Hokuto Hospital

Introduction: Static bone cavity (SBC) is a rare, unilateral, oval-shaped radiolucent bone defect that is presumed to develop as a result of focal pressure from surrounding soft tissues. It is commonly observed in the posterior mandibular angle of adult males. It is usually asymptomatic without clinical intervention. Case Report: A 36-year-old female diagnosed SBC for 10 years ago, accidentally by radiographic study. The cavity of bone defect has been enlarged gradually without any symptoms. Computed tomography (CT) showed the oval-shaped depression 20 mm × 13 mm × 8 mm in size at the left mandibular area. Magnetic resonance imaging (MRI) showed no tumor-like components in the cavity. Computed tomography angiography revealed the submental artery from the facial artery runs around the cavity. These radiographical findings presumed that localized pulsative pressure by the submental artery had formed SBC. Because of progressive enlargement of bone cavity in young female, it was afraid that mandibular bone fracture would be brought in later. To prevent the increment of bone deficit, the endovascular intervention had been performed. The submental artery was embolized by glue. Then, the growth of SBC has been suppressed after the endovascular intervention. Conclusion: The incidence of SBC in young female is rare. Further the increment of bone deficit is observed in last 10 years without clinical deficits.

Background11C-methionine positron emission tomography is one of the most reliable imaging modalities for ­glioblastoma visualization. This investigation aimed to generate an 11C-methionine positron emission tomography-like image, “Gliomap,” from contrast-enhanced magnetic resonance imaging via a conditional Generative Adversarial Network (Gliomap-GAN).MethodsEighty-one newly diagnosed glioblastoma patients with preoperative contrast-enhanced magnetic resonance imaging and 11C-methionine positron emission tomography were retrospectively collected. T1-weighted, T2-weighted, and Gd-enhanced T1-weighted images were co-registered and intensity normalized, followed by the creation of a contrast-enhancement subtraction map. They were used as source data to train Gliomap-GAN, targeting the corresponding 11C-methionine positron emission tomography image. The training dataset comprised 2459 images augmented to 4918 pairs by mirroring. The test dataset consisted of 593 pairs. Furthermore, an additional five patients with 16 image-guided sampled tissues were used for histological validation of the generated Gliomap.ResultsGliomaps visually resembled the original 11C-methionine positron emission tomography images. The residual error between Gliomaps and the original images from test datasets was 0.07 ± 0.04 (mean ± SD) in tumor-to-normal tissue ratio. The Sørensen-Dice coefficient between the lesions predicted by Gliomap and 11C-methionine positron emission tomography reached 0.88 ± 0.07 (mean ± SD) at a threshold of tumor-to-normal tissue ratio of 1.5. The absolute values of Gliomap showed a significant positive correlation with tumor cell density (P = .02).ConclusionThe present research demonstrates that the Gliomap, generated from contrast-enhanced magnetic resonance imaging using generative artificial intelligence, is a promising imaging surrogate for visualizing tumor cell density in newly diagnosed glioblastoma.

Introduction: A rare case of hemi facial spasm that disappeared with the onset of ipsilateral Wallenberg syndrome was observed. Case Report: A 74-year-old woman had a left vertebral artery occlusion. The patient presented with left Wallenberg syndrome by a left medullo-lateral infarction. In addition, the left hemi facial spasm, from which had been suffered for last six months, disappeared. Conclusion: The patient had ipsilateral vertebral artery occlusion. The occluded artery had caused the facial spasm with pulsatile stimulation against the root exit zone of VII nerve. Because of lateral area of medulla oblongata was perfused with contralateral posterior inferior cerebellar artery, ipsilateral medulla infarction had been left only slight neurological deficits. This report presents a fortunate case with anatomical and hemodynamic features.

We aimed to clarify the clinical characteristics and outcomes of patients with in-hospital onset ischemic stroke (IOS) compared with those in patients with community-onset ischemic stroke (COS). Patients from the Japan Stroke Data Bank, a hospital-based multicenter prospective registry, who were diagnosed with acute ischemic stroke (AIS) within 24 h of onset between January 2001 and December 2020 were included in this study. We assessed favorable outcomes at discharge corresponding to a modified Rankin Scale (mRS) score of 0-2, unfavorable outcomes corresponding to an mRS score of 5-6, and mortality. We also examined trends in these outcomes at 4-year intervals over a period of 20 years. Of the 100,865 patients analyzed, 2979 had IOS (1416 women, mean age 77 ± 12 years) and were older than those with COS (n = 97,886; 39,110 women, mean age 74 ± 12 years). Multivariate analysis revealed that younger age, higher premorbid mRS score, absence of stroke history, normotension, congestive heart failure, coronary artery disease, chronic kidney disease, liver disease, malignancy, tendency to bleed, and cardioembolic stroke were positively associated with IOS. Compared with COS, IOS was inversely associated with a favorable outcome (42.1% vs 64.8%, adjusted odds ratio [aOR] 0.72 [95% confidence interval (CI) 0.63-0.82]), positively associated with an unfavorable outcome (mRS 5-6 at discharge; 34.3% vs 15.5%, aOR 1.31 [95% CI 1.16-1.48]), and mortality (11.8% vs 4.6%, aOR 1.59 [95% CI 1.37-1.84]). Over 20 years, the mortality rate significantly decreased in both patients with IOS and COS (p < 0.01 both). IOS is associated with unfavorable outcomes and higher mortality rates during acute hospitalization. The mortality rates in patients with IOS decreased over time, similar to those observed in patients with COS.

