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Understanding factors associated with improvements in subjective shoulder function after arthroscopic rotator cuff repair (ARCR) helps clinicians identify targets for postoperative rehabilitation. The aim of this study was to investigate the factors associated with subjective shoulder function after ARCR.

After arthroscopic rotator cuff repair (ARCR), it is crucial for clinicians to predict the functional recovery in the early postoperative period for considering rehabilitation strategies. The aim of this study was to identify the prognostic factors in the early postoperative period for achieving full recovery of range of motion (ROM) at 6 months after ARCR.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment for relapsed or refractory non-Hodgkin lymphoma (R/R NHL). Allo-HSCT using post-transplant cyclophosphamide (PTCY-haplo) and umbilical cord blood transplantation (uCBT) are important donor options in the absence of matched related siblings. However, the data comparing these two donor sources in R/R NHL are limited. Using the Japanese nationwide transplantation registry data, we identified 857 patients with R/R NHL, including 169 patients who received PTCY-haplo and 688 who received uCBT for their first allo-HSCT between January 2013 and December 2021; 514 patients (60%) had B-cell lymphoma. More PTCY-haplo recipients received allo-HSCT using a reduced-intensity conditioning regimen in recent years. The 3-year overall survival (OS), progression-free survival (PFS), and graft-versus-host disease (GVHD)-free/relapse-free survival (GRFS) rates in the PTCY-haplo and uCBT groups were 44% versus 39% (P= 0.326), 34% versus 33% (P= 0.660), and 19% versus 23% (P= 0.910), respectively; the adjusted hazard ratios for OS, PFS, and GRFS were 0.89 (95% confidence interval: 0.69–1.15, P= 0.373), 0.98 (0.78–1.22, P= 0.852), and 0.92 (0.83–1.21, P= 0.920), respectively. The PTCY-haplo group showed faster neutrophil and platelet engraftment and a lower incidence of grade III-IV acute GVHD. Thus, PTCY-haplo and uCBT could serve as alternative donor sources in patients with R/R NHL.

Although comprehensive genomic profiling has become standard in oncology for advanced solid tumors, the full potential of circulating tumor DNA (ctDNA)-based profiling in capturing tumor heterogeneity and guiding therapy selection remains underexploited, marked by a scarcity of evidence on its clinical impact and the assessment of intratumoral heterogeneity. The GOZILA study, a nationwide, prospective observational ctDNA profiling study, previously demonstrated higher clinical trial enrollment rates using liquid biopsy compared with tissue screening. This updated analysis of 4,037 patients further delineates the clinical utility of ctDNA profiling in advanced solid tumors, showcasing a significant enhancement in patient outcomes with a 24% match rate for targeted therapy. Patients treated with matched targeted therapy based on ctDNA profiling demonstrated significantly improved overall survival compared with those receiving unmatched therapy (hazard ratio, 0.54). Notably, biomarker clonality and adjusted plasma copy number were identified as predictors of therapeutic efficacy, reinforcing the value of ctDNA in reflecting tumor heterogeneity for precise treatment decisions. These new insights into the relationship between ctDNA characteristics and treatment outcomes advance our understanding beyond the initial enrollment benefits. Our findings advocate for the broader adoption of ctDNA-guided treatment, signifying an advancement in precision oncology and improving survival outcomes in advanced solid tumors.

Heating crystal samples of 9,10-diphenylanthracene endoperoxide (1) and its deuterated derivative (1-d10) to 200 °C led to singlet-oxygen chemiluminescence (CL) from the mixtures of the crystalline and molten states. To understand the events in the heated samples, the reactions of 1and 1-d10in crystals were investigated by powder X-ray diffraction measurements and thermal analyses. The used crystals of 1and 1-d10obtained from a mixture of ethyl acetate (EA) and n-hexane contained EA. Other crystals of 1obtained by slow recrystallization with the same solvents had a solvent-free structure (form II) different from the reported one (form I). The results confirmed that the EA-containing crystals of 1and 1-d10were transformed to form II in two steps at 40–50 and 60–75 °C under heating at elevated temperature. Thus, the crystal samples had the form-II structure soon after heating to 200 °C. The behavior of the heated samples indicates that the crystal lattice inhibits the thermal reactivity of 1. Thus, the temperature for initiating the thermolytic reaction of 1becomes higher than the melting point. An exploration of the potential energy surface (PES) obtained by density functional theory (DFT) calculations also supports that the deoxygenation of 1is prevented by retaining the anthracene framework in the crystalline state. This study indicates that the method to use a CL-active compound is a powerful tool to analyze the reaction behavior in the crystalline state.Thermolytic reactions of 9,10-diphenylanthracene endoperoxide and its deuterated derivative in heated crystals were investigated by powder X-ray diffraction measurements and thermal analyses. Observed reaction behaviors indicate that the crystal lattice of the reactant inhibits the reactivity of the endoperoxides giving a situation where the temperature for initiating the thermolytic reactions becomes higher than the melting point.

