Measurements of insulin-like growth factor-I (IGF-I) are useful not only for diagnosis and management of patients with growth hormone (GH)-related disorders but also for assessing nutritional status. ...We reported population-based references of serum IGF-I in 1996. However, they did not properly reflect data in the transition period from puberty to maturity. The aim of the present study was to re-establish a set of normative data for IGF-I for the Japanese population. The study included 1,685 healthy Japanese subjects (845 males, 840 females) from 0 to 83 years old. Subjects suffering from diseases that could affect IGF-I levels were excluded. Obese or extremely thin adult subjects were also excluded. IGF-I concentrations were determined by commercially available immunoradiometric assays. The reference intervals were calculated using the LMS method. Median IGF-I levels reached 310 ng/mL in males at the age of 14 years and 349 ng/mL in females at the age of 13 years, falling to 124 ng/mL and 103 ng/mL, respectively, by the age of 70 years. The mean pretreatment IGF-1 SD scores in patients with severe GH deficiency (GHD) obtained from the database of the Foundation for Growth Science and from clinical studies for adult GHD were -2.1±1.6 and -4.9±2.5, respectively. The present study established age- and gender-specific normative IGF-I data for the Japanese population and showed the utility of these references for screening patients with severe GHD.
The formation of linear hydrocarbon chains by sequential coupling of C1 units on the metal surface is the central part of the Fischer–Tropsch (F-T) synthesis. Organometallic complexes have provided ...numerous models of relevant individual C–C coupling events but have failed to reproduce the complete chain lengthening sequence that transforms a linear C n hydrocarbon chain into its C n+1 homologue in an iterative fashion. In this work, we demonstrate stepwise growth of linear C n hydrocarbon chains and their conversion to their C n+1 homologues via consecutive addition of CH2 units on a molecular diruthenium carbide platform. The chain growth sequence is initiated by the formation of a μ-η1:η1-CCH2 ligand from a C + CH2 coupling between the μ-carbido complex (Cp*Ru)2(η-NPh)(μ-C) (1; Cp* = η5-C5Me5) and Ph2SCH2. Then, the chain propagates via a general CCHR + CH2 coupling and subsequent hydrogen-assisted isomerization of the resulting allene ligand μ-η1:η3-H2CCCHR to a higher vinylidene homologue μ-η1:η1-CCH(CH2)R. By repeating this reaction sequence, up to C6 chains have been synthesized in a stepwise fashion. The key step of this chain homologation sequence is the selective hydrogenation of the μ-η1:η3-allene unit to the corresponding μ-alkylidene ligand. Isotope labeling and computational studies indicate that this transformation proceeds via the hydrogenation of the allene ligand to a terminal alkene form and its isomerization to the μ-alkylidene ligand facilitated by the coordinatively unsaturated diruthenium platform.
Narrow‐band imaging (NBI) is an optical digital enhancement method that allows the observation of vascular and surface structures of colorectal lesions. Its usefulness in the detection and diagnosis ...of colorectal polyps has been demonstrated in several clinical trials and the diagnostic algorithms have been simplified after the establishment of endoscopic classifications such as the Japan NBI Expert Team classification. However, there were issues including lack of brightness in the earlier models, poor visibility under insufficient bowel preparation, and the incompatibility of magnifying endoscopes in certain endoscopic platforms, which had impeded NBI from becoming standardized globally. Nonetheless, NBI continued its evolution and the newest endoscopic platform launched in 2020 offers significantly brighter and detailed images. Enhanced visualization is expected to improve the detection of polyps while universal compatibility across all scopes including magnifying endoscopy will promote the global standardization of magnifying diagnosis. Therefore, knowledge related to magnifying colonoscopy will become essential as magnification becomes standardly equipped in future models, although the advent of computer‐aided diagnosis and detection may greatly assist endoscopists to ensure quality of practice. Given that most endoscopic departments will be using both old and new models, it is important to understand how each generation of endoscopic platforms differ from each other. We reviewed the advances in the endoscopic platforms, artificial intelligence, and evidence related to NBI essential for the next generation of endoscopic practice.
With advancement of cancer treatment and development of neuroimaging techniques, contemporary clinical pictures of pituitary metastases (PMs) must have changed from past reports. The goal of this ...paper was to elucidate the clinical features of PMs and current clinical practice related to those lesions. In this retrospective study, questionnaires were sent to 87 physicians who had treated PMs in Japan.
Between 1995 and 2010, 201 patients with PMs were treated by the participating physicians. The diagnosis of PM was histologically verified in 69 patients (34.3%). In the other 132 patients (65.7%), the PM was diagnosed by their physicians based on neuroimaging findings and clinical courses. The most frequent primary tumor was lung (36.8%), followed by breast (22.9%) and kidney (7.0%) cancer. The average interval between diagnosis of primary cancer and detection of PM was 2.8 ± 3.9 (SD) years. Major symptoms at diagnosis were visual disturbance in 30.3%, diabetes insipidus in 27.4%, fatigue in 25.4%, headache in 20.4%, and double vision in 17.4%. Major neuroimaging features were mass lesion in the pituitary stalk (63.3%), constriction of tumor at the diaphragmatic hiatus (44.7%), hypothalamic mass lesion (17.4%), and hyperintensity in the optic tract (11.4%). Surgical treatment was performed in 26.9% of patients, and 74.6% had radiation therapy; 80.0% of patients who underwent radiotherapy had stereotactic radiotherapy. The median survival time was 12.9 months in total. Contributing factors for good prognosis calculated by Cox proportional hazard analysis were younger age, late metastasis to the pituitary gland, smaller PM size, and radiation therapy. The Kaplan-Meier survival was significantly better in patients with breast cancer and renal cell cancer than in those with lung cancer.
