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Abstract Background Superior outcomes have been obtained for neoadjuvant treatment with immune checkpoint inhibitors (ICI) plus chemotherapy over neoadjuvant chemotherapy alone, especially in patients with high programmed cell death ligand 1 (PD‐L1) expression. However, it is not always possible to obtain sufficient tumor specimens for biomarker testing before surgery. In this study, we explored clinical factors that can predict high PD‐L1 expression. Methods We retrospectively enrolled 340 lung cancer patients who received pulmonary resection between 2014 and 2023 and who had PD‐L1 expression data. Chi‐squared tests and logistic regression analyses were used to identify clinical factors associated with high PD‐L1 status. Results Univariable and multivariable analyses revealed that smoking, high maximum standardized uptake value (SUVmax) of 18F‐fluorodeoxyglucose positron emission computed tomography (18F‐FDG PET/CT), and high plasma fibrinogen are independent predictors of high PD‐L1 expression. A predictive score for high PD‐L1 expression (ranging from 0 to 3) was developed based on these parameters. Notably, only 5% of patients with a score of 0 exhibited high PD‐L1 expression, whereas this proportion increased to 53% for patients with a score of 3. Conclusion These results showed that plasma fibrinogen, smoking history, and SUVmax are predictors of high PD‐L1 expression, providing a basis for identifying patients expected to benefit from neoadjuvant ICI treatment.

Edwardsiella tarda is a gram-negative bacillus that is typically found in freshwater environments and the feces of reptiles. A 48-year-old woman with Marfan's syndrome presented to our hospital with fever, nausea, and general fatigue. She had previously undergone a mechanical Bentall procedure and total aortic arch replacement for acute type A aortic dissection. E tarda was identified from the blood culture. Computed tomography scanning revealed a mycotic aneurysm of the dissecting descending aorta. Despite appropriate intravenous antibiotic therapy, the aneurysm dilated rapidly. Thus, an emergency surgery was performed to replace the descending aorta with a graft that was surrounded by a latissimus dorsi muscle flap. Her postoperative course was uneventful.

A 38-year-old man visited the otolaryngology department because of sudden onset of hoarseness a few days ago. A fiberoptic laryngoscopy revealed paralytic left vocal cord, indicating the left recurrent laryngeal nerve paralysis. Computed tomography angiography revealed a 44-mm aortic pseudoaneurysm with thrombus originating at the left subclavian artery. At total aortic arch replacement, an intimal defect was found at the origin of the left subclavian artery, where the pseudoaneurysm originated. A longitudinal ulcer-like lesion of intima was noticed. Pathology of the aortic wall revealed undifferentiated intimal sarcoma of the aorta. The aortic pseudoaneurysm developed owing to invasion of intimal sarcoma.

Introduction: Molecular residual disease detected by circulating tumor DNA (ctDNA) has been reported to be predictive of patients’ outcomes in various types of cancers after curative intent treatment. Nevertheless, additional detailed information regarding the association of longitudinal ctDNA detection with long-term follow-up in lung cancer is needed. Here, we report on a cohort of patients with NSCLC who underwent definitive surgery and ctDNA analysis in the pre-operative, adjuvant, and surveillance settings. Method: Plasma samples were collected from 46 patients with clinical stage II-III NSCLC before surgery (n = 46), after surgery (n = 45), and every six months until two years thereafter (n = 78). A clinically validated, personalized, tumor-informed 16-plex polymerase chain reaction–next-generation sequencing assay was used for the detection and quantification of ctDNA in retrospectively analyzed plasma samples. Results: Circulating tumor DNA was detected in the first postoperative (within 51 days after surgery) plasma samples in 13% (6/45) of patients (landmark analysis). All of them had disease recurrence within a median of 9.1 months. These patients had shorter recurrence-free and overall survivals than those without detectable ctDNA at a landmark time point (p < 0.01) and in multivariate analyses (p < 0.03). Longitudinally (considering all postoperative follow-up time points), ctDNA was detected in 13 patients, all of whom experienced disease recurrence (positive predictive value = 100%). Three patients who had central nervous system–only metastases did not have detectable ctDNA. Conclusions: The presence of ctDNA post-surgery or during surveillance identifies patients with NSCLC at high risk of recurrence. Serial testing is important to detect disease recurrence earlier (lead-time: 3.2 months).

Abstract Background The prognosis of patients with lung cancer accompanied by interstitial pneumonia is poorer than that of patients with lung cancer but without interstitial pneumonia. Moreover, the available therapeutic interventions for lung cancer patients with interstitial pneumonia are limited. Therefore, a new treatment strategy for these patients is required. The aim of the present study was to investigate the pathophysiological relationship between interstitial pneumonia and lung cancer and explore potential therapeutic agents. Methods A novel hybrid murine model of lung cancer with interstitial pneumonia was established via bleomycin-induced pulmonary fibrosis followed by orthotopic lung cancer cell transplantation into the lungs. Changes in tumor progression, lung fibrosis, RNA expression, cytokine levels, and tumor microenvironment in the lung cancer with interstitial pneumonia model were investigated, and therapeutic agents were examined. Additionally, clinical data and samples from patients with lung cancer accompanied by interstitial pneumonia were analyzed to explore the potential clinical significance of the findings. Results In the lung cancer with interstitial pneumonia model, accelerated tumor growth was observed based on an altered tumor microenvironment. RNA sequencing analysis revealed upregulation of the hypoxia-inducible factor 1 signaling pathway. These findings were consistent with those obtained for human samples. Moreover, we explored whether ascorbic acid could be an alternative treatment for lung cancer with interstitial pneumonia to avoid the disadvantages of hypoxia-inducible factor 1 inhibitors. Ascorbic acid successfully downregulated the hypoxia-inducible factor 1 signaling pathway and inhibited tumor progression and lung fibrosis. Conclusions The hypoxia-inducible factor 1 pathway is critical in lung cancer with interstitial pneumonia and could be a therapeutic target for mitigating interstitial pneumonia-mediated lung cancer progression.