BackgroundEnoyl-CoA hydratase short-chain 1 (ECHS1) is an enzyme involved in the metabolism of branched chain amino acids and fatty acids. Mutations in the ECHS1gene lead to mitochondrial short-chain enoyl-CoA hydratase 1 deficiency, resulting in the accumulation of intermediates of valine. This is one of the most common causative genes in mitochondrial diseases. While genetic analysis studies have diagnosed numerous cases with ECHS1variants, the increasing number of variants of uncertain significance (VUS) in genetic diagnosis is a major problem.MethodsHere, we constructed an assay system to verify VUS function for ECHS1gene. A high-throughput assay using ECHS1knockout cells was performed to index these phenotypes by expressing cDNAs containing VUS. In parallel with the VUS validation system, a genetic analysis of samples from patients with mitochondrial disease was performed. The effect on gene expression in cases was verified by RNA-seq and proteome analysis.ResultsThe functional validation of VUS identified novel variants causing loss of ECHS1function. The VUS validation system also revealed the effect of the VUS in the compound heterozygous state and provided a new methodology for variant interpretation. Moreover, we performed multiomics analysis and identified a synonymous substitution p.P163= that results in splicing abnormality. The multiomics analysis complemented the diagnosis of some cases that could not be diagnosed by the VUS validation system.ConclusionsIn summary, this study uncovered new ECHS1cases based on VUS validation and omics analysis; these analyses are applicable to the functional evaluation of other genes associated with mitochondrial disease.

Objectives: Gastrointestinal (GI) perforations are one of the major adverse events of endoscopic procedures. Polyglycolic acid (PGA) sheets with fibrin glue have been reported to close GI perforations. However, its clinical outcome has not yet been fully investigated; thus, we conducted a multicenter retrospective observational study to assess the efficacy of PGA sheeting for GI perforation. Methods: The medical records of patients who underwent PGA sheeting for endoscopic GI perforations between April 2013 and March 2018 in 18 Japanese institutions were retrospectively analyzed. PGA sheeting was applied when the clip closure was challenging or failed to use. Perforations were filled with one or several pieces of PGA sheets followed by fibrin glue application through an endoscopic catheter. Nasal or percutaneous drainage and endoscopic clipping were applied as appropriate. Clinical outcomes after PGA sheeting for intraoperative or delayed perforations were separately evaluated. Results: There were 66 intraoperative and 24 delayed perforation cases. In intraoperative cases, successful closure was attained in 60 cases (91%). The median period from the first sheeting to diet resumption was 6 days (interquartile range [IQR], 4–8.8 days). Large perforation size (≥ 10 mm) and duodenal location showed marginal significant relationship to higher closure failure of intraoperative perforations. In delayed perforation cases, all cases had successful closure. The median period from the first sheeting to diet resumption was 10 days (IQR, 6–37.8 days). No adverse events related to PGA sheeting occurred. Conclusion: Endoscopic PGA sheeting could be a therapeutic option for GI perforations related to GI endoscopic procedures.

AJM300 is an oral, small-molecule α4-integrin antagonist. We assessed the efficacy and safety of AJM300 in patients with moderately active ulcerative colitis.

This study investigated neuronal sources of slow cortical potentials (SCPs) evoked during vagus nerve stimulation (VNS) in patients with epilepsy who underwent routine electroencephalography (EEG) after implantation of the device.

Adamantylideneadamantane 1,2-dioxetane (Adox), one of the most stable 1,2-dioxetanes, was used to investigate the kinetic properties of its chemiluminescent thermolytic reaction in the crystalline state by monitoring chemiluminescence (CL) in real time. Soon after heating of single crystals at 140 °C, it was found that the thermolytic reactions of Adox in the crystals proceeded with zero-order kinetics for several minutes. During the period showing the zero-order kinetics, CL intensities were dependent on the volumes of crystals, and the inside crystals were maintained in a thermal steady state with a constant thermal diffusivity. After this period, the heated crystals of Adox started to break showing different kinetics. This study indicates that a crystalline-state CL reaction is useful to track its progress in real time for analyzing the kinetics.Chemiluminescence (CL) reactions of adamantylideneadamantane 1,2-dioxetane in crystals were investigated by heating crystal samples including single crystals, to show that the reactions proceeded with the zero-order kinetics in the initial stage and CL intensities were dependent on the volumes of crystals during this stage. Therefore, a crystalline-state CL reaction is useful to track its progress in real time.

