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This study evaluates the interdependence between pricing and expectations. We investigated not only the ways in which traders’ thoughts determined asset prices, but also the feedback process from prices to expectations. In our laboratory market, subjects were asked to estimate the number of balls in a jar and trade an asset whose value was equal to that number. Our asset market, where transactions were eventually settled at the asset value, was like futures markets. The subjects alternately repeated the process of guessing and transaction. A double-auction was used to design our market. Our findings indicated a downward bias in the subjects’ estimates, which led to lower transaction prices, since the price converged to the equilibrium price that was determined by the median of estimates. The subjects’ experience in our laboratory markets had no systematic effect on the accuracy of estimates, but made them less heterogenous. Our subjects were apt to revise their estimates with reference to prices in a market. We examined the estimation revision process of the subjects using the partial adjustment model.

Background Prognosis of nephrotic syndrome has been evaluated based on pathological diagnosis, whereas its clinical course is monitored using objective items and the treatment strategy is largely the same. We examined whether the entire natural history of nephrotic syndrome could be evaluated using objective common clinical items. Methods Machine learning clustering was performed on 205 cases from the Japan Nephrotic Syndrome Cohort Study, whose clinical parameters, serum creatinine, serum albumin, dipstick hematuria, and proteinuria were traceable after kidney biopsy at 5 measured points up to 2 years. The clinical patterns of time-series data were learned using long short-term memory (LSTM)-encoder–decoder architecture, an unsupervised machine learning classifier. Clinical clusters were defined as Gaussian mixture distributions in a two-dimensional scatter plot based on the highest log-likelihood. Results Time-series data of nephrotic syndrome were classified into four clusters. Patients in the fourth cluster showed the increase in serum creatinine in the later part of the follow-up period. Patients in both the third and fourth clusters were initially high in both hematuria and proteinuria, whereas a lack of decline in the urinary protein level preceded the worsening of kidney function in fourth cluster. The original diseases of fourth cluster included all the disease studied in this cohort. Conclusions Four kinds of clinical courses were identified in nephrotic syndrome. This classified clinical course may help objectively grasp the actual condition or treatment resistance of individual patients with nephrotic syndrome.

Well-leg compartment syndrome (WLCS) is a potentially life-threatening postoperative complication related to the Lloyd-Davies surgical position, which can place increased external pressure on the calf region. We conducted this study to analyze external pressure changes, by applying a leg holder system to the left calf region of patients placed in the Lloyd-Davies position during laparoscopic surgery.The study participants were 50 patients who underwent laparoscopic surgery for colorectal cancer in the Lloyd-Davies position. We assessed the maximum external pressure (MEP) on the left calf region using a pressure-distribution measurement system. Intraoperative measurements were taken continuously, and the MEP was evaluated with the patient horizontal and every 30 min during surgery in the head and right-down tilt position.The intraoperative MEP increased gradually when the patient was in the head and right-down tilt position and decreased when the patient was returned to the horizontal position. The MEP was higher in patients aged 60 years, those who were obese, and those with a thick calf circumference. Both body mass index (BMI) and the maximum left calf circumference (MLCC) were found to correlate with the MEP.In addition to a high BMI, which is a well-known risk factor for WLCS, a high MLCC should be considered another risk factor, especially for patients under 60 years.

Although synchronized oscillations are found in a variety of systems and living organisms in nature, there has been no report on technologically important materials. We have observed by a fluorescence microscope that a large number of carbon nanotubes (CNTs) dispersed in an aqueous mixture of the surfactant and dye execute synchronized oscillations spontaneously. The movement was quantified to give a power spectrum, revealing a single, sharp synchronization peak at 20 Hz. It was found not to be affected nor created by external vibrations. The surfactant concentration dependence demonstrates that the Kuramoto model is applicable to describe the CNT synchronization. It is always associated with the power-law noise, indicating the presence of complex heterogeneous networks. These results suggest a highly cooperative form of the sparse CNT network connected with variable linkages.

Purpose The purpose of this study was to evaluate whether deep learning reconstruction (DLR) improves the image quality of intracranial magnetic resonance angiography (MRA) at 1.5 T. Materials and methods In this retrospective study, MRA images of 40 patients (21 males and 19 females; mean age, 65.8 ± 13.2 years) were reconstructed with and without the DLR technique (DLR image and non-DLR image, respectively). Quantitative image analysis was performed by placing regions of interest on the basilar artery and cerebrospinal fluid in the prepontine cistern. We calculated the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) for analyses of the basilar artery. Two experienced radiologists evaluated the depiction of structures (the right internal carotid artery, right ophthalmic artery, basilar artery, and right superior cerebellar artery), artifacts, subjective noise and overall image quality in a qualitative image analysis. Scores were compared in the quantitative and qualitative image analyses between the DLR and non-DLR images using Wilcoxon signed-rank tests. Results The SNR and CNR for the basilar artery were significantly higher for the DLR images than for the non-DLR images (p p p p = 0.072–0.565), were also significantly higher for the DLR images than for the non-DLR images. Conclusion DLR enables the production of higher quality 1.5 T intracranial MRA images with improved visualization of arteries.

