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The accumulation of defective polypeptides in cells is a major cause of various diseases. However, probing defective proteins is difficult because no currently available method can retrieve unstable defective translational products in a soluble state. To overcome this issue, there is a need for a molecular device specific to structurally defective polypeptides. In this study, we developed an artificial protein architecture comprising tandemly aligned BAG6 Domain I, a minimum substrate recognition platform responsible for protein quality control. This tandem-aligned entity shows enhanced affinity not only for model defective polypeptides but also for endogenous polyubiquitinated proteins, which are sensitive to translational inhibition. Mass-spectrometry analysis with this probe enabled the identification of endogenous defective proteins, including orphaned subunits derived from multiprotein complexes and misassembled transmembrane proteins. This probe is also useful for the real-time visualization of protein foci derived from defective polypeptides in stressed cells. Therefore, this "new molecular trap" is a versatile tool for evaluating currently "invisible" pools of defective polypeptides as tangible entities., (© 2025 Iwasa et al.)

Background/Objectives : Undernutrition increases the mortality risk in older persons requiring long-term care; further, it is associated with oral functions such as swallowing and chewing. Moreover, occlusion affects oral function and is crucially involved in nutritional intake. The present study aimed to examine the association between the number of molar occlusions and undernutrition according to body mass index (BMI) in older persons requiring long-term care. Methods : Japanese older persons requiring long-term care were categorized based on BMI (<20 kg/m 2 vs. 20 kg/m 2 ). We examined the association between undernutrition and the number of molar occlusions (one in each of the left and right premolars and molars, for a total of four). Results : Among 893 included participants, 440 (49.3%) had BMI < 20 kg/m 2 and 453 (50.7%) had BMI > 20 kg/m 2 . Binomial logistic regression analysis revealed that BMI < 20 kg/m 2 was significantly associated with increased number of molar occlusions (odds ratio: 0.52-0.70, 95% CI: 0.28-1.00). This indicated that a decrease in the number of molar occlusions was associated with malnutrition as determined through BMI in older persons requiring long-term care and residing in long-term care insurance facilities in Japan. Conclusions : Our findings suggest that maintaining occlusal support may help maintain nutritional status in older persons requiring long-term care.

The growing need for high-performance computing continues to drive improvement in circuit and device technologies, particularly with respect to speed and power efficiency. Device scaling remains the most effective strategy for meeting circuit performance requirements while reducing power consumption. Thanks to their solution processability, colloidal semiconductor quantum dots (QDs) are highly suitable for device miniaturisation as quantum information science platforms. Quantum mechanical effects must be carefully considered when designing nanometre-scale electronic devices ( i.e. , transistors) that incorporate a single QD. Here, we demonstrate a resonant tunnelling transistor (RTT) based on a single lead sulfide (PbS) QD anchored by a bidentate ligand molecule attached to heteroepitaxial spherical Au/Pt nanogap electrodes. Five negative differential resistances (NDRs) were observed at both positive and negative drain voltages in output characteristics, which could be attributed to the formation of a double-barrier "quantum well" structure with the strong Fermi level pinning of the discrete energy level of the QD to one electrode. Furthermore, these NDRs could be tuned by applying a gate electric field, which will become one of the keys for enabling quantum and neuromorphic electronics. This demonstration of single PbS-QD-based RTTs paves the way for sub-10 nm solution-processable quantum electronic devices.

The objective of our research is to improve the power generation of a thermoelectric generator (TEG) using a single-walled carbon nanotube (SWCNT) sheet by applying the out-of-plane deformation of a slitted kirigami structure. In order to obtain a large amount of power from a TEG using a thin-film thermoelectric (TE) element such as a SWCNT sheet, it is necessary to generate a large temperature difference in the in-plane direction of the thin-film TE element. However, it is difficult to realize a large temperature difference when the thin-film TE element is in contact with a heat source due to the need for a layer with high heat insulation. In this research, we proposed and fabricated a TEG with the out-of-plane deformation of a kirigami structure with slits using a p-n patterned SWCNT sheet as the thin-film TE material and evaluated the open circuit voltage with respect to the out-of-plane deformation and the number of TE elements. As a result, the output performance of SWCNT TEG was clarified when the out-of-plane deformation and the number of TE element pairs were varied.

Mathematical models of immune responses have traditionally focused on adaptive immunity and pathogen-immune dynamics. However, recent advances in immunology have highlighted the critical role of innate immunity. In response to physical damage or pathogen attacks, innate immune cells circulating throughout the body rapidly migrate from blood vessels and accumulate at the site of injury, triggering inflammation. These cells engulf, break down, and eliminate pathogens. This innate immune response occurs much faster than adaptive immune responses, which require time for cell activation and proliferation. While inflammation helps eliminate pathogens, it can sometimes lead to chronic inflammation by triggering excessive immune responses, ultimately causing tissue damage. In this study, we examine a simple dynamical model of innate immunity. The analysis indicates that when an infection occurs, it triggers inflammation, which activates the innate immune system and initiates the activation cycle. Consequently, pathogens may be eradicated, leaving behind persistent chronic inflammation. Alternatively, the pathogens may not be eradicated, with their abundance either stabilizing at a positive level or oscillating indefinitely. The dynamics exhibit both transcritical and Hopf bifurcations. When innate immunity is activated in the absence of inflammation, pathogens are eradicated more easily, and the likelihood of oscillations in inflammation, immune responses, and pathogen abundance is reduced., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2025. The Author(s).)