Direct and indirect clipping treatments are used worldwide to treat colonic diverticular bleeding (CDB), but their effectiveness has not been examined in multicenter studies with more than 100 cases. We sought to determine the short‐ and long‐term effectiveness of direct versus indirect clipping for CDB in a nationwide cohort. We studied 1041 patients with CDB who underwent direct clipping (n= 360) or indirect clipping (n= 681) at 49 hospitals across Japan (CODE BLUE‐J Study). Multivariate analysis adjusted for age, sex, and important confounding factors revealed that, compared with indirect clipping, direct clipping was independently associated with reduced risk of early rebleeding (<30 days; adjusted odds ratio [AOR] 0.592, p= 0.002), late rebleeding (<1 year; AOR 0.707, p= 0.018), and blood transfusion requirement (AOR 0.741, p= 0.047). No significant difference in initial hemostasis rates was observed between the two groups. Propensity‐score matching to balance baseline characteristics also showed significant reductions in the early and late rebleeding rates with direct clipping. In subgroup analysis, direct clipping was associated with significantly lower rates of early and late rebleeding and blood transfusion need in cases of stigmata of recent hemorrhage with non‐active bleeding on colonoscopy, right‐sided diverticula, and early colonoscopy, but not with active bleeding on colonoscopy, left‐sided diverticula, or elective colonoscopy. Our large nationwide study highlights the use of direct clipping for CDB treatment whenever possible. Differences in bleeding pattern and colonic location can also be considered when deciding which clipping options to use.

Graphical abstract:

ObjectiveNeonatal-onset mitochondrial disease has not been fully characterised owing to its heterogeneity. We analysed neonatal-onset mitochondrial disease in Japan to clarify its clinical features, molecular diagnosis and prognosis.DesignRetrospective observational study from January 2004 to March 2020.SettingPopulation based.PatientsPatients (281) with neonatal-onset mitochondrial disease diagnosed by biochemical and genetic approaches.InterventionsNone.Main outcome measuresDisease types, initial symptoms, biochemical findings, molecular diagnosis and prognosis.ResultsOf the 281 patients, multisystem mitochondrial disease was found in 194, Leigh syndrome in 26, cardiomyopathy in 38 and hepatopathy in 23 patients. Of the 321 initial symptoms, 236 occurred within 2 days of birth. Using biochemical approaches, 182 patients were diagnosed by mitochondrial respiratory chain enzyme activity rate and 89 by oxygen consumption rate. The remaining 10 patients were diagnosed using a genetic approach. Genetic analysis revealed 69 patients had nuclear DNA variants in 36 genes, 11 of 15 patients had mitochondrial DNA variants in five genes and four patients had single large deletion. The Cox proportional hazards regression analysis showed the effects of Leigh syndrome (HR=0.15, 95% CI 0.04 to 0.63, p=0.010) and molecular diagnosis (HR=1.87, 95% CI 1.18 to 2.96, p=0.008) on survival.ConclusionsNeonatal-onset mitochondrial disease has a heterogenous aetiology. The number of diagnoses can be increased, and clarity regarding prognosis can be achieved by comprehensive biochemical and molecular analyses using appropriate tissue samples.

Background and aims: At specialized facilities, endoscopic submucosal dissection (ESD) has currently been performed even for difficult cases such as tumors extending to a diverticulum that previously required surgery. This study aims to classify the type of lesion according to the degree of infiltration to a diverticulum and assessed the safety and efficacy of ESD for each type of lesion. Methods: We retrospectively reviewed ESD for lesions at NTT Medical Center Tokyo between January 2014 and April 2019. Lesions were classified as follows: Type 1: lesions in contact with or within 3 mm of the edge of a diverticulum; Type 2: lesions that partially infiltrated into a diverticulum; and Type 3: lesions that infiltrated into and completely covered the diverticulum. Furthermore, ESD strategies were divided into A and B, which indicates that a lesion was resected separately from the diverticulum and along the entire diverticulum, respectively. The clinicopathological characteristics and clinical outcomes were analyzed according to the strategy. Results: A total of 47 lesions satisfied inclusion criteria (19 Type 1, 12 Type 2, and 16 Type 3 lesions). 19 Type 1 and 8 Type 2 lesions were resected using Strategy A, while 4 Type 2 and 16 Type 3 lesions were resected using Strategy B. En bloc resection was achieved in all cases. In Strategy A, the R0 resection rate was 96.3% and the curative resection rate was 88.9%. On the contrary, in Strategy B, the R0 resection rate was 95.0% and the curative resection rate was 90.0%. In Strategy B, one of the patients developed post-operative bleeding that required endoscopic hemostasis; another patient developed delayed perforation that required emergency surgery. Conclusions: ESD for colorectal neoplasms in proximity or extending to a diverticulum is challenging, but this procedure can be a safe and effective therapeutic option.