Background Horseshoe kidney is one of the most common congenital renal fusion anomalies and is characterized by abnormalities in the position, rotation, vascular supply, and ureteral anatomy of the kidney. When performing surgery for colorectal cancer in patients with horseshoe kidneys, anatomical identification is important to avoid organ injuries. Several reports on surgery for colorectal cancer with horseshoe kidneys have described the usefulness of three-dimensional (3D) computed tomography (CT) angiography for detecting abnormalities in vascular supply. However, few reports have focused on the prevention of ureteral injury in surgery for colorectal cancer with horseshoe kidney, despite abnormalities in the ureteral anatomy. Here, we report a case in which laparoscopic sigmoid colon resection for sigmoid colon cancer with a horseshoe kidney was safely performed using fluorescent ureteral catheters. Case presentation A 60-year-old Japanese man presented to our hospital testing positive for fecal occult blood. Colonoscopy revealed sigmoid colon cancer, and CT confirmed a horseshoe kidney. The 3D-CT angiography showed aberrant renal arteries from the aorta and right common iliac artery, and the left ureter passed across the front of the renal isthmus. A fluorescent ureteral catheter was placed in the left ureter before the surgery to prevent ureteral injury. Laparoscopic sigmoid colon resection with D3 lymph node dissection was performed. The fluorescent ureteral catheter enabled the identification of the left ureter that passed across the front of the renal isthmus and the safe mobilization of the descending and sigmoid colon from the retroperitoneum. The operative time was 214 min, with intraoperative bleeding of 25 mL. The patient’s postoperative course was good: no complications arose and she was discharged on the seventh postoperative day. Conclusion In patients with horseshoe kidney, the use of fluorescent ureteral catheters and 3D-CT angiography enables safer laparoscopic surgery for colorectal cancer. We recommend the placement of fluorescent ureteral catheters in such surgeries to prevent ureteral injury.

Cancer-associated fibroblasts (CAFs) are a critical component of the tumor microenvironment and play a central role in tumor progression. Previously, we reported that CAFs might induce tumor immunosuppression via interleukin-6 (IL-6) and promote tumor progression by blocking local IL-6 in the tumor microenvironment with neutralizing antibody. Here, we explore whether an anti-IL-6 receptor antibody could be used as systemic therapy to treat cancer, and further investigate the mechanisms by which IL-6 induces tumor immunosuppression. In clinical samples, IL-6 expression was significantly correlated with α-smooth muscle actin expression, and high IL-6 cases showed tumor immunosuppression. Multivariate analysis showed that IL-6 expression was an independent prognostic factor. In vitro, IL-6 contributed to cell proliferation and differentiation into CAFs. Moreover, IL-6 increased hypoxia-inducible factor 1α (HIF1α) expression and induced tumor immunosuppression by enhancing glucose uptake by cancer cells and competing for glucose with immune cells. MR16-1, a rodent analog of anti-IL-6 receptor antibody, overcame CAF-induced immunosuppression and suppressed tumor progression in immunocompetent murine cancer models by regulating HIF1α activation in vivo. The anti-IL-6 receptor antibody could be systemically employed to overcome tumor immunosuppression and improve patient survival with various cancers. Furthermore, the tumor immunosuppression was suggested to be induced by IL-6 via HIF1α activation.

