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In this case, a 66‐year‐old female patient presented with the chief complaint of abdominal distention. Computed tomography and magnetic resonance imaging revealed no enlarged ovaries or obvious primary lesions; however, massive ascites and peritoneal disseminated nodules were observed. Ascites cytology revealed adenocarcinoma and immunohistochemical findings suggested serous carcinoma. The patient then underwent tumor reduction surgery after preoperative chemotherapy for suspected Stage IIIC primary peritoneal carcinoma. Postoperative histopathology revealed carcinoma consisting mainly of high‐grade serous carcinoma (HGSC) and sarcoma. In addition, serous intraepithelial carcinoma (STIC) of the fallopian tube was observed in the fimbriae of the left fallopian tube. Recently, it has been noted in the literature that most cases of peritoneal carcinoma are metastases or dissemination of carcinoma originating from the fimbriae of the fallopian tube. This is a rare case of peritoneal carcinosarcoma with STIC, and its report leads to a better understanding of the disease's features and possible therapeutic approaches. [ABSTRACT FROM AUTHOR]

Thrombocytopenia frequently occurs in patients with sepsis. Disseminated intravascular coagulation (DIC) may be a possible cause of thrombocytopenia owing to its high prevalence and association with poor outcomes; however, it is important to keep the presence of other diseases in mind in sepsis practice. Thrombotic microangiopathy (TMA), which is characterized by thrombotic thrombocytopenic purpura, Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (HUS), and complement-mediated HUS, is characterized by thrombocytopenia, microangiopathic hemolytic anemia, and organ damage. TMA has become widely recognized in recent years because of the development of specific treatments. Previous studies have reported a remarkably lower prevalence of TMA than DIC; however, its epidemiology is not well defined, and there may be cases in which TMA is not correctly diagnosed, resulting in poor outcomes. Therefore, it is important to differentiate DIC from TMA. Nevertheless, differentiating between DIC and TMA remains a challenge as indicated by previous reports that most patients with TMA can be diagnosed as DIC using the universal coagulation scoring system. Several algorithms to differentiate sepsis-related DIC from TMA have been suggested, contributing to improving the care of septic patients with thrombocytopenia; however, it may be difficult to apply these algorithms to patients with coexisting DIC and TMA, which has recently been reported. This review describes the disease characteristics, including epidemiology, pathophysiology, and treatment, of DIC, TMA, and other diseases with thrombocytopenia and proposes a novel practical approach flow, which is characterized by the initiation of the diagnosis of TMA in parallel with the diagnosis of DIC. This practical flow also refers to the longitudinal diagnosis and treatment flow with TMA in mind and real clinical timeframes. In conclusion, we aim to widely disseminate the results of this review that emphasize the importance of incorporating consideration of TMA in the management of septic DIC. We anticipate that this practical new approach for the diagnostic and treatment flow will lead to the appropriate diagnosis and treatment of complex cases, improve patient outcomes, and generate new epidemiological evidence regarding TMA. [ABSTRACT FROM AUTHOR]

There are many reports on the positional relationship between the ileocolic artery and superior mesenteric vein (SMV). However, there have been no reports of anomalous venous confluence in the ileocecal vessel area. A 69‐year‐old man was diagnosed with cecal cancer on a preoperative examination of a lung tumor. We planned to perform surgery for the cecal cancer. Computed tomography angiography revealed an anomalous vein confluence in the ileocolic region. We performed robot‐assisted ileocecal resection. Although the small intestinal vein was misidentified as the SMV at first, we confirmed the misidentification, identified the SMV on the dorsal side of the ileocolic artery, and ligated the ileocolic vessels with precise forceps manipulation during robotic surgery. Especially for cases with vascular anomalies revealed by preoperative computed tomography angiography, robotic surgery may be useful, as flexible forceps manipulation prevents vascular injury. [ABSTRACT FROM AUTHOR]