Background and Aims: Endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) with on-demand endoscopic necrosectomy, increasingly utilized to manage walled-off necrosis (WON), is associated with substantial morbidity and mortality. This multicenter study aimed to externally validate recently developed quadrant (an abdominal quadrant distribution), necrosis, and infection (QNI) criteria for risk stratification in this setting., Methods: Of 423 patients with pancreatic fluid collections treated in a large multi-institutional cohort between 2010 and 2020, 212 with available preprocedural computed tomography images were included. Clinical outcomes between high- and low-risk groups defined according to QNI criteria were compared., Results: The clinical success rate did not differ significantly between the QNI-high and QNI-low groups (74.4% vs. 83.5%, respectively; P = 0.12). Time to clinical success was longer in the QNI-high group compared with the QNI-low group (median, 68 vs. 46 days, respectively; P = 0.0016). Compared with the QNI-low group, the QNI-high group was associated with higher rates of percutaneous interventions, direct endoscopic necrosectomy, mortality, and adverse events. The QNI-high group was independently associated with time to clinical success (hazard ratio 0.64, 95% confidence interval 0.46-0.87; P =0.005) in multivariable Cox proportional hazards regression analysis, and with the risk of ≥grade III adverse events (odds ratio 2.93, 95% confidence interval 1.04-8.20; P = 0.04) in multivariable logistic regression analysis., Conclusions: The QNI criteria effectively stratified time to clinical success and the risk of adverse outcomes for patients receiving EUS-PFD of WON. Further investigations could elucidate appropriate management strategies based on QNI-based risk stratification., (Copyright © 2025 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

The leaves of many trees emit biogenic volatile organic compounds (BVOCs) that protect them from various threats, including herbivory, pathogens, and heat stress. In a previous study, we analyzed the optimal seasonal schedule for producing isoprene, a highly volatile BVOC, in leaves to mitigate heat damage and maximize net carbon gain. In this paper, we investigate the seasonal production schedule of BVOCs stored in leaves, such as monoterpenes and sesquiterpenes, which decay slowly. When the leaves are bitten, these chemicals are emitted and help to prevent further herbivory. The optimal seasonal schedule, analyzed using Pontryagin's maximum principle, includes a period of singular control. Producing BVOCs for defense is advantageous if their decay rate is slow and the photosynthetic rate is fast. The amount of BVOCs produced increases with slower decay rate and faster photosynthetic rate. But it does not increase monotonically with the magnitude of the threat. BVOCs are produced earlier than the peak period of the threat for which the chemicals are intended. Based on the results of the model, we discuss the reported variations in BVOC production among different chemical species and tree species, as well as the seasonal patterns of gene expression in different pathways for BVOC production., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Landscapes are shaped by tectonic, climatic, and surface processes over geological timescales, but we rarely witness the events of marked landscape change. The moment magnitude 7.5 Noto Peninsula earthquake in central Japan was caused by a large thrust faulting, up to nearly 10 meters of slip, that expanded more than 150 kilometers along the fault zone. The deformation field reconstructed from satellite data and field surveys reveals up to 4.4 meters of uplift and associated coastal advance along the entire northern coast of the peninsula, meter-scale systematic movement of the mountain slopes consistent with slip on flexural faults, and activation of secondary inland faults, suggesting synchronized ruptures. The findings show excellent consistency between the coseismic deformation and geomorphic features and provide a vivid example of the role of a major earthquake in landscape formation.

Quasi-phase matching (QPM) is a technique extensively utilized in nonlinear optics for enhancing the efficiency and stability of frequency conversion processes. However, the conventional QPM relies on periodically poled ferroelectric crystals, which are limited in availability. The 3R phase of molybdenum disulfide (3R-MoS 2 ), a transition metal dichalcogenide (TMDc) with the broken inversion symmetry, stands out as a promising candidate for QPM, enabling efficient nonlinear process. Here, we experimentally demonstrate the QPM at nanoscale, utilizing van der Waals stacking of 3R-MoS 2 layers with specific orientation to realize second harmonic generation (SHG) enhancement beyond the non QPM limit. We have also demonstrated enhanced spontaneous parametric down-conversion (SPDC) via QPM of 3R-MoS 2 homo-structure, enabling more efficient generation of entangled photon pairs. The tunable capacity of 3R-MoS 2 van der Waals stacking provides a platform for tuning phase-matching condition. This technique opens interesting possibilities for potential applications in nonlinear process and quantum technology., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

In this paper, we apply a surface-shunting method to prevent quenches in no-insulation (NI) REBCO magnets triggered by external failures of magnet current leads or power suppliers (i.e., fault mode). In a high-field magnet system, an NI coil may still be at risk during the mentioned quench events even if the whole magnet is well-designed, non-defective, and properly operated. The mechanism of this fault-mode quench initiation and propagation still remains unclear, complicating the development of reliable quench protection. Here, we present this mechanism to demonstrate a corresponding practical quench-preventive approach named surface shunting, which utilizes a low-temperature solder attached to the top and bottom of pancake coils. We validate the effectiveness of this approach by comparing the electromagnetic, thermal, and mechanical behaviors in the fault mode with and without the shunt. We conclude that the surface shunt suppresses the fault-mode quench initiation and propagation by redirecting the original turn-to-turn current and induced overcurrent out of the NI winding. We anticipate this work can provide a solution to improve the operational safety of high-field HTS NI magnets against quench and potential damage during fault modes.

This study aimed to observe human trapezius muscle (TpzM) development during early fetal period and apply diffusion tensor imaging (DTI) analysis to describe the muscle architecture that leads to physiological functions. Human embryonic and early fetal specimens were selected for this study. TpzM was first detected at Carnegie stage 20. The position of the TpzM changed with the formation of the scapula, clavicle, and vertebrae, which are its insertions and origins. DTI revealed the fiber orientation from each vertebral level to dissect each muscle. Fiber orientation in the ventral view gradually changed from the cervical to thoracic vertebrae, except for the middle part at which the insertions changed, which was almost similar in all early fetal specimens. The TpzM volume increased from C1 to C7 in the upper part, reached local maxima at C6 and C7 in the middle, and then decreased. These muscles can be categorized into three parts according to their insertions and presented with the features of each part. The fiber orientation and distribution of the three parts at the vertebral level were almost constant during the early fetal period. The border between the upper and middle parts was mainly located around the C6 and C7 vertebral levels, whereas the middle and lower parts were between the Th1 and Th2 vertebral levels. A three-dimensional change in the fiber orientation in the upper part of the TpzM according to the vertebral level was noticeable. Our data will help to elucidate the developmental processes of TpzM., (© 2024 Anatomical Society.)

