A Deep Learning-Based Assessment Pipeline for Intraepithelial and Stromal Tumor-Infiltrating Lymphocytes in High-Grade Serous Ovarian Carcinoma

Tumor-infiltrating lymphocytes (TILs) are associated with improved survival in patients with epithelial ovarian cancer. However, the evaluation of TILs has not been applied to routine clinical practice because of reproducibility issues. We developed two convolutional neural network models to detect TILs and to determine their spatial location in whole slide images, and established a spatial assessment pipeline to objectively quantify intraepithelial and stromal TILs in patients with high-grade serous ovarian carcinoma. The predictions of the established models showed a significant positive correlation with the number of CD8+ T cells and immune gene expressions. We demonstrated that patients with a higher density of intraepithelial TILs had a significantly prolonged overall survival and progression-free survival in multiple cohorts. On the basis of the density of intraepithelial and stromal TILs, we classified patients into three immunophenotypes: immune inflamed, excluded, and desert. The immune-desert subgroup showed the worst prognosis. Gene expression analysis showed that the immune-desert subgroup had lower immune cytolytic activity and T-cell-inflamed gene-expression profile scores, whereas the immune-excluded subgroup had higher expression of interferon-γ and programmed death 1 receptor signaling pathway. Our established evaluation method provides detailed and comprehensive quantification of intraepithelial and stromal TILs throughout hematoxylin and eosin-stained slides, and has potential for clinical application for personalized treatment of patients with ovarian cancer.

A tissue-silicone integrated simulator for right ventricular pulsatile circulation with severe functional tricuspid regurgitation

There is a great demand for development of a functional tricuspid regurgitation (FTR) model for accelerating development and preclinical study of tricuspid interventional repair devices. This study aimed to develop a severe FTR model by creating a tissue-silicone integrated right ventricular pulsatile circulatory simulator. The simulator incorporates the porcine tricuspid annulus, valve leaflets, chordae tendineae, papillary muscles, and right ventricular wall as one continuous piece of tissue, thereby preserving essential anatomical relationships of the tricuspid valve (TV) complex. We dilated the TV annulus with collagenolytic enzymes under applying stepwise dilation, and successfully achieved a severe FTR model with a regurgitant volume of 45 ± 9 mL/beat and a flow jet area of 15.8 ± 2.3 cm2 (n = 6). Compared to a normal model, the severe FTR model exhibited a larger annular circumference (133.1 ± 8.2 mm vs. 115.7 ± 5.5 mm; p = 0.009) and lower coaptation height (6.6 ± 1.0 mm vs. 17.7 ± 1.3 mm; p = 0.003). Following the De-Vega annular augmentation procedure to the severe FTR model, a significant reduction in regurgitant volume and flow jet area were observed. This severe FTR model may open new avenues for the development and evaluation of transcatheter TV devices.

Endoscopic Pedicle Saphenous Vein Graft Harvesting

The excellent long-term patency of no-touch (NT) saphenous vein grafts (SVGs) makes the grafts very attractive for coronary artery bypass grafting; however, NT-SVG harvesting has a greater incidence of wound complications than conventional methods. Since 2009, we have performed endoscopic vein harvesting (EVH) in our department with very few major wound complications. Because NT-SVG harvesting is expected to provide long-term patency, if performed with EVH, the incidence of wound complications will be reduced. Thus, we began performing endoscopic pedicle SVG harvesting (Pedicle-EVH) in March 2019. Herein, we report the early results obtained using our current Pedicle-EVH procedure. No major wound complications were reported, and the early results, including patency, were satisfactory. To harvest the pedicle SVG, however, we used a different method than the NT-SVG procedure, so careful monitoring will be needed to assess long-term outcomes.

Correction: 'Transition mechanism for a periodic bar-and-joint framework with limited degrees of freedom controlled by uniaxial load and internal stiffness' (2018), by Tanaka et al

[This corrects the article DOI: 10.1098/rsos.180139.][This corrects the article DOI: 10.1098/rsos.180139.].

Difference in tissue temperature change between two cryoballoons

BACKGROUND

Cryoballoon ablation, especially Arctic Front Advance Pro (AFA-Pro) (Medtronic, Minneapolis, Minnesota, USA), has been widely recognised as a standard approach to atrial fibrillation (AF). Recently, Boston Scientific has released a novel cryoballoon system (POLARx). Despite comparable acute clinical outcomes of these two cryoballoons, the recent study reported a higher complication rate, especially for phrenic nerve palsy, with POLARx. However, their impact on biological tissue remains unclear.

