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The relationship between hospital case volume and in-hospital mortality, often referred to as the volume-outcome relationship, has been studied in various types of surgery. Despite its usefulness in policymaking, it has not been reported in operative trauma surgery. This study aimed to identify the volume-outcome relationship in severe operative trauma surgery.A retrospective cohort study was conducted using a risk adjustment method based on the International Classification of Diseases 10th Revision Codes in a Japanese nationwide administrative database. Patients discharged from July 1, 2010, to March 31, 2015, who underwent severe operative trauma surgery, defined as having a mortality rate equal to or greater than 10%, were included. A logistic regression model with random effects was used for analysis. Annual hospital case volume was categorized into 4 groups:6 (reference group), 6 to 11, 12 to 17, and ≥18. Subgroup analysis on head and torso trauma surgery was conducted.The study population consisted of 18,382 patients from 964 hospitals. Overall mortality was 19.7%. The adjusted odds ratio for mortality did not reduce significantly in the higher hospital case volume category. Subgroup analysis revealed that the adjusted odds ratio reduced significantly in the subgroup of torso surgery (6 cases/y [reference] vs ≥6 cases/y; adjusted odds ratio, 0.55; 95% confidence interval, 0.42-0.73), but not in the operative head trauma surgery subgroup.A volume-outcome relationship was not identified in severe operative trauma surgery but was observed in the operative torso trauma surgery subgroup.

Silent myocardial ischemia, defined as objective evidence of myocardial ischemia without symptoms, is associated with ischemic stroke. Nevertheless, silent myocardial infarction is a rare cause of ischemic stroke, especially in young adults with no medical history.Herein, we report a young adult patient with acute ischemic stroke treated with repeated mechanical thrombectomy for recurrent large vessel occlusions caused by left ventricular thrombus following a silent myocardial infarction.A 40-year-old man was transferred by ambulance to our hospital because of a generalized seizure. He was diagnosed with cerebral infarction and left middle cerebral artery occlusion. We performed intravenous thrombolysis and mechanical thrombectomy. Recanalization was achieved and his symptoms gradually improved. However, the day after treatment he developed bilateral cerebellar infarction and basilar artery occlusion. We performed a second mechanical thrombectomy and recanalization was achieved. Transthoracic echocardiography revealed a mobile left ventricular thrombus. Although he had no previous chest symptomatic episodes, cardiac examination confirmed myocardial infarction of unknown onset. He was diagnosed with acute ischemic stroke with large vessel occlusions caused by left ventricular thrombus following a silent myocardial infarction. Anticoagulation therapy reduced the amount of thrombus. At 1-year follow-up, he had not experienced any recurrences or symptoms.Silent myocardial infarction should be considered a cause of ischemic stroke in young adults, even without any vascular risk factors. Recurrent large vessel occlusion may occur in patients with left ventricular thrombus, and repeated mechanical thrombectomy should be considered for treatment.

Background Robot-assisted laparoscopic surgery has several advantages over conventional laparoscopy. However, population-based comparative studies for low anterior resection are limited. This article aimed to compare peri-operative results of robot-assisted low anterior resection (RALAR) and laparoscopy Methods This retrospective cohort study used data from patients treated with RALAR or conventional laparoscopic low anterior resection (CLLAR) between October 2018 and December 2019, as recorded in the Japanese National Clinical Database, a data set registering clinical information, perioperative outcomes, and mortality. Of note, the registry does not include information on the tumour location (centimetres from the anal verge) and diverting stoma creation. Perioperative outcomes, including rate of conversion to open surgery, were compared between RALAR and CLLAR groups. Confounding factors were adjusted for using propensity score matching. Results Of 21 415 patients treated during the study interval, 20 220 were reviewed. Two homogeneous groups of 2843 patients were created by propensity score matching. The conversion rate to open surgery was significantly lower in the RALAR group than in the CLLAR group (0.7 versus 2.0 per cent; P < 0.001). The RALAR group had a longer operating time (median: 352 versus 283 min; P < 0.001), less intraoperative blood loss (15 versus 20 ml; P < 0.001), a lower in-hospital mortality rate (0.1 versus 0.5 per cent; P = 0.007), and a shorter postoperative hospital stay (median: 13 versus 14 days; P < 0.001) compared with the CLLAR group. The CLLAR group had a lower rate of readmission within 30 days (2.4 versus 3.3 per cent; P = 0.045). Conclusion These data highlight the reduced conversion rate, in-hospital mortality rate, intraoperative blood loss, and length of postoperative hospital stay for rectal cancer surgery in patients treated using robot-assisted laparoscopic surgery compared with laparoscopic low anterior resection., A retrospective cohort study was undertaken using data from 20 220 patients who underwent robot-assisted low anterior resection (RALAR) or conventional laparoscopic low anterior resection as recorded in the National Clinical Database in Japan. The data highlight the potential benefit of RALAR in improving the conversion rate to open surgery, in-hospital mortality rate, intraoperative blood loss, and length of postoperative hospital stay for rectal cancer surgery.