At the time of this writing, approximately 60% (120/201) of PMs had been treated by stereotactic radiation therapy in Japan. The median survival time was much longer than that reported in past series. To confirm the changes of clinical features and medical practice, a prospective and population-based survey is mandatory.
In 2017, WHO published an updated classification of the pituitary adenomas according to the lineages defined by the transcription factors, PIT1, SF1 and TPIT. Nomenclature of the pituitary tumors ...follows the mature cell types such as somatotroph (GH), lactotroph (LH), thyrotroph, corticotroph, and gonadotroph (FSH, LH). Null cell adenomas are defined by the absence of expression of any hormones and transcription factors. Not infrequently, the pituitary adenomas are invasive to the adjacent structures and are designated as aggressive adenomas. Knosp grading is often used to define the aggressiveness of the tumor. Sparsely granulated somatotroph adenomas and Crooke cell corticotroph adenomas are representative aggressive adenomas. Recently, genomics regarding various adenomas have been clarified, such as GNAS for somatotrophs and USP8 for corticotrophs. Familial pituitary adenomas are another aspect which has been clarified such as MEN1, Carney’s complex, familial isolated pituitary adenoma and McCune-Albright syndrome. The pituitary adenomas often produce GH or PRL, hormones of PIT1 transcription factor. It has been agreed that the pituitary adenomas share the characteristics of neuroendocrine neoplasms. The terminology of pituitary neuroendocrine tumor has been discussed. This review article covers various aspects of pituitary adenomas.
The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral ...and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel’s cave, parapharyngeal space, infratemporal fossa, etc. To gain access to the upper lateral skull base, a simple opening of the ethmoid sinus provides sufficient exposure of this area. To reach the lower lateral skull base, a transpterygoid approach, following ethmoidectomy, is a key procedure providing wide exposure of this area. Understanding of surgical anatomy is mandatory for treating ventrolateral skull base lesions via EEA. An appropriate, less-invasive approach should be applied depending on the size, location, and type of lesion.
Background and Aim
Accurate polyp size estimation is necessary for appropriate management of colorectal polyps. Polyp size is often determined by subjective visual estimation in clinical situations; ...however, it is inaccurate, especially for beginner endoscopists. We aimed to clarify the usefulness of our short training video, available on the Internet, for accurate polyp size estimation.
Methods
We conducted a multicenter prospective controlled study in Japan. After completing a pretest composed of near and far images of 30 polyps, participants received the educational video lecture (<10 min long). The educational content included the knowledge of strategies based on polyp size and criteria for size estimation including the endoscopic equipment size and videos of polyps in vivo. After one month, the participants undertook a posttest. The primary outcome was a change in the accuracy of polyp size visual estimation between the pretest and posttest in beginners.
Results
Participants including 111 beginners, 52 intermediates, and 97 experts from 51 institutions completed both tests. Accuracy of polyp size estimation in the beginners showed a significant increase after the video lecture 54.1% (51.3–57.0%) to 59.0% (56.5–61.5%), P = 0.003. Multivariable logistic regression analysis showed that the category of beginners and a low score on pretest (P = 0.020 and <0.001, respectively) were the factors that contributed to an increase of ≥10% in the accuracy.
Conclusion
Our educational video led to an improvement in polyp size estimation in beginners. Furthermore, this video may be useful for non‐beginners with insufficient polyp size estimation accuracy.
Angiogenesis plays a crucial role in tumor growth. Recently, endocan has emerged as a new marker of vascular endothelial cells from cancers in other organs. In this study, we elucidated the ...relationship between endocan expression and tumor invasion of pituitary adenoma. Tumor tissues were obtained from 70 patients with pituitary adenoma and were examined using fluorescence immunohistochemistry. Tissue samples included 4 adrenocorticotrophic hormone producing adenomas, 10 growth hormone-producing adenomas, 49 clinically nonfunctioning adenomas, 6 prolactin producing adenomas, and 1 thyroid-stimulating hormone producing adenoma. Endocan was exclusively expressed in CD34-positive vascular endothelial cells, with over 90 % colocalization. The CD34 expression was significantly elevated with endocan expression (linear regression slope, 1.200; r
2
= 0.268, F = 23.08,
p
< 0.0001). As a percentage of CD34 expression, endocan expression was elevated in a Knosp grading dependent manner (Spearman’s r-value, 0.651;
p
< 0.0001), and was also significantly elevated in macroadenomas compared with microadenomas (
p
= 0.0133). However, no differences in endocan expression were observed between hormonal subtypes (
p
= 0.066; Kruskal–Wallis test), age (Spearman’s rank correlation test,
p
= 0.4909), or sex (Mann–Whitney test,
p
= 0.1701). These data show that endocan is closely related to tumor angiogenesis, and may predict tumor invasion into neighboring cavernous sinuses in pituitary adenomas.
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