovascular events. However, it is difficult to predict second adverse events using these biomarkers at the point in time when the first cardiovascular event occurs. Therefore, we evaluated atherothrombosis-related biomarkers to determine their associations with prognosis after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. A total of 309 AMI patients were enrolled in this study. The patients had undergone successful coronary interventions and the levels of various atherothrombosis-related biomarkers were assessed within the first postoperative hour. Biomarkers other than those assessed by routine biochemical tests were analyzed, including defined endothelial cell damage markers such as thrombomodulin (TM), inflammatory markers such as C-reactive protein (CRP), and coagulation and fibrinolysis system markers such as D-dimer, prothrombin fragment F1+2 (F1+2) and plasminogen activator inhibitor-1 (PAI-1). Major adverse cardiac events (MACEs) occurred in 98 patients during the follow-up period (872.6±579.8 days). Multivariate analysis revealed that clinical parameters such as decreased levels of left ventricular ejection fraction and elevated levels of brain natriuretic peptide, hemoglobin A1c and TM were significantly associated with MACEs. The association between TM and MACEs was especially high (OR: 3.65, 95% CI; 1.75–7.68). Neither dyslipidemia, hypertension, smoking, advanced age, a history of cardiac events nor the type of AMI were associated with MACEs. TM is independently associated with MACEs and may be predictive of second events following PCI in patients with AMI