OBJECTIVE

The purpose of our study is to evaluate temperature change of biological tissue during cryoablation of each cryoballoon using a porcine experimental model.

METHOD

A tissue-based pulmonary vein model was constructed from porcine myocardial tissue and placed on a stage designed to simulate pulmonary vein anatomy and venous flow. Controlled cryoablations of AFA-Pro and POLARx were performed in this model to evaluate the tissue temperature. A temperature sensor was set behind the muscle and cryoballoon ablation was performed after confirming the occlusion of pulmonary vein with cryoballoon.

RESULTS

The mean tissue nadir temperature during cryoablation with AFA-Pro was -41.5°C±4.9°C, while the mean tissue nadir temperature during cryoablation with POLARx was -58.4°C±5.9°C (p<0.001). The mean balloon nadir temperature during cryoablation with AFA-Pro was -54.6°C±2.6°C and the mean balloon nadir temperature during cryoablation with POLARx was -64.7°C±3.8°C (p<0.001).

CONCLUSION

POLARx could freeze the biological tissue more strongly than AFA-Pro.

Biaxial tensile testing system for measuring mechanical properties of both sides of biological tissues

The aortic wall exhibits a unique elastic behavior, periodically expanding in aortic diameter by approximately 10% during heartbeats. This elastic behavior of the aortic wall relies on the distinct yet interacting mechanical properties of its three layers: intima, media, and adventitia. Aortic aneurysms develop as a result of multifactorial remodeling influenced by mechanical vulnerability of the aortic wall. Therefore, investigating the mechanical response of the aneurysmal wall, in conjunction with changes in microstructural parameters on both the intimal and adventitial sides, may offer valuable insights into the mechanisms of aortic aneurysm development or rupture. This study aimed to develop a biaxial tensile testing system to measure the mechanical properties of both sides of the tissue to gain insights concerning the interactions in anisotropic layered tissue. The biaxial tensile test set-up consisted of four motors, four cameras, four load cells, and a toggle switch. Porcine ascending aortas were chosen as the test subject. Graphite particles with diameters of approximately 5-11 [μm] were randomly applied to both sides of the aorta. Strain measurements were obtained using the stereo digital-image correlation method. Because stretching a rectangular specimen with a thread inevitably concentrates and localizes stress, to reduce this effect the specimen's shape was investigated using finite element analysis. The finite element analysis showed that a cross-shaped specimen with diagonally cut edges would be suitable. Therefore, we prepared specimens with this novel shape. This test system showed that mechanical response of the aortic tissue was significantly different between the intimal and adventitial side in the high-strain range, due to the disruption of collagen fibers. The adventitia side exhibited a smaller elastic modulus than the intimal side, accompanied by disruption of collagen fibers in the adventitia, which were more pronounced in the longitudinal direction. In contrast, in the mid-strain range, the elastic modulus did not differ between the intimal and adventitial sides, irrespective of longitudinal or circumferential direction, and collagen fibers were not disrupted but elongated. A biaxial tensile test system, which measures the mechanical properties of both sides of biological tissues and the shape of the specimen for reducing the concentration of stress at the chuck region, was developed in this study. The biaxial tensile testing system developed here is useful for better understanding the influences of mechanical loads and tissue degeneration on anisotropic, layered biological tissues.

Noninvasive Positive-Pressure Ventilation for Preeclampsia-Induced Pulmonary Edema: 3 Case Reports and a Literature Review

Pulmonary edema caused by severe preeclampsia can be an indication for pregnancy termination. We aimed to investigate whether noninvasive positive-pressure ventilation (NPPV) was useful for preeclampsia-induced pulmonary edema. Three cases of preeclampsia-induced pulmonary edema managed with NPPV in our institute were reviewed retrospectively. A literature review was conducted regarding NPPV usage during pregnancy. NPPV was initiated at 30, 20, and 24 weeks of gestation in the 3 cases. In all cases, NPPV slowed the progression of pulmonary edema and succeeded in delaying pregnancy termination by 17 days on average. Maternal outcomes were positive, and no intubation was required. Between 1994 and 2017, there were 11 articles describing 12 cases in which NPPV was applied for pulmonary edema during pregnancy. However, there has been no case of NPPV management of preeclampsia-induced pulmonary edema thus far. Maternal and fetal outcomes were positive in these 12 cases. NPPV may contribute to prolonging pregnancy in patients with poor oxygenation due to preeclampsia-induced pulmonary edema. However, patients should be closely monitored, and the decision to intubate or terminate the pregnancy should be made without delay when the maternal or fetal condition worsens.