Background: Treating oral problems with dentist intervention during hospitalisation may improve patients' food intake status., Objectives: This study aimed to clarify whether convalescent rehabilitation ward inpatients in a hospital with hospital dentistry (HHD) had a better diet at discharge than those in a hospital without hospital dentistry (HNHD)., Methods: Retrospective observational study including inpatients with dental involvement in a HHD with dentists and dental hygienists and HNHD with dental hygienist and visiting dental service between 1 March and 31 August 2022. Data included age, sex, body mass index (BMI), Functional Independent Measure (FIM) motor and cognitive, Oral Health Assessment Tool (OHAT) score, Food Intake LEVEL Scale (FILS), whether the FILS ≥8 (indicating that patient eats also a non-texture-modified diet), remained and functional tooth numbers and speech language hearing therapist (SLHT) and dentist interventions. Comparisons between the two hospitals and factors that affected the FILS ≥8 were examined., Results: A total of 333 and 89 inpatients were included in the HHD and HNHD groups, respectively. After propensity score matching, the HHD group had a significantly higher rate of FILS ≥8, functional tooth numbers at discharge, and SLHT and dentist intervention rates. The multivariable logistic regression analysis for propensity score matching participants showed that the significant independent variables for FILS ≥8 were age, BMI, FILS, FIM motor (all at admission) and SLHT and dentist interventions. Odds ratio for dentist intervention was 14.46 (95% CI: 4.36-48.01)., Conclusions: Dentists are necessary to improve patients' food intake status in convalescent rehabilitation wards., (© 2024 John Wiley & Sons Ltd.)

Intercalation of guest ions into a van der Waals (vdW) gap in layered materials is a powerful route to create novel material phases and functionalities. Ionic gating is a technique to control the motions and configuration of ions for both intercalation and surface electrostatic doping. The advance of ionic gating enables the in situ probe of dynamics of ion diffusion, carrier doping, and transport properties. Here we performed in situ resistivity and Raman experiments on the potassium ion (K + ) intercalation of single-crystal MoS 2 and constructed a temperature-carrier density phase diagram. The K + -intercalation induces a structural transition from the prismatically coordinated phase to the octahedrally coordinated phase, where anisotropic three-dimensional superconductivity and a possible charge density wave state were observed. The present ionic gating offers a comprehensive view of the intercalated phases and proves that the electrostatically induced superconductivity is distinct from that in the intercalated phase.

The platelet-derived growth factor (PDGF) family contributes to the progression of steatohepatitis; however, changes in and the characteristics of isoform-specific expression remain unclear. Since diabetes is a major driver of metabolic dysfunction-associated steatohepatitis (MASH), we characterized the mouse model of diabetic MASH (dMASH) by focusing on PDGF signaling. Pdgfa-d expression was markedly higher in hepatic stellate cells among flow-sorted cells in control mice and also increased in dMASH. In contrast, a reanalysis of human single-cell RNA-Seq data showed the distinct distribution of each PDGF isoform with disease progression. Furthermore, inflammation and fibrosis in the liver were less severe in diabetic MASH using tamoxifen-induced PDGF receptor β (PDGFRβ)-deficient mice (KO) than in control dMASH using floxed mice (FL) at 12 weeks old. Despite the absence of tumors, the expression of tumor-related genes was lower in KO than in FL. Tumorigenesis was significantly lower in 20-week-old KO. An Ingenuity Pathway Analysis of differentially expressed miRNA between FL and KO identified functional networks associated with hepatotoxicity and cancer. Therefore, PDGFRβ signals play important roles in the progression of steatohepatitis and tumorigenesis in MASH, with the modulation of miRNA expression posited as a potential underlying mechanism., (© 2024. The Author(s).)

Objectives: The placement of plastic stents (PS), including intraductal PS (IS), is useful in patients with unresectable malignant hilar biliary obstruction (UMHBO) because of patency and ease of endoscopic reintervention (ERI). However, the optimal stent replacement method for PS remains unclear., Methods: This retrospective study included 322 patients with UMHBO. Among them, 146 received PS placement as initial drainage (across-the-papilla PS [aPS], 54; IS, 92), whereas 75 required ERI. Eight bilateral aPS, 21 bilateral IS, and 17 bilateral self-expandable metallic stent (SEMS) placements met the inclusion criteria. Rates of technical and clinical success, adverse events, recurrent biliary obstruction (RBO), time to RBO (TRBO), overall survival, and secondary ERI were compared., Results: There were no significant intergroup differences in rates of technical or clinical success, adverse events, RBO occurrence, or overall survival. The median TRBO was significantly shorter in the aPS group (47 days) than IS (91 days; P = 0.0196) and SEMS (143 days; P < 0.01) groups. Median TRBO did not differ significantly between the IS and SEMS groups (P = 0.44). On Cox multivariate analysis, the aPS group had the shortest stent patency (hazard ratio 2.67 [95% confidence interval 1.05-6.76], P = 0.038). For secondary ERI, the median endoscopic procedure time was significantly shorter in the IS (22 min) vs. SEMS (40 min) group (P = 0.034)., Conclusions: Bilateral IS and SEMS placement featured prolonged patency after first ERI. Because bilateral IS placement is faster than SEMS placement and IS can be removed during secondary ERI, it may be a good option for first ERI., (© 2024 Japan Gastroenterological Endoscopy Society.)

The oral mucosa is the first line of defense against pathogenic bacteria and plays a vital role in maintaining tolerance to food antigens and commensal bacteria. We used CD11c reporter mice to visualize dendritic cells (DCs), a key immune cell population, in the oral cavity. We identified differences in DC density in each oral tissue region. Sublingual immune cell clusters (SLICs) extended from the lamina propria to the epithelium, where DCs and T cells resided in close contact with each other and innate lymphoid cells. Targeted in situ photolabeling revealed that the SLICs comprised mostly CD11c+CD11b+ DCs and were enriched for cDC1s and Langerhans cells. Although the frequency of T cell subsets was similar within and outside the SLICs, tissue-resident memory T cells were significantly enriched within the clusters and cluster size increased in response to inflammation. Collectively, we found that SLICs form a unique microenvironment that facilitates T cell-DC interactions in the steady state and during inflammation. Since the oral mucosa is an important target for needle-free vaccination and sublingual immunotherapy to induce tolerogenic responses, the insight into the localized immunoregulation provided in this study may accelerate the development of these approaches.