The Endoscopic Surgical Skill Qualification System (ESSQS) was developed by the Japan Society for Endoscopic Surgery as a means of subjectively assessing the proficiency of laparoscopic surgeons. We conducted a study to evaluate how involvement of an ESSQS skill-qualified (SQ) surgeon influences short-term outcomes of laparoscopic cholecystectomy performed for acute cholecystitis. Previous reports suggest that assessment of the video-rating system is a potential tool to discriminate laparoscopic surgeons' proficiency and top-rated surgeons face less surgical mortality and morbidity in bariatric surgery.Data from the National Clinical Database regarding laparoscopic cholecystectomy performed for acute cholecystitis between January 2016 and December 2018 were analyzed. Outcomes were compared between patients grouped according to involvement vs. non-involvement of an SQ surgeon. Outcomes were also compared between patients grouped according to whether their operation was performed by biliary tract-, stomach-, or colon-qualified surgeon.Of the 309,998 laparoscopic cholecystectomies during the study period, 65,295 were suitable for inclusion in the study and 13,670 (20.9%) were performed by an SQ surgeon. Patients' clinical characteristics did not differ between groups. Thirty-day mortality was significantly lower in the SQ group (0.1%) 16/13,670 than in the non-SQ group (0.2%) 140/51,625 (P = 0.001). Thirty-day mortality was [0.1% (9/7173)] in the biliary tract-qualified group, [0.2% (5/3527)] in the stomach-qualified group, and [0.1% (2/3240)] in the colon-qualified group.Surgeons with ESSQS certification outperform the non-skilled surgeons in terms of surgical mortality in 30 and 90 days. Further verification of the value of the ESSQS is warranted and similar systems may be needed in countries across the world to ensure patient safety and control the quality of surgical treatments.

In several primates and carnivores, pronation/supination angles of the forearm skeleton were examined, and it is thought that a larger angle is useful to acquire dexterous behaviors in feeding and/or life style, including climbing. In this study, the pronation/supination angles in Asiatic black, brown and polar bears were nondestructively examined. These specimens were classified as adult or non-adult. Three or four carcasses of each group of Asiatic black and brown bears were used for CT analysis, whereas only one adult polar bear was used. The forearms were positioned within the gantry of a CT scanner in both maximally supinated and pronated states. Extracted cross-sectional CT images of two positions were superimposed by overlapping the outlines of each ulna. The centroids of the radii were detected, and then the centroid of each radius and the midpoint of a line which connects between both ends of the surface of each radius facing the ulna, were connected by lines to measure the angle of rotation as an index of pronation/supination. In adult brown and polar bears, the angles were smaller as compared with the other groups (Asiatic black and non-adult brown bears). Asiatic black and non-adult brown bears can climb trees, whereas adult brown bears and polar bears cannot. This suggests that the pronation/supination angle is related to arboreal activity in Ursidae.

Background How bats deviate heterochronically from other mammals remains largely unresolved, reflecting the lack of a quantitative staging framework allowing comparison among species. The standard event system (SES) is an embryonic staging system allowing quantitative detection of interspecific developmental variations. Here, the first SES-based staging system for bats, using Asian parti-colored bat (Vespertilio sinensis) is introduced. General aspects of normal embryonic development and the three-dimensional development of the bat cochlea were described for the first time. Recoding the embryonic staging tables of 18 previously reported bat species and Mus musculus into the SES system, quantitative developmental comparisons were performed. Results It was found that limb bud development of V. sinensis is relatively late among 19 bat species and late limb development is a shared trait of vespertilionid bats. The inner ear cochlear canal forms before the semicircular canal in V. sinensis while the cochlear canal forms after the semicircular canal in non-volant mammals. Conclusions The present approach using the SES system provides a powerful framework to detect the peculiarities of bat development. Incorporating the timing of gene expression patterns into the SES framework will further contribute to the understanding of the evolution of specialized features in bats.