Objective. The aim of this study was to clarify the effect of a stable concentration of propofol on interictal high‐frequency oscillations (HFOs), which may contribute to identifying the epileptogenic zone intraoperatively for resection surgery. Methods. Nine patients with drug‐resistant focal epilepsy who underwent invasive pre‐surgical evaluation with chronic subdural electrodes were recruited. Five‐minute electrocorticograms during wakefulness, slow‐wave sleep, and under a stable brain concentration of propofol were recorded with the same electrodes. In each patient, 1–10 pairs of electrodes were selected for both electrodes with EEG changes within 5 seconds from the ictal onset (ictal pattern for 5 seconds [IP5]) and those outside the area of IP5 with no interictal epileptiform discharges (non‐epileptiform [nEPI]). The numbers of ripples (80‐250 Hz) and fast ripples (>250 Hz) were measured semi‐automatically using an established algorithm. Statistical testing was performed with a mixed effect model. Results. Thirty‐seven pairs of electrodes from nine patients were analysed for IP5 and 29 pairs from seven patients were analysed for nEPI. The numbers of HFOs differed between the areas (IP5 and nEPI) and among the conditions (wakefulness, slow‐wave sleep, propofol anaesthesia) (all p <0.01). The HFO occurrence rates were significantly higher for IP5 than those for nEPI in all conditions (for both ripples and fast ripples in all conditions; p <0.01). Significance. The occurrence rates of HFOs for IP5 were significantly higher than those for nEPI under propofol anaesthesia. These are fundamental findings for intraoperative HFO analysis, however, the following limitations should be considered: physiological HFOs could not be completely differentiated from pathological HFOs; in order to apply an HFO detector, an appropriate cut‐off threshold is needed; an artefact of the impulse response filter appears as an HFO; and the series was comprised of a small number of heterogeneous patients.

Unexpected failures of a Heck reaction in the lab led to the detection of 5-hydroperoxy-1-methyl-2-pyrrolidinone (NMP-5-OOH) in the cosolvent 1-methyl-2-pyrrolidinone (NMP). This hydroperoxide, formed by autoxidation in the presence of air, oxidized the ligand tri(o-tolyl)phosphine (P(o-tol)3) to tri(o-tolyl)phosphine oxide (O═P(o-tol)3) and ultimately slowed down the Heck reaction. Because of this finding, control strategies were implemented for NMP quality and air exclusion during manufacturing campaigns, which ensured delivery of metric tons of compound 2en route to Ronacaleret Hydrochloride used in clinical studies. Similar detrimental impact of NMP-5-OOH to the ligand-free Heck reaction was also demonstrated.

Graft failure (GF) is a life-threatening complication after allogeneic stem cell transplantation. Although salvage cord blood transplantation (CBT) is a curative therapy for GF, the optimal immunosuppression after salvage CBT remains unknown. Using nationwide registration data, we compared the transplant outcomes of patients who developed GF and underwent salvage CBT using immunosuppressants, including calcineurin (CNI) alone (n?=?177); CNI plus methotrexate (CNI+MTX, n?=?150); and CNI plus mycophenolate mofetil (CNI+MMF, n?=?161). The CNI+MMF group, in comparison with the CNI+MTX and CNI alone groups, demonstrated better neutrophil recovery at 30 days (62.7 vs. 42.7 vs. 53.1%, P?

Comprehensive genomic profiling enables genomic biomarker detection in advanced solid tumors. Here, to evaluate the utility of circulating tumor DNA (ctDNA) genotyping, we compare trial enrollment using ctDNA sequencing in 1,687?patients with advanced gastrointestinal (GI) cancer in SCRUM-Japan GOZILA (no. UMIN000016343), an observational ctDNA-based screening study, to enrollment using tumor tissue sequencing in the same centers and network (GI-SCREEN, 5,621?patients). ctDNA genotyping significantly shortened the screening duration (11 versus 33?days, P?

Selenium (Se) is an essential trace element in animals; however, the element can become highly toxic in excess amounts beyond the nutritional level. Although Se is mainly excreted into urine as a selenosugar within the nutritional level, excess amounts of Se are transformed as an alternative urinary metabolite, trimethylselenonium ion (TMSe). Se methylation appears to be an important metabolic process for the detoxification of excess Se; however, the biochemical mechanisms underlying the Se methylation have not been elucidated. In this study, we evaluated biochemical characteristics of two human methyltransferases for Se methylation, thiopurine S-methyltransferase (TPMT) and indolethylamine N-methyltransferase (INMT). The first methylation of Se, i.e., a nonmethylated to a monomethylated form, was specifically driven by TPMT, and INMT specifically mediated the third methylation, i.e., dimethylated to trimethylated form. The second methylation, i.e., a monomethylated to dimethylated form, was driven by either TPMT or INMT. Exogenous expression of TPMT, but not INMT, ameliorated the cytotoxicity of inorganic nonmethylated selenium salt, suggesting that only TPMT gave the cellular resistance against selenite exposure. TPMT was ubiquitously expressed in most mouse tissues and preferably expressed in the liver and kidneys, while INMT was specifically expressed in the lung and supplementally expressed in the liver and kidneys. Our results revealed that both TPMT and INMT cooperatively contributed to the TMSe production, enabling urinary excretion of Se and maintenance of homeostasis of this essential yet highly toxic trace element. Thus, TPMT and INMT can be recognized as selenium methyltransferases as a synonym.

