Adenosquamous carcinoma(ASqC) and undifferentiated carcinoma(UC) of the pancreas are rare, and thus we do not clearly know their biological characteristics. We therefore conducted a clinicopathological study of 17 patients with ASqC or UC to investigate their clinical features, imaging findings, histopathological findings of resected specimens, and prognostic factors. The subjects were 9 patients (11.1%) with ASqC and 8 (9.9%) with UC among 81 patients with invasive ductal carcinoma. Mean survival time was 16.3±5.0 months in the patients with ASqC and 12.4±5.6 months in those with UC. Analysis of prognostic factors revealed that survival was shorter in the patients with confluent multinodular type than in those with simple nodular type (5.0±2.4 vs. 18.4±4.8 months, P = 0.039) in patients with stage IVb rather than stage III or IVa cancer (6.2±2.9 vs. 19.4±5.2 months, P = 0.026). Survival tended to be slightly shorter in patients who had recurrence within 6 months. Histopathological findings of immunostaining revealed that all 17 patients were positive with CK7 (a marker for adenocarcinoma) in all 17 patients. ASqC and UC were suggested to be differentiated from adenocarcinoma. They are known to have a poorer outcome than common pancreatic cancer, but may be associated with a relatively good outcome in some patients.

Background: Intra-plaque hemorrhage in carotid atheromatous plaque is a recognized high-risk state for ischemic events. Intra-plaque neovascularization can now be visualized by contrast-enhanced carotid ultrasonography (CEUS). These neovessels appear prone to rupture and may be a marker for high-risk of intra-plaque hemorrhage. This study aimed to investigate relationships among circulating biomarkers associated with carotid plaque instability and the presence of intra-plaque hemorrhage on magnetic resonance imaging (MRI) and intra-plaque neovascularization on CEUS in patients with advanced atherosclerotic plaques.
Methods: Fifty-one patients with mild to severe carotid stenosis were prospectively enrolled, and carotid ultrasonography, CEUS, and MRI were performed. Circulating levels of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), pentraxin 3 (PTX3), myeloperoxidase (MPO), matrix metalloproteinase (MMP)-9, and high-sensitivity- C-reactive protein (hs-CRP) were also measured.
Results: Carotid plaques were categorized into 3 groups based on MRI findings: fibrous tissue, n=13; lipid/necrotic core, n=30; and intra-plaque hemorrhage, n=8. Regarding plaque echogenicity, 24 plaques were hypoechoic, and 27 were non-hypoechoic. Intra-plaque neovascularization on CEUS was observed in 14 plaques. Multivariate logistic regression analysis identified hypoechoic plaque (odds ratio, 63.126; 95% confidence interval, 1.102–3616.91) and serum hs-CRP (1.064; 1.002–1.130) as factors significantly associated with intra-plaque hemorrhage. Hypoechoic plaque (30.362; 2.462–374.37), and serum hs-CRP (1.066; 1.003–1.132) were revealed as factors significantly associated with intra-plaque neovascularization.
Conclusions: Hypoechoic plaque and hs-CRP levels were identified as common predictors of intra-plaque hemorrhage and intra-plaque neovascularization. Longitudinal studies are warranted to clarify the roles of intra-plaque neovascularization on CEUS and hs-CRP levels in intra-plaque hemorrhage and ischemic stroke.