We determined species diversity, seasonal reproduction, and echolocation patterns in the bat community of Bidoup Nui Ba National Park (BNBNP), Lam Dong Province, on the Dalat Plateau of the Central Highlands of Vietnam. We documented 27 species with 211 individuals captured in 26 994 m2 mist-net-hours and 3015 m2 harp-trap-hours of effort. We found five species of pteropodids and 22 species of insectivorous bats in four families, including regional records and species seldom captured in Vietnam. Bat species richness at BNBNP is now known to be 33 species, including six found in a prior study. Based on the inverse Simpson Index of Diversity, evenness of captures was low, reflecting the high abundance of a few species with many species documented by just one or two individuals. Insectivorous bats were pregnant in the late dry season, but not during the wet season when lactation occurred and volant juveniles were captured. Echolocation call characteristics were determined for 19 species of insectivorous bats. Call patterns were consistent with some but not all reports in the literature from elsewhere in southeast Asia. This suggests the existence of cryptic species or geographic and habitat variability in echolocation calls of southeast Asian bats that requires further study.

Researchers have found how driving electric vehicles (EVs) can be one solution to the negative environmental impact of petrol or diesel cars because they produce substantially lower emissions and are more energy-efficient than conventional cars. EVs are predicted to be the disruptive market force for transportation and technology. Of one million EVs sold in 2017, more than half of global sales were in China. China has a strong leadership position in the EV industry. The purpose of this study is to examine the US consumers’ reliance on Country-Of-Origin (COO) information in evaluating the quality of the Chinese-brand EVs (CBEVs) made-in various countries. Researchers suggest that consumers use COO as an information cue when evaluating a product, particularly if they lack detailed knowledge of the product. The results show that the perceived product quality of electric vehicles made in various countries influences consumers’ purchasing behavior. The study also found that consumers’ ethnocentrism has an effect on their buying behavior.

Bats are the second-most speciose group of mammals, comprising 20% of species diversity today. Their global explosion, representing one of the greatest adaptive radiations in mammalian history, is largely attributed to their ability of laryngeal echolocation and powered flight, which enabled them to conquer the night sky, a vast and hitherto unoccupied ecological niche. While there is consensus that powered flight evolved only once in the lineage, whether laryngeal echolocation has a single origin in bats or evolved multiple times independently remains disputed. Here, we present developmental evidence in support of laryngeal echolocation having multiple origins in bats. This is consistent with a non-echolocating bat ancestor and independent gain of echolocation in Yinpterochiroptera and Yangochiroptera, as well as the gain of primitive echolocation in the bat ancestor, followed by convergent evolution of laryngeal echolocation in Yinpterochiroptera and Yangochiroptera, with loss of primitive echolocation in pteropodids. Our comparative embryological investigations found that there is no developmental difference in the hearing apparatus between non-laryngeal echolocating bats (pteropodids) and terrestrial non-bat mammals. In contrast, the echolocation system is developed heterotopically and heterochronically in the two phylogenetically distant laryngeal echolocating bats (rhinolophoids and yangochiropterans), providing the first embryological evidence that the echolocation system evolved independently in these bats.

In the past decade, the early Acheulean before 1 Mya has been a focus of active research. Acheulean lithic assemblages have been shown to extend back to ∼1.75 Mya, and considerable advances in core reduction technologies are seen by 1.5 to 1.4 Mya. Here we report a bifacially flaked bone fragment (maximum dimension ∼13 cm) of a hippopotamus femur from the ∼1.4 Mya sediments of the Konso Formation in southern Ethiopia. The large number of flake scars and their distribution pattern, together with the high frequency of cone fractures, indicate anthropogenic flaking into handaxe-like form. Use-wear analyses show quasi-continuous alternate microflake scars, wear polish, edge rounding, and striae patches along an ∼5-cm-long edge toward the handaxe tip. The striae run predominantly oblique to the edge, with some perpendicular, on both the cortical and inner faces. The combined evidence is consistent with the use of this bone artifact in longitudinal motions, such as in cutting and/or sawing. This bone handaxe is the oldest known extensively flaked example from the Early Pleistocene. Despite scarcity of well-shaped bone tools, its presence at Konso shows that sophisticated flaking was practiced by ∼1.4 Mya, not only on a range of lithic materials, but also occasionally on bone, thus expanding the documented technological repertoire of African Early Pleistocene Homo.