Shared socio-economic pathways (SSPs) are alternative global development scenarios focused on the mitigation of and adaptation to climate change. However, global SSPs would need revised versions for regional or local assessment, which is the so-called extended version, because global narratives may lack region-specific important drivers, national policy perspectives, and unification of data for each nation. Thus, it is necessary to construct scenarios that can be used for governments in response to the SSPs to reflect national and sub-national unique situations. This study presents national SSP scenarios, specifically focusing on Japan (hereafter, Japan SSPs), as well as a process for developing scenarios that qualitatively links to global SSPs. We document the descriptions of drivers and basic narratives of Japan SSPs coherent with global SSPs, based on workshops conducted by local researchers and governments. Moreover, we provide a common data set of population and GDP using the national scale. Japan SSPs emphasized population trends different from global SSPs and influencing factors, citizen participation, industrial development resulting from economic change, distribution, and inequality of sub-national population, among others. We selected data sets from existing population projections that have been widely used by Japanese researchers; the data show that the population and GDP of Japan SSPs are expected to be about 20–25% less than global SSPs by 2100.

Respiratory disease occurs frequently in children. The nasal cavity, trachea, and oral cavity are considered the primary routes of infection. We aimed to investigate the types of microbial pathogens present in the oral cavities of children with respiratory disease. In addition, we compared the detection rates of different pathogens between the oral cavity and the nasopharynx according to Hellman dental age.

Hemiarthroplasty (HHR) using a smaller head with rotator cuff reconstruction is a treatment option for cuff tear arthropathy (CTA), offering advantages like facilitating rotator cuff tear closure, increasing the lever arm of deltoid, and restoring function in irreparable cuff tears. This study aimed to evaluate the long-term outcomes of this procedure.

Thermolytic reactions of 9,10-diphenylanthracene endoperoxide (1) and its derivatives having deuterated phenyl groups and phenyl groups with fluorinated substituents were investigated as chemiluminescence (CL) reactions proceeding by heating crystal samples. While heated crystals of 1showed negligible CL, CL emissions from singlet oxygen (1O2) generated by thermolyses of the derivatives were observable in the heated solid-liquid mixture states, indicating that the modifications for the derivatives were effective to suppress the 1O2deactivation.By heating crystal samples of 9,10-diphenylanthracene endoperoxide derivatives having deuterated phenyl groups and phenyl groups with fluorinated substituents over 150 °C, we could observe near-infrared chemiluminescence from singlet oxygen generated by thermolytic reactions of the derivatives in the heated solid-liquid mixture states, while heated crystals of 9,10-diphenylanthracene endoperoxide showed negligible chemiluminescence.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

Introduction

Introduction Procurement of enough CD34 +cells (CD34 +) by apheresis is essential for the successful engraftment of peripheral blood stem cell transplantation (PBSCT). To determine the processed blood volume of apheresis to obtain a certain number of CD34 +, collecting efficiency 2 (CE2) is generally used, which is calculated from the total amount of CD34 +in the product (PBSC-CD34 +) divided by pre-apheresis CD34 +in the peripheral blood (PB-CD34 +) and by processed blood volume, and CE2 is determined beforehand from the accumulated data in each apheresis site. However, we sometimes experience cases in which collected amount of CD34 +are far from our expected values. It is probably because of the introduction of various CD34 +mobilization methods, new automated blood cell separators and protocols. Hence, we investigated thoroughly the kinetics of CD34 +in PBSC collection.

Glycoxidation product, carboxymethyllysine (CML), and lipoxidation product, acrolein-modified lysine (AML), have been suggested to represent general markers of oxidative stress and longterm damage to proteins in aging and diabetes. To [...]

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls.Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement.Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954).Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

An 83-year-old man underwent transcatheter arterial chemoembolization (TACE) for a 20-mm hepatocellular carcinoma (HCC) in Couinaud’s segment 4. Computed tomography (CT) 4 months after TACE showed tumor thrombus in the portal vein in addition to diffuse metastases and arterioportal shunts in the left lobe. Although we performed the best supportive care, the tumor thrombus in the portal vein and tumors in the left lobe had completely disappeared on CT 16 months after the TACE. Rapidly grown portal vein tumor thrombus and arterioportal shunt might be the causes of spontaneous regression of HCC, probably associated with tumor hypoxia.