Background: Benign choledochojejunal anastomotic stricture (CJS) is a complication of pancreaticoduodenectomy and choledochojejunostomy. Typically managed with endoscopic balloon dilatation, CJS has a high recurrence rate. Covered metallic stent (CMS) placement is a potential alternative; however, a comprehensive evaluation is lacking., Objectives: The aim of this study was to evaluate the treatment outcomes of CMS placement in patients with CJS., Methods: We retrospectively analyzed patients who underwent balloon dilation via endoscopic retrograde cholangiopancreatography using a double-balloon endoscope for CJS between October 2010 and October 2023. The study outcomes included technical and clinical success rates, adverse event rates, choledochojejunal anastomotic stricture recurrence rates, and time to recurrence for balloon dilation and CMS treatment for CJS., Results: There were 43 patients, 55 procedures (40 balloon dilation and 15 CMS placement). The technical and clinical success rates were 100% for both treatments. Recurrence of CJS was observed in 35% (14/40) of the patients in the balloon dilation group. The recurrence rate was significantly higher in the balloon dilation group than in the CMS group (35% vs. 0%, p = 0.006). The time to CJS recurrence was significantly shorter in the balloon dilation group than in the covered metallic stent group (NR vs. NR, p = 0.03)., Conclusion: Placement of CMS for treating patients with CJS was demonstrated to be an effective and safe method with a lower recurrence rate than balloon dilation., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Previous studies have poorly described the initial development process of the tendinous intersections of the rectus abdominis muscle (RAM). The present study aimed to observe the formation of tendinous intersections in the RAM during the early fetal period using diffusion tensor imaging (DTI). Fifteen human fetal specimens (crown-rump length [CRL]: 39.5-93.7 mm) were selected. Three-dimensional measurements revealed that Zone-4 (i.e., the zone between the pubic symphysis and the caudal base of the umbilical ring in the RAM) had a smaller width and was thicker than Zone-1 and Zone-2 (i.e., the zones between the costal arch and the cranial base of the umbilical ring) and Zone-3 (i.e., the zone at the umbilical ring). Characteristics of tendinous intersections in the RAM during the early fetal period were assessed according to number, size, type, laterality, and sex. The mean number of tendinous intersections on both sides was 3.1 (range: 2.0-4.0), and 21% of specimens had only two tendinous intersections, which was higher than that reported in previous adult studies. The present data suggest that the formation of tendinous intersections was still in progress in specimens with two tendinous intersections in the RAM and that the third tendinous intersection was formed in Zone-2. Ordinal logistic regression via generalized estimating equations revealed that the odds for a higher type of tendinous intersections in Zone-1 and Zone-2 were significantly higher than those in Zone-4 (adjusted odds ratio: 14.85, 8.84). The odds for the presence of incomplete types (tendinous intersections that could not completely transverse the RAM) in Zone-3 were significantly higher than those in Zone-1 (adjusted odds ratio: 7.4). The odds for missing tendinous intersections in Zone-4 were significantly higher than those in Zone-1 (adjusted odds ratio: 20.5). These zonal differences in the formation of tendinous intersections were consistent with those observed in previous adult studies. In this study, DTI detected tendinous intersections in a sample with a CRL of 45.8 mm (approximately 11 weeks of gestation), which is earlier than that in previous histological findings, indicating that the RAM does not have mature tendinous intersections until the 17th week of gestation. In conclusion, DTI could detect the premature differentiation of tendinous intersection formation. Our data may aid in elucidating the developmental processes of tendinous intersections in the RAM., (© 2024 Anatomical Society.)

In noncentrosymmetric superconductors, superconducting and normal conductions can interchange on the basis of the current flow direction. This effect is termed a superconducting diode effect (SDE), which is a focal point of recent research. The broken inversion and time-reversal symmetry is believed to be the requirements of SDE, but their intrinsic role has remained elusive. Here, we report strain-controlled SDEs in a layered trigonal superconductor, PbTaSe 2 . The SDE was found exclusively in a strained device with its absence in an unstrained device despite that it is allowed in unstrained trigonal structure. Moreover, the zero-field or magnetic field-even (magnetic field-odd) SDE is observed when the strain and current are along armchair (zigzag) direction The results unambiguously demonstrate the intrinsic SDE under time-reversal symmetry and the critical role of strain-induced electric polarization.

The ability to perform magnetic resonance (MR) imaging or spectroscopy at significantly different magnetic field strengths during scanning holds great potential for expanding the range of contrast parameter options and obtaining high "superthermal" spin polarization for increased signal-to-noise ratio (SNR) or measuring certain spins at what would otherwise be impractically high RF frequencies. Enabling measurements at multiple field strengths heretofore has required either rapidly altering the strength of a resistive magnet with pulsed currents or shuttling the specimen between two field regions. We propose a novel approach to switching-field MR that we expect to be practical for live animal and ultimately human imaging. In this paper we propose the design of a liquid-helium-free fast switching-field MR magnet that can change the field very quickly in time (≤ 1 s) between significantly different field strengths. For this magnet, two types of Nb 3 Sn wire are selected, and AC loss is measured by electrical method, and characteristics are analyzed.

