Mark Meyer

1,25-Dihydroxyvitamin D regulates expression of the tryptophan hydroxylase 2 and leptin genes: implication for behavioral influences of vitamin D

To investigate vitamin D‐related control of brain‐expressed genes, candidate vitamin D responsive elements (VDREs) at ‐7/‐10 kb in human tryptophan hydroxylase (TPH)2 were probed. Both VDREs bound the vitamin D receptor (VDR)‐retinoid X receptor (RXR) complex and drove reporter gene transcription in response to 1,25‐dihydroxyvitamin D3 (1,25D). Brain TPH2 mRNA, encoding the rate‐limiting enzyme in serotonin synthesis, was induced 2.2‐fold by 10 nM 1,25D in human U87 glioblastoma cells and 47.8‐fold in rat serotonergic RN46A‐B14 cells. 1,25D regulation of leptin (Lep), encoding a serotoninlike satiety factor, was also examined. In mouse adipocytes, 1,25D repressed leptin mRNA levels by at least 84%, whereas 1,25D induced leptin mRNA 15.1‐fold in human glioblastoma cells. Chromatin immunoprecipitation sequencing analysis of the mouse Lep gene in response to 1,25D revealed a cluster of regulatory sites (cis‐regulatory module; CRM) at ‐28 kb that 1,25D‐dependendy docked VDR, RXR, C/EBPp, and RUNX2. This CRM harbored 3 VDREs and single C/EBPβ and RUNX2 sites. Therefore, the expression of human TPH2 and mouse Lep are governed by 1,25D, potentially via respective VDREs located at ‐7/‐10 kb and ‐28 kb. These results imply that vitamin D affects brain serotonin concentrations, which may be relevant to psychiatric disorders, such as autism, and may control leptin levels and affect eating behavior.—Kaneko, I., Sabir, M. S., Dussik, C. M., Whitfield, G. K., Karrys, A., Hseih, J.‐C., Haussler, M. R., Meyer, M. B., Pike, J. W., Jurutka, P. W. 1,25‐dihydroxyvitamin D regulates expression of the tryptophan hydroxylase 2 and leptin genes: implication for behavioral influences of vitamin D. FASEB J. 29, 4023‐4035 (2015). www.fasebj.org

Unicentric Castleman’s disease presenting as a pulmonary mass: A diagnostic dilemma

Patient: Female, 16 Final Diagnosis: Castleman’s Disease Symptoms: Chest pain • cough non-productive Medication: — Clinical Procedure: — Specialty: Oncology Objective: Rare disease Background: Castleman’s disease, or angiofollicular lymphoid hyperplasia, is a rare disorder and can be easily misdiagnosed as lymphoma, neoplasm, or infection. The diagnosis is challenging due to the nonspecific signs and symptoms as well as the rarity of the disease. We present an unusual case of a young girl presenting with an enlarging pulmonary mass that was believed to be infectious in origin. Case Report: A 16-year-old Native American female from Arizona initially presented with occasional non-productive cough and chest pain. Imaging revealed a 3-cm left upper lobe lobulated mass. This mass was thought to be due to coccidioidomycosis and was treated with fluconazole. Follow-up imaging demonstrated growth of the mass to 4.8 cm. The patient underwent a left video-assisted thoracoscopic left upper lobectomy and mediastinal lymphadenectomy. Histopathological examination revealed Castleman’s disease. Conclusions: Pulmonary masses in young patients can be easily misdiagnosed as infections or cancer. We present the case of a 16-year-old female misdiagnosed as having a fungal infection of the lung, which was later revealed to be Castleman’s disease of the left upper lobe.

Unusual presentation of a giant benign inflammatory polyp in the upper esophagus

Highlights • This case report highlights a rare type of esophageal polyps (inflammatory fibroid polyp).• This case report presents a giant esophageal inflammatory fibroid polyp.• This case report represents the second reported case for giant inflammatory fibroid polyps that is originated from the upper esophagus.

First North American 50 cc Total Artificial Heart Experience: Conversion from a 70 cc Total Artificial Heart.

The 70 cc total artificial heart (TAH) has been utilized as bridge to transplant (BTT) for biventricular failure. However, the utilization of 70 cc TAH has been limited to large patients for the low output from the pulmonary as well as systemic vein compression after chest closure. Therefore, the 50 cc TAH was developed by SynCardia (Tucson, AZ) to accommodate smaller chest cavity. We report the first TAH exchange from a 70 to 50 cc due to a fit difficulty. The patient failed to be closed with a 70 cc TAH, although the patient met the conventional 70 cc TAH fit criteria. We successfully closed the chest with a 50 cc TAH.