Aim: Ovarian cancer is a gynecological malignancy with a poor prognosis. For platinum‐sensitive relapsed ovarian cancer, maintenance therapy with poly‐ADP ribose polymerase (PARP) inhibitors after chemotherapy is considered; however, olaparib treatment does not always lead to sufficient progression‐free survival (PFS). This study aimed to identify factors that predict the efficacy of maintenance therapy using olaparib in platinum‐sensitive relapsed ovarian cancer. Methods: Twenty‐seven patients with platinum‐sensitive relapsed ovarian cancer, who received initial treatment and showed complete or partial response to prior chemotherapy at our hospital, were included. The primary outcome was the time from the end of previous platinum‐based chemotherapy to disease progression (PFS). The Kaplan–Meier method was used to generate time‐to‐event curves for PFS; multivariate analysis was performed using the Cox proportional hazards regression model. Results: The median PFS was 12 months (95% confidence interval [CI]: 8.3–15.8). Before olaparib administration, the median PFS was 12 months in the <4.1 neutrophil‐to‐lymphocyte ratio group and 4 months in the ≥4.1 group, with PFS being significantly better in the <4.1 group (log‐rank: p = 0.023). When comparing serum cancer antigen 125 (CA125) levels, the median PFS was 13 months in the <18 U/mL group and 6 months in the >18 U/mL group (log‐rank: p = 0.022). Multivariate Cox regression analysis revealed that CA125 was the factor affecting PFS (hazard ratio: 4.85; 95% CI: 1.53–15.38). Conclusions: Serum CA125 levels at olaparib initiation in patients with platinum‐sensitive relapsed ovarian cancer may predict PFS as an effect of maintenance therapy using olaparib to treat recurrent disease. [ABSTRACT FROM AUTHOR]

Grain sizes influence beach morphologies, processes, and states (e.g., dissipative, reflective and intermediate), however previous studies analysing beach grain size are often spatially and temporarily sparse. In this study, an automated mobile grain size estimation method using digital photographs (mobile digital grain size, MDGS) was developed and tested at a mixed sediment beach consisting of sand and gravels. The data collection system consisted of a downward‐looking camera, Real Time Kinematic Global Navigation Satellite System, and a camera‐triggering single‐board computer, attached to an all‐terrain vehicle. Digital photographs were collected monthly from January 2021 to March 2022 over a section spanning ~700 m alongshore and processed automatically using an existing (non‐mobile) DGS estimation method. The MDGS results were generally consistent with manually estimated grain sizes (n = 962, r2 = 0.74, RMSE = 5.9 mm) and UAV orthomosaic imagery, although the MDGS sometimes overestimated manually estimated grain sizes particularly for photographs with relatively small sediments. Modelled nearshore waves and subaerial beach survey data from mobile terrestrial LiDAR were used to explore using MDGS in morphological studies. Seasonal grain size trends, observed relationships between nearshore wave height and spatially averaged beach grain size, and the general increasing trends of grain sizes with both beach elevation and local roughness/slope were consistent with previous studies, highlighting the use of MDGS for morpho‐sedimentary mixed sediment beach research. The MDGS provides a unique method to conduct spatially and temporarily high‐resolution mapping of gravel size sediments over large areas (>102 m alongshore). Potential improvements of the MDGS include additional low elevation cameras for improved fine (e.g., sand) grain size estimates, decreased time between photo triggering, and automated removal of erroneous photographs containing surface irregularities (e.g., tire tracks) and non‐sediment features (e.g., seaweed). Overall, the MDGS provides improved surface grain size mapping and investigations of complex grain size–morphology relationships of mixed sediment beaches. [ABSTRACT FROM AUTHOR]