Background and Aims: Pancreatic juice cytology is useful for diagnosing pancreatic duct strictures and cystic lesions. However, some cases cannot be diagnosed using cytology. This study aimed to evaluate the utility of the overnight-stored pancreatic juice cell block (CB) method for diagnosing pancreatic disease., Methods: This retrospective study included 32 patients who presented with pancreatic duct strictures or cystic lesions between 2018 and 2024. The sensitivity, specificity, and accuracy of the CB method and single/multiple pancreatic juice cytology were compared to evaluate the utility of the CB., Result: An endoscopic nasopancreatic drainage tube was placed in the main pancreatic duct, and pancreatic juice was collected to create a CB specimen. The median amount of pancreatic juice collected was 180(30-200) mL, and the median number of cytological examinations was three(2-8). Of the 32 cases, 13 were malignant, and 19 were benign (non-malignant). The sensitivity was significantly higher for the CB method (62 %) than for single cytology(15 %, P = 0.0414), and there was no significant difference between CB and multiple cytology(54 %, P = 1.0). The specificity and accuracy were not significantly different between the CB method and single or multiple cytology. When multiple cytology and CB were combined, sensitivity improved to 77 %. The pathological findings of the CB specimens were similar to the surgical specimens, including immunohistochemistry., Conclusion: The overnight-stored pancreatic juice CB method was more effective than single cytology, with similar sensitivities to multiple cytology and can also be used for immunohistochemistry. The pancreatic juice CB method is useful for pancreatic juice assessment., (Copyright © 2024 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Objectives: This study aimed to investigate the impact of the COVID-19 pandemic on the examination and treatment of colorectal cancer (CRC) and on the behaviors of patients and practitioners., Methods: This is a retrospective analysis of the CRC patients who presented to our department between April 2019 and March 2021 and underwent surgery. Clinical presentation of CRC and time from symptom onset to medical presentation were compared between the control (April 2019 to March 2020, n=124) and COVID-19 pandemic periods (April 2020 to March 2021, n=111)., Results: Two hundred and thirty-five patients were reviewed. The rate of positive fecal occult blood tests was significantly lower during the COVID-19 pandemic period (13.5 vs. 25.0%, P = 0.027). Among the symptomatic patients who had melena and abdominal symptoms, the time from symptom onset to medical presentation was significantly longer during the COVID-19 period (115 vs. 31 days, P < 0.001). In addition, the interval between presenting to a practitioner and being referred to our department was similar between the two periods (19 vs. 13 days, P = 0.092). There were no significant differences in the stage of cancer between the two periods. The rate of preoperative sub-obstruction was significantly higher during the COVID-19 period (41.4 vs 23.4%, P = 0.003). There was no significant difference in overall survival and recurrence-free survival between two periods., Conclusions: Hesitation to seek examination and treatment for CRC was observed in patients but not in practitioners during the COVID-19 pandemic period. The prognosis did not change., Competing Interests: Conflicts of Interest There are no conflicts of interest., (Copyright © 2024 The Japan Society of Coloproctology.)

Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX are widely used as first-line regimens for unresectable pancreatic cancer (PC). When GnP therapy is selected, considering patient age or condition, second-line FOLFIRINOX is sometimes difficult to administer owing to its toxicity. This study aimed to determine the recommended dose (RD) of S-IROX (S-1, oxaliplatin, and irinotecan combination) regimens in patients with unresectable PC after first-line GnP failure. This phase-I study used the "3 + 3" dose-escalation design with two dose levels. Patients who failed first-line GnP therapy for unresectable PC were enrolled. Oxaliplatin and irinotecan were administered on day 1, and S-1 was administered orally twice daily on days 1-7, followed by 7 days of rest. The primary endpoints were dose-limiting toxicities (DLTs) and determination of RD. The secondary endpoint was the evaluation of potential antitumor activity. Nine patients received the second-line S-IROX regimen. In level-0 (S-1, 80 mg/m 2 ; oxaliplatin, 85 mg/m 2 ; and irinotecan, 120 mg/m 2 ), no patient experienced DLT; however, one patient experienced grade 3 neutropenia. At level-1 (irinotecan increased to 150 mg/m 2 ), one of six patients experienced DLTs, including G3 diarrhea. The RD was confirmed at the level-1 dose. The response rate, disease control rate, median progression-free survival, and median overall survival were 33.3%, 77.8%, 172 (range:77-422) days, and 414 (101-685) days, respectively. One patient underwent surgery after the second-line S-IROX therapy. Second-line S-IROX treatment was deemed acceptable. The RD was set at level-1 dose (S-1, 80 mg/m 2 ; oxaliplatin, 85 mg/m 2 ; and irinotecan, 150 mg/m 2 )., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The leaves of many trees emit volatile organic compounds (abbreviated as BVOCs), which protect them from various damages, such as herbivory, pathogens, and heat stress. For example, isoprene is highly volatile and is known to enhance the resistance to heat stress. In this study, we analyze the optimal seasonal schedule for producing isoprene in leaves to mitigate damage. We assume that photosynthetic rate, heat stress, and the stress-suppressing effect of isoprene may vary throughout the season. We seek the seasonal schedule of isoprene production that maximizes the total net photosynthesis using Pontryagin's maximum principle. The isoprene production rate is determined by the changing balance between the cost and benefit of enhanced leaf protection over time. If heat stress peaks in midsummer, isoprene production can reach its highest levels during the summer. However, if a large portion of leaves is lost due to heat stress in a short period, the optimal schedule involves peaking isoprene production after the peak of heat stress. Both high photosynthetic rate and high isoprene volatility in midsummer make the peak of isoprene production in spring. These results can be clearly understood by distinguishing immediate impacts and the impacts of future expectations., (© 2024. The Author(s).)

The identification of anticancer therapies using next-generation sequencing (NGS) is necessary for the treatment of cholangiocarcinoma. NGS can be easily performed when cell blocks (CB) are obtained from bile stored overnight. We compared NGS results of paired CB and surgically resected specimens (SRS) from the same cholangiocarcinoma cases. Of the prospectively collected 64 bile CBs from 2018 to 2023, NGS was performed for three cases of cholangiocarcinoma that could be compared with the SRS results. The median numbers of DNA and RNA reads were 95,077,806 [CB] vs. 93,161,788 [SRS] and 22,101,328 [CB] vs. 24,806,180 [SRS], respectively. We evaluated 588 genes and found that almost all genetic alterations were attributed to single-nucleotide variants, insertions/deletions, and multi-nucleotide variants. The coverage rate of variants in SRS by those found in CB was 97.9-99.2%, and the coverage rate of SRS genes by CB genes was 99.6-99.7%. The NGS results of CB fully covered the variants and genetic alterations observed in paired SRS samples. As bile CB is easy to prepare in general hospitals, our results suggest the potential use of bile CB as a novel method for NGS-based evaluation of cholangiocarcinoma.

