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Background: Anastomotic stricture is a relatively common postoperative complication after esophagectomy. Previous studies have indicated that impaired perioperative blood perfusion at the anastomosis is associated with the occurrence of stricture. Therefore, we analyzed the association between endoscopically assessed blood perfusion during the early postoperative period and anastomotic stricture. Methods: This retrospective study evaluated patients who underwent esophagectomy at Tokyo Medical and Dental University between 2010 and 2015. The patients had undergone nasal endoscopy on the 1st and 8th postoperative days. The findings were used to evaluate blood perfusion at the anastomosis and gastric tube, which was classified based on mucosal color as ischemia (white) or congestion (blue or black). Univariate and multivariable logistic regression analyses were performed to identify risk factors for anastomotic stricture. Results: The study included 197 patients and anastomotic stricture was observed in 60 patients (30.4%). The multivariable analysis revealed that postoperative gastric tube congestion was a risk factor for stricture (odds ratio [OR]: 6.440, 95% confidence interval [CI]: 2.660–15.600; p < 0.001). Lower risks of anastomotic stricture were associated with pathological stage III–IV disease (OR: 0.325, 95% CI: 0.161–0.656; p = 0.002). Conclusion: This study revealed that endoscopically detected congestion at the anastomosis on the first postoperative day was a risk factor for anastomotic stricture. [ABSTRACT FROM AUTHOR]

Background: A time interval between diagnosis and surgery for gastric cancer is necessary, although its impact on survival remains controversial. We evaluated the impact of preoperative time interval on survival in gastric cancer patients. Methods: We enrolled 332 patients who underwent curative gastrectomy for clinical stage (cStage) I–III gastric cancer between 2012 and 2015. We separately analyzed early- (cStage I) and advanced-stage (cStages II and III) patients. Early-stage patients were divided according to preoperative time interval: short (≤ 42 days) and long (> 42 days) groups. Advanced-stage patients were also divided into short (≤ 21 days) and long (> 21 days) groups. We compared the survival between the short and long groups in early- and advanced-stage patients. Results: The median preoperative time interval was 29 days, and no significant differences were found in patient characteristics between the short and long groups in early- and advanced-stage patients. In early-stage patients, the 5-year survival rates of the short and long groups were 86.5% and 88.4%, respectively (P = 0.917). In advanced-stage patients, the 5-year survival rates were 72.1% and 70.0%, respectively (P = 0.552). In multivariate analysis, a longer time interval was not selected as an independent prognostic factor in early- and advanced-stage patients. Conclusions: In this study, survival difference was not found based upon preoperative time interval. The results do not affirm the delay of treatment without reason, however, imperative extension of preoperative time interval may be justified from the standpoint of long-term survival. [ABSTRACT FROM AUTHOR]

BCP-ALL of the XLA patients did not show a distinctive methylation profile. X-linked agammaglobulinemia, Bruton's tyrosine kinase, acute lymphoblastic leukemia, acute megakaryoblastic leukemia, tumor suppressor Keywords: X-linked agammaglobulinemia; Bruton's tyrosine kinase; acute lymphoblastic leukemia; acute megakaryoblastic leukemia; tumor suppressor EN X-linked agammaglobulinemia Bruton's tyrosine kinase acute lymphoblastic leukemia acute megakaryoblastic leukemia tumor suppressor 1277 1281 5 06/18/21 20210615 NES 210615 X-linked agammaglobulinemia (XLA) is an inborn error of immunity caused by pathogenic variants in I Bruton's tyrosine kinase i ( I BTK i ). Future studies in which many patients with XLA with leukemia are enrolled may be able to clarify the more detailed characteristics of leukaemic cells in XLA. [Extracted from the article]

Background: Currently, there is no consensus for an optimal minimally invasive esophagectomy (MIE) approach. This study aimed to compare hybrid MIE (hMIE) with neck-abdominal first approach to standard open esophagectomy (OE). Methods: Data from a cohort of 301 patients were retrospectively analyzed. All participants received either hMIE or OE for the treatment of esophageal squamous cell carcinoma at Tokyo Medical and Dental University between January 2003 and December 2013. Analyses included propensity score matching and the Kaplan–Meier statistical method to determine overall survival (OS) and disease-free survival (DFS) of the cohort. Results: After one-to-one propensity score matching, there were 68 patient pairs. The hMIE group had significantly lower incidence of severe postoperative complications (20.1% vs. 7.4%; p = 0.026) and severe respiratory complications (7.4% vs. 0%; p = 0.058) than the OE group. The 5-year oncological outcomes of the two groups were almost equivalent (OS: OE, 55.0%; hMIE, 69.0%; p = 0.063 and DFS: OE, 54.0%; hMIE, 62.0%; p = 0.28). Conclusions: This study compared hMIE with neck-abdominal first approach to standard OE. The results showed significantly less severe postoperative complications for hMIE with neck-abdominal first approach in comparison with OE, without a compromise in long-term oncological outcomes. [ABSTRACT FROM AUTHOR]