Cobbles provide a nature‐based method to help generate beach stability. However, few detailed cobble movement observations exist. This study deployed 344 radio‐frequency identification tagged cobbles in a California beach in November–December 2020. Coincident LiDAR surveys quantified beach morphology. Cobbles were mapped daily for 10 days and then ∼ monthly until January 2023. Cobble detection rates ranged 17%–92%, and generally declined with time (with slight increases during winter months). Cobble movement exhibited complex patterns, sometimes moving in opposing directions during the same time period. Large winter waves (up to ∼4 m) resulted in average displacements of 40 m per month between November 2020 and April 2021. From April 2021 to August 2022, most cobbles were located high on the beach and net alongshore movements were relatively low, despite several moderate size (∼2 m) wave events. The largest wave event in January 2023 (>4 m) moved cobbles to the highest elevations of the study period. The initial release location and accommodation space in the back beach influenced cobble movement and final position. Cobbles high on the beach were relatively stable compared to lower elevation cobbles, and more than half of all cobble detections were within 50 m of the initial release location. However, three cobbles moved >500 m. The probability distribution of displacement was approximately exponential. Statistically, alongshore cobble spreading followed a non‐Gaussian subdiffusive process. Despite myriad sources of noise, the results suggest that cobble shape and mass were related to maximum cobble displacement. Overall, displacements increased with incident wave energy and depended on elevation relative to total water level. Plain Language Summary: Cobbles may provide a nature‐based method to help generate beach stability and prevent backshore erosion. However, few detailed observations of cobble motion exist. To better understand cobble dynamics, this study installed radio‐frequency identification tags inside cobble to allow individual cobble tracking. Three hundred forty four tagged cobbles were released in a California beach and tracked for 26 months. Cobble movement exhibited complex patterns, sometimes moving in opposing directions during the same time period. Cobble displacement increased with wave energy and detection rates generally decreased with time. Large winter waves resulted in average displacements of 40 m per month. Over the study period, three cobbles moved >500 m. However, many cobbles moved to, or remained at, higher, more stable elevations on the furthest inland portion of the beach. The largest wave event moved cobbles to the highest observed elevations. Cobbles high on the back of the beach were relatively stable compared to lower elevation cobbles. More than half of all cobble detections were within 50 m of the initial release location. The initial release location and accommodation space on the back beach influenced cobble movement and final position. The results suggest that shape and mass influence cobble movement. Key Points: Three hundred forty four radio‐frequency identification tagged cobbles were tracked for 26 months at a southern California beachCobble displacements increased with incident wave energy, fit an exponential distribution, and exhibited alongshore sub‐diffusive spreadingThe initial release location influenced cobble movement and final positions. Many cobbles moved to, or remained at higher, more stable elevations [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the association between endotheliopathy represented by high levels of circulating syndecan-1 (SDC-1) and coagulofibrinolytic responses due to trauma, which can lead to disseminated intravascular coagulation (DIC). Methods: We retrospectively evaluated 48 eligible trauma patients immediately admitted to our hospital and assessed SDC-1 and coagulofibrinolytic parameters for 7 days after admission. We compared the longitudinal changes of coagulofibrinolytic parameters and SDC-1 levels between two groups (high and low SDC-1) according to median SDC-1 value on admission. Results: The median circulating SDC-1 level was 99.6 (61.1–214.3) ng/mL on admission, and levels remained high until 7 days after admission. Coagulofibrinolytic responses assessed by biomarkers immediately after trauma were correlated with SDC-1 elevation (thrombin–antithrombin complex, TAT: r = 0.352, p = 0.001; antithrombin, AT: r = −0.301, p < 0.001; plasmin-α2-plasmin inhibitor complex, PIC: r = 0.503, p = 0.035; tissue plasminogen activator, tPA: r = 0.630, p < 0.001). Sustained SDC-1 elevation was associated with intense and prolonged coagulation activation, impairment of anticoagulation, and fibrinolytic activation followed by inhibition of fibrinolysis, which are the primary responses associated with development of DIC in the acute phase of trauma. Elevation of circulating SDC-1 level was also associated with consumption coagulopathy and the need for transfusion, which revealed a significant association between high SDC-1 levels and the development of DIC after trauma (area under the curve, AUC = 0.845, cut-off value = 130.38 ng/mL, p = 0.001). Conclusions: High circulating levels of syndecan-1 were associated with intense and prolonged coagulation activation, impairment of anticoagulation, fibrinolytic activation, and consumption coagulopathy after trauma. Endotheliopathy represented by SDC-1 elevation was associated with trauma induced coagulopathy, which can lead to the development of DIC. [ABSTRACT FROM AUTHOR]

Objectives: Laryngeal complications have been reported after endotracheal intubation and prone positioning in patients with critical coronavirus disease 2019 (COVID‐19), but their association is unclear. In this study, we investigated the rate of laryngeal complications in patients with COVID‐19 compared to an alternative condition (control group). Methods: We retrospectively analyzed the data of 40 patients who underwent endotracheal intubation for either COVID‐19 or an alternative condition (control group). Data on age, sex, body mass index (BMI), cardiovascular disease (CVD) risk factors, use of prone therapy, duration of endotracheal intubation, and duration from extubation/tracheostomy to laryngeal evaluation were collected from medical records. Results: There were no significant differences in BMI, frequency of CVD risk factors, duration of endotracheal intubation, or duration from extubation/tracheostomy to laryngeal evaluation between the two groups. In the COVID‐19 group, all patients adopted the prone position. In comparison, only one patient in the control group adopted the prone position. Significant differences were observed between the two groups regarding the incidence of vocal fold immobility and laryngeal granuloma. Conclusion: Laryngeal complications were more common in the COVID‐19 group than in the control group. Prone positioning may be a risk factor for these complications. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Flights of Holocene marine terraces are useful for reconstructing past earthquakes, but coastal erosion can remove terraces from the landscape, potentially leading to incorrect estimates of earthquake magnitude and frequency. Relatively little effort has been afforded to studying terrace erosion processes, and this paper presents the first field evidence that we are aware of documenting terrace erosion rates. Two case studies from New Zealand provide a unique opportunity to observe the beginning and end phases of terrace development. We present downwear and backwear erosion measurements, showing that both sets of processes are important. Micro‐erosion meter measurements from Kaikōura Peninsula, South Island, confirm that downwear processes are modifying new marine terraces that were created when the peninsula was uplifted about 1 m during the 2016 earthquake. Erosion rates were high immediately following uplift as the relatively barren intertidal rock shore platform rapidly transformed into an incipient marine terrace with cover deposits. However, the Kaikōura earthquake uplifted shore platforms only a small distance above the upper tidal limit and ongoing downwear and backwear erosion may begin to remove parts of this terrace in future decades. We explored this prospect with a case study at Māhia Peninsula, North Island, where 100–300 years have elapsed since the last terrace‐forming earthquake. Historical photographs were used to document about 80 years of backwear erosion. Terrace erosion rates have been nearly constant through this period, and extrapolation implies that the terrace will be removed in places by 2030. The erosion data in this paper provide new insights into how terraces can be removed from the landscape, but there are many complicating factors. To help understand these factors we present a new conceptual model of marine terrace creation and destruction for soft‐rock coasts. [ABSTRACT FROM AUTHOR]

