Femoral neck stress fractures are rare and when treating are difficult to achieve favorable outcomes. This study characterizes outcomes associated with the use of cephalomedullary nails for fixation of Pauwels type-3 vertical femoral neck undisplaced-incomplete insufficiency fractures. Four consecutive patients with a Pauwels type-3 vertical femoral neck tensile insufficiency fracture from 2016 to 2018 were reviewed. Magnetic resonance imaging data revealed tensile visible fracture lines and hip-joint effusions with a high shear angle. For all patients, bone mineral density and vitamin D levels were low; vitamin D therapy was initiated immediately. Surgical procedures were conducted with cephalomedullary nails (Gamma 3 locking nail system; Stryker) under general anesthesia. A cephalomedullary nail appears to be a safe and effective alternative to the use of multiple parallel screws or a sliding hip screw for fixation of vertical femoral neck stress fractures (level of evidence: Level V).

Paper-based analytical devices are fluidic chips fabricated with extremely inexpensive materials, namely paper, thereby allowing their use as a zero-cost analytical device in third-world countries that lack access to expensive diagnostic infrastructures. The aim of this review is to discuss: (1) microfluidic paper-based analytical devices (microPADs) for quantitative analysis, (2) fabrication of two- or three-dimensional microPADs, (3) analytical methods of microPADs, and (4) our opinions regarding the future applications of microPADs for quantitative urinalysis.
Developing Countries ; Methods ; Microfluidics ; Urinalysis*

Purpose: Silent information regulator 1 (SIRT1) in the brain is essential for maintaining cellular homeostasis and plays a neuroprotective role in cerebral ischemia and neurodegenerative disorders. The effect of preischemic treadmill exercise on chronic cerebral hypoperfusion (CCH)-induced spatial learning memory impairment, microvascular injury, and blood-brain barrier (BBB) disruption in relation with SIRT1 expression was evaluated. Methods: Prior to bilateral common carotid artery occlusion (BCCAO) surgery, the rats in the exercise groups performed low-intensity treadmill running for 30 minutes once daily during 8 weeks. BCCAO surgery was performed on male Wistar rats at 12 weeks of age. Spatial learning memory was measured using the Morris water maze test. Neuronal nuclear antigen, SIRT1, and rat endothelial cells antigen 1 were determined by immunohistochemistry and platelet-derived growth factor receptor beta was determined by immunofluorescence. Results: Preischemic treadmill exercise ameliorated spatial learning memory impairment and enhanced SIRT1 expression in the BCCAO rats. Preischemic treadmill exercise ameliorated BCCAO-induced damage to microvasculature and pericytes that make up the BBB. The effect of preischemic treadmill exercise was lost with sirtinol treatment. Conclusions These results can apply treadmill exercise prior to cerebral ischemia as a rational preventive and therapeutic intervention strategy to improve cognitive dysfunction in CCH patients.

Pancreatic cancer typically presents as a focal hypoechoic, hypovascular solid mass with irregular margins on ultrasound. Pancreatic tail disease can be difficult to detect on abdominal ultrasonography. A 75-year-old man visited our institution with upper abdominal pain. We successfully visualized a pancreatic tail mass on abdominal transsplenic scan and multiple liver masses via abdominal transverse scan. His diagnosis was confirmed as pancreatic tail cancer with liver metastasis following endoscopic ultrasound-guided fine-needle biopsy. Abdominal transsplenic scan proved valuable for diagnosing pancreatic tail disease because abdominal ultrasound has limited utility for evaluating pancreatic tail masses due to obscuration by bowel gas.

A 65-year-old female visited us due to gait disturbance. A neurological examination showed cognitive impairment, dystonia, myoclonus, bradykinesia, postural instability, and freezing of gait (FOG). She was diagnosed with extrapontine myelinolysis based on her history of hyponatremia and high signal intensities (HSIs) in both striata on T2-weighted images. Her neurological problems including FOG improved over 25 days. In a follow-up MRI 50 days after the onset, HSIs disappeared in the striata but new ones appeared in the pons. FOG may have been related to striatal dysfunction in this patient.
Aged ; Cognition Disorders ; Dystonia ; Female ; Follow-Up Studies ; Freezing* ; Gait* ; Humans ; Hypokinesia ; Hyponatremia ; Magnetic Resonance Imaging ; Myelinolysis, Central Pontine* ; Myoclonus ; Neurologic Examination ; Pons ; Weather

BACKGROUND: Developing predictive markers for hepatocellular carcinoma (HCC) is important, because many patients experience recurrence and metastasis. Epithelial to mesenchymal transition (EMT) is a developmental process that plays an important role during embryogenesis and also during cancer metastasis. Paired-related homeobox protein 1 (Prrx-1) is an EMT inducer that has recently been introduced, and its prognostic significance in HCC is largely unknown. METHODS: Tissue microarray was constructed using surgically resected primary HCCs from 244 cases. Immunohistochemical staining of E-cadherin and Prrx-1 was performed. The correlation between E-cadherin loss and Prrx-1 expression, as well as other clinicopathologic factors, was evaluated. RESULTS: E-cadherin expression was decreased in 96 cases (39.4%). Loss of E-cadherin correlated with a higher recurrence rate (p < .001) but was not correlated with patient's survival. Thirty-two cases (13.3%) showed at least focal nuclear Prrx-1 immunoreactivity while all non-neoplastic livers (n = 22) were negative. Prrx-1 expression was not associated with E-cadherin loss, survival or recurrence rates, pathologic factors, or the Ki-67 labeling index. Twenty tumors that were positive for E-cadherin and Prrx-1 had significantly higher nuclear grades than the rest of the cohort (p = .037). In Cox proportional hazard models, E-cadherin loss and large vessel invasion were independent prognostic factors for shorter disease-free survival. Cirrhosis and high Ki-67 index (> 40%) were independent prognostic factors for shorter overall survival. CONCLUSIONS: Prrx-1 was expressed in small portions of HCCs but not in normal livers. Additional studies with a large number of Prrx-1-positive cases are required to confirm the results of this study.
Cadherins* ; Carcinoma, Hepatocellular* ; Cohort Studies ; Disease-Free Survival ; Embryonic Development ; Epithelial-Mesenchymal Transition ; Female ; Fibrosis ; Genes, Homeobox ; Humans ; Liver ; Neoplasm Metastasis ; Pregnancy ; Proportional Hazards Models ; Recurrence