We report a 33‐year‐old Japanese man who suffered from repetitive generalized tonic‐clonic seizures which were medically intractable. Neurosyphilis was serologically diagnosed in blood and cerebrospinal fluid, and penicillin G (PcG) was consequently effective. The EEG during PcG pre‐treatment showed frequent right occipital spikes and right frontocentral slow waves, which disappeared after treatment. During pre‐treatment, positron emission tomography with 18‐fluorodeoxyglucose and Tc‐99m ethyl cysteinate dimer single‐photon emission computed tomography revealed occipital hypermetabolism and hyperperfusion (“hot” area) and fronto‐temporo‐parietal hypometabolism and hypoperfusion (“cool” area) over the right hemisphere. The spike sources of magnetoencephalography during pre‐treatment were localized to “hot” areas, and the slow activities were distributed to the fronto‐temporo‐parietal region, corresponding to “cool” areas. The inflammatory seizure focus and reversible dysfunctional zone associated with neurosyphilis were clearly delineated using these techniques.

Focal segmental glomerulosclerosis (FSGS) is caused by various etiologies, with mitochondrial dysfunction being one of the causes. FSGS is known to be associated with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS), which is a subclass of mitochondrial disease. However, it has rarely been reported in other mitochondrial disease subclasses. Here, we reported a 20-year-old man diagnosed with FSGS associated with chronic progressive external ophthalmoplegia (CPEO) due to mitochondrial DNA (mtDNA) 3243A>G mutation. He presented with left ptosis, short stature, mild sensorineural deafness, and cardiac conduction block. A renal biopsy sample showed segmental sclerosis and adhesions between capillaries and Bowman’s capsule, indicating FSGS. Electron microscopy demonstrated abnormal aggregated mitochondria in podocytes, and the basement membrane and epithelial cells of Bowman’s capsule. Skeletal muscle biopsy also showed accumulation of abnormal mitochondria. mtDNA analysis identified heteroplasmic mtDNA 3243A>G mutation with no large-scale deletions. From these findings, we diagnosed the case as CPEO with multi-organ involvement including FSGS. Our report demonstrates that CPEO, as well as MELAS, can be associated with FSGS. Because mitochondrial disease presents with a variety of clinical symptoms, atypical cases with non-classical manifestations are observed. Thus, mitochondrial disease should be considered as an underlying cause of FSGS with systemic manifestations even with atypical phenotypes.

Since the endoscopic resection of laterally spreading tumors (LSTs) involving the appendiceal orifice remains technically difficult, such lesions are usually treated by surgical resection. However, with recent advances in endoscopic devices, endoscopic submucosal dissection (ESD) has become feasible and may be safely performed even for lesions involving the appendiceal orifice. Therefore, in order to assess the validity of endoscopic treatment for such lesions, we retrospectively evaluated the safety and efficacy of ESD. A total of 30 patients with LSTs extending to within 10 mm of the appendiceal orifice (Group AO) and 122 patients with cecal LSTs located away from the appendiceal orifice (Group C) who were treated between December 2011 and September 2015 were retrospectively enrolled in the present study. The indications for ESD were determined by the preoperative endoscopic diagnosis made on the basis of Kudo’s pit pattern classification. Based on these preoperative endoscopic diagnoses, 8 of the 30 enrolled patients underwent surgical resection as the initial treatment, because the tumor showed deep invasion beyond the orifice and/or a VN pit pattern was visible. The treatment outcomes (en blocR0 resection rates, tumor size, procedure time, and complication rates) were compared between the two groups. The sensitivity and specificity for the cancer diagnosis were 81.8 and 94.7%, respectively. There was no significant difference in the en blocR0 resection rate between Group AO and Group C (90.9 vs. 95.9%, P= 0.23). Furthermore, there were also no differences in the mean tumor size (30.0 ± 20.8 vs. 34.9 ± 14.5 mm, P= 0.17) or mean OR time (55.0 ± 39.2 vs. 58.9 ± 48.2 min P= 0.72) between the two groups. One case from Group AO (4.5%) was complicated by a perforation, which was successfully managed endoscopically. Although proficiency in endoscopic techniques is required, our results indicate that LSTs involving the appendiceal orifice can be successfully treated by ESD.

