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We present a case of a thoracic schwannoma with an intravertebral component, a so-called "dumbbell-type" tumor, that was resected with a combined minimally invasive approach using microsurgery and thoracoscopic surgery simultaneously. A 31-year-old man was admitted to our hospital for treatment of a thoracic schwannoma 45 mm in maximal diameter at the level of the third thoracic vertebra. After the tumor was separated from intravertebral structures by using a microsurgical technique via the posterior approach with a hemilaminectomy and minimal unilateral facetectomy, the mass was removed completely by using video thoracoscopy. We stress that this approach should be the most useful and less invasive technique for treating the dumbbell-type of thoracic neurogenic tumor compared with a single or combination technique involving thoracotomy, multi-level laminectomy and costotransversectomy. Below, we make some notes on this technique from the neurosurgeon's standpoint.

Background Although COVID-19 severity in cancer patients is high, the safety and immunogenicity of the BNT162b2 mRNA COVID-19 vaccine in patients undergoing chemotherapy for solid cancers in Japan have not been reported. Methods We investigated the safety and immunogenicity of BNT162b2 in 41 patients undergoing chemotherapy for solid cancers and in healthy volunteers who received 2 doses of BNT162b2. We evaluated serum IgG antibody titers for S1 protein by ELISA at pre-vaccination, prior to the second dose and 14 days after the second vaccination in 24 cancer patients undergoing cytotoxic chemotherapy (CC group), 17 cancer patients undergoing immune checkpoint inhibitor therapy (ICI group) and 12 age-matched healthy volunteers (HV group). Additionally, inflammatory cytokine levels were compared between the HV and ICI groups at pre and the next day of each vaccination. Results Anti-S1 antibody levels were significantly lower in the ICI and CC groups than in the HV group after the second dose (median optimal density: 0.241 [0.063–1.205] and 0.161 [0.07–0.857] vs 0.644 [0.259–1.498], p = 0.0024 and p < 0.0001, respectively). Adverse effect profile did not differ among the three groups, and no serious adverse event occurred. There were no differences in vaccine-induced inflammatory cytokines between the HV and ICI groups. Conclusion Although there were no significant differences in adverse events in three groups, antibody titers were significantly lower in the ICI and CC groups than in the HV group. Further protection strategies should be considered in cancer patients undergoing CC or ICI.

lobal left ventricular systolic and diastolic functions in patients with coronary artery disease (CAD) are traditionally assessed as important clinical and prognostic parameters. Several studies have recently demonstrated, by using non-invasive techniques including echocardiography, magnetic resonance imaging and radionuclide ventriculography, that the assessment of regional myocardial function provides important diagnostic and prognostic information in addition to that provided by global assessment alone. [1][2][3][4][5][6] It has been shown that the indices of global left ventricular systolic and diastolic functions are associated with each other, but the relationship between regional myocardial contraction and relaxation remains unknown.Echocardiographic tissue Doppler strain rate (SR) imaging is a new means of information about regional myocardial function that uses tissue velocity data to calculate velocity gradients between 2 distinct points along an ultrasound beam. It is therefore theoretically less susceptible than tissue velocity imaging to cardiac translational motion and to myocardial tethering. Thus, SR imaging might be Circulation Journal Vol. 71, April 2007 able to analyze regional myocardial function more appropriately than tissue velocity imaging. [7][8][9][10][11] Wall motion score is a parameter of regional left ventricular systolic function and the wall motion score index, which is an average of wall motion scores among assessable segments, and correlates with left ventricular ejection fraction (LVEF). 12,13 In contrast, whether SR indices of regional myocardial function are associated with whole left ventricular function has not been clarified.The present study aimed to assess the relationship between regional myocardial systolic and diastolic function in patients with CAD using SR imaging. We also evaluated whether SR imaging findings of regional myocardial contraction and relaxation reflect global left ventricular systolic and early diastolic function, respectively. Methods Study PopulationFifty patients with CAD were eligible for recruitment into the present study. Patients with heart failure, valvular or congenital heart disease were excluded. All patients were successfully treated with a prior balloon angioplasty and intracoronary stenting, and had no ischemic myocardial segments defined as a reversible myocardial perfusion defect as indicated by exercise or adenosine triphosphate stress technetium-99m tetrofosmin single-photon emission computed tomography. Of these patients, 5 were excluded because of inadequate echocardiographic image quality.

This randomized clinical trial investigates the effect of 15-mg edoxaban in patients aged 80 years and older who are not candidates for standard-dose oral anticoagulants owing to bleeding risk.