Summary: Increased liver stiffness and insulin resistance are important therapeutic targets in patients with nonalcoholic fatty liver disease (NAFLD). A hybrid training system (HTS) has been developed which combines application of electrical stimulation and volitional contractions. We compared the effect of walking exercise (5.6 km/h) both with and without simultaneous HTS on liver stiffness and insulin resistance. In a single-blind, controlled trial, 32 subjects with NAFLD were randomized to 12 weeks of triweekly 30 minute walking exercise with either HTS (HTS group) or without HTS (control group). Transient elastography for the assessment of liver stiffness, body weight, visceral fat, the homeostasis model assessment of insulin resistance, fasting blood glucose, serum aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase were evaluated. Data were evaluated using the linear model after adjusting the baseline value. In the subjects with BMI of 27 kg/m² or more, the decrement of transient elastography in the HTS group was significantly larger than in the control group (mean ± standard error: Δ2.13 ± 0.64 kPa vs. Δ-0.67 ± 0.42 kPa, p=0.0009). There were no significant differences between groups in other endpoints. These results showed that simultaneously combining electrical stimulation with walking exercise could potentially improve liver stiffness in people who have NAFLD. In fact, because the exercise effect was increased by HTS without increasing the walking speed, this HTS could be especially useful for obese or overweight subjects, in whom NAFLD and joint problems often coexist. However, its effects on insulin resistance and body composition were not clear.

Summary: Background: Recent progress of cancer therapy has increased the number of cancer survivors, in whom cardiovascular diseases (CVDs) have become a big concern. This study aimed to clarify the prevalence of various types of CVDs in cancer patients, using the database of the Cardiovascular Medicine in Kurume University Hospital.

Methods and Results: This retrospective cohort study enrolled 11,093 hospitalized patients in Cardiovascular Medicine, Kurume University Hospital from April 2011 to March 2019. Among 11,093 enrolled patients, there were 992 CVDs patients with cancer (8.94%). The five most prevalent forms of cancer were colon cancer, prostate cancer, hepatocellular carcinoma, lung cancer, and gastric cancer. Although there was no statistical significance, the comorbidity of breast cancer gradually increased during the study period (2011-2018). In all CVDs, prostate cancer, lung cancer, and uterine cancer tended to increase as comorbidities, while hepatocellular carcinoma and tongue cancer tended to decrease during the observational period. The absolute number of patients with cancer increased in all CVDs, including coronary artery diseases, heart failure, arrhythmia, and pulmonary hypertension.

Conclusions: The present study demonstrates that the prevalence of cancer in hospitalized CVDs patients was around 10%, and is showing a tendency to increase. Thus, cancer may have substantial impacts on CVDs treatment.

Summary: Objective: The aim of this study is to evaluate the utility of adjuvant radiotherapy (intraoperative radiotherapy, IORT; postoperative radiotherapy, PORT), and definitive radiotherapy for non-metastatic pancreatic cancer.

Methods: Ninety-nine patients were analyzed. Thirty patients underwent IORT with surgery, 31 underwent PORT after surgery, and 38 underwent definitive radiotherapy. Tumor stage [Union for International Cancer Control (UICC) 2009] was as follows: Stage I, 7; IIA, 16; IIB, 31; III, 45. The doses for IORT, PORT, and definitive radio therapy were 20 to 30, 40 to 64.6, and 50.4 to 61.2 Gy, respectively. Associations between clinical parameters including age, gender, tumor site, stage, performance status, surgical margin, and use of chemotherapy and local control (LC) or overall survival (OS) were analyzed.

Results: Follow-up periods for all patients were 1.1-145 months (median, 11). OS rate in the IORT, PORT, and definitive radiotherapy groups was 22%, 16%, and 6%, respectively, at 2 years. The 5-year OS rate was 13%, 3.2%, and 0%, respectively. Local control rate at 2 years was 33%, 35%, and 0%, respectively. No Grade ≥ 3 tox icities were observed. Distant metastasis was less common in the IORT group. Stage and surgical margin were sig nificant factors for OS after IORT. Performance status and chemotherapy were significant factors for OS after PORT and definitive radiotherapy.

Conclusions: The present study showed the safety of the three treatment modalities, but the outcomes were not satisfactory. More intensive strategies including radiotherapy should be investigated.

Summary: The Polycomb group protein (PcG) SUZ12 forms Polycomb repressive complexes together with histone methyltransferase EZH2. Although the complexes have been demonstrated to be involved in epigenetic maintenance of gene expression in a transcriptional repressive state, it is unclear how they are recruited to the target genes. Here we report that SUZ12 directly interacts with site-specific transcriptional repressor E2F6 and forms a complex together with EZH2. SUZ12 interacts with E2F6 selectively among the E2F family proteins and E2F6- containing SUZ12-EZH2 complex was biochemically purified from HEK293 cells stably expressing Flag-tagged SUZ12. Chromatin immunoprecipitation assays revealed the target genes of the E2F6-SUZ12-EZH2 complex. Contrary to expectation, the promoter regions of these genes are not or only weakly tri-methylated at histone H3-K27, and their expression is down-regulated by depletion of EZH2. Given that the transactivation function of SUZ12-EZH2 has been previously reported, the inhibitory effect on E2F6-mediated transcriptional repression by physical interaction can be considered a candidate mechanism of gene activation by these PcGs.

Summary: The foramen magnum is an important structure of the skull base. A unique foramen magnum with posterior notching was found in an adult male skull, around 60 years old at death. The posterior notch was roughly V-shaped and resulted in posterior elongation of the foramen magnum. Variants such as described herein should be kept in mind when interpreting radiological imaging or operating on patients.

Summary: The infraorbital canal serves as a conduit for the infraorbital nerve. The canal travels anteriorly beneath the globe where it emerges onto the face at the infraorbital foramen. Variations in the morphology of the infraorbital canal have been reported and classified based on their relationship with the maxillary sinus. Similarly to the other orbital fat compartments, fat in the infraorbital canal serves as protection to the structures it surrounds. Generally, the orbital fat compartments do not undergo hypertrophy without a pathological etiology, therefore, it has been hypothesized that herniations of orbital fat are a result of age-related bony changes in the orbit. The inferior orbital rim, in particular, acts to support structures of the orbit including the fat compartments, ligaments, and muscles. The most commonly reported herniations are those of the infraorbital fat pads, which either prolapse into the inferior orbital fissure or move anteriorly to give patients the appearance of a bulging lower eyelid. Additionally, there are reports of traumatic injuries that result in herniation of the buccal fat pad into the maxillary sinus. Herein, we report a rare case of a herniation of the infraorbital canal fat into the maxillary sinus and review the salient literature.

Summary: We present a case of intestinal malrotation with an absent inferior vena cava, which was found in a cadaver during a dissection course in our medical school. The intestinal malrotation was Amir–Jahed type 2, with the large intestine on the right side and the small intestine on the left side of the abdominal cavity. The descending colon was fixed on the right side of the posterior abdominal wall and continued into the pelvic cavity from the right side. The cadaver also had a venous system anomaly. The pre-renal segment of the inferior vena cava, which is a section between the renal vein and the hepatic vein, was absent. The inferior vena cava connected to the azygos vein after being joined by bilateral renal veins. The only hepatic segment of the inferior vena cava, which was posterior to the liver and received hepatic veins, penetrated the diaphragm and flowed into the right atrium. To our knowledge, this is the first report of these two anomalies appearing concurrently. We discuss the details of this case and the embryological considerations.