Idiopathic normal pressure hydrocephalus in elderly people is considered a form of glymphopathy caused by malfunction of the waste clearance pathway, called the glymphatic system. Tau is a representative waste material similar to amyloid-β. During neurodegeneration, lipocalin-type prostaglandin D synthase (L-PGDS), a major cerebrospinal fluid (CSF) protein, is reported to act as a chaperone that prevents the neurotoxic aggregation of amyloid-β. L-PGDS is also a CSF biomarker in idiopathic normal pressure hydrocephalus and significantly correlates with tau concentration, age, and age-related brain white matter changes detected by magnetic resonance imaging. To investigate this glymphopathy, we aimed to analyze white matter changes and contributing factors in vivo and their interactions ex vivo. Cerebrospinal tap tests were performed in 60 patients referred for symptomatic ventriculomegaly. Patients were evaluated using an idiopathic normal pressure hydrocephalus grading scale, mini-mental state examination, frontal assessment battery, and timed up-and-go test. The typical morphological features of high convexity tightness and ventriculomegaly were measured using the callosal angle and Evans index, and parenchymal white matter properties were evaluated with diffusion tensor imaging followed by tract-based spatial statistics. Levels of CSF biomarkers, including tau, amyloid-β, and L-PGDS, were determined by ELISA, and their interaction, and localization were determined using immunoprecipitation and immunohistochemical analyses. Tract-based spatial statistics for fractional anisotropy revealed clusters that positively correlated with mini-mental state examination, frontal assessment battery, and callosal angle, and clusters that negatively correlated with age, disease duration, idiopathic normal pressure hydrocephalus grading scale, Evans index, and L-PGDS. Other parameters also indicated clusters that correlated with symptoms, microstructural white matter changes, and L-PGDS. Tau co-precipitated with L-PGDS, and colocalization was confirmed in postmortem specimens of neurodegenerative disease obtained from the human Brain Bank. Our study supports the diagnostic value of L-PGDS as a surrogate marker for white matter integrity in idiopathic normal pressure hydrocephalus. These results increase our understanding of the molecular players in the glymphatic system. Moreover, this study indicates the potential utility of enhancing endogenous protective factors to maintain brain homeostasis.

We modified the Viabahn Open Revascularization Technique for managing extensive internal iliac artery aneurysms concomitant with aortoiliac aneurysms to facilitate the proximal suture with the exclusion of internal iliac artery aneurysms. Preceding open surgery, deployment of the Viabahn stent graft in the superior gluteal artery with coil embolization of the iliolumbar and inferior gluteal arteries was performed. Subsequently, during open surgery, a direct anastomosis between the vascular graft and the Viabahn stent graft was performed. Notably, extensive dissection around the internal iliac arteries was not required. Postoperative computed tomography angiography revealed the patent internal iliac artery branches and complete exclusion of the extensive aneurysms.

Background and Objectives: Integrating large language models (LLMs) such as GPT-4 Turbo into diagnostic imaging faces a significant challenge, with current misdiagnosis rates ranging from 30–50%. This study evaluates how prompt engineering and confidence thresholds can improve diagnostic accuracy in neuroradiology. Methods: We analyze 751 neuroradiology cases from the American Journal of Neuroradiology using GPT-4 Turbo with customized prompts to improve diagnostic precision. Results: Initially, GPT-4 Turbo achieved a baseline diagnostic accuracy of 55.1%. By reformatting responses to list five diagnostic candidates and applying a 90% confidence threshold, the highest precision of the diagnosis increased to 72.9%, with the candidate list providing the correct diagnosis at 85.9%, reducing the misdiagnosis rate to 14.1%. However, this threshold reduced the number of cases that responded. Conclusions: Strategic prompt engineering and high confidence thresholds significantly reduce misdiagnoses and improve the precision of the LLM diagnostic in neuroradiology. More research is needed to optimize these approaches for broader clinical implementation, balancing accuracy and utility.

Summary: Tandem running in ants is a sophisticated form of communication. Precise measurement of movement coordination by the tandem pair can shed light on social interactions. Here, we describe an integrative approach to obtain long movement trajectories of a specific tandem pair within a crowd of ants. We describe a maze-like arena, video recording and editing, and movement tracking. We integrate two pieces of image-based tracking software that have distinct individual assignment strategies. This protocol aids comparative studies of recruitment communication across species.For complete details on the use and execution of this protocol, please refer to Mizumoto et al. (2023)1 and Valentini et al. (2020).2 : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.