Background The cardiopulmonary resuscitation guidelines revised in 2015 recommend target chest compression rate (CCR) and chest compression depth (CCD) of 100–120 compressions per minute (cpm) and 5–6 cm, respectively. We hypothesized that the new guidelines are harder to comply with, even with proper feedback. Methods This prospective observational study using data collected from the participants of an Immediate Cardiac Life Support course included the evaluation of chest compressions using performance data from a feedback device after the completion of the course. Participants completed chest compressions for 1 min and were provided with feedback, after which they performed another cycle of CC. Primary outcome measures were CCR and CCD as well as the correct CCR percentage and CCD percentage for pre and post feedback. Results The study included a total of 88 participants. The median pre-CCR was 112.5 cpm (interquartile range [IQR] 108–116 cpm), and the median correct pre-CCR percentage was 96% (IQR 82.5–99.5%). After the feedback, there was a slight increase in the correct CCR percentage (99% [IQR 92.5–100%]). Conversely, the median pre-CCD was 5.4 cm (IQR 4.9–5.8 cm), and the median pre-correct CCD percentage was 66% (IQR 18.5–90%). The increase in the median post-correct CCD percentage to 72% (IQR 27–94%) observed after the feedback was not statistically significant (P = 0.361). Conclusions Compliance with the new guidelines for chest compressions, especially those regarding the CCD, might be difficult. However, whether the changes in guidelines affect outcomes in actual clinical settings is uncertain and requires further investigation.

We compared the temporomandibular joint structure between species of the order Carnivora and investigated its variation among family lineages. We also investigated the effect of the masticatory muscle physiological cross-sectional area (PCSA) on temporomandibular joint structure. The masticatory muscle is composed of multiple muscles, which contract in different directions and exert pressure on the temporomandibular joint. We investigated the effect of the ratio of each muscle’s PCSA—an indicator of muscle force—and muscle size relative to body size on temporomandibular joint structure. The temporalis PCSA relative to body size showed the highest correlation with temporomandibular joint structure. When the temporalis PCSA is large relative to body size, the preglenoid projects caudally, the postglenoid projects rostrally and the pre-postglenoid angle interval is small, indicating that the condyle is locked in the fossa to reinforce the temporomandibular joint. Most Carnivora use blade-like carnassial teeth when slicing food. However, dislocation occurs when the carnassial teeth are used by the temporalis muscle. Our results suggest that the temporomandibular joint is reinforced to prevent dislocation caused by the temporalis muscle. In Mustelidae, the temporomandibular joint with a rostrally projecting postglenoid is suitable for carnassial biting using the temporalis muscle. In Felidae, the force of the masseter onto the carnassial teeth is diverted to the canine by tightening the temporomandibular joint. In Canidae, the masticatory muscle arrangement is well-balanced, enabling combined action. Hence, reinforcement of the temporomandibular joint by bone structure is unnecessary.

We propose a device to store antlered deer skulls, “the antlered deer skull rack”. The frames were made of pipes, and can hold about 8 skull specimens of sika deer (Cervus nippon). It is easy to change the order of skulls. It is also possible to carry the whole rack and if a shelf to hold multiple racks is available, the racks can be three-dimensionally arranged, which results in space saving.

The consumption of products, including automobiles, has been increasing rapidly in Asian developing and transition (D&T) countries, and appropriate diffusion of remanufacturing in the region is necessary to achieve sustainable consumption and production. This paper presents analyses of consumer perceptions of remanufactured auto parts (RAPs) in three Southeast Asian D&T countries: Malaysia, Thailand, and Vietnam. The authors conducted internet questionnaire surveys, targeting 500 respondents in each country, and examined consumers' knowledge of RAPs, perceptions of the benefits and risks, and consumers' purchase intentions of RAPs. Our study reveals that consumers' knowledge and perceived benefits of RAPs positively affect consumers' purchase intentions of RAPs in all three countries, but the influence of the perceived risks is not found. The cross-comparison of the perceptions in the countries reveals that knowledge of RAPs and the perceived benefits and risks are relatively high in Vietnam compared to those in Malaysia and Thailand. This study analyzes if consumers have a higher preference for certified RAPs than uncertified ones. A higher level of quality assurance in a country is critical for product diffusion in the market. The study clarifies that the purchasing decisions are also influenced by the country-of-origin (COO) of RAPs. Drawing on our study results, we suggest measures to promote markets for remanufactured products in D&T countries and provide policy options to accelerate the promotion of resource efficiency practices.

Semiaquatic walking has resulted in the evolution of functional and morphological changes in various hoofed mammals, such as hippopotamus and Brazilian tapir. The biomechanics of skilful walking in wetlands or at the bottom of a waterbody involve the medio-lateral opening and closing of the feet to effectively support and stabilize the body on soft ground and to reduce the water resistance during recovery stroke, respectively. We demonstrate that the opening and closing of the feet in hippopotamus and Brazilian tapir are mediated by the adduction and abduction of the most medial and lateral phalanges from the CT examination. The axial toes, metacarpals and metatarsals do not contribute to changes in the width and shape of the feet, unlike the medial and lateral toes. We suggest that this semiaquatic walking motion is derived from the original terrestrial mode of locomotion, in contrast to the highly functional swimming motion using webs or fins in morphologically modified feet and tail. From the present data we demonstrate that semiaquatic locomotion evolved due to the acquisition of adductor-abductor mobility in the phalanges of the most medial and lateral digits, as shown in hippopotamus and Brazilian tapir.