Human herpesvirus‐6 (HHV‐6) is a common pathogen affecting the human population. Primary HHV‐6 infection generally occurs during infancy and causes exanthema subitum. Moreover, HHV‐6 may exhibit inherited chromosomally integrated HHV‐6 (iciHHV‐6) in certain individuals. Although iciHHV‐6 is generally known to be nonpathogenic, it may cause reactivation in patients with primary immunodeficiency disease (PID). XIAP deficiency is a rare PID characterized by recurrent hemophagocytic lymphohistiocytosis (HLH). It has been reported that the Epstein‐Barr virus primarily causes HLH; however, the other pathogens, including HHV‐6, can also cause this complication. We encountered a case of XIAP deficiency accompanied by iciHHV‐6. He suffered from recurrent HLH, for which allogeneic bone marrow transplantation (BMT) was performed as a curative therapy. During the course of BMT, the patient experienced HLH three times, but there was no reactivation of endogenous HHV‐6 from iciHHV‐6. Finally, the patient achieved complete donor chimerism and a decline in HHV‐6 DNA copy number in whole blood. This case report demonstrates no evidence of reactivation of iciHHV‐6 during BMT in a patient with XIAP deficiency. [ABSTRACT FROM AUTHOR]

High-throughput analysis revealed the unique immunoglobulin gene rearrangements in plasmacytoma-like post-transplant lymphoproliferative disorder Keywords: autoimmune disease; plasmacytoma; post-transplant lymphoproliferative disorder; X-linked inhibitor of apoptosis protein (XIAP) deficiency EN autoimmune disease plasmacytoma post-transplant lymphoproliferative disorder X-linked inhibitor of apoptosis protein (XIAP) deficiency e164 e168 5 05/19/20 20200515 NES 200515 Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ and haematopoietic stem cell transplantation (SOT, HSCT), which occurs in 1-20% of transplant recipients.[1] The majority of PTLD cells are of the B-cell type, but <5% of PTLD cells are plasma-cell type, including plasmacytoma-like lesion and plasma cell myeloma.[1] Although their worse prognosis than non-PTLD myeloma is clinically significant, only case reports and registry studies have been available.[2] In the present study, we describe the first detailed analysis of plasmacytoma-like PTLD. These findings were consistent with the lambda light-chain restriction of PTLD cells, suggesting that multiple autoantibodies produced by PTLD cells led to multiple autoimmune diseases. Four patients developed diseases within 16 months, whereas plasma cell-type PTLD usually demonstrates a delayed onset.[2] These observations suggest that autoreactive plasma cells of recipient origin could contribute to not only PTLD but also autoimmune diseases after transplantation. [Extracted from the article]

Biomimetic epoxide‐opening cascades of polyepoxides enable the efficient and rapid construction of polyether frameworks. Herein, we show that the epoxide‐opening cascade cyclization that affords tetrahydrofuran products in acidic aqueous media produces tetrahydropyran (THP) in neutral water. THP formation proceeded by simply heating polyepoxides in neutral water and followed a different cyclization mode from those observed so far. The novel cascade cyclization in H2O was applied to the synthesis of a new nerolidol‐type sesquiterpenoid, resulting in revision of the proposed structure and determination of the absolute configuration. [ABSTRACT FROM AUTHOR]

Objective: To assess the usefulness of modified esophagogastroduodenoscopy (EGD) for the detection of second primary malignancies of the esophagus or hypopharynx in patients with oral squamous cell carcinoma and determine the association between the oral lesion subsite and esophageal or hypopharyngeal lesion occurrence. Study Design: Retrospective review. Methods: In total, 166 patients with oral squamous cell carcinoma without any established symptoms of esophageal or hypopharyngeal squamous cell carcinoma underwent modified EGD based on the Valsalva maneuver and U‐turn method, image‐enhanced endoscopy, and chromoendoscopy using Lugol's iodine for diagnosis. All suspected lesions were biopsied to determine the clinical stages and duplication rates. Odds ratios for the occurrence of duplicate lesions according to the oral lesion subsite were determined. Results: In total, 37 esophageal and 16 hypopharyngeal lesions were detected. According to the Union for International Cancer Control/American Joint Committee on Cancer classification (2009), 75.7% and 5.4% esophageal lesions were classified as stage IA and IB, respectively, and 50% and 18.8% hypopharyngeal lesions as stage II and stage I, respectively. Approximately 59.1% and 50% esophageal and hypopharyngeal lesions, respectively, were successfully treated by endoscopic resection. Oral lesions involving the floor of the mouth were more frequently accompanied by second primary malignancies of the esophagus or hypopharynx. Conclusions: Modified EGD is an effective noninvasive technique for early diagnosis and treatment of second primary malignancies of the esophagus and hypopharynx in patients with oral squamous cell carcinoma. In particular, patients with floor of the mouth lesions need close monitoring for hypopharyngeal and esophageal lesions. Level of Evidence: 3b. [ABSTRACT FROM AUTHOR]

