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We prepared 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)-oxidized samples from never-dried Japanese cedar (JC) holocellulose, JC-callus, and bacterial cellulose (BC). The original never-dried samples and their TEMPO-oxidized products were characterized by neutral sugar composition analysis. TEMPO-oxidized cellulose nanofibrils (TEMPO-CNFs) were prepared from the TEMPO-oxidized samples by ultrasonication in water. The carboxy groups in TEMPO-CNFs were position-selectively esterified with 9-anthryl diazomethane (ADAM) to prepare TEMPO-CNF-COOCH2-C14H9 samples, which had UV absorption peak at 365 nm. The mass-average degree of polymerization (DPw) values of 1% lithium chloride/N,N-dimethylacetamide (LiCl/DMAc) solutions of the original samples were determined by size-exclusion chromatography in combination with multi-angle laser-light scattering, ultraviolet absorption, and refractive index detection (SEC/MALLS/UV/RI), and were 5490, 2660, and 2380 for the JC holocellulose, JC-callus, and BC samples, respectively. The TEMPO-CNF-COOCH2-C14H9 sample solutions in 1% LiCl/DMAc were analyzed by SEC/MALLS/UV/RI to obtain SEC elution patterns. The patterns corresponded to the molar mass and carboxy group distributions of the samples, which were detected by RI and UV absorption of anthryl groups, respectively. The carboxy groups existed in the entire molar mass distribution regions of all the TEMPO-CNF samples, although their lower molar mass regions contained higher carboxy group densities. The obtained results indicate that random depolymerization occurred on the cellulose microfibril surfaces at the initial stage of TEMPO-catalyzed oxidation and/or ultrasonication in water. This depolymerization mechanism can explain all the obtained SEC-elution patterns of the TEMPO-CNFs, without considering the presence of periodically disordered regions in the cellulose microfibrils of the never-dried cellulose samples. [ABSTRACT FROM AUTHOR]

A commercial TEMPO-oxidized cellulose (TOC) and three laboratory-made TOC samples prepared under different conditions were converted to aqueous 0.4% dispersions of TEMPO-oxidized cellulose nanofibrils (TEMPO-CNFs) by high-pressure homogenization in water under the same conditions. The obtained TEMPO-CNF/water dispersions were irradiated with ultraviolet (UV) light for 0–48 h using a high-pressure mercury lamp at a main wavelength of 365 nm. The changes in the light transmittance, viscosity, pH, zeta-potential, and average particle size of the dispersions, and mass recovery ratio, molar mass, and carboxylate content of the acid-insoluble and freeze-dried fractions separated and isolated from the UV-irradiated dispersions were investigated. The results were analyzed in terms of the UV-irradiation time. The dispersion pH, and the mass recovery ratio, carboxylate content, and mass-average degree of polymerization (DPw) of the acid-soluble fraction decreased with increasing UV-irradiation time. This shows that some acid-soluble acidic compounds were formed from the TEMPO-CNFs via UV-induced depolymerization, degradation, and removal of carboxylate groups from the TEMPO-CNFs in water, depending on the UV-irradiation time. The average CNF length, which was determined from atomic force microscopy images, decreased with increasing UV-irradiation time. After UV irradiation of dispersions of the laboratory-made TEMPO-CNFs for 12 h, the average CNF lengths were 130–150 nm and their length distributions were narrower. UV irradiation of TEMPO-CNF/water dispersions is therefore a promising method for efficiently decreasing the dispersion viscosity, DPw, and average CNF length, depending on the TEMPO-CNF properties and UV-irradiation conditions. [ABSTRACT FROM AUTHOR]

Multicentric Castleman's disease (MCD) is a benign lymphoproliferative disorder with heterogenous clinical symptoms, and involves systemic organs in addition to lymph nodes. Herein, we present the case of a 55-year-old man with MCD characterized by an extensive infiltration of IgG4+ plasma cells in the kidneys. The patient presented to our hospital with a high fever and diarrhea. On admission, laboratory analysis revealed anemia, renal dysfunction (eGFR 30 mL/min/1.73 m2), polyclonal gammopathy (IgG 7130 mg/dL), elevated serum IgG4 level (2130 mg/dL), and increased C-reactive protein (8.0 mg/dL). An enlargement of lymph nodes in the axillary, mediastinal, para-aortic, and inguinal regions was observed on abdominal computed tomography. Axillary lymph node biopsy revealed interfollicular expansion due to dense plasma cell infiltration. Renal biopsy demonstrated significant plasma cell infiltration into the tubulointerstitium. Immunohistochemical analysis showed a 40% IgG4-positive/IgG-positive plasma cell ratio, meeting the diagnostic criteria for an IgG4-related disease. Amyloid A deposition was observed along vessel walls, and immunofluorescence analysis indicated granular positivity of IgG and C3 along the glomerular capillary wall. Elevated levels of interleukin-6 (21 pg/mL) and vascular endothelial growth factor (VEGF; 1210 pg/mL) were noted. Based on these findings, and the histological finding of the lymph node biopsy, idiopathic MCD was diagnosed. Corticosteroid monotherapy was only partially effective. Subsequently, tocilizumab administration was initiated, leading to sustained remission, even after discontinuation of prednisolone. Due to the diverse responses to steroid therapy and the varying prognoses observed in MCD and IgG4-related disease, it is essential to carefully diagnose MCD by thoroughly assessing the organ distribution of the disease, its response to steroid therapy, and any additional pathological findings. [ABSTRACT FROM AUTHOR]

Hydrolysis of cellulose in concentrated phosphoric acid is known to give two distinctive mono-disperse cello-oligomers: the degree of polymerization (DP) of 7 and 15. To understand the formation mechanism of monodisperse cello-oligomers, the transition of DP during phosphoric hydrolysis was monitored by size-exclusion chromatography combined with multiangle laser-light scattering analyses (SEC/MALLS). The obtained results suggested that not the hydrolysis at a specific length but random hydrolysis was likely. The rate of hydrolysis slowed down when the DP reached around 40, and the pool of cello-oligomers appeared at the incubation of 35 days. Then, the mono-disperse cello-oligomers were recovered from the pool of cello-oligomers by fractionation based on the solubility difference. [ABSTRACT FROM AUTHOR]