Understanding host behavioral change in response to epidemics is important to forecast the disease dynamics. To predict the behavioral change relevant to the epidemic situation (e.g., the number of reported cases), we need to know the epidemic situation at the moment of decision, which is difficult to identify from the records of actually performed human mobility. In this study, the largest travel accommodation reservation data covering half of the existed accommodations in Japan was analyzed to observe decision-making timings and how it responded to the changing epidemic situation during Japan's Coronavirus Disease 2019 until February 2023. To this end, we measured mobility avoidance index proposed in Ito et al., 2022 to indicate people's decision of mobility avoidance and quantified it using the time-series of the accommodation booking/cancellation data. We observed matches of the peak dates of the mobility avoidance and the number of reported cases, and mobility avoidance changed proportional to the logarithmic number of reported cases. We also found that the slope of mobility avoidance against the change of the logarithmic number of reported cases were similar among the epidemic waves, while the intercept of that was much reduced as the first epidemic wave passed by. People measure the intensity of epidemic by logarithm of the number of reported cases. The sensitivity of their response is established during the first wave and the people's response became weakened after the first experience, as if the number of reported cases were multiplied by a constant small factor., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The high surface-area-to-volume ratio of colloidal quantum dots (QDs) positions them as promising materials for high-performance supercapacitor electrodes. However, the challenge lies in achieving a highly accessible surface area, while maintaining good electrical conductivity. An efficient supercapacitor demands a dense yet highly porous structure that facilitates efficient ion-surface interactions and supports fast charge mobility. Here we demonstrate the successful development of additive-free ultrahigh energy density electric double-layer capacitors based on quantum dot hierarchical nanopore (QDHN) structures. Lead sulfide QDs are assembled into QDHN structures that strike a balance between electrical conductivity and efficient ion diffusion by employing meticulous control over inter-QD distances without any additives. Using ionic liquid as the electrolyte, the high-voltage ultrathin-film microsupercapacitors achieve a remarkable combination of volumetric energy density (95.6 mWh cm -3 ) and power density (13.5 W cm -3 ). This achievement is attributed to the intrinsic capability of QDHN structures to accumulate charge carriers efficiently. These findings introduce innovative concepts for leveraging colloidal nanomaterials in the advancement of high-performance energy storage devices.

Multiferroic materials have attracted considerable attention owing to their unique magnetoelectric or magnetooptical properties. The recent discovery of few-layer van der Waals multiferroic crystals provides a new research direction for controlling the multiferroic properties in the atomic layer limit. However, research on few-layer multiferroic crystals is limited and the effect of thickness-dependent symmetries on those properties is less explored. In this study, the symmetries and magnetoelectric responses of van der Waals multiferroic CuCrP 2 S 6 are investigated by optical second harmonic generation (SHG). Structural and magnetic phase transitions are successfully probed by the temperature-dependent SHG signals, revealing significant changes by applying the magnetic field reflecting the magnetoelectric effect. Moreover, it is found that symmetries and resultant magnetoelectric responses can be modulated by the number of layers. These results offer a new principle of controlling the multiferroicity and indicate that 2D van der Waals multiferroic material is a promising building block for functional nanodevices., (© 2024 The Authors. Advanced Materials published by Wiley‐VCH GmbH.)

Background/aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML)., Methods: Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles., Results: Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1-6] vs. 4 [1-6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group., Conclusions: Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

Background: Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for pancreatic stones in chronic pancreatitis. In contrast, peroral pancreatoscopy-guided lithotripsy (POPS-L) remains underexplored, with limited comparative studies to ESWL. This study compared the treatment outcomes of disposable POPS-L tools and ESWL for pancreatic stones., Methods: A retrospective analysis was conducted on 66 patients who had undergone pancreatic stone treatment at three institutions between 2006 and 2022. The treatment outcomes of POPS-L and ESWL were compared., Results: This study included 19 and 47 patients who had undergone POPS-L and ESWL, respectively. In a comparison between POPS-L and ESWL, the stone clearance rates were 78.9% vs. 70.2% ( p = 0.55), while the procedure-related complication rates were 21% vs. 6.3% ( p = 0.09). The median total session counts were 1 vs. 5 ( p < 0.01). The cumulative stone recurrence rates were comparable in both groups. Multivariate analysis revealed no significant factors influencing the stone clearance rates, and the choice between POPS-L and ESWL did not affect the stone clearance rates., Conclusions: POPS-L and ESWL exhibited comparable treatment outcomes in terms of stone clearance, complications, and recurrence rates. Furthermore, POPS-L is advantageous due to the need for fewer sessions to achieve pancreatic stone clearance.

Magnetic semimetals form an attractive class of materials because of the nontrivial contributions of itinerant electrons to magnetism. Because of their relatively low-carrier-density nature, a doping level of those materials could be largely tuned by a gating technique. Here, we demonstrate gate-tunable ferromagnetism in an emergent van der Waals magnetic semimetal Cr 3 Te 4 based on an ion-gating technique. Upon doping electrons into the system, the Curie temperature ( T C ) sharply increases, approaching near to room temperature, and then decreases to some extent. This non-monotonous variation of T C accompanies the switching of the magnetic anisotropy, synchronously followed by the sign changes of the ordinary and anomalous Hall effects. Those results clearly elucidate that the magnetism in Cr 3 Te 4 should be governed by its semimetallic band nature.