A partial crocodylian skull was found among the paleontological collection at the Archaeological Museum, Waseda University in Honjo-shi, Saitama Prefecture. Following a bibliographical survey, this was verified as a specimen reported by Tokunaga as the first known crocodile from Taiwan but then regarded as lost due to World War II. Molten glass debris is attached to the specimen, suggesting that it had been subject to air raids during World War II in May 1945, most likely at the Waseda University campus. Based on its largest seventh maxillary alveoli and the prominent lateral expansion towards the posterior direction, this specimen was identified as Toyotamaphimeia sp.; up to now a single species under this genus has been reported. The discovery demonstrates that this crocodylian genus once had a wide geographical distribution during the Pleistocene.

Objective To examine whether there is an association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. Methods A retrospective cohort study using a national clinical database in Japan was conducted. Patients who underwent emergency thoracic aortic surgery from January 1, 2014, to December 31, 2016, were included. Patients with type B dissection were excluded. A multilevel logistic regression analysis was performed to examine the association between prehospital transfer distance and surgical mortality. In addition, an instrumental variable analysis was performed to address unmeasured confounding. Results A total of 12,004 patients underwent emergency thoracic aortic surgeries at 495 hospitals. Surgical mortality was 13.8%. The risk-adjusted mortality odds ratio for standardized distance (mean 12.8 km, standard deviation 15.2 km) was 0.94 (95% confidence interval, 0.87-1.01; P = .09). Instrumental variable analysis did not reveal a significant association between transfer distance and surgical mortality as well. Conclusions No significant association was found between surgical mortality and prehospital transfer distance in emergency thoracic aortic surgery cases. Suspected cases of acute thoracic aortic syndrome may be transferred safely to distant high-volume hospitals.

Comparative analysis of the foot muscle architecture among extant great apes is important for understanding the evolution of the human foot and, hence, human habitual bipedal walking. However, to our knowledge, there is no previous report of a quantitative comparison of hominoid intrinsic foot muscle dimensions. In the present study, we quantitatively compared muscle dimensions of the hominoid foot by means of multivariate analysis. The foot muscle mass and physiological cross-sectional area (PCSA) of five chimpanzees, one bonobo, two gorillas, and six orangutans were obtained by our own dissections, and those of humans were taken from published accounts. The muscle mass and PCSA were respectively divided by the total mass and total PCSA of the intrinsic muscles of the entire foot for normalization. Variations in muscle architecture among human and extant great apes were quantified based on principal component analysis. Our results demonstrated that the muscle architecture of the orangutan was the most distinctive, having a larger first dorsal interosseous muscle and smaller abductor hallucis brevis muscle. On the other hand, the gorilla was found to be unique in having a larger abductor digiti minimi muscle. Humans were distinguished from extant great apes by a larger quadratus plantae muscle. The chimpanzee and the bonobo appeared to have very similar muscle architecture, with an intermediate position between the human and the orangutan. These differences (or similarities) in architecture of the intrinsic foot muscles among humans and great apes correspond well to the differences in phylogeny, positional behavior, and locomotion.

This study investigates consumers' perception and their green purchasing behavior relating to remanufactured auto parts (RAPs) in Japan, where RAPs market remains relatively undeveloped. It also reports factors affecting green purchasing behavior in the US, where RAPs enjoy a long history and continuing success. This study uses an internet survey of 500 Japanese and 473 US respondents to examine how underlying factors, such as consumer knowledge of RAPs, perceptions of benefits and risk, and price consciousness, influence the behavioral intentions of consumers. The results indicate that purchase intention is strongly influenced by these underlying factors in two different markets. This study also provides a brief historical review of the growth of the Japanese RAPs market. In the review, stakeholders' influences on consumers’ perception of RAPs are highlighted. The implications of the results and review on effective measures to promote RAPs in Japan and in an economy where markets for remanufactured products are in their early stage of development are discussed.

Background: An extremely tortuous superior cerebellar artery is a rare anomaly. We report a case of an extremely tortuous superior cerebellar artery mimicking an aneurysm. Case Description: A 77-year-old woman was initially diagnosed with unruptured cerebral aneurysm at the right basilar artery-superior cerebellar artery junction by magnetic resonance angiography. Catheter angiogram revealed that there was no apparent aneurysm at the basilar artery-superior cerebellar artery junction and the lesion was actually an extremely tortuous superior cerebellar artery. Conclusion: Although an extremely tortuous superior cerebellar artery is rare, it should be considered when examining other vascular lesions.