The molar masses and molar mass distributions of three commercial regenerated cellulose samples, viscose rayon, Tencel, and Bemliese (or cuprammonium nonwoven), have been determined by dissolution in 8% (w/w) lithium chloride/N,N-dimethylacetamide (LiCl/DMAc) and subsequent size-exclusion chromatography with multi-angle laser-light scattering detection (SEC/MALLS). Before dissolution in LiCl/DMAc, the regenerated cellulose samples were pretreated by the following three methods: (1) soaking in ethylene diamine (EDA) and subsequent solvent exchange to N,N-dimethylacetamide (DMAc) through methanol, (2) soaking in water and subsequent solvent exchange to DMAc through ethanol, and (3) soaking in water and subsequent solvent exchange to tert-butyl alcohol through ethanol and freeze dying. The pretreated samples were dissolved in 8% (w/w) LiCl/DMAc by stirring the cellulose/LiCl/DMAc mixtures for 1–3 weeks followed by dilution to 1% (w/v) LiCl/DMAc for SEC/MALLS analysis. The EDA- and water-pretreated samples gave almost the same SEC-elution pattens and molar mass plots, resulting in similar number- and mass-average molar masses. However, the freeze-dried samples gave 10%‒20% lower mass recovery ratios than those obtained for the EDA- or water-pretreated samples, probably because of incomplete dissolution of the freeze-dried samples in 8% (w/w) LiCl/DMAc. The average mass-average degree of polymerization values of viscose rayon, Tencel, and Bemliese were 340, 530, and 880, respectively. The slopes of the conformation plots were 0.58–0.62, showing that all of the molecules in the three regenerated cellulose samples were dissolved in 1% (w/v) LiCl/DMAc, forming linear random-coil conformations. [ABSTRACT FROM AUTHOR]

Background: Advances in whole-slide image capture and computer image analyses using deep learning technologies have enabled the development of computer-assisted diagnostics in pathology. Herein, we built a deep learning algorithm to detect lymph node (LN) metastasis on whole-slide images of LNs retrieved from patients with gastric adenocarcinoma and evaluated its performance in clinical settings. Methods: We randomly selected 18 patients with gastric adenocarcinoma who underwent surgery with curative intent and were positive for LN metastasis at Chiba University Hospital. A ResNet-152-based assistance system was established to detect LN metastases and to outline regions that are highly probable for metastasis in LN images. Reference standards comprising 70 LN images from two different institutions were reviewed by six pathologists with or without algorithm assistance, and their diagnostic performances were compared between the two settings. Results: No statistically significant differences were observed between these two settings regarding sensitivity, review time, or confidence levels in classifying macrometastases, isolated tumor cells, and metastasis-negative. Meanwhile, the sensitivity for detecting micrometastases significantly improved with algorithm assistance, although the review time was significantly longer than that without assistance. Analysis of the algorithm's sensitivity in detecting metastasis in the reference standard indicated an area under the curve of 0.869, whereas that for the detection of micrometastases was 0.785. Conclusions: A wide variety of histological types in gastric adenocarcinoma could account for these relatively low performances; however, this level of algorithm performance could suffice to help pathologists improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Overactivated microglia play a key role in sepsis-associated encephalopathy (SAE), although the involvement of T cells is unclear. γδT cells in the brain and meninges regulate normal fear responses via interleukin (IL)-17 in healthy mice. In our sepsis model, the mice showed exacerbated anxious behavior at 10 days post-induction (dpi). At 8 dpi, IL-17 mRNA was significantly upregulated in the brains of septic mice compared with those of control mice. Simultaneously, the number of γδT cells increased in the brains of septic mice in a severity-dependent manner. Additionally, IL-17-producing γδT cells, expressing both the C-X-C motif receptor (CXCR) 6 and the C-C motif receptor (CCR) 6, increased in mice brains, dependent on the severity of sepsis. The frequency of γδT cells in the meninges fluctuated similarly to that in the brain, peaking at 8 dpi of sepsis. Behavioral tests were performed on septic mice after the continuous administration of anti-γδTCR (α-γδTCR) or anti-IL-17A (α-IL-17A) antibodies to deplete the γδT cells and IL-17A, respectively. Compared with IgG-treated septic mice, α-γδTCR- and α-IL-17A-treated septic mice showed suppressed microglial activation and improvements in anxious behavior. These results suggested that CCR6+CXCR6+ IL-17-producing γδT cells in the brain and meninges promote the exacerbation of SAE and sepsis-induced psychological disorders in mice. [ABSTRACT FROM AUTHOR]

It is necessary to delignify wood samples and treat them with ethylene diamine (EDA) before they are dissolved in 8% (w/v) lithium chloride/N,N-dimethylacetamide (LiCl/DMAc) prior to size-exclusion chromatography (SEC) analysis. In the present study, the effects of delignifying birch wood powder 0–3 times with NaClO2 and subsequently treating it with EDA on its solubility in 8% (w/v) LiCl/DMAc and its SEC data. The neutral sugar composition of the birch powder was almost unaffected by either delignification or treatment with EDA. Treatment of the birch powder with EDA resulted in 28% solubilities in 8% (w/v) LiCl/DMAc. Approximately 11% of cellulose molecules in the birch wood powder was dissolved, and detected as a high-molar-mass (HMM) fraction in the SEC elution pattern. Each single delignification treatment increased the solubility in 8% (w/v) LiCl/DMAc to 68–74% after EDA treatment. Based on the glucose contents of the delignified samples, almost all cellulose molecules in the delignified samples were dissolved in 8% (w/v) LiCl/DMAc after EDA treatment, and detected as the HMM fractions in the SEC elution patterns. The HMM cellulose molecules in the EDA-treated birch powder had linear random-coil conformations in 1% (w/v) LiCl/DMAc. However, the SEC data suggest that there probably were some chemical linkages between the HMM cellulose molecules and lignin or NaClO2-treated lignin fragments in the HMM fractions. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We report a young woman with ileocecal endometriosis who presented with repeated abdominal pain. Under hormonal effects, the endometrium may proliferate and cause bleeding in the bowel wall, leading to cyclical abdominal pain. When recurring abdominal pain is observed in reproductive‐aged women, physicians should always be aware of gastrointestinal endometriosis. [ABSTRACT FROM AUTHOR]