Some viruses exhibit "rebound" when the administration of antiviral drugs is discontinued. Viral rebound caused by resistance mutations or latent reservoirs has been studied mathematically. In this study, we investigated the viral rebound due to other causes. Since immunity is weaker during antiviral treatment than without the treatment, drug discontinuation may lead to an increase in the viral load. We analyzed the dynamics of the number of virus-infected cells, cytotoxic T lymphocytes, and memory cells and identified the conditions under which the viral load increased upon drug discontinuation. If drug is administered for an extended period, a viral rebound occurs when the ratio of viral growth rate in the absence to that in the presence of the antiviral drug exceeds the "rebound threshold." We analyzed how the rebound threshold depended on the patient's conditions and the type of treatment. Mathematical and numerical analyses revealed that rebound after discontinuation was more likely to occur when the drug effectively reduced viral proliferation, drug discontinuation was delayed, and the processes activating immune responses directly were stronger than those occurring indirectly through immune memory formation. We discussed additional reasons for drugs to cause viral rebound more likely., Competing Interests: Declaration of competing interest The authors have declared that no competing interests related to this article. Akane Hara's affiliation, the Laboratory of Pharmaceutical Quality Assurance and Assessment (University of Toyama) is an endowed laboratory supported by an unrestricted grant from Nichi-Iko Pharmaceutical Co. Ltd. (Toyama, Japan)., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Although intraductal plastic stent (IS) placement is an effective treatment for unresectable malignant hilar biliary obstruction (UMHBO), the effectiveness of unilateral and bilateral IS drainage remains controversial. This retrospective study investigated the effectiveness of bilateral IS placement for UMHBO using the propensity score matching method., Methods: Patients who underwent transpapillary endoscopic stenting for UMHBO were analyzed for technical and clinical success, adverse events, and time to recurrent biliary obstruction (TRBO)., Results: A total of 321 patients were enrolled in the study with 27 patients in each unilateral and bilateral IS group in the propensity score-based cohort. Technical success was 100%, while clinical success was 93% and 96% in the unilateral and bilateral IS groups, respectively (p = 1.0). Cholecystitis occurred in 4% and 7%, respectively (p = 1.0). The median TRBO was shorter in the unilateral group (129 [5-383] days) than that in the bilateral group (226 [16-563] days) (p = .0281). Bilateral IS placement was an independent long TRBO factor (hazard ratio [HR] 0.46; 95% confidence interval [CI]: 0.21-0.97; p = .041)., Conclusions: Unilateral and bilateral IS placement had high technical and clinical success rates in primary stent placement. However, bilateral IS placement showed a longer TRBO. Bilateral IS placement may be a good option for initial UMHBO drainage., (© 2023 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)

A 60-year-old man with a high IgG4 level was found to have pancreatic tail enlargement on computed tomography (CT), and autoimmune pancreatitis (AIP) was confirmed by a histological diagnosis. He was treated with prednisolone for one year and seven months, at which point his treatment finished. Four months later, however, he had hematemesis from gastric varices. CT showed recurrence of pancreatic tail enlargement with obstruction of the splenic artery and vein and formation of collateral blood vessels to the gastric fornix. Endoscopic injection sclerotherapy was performed, and he underwent splenectomy. This case highlights the importance of paying attention to peripancreatic vascular abnormalities during follow-up of AIP patients.

Background: One-stage endoscopic management, where papillary interventions and stone removal are simultaneously performed, has been reported to be an effective treatment for acute cholangitis caused by common bile duct stones (CBDS). However, there have been few reports comparing it with two-stage management, and there is no established strategy for the indication of one-stage management. The aim of the present study was to compare the short- and long-term outcomes between one- and two-stage management for acute cholangitis caused by CBDS., Methods: We retrospectively studied 577 patients who underwent one- or two-stage endoscopic management for acute cholangitis between May 2010 and December 2020. The patients were divided into one- and two-stage groups by endoscopic management. The clinical outcomes were compared between groups., Results: The technical and clinical success were similar in both groups, although the length of hospital stay was significantly shorter in the one-stage group. Although there was no difference in the early adverse event (AE) between two groups, post-ERCP pancreatitis was recognized in 3.4% and 10.0%, which was significantly higher in the two-stage group. The cumulative late AE rate was 22.6% and 14.1%, which was significantly higher in the one-stage group. In the multivariate analyses, intervention (one-stage), number of CBDS ≥2, biliary drainage, the use of ML, and gallbladder stone were identified as significant factors associated with the recurrence of CBDS., Conclusion: Although one-stage endoscopic management is useful and safe with reducing hospital stays, diligent postoperative follow-up with consideration to recurrence of CBDS is essential., (© 2024 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)

The pyramidalis muscle (PM) is a paired small triangular muscle of the anterior abdominal wall; however, its physiological significance is unclear. Recent studies have failed to detect this muscle during embryonic period. Hence, the present study aimed to determine the time when PM is emerging and reveal its features using high-resolution magnetic resonance imaging. Fourteen embryos between Carnegie stage (CS)18 and CS23 and 59 fetuses (crown-rump length: 39.5-185.0 mm) were selected for this study. The PM was first detected in one of the three samples at CS20. It was detected in five of the seven samples (71.4%) between CS21 and CS23. Forty-eight samples (81.4%) at early fetal period had PMs on both the right and left sides, and 3 (5.1%) had it only on the right side. Eight samples (13.6%) had no PMs. No side-differences or sexual dimorphisms were detected. The PM length was larger than the width in most samples, although the length/width ratio varied among the samples. The PM/rectus abdominis muscle length and PM/umbilicus-pubic symphysis length ratios were almost constant, irrespective of the crown-rump length. The PM was located ventrally inferior to the rectus abdominis and closer to the medial muscle groups of the lower limb than the rectus abdominis. The present study demonstrated that PM formation occurred in the late embryonic period, and that the frequency, side differences, sex dimorphism, and spatial position of the PM in the early fetal period were similar to those in adults., (© 2024 Japanese Teratology Society.)

A 59-year-old man receiving sunitinib chemotherapy for postoperative recurrence of renal cell carcinoma (RCC) metastases was found to have multiple metastases on contrast-enhanced computed tomography (CECT). CECT revealed a typical hyperdense enhanced nodule in the arterial phase of the stomach and head and tail of the pancreas. However, in the uncinate process of the pancreas, CECT revealed an atypical image and a hypodense enhanced nodule in each phase. Both lesions were finally pathologically diagnosed as clear cell carcinoma. Treatment-modified pancreatic metastases from RCC may present with nonspecific images; therefore, caution is required when deciding on treatment strategies.