The mastication system of the southern tamandua (Tamandua tetradactyla) was examined by means of gross anatomy and three dimensional image analysis. Three-dimensional computed tomography image analysis revealed that the mandibles medio-laterally rotated during the mastication. The temporal muscle dorso-medially pull the dorsal part of the mandubular bones, and the masseter muscle latero-rostrally operates the ventro-lateral part of the mandibles. The two muscles may contribute to the opening of the mandibles to enlarge the oral cavity and to house the contractile tongue. In contrast the medial and lateral pterygoid muscles may act as a closer of the mandible to medially pulling the ventro-medial part of the mandibles. The extraordinarily specialized mastication mechanism is functionally similar to that of the giant anteater. Although the muscles of the giant anteater show a more complicated structure in the temporal and masseter muscles than those of the southern tamandua, the weight distributio...

application/pdf, Taiwan Island is thought to have formed around 6.0 million years ago, but, the formation of a 'proto-Taiwan' began around 9.0 million years ago. During the late Miocene, the proto-Taiwan is thought to have been a part of the Asian mainland. During the Pleistocene, Taiwan Island was again occasionally connected with the Asian mainland. Several mammal species migrated from the Asian mainland to Taiwan during Pleistocene glacial periods. Despite the connections between Taiwan and the Asian mainland, Taiwan has some endemic mammal species. Recent genetic evidence suggests that arboreal squirrels (Petaurista alborufus, P. philippensis, Belomys pearsonii, and Tamiops maritimus) adapted to Taiwan's mountainous forests are endemic species. Since these squirrels may have similarly evolved from separate ancestral stock in Taiwan, we investigated the phylogenetic relationship of Perny's long-nosed squirrel (Dremomys pernyi) from Taiwan and the Asian mainland by using mitochondrial cytochrome b gene sequences. The Taiwanese form was distantly related to the mainland form, showing deep genetic difference (10.18-10.88%). Therefore, D. pernyi could include at least two distinct species, with the Taiwanese form being a species endemic to Taiwan.

Long necks have evolved independently in several different taxa, but the processes underlying the evolution of this trait are not yet fully understood. In this study, we examined the skeletal mechanism underlying the neck elongation in the tribe Antilopini (Bovidae, Artiodactyla). We calculated the growth patterns of the cervical vertebrae in the gerenuk (Litocranius walleri), which possesses the longest neck in this tribe, and compared it with those in two related species. The growth rates of the vertebrae were not significantly different between species, suggesting that the long neck of the gerenuk has resulted from the elongation of the cervical vertebrae during the fetal or juvenile stage. The morphology of the cervical vertebrae of gerenuks differed from that of the closely related, relatively long-necked dama gazelle (Nanger dama), with protrusions occurring on the dorsal surface of the ventral arch of the atlas. This implies that gerenuks possess a well-developed transverse ligament of the atlas that functions to hold the dens of the axis against the atlas. We also found that the atlas lies in close proximity to the neural spine of the axis in the gerenuk, suggesting that hyperextension of the atlantoaxial joint is osteologically limited in this species. While foraging on high foliage, gerenuks flex and extend their necks freely in a bipedal posture without moving their entire body. These morphological characteristics peculiar to the gerenuk enhance the rigidity of the atlantoaxial joint and decrease the risk of subluxation of the joint during this unique foraging behavior.

OBJECTIVE The authors describe a method by which they easily and atraumatically navigate a large-bore reperfusion catheter of the Penumbra system to an embolus by using a coaxial system with a compliant balloon catheter in patients with tortuous arteries. METHODS A retrospective review of the prospective endovascular database was performed to identify cases in which a coaxial system with a compliant balloon catheter (Scepter C, MicroVention/Terumo; or TransForm C, Stryker Neurovascular) and a large-bore reperfusion catheter of the Penumbra system (Penumbra, Inc.) was used. The authors achieved a stable guiding sheath position and delivered the coaxial system with a compliant balloon catheter and a large-bore reperfusion catheter. Then, the balloon was inflated somewhat when the distal tip of the balloon was slightly advanced from the tip of the reperfusion catheter, and together the coaxial system was advanced to an embolus over a 0.014-in guidewire, even around the corner. When the distal tip of the balloon catheter reached the embolus, the authors deflated the balloon and navigated the large-bore reperfusion catheter to the embolus. Finally, the aspiration of the embolus with the Penumbra MAX pump was begun. RESULTS Between May 2014 and September 2015, the authors used this technique in 17 cases: 16 cases of middle cerebral artery occlusion (including 5 cases of internal carotid artery occlusion) and 1 case of basilar artery occlusion (age range 36–88 years, mean age 74.7 years, 13 men). For the reperfusion catheter of the Penumbra system, the 5MAX ACE was used in 15 cases, and the 5MAX was used in 2 cases. As a compliant balloon catheter, the Scepter C was used in 16 cases, and the TransForm C was used in 1 case. The technique was successful in 16 cases (94.1%). No parent artery dissections were noted in any cases. Catheter-induced vasospasm was noted in 1 case, but the vasospasm was transient. CONCLUSIONS A coaxial system with a compliant balloon catheter can help safely and easily to navigate the large-bore reperfusion catheter of the Penumbra system to an embolus in patients with tortuous arteries.