Commercial cellulose is dried and/or hydrothermally treated under various conditions during isolation and purification. These processes may influence the structures and properties of the resulting cellulose products. In the present study, never-dried ramie and cotton cellulose samples were prepared from ramie bast and cotton fibers by delignification and KOH treatment. The neutral sugar compositions, X-ray diffraction (XRD) patterns, solid-state carbon 13 nuclear magnetic resonance (13C-NMR) spectra, and molar masses of the cellulose samples were determined to elucidate their chemical and crystal structures. Transmission electron microscopy (TEM) and atomic force microscopy (AFM) images of TEMPO-oxidized cellulose nanofibrils prepared from the cellulose samples were examined to determine their microfibril structures and morphologies (TEMPO = 2,2,6,6-tetramethylpiperidine-1-oxyl radical). The highest post-treatment glucose contents of the ramie and cotton cellulose samples were 93 and 98%, respectively. Cellulose I crystal widths in the ramie and cotton cellulose samples, calculated from their XRD patterns, were 3.5–3.8 and 4.6–5.1 nm, respectively. The ramie and cotton cellulose samples produced by pre-treating the never-dried samples under suitable conditions had higher molar masses than commercial products. The fibril widths determined from the AFM height images of the TEMPO-oxidized cellulose nanofibrils prepared from the never-dried ramie and cotton cellulose samples were 2.8 ± 0.7 and 3.1 ± 0.8 nm, respectively. These values were smaller than those of commercial ramie and cotton cellulose fibers. Therefore, the large cellulose I crystal widths found in commercial ramie and cotton cellulose fibers may result from the drying conditions of those fibers during production. [ABSTRACT FROM AUTHOR]

Muscle mass is an important factor for surviving an illness. Ultrasound has gained increased attention as a muscle mass assessment method because of its noninvasiveness and portability. However, data on the frequency of ultrasound-based muscle mass assessment are limited, and there are some barriers to its implementation. Hence, a web-based cross-sectional survey was conducted on healthcare providers in Japan, which comprised four parts: 1) participant characteristics; 2) general muscle mass assessment; 3) ultrasound-based muscle mass assessment; and 4) the necessity of, interest in, and barriers to its implementation. Necessity and interest were assessed using an 11-point Likert scale, whereas barriers were assessed using a 5-point Likert scale, in which "Strongly agree" and "Agree" were counted for the analysis. Of the 1,058 responders, 1,026 participants, comprising 282 physicians, 489 physical therapists, 84 occupational therapists, 120 nurses, and 51 dieticians, were included in the analysis. In total, 93% of the participants were familiar with general muscle mass assessment, and 64% had conducted it. Ultrasound-based muscle mass assessment was performed by 21% of the participants. Necessity and interest scored 7 (6–8) and 8 (7–10), respectively for ultrasound-based muscle mass assessment. The barriers to its implementation included lack of relevant education (84%), limited staff (61%), and absence of fixed protocol (61%). Regardless of the necessity of and interest in ultrasound-based muscle mass assessment, it was only conducted by one-fifth of the healthcare providers, and the most important barrier to its implementation was lack of education. [ABSTRACT FROM AUTHOR]

Post-intensive care syndrome (PICS) comprises physical, mental, and cognitive disorders following a severe illness. The impact of PICS on long-term prognosis has not been fully investigated. This study aimed to: (1) clarify the frequency and clinical characteristics of PICS in sepsis patients and (2) explore the relationship between PICS occurrence and 2-year survival. Patients with sepsis admitted to intensive care unit were enrolled. Data on patient background; clinical information since admission; physical, mental, and cognitive impairments at 3-, 6-, and 12-months post-sepsis onset; 2-year survival; and cause of death were obtained from electronic medical records and telephonic interviews with patients and their families. At 3 months, comparisons of variables were undertaken in the PICS group and the non-PICS group. Among the 77 participants, the in-hospital mortality rate was 11% and the 2-year mortality rate was 52%. The frequencies of PICS at 3, 6, and 12 months were 70%, 60%, and 35%, respectively. The 2-year survival was lower in the PICS group than in the non-PICS group (54% vs. 94%, p < 0.01). More than half of the survivors had PICS at 3 and 6 months after sepsis. Among survivors with sepsis, those who developed PICS after 3 months had a lower 2-year survival. [ABSTRACT FROM AUTHOR]

Background: Thyrocervical trunk rupture is an unusual, but critical, complication associated with central venous catheter (CVC) placement. The management of this complication has not been fully determined because it is rare. Case presentation: A 53-year-old Japanese woman with anorexia nervosa developed refractory ventricular fibrillation. After returning spontaneous circulation, a CVC was successfully placed at the initial attempt in the right internal jugular vein using real-time ultrasound guidance. Immediately after CVC placement, she developed enlarging swelling around the neck. Contrast-enhanced computed tomography showed massive contrast media extravasation around the neck and mediastinum. Brachiocephalic artery angiography showed a "blush" appearance of the ruptured right thyrocervical trunk. After selective arterial embolization with 33% N-butyl-2-cyanoacrylate, the extravasation completely disappeared and hemostasis was achieved. Conclusion: Our findings suggest that severe vascular complications arising from CVC placement can occur in patients with a fragile physiological state. Endovascular embolization is an effective treatment for such complications. [ABSTRACT FROM AUTHOR]

Background: Spinal fractures rarely cause hemothorax, and no treatment consensus has been reached. Conservative treatment is generally selected in cases without arterial injury, but there have been some reports of uncontrolled bleeding. Here we report a case of hemothorax caused by spinal fracture without arterial injury treated with transcatheter arterial embolization.Case Presentation: An 88-year-old Japanese woman with back pain was diagnosed with hemothorax due to bleeding from an unstable fracture of the tenth thoracic vertebra. Contrast-enhanced computed tomography revealed no obvious arterial injury. We performed transcatheter arterial embolization of the bilateral tenth intercostal arteries to prevent rebleeding. The hemothorax did not worsen until surgical spinal fixation 9 days post-transcatheter arterial embolization, and she was discharged 30 days after admission.Conclusion: Transcatheter arterial embolization for hemothorax caused by spinal fractures without obvious arterial injury may be a useful bridge to spinal fixation. [ABSTRACT FROM AUTHOR]