Objective: This study aimed to assess age-related changes in Stroop Color and Word test indices in individuals with high-functioning pervasive developmental disorder (HF-PDD) and compare their performance with typically developing (TD) individuals., Methods: There were a total of 125 participants (57 TD, 68 HF-PDD), aged 6-24. Stimuli were displayed on computer screens, and participants verbally responded with response times recorded via voice key function., Results: Single regression analysis revealed age-associated trends in Stroop test indices for both groups, indicating shorter response times and reduced Stroop interference with age. The age at which the best Stroop test results were obtained ranged from 220 to 260 months for TD and from 195 to 201 months for HF-PDD. While color naming and word reading tasks showed no significant group differences, color word naming task response times were significantly longer for the HF-PDD group. Around 30% of HF-PDD participants scored over two standard deviations above the TD mean., Conclusions: Both TD and HF-PDD groups exhibited age-related changes in Stroop task performance, which were fitted by a quadratic regression curve. Prolongation of the color word naming task in the HF-PDD group suggests that approximately 30% of individuals with HF-PDD have difficulty with stereotype suppression. J. Med. Invest. 71 : 254-259, August, 2024.

Colloidal quantum dots are sub-10 nm semiconductors treated with liquid processes, rendering them attractive candidates for single-electron transistors operating at high temperatures. However, there have been few reports on single-electron transistors using colloidal quantum dots due to the difficulty in fabrication. In this work, we fabricated single-electron transistors using single oleic acid-capped PbS quantum dot coupled to nanogap metal electrodes and measured single-electron tunneling. We observed dot size-dependent carrier transport, orbital-dependent electron charging energy and conductance, electric field modulation of the electron confinement potential, and the Kondo effect, which provide nanoscopic insights into carrier transport through single colloidal quantum dots. Moreover, the large charging energy in small quantum dots enables single-electron transistor operation even at room temperature. These findings, as well as the commercial availability and high stability, make PbS quantum dots promising for the development of quantum information and optoelectronic devices, particularly room-temperature single-electron transistors with excellent optical properties., (© 2023. The Author(s).)

Background and Aims: Intraductal plastic stent (IS) placement for unresectable malignant hilar biliary obstruction (UMHBO) is an effective option for biliary drainage. However, the effectiveness of bilateral IS placement compared with bilateral self-expandable metal stent (SEMS) placement remains unclear., Methods: Overall, 301 patients with UMHBO were enrolled; 38 patients underwent bilateral IS placement (IS group) and 38 patients underwent SEMS placement (SEMS group) in the propensity score-based cohort. Both groups were compared for technical and clinical success, adverse events (AEs), recurrent biliary obstruction (RBO), time to RBO (TRBO), overall survival (OS), and endoscopic reintervention (ERI)., Results: No significant differences were observed between the groups regarding technical and clinical success, AEs and RBO occurrence rates, TRBO, or OS. The median initial endoscopic procedure time was significantly shorter in the IS group (23 vs 49 minutes, P < .01). ERI was performed on 20 and 19 patients in the IS and SEMS groups, respectively. The median ERI procedure time was significantly shorter in the IS group (22 vs 35 minutes, P = .04). Median TRBO after ERI with plastic stent placement tended to be longer in the IS group (306 vs 56 days, P = .068). A Cox multivariate analysis showed that the IS group was the significant related factor for TRBO after ERI (hazard ratio, .31; 95% confidence interval, .25-.82; P = .035)., Conclusions: Bilateral IS placement can reduce the duration of the endoscopic procedure and provide sufficient stent patency both initially and after ERI stent placement, and the stents are removable. Bilateral IS placement is considered a good option for initial UMHBO drainage. (Clinical trial registration number: UMIN000050546.)., Competing Interests: Disclosure All authors disclosed no financial relationships. This work was supported by JSPS KAKENHI (grant no. JP23K14646, Mitsuru Okuno)., (Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Objectives: Bilateral self-expandable metallic stent (SEMS) placement for unresectable malignant hilar biliary obstruction (UMHBO) is an effective option for biliary drainage with long-term stent patency. Laser-cut and braided SEMS can be used for bilateral SEMS placement. This study aimed to clarify any differences in the clinical features and proper use of the laser-cut and braided SEMS placement using the stent-in-stent method for UMHBO., Methods: In this study, 78 patients who underwent bilateral stent-in-stent SEMS placement for UMHBO were included. The patients were divided into the laser-cut (n = 33) and braided groups (n = 45). Both groups were compared for technical and clinical success, adverse events (AEs), time to recurrent biliary obstruction (TRBO), overall survival, and endoscopic reintervention (ERI)., Results: There were no significant differences in technical and clinical success rates (laser-cut vs. braided group, 97% vs. 95.6%, P = 1.0), AEs (21.2% vs. 15.6%. P = 0.56), median TRBO (242 days vs. 140 days, P = 0.36), and median overall survival (654 days vs. 675 days, P = 0.58). ERI was required in 15 patients in the laser-cut group and in 20 patients in the braided group. The technical and clinical success rates of ERI (60% vs. 85%) were not significantly different (P = 0.13); however, the median ERI procedure time was significantly longer in the laser-cut group (38 min) than in the braided group (22 min; P = 0.02)., Conclusion: No significant difference in initial SEMS placement was noted between the laser-cut and braided groups; however, the laser-cut group required a longer ERI procedure time than that required by the braided group. The use of braided SEMS may be a convenient option for ERI., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured. As the artery was directly visible, we grasped it using a Coagrasper and coagulated the bleeding point. However, the bleeding was aggravated after coagulation owing to an extension of the vessel damage. The entire vessel was grasped, and complete hemostasis was achieved. The Coagrasper is useful for managing arterial bleeding; however, it should be employed only on the basis of its characteristics and in suitable scenarios.

A 45-year-old man was referred to our hospital with a complaint of right scrotal discomfort. With a diagnosis of testicular tumor, right orchiectomy was performed. The tumor was histologically diagnosed as malignant Sertoli cell tumor pT1N0M0. A pulmonary nodule appeared, 53 months after the operation, and increased in size there after. Thoracoscopic left upper lobectomy was performed 64 months after the operation, and the pathological diagnosis was metastasis of malignant Sertoli cell tumor. No recurrence has been observed for 94 months after the resection of the metastatic lesion.