Laimer's Diverticulum, A Rare True Diverticulum Inferior to the Cricopharyngeus: Report of a Case and Review of the Literature

Hypopharyngeal esophageal diverticula are rare with the most common type being the Zenker’s diverticulum. This diverticulum arises from Killian’s triangle above the cricopharyngeus muscle; however there are two much rarer hypopharyngeal diverticula distinct from the Zenker’s diverticulum, the Killian-Jamieson diverticulum and the Laimer’s diverticulum. We present a 46 year old male with a hypopharyngeal diverticulum inferior to the cricopharyngeus in the posterior midline consistent with a Laimer’s diverticulum, detail our surgical technique, and review the literature on the diagnosis, etiology, and treatment of this rare phenomenon.

Robotic transthoracic first-rib resection for Paget–Schroetter syndrome

OBJECTIVESnFirst-rib resection is a key component in the treatment of Paget-Schroetter syndrome. We report our experience with robotic first-rib resection.nnnMETHODSnPatients diagnosed with Paget-schroetter syndrome underwent thrombolysis followed by robotic first-rib resection. The diagnosis was made by preoperative venography (VA) and magnetic resonance venography. The robot was used to dissect the first rib, disarticulate the costosternal joint and divide the scalene muscles. Success of the first-rib resection was assessed by physical examination, venogram and magnetic resonance venography.nnnRESULTSnEighty-three robotic first-rib resections were performed (49 men and 34 women). The mean age of the patients was 24u2009yearsu2009±u20098.5u2009years. The operative time was 127.6u2009minu2009±u200920.8u2009min. The median hospitalization was 4u2009days. There were no surgical complications, neurovascular injuries or mortality. Patients with a patent subclavian vein on the postoperative venogram (57 of 83 patients, 69%) were anticoagulated with warfarin for 3u2009months. In the remaining 27 patients with a persistent postoperative occlusion of the subclavian vein, 21 (21 of 83 patients, 24%) underwent angioplasty and were anticoagulated with warfarin for 3u2009months, and 6 (6 of 83, 7%) required stent placement to achieve complete vein patency. Patients who underwent stent placement received antiplatelet therapy in addition to warfarin anticoagulation for 3u2009months. At a median follow-up of 24u2009months, all patients had an open subclavian vein with a patency rate of 100%.nnnCONCLUSIONSnThe robotic transthoracic first-rib resection is feasible and allows for a minimally invasive resection of the first rib, while minimizing neurovascular complications.

Long-term results of robotic anatomical segmentectomy for early-stage non-small-cell lung cancer

OBJECTIVESnAnatomical segmentectomy is advocated for curative resection in select patients. We investigated the long-term results of robotic anatomical segmentectomy with mediastinal nodal dissection in patients with early-stage lung cancer.nnnMETHODSnWe retrospectively reviewed patients who underwent robotic anatomical segmentectomy for early-stage non-small-cell lung cancer (NSCLC). The follow-up data were obtained to determine survival and statistically significant risk factors in both univariable and multivariable models.nnnRESULTSnSeventy-one patients had clinical stage I NSCLC (36 men, 35 women, mean age 70u2009±u200912u2009years). All patients underwent R0 resection. The mean operating time was 134u2009min. Ten of 71 (14%) patients were upstaged. Eight of 71 (11%) patients were upstaged due to the size of tumour in the pathological specimen, and 2 of 71 (3%) patients were upstaged due to microscopic N2 nodal metastasis. Median hospitalization was 4u2009days (2-31u2009days). Complication rate was 29%. There were no complications attributable to the surgical robot. No patient died within 90u2009days. Mean follow-up was 54u2009months (range 2u2009months to 9u2009years). The overall 5-year survival was 43%, whereas lung cancer-specific 5-year survival was 55%. The 5-year lung cancer-specific survival for pathological stage I disease was 73%. Local or mediastinal recurrence occurred in 4 of 71(5%) patients. Pathological upstaging or recurrence resulted in 0% 5-year survival. The univariable and multivariable analyses showed that advanced age and pathological upstaging were statistically significant risk factors for lung cancer-specific death.nnnCONCLUSIONSnRobotic anatomical segmentectomy with mediastinal nodal dissection is a safe and feasible procedure. Accurate preoperative clinical staging is of critical importance for long-term survival.

Unilateral robotic hybrid mini-maze: a novel experimental approach.

A complete Cox maze IV procedure is difficult to accomplish using current endoscopic and minimally invasive techniques. These techniques are hampered by inability to adequately dissect the posterior structures of the heart and place all necessary lesions. We present a novel approach, using robotic technology, that achieves placement of all the lesions of the complete maze procedure.