Indocyanine green (ICG) fluorescence angiography has recently been reported useful as a method for predicting intestinal blood flow and may reduce anastomotic leakage. However, the quantification method for ICG fluorescence angiography has not been established. We usually measure the tissue oxygen saturation (StO2) in the intestinal tract via near‐infrared spectroscopy, as it is able to measure the oxygen concentration accurately and immediately shows objective data. In this study, we propose that the time to reach the anastomotic site after intravenous ICG injection is an effective parameter for quantifying ICG fluorescence angiography from the comparison to the data of StO2 in the intestinal tract. [ABSTRACT FROM AUTHOR]

A branch-and-bound procedure for minimizing the makespan in multiple-machine permutation flowshop scheduling problems (FSP) was developed. The algorithm, which employs membership functions to perform a fuzzy approximation based on a new dominance relation, was evaluated via benchmark tests and Monte Carlo simulations. The results showed its suitability for FSP problems with up to 1,000 jobs on systems with less than six machines.

Holocene marine terraces occur globally and record information about the timing and magnitude of past coseismic events. Staircased terraces develop through repetitive coseismic uplift of shore platforms, but are also subject to destruction from subsequent wave erosion and rock weathering. In this study we calibrate a rock coast evolution model using terrace field data from Mahia Peninsula, New Zealand, and use it to investigate how relative sea level (RSL) change influences Holocene terrace development. Analyses of 10,002 simulations reveal time periods of extremely rapid terrace creation and destruction as a result of shore platform development processes that are modulated both by episodic and gradual RSL change scenarios. Subtle differences in these scenarios give rise to completely different terrace sequences, even if coseismic event timing is held constant. Improved interpretation of Holocene terrace sequences require higher resolution paleo RSL data and chronological data on shore platform development. Plain Language Summary: Holocene marine terraces develop when tectonically active rock coasts are uplifted during earthquakes, and thus provide the information about the timing and magnitude of past seismic events that is useful to estimate future seismic hazards. However, the record is often partial because once terraces are uplifted, subsequent marine erosion processes (wave erosion and intertidal rock weathering) start destroying terraces and can completely remove them from the landscape. This can confound paleo‐seismic interpretations of Holocene terrace sequences. In this study we used a numerical model to explore how earthquake‐driven episodic and climate‐driven gradual relative sea level (RSL) changes can influence marine erosion processes, and therefore Holocene terrace preservation. The simulation results reveal that subtle differences in episodic and gradual RSL change histories can lead to periods in which marine erosion are greatly accelerated, which can completely alter terrace sequences that are preserved in the landscape. Until this study, we had little understanding of the way in which RSL modulates the erosion processes that control terrace creation and destruction. We conclude that better interpretation of past seismic event history from Holocene terraces require a more detailed understanding of RSL history and higher resolution data on rates of shore platform formation through time. Key Points: The effects of episodic and gradual relative sea level (RSL) change on Holocene marine terrace development are numerically exploredEven subtle differences in RSL have large impacts on shore platform development rates, thereby changing preserved terrace sequencesBetter understanding of past RSL and shore platform development history will improve paleo‐seismic interpretation of Holocene terraces [ABSTRACT FROM AUTHOR]

Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy. [ABSTRACT FROM AUTHOR]