Transition mechanism for a periodic bar-and-joint framework with limited degrees of freedom controlled by uniaxial load and internal stiffness

A specific periodic bar-and-joint framework with limited degrees of freedom is shown to have a transition mechanism when subjected to an external force. The static nonlinear elasticity of this framework under a uniaxial load is modelled with the two angular variables specifying the rotation and distortion of the linked square components. Numerically exploring the equilibrium paths then reveals a transition state of the structure at a critical value of the internal stiffness. A simplified formulation of the model with weak nonlinear terms yields an exact solution of its transition state. Load-displacement behaviour and stability for the two systems with or without approximation are analysed and compared.

Identification of aqueous access residues of the sodium half channel in transmembrane helix 5 of the Fo-a subunit of Propionigenium modestum ATP synthase

The F_o-a subunit of the Na⁺-transporting F_oF₁ ATP synthase from Propionigenium modestum plays a key role in Na⁺ transport. It forms half channels that allow Na⁺ to enter and leave the buried carboxyl group on F_o-c subunits. The essential Arg residue R226, which faces the carboxyl group of F_o-c subunits in the middle of transmembrane helix 5 of the F_o-a subunit, separates the cytoplasmic side and periplasmic half-channels. To elucidate contributions of other amino acid residues of transmembrane helix 5 using hybrid F_oF₁ (F_o from P. modestum and F₁ from thermophilic Bacillus PS3), 25 residues were individually mutated to Cys, and effects of modification with the SH-modifying agent N-ethylmaleimide (NEM) on ATP synthesis and hydrolysis activity were analyzed. NEM significantly inhibited ATP synthesis and hydrolysis as well as proton pumping activities of A214C, G215C, A218C, I223C (cytoplasmic side from R226), and N230C (periplasmic side from R226) mutants and inhibited ATP synthesis activity of the K219C mutant (cytoplasmic side from R226). Thus, these residues contribute to the integrity of the Na⁺ half channel, and both half channels are present in the F_o-a subunit.

Association between bone scan index and activities of daily living in patients with advanced non-small cell lung cancer

PURPOSE

The aim of this retrospective cross-sectional study was to investigate the association between the bone scan index (BSI) and activities of daily living (ADL) in patients with advanced non-small cell lung cancer (NSCLC).

METHODS

Among patients with advanced NSCLC, subjects who underwent bone scintigraphy were recruited from this study. Clinical information about patients, including the Barthel Index of ADL, was extracted from their medical charts. Variables including the age, sex, BSI, presence/absence skeletal-related events (SREs), diagnostic state (initial vs. relapse), and history of use of certain medications (e.g. opiates) were evaluated as factors possibly associated with the Barthel Index. In Addition, associations between these factors, including the Barthel Index, with the overall survival were also assessed.

RESULTS

A total of 111 patients with bone metastases were selected. The BSI and Barthel Index of the patients were 1.59 ± 2.25 and 69.7 ± 19.6, respectively. Multivariable analysis identified age (≥70 years), a high BSI (≥1.0), and presence of SREs were as factors statistically significantly associated with lower values of the Barthel Index (<75). On the other hand, Cox proportional hazards analysis identified low values of the Barthel Index (<75), use of opiates, and male sex as significant factors associated with a shorter overall survival; the BSI was not associated with the overall survival in the patients with advanced NSCLC in this study.

CONCLUSION

The results suggest that a high BSI (≥1.0) is an independent predictor of poor ADL in patients with NSCLC, while showing no correlation with the overall survival.

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial

Objectives:

To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.

Design:

Parallel-arm, individual randomized controlled trial.

Methods:

Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups.

Results:

Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly (p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference (p < 0.001).

Conclusion:

The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly.

ClinicalTrial.govIdentifier-UMIN000015567

Adsorption efficiency of natural materials for low-concentration cesium in solution

In this study, several natural materials were investigated in order to clarify their potential use as cesium (Cs) adsorbents in situ. Four materials--carbonized rice hull, beech sawdust, oak sawdust, and charcoal (Japanese cedar)--which were previously shown to have Cs adsorption capabilities, were examined. Cs adsorption experiments were conducted using different initial Cs and adsorbent concentrations. The physical properties, adsorption isotherms, and adsorption processes were then examined, so as to exploit the Cs adsorption characteristics in the field. Based on these findings, carbonized rice hull and beech sawdust were selected as effective Cs adsorbents. It was found that these materials show continuous and stable Cs adsorption rates for different initial Cs concentrations. The adsorption efficiency of these two adsorption materials in combination was considered, and it was shown that the adsorption isotherms for carbonized rice hull and beech sawdust follow the Freundlich model. Furthermore, the beech sawdust adsorption process exhibited better agreement with the calculated values obtained via the adsorption rate model and the adsorption kinetics model than did the carbonized rice hull adsorption.