Background and Purpose: Several salivary markers have been utilized to evaluate acute or chronic psychological stress in various conditions. However, the clinical utility of these biomarkers in acute stroke patients remains uncertain. The aim of this study was to investigate changes in salivary stress markers related to acute stroke, both in conscious and unconscious patients, to assess the feasibility of using salivary stress markers in acute stroke patients.
Subjects and Methods: A total of 27 patients with acute ischemic stroke (AIS) as shown on diffusion magnetic resonance imaging (MRI) (mean age, 67.7 ± 12.9 years; 19 males, 70.4%) and 11 control subjects were studied. Saliva was collected from patients with AIS within 24 hours after onset (Day-1), followed by serial collection at Day-4 and Day-7 using a polymer roll saturation method. Salivary concentrations of immunoglobulin A (IgA), cortisol, alpha-amylase, and dehydroepiandrosterone (DHEA) were measured by the enzyme-linked immunosorbent assay. The patients were divided into two groups based on their level of consciousness as evaluated by the National Institutes of Health Stroke Scale (NIHSS) on admission: the alert group (n=20) and the unconscious group (n=7). Motor activity on Day-1 was classified into three categories: in bed, sitting out of bed, and higher motor activity. A multiple linear regression model was used to determine independent factors associated with changes in salivary stress markers.
Results: Salivary IgA and cortisol in patients with AIS at Day-1 were significantly higher than in controls (p=0.004 in IgA; p=0.002 in cortisol), and salivary amylase at Day-1 was significantly lower (p=0.049). Salivary IgA was significantly correlated with the NIHSS score (r=0.534, p=0.004) and with initial infarct volume as determined by diffusion MRI (r=0.606, p=0.001). There were no significant serial changes in any of the salivary stress markers. Multiple linear regression analyses demonstrated that motor activity levels in patients without consciousness disturbance was significantly associated with salivary IgA levels.
Conclusions: This exploratory study demonstrated the potential utility of salivary IgA in acute ischemic stroke patients. Further studies are warranted to explore the relationship between salivary IgA and the impact of psychological stress on acute ischemic stroke patients.

[Objective]
Recognizing that the safety and efficacy of laparoscopic surgery for rectal cancers have not been fully established, we conducted a retrospective study to determine whether the percentage of the pelvic cavity occupied by a rectal tumor affects the difficulty of laparoscopic rectal surgery or the occurrence of postoperative complications.
[Methods]
Our study involved 100 patients with rectosigmoid (Rs), upper rectal (Ra), or lower rectal (Rb) cancer treated by laparoscopic surgery at our hospital. Pelvic volume (PV), rectal volume (RV), tumor volume (TV), and respective percentages of the pelvic cavity they occupied were determined on the basis of preoperative computed tomography colonography (CTC) reconstruction images. We analyzed the relation between these percentages and the time to resection, blood loss volume, and number of staples used on the rectal stump (as measures of surgical difficulty) and anastomotic leakage (as a postoperative complication).
[Results]
Univariate analysis revealed significant differences in age (P = 0.009), PV (P = 0.012), TV (P = 0.042), percentage of the pelvic cavity occupied by the tumor (P = 0.011), and percentage of the pelvic cavity by the tumor and rectum together (P = 0.003) in all patients who developed anastomotic leakage and those who did not. Significant differences were also found in PV (P = 0.029) and in the percentage of the pelvic cavity occupied by the tumor and rectum together (P = 0.041) between the Ra patients in whom anastomotic leakage occurred and those in whom it did not occur. The blood loss volume and number of staples used differed significantly between the high-percentage occupancy group and low-percentage occupancy group (P = 0.050 and P = 0.001, respectively). Further, the number of staples used differed significantly between the high-percentage occupancy Ra group and low-percentage occupancy Ra group (P = 0.019). The data point to increased surgical difficulty and to an increased risk of anastomotic leakage when the percentage of the pelvic cavity occupied by the tumor is high.
[Conclusion]
The percentages of the pelvic cavity occupied by the tumor and rectum are factors that influence surgical difficulty and the occurrence of complications and should be taken into consideration during the planning stages to ensure safe laparoscopic rectal cancer surgery.

Background: Pulmonary perfusion scintigraphy is a useful method to assess improvements in airflow limitation. However, the number of institutions equipped with pulmonary perfusion scintigraphy equipment is limited. Computed tomography (CT) scans are quick to perform and can be performed in severe cases. Recently, it has been reported that the percentage of the cross-sectional area of pulmonary small vessels (%CSA<5) can be measured by analyzing CT images that correlate with the radionuclide uptake rate shown by pulmonary perfusion scintigraphy.
Methods: We retrospectively reviewed CT scans of 14 patients with unilateral bronchial obstruction due to malignant disease to measure the %CSA<5 before and after interventional bronchoscopy using the semi-automatic image-processing program (ImageJ). In 5 cases, we examined the correlation between the %CSA<5 and the radionuclide uptake rate visualized by pulmonary perfusion scintigraphy.
Results: The %CSA<5 in the obstructed side of the lung after treatment displayed significant improvements after intervention (p = 0.04). Among the 5 cases that underwent pulmonary perfusion scintigraphy before and after the treatment, the radionuclide uptake rate of the obstructed side improved in all patients, whereas the %CSA<5 improved in 4 of the 5 patients.
Conclusion: Measurement of the %CSA<5 might be useful to assess the outcome of interventional bronchoscopy.