Objectives To establish a CT lymphangiography method in mice via direct lymph node puncture. Methods We injected healthy mice (n = 8) with 50 µl of water-soluble iodine contrast agent (iomeprol; iodine concentration, 350 mg/mL) subcutaneously into the left-rear foot pad (interstitial injection) and 20 µl of the same contrast agent directly into the popliteal lymph node (direct puncture) 2 days later. Additionally, we performed interstitial MR lymphangiography on eight mice as a control group. We calculated the contrast ratio for each lymph node and visually assessed the depiction of lymph nodes and lymphatic vessels on a three-point scale. Results The contrast ratios of 2-min post-injection images of sacral and lumbar–aortic lymph nodes were 20.7 ± 16.6 (average ± standard deviation) and 17.1 ± 12.0 in the direct puncture group, which were significantly higher than those detected in the CT or MR interstitial lymphangiography groups (average, 1.8–3.6; p = 0.008–0.019). The visual assessment scores for sacral lymph nodes, lumbar–aortic lymph nodes, and cisterna chyli were significantly better in the direct puncture group than in the CT interstitial injection group (p = 0.036, 0.009 and 0.001, respectively). The lymphatic vessels between these structures were significantly better scored in direct puncture group than in the CT or MR interstitial lymphangiography groups at 2 min after injection (all p ≤ 0.05). Conclusions In CT lymphangiography in mice, the direct lymph node puncture provides a better delineation of the lymphatic pathways than the CT/MR interstitial injection method. Key Points •The contrast ratios of 2-min post-injection images in the direct CT lymphangiography group were significantly higher than those of CT/MR interstitial lymphangiography groups. •The visibility of lymphatic vessels in subjective analysis in the direct CT lymphangiography group was significantly better in the direct puncture group than in the CT/MR interstitial lymphangiography groups. •CT lymphangiography with direct lymph node puncture can provide excellent lymphatic delineation with contrast being maximum at 2 min after injection.

Purpose To evaluate whether deep learning reconstruction (DLR) accelerates the acquisition of 1.5-T magnetic resonance imaging (MRI) knee data without image deterioration. Materials and methods Twenty-one healthy volunteers underwent MRI of the right knee on a 1.5-T MRI scanner. Proton-density-weighted images with one or four numbers of signal averages (NSAs) were obtained via compressed sensing, and DLR was applied to the images with 1 NSA to obtain 1NSA-DLR images. The 1NSA-DLR and 4NSA images were compared objectively (by deriving the signal-to-noise ratios of the lateral and the medial menisci and the contrast-to-noise ratios of the lateral and the medial menisci and articular cartilages) and subjectively (in terms of the visibility of the anterior cruciate ligament, the medial collateral ligament, the medial and lateral menisci, and bone) and in terms of image noise, artifacts, and overall diagnostic acceptability. The paired t-test and Wilcoxon signed-rank test were used for statistical analyses. Results The 1NSA-DLR images were obtained within 100 s. The signal-to-noise ratios (lateral: 3.27 ± 0.30 vs. 1.90 ± 0.13, medial: 2.71 ± 0.24 vs. 1.80 ± 0.15, both p p Conclusion Compared with the 4NSA images, the 1NSA-DLR images exhibited less noise, higher overall image quality, and allowed more precise visualization of the menisci and ligaments.

This paper presents a pump using polyvinyl chloride (PVC) gel. PVC gels are compliant, have a simple structure, and exhibit large deformation at voltages in the range of 100–1000 V, which make them suitable for micropumps. In this study, a PVC gel sheet with a surface pattern that enhances active deformation in the thickness direction was employed for the fabrication of a pump. To this end, the PVC gel sheet was sandwiched between three sets of anode and cathode electrodes, after which voltages were sequentially applied to these electrodes to generate a peristaltic deformation of the gel sheet, thus pushing the liquid and creating a one-directional flow. Various pumps were fabricated using PVC gel sheets with different surface patterns, and the pumps were characterized. The pumps exhibited an outline dimension of 35 mm × 25 mm with a thickness of 4 mm, corresponding to a total volume of 3.5 × 103 mm3. The results revealed that the pump fabricated using a 174-μm-high pyramid-patterned gel sheet generated a flow rate of 224.1 µL/min at an applied voltage of 800 V and a driving frequency of 3 Hz. This observed value is comparable to or better than those of existing pumps based on smart materials.

It has been commonly accepted for a long time that the cerebrospinal fluid (CSF) drains into arachnoid granulations from the subarachnoid space to the dural venous sinus unidirectionally. However, recently, periventricular capillaries and lymphatic concepts have been introduced. The CSF moves along the perivascular space and drains into the capillary vessels or meningeal lymphatic tissues. CSF is involved in removing brain waste out of the brain. In this study, we investigated the outflow mechanism of substances in the CSF from the brain. We investigated the movement of CSF by injection of gold colloid conjugates (2, 40, and 200 nm) into the lateral ventricles of mouse fetuses and evaluated the deposition by silver stain with tissue transparency and electron microcopy. Cadaverine was also injected into the lateral ventricle to determine its movement tract. The gold particle deposition was mainly observed in the frontal skull base. Electron microscopic study showed that the gold particle deposition was observed on the choroid plexus and ependyma in the lateral ventricle and also red blood cells in the heart and liver. Two-nanometer particles were exclusively observed in the liver. Cadaverine injection study demonstrated that cadaverine was observed at the extracranial frontal skull base, choroid plexus, ependymal surface, and perivascular area in the brain white matter. The particles in the CSF were shown to move from the brain to the frontal skull base and also into the blood stream through the choroid plexus in the fetus. The outflow of particles in the CSF may be regulated by molecular size. This new information will contribute to the prevention of brain degeneration due to brain waste deposition.