Pim-2 kinase is an important target of treatment for tumor progression and bone loss in myeloma

Pim-2 kinase is overexpressed in multiple myeloma (MM) cells to enhance their growth and survival, and regarded as a novel therapeutic target in MM. However, the impact of Pim-2 inhibition on bone disease in MM remains unknown. We demonstrated here that Pim-2 expression was also upregulated in bone marrow stromal cells and MC3T3-E1 preosteoblastic cells in the presence of cytokines known as the inhibitors of osteoblastogenesis in MM, including interleukin-3 (IL-3), IL-7, tumor necrosis factor-α, transforming growth factor-β (TGF-β) and activin A, as well as MM cell conditioned media. The enforced expression of Pim-2 abrogated in vitro osteoblastogenesis by BMP-2, which suggested Pim-2 as a negative regulator for osteoblastogenesis. Treatment with Pim-2 short-interference RNA as well as the Pim inhibitor SMI-16a successfully restored osteoblastogenesis suppressed by all the above inhibitory factors and MM cells. The SMI-16a treatment potentiated BMP-2-mediated anabolic signaling while suppressing TGF-β signaling. Furthermore, treatment with the newly synthesized thiazolidine-2,4-dione congener, 12a-OH, as well as its prototypic SMI-16a effectively prevented bone destruction while suppressing MM tumor growth in MM animal models. Thus, Pim-2 may have a pivotal role in tumor progression and bone loss in MM, and Pim-2 inhibition may become an important therapeutic strategy to target the MM cell-bone marrow interaction.

Endothelin B receptor expression correlates with tumour angiogenesis and prognosis in oesophageal squamous cell carcinoma

Background:

The endothelin axis has been shown to have a pivotal role in several human malignancies. The aim of this study was to clarify the clinical importance of endothelin receptor type B (ETBR) in human oesophageal squamous cell carcinoma (OSCC).

Methods:

We evaluated ETBR expression in 107 patients with OSCC by immunohistochemistry. Microvessel density (MVD) and lymphatic vessel density were assessed by CD31 and D2-40 immunostaining, respectively. Furthermore, CD4, CD8, and CD45RO+ tumour-infiltrating lymphocytes (TILs) were immunohistochemically analysed.

Results:

Sixty-one (57%) cases showed high expression of ETBR. Endothelin receptor type B expression was correlated with several clinicopathological factors including tumour differentiation, tumour depth, and lymph node metastasis. The overall and disease-specific survival rates were significantly lower in patients with high ETBR expression than patients with low expression. Furthermore, multivariate analysis revealed that ETBR status was an independent prognostic factor for patient survival. Mechanistic analysis indicated that MVD was significantly higher in tumour tissues with high ETBR expression compared with those with low expression, suggesting that angiogenesis may be a key mechanism in tumour progression and metastasis of OSCC mediated by ETBR expression. By contrast, there were no significant correlations between TILs and ETBR expression.

Conclusion:

Endothelin receptor type B has a pivotal role in oesophageal cancer and may be therapeutic target for this intractable malignancy.

Effects of macronutrient intake on thigh muscle mass during home-based walking training in middle-aged and older women

We examined whether post-exercise macronutrient supplementation during a 5-month home-based interval walking training (IWT) accelerated exercise-induced increases in skeletal muscle mass and strength in healthy middle-aged and older women. Thirty-five women (41-78 years) were randomly divided into two groups: IWT alone (CNT, n = 18) or IWT plus post-exercise macronutrient (7.6 g protein, 32.5 g carbohydrate, and 4.4 g fat) supplementation (NUT, n = 17). For IWT, all subjects were instructed to repeat five or more sets of 3-min low-intensity walking at 40% peak aerobic capacity (Vo2 peak ), followed by a 3-min high-intensity walking above 70% Vo2 peak per day for 4 or more days per week. We determined Vo2 peak , thigh muscle tissue area by computer tomography, and thigh muscle strength in all subjects before and after IWT. We found that an increase in hamstring muscle tissue area was 2.8 ± 1.2% in NUT vs -1.0 ± 0.7% in CNT and that in isometric knee flexion force was 16.3 ± 3.7% in NUT vs 6.5 ± 3.0% in CNT; both were significantly higher in NUT than in CNT (both, P < 0.001). Thus, post-exercise macronutrient supplementation enhanced the increases in thigh muscle mass and strength, although partially, in home-based IWT in middle-aged and older women.