Recently, the phenomenon of enantiodivergence was uncovered as a new phenomenon in the biosynthesis of natural products. In nature, chiral natural products are usually produced in optically active form, but both enantiomers sometimes arise in different genera and/or species or in a single species. Here we show through enantioselective total synthesis that the natural product isodehydrothyrsiferol shows partial enantiodivergency in that six of the nine or ten asymmetric centers are enantiomeric to those of other members of the marine squalene-derived triterpenoid thyrsiferol family. In addition, isodehydrothyrsiferol and dehydrothyrsiferol, which show partial enantiodivergency, were isolated from the same producer, the red alga Laurencia viridis. These results demonstrate that partial enantiodivergence can develop even between natural products originating from a single species. [ABSTRACT FROM AUTHOR]

Key Clinical Message We describe a neonate with abdominal distension, massive hepatomegaly, and high serum neuron-specific enolase level suggestive of congenital neuroblastoma. The patient died of pulmonary hemorrhage after therapy. Autopsy revealed that the tumor cells in the liver indicated acute megakaryocytic leukemia with the RBM15- MKL1 fusion gene. [ABSTRACT FROM AUTHOR]

Background Most infants with pneumothorax have underlying conditions. Pneumocystis jirovecii pneumonia ( PCP) frequently occurs in patients with severe combined immunodeficiency ( SCID). The aim of this study was to determine clinical features of PCP-associated pneumothorax in SCID patients. Methods The medical records of four SCID patients with pneumothorax were retrospectively reviewed. Results All four patients were diagnosed as having SCID at the time of contracting PCP. All patients received mechanical ventilation because of severe respiratory failure. Only one patient was successfully extubated and was alive following hematopoietic stem cell transplantation ( HSCT); of the remaining patients, however, two died of respiratory failure, and one patient died of early HSCT-related complications. Conclusions Pneumothorax associated with PCP can occur in SCID patients, and they may have a poor prognosis. If pneumothorax occurs in infants, both respiratory management and prompt investigation of the underlying conditions are needed, considering the possibility of PCP associated with SCID. [ABSTRACT FROM AUTHOR]

The article presents a case study related to 7-year-old boy has received allogeneic hematopoietic stem cell transplantation (HSCT) for severe congenital neutropenia at the age of seven years to second allogeneic HSCT because of donor-type aplasia. It mentions that the patient had a history of catheter has related to blood stream Fusarium infection at the six years, the immunosuppressive treatment of graft-versus-host disease, and the unavailability of a human leucocyte antigen matching donor.

This paper presents a method to estimate the output voltage of a high-speed, surface permanent magnet generator with large air gap length at design stage. The output voltage is estimated by the induced electromotive force and the synchronous inductance obtained from the analytical results of the flux linkage using FEM. Also, a method to classify the synchronous inductance per causative factor is proposed. The air gap leakage inductance is not negligible in a large-air-gap machine like this generator. The validity of the proposed method has been proved by the measured values of a generator designed by this method, and the measured values also show that the output voltage of the generator is within the permissible range. The method proposed in this paper will be an effective tool to design a high-speed, surface permanent magnet generator with large air gap length. © 2005 Wiley Periodicals, Inc. Electr Eng Jpn, 153(2): 52–60, 2005; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/eej.20228 [ABSTRACT FROM AUTHOR]

Streptococcus pyogenes is the most common cause of post-infectious glomerulonephritis. Described herein is the case of a 5-year-old girl with febrile post-streptococcal acute glomerulonephritis ( PSAGN) associated with pneumococcal bacteremia. The chief complaints were fever and macrohematuria without respiratory symptoms. Urinalysis indicated a protein level of 3+. Serological data showed elevated anti-streptolysin O ( ASO) and hypocomplementemia. Blood culture was positive for S. pneumoniae. Her acute renal failure was mild and improved over several days. Although PSAGN was confirmed by elevated ASO and transient hypocomplementemia, the clinical course was consistent with those of several reported cases of AGN associated with pneumococcal infection. To our knowledge, there have been few reports on the relationship between pneumococcal infection and the incidence of PSAGN. We suggest the hypothesis that pneumococcal infection itself could exaggerate the complement reaction leading to PSAGN. It is important to consider PSAGN associated with a microbial infection such as S. pneumoniae when faced with a febrile patient with AGN. [ABSTRACT FROM AUTHOR]

Highlights from the article: Titelbild: Critical Switching of Cyclization Modes of Polyepoxides in Acidic Aqueous Media and Neutral Water: Synthesis and Revised Structure of a Nerolidol-Type Sesquiterpenoid (Angew. Im Titelbild steht eine Schienenweiche für diesen divergierenden Verlauf der Polyepoxid-Cyclisierung, wobei der rechte Waggon die THP-Bildung beim Erhitzen in neutralem Wasser darstellt. Eine Alkyl-MOF-basierte Methan-Nanofalle mit gegenüberliegenden offenen Metallzentren und dichten Alkylgruppen wird von S. Ma, Z. Niu et al. in ihrer Zuschrift auf S. 10244 vorgestellt.

The article presents a case study of a 17-year-old boy, with a history of acute promyelocytic leukemia (APL) at the age of 13 years, who underwent brain magnetic resonance imaging (MRI) because of transient disorientation. There were abnormal signals being detected in the frontal and parietal bone marrow by chance. The transient disorientation was found to be associated with epilepsy.