Background Emergency gastrointestinal surgery, although rare, is known for its high mortality and morbidity. However, the risks of emergency surgery for gastrointestinal cancer have not been investigated in depth. This study aimed to investigate the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and to identify associated risk factors. Methods We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with gastrointestinal cancer who underwent esophageal resection, total gastrectomy, distal gastrectomy, right hemicolectomy, or low anterior resection between 2012 and 2017. The impacts of emergency surgery on 30‐day mortality and incidence of overall postoperative complications were compared with those of non‐emergency surgery. Risk factors for mortality and overall postoperative complications were then sought in patients who underwent emergency surgery. Results Thirty‐day mortality and incidence of overall postoperative complications were significantly higher in emergency surgeries for gastric, colon, and rectal cancers than in non‐emergency surgeries (odds ratios 4.86‐6.98 and 1.68‐2.18, respectively; all P, This article shows the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and associated risk factors by using a nationwide registry in Japan. Our findings are expected to serve as a reference for postoperative management.

Purpose The Japanese Intensive care PAtient Database (JIPAD) was established to construct a high-quality Japanese intensive care unit (ICU) database. Materials and methods A data collection structure for consecutive ICU admissions in adults (≥16 years) and children (≤15 years) has been established in Japan since 2014. We herein report a current summary of the data in JIPAD for admissions between April 2015 and March 2017. Results There were 21,617 ICU admissions from 21 ICUs (217 beds) including 8416 (38.9%) for postoperative or procedural monitoring, defined as adult admissions following elective surgery or for procedures and discharged alive within 24 h, 11,755 (54.4%) critically ill adults other than monitoring, and 1446 (6.7%) children. The standardized mortality ratios (SMRs) based on the Acute Physiology and Chronic Health Evaluation (APACHE) III-j, APACHE II, and Simplified Acute Physiology Score II scores in adults ranged from 0.387 to 0.534, whereas the SMR based on the Paediatric Index of Mortality 2 in children was 0.867. Conclusion The data revealed that the SMRs based on general severity scores in adults were low because of high proportions of elective and monitoring admission. The development of a new mortality prediction model for Japanese ICU patients is needed.

We investigated human-suid interactions to understand how suids could coexist with humans in the Ryukyu Islands, Japan, for centuries despite the limited carrying capacity of each island and their overlapping nutritional needs with humans. We carried out dental microwear texture analysis (DMTA) and geometric morphometric (GMM) analysis on suid remains excavated from different localities on the Ryukyu Islands to determine their feeding patterns. The DMTA results suggested that humans approximately 7000 to 4400 BP probably reared/kept some suids before slaughter. Their “wild” molar shape suggested that they lived in proximity to the wild ecosystem and were probably not part of the domestic stock. Our results showed that suids belonged to a reared population that was captured by hunting for delayed consumption. The emerging picture is that suids were fed leftovers or other by-products of human activities. Thus, we conclude that suids and humans created an interdependent relationship instead of becoming competitors, which enabled them to coexist on the islands. The DMTA results suggested that the pig husbandry system of the islands varied during the 17th–19th centuries. In the central region of the islands, pigs were fed a much softer diet than natural resources in a floored stall, whereas in the southern region, pigs were allowed to range freely around human settlements. The GMM analysis of the outline shape of the teeth of suids from this period showed that they were morphologically similar to the modern native domestic breed found on the Ryukyu Islands, regardless of geographical setting of each archaeological site. These results suggest that some suids were transported overseas.