PURPOSE: Deregulation of microRNA-370 (miR-370) has been reported in various cancers, in which it can act as either an oncogene or a tumor suppressor gene. However, the clinicopathologic significance of miR-370 expression in breast cancer has not been studied. METHODS: The expression of miR-370 was determined with quantitative real-time polymerase chain reaction in 60 formalin-fixed, paraffin-embedded primary breast cancer tissues. Additionally, the protein expression levels of previously known targets of miR-370, such as FOXM1, FOXO1, and FOXO3a, were detected using immunohistochemistry. Finally, we analyzed its correlation with target protein expression, clinicopathologic features, and clinical outcome. RESULTS: High levels of miR-370 expression correlated with lymph node metastasis (p=0.009), advanced stage (p=0.002), and frequent perineural invasion (p=0.042). Moreover, patients with high miR-370 expression had poor disease-free survival compared with the low-expression group. However, no correlation was observed between miR-370 and its target protein expression. CONCLUSION: Our results indicate that upregulation of miR-370 in breast cancer is correlated with breast cancer progression and that it might be a potential biomarker for predicting clinical outcomes.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Genes, Tumor Suppressor ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Oncogenes ; Prognosis* ; Real-Time Polymerase Chain Reaction ; Up-Regulation

Purpose: Ulcerative colitis (UC) is known to have an association with the increased risk of colorectal cancer (CRC), and UC-associated CRC does not follow the typical progress pattern of adenoma-carcinoma. The aim of this study is to investigate molecular characteristics of UC-associated CRC and further our understanding of the association between UC and CRC. Methods: From 5 patients with UC-associated CRC, matched normal, dysplasia, and tumor specimens were obtained from formalin-fixed paraffin-embedded (FFPE) samples for analysis. Genomic DNA was extracted and whole exome sequencing was conducted to identify somatic variations in dysplasia and tumor samples. Statistical analysis was performed to identify somatic variations with significantly higher frequencies in dysplasia-initiated tumors, and their relevant functions were investigated. Results: Total of 104 tumor mutation genes were identified with higher mutation frequencies in dysplasia-initiated tumors. Four of the 5 dysplasia-initiated tumors (80.0%) have TP53 mutations with frequent stop-gain mutations that were originated from matched dysplasia. APC and KRAS are known to be frequently mutated in general CRC, while none of the 5 patients have APC or KRAS mutation in their dysplasia and tumor samples. Glycoproteins including mucins were also frequently mutated in dysplasia-initiated tumors. Conclusion UC-associated CRC tumors have distinct mutational characteristics compared to typical adenoma-carcinoma tumors and may have different cancer-driving molecular mechanisms that are initiated from earlier dysplasia status.

PURPOSE: To assess the usefulness of an ultrasound (US)-guided peritoneal biopsy for the solitary peritoneal thickening visualized as only infiltrated fat on a computed tomography (CT) scan. MATERIALS AND METHODS: This retrospective study included 36 patients (16 males, 20 females; mean age, 51.7 years) who underwent a US-guided biopsy for the solitary peritoneal thickening of unknown cause visualized as only infiltrated fat without an apparent mass formation on a CT scan. The rate of the specific histopathological diagnosis and accuracy for the diagnosis of malignant disease was assessed. RESULTS: The procedure was technically successful with the acquisition of an adequate amount of the specimen for microscopic examination from all patients. A specific histopathological diagnosis was made in 31/36 patients (86.1%): peritoneal carcinomatosis in 15/31 (48.4%), tuberculous peritonitis in 15/31 (48.4%) and panniculitis in 1/31 (3.2%). A non-specific histopathological diagnosis was made in 5/36 (13.9%): chronic inflammation in 4/5 (80%) and mesothelial hyperplasia in 1/5 (20%). The procedure showed sensitivity of 83.3%, with a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 85.7%, and an accuracy rate of 86.1% for the diagnosis of malignant diseases. CONCLUSION The US-guided peritoneal biopsy is a fairly accurate diagnostic procedure for the peritoneal thickening visualized as only infiltrated fat on a CT scan, and it can be used before performing laparoscopic or an open biopsy.

The Korean Bronchoesophagological Society appointed a task force to develop a clinical practice guideline for tracheostomy. The task force conducted a systematic search of the Embase, Medline, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to key questions. Evidence-based recommendations for practice were ranked according to the American College of Physicians grading system. An external expert review and a Delphi questionnaire were conducted to reach a consensus regarding the recommendations. Accordingly, the committee developed 18 evidence-based recommendations, which are grouped into seven categories. These recommendations are intended to assist clinicians in performing tracheostomy and in the management of tracheostomized patients.