Green tea (GT) alters the disposition of a number of drugs, such as nadolol and lisinopril. However, it is unknown whether GT affects disposition of hydrophilic anti‐allergic drugs. The purpose of this study was to investigate whether pharmacokinetics of fexofenadine and pseudoephedrine are affected by catechins, major GT components. A randomized, open, 2‐phase crossover study was conducted in 10 healthy Japanese volunteers. After overnight fasting, subjects were simultaneously administered fexofenadine (60 mg) and pseudoephedrine (120 mg) with an aqueous solution of green tea extract (GTE) containing (−)‐epigallocatechin gallate (EGCG) of ~ 300 mg or water (control). In vitro transport assays were performed using HEK293 cells stably expressing organic anion transporting polypeptide (OATP)1A2 to evaluate the inhibitory effect of EGCG on OATP1A2‐mediated fexofenadine transport. In the GTE phase, the area under the plasma concentration‐time curve and the amount excreted unchanged into urine for 24 hours of fexofenadine were significantly decreased by 70% (P < 0.001) and 67% (P < 0.001), respectively, compared with control. There were no differences in time to maximum plasma concentration and the elimination half‐life of fexofenadine between phases. Fexofenadine was confirmed to be a substrate of OATP1A2, and EGCG (100 and 1,000 μM) and GTE (0.1 and 1 mg/mL) inhibited OATP1A2‐mediated uptake of fexofenadine. On the contrary, the concomitant administration of GTE did not influence the pharmacokinetics of pseudoephedrine. These results suggest that intake of GT may result in a markedly reduced exposure of fexofenadine, but not of pseudoephedrine, putatively by inhibiting OATP1A2‐mediated intestinal absorption. [ABSTRACT FROM AUTHOR]

Background/Aim: Tumor budding (TB) has recently been recognized worldwide as a prognostic predictor in several solid cancers. The objective of this study was to explore the relationship between TB and clinicopathological characteristics, postoperative relapse, and survival in patients with stage II colon cancer. Patients and Methods: A total of 213 patients with stage II colon cancer were retrospectively enrolled at Saitama Medical Center, Dokkyo Medical University from 2010 to 2016. TB was evaluated in hotspot areas on hematoxylin and eosin-stained slides at the invasive front of the tumor to define a low-grade group (BD1) and a high-grade group (BD2 or BD3). Results: High-grade TB was found in 38.3% of cases, and was associated with pT4, presence of lymphovascular invasion, and tumor relapse (p=0.02, p=0.03, p=0.002, respectively). Patients with highgrade TB showed worse relapse-free survival (RFS) and overall survival (OS) rates than patients with low-grade TB (5-year RFS: High 75.6% vs. Low 92.1%, p=0.001; 5-year OS: High 93.7% vs. Low 93.7%, p=0.001). On multivariate analysis for predictors of RFS and OS, high-grade TB was significant for both RFS and OS (RFS, p=0.003; OS, p=0.005). Patients with high-grade TB experienced lung and liver relapses significantly more frequently than patients with low-grade TB (p=0.03 each). Among patients who received adjuvant chemotherapy (AC), no patients showed lung or liver relapse even in the presence of high-grade TB. Conclusion: TB may offer a useful predictor of relapse in patients with stage II colon cancer after surgery, and AC should be considered for patients with high-grade TB. [ABSTRACT FROM AUTHOR]

2,2,6,6-Tetramethylpiperidine-1-oxyl radical (TEMPO)-mediated oxidation has been applied to bacterial cellulose (BC). The TEMPO-oxidized BC (TO-BC) gel particles were subjected to ultrasonication in water to prepare mechanically fibrillated TO-BC (TO-BC-U) samples. The carboxy contents of the TO-BC samples were 1.5‒1.6 mmol/g. X-ray diffraction patterns and solid-state 13C-nuclear magnetic resonance (NMR) spectra of the BC, TO-BC, and TO-BC-U samples showed that cellulose Iα was the dominant crystalline structure. The crystallinities of the samples calculated from the carbon signal areas in the NMR spectra were approximately the same between the BC and TO-BC samples, showing that TEMPO-mediated oxidation selectively occurred on the crystalline BC fibril surfaces. However, the crystallinities of the TO-BC-U samples were lower than those of the BC and TO-BC samples, indicating that ultrasonication of the TO-BC samples in water caused partial decreases in crystallinity. The TO-BC-U samples contained both single fibrils and fibril bundles; completely individualized TO-BC-U fibrils with homogeneous widths was not obtained. The average widths of the single TO-BC-U fibrils were ~ 3 nm, which are close to those of TO-cellulose nanofibrils prepared from wood-cellulose samples. Thus, the crystalline BC fibrils with widths of ~ 3 nm were the smallest crystalline elements. The lengths of the TO-BC samples were greater than 2‒3 µm, whereas the weight-average cellulose chain lengths of the cellulose/TEMPO-oxidized cellulose molecules in TO-BC-U samples were < 800 nm. Hence, each TO-BC-U fibril consisted of multiple cellulose and oxidized cellulose molecules, which were packed along the longitudinal direction. [ABSTRACT FROM AUTHOR]

Eosinophilic pancreatitis (EP) is very rare and characterised by infiltration of eosinophils into the pancreatic parenchyma. A 40-year-old man was diagnosed with total-colitis-type ulcerative colitis at the age of 15 years. He was then diagnosed with steroid-dependent ulcerative colitis. He was given golimumab, which resulted in remission. Ten months after beginning golimumab, he was urgently hospitalised with a diagnosis of acute pancreatitis. Hence, endoscopic ultrasound-guided fine needle biopsy was performed to obtain a definitive diagnosis. Pathologically, abundant infiltration of eosinophils was observed in the edematous intralobular stroma of the pancreas. He was diagnosed with EP, and treated with corticosteroids. [ABSTRACT FROM AUTHOR]