Ni-added LSM compositions (La1-xSrxMn0.8Ni0.2O3 with x={0.1 to 0.5}) and YSZ mixtures (50/50 wt%) were used for evaluating their chemical stability at high temperature (1300oC). Ni-added LSM raw powders were fabricated by using a glycine route. X-ray diffraction was used to quantify and identify crystallographic phases. DC four-probe measurement was used for electrical characterization. Results show that Ni-addition at the B-site of LSM structure is effective for suppressing the secondary phase formation, particularly La2Zr2O7, when strontium content is between 0.1[?]x[?]0.2. Electrical conductivity was about 100 S cm-1 within the chemically stable strontium content range. Therefore, it is expected that suppression of La2Zr2O7 formation at high temperature could improve SOFC performance, especially during long time operation, thus supporting the co-sintering of a whole SOFC ceramic stack at high temperature.

Venous thromboembolism (VTE) is a serious complication of surgery, including gynecologic surgery. The plasma D-dimer test and proximal/distal vein compression ultrasonography are frequently used as an easy, preoperative VTE screening method. However, targeted patients for these two examinations have not been established.

The indications for laparoscopic gastrectomy for early stomach cancer have spread worldwide, and the short-term outcomes have been favorable. Intraabdominal delta-shaped gastroduodenostomy using endoscopic linear staplers, a technique which was developed by Kanaya et al. is one of the feasible reconstructive procedures. Pure laparoscopic surgery is reported to be associated with several intraoperative and postoperative advantages in comparison with laparoscopy-assisted surgery. However, the clinical results remain uncertain. The present study aimed to evaluate both the technical feasibility and safety of delta-shaped anastomosis with LDG according to the short-term outcomes. The study group was composed of 229 patients who underwent delta-shaped anastomosis with LDG at Gifu University School of Medicine from December 2004 to December 2014. The median total operative blood loss and operative time were 20 ml and 277 min, respectively. Postoperative complications were detected in 20 (8.7 %) patients. The complications included: anastomotic stenosis, n= 3 (1.3 %); anastomotic leakage, n= 3 (1.3 %); pancreatic injury, n= 8 (3.5 %); anastomotic ulcer, n= 1 (0.4 %); bowel obstruction, n= 1 (0.4 %); abdominal abscess, n= 1 (0.4 %); lymphorrhea, n= 1 (0.4 %); cardiac failure, n= 1 (0.4 %); and infection, n= 1 (0.4 %). The complications were classified as grade 2, n= 4 (1.7 %); grade 3a, n= 12 (5.2 %); grade 3b, n= 4 (1.7 %); and grade 4 and 5, n= 0 (0 %). The findings of the present study indicate the safety of Kanaya’s procedure and that it should provide better outcomes in patients who undergo intracorporeal gastroduodenostomy after laparoscopic distal gastrectomy.

A nationwide retrospective study for the clinical outcomes of 99 patients who had received thymoglobulin at a median total dose of 2.5 mg/kg (range, 0.5–18.5 mg/kg) as a second-line treatment for steroid-resistant acute GvHD was conducted. Of the 92 evaluable patients, improvement (complete or partial response) was observed in 55 patients (60%). Multivariate analysis demonstrated that male sex and grade III and IV acute GvHD were associated with a lower improvement rate, whereas thymoglobulin dose (<2.0, 2.0–3.9 and ⩾4.0 mg/kg) was NS. Factors associated with significantly higher nonrelapse mortality included higher patient age (⩾50 years), grade IV acute GvHD, no improvement of GvHD and higher dose of thymoglobulin (hazard ratio, 2.55; 95% confidence interval, 1.34–4.85; P=0.004 for 2.0–3.9 mg/kg group and 1.79; 0.91–3.55; P=0.093 for ⩾4.0 mg/kg group). Higher dose of thymoglobulin was associated with a higher incidence of bacterial infections, CMV antigenemia and any additional infection. Taken together, low-dose thymoglobulin at a median total dose of 2.5 mg/kg provides a comparable response rate to standard-dose thymoglobulin reported previously, and <2.0 mg/kg thymoglobulin is recommended in terms of the balance between efficacy and adverse effects.

We prepared the carbon electrodes using the three carbon materials (EC300J (Ketjen Black), ECP600JD (Ketjen Black), and CNovel MH) as a positive electrode, analyzed the discharge products, and investigated the factor affecting the electrochemical characteristics. The discharge tests showed that the discharge capacities of ECP600JD and CNovel MH electrodes were higher than that of EC300J electrode. The FE-SEM and EDX showed that the Li2O2 aggregation generated on the EC300JD electrode. On the other hand, the Li2O2 is highly dispersed on the ECP600JD and CNovel MH electrodes. From the nitrogen adsorption-desorption measurements, strong relationship between the discharge capacity and surface area of mesopore (3-10 nm) before discharge were confirmed. It was suggested that surface area of mesopore (3-10 nm) of carbon electrode had an influence on the discharge profile.