Summary The Palaeognathae comprise the flightless ratites and the volant tinamous, and together with the Neognathae constitute the extant members of class Aves. It is commonly believed that Palaeognathae originated in Gondwana since most of the living species are found in the Southern Hemisphere [1–3]. However, this hypothesis has been questioned because the fossil paleognaths are mostly from the Northern Hemisphere in their earliest time (Paleocene) and possessed many putative ancestral characters [4]. Uncertainties regarding the origin and evolution of Palaeognathae stem from the difficulty in estimating their divergence times [1, 2] and their remarkable morphological convergence. Here, we recovered nuclear genome fragments from extinct elephant birds, which enabled us to reconstruct a reliable phylogenomic time tree for the Palaeognathae. Based on the tree, we identified homoplasies in morphological traits of paleognaths and reconstructed their morphology-based phylogeny including fossil species without molecular data. In contrast to the prevailing theories, the fossil paleognaths from the Northern Hemisphere were placed as the basal lineages. Combined with our stable divergence time estimates that enabled a valid argument regarding the correlation with geological events, we propose a new evolutionary scenario that contradicts the traditional view. The ancestral Palaeognathae were volant, as estimated from their molecular evolutionary rates, and originated during the Late Cretaceous in the Northern Hemisphere. They migrated to the Southern Hemisphere and speciated explosively around the Cretaceous-Paleogene boundary. They then extended their distribution to the Gondwana-derived landmasses, such as New Zealand and Madagascar, by overseas dispersal. Gigantism subsequently occurred independently on each landmass.

The ranges of pronation/supination of forearms in raccoons, raccoon dogs and red pandas were nondestructively examined. Three carcasses of each species were used for CT analysis, and the left forearms were scanned with a CT scanner in two positions: maximal supination and maximal pronation. Scanning data were reconstructed into three-dimensional images, cross-sectional images were extracted at the position that shows the largest area in the distal part of ulna, and then, the centroids of each cross section of the radius and ulna were detected. CT images of two positions were superimposed, by overlapping the outlines of each ulna, and then, the centroids were connected by lines to measure the angle of rotation, as an index of range of mobility. The measurements in each animal were analyzed, using the Tukey-Kramer method. The average angle of rotation was largest in raccoons and smallest in raccoon dogs, and the difference was significant. In the maximally pronated forearm of all species, the posture was almost equal to the usual grounding position with palms touching the ground. Therefore, the present results demonstrate that the forearms of raccoons can supinate to a greater degree from the grounding position with palms on the ground, as compared with those of raccoon dogs and red pandas.

We morphologically examined the functions of mastication muscles in Carnivora to clarify their evolutionary diversification. We measured the physiological cross-sectional area (PCSA) of the mastication muscles in 18 species of Carnivora belonging to six families and 17 genera. PCSA of all mastication muscles correlated to the body size of species. In addition, PCSA of the mastication muscles was also determined by the phylogenetic factor in Carnivora. Felidae showed significantly the higher ratio of PCSA of the whole masseter and PCSA of the superficial masseter muscles against PCSA of total muscles and the residuals of PCSA of medial pterygoid, whole masseter and superficial masseter muscles of Felidae were well larger compared with those of the other families. We suggest that the tendency of PCSA is toward functional adaptation for facilitating contact of the upper blade of the carnassial against the lower blade. Mustelidae possessed the highest ratio of PCSA of the temporalis muscles per PCSA...

Summary This study compares U.S. and Japanese consumers’ perceptions of remanufactured auto parts. Remanufactured parts have a long history and enjoy continuing success in the U.S. domestic aftermarket. In contrast, although Japan's domestic aftermarket is growing, it remains comparatively underdeveloped. This research examines whether customers’ perceptions of remanufactured products explain their lower acceptance in Japan. Our Internet survey of 440 U.S. and 300 Japanese respondents examined their knowledge of remanufactured auto parts, perceptions of their benefits and risks, and price consciousness. The results reveal that Japanese consumers know less about remanufactured products, perceiving them as entailing lower benefits and greater risk, especially concerning quality, and are less price conscious. Drawing on its results, this study suggests measures to promote markets for remanufactured auto parts in Japan and in economies in which such markets are in an early stage of development.

The three-dimensionally real position and movement of the scapula in the lateral side of the ribcage could not be clarified in the horse, since the body size of the horse is too large to apply the CT scanning and image analysis methods. In this study, therefore, we examined the position and the movability of scapula using a carcass of the Falabella which is one of the smallest breeds of the horse. The whole skeletal system in thoracic part of the Falabella could be three-dimensionally observed by CT scanning method. The three-dimensional images show that the scapula cranially slides and the ventral part of the scapula dorso-cranially rotates, when the shoulder joint moves to the most cranial position as simulation. The three-dimensional rotation angle was approximately 10 degrees. As a result of comparative osteology of the scapula between Falabella and the large draft horse, the infraspinous fossa was caudally enlarged in the larger draft horse, whereas the Falabella had narrower infraspinous fossa. We suggest that it may be due to the adaptational morphological change in the scapula bearing various body weights among breeds. The three-dimensional CT image analysis and the simulation in carcass contribute to the analysis of the bone movements of the horse during walking and running locomotion as well as the motion analysis from external functional-morphological data.