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Abstract Glioblastoma (GBM) is an incurable brain cancer, where dismal outcomes result from disease recurrence driven by tumour-initiating glioma stem cells (GSCs). GSCs survive and expand in the brain after surgery, radiation and temozolomide (TMZ) amidst weak immune and natural killer (NK) cell surveillance. Efficient NK cell-mediated killing of GBM cells occurs at high effector to target ratios precluding effective eradication of large tumour remnants, as enforced by clinical trials with autologous NK cells in an adjuvant setting. Here we explore in a human GSC xenograft model whether tumor depopulation using high dose Temozolomide (TMZ) could create a window of curative opportunity for endogenous or exogenous NK cells. We observed that while subcutaneous (sc) xenografts of patient derived GSCs are infiltrated by endogenous functional (NCR1+) NK cells in SCID mice, the corresponding intracranial (ic) tumours remained NK cell depleted. Notably, while TMZ caused near complete regression of intracranial GSC xenografts this was followed by inevitable recurrence of drug-resistant lesions. To explore whether direct delivery of NK cells into depopulated intracranial tumours would change the lethal course of the disease, mice were injected with GSCs intracranially, and upon tumour formation were treated with a sequence of TMZ (systemically), at 2, 7, 14, and 21 days later with irradiated NK92MI cells. Remarkably, this combined therapy completely obliterated recurrent disease at 2 and 7 days but not beyond 14 days. To assess whether NK92MI cells could be replaced by their derived extracellular vesicles (NK-EVs), the latter were injected i.c. post TMZ in GSC xenograft bearing mice. A single injection of NK-EVs resulted in tumour eradication in some but not all mice. Thus, chemotherapy-dependent tumour depopulation may create a unique window of opportunity for curative NK-mediated immunotherapy in GBM.

This chapter explores the relationships between energy transitions and smart cities in Russia in the context of the country's climate and energy agendas. Following its international commitments, including the Paris Agreement, the country has been developing national action plans for climate change and climate adaptation. Energy consumption in Russia is dominated by heating, with cities playing a crucial role. Digitalisation actively transforms the country's energy infrastructure, which is supported by the state, and the concept of ‘smart cities’ is being developed with a focus on digitalisation in the housing and utilities sector. The chapter emphasises the need for comprehensive strategies to achieve sustainable energy and urban development .

BackgroundHyalinizing trabecular tumor (HTT) is an uncommon follicular cell-derived thyroid tumor classified as a low-risk neoplasm by the World Health Organization Classification of Tumors of Endocrine Organs, 5th edition. The PAX8-GLIS3 gene fusion is reportedly a pathognomonic genetic alteration of HTT.Case presentationA 43-year-old Japanese female was incidentally discovered to have an 8-mm, well-defined, hypoechoic mass in the left lobe of the thyroid gland by ultrasound examination. Contrast-enhanced computed tomography scan revealed a solid mass exhibiting slight homogeneous enhancement in the lower pole of the thyroid gland. The mass was diagnosed as atypia of undetermined significance by fine-needle aspiration cytology. The patient underwent left hemithyroidectomy with routine central compartment dissection. Histologic findings revealed tumor cells with elongated nuclei and intranuclear pseudoinclusions arranged with trabeculae architecture or small nests in hyalinized stroma. Weak membranous and cytoplasmic staining was found by MIB1 (Ki-67) immunostaining. The final diagnosis was HTT of the thyroid gland. Next-generation sequencing genetic analysis of a surgical specimen revealed no pathologic mutations, including BRAF, H/K/NRAS, or RET-PTC fusions. The PAX8-GLIS3 fusion was detected by RT-PCR.ConclusionsA rare case of HTT was demonstrated through imaging, cytologic, histologic and molecular investigations. PAX8-GLIS3 fusion detected by RT-PCR and Sanger sequencing was confirmed to be a genetic hallmark of HTT.