The morphology of the suprascapular (SS) notch is a very important factor in treatment of suprascapular nerve (SSN) palsy. Several studies have reported SS notch morphology in cadavers or using three-dimensional computed tomography (3D-CT); however, none has reported the distribution of SS notch morphology according to age group. In addition, the correlation between SS notch morphology and SSN palsy remains unclear. The purposes of this study were to investigate the morphological distribution of the SS notch by age group in a large population and to assess the relationship between SS notch morphology and SSN palsy.

Little is known regarding the incidence of the shoulder instability in Japan. The aim of this study was to evaluate the incidence of traumatic shoulder instability among Japanese military cadets. A prospective cohort study was performed to capture all traumatic shoulder instability events between 2009 and 2012 among cadets in a military educational academy of the Japan Self Defense Forces. The total number of cadets in the cohort was 5,402 (average age 20.6 years). The incidence of instability events, including dislocation or subluxation, was calculated. Chronicity, demographics of participants, mechanism of injury, and athletic events were also evaluated. The incidence of traumatic dislocation was 4.1/1,000 person-years and that of subluxation was 6.1/1,000 person-years. The incidence of primary dislocation or subluxation was 5.4/1,000 person-years and that of recurrent dislocation or subluxation was 4.7/1,000 person-years. Of first dislocations or subluxations, 92% occurred during sports activities, including after-school sports activities, military training, and gym classes. In conclusion, the overall incidence of shoulder instability events among Japanese military cadets was 10.3/1,000 person-years, and was extremely high. Most shoulder instability events occurred during sports activities, and a program to prevent such injuries during sports activities is necessary for young participants.

Despite the widespread use of surgical energy devices and the potential for rare but serious complications, pilot data from North America suggest that surgeons and surgical trainees have knowledge gaps in their safe use. The purpose of this study was to determine baseline knowledge of general surgeons and surgical trainees regarding the safe use of electrosurgery (ES) across varying levels of experience in Japan. Participants completed a 35-item multiple-choice question examination, testing critical knowledge of ES. The examination was developed according to the objectives and blueprints of SAGES’ Fundamental Use of Surgical Energy™ curriculum. Sections of the examination included: “principles of ES,” “ES-related adverse events,” “monopolar and bipolar devices,” and “pediatric considerations and interference with implantable devices.” Scores were compared between PGY > 5 and PGY 1–5 participants. A total of 145 general surgeons and surgical trainees of all years after medical school (PGY 1–5: 57, PGY > 5: 88) from ten academic and five community hospitals completed the assessment (mean age 35; 91 % male). The mean score in the entire cohort was 58 ± 12 % (range 23–83 %), with significantly higher scores in the PGY > 5 group compared to the PGY 1–5 group (60 ± 11 vs. 53 ± 12 %, p< 0.01). Among all participants, 92 % were not familiar with best practices when using ES on patients with a pacemaker; 44 % believe that ES uses thermal energy from cautery; 19 % did not know how to manage an operating room fire; 16 % thought that a dispersive electrode should be cut to fit a child; and 27 % believe that insulation failure in minimally invasive surgical instruments is mostly visible under careful inspection. General surgeons and trainees at all levels have knowledge gaps in the safe and effective use of energy devices, regardless of years of experience. There is a need for educational curricula to help address these gaps and contribute to safer surgery.

Although activated partial prothrombin time (aPTT) has often been used as a biomarker for evaluating the safety of dabigatran use in patients with non-valvular atrial fibrillation (NVAF), the optimal frequency of aPTT measurements is unclear. This study aimed to identify the frequency distribution of aPTT measurements in clinical practice and its clinical significance. This was a retrospective cooperative study conducted in 2 sites. All NVAF patients who underwent aPTT measurements before and after dabigatran treatment were included (n=380). The patients were divided into 2 groups according to the frequency of aPTT measurements during the first 3 months after drug prescription: Group A: infrequent group with only 1 measurement; and Group B: frequent group with =2 measurements. The clinical characteristics and outcomes were compared between the groups. The frequency of aPTT measurements in the 3 months after dabigatran initiation varied: 240 patients underwent 1 measurement (Group A), and the remaining 140 patients underwent repeated measurements (Group B). There were significant differences in age and creatinine clearance (Ccr) between the groups (Group A vs. Group B: age 64.0±11.7 vs. 67.0±11.1 years, p=0.01; Ccr 83.8±30.3 vs.76.7±31.1 mL/min, p=0.03). During the mean follow-up period of 310 days, there were no significant differences in the discontinuation rate and incidence of bleeding (17% vs. 15% and 5% vs. 3%, respectively; both not significant). In Group B, the aPTT rarely increased beyond twice the upper normal limit within the 3 months (2.1%), although the correlation between the initial and subsequent aPTT measurements was low (r=0.366). In this retrospective study, the frequency of aPTT measurements after dabigatran initiation might have been dependent on patient characteristics. However, frequent aPTT measurements did not lead to a reduction in adverse clinical events.