Raw material selection for cellulose nanofiber (CNF) production is a crucial step for tailoring CNF properties for its intended applications. Thus, understanding the dependency of the raw material on the resulting CNF properties is imperative. However, this understanding is lacking for newly emerging phosphorylated CNFs. Herein, four types of wood cellulosic materials, namely softwood- and hardwood-derived holocelluloses and purified celluloses, were subjected to phosphorylation. The holocelluloses possessed greater amounts of phosphate groups (up to 2.8 mmol/g) than celluloses (2.2–2.4 mmol/g). Significant amounts of hemicelluloses were retained after phosphorylation in both holocelluloses. The amounts of hemicellulose-derived residual neutral sugars significantly differed depending on the wood species. The disintegration into CNFs was governed not only by the amount and structure of the phosphate groups, but also by the fiber morphology and hemicellulose content of the raw material. Polyphosphate groups, cross-linking via phosphates, and carbamates, which were formed by side reactions, were also quantified. [ABSTRACT FROM AUTHOR]

NaClO2-treated residues or holocellulose samples were prepared from birch and Douglas fir wood powders by repeated cycles of delignification. These delignified samples were characterized from their weight recovery ratios, neutral sugar compositions, size-exclusion chromatograms using 1% (w/v) lithium chloride/N,N-dimethylacetamide as eluent, and solid-state 13C nuclear magnetic resonance (NMR) spectra. Neutral sugar composition analysis revealed that the weight ratios of cellulose and xylan fractions were almost constant irrespective of the number of repeated delignification cycles for up to seven and eight cycles for birch and Douglas fir, respectively. The contents of acetyl ester groups were constant between the delignified samples. The glucomannan molecules present in Douglas fir were partly removed from the delignified residues as the number of delignification cycles increased. The SEC analysis showed that the high-molar-mass (HMM) cellulose fractions of birch samples decreased slightly in molar mass with increased number of delignification cycles. The molar mass values in the HMM fractions of Douglas fir samples were much higher than those of the birch samples because of the presence of branched structures with glucomannan, and were mostly unchanged as the number of delignification cycles increased. Solid-state 13C NMR analysis of the NaClO2-treated residues and their acid-insoluble fractions showed that carboxy groups were formed in the residual lignin fractions by the oxidative delignification treatment with NaClO2. Thus, neutral sugar composition, SEC analysis, and solid-state 13C NMR analysis can be used for comprehensive and manifold characterization of NaClO2-treated residues or holocellulose samples prepared from various plant samples. [ABSTRACT FROM AUTHOR]

Eucalyptus (Eucalyptus globulus) cellulose was isolated from wood powder by dewaxing, delignification, and subsequent 4% NaOH extraction. 2,2,6,6-Tetramethyl-piperidine-1-oxyl (TEMPO)-oxidized eucalyptus celluloses were prepared from never-dried eucalyptus cellulose (EC) in yields of 96% and 72% (based on the dry weight of EC) when oxidized with NaOCl of 5 and 10 mmol/g-EC, respectively. Their carboxy contents were 1.4 and 1.8 mmol/g, respectively, when determined by conductivity titration. The crystallinity of cellulose I for EC decreased by TEMPO-mediated oxidation, showing that the originally crystalline region in EC was partly converted to disordered regions by TEMPO-mediated oxidation. Correspondingly, the relative signal area of C6‒OH/C1 with the trans-gauche (tg) conformation attributed to crystalline cellulose I in the solid-state 13C NMR spectrum of EC decreased from 0.42 to 0.34 by TEMPO-mediated oxidation with NaOCl of 10 mmol/g-EC. TEMPO-oxidized EC prepared with NaOCl of 10 mmol/g-EC was almost completely converted into individual TEMPO-oxidized EC nanofibrils (TEMPO-ECNFs) of homogeneous widths of ∼3 nm widths and lengths of >1 μm by mechanical disintegration in water. However, the TEMPO-ECNFs contained many kinks and had uneven surfaces, probably owing to significant damage occurring on the surface cellulose molecules of crystalline cellulose microfibrils during TEMPO-mediated oxidation. [ABSTRACT FROM AUTHOR]

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances. [ABSTRACT FROM AUTHOR]

Some gastric epithelial neoplasms show predominant chief cell differentiation (oxyntic gland neoplasms), in which the entity of "gastric adenocarcinoma of fundic gland type" was firstly designated, whereas a possible more aggressive subgroup "gastric adenocarcinoma of fundic gland mucosa type" (GA-FGM) was subsequently proposed. However, the histopathologic progression mode of these neoplasms has not been sufficiently reported. In this article, we describe a case of GA-FGM in which we could observe its progression during 5 years. The tumor was removed by endoscopic submucosal dissection 5 years after the first biopsy, which had already shown a feature of oxyntic gland neoplasm. During the follow-up period, the endoscopy revealed little change in the tumor appearance. However, the histology of endoscopic submucosal dissection showed submucosal extension with its histological progression. Besides, other oxyntic gland neoplasms of the stomach were observed metachronously or synchronously, giving an implication about a common pathogenetic basis of these lesions. [ABSTRACT FROM AUTHOR]

Dried cotton linters and ramie cellulose samples were oxidized with 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)/NaBr/NaClO and NaBr/NaClO (i.e., TEMPO-free) in water at pH 10. The carboxy contents, degrees of polymerization (DPs), X-ray diffraction patterns, and solid-state 13C NMR spectra were measured or obtained for the oxidized products with and without subsequent NaBH4 reduction. Cellulose nanofibrils were prepared from the oxidized cellulose samples by sonication in water and observed by atomic force microscopy and transmission electron microcopy. Because the cellulose molecules were depolymerized with NaBr/NaClO, the depolymerization behavior of the cellulose samples with TEMPO/NaBr/NaClO can be mainly explained by depolymerization with NaBr/NaClO (i.e., not TEMPO-related compounds or reactions). However, because C6-aldehydes formed in the disordered regions periodically present along the longitudinal direction of each cellulose microfibril, the viscosity-average DP values of the TEMPO/NaBr/NaClO-oxidized cellulose samples decreased to 200–300, while those with subsequent NaBH4 reduction exhibited much higher DP values. The nanofibrils prepared from the TEMPO/NaBr/NaClO-oxidized cellulose samples had smallest fibril heights or widths of 5–6 nm. However, significant amounts of unfibrillated bundles with heights of 10–40 mm were present in the nanofibril/water dispersions. The high carboxy contents of the TEMPO/NaBr/NaClO-oxidized cellulose samples (1.62–1.63 mmol/g) indicated that significant amounts of carboxy groups were likely present in the disordered regions, probably forming tail-like polyglucuronate chains. Solid-state 13C NMR analysis revealed that some of the glucosyl units originally with the tg C6–OH conformation were transformed to other conformations by TEMPO/NaBr/NaClO oxidation, while the crystalline C4 signal areas remained constant. [ABSTRACT FROM AUTHOR]