Embryonal rhabdomyosarcoma of the uterus in a 35-year-old woman: case report and review of the literature

Embryonal rhabdomyosarcoma (RMS) is a rare sarcoma that characteristically occurs in children. The current treatment protocols are based on trials performed in patients under 21 years of age. Embryonal RMS in women over 20 years of age is rare, and studies on treatments and outcomes are limited. The authors here in report a case of a 35-year-old woman with ectocervical RMS who was treated with radical hysterectomy followed by chemotherapy. She is currently disease-free. Based on a literature review, the authors recommend a surgical approach in combination with chemotherapy for treatment of embryonal RMS in adult patients.

Neurofibromatosis 2 gene has novel alternative splicings which controls intracellular protein binding

Three novel isoforms of the neurofibromatosis 2 (NF2) gene transcripts generated from alternative splicing were identified from normal human brain, schwannoma and glioma tissues. The 3 novel transcripts lack exon 2, exons 2 and 3, exons 2-4, respectively. Recombinant isoform proteins encoded by those new transcripts have lost the previously reported ability to bind S-35-methionine labeled cellular proteins. Two of seven glioblastoma tissues expressed significantly high levels of the shorter transcripts whereas low grade astrocytomas expressed levels similar to those found in normal brain, suggesting that genomic mutation or aberrant alternative splicing of the NF2 gene may contribute to the progression of malignant gliomas.

Effect of Minor Alloying Element on Dispersing Nano-particles in ODS Steel

From the irradiation resistance and high-temperature strength, oxide dispersion strengthened (ODS) ferritic steels are candidate materials for advanced and fusion reactors. For the development of advanced steels the key issue is to homogenize nano-particles into matrix. Recent studies have indicated that Ti addition can homogenize Y-Ti complex particles into ferrite matrix, but the reason of the effect of additional elements has not been clarified. In this model study, we focus on the effect of additional elements, such as IV and V families and other oxide formers, which can control potentially the distribution of the oxide particles. The materials used in this study were based on Fe-9Cr-Y2O3 alloys which were mechanical alloyed (MA) from the powder of Fe, Cr and Y2O3, which was added systematically with the element of Ti, Zr, Ta, V, Nb, Hf, Al, Si and others. Usually ODS fabrication process is required for hot extrusion, but we annealed up to 1150 C for simplify the microstructure. To evaluate the distribution of ODS particles; we used TEM equipped with EDS after electro-polishing or FIB techniques. (1) In the case of Si or Al addition, oxides were disappeared after MA process, which means Y2O3 and other elements should be in solution at non-equilibrium condition. Two types of oxides of Y2O3 and Al2O3 or SiO2 developed after the annealing at 850 C, but only complex oxides were developed after the annealing at 1150 C. This result suggests that the oxide formation is independent process for Y and Si or Al. (2) In the case of Ti addition, oxides also were disappeared after MA process, but developed after annealing at 1150 C. This means that Ti can stabilize complex oxides of Y and Ti, and enhance the fine distribution of the oxides comparing with simple Fe-9Cr-Y2O3 alloy.

Microstructures and Mechanical Properties of 6061 Al Matrix Smart Composite Containing TiNi Shape Memory Fiber

6061 Al-matrix composite with TiNi shape memory fiber as reinforcement has been fabricated by vacuum hot pressing to investigate the microstructure and mechanical properties. The yield stress of this composite increases with increasing amount of prestrain, and it also depends on the volume fraction of fiber and heat treatment. The smartness of the composite is given due to the shape memory effect of the TiNi fiber which generates compressive residual stresses in the matrix material when heated after being prestrained. Microstructual observations have revealed that interfacial reactions occur between the matrix and fiber, creating two intermetallic layers. The flow strength of the composite at elevated temperatures is significantly higher than that of the matrix alloy without TiNi fiber.

Mechanical Properties of Smart Metal Matrix Composite by Shape Memory Effects

The thermomechanical behavior of TiNi shape memory alloy fiber reinforced 6061 aluminum matrix smart composite is investigated experimentally and analytically. The yield stress of the composite is observed to increase with prestrain given to the composite. Analytical model is developed by utilizing a shape memory alloy constitutive model of exponential type for the thermomechanical behavior of the composite. The model predicts that the composite yield stress increases with increasing prestrain, and the key parameters in affecting the composite yield stress are prestrain and matrix heat treatment. The model predicts reasonably well the experimental results of the enhanced composite yield stress.