In mismatch repair (MMR) immunohistochemistry, four MMR proteins’ staining pattern reveals which particular gene may be defective. However, in the null phenotype, four MMR proteins are lost; consequently, it will be challenging to assume the target gene by immunohistochemistry and to determine whether deficient MMR was sporadic or germline. A 70-year-old man underwent right hemicolectomy with the diagnosis of ascending colon cancer. The postoperative histopathology revealed the diagnosis of medullary carcinoma and the loss of all four MMR expressions in immunohistochemistry. The mutation analysis using a peripheral blood sample showed no germline mutations in the four genes. This clinical case presents an unusual colon carcinoma that showed a MMR protein immunohistochemistry null phenotype. The cause of expression loss of MMR proteins can be explained by the loss of MLH1 and MSH2 functions associated with somatic loss of function mutations, functional loss in all four MMR proteins associated with somatic loss of function mutations, or Lynch-like syndrome. Correct interpretation and accumulation of relevant cases are necessary to unveil unusual cases in the era of universal screening.

Previous studies reported conflicting results regarding an association between serum albumin concentration and the cumulative incidence of remission of proteinuria in adult patients with minimal change disease (MCD). The present study aimed to clarify the clinical impact of serum albumin concentration and the cumulative incidence of remission and relapse of proteinuria in 108 adult patients with MCD at 40 hospitals in Japan, who were enrolled in a 5-year prospective cohort study of primary nephrotic syndrome, the Japan Nephrotic Syndrome Cohort Study (JNSCS). The association between serum albumin concentration before initiation of immunosuppressive treatment (IST) and the cumulative incidence of remission and relapse were assessed using multivariable-adjusted Cox proportional hazards models. Remission defined as urinary protein 2: 1.43 [1.08, 1.90]), whereas they were not associated with relapse. A multivariable-adjusted model showed that patients with high eGFR level (≥ 60 mL/min/1.73 m2) and low albumin concentration (≤ 1.5 g/dL) achieved significantly early remission, whereas those with low eGFR (2) and high albumin concentration (> 1.5 g/dL) showed significantly slow remission. In conclusion, lower serum albumin concentration and higher eGFR were associated with earlier remission in MCD, but not with relapse.

Purpose To investigate the utility of the device for evaluating intestinal oxygenation and viability using an animal model. Methods Sprague–Dawley rats underwent laparotomy under general anesthesia, and the blood vessels in the terminal ileum were clamped to create ischemia. We measured the regional tissue oxygenation saturation (rSO2) using an oximeter after 1, 3, and 6 h of vessel clamping. Ischemic tissue damage was assessed using a histological score. The intestine was reperfused after each clamping period, and intestinal rSO2 and survival rate were evaluated. Results When reperfusion was performed at 1 and 3 h after ischemia, rSO2 increased after 10 min, and it improved to the same level as for normal intestine after 1 h; all rats survived for 1 week. In contrast, after 6 h of ischemia, rSO2 did not increase after reperfusion, and all animals died within 2 days. The histological scores increased after 1 h of reperfusion, with longer clamping periods. Conclusion A finger-mounted tissue oximeter could evaluate intestinal ischemia and the viability, which is thus considered to be a promising result for future clinical application.

Background Carotid artery manipulation is not a special technique but reports of intraoperative ventricular fibrillation are rare. The risk of fatal arrhythmias may be hidden behind routine surgical techniques and anesthetic management. We focused on QT prolongation and QT dispersion. Case presentation A 77-year-old man underwent carotid endarterectomy and bailout stenting. Although there were no obvious preoperative risk factors for intraoperative ventricular tachyarrhythmia, ventricular fibrillation (VF) had occurred during a maneuver of the carotid artery under hypercapnia. QTc was prolonged from 317 ms before surgery to 458 ms before the onset of VF. QTc dispersion between leads II and III was also increased to 50 ms. Hypomagnesemia was noted after resuscitation by electrical defibrillation, adrenaline, and noradrenaline. Conclusions We considered that the combination of multiple risk factors led to the development of ventricular fibrillation. It should be noted that carotid artery manipulation has the potential to cause arrhythmias.