A TEMPO-oxidized cellulose nanofibril (TEMPO-CNF)/water dispersion was mixed with an aqueous solution of hydroxypropyl cellulose (HPC), hydroxyethyl cellulose (HEC), methyl cellulose (MC), or carboxymethyl cellulose sodium salt (CMC). The mixtures were converted into TEMPO-CNF/cellulose ether composite films containing 0–5% TEMPO-CNFs by casting and drying of the aqueous mixtures. All the composite films had high light transparency. However, the tensile properties of the composite films of a given TEMPO-CNF content differed for the HPC and HEC, MC, and CMC matrices. The nano-reinforcing effect owing to TEMPO-CNFs was evident in the TEMPO-CNF/HPC composite films, which became strong but brittle. In contrast, the TEMPO-CNF/HEC composite films did not exhibit this nano-reinforcing effect. Transmission electron microscopy observation of the film cross-sections revealed that the TEMPO-CNF elements were homogeneously distributed in the 5% TEMPO-CNF/HPC composite film. In contrast, the TEMPO-CNF elements were densely present on the top and bottom surfaces of the 5% TEMPO-CNF/HEC composite film; the TEMPO-CNFs were heterogeneously distributed in the HEC matrix. The low gelation or aggregation concentrations of TEMPO-CNFs in water may have resulted in the different distribution states of TEMPO-CNFs, depending on the cellulose ether matrix used, and hence the different tensile behaviors. [ABSTRACT FROM AUTHOR]

Anastomosing hemangioma (AH) is rare and a newly recognized variant of capillary hemangioma that is mostly found in the genitourinary tract. Additionally, AH is sometimes difficult to diagnose without pathological specimens. It is difficult to diagnose preoperatively due to the lack of specific clinical and radiologic appearance. The present report describes the imaging features from a radiological perspective and outlines the clinicopathologic features and treatment options. A 67-year-old woman was referred to Dokkyo Medical University Saitama Medical Center (Koshigaya, Japan) for a retroperitoneal tumor that was identified at a medical checkup 4 years prior. The patient had no symptoms, no abnormal physical signs and no past medical or specific family history. Routine blood tests were all within the normal ranges. A nonenhanced CT scan showed a circular, homogenous, well-circumscribed retroperitoneal tumor that was ~32×23 mm in size, between the abdominal aorta and the inferior vena cava, and just below the left renal vein. On a contrast-enhanced multidetector CT scan, the tumor showed heterogeneous septal enhancement in the arterial phase and persistent enhancement in the portal phase. The tumor was diagnosed as a benign neurogenic tumor or a retroperitoneal cavernous hemangioma at the time, and the patient was intended to be followed up at the outpatient clinic. However, it gradually increased to a maximum diameter of 35 mm over 4 years. Finally, it was completely resected by open laparotomy and pathologically diagnosed as AH. Retroperitoneal hemangioma is extremely rare in adulthood and has been confirmed in only 1–3% of all retroperitoneal tumors. To the best of our knowledge, only 6 cases of para-aortic AH have been reported. The incidence of this variant is very low. However, AH may be included in the differential diagnosis when a slowly progressing heterogeneous mass appears in the para-aortic region that exhibits a CT-enhanced pattern similar to a typical cavernous hemangioma. [ABSTRACT FROM AUTHOR]

The land plants evolved from a salt-water algal ancestor, diversifying on land into fresh-water algae, mosses, ferns, gymnosperms, and finally the angiosperms that dominate land today. In this study, the structures of high-molar-mass fractions in holocelluloses prepared from chara (a freshwater alga), haircap moss, adiantum, ginkgo, Japanese cedar, and eucalyptus were investigated using size-exclusion chromatography with multi-angle laser-light scattering, ultraviolet, and refractive index detection (SEC/MALLS/UV/RI). 4% NaOH-extracted holocelluloses prepared from the above algal and land plants were dissolved in 8% (w/w) lithium chloride/N,N-dimethylacetamide and subjected to SEC/MALLS/UV/RI analysis. The neutral sugar compositions of the samples were also measured. The holocelluloses prepared from chara, haircap moss, and adiantum had the same crystalline microfibril structures (~ 3 nm in width) as those prepared from ginkgo, Japanese cedar, and eucalyptus. However, SEC/MALLS/UV/RI analysis gave different results among samples. Haircap moss, adiantum, Japanese cedar, and ginkgo had cellulose/glucomannan branched structures linked through degraded fragments of residual lignin or lignin-like phenolic compounds. In contrast, 4% NaOH-extracted chara holocellulose had no such branched structures, but contained the same linear structure as found in eucalyptus. The results obtained in this study, therefore, showed the possibility that land plant cellulose fibers, have branched structures with glucomannan in the HMM fractions, even though the cellulose fibers are prepared by repeated delignification and successive 4% NaOH extraction. [ABSTRACT FROM AUTHOR]

A 70-year-old man presented with proteinuria, microscopic hematuria, and an increased level of serum creatinine. A systemic workup revealed that the patient had bronchogenic carcinoma and anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis concurrently. Despite the increase in the cumulative number of publications on paraneoplastic glomerulopathies, an awareness of the link between cancer and ANCA-associated glomerulonephritis is lacking. We strongly recommend the accumulation of more cases similar to our own, thereby allowing us to clarify the management strategies as well as the nature of this disease condition more precisely. [ABSTRACT FROM AUTHOR]

Developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome, the most severe end of neonatal diabetes mellitus, is caused by mutation in the ATP-sensitive potassium (KATP) channel. In addition to diabetes, DEND patients present muscle weakness as one of the symptoms, and although the muscle weakness is considered to originate in the brain, the pathological effects of mutated KATP channels in skeletal muscle remain elusive. Here, we describe the local effects of the KATP channel on muscle by expressing the mutation present in the KATP channels of the DEND syndrome in the murine skeletal muscle cell line C2C12 in combination with computer simulation. The present study revealed that the DEND mutation can lead to a hyperpolarized state of the muscle cell membrane, and molecular dynamics simulations based on a recently reported high-resolution structure provide an explanation as to why the mutation reduces ATP sensitivity and reveal the changes in the local interactions between ATP molecules and the channel. [ABSTRACT FROM AUTHOR]

Lisinopril, a highly hydrophilic long‐acting angiotensin‐converting enzyme inhibitor, is frequently prescribed for the treatment of hypertension and congestive heart failure. Green tea consumption may reduce the risk of cardiovascular outcomes and total mortality, whereas green tea or its catechin components has been reported to decrease plasma concentrations of a hydrophilic β blocker, nadolol, in humans. The aim of this study was to evaluate possible effects of green tea extract (GTE) on the lisinopril pharmacokinetics. In an open‐label, randomized, single‐center, 2‐phase crossover study, 10 healthy subjects ingested 200 mL of an aqueous solution of GTE containing ~ 300 mg of (–)‐epigallocatechin gallate, a major catechin component in green tea, or water (control) when receiving 10 mg of lisinopril after overnight fasting. The geometric mean ratio (GTE/control) for maximum plasma concentration and the area under the plasma concentration‐time curve of lisinopril were 0.289 (90% confidence interval (CI) 0.226–0.352) and 0.337 (90% CI 0.269–0.405), respectively. In contrast, there were no significant differences in time to reach maximum lisinopril concentration (6 hours in both phases) and renal clearance of lisinopril (57.7 mL/minute in control vs. 56.9 mL/minute in GTE). These results suggest that the extent of intestinal absorption of lisinopril was significantly impaired in the presence of GTE, whereas it had no major effect on the absorption rate and renal excretion of lisinopril. Concomitant use of lisinopril and green tea may decrease oral exposure to lisinopril, and therefore result in reduced therapeutic efficacy. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the effects of a single green tea (GT), administered concomitantly or 1 hour before nadolol intake on nadolol pharmacokinetics. Methods: In a randomized 3‐phase crossover study, 11 healthy volunteers received an oral administration of nadolol with, or 1 hour after preingestion of brewed GT, or with water in a volume of 150 mL. Results: Geometric mean ratio with 90% confidence interval for nadolol AUC0–48 was 0.371 (0.303–0.439) with concomitant GT. In addition, ingestion of GT 1 hour before nadolol administration resulted in a significant reduction of nadolol AUC0–48 with geometric mean ratio of 0.536 (0.406–0.665). There were no differences in time to maximal plasma concentration and renal clearance of nadolol among groups. Conclusion: These results suggest that single concomitant ingestion of GT substantially decreases plasma concentrations of nadolol. Moreover, the reduction in nadolol bioavailability could persist for at least 1 hour after drinking a cup of GT. [ABSTRACT FROM AUTHOR]

Background: Applying excessive force during endotracheal intubation (ETI) is associated with several complications, including dental trauma and hemodynamic alterations. A gum-elastic bougie (GEB), a type of tracheal tube introducer, is a useful airway adjunct for patients with poor laryngoscopic views. However, how the use of a GEB affects the force applied during laryngoscopy is unclear. We compared the force applied on the oral structures during ETI performed by novices using the GEB versus an endotracheal tube + stylet.Methods: This prospective crossover study was conducted from April 2017 to March 2019 in a public medical university in Japan. In total, 209 medical students (4th and 5th grade, mean age of 23.7 ± 2.0 years) without clinical ETI experience were recruited. The participants used either a Macintosh direct laryngoscope (DL) or C-MAC video laryngoscope (VL) in combination with a GEB or stylet to perform ETI on a high-fidelity airway management simulator. The order of the first ETI method was randomized to minimize the learning curve effect. The outcomes of interest were the maximum forces applied on the maxillary incisors and tongue during laryngoscopy. The implanted sensors in the simulator quantified these forces automatically.Results: The maximum force applied on the maxillary incisors was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (39.0 ± 23.3 vs. 47.4 ± 32.6 N, P < 0.001) and C-MAC VL (38.9 ± 18.6 vs. 42.0 ± 22.1 N, P < 0.001). Similarly, the force applied on the tongue was significantly lower when using a GEB than when using an endotracheal tube + stylet both with the Macintosh DL (31.9 ± 20.8 vs. 37.8 ± 22.2 N, P < 0.001) and C-MAC VL (35.2 ± 17.5 vs. 38.4 ± 17.5 N, P < 0.001).Conclusions: Compared with the use of an endotracheal tube + stylet, the use of a GEB was associated with lower maximum forces on the oral structures during both direct and indirect laryngoscopy performed by novices. Our results suggest the expanded role of a GEB beyond an airway adjunct for difficult airways. [ABSTRACT FROM AUTHOR]

Objective: We reported previously that T‐cell‐specific RORγt‐transgenic mice under human CD2 promoter (RORγt‐Tg mice) developed severe spontaneous Sjögren's syndrome (SS)‐like sialadenitis, induced by RORγt‐overexpressing CD4+T cells and reduced regulatory T cells. The purpose of this study was to clarify the effectiveness and mechanisms of action of A213, a RORγt antagonist, in RORγt‐Tg mice with SS‐like sialadenitis. Methods: Six‐week‐old RORγt‐Tg mice were administered orally of A213 or phosphate‐buffered saline every 3 days for 2 weeks. We analyzed saliva volume, histopathology of salivary glands, populations of T cells in splenocytes and cervical lymph nodes (cLNs), and the protein expression levels of CD69 on CD4+CD25+Foxp3− and CD4+CD25+Foxp3+ cells in cLNs. We also investigated in vitro the potential immunomechanisms of action of A213. Results: A213 significantly increased saliva volume, reduced mononuclear cell infiltration in salivary glands, and reduced the focus score of sialadenitis. Analysis of the immunomechanisms using cLNs showed A213 significantly reduced the proportion of CD4+CD25+/CD4+ T cells and the protein expression levels of CD69 on CD4+CD25+Foxp3− cells. In vitro experiments showed that A213 suppressed CD25 expression on CD4+ T cells and reduced IL‐2 production from CD4+ T cells derived from RORγt‐Tg mice. Conclusion: A213 improves SS‐like sialadenitis through the inhibition of CD4+CD25+ cells in cLNs. [ABSTRACT FROM AUTHOR]