At our hospital, we have been using the criteria reported by Watanabe et al. to determine the treatment plan for patients with of perforated gastroduodenal ulcers to determine whether they should undergo surgery. Between April 2003 and March 2015, we evaluated 117 cases of perforation, and among these, we selected conservative treatment for 14 cases. One of these 14 cases required conversion to surgery. Although we selected surgical treatment in 103 cases, at surgery, the perforation was already covered in 19 cases. The Watanabe score was found to have a sensitivity of 0.99 and specificity of 0.41, and none of the cases judged using this scoring method had perforation as a cause of death. We have therefore determined the validity of the Watanabe score. However, we believe that we performed an excessive amount of surgery as we found some cases in which the perforation was already covered and therefore could have been managed conservatively. To avoid this, we have proposed the following new scoring system, which uses coefficients to provide weighting during logistic regression analysis for the four items found to have a significant difference in terms of their Watanabe scores. The formula is calculated as: 0.36 + 1.29 [if symptoms of peritoneal irritation are limited to the epigastrium] + 0.92 [if no severe concomitant disease] + 0.80 [if duration is less than 6 hours from the time of onset to initial examination] + 0.63 [if progression of ascites is limited to the epigastrium]. If the total score is 2.08 or greater, then conservative treatment is selected. This new scoring system not only decreases the number of items evaluated when compared to the Watanabe system, but with a sensitivity of 0.94 and specificity of 0.63, it may also provide a more definitive method for determining the treatment plan.

Aim: The aim of the present study was to evaluate the effects of radiation dose reduction and iterative reconstruction protocols on coronary artery calcium (Agatston) scores using a pulsating cardiac phantom.
Materials and Methods: We used a pulsating cardiac phantom containing three calcified cubes of different sizes (3-mm diameter: small, 4-mm diameter: medium, and 5-mm diameter: large) and four calcified hydroxyapatite cubes of varying density in order to model coronary artery calcification: 5% (44HU), 15% (233HU), 25% (586HU), and 35% (792HU). Images were acquired with a 320-slice MDCT (Aquilion ONE ViSION Edition, Toshiba, Nasu, Japan), using ECG gated volume scans with tube potential:120kV, 275 ms rotation time, 60, 70, 100, 150 and 240mA tube current. The Agatston scores at all dose variations in all five reconstruction methods (filtered back projection [FBP] and adaptive iterative dose reconstruction [AIDR3D]: Weak, Mild, Standard, and Strong) for all three phantom sizes were compared to the reference dose protocol reconstructed with FBP.
Results: When the FBP and AIDR 3D: Weak protocol were used, Agatston scores significantly increased in all phantom sizes as doses of radiation decreased (p<0.001). When the AIDR3D: Mild, Standard, and Strong protocols were used, no significant differences in Agatston scores were observed for any phantom size among different radiation dose protocols. For all radiation dose protocols, Agatston scores significantly decreased as IR levels increased (p<0.003, respectively). When AIDR 3D: Mild was used, no significant differences in Agatston scores were observed between IR and FBP protocols for any phantom size.
Conclusions: The AIDR3D: Mild protocol allowed for significant reductions in radiation dose relative to standard FBP protocols, without influencing Agatston scores. Therefore, evaluation of CAC score using a combination of low-dose radiation and IR may present a reliable alternative to conventional CAC scoring.

Purpose: Taxane-based combination chemotherapy remains the predominant treatment for breast cancer. However, taxane-related drug resistance and neurotoxicity have prompted us to develop substitute treatment strategies. Kinesin spindle protein (KSP), which is essential for formation of the bipolar mitotic spindle and cell cycle progression through mitosis, has been identified as an attractive target for cancer chemotherapy. We investigated, both in vitro and in vivo, the anti-cancer effect of KPYB10602, a novel KSP inhibitor, in breast cancer.
Materials and Methods: Anti-proliferative activity of KPYB10602 in breast cancer cells was assessed by cell viability assay. The anti-cancer effect and inhibitory mechanism of KPYB10602 in breast cancer cells was further explored by immunofluorescence microscopy, flow cytometry, ELISA, and western blotting. In addition, the anti-tumor effect of KPYB10602 was evaluated in subcutaneous xenograft models.
Results: KPYB10602 showed anti-cancer activity in breast cancer cells. The KPYB10602 treatment was shown to result in induction of mitotic arrest with monopolar spindle formation and then apoptotic cell death. This might occurred via a mitochondria-mediated pathway. KPYB10602 also effectively suppressed tumor growth in a subcutaneous xenograft model.
Conclusion: KSP is a good target for breast cancer chemotherapy, and KPYB10602 has a potential as a novel anti-cancer agent for breast cancer.

Background: The rate of disease progression differs among patients with degenerative cerebellar ataxia.
Purpose: We determined the annual cerebellar volume atrophy rate with magnetic resonance imaging (MRI) and disease progression in ataxia with the International Cooperative Ataxia Rating Scale (ICARS) according to the subtype of cerebellar degeneration using longitudinal follow-up data.
Methods: We examined 50 patients consisting of 22 cases of spinocerebellar ataxia (SCA), 17 cases of multiple system atrophy (MSA), and 11 cases of cortical cerebellar ataxia (CCA). In all patients, at least two sets of evaluations including MRI and ICARS scoring were performed. A total of 146 sets of evaluations was obtained with the longest follow-up period being 77 months. The cerebellar volume of all patients (ml) was divided by each cranial AP diameter (mm) to correct for the individual head size differences as a volume index (Vdx). The annual atrophy volume in Vdx and the annual progression in the ICARS were calculated in each patients.
Results: The annual atrophy rates for each subtype were: SCA: 0.027 ± 0.020 ml/mm, MSA: 0.039 ± 0.026 ml/mm, and CCA: 0.019 ± 0.016 ml/mm. There was a significant difference among subtypes (p = 0.049). The ICARS scores (annual progression) were 4.79 ± 3.86, 8.82 ± 3.93, and 2.31 ± 1.96 for SCA, MSA, and CCA, respectively (p = 0.002).The progression in ICARS per decrease in Vdx of 0.01 ml/mm in MSA, SCA and CCA was measured as 5.9 points,1.8 points and 1.4 points, respectively.
Conclusions: The annual atrophy rate and ICARS score (annual progression) were significantly different among subtypes of cerebellar degeneration. MRI-based cerebellar volume measurements can be used as an imaging biomarker for disease progression.

Five years prior to visiting our hospital, an 87-year-old woman had been diagnosed as having Alzheimer’s disease, and cognitive symptoms slowly progressed over the course of 4 years. Cortical signal hyperintensities centered on the bilateral temporal and frontal regions on head diffusion-weighted imaging (DWI) and cerebrospinal levels of 14-3-3 protein were high. Prion protein gene testing showed a mutation in codon 180 from Val to Ile, and the genetic prion disease Creutzfeldt-Jakob disease with V180I mutation was diagnosed. In the course of slowly progressive dementia in the elderly, identification of genetic prion diseases may be facilitated by confirmation of changes in cortical signal hyperintensities on DWI over time.

In this study, we report two cases of appendiceal diverticulitis with perforation. Case 1 was a 50-year-old man who visited our hospital because of epigastralgia and pyrexia. He had rebound tenderness in the right lower abdominal quadrant, as well as an increased inflammatory response observed upon biological examination. Computed tomography revealed an enlarged appendix. He was diagnosed with acute appendicitis, and emergency surgery was performed. Based on pathological examination, he was finally diagnosed with appendiceal diverticulitis with perforation. Case 2 was a woman in her twenties with a chief complaint of lower abdominal pain. She had consulted a nearby gynecologist when she first experienced the pain. She presented to our hospital the next day because her symptoms had not improved, even after taking analgesic drugs. There was muscular defense in the lower abdominal quadrant, as well as an increased inflammatory response. Emergency surgery was performed, and she was diagnosed with appendiceal diverticulitis with perforation based on pathological examination. Although appendiceal diverticulitis is rare, perforation has been reported to occur with it frequently. In addition to describing our two cases, we also provide a review of the literature.