Circulating lipopolysaccharide (LPS) concentrations are often elevated in patients with sepsis or various endogenous diseases related to bacterial translocation from the gut. Systemic inflammatory responses induced by endotoxemia induce severe involuntary loss of skeletal muscle, termed muscle wasting, which adversely affects the survival and functional outcomes of these patients. Currently, no drugs are available for the treatment of endotoxemia-induced skeletal muscle wasting. Here, we tested the effects of TAK-242, a Toll-like receptor 4 (TLR4)-specific signalling inhibitor, on myotube atrophy in vitro and muscle wasting in vivo induced by endotoxin. LPS treatment of murine C2C12 myotubes induced an inflammatory response (increased nuclear factor-κB activity and interleukin-6 and tumour necrosis factor-α expression) and activated the ubiquitin–proteasome and autophagy proteolytic pathways (increased atrogin-1/MAFbx, MuRF1, and LC-II expression), resulting in myotube atrophy. In mice, LPS injection increased the same inflammatory and proteolytic pathways in skeletal muscle and induced atrophy, resulting in reduced grip strength. Notably, pretreatment of cells or mice with TAK-242 reduced or reversed all the detrimental effects of LPS in vitro and in vivo. Collectively, our results indicate that pharmacological inhibition of TLR4 signalling may be a novel therapeutic intervention for endotoxemia-induced muscle wasting. [ABSTRACT FROM AUTHOR]

Objective: IgG4‐related disease (IgG4‐RD) is a unique inflammatory disorder in which Th2 cytokines promote IgG4 production. In addition, recent studies have implicated the Toll‐like receptor (TLR) pathway. This study was undertaken to examine the expression of TLRs in salivary glands (SGs) from patients with IgG4‐RD. Methods: SGs from 15 patients with IgG4‐RD, 15 patients with Sjögren's syndrome (SS), 10 patients with chronic sialadenitis, and 10 healthy controls were examined histologically. TLR family gene expression (TLR‐1 through TLR‐10) was analyzed by DNA microarray in the submandibular glands (SMGs). Up‐regulation of TLRs was confirmed in SGs from patients with IgG4‐RD. Finally, the phenotype of human TLR‐7 (huTLR‐7)–transgenic C57BL/6 mice was assessed before and after stimulation with TLR agonist. Results: In patients with IgG4‐RD, TLR‐4, TLR‐7, TLR‐8, and TLR‐9 were overexpressed. Polymerase chain reaction validated the up‐regulation of TLR‐7 in IgG4‐RD compared with the other groups. Immunohistochemical analysis confirmed strong infiltration of TLR‐7–positive cells in the SGs of patients with IgG4‐RD. Double immunohistochemical staining showed that TLR‐7 expression colocalized with CD163+ M2 macrophages. After in vitro stimulation with a TLR‐7 agonist, CD163+ M2 macrophages produced higher levels of interleukin‐33 (IL‐33), which is a Th2‐activating cytokine. In huTLR‐7–transgenic mice, the focus and fibrosis scores in SMGs, pancreas, and lungs were significantly higher than those in wild‐type mice (P < 0.05). Moreover, the concentration of serum IgG, IgG1, and IL‐33 in huTLR‐7–transgenic mice was distinctly increased upon stimulation with a TLR‐7 agonist (P < 0.05). Conclusion: TLR‐7–expressing M2 macrophages may promote the activation of Th2 immune responses via IL‐33 secretion in IgG4‐RD. [ABSTRACT FROM AUTHOR]

Holocelluloses, TEMPO-oxidized holocelluloses, and TEMPO-oxidized cellulose nanofibrils were prepared from buckwheat and rice husks to characterize the cellulose microfibril morphologies and holocellulose molar masses. The buckwheat and rice husks had ash contents of 0.8% and 23%, respectively. All TEMPO-oxidized holocelluloses had cellulose I crystal structures. TEMPO-oxidized cellulose nanofibrils prepared from the two husks were both ~ 3 nm wide. As significant amounts of xylan remained in the TEMPO-oxidized buckwheat and rice husk holocelluloses, the TEMPO-oxidized cellulose nanofibrils prepared from them by mechanical disintegration in water gave yields as low as 14–17% (based on dry weight of dewaxed husk samples). Atomic force microscopy images of TEMPO-oxidized cellulose nanofibrils prepared from buckwheat husks showed that individual nanofibrils with widths of ~ 3 nm were quite flexible, while nanofibril bundles had rigid and needle-like morphologies. Rice husks had a high ash content, with part of the ash remaining in the corresponding holocellulose, TEMPO-oxidized holocellulose, and TEMPO-oxidized cellulose nanofibrils. Never-dried buckwheat husk cellulose (prepared by removal of hemicelluloses from holocellulose) and oven-dried buckwheat husk holocellulose containing a significant amount of hemicelluloses had leveling-off degrees of polymerization (DPs) of 650 and 810, respectively, after dilute acid hydrolysis. In contrast, oven-dried buckwheat husk cellulose had a leveling-off DP of 270. [ABSTRACT FROM AUTHOR]

Progress of the chemotherapy for advanced colorectal cancer has led to better prognosis and more chance for resectability of liver metastasis. (B) Histologic view of the liver showing sinusoidal dilatation, congestion, and atrophy of liver trabeculae (affected area), except for a quarter of the area of the lower left that seems to be relatively preserved (preserved area). However, contrary to the expectation, SMA-positive cells also distributed widely even in the liver without fibrosis or other significant changes. [Extracted from the article]

Nephrotic syndrome (NS) is a pivotal manifestation of glomerular injury associated with various types of neoplasms. It may either precede or act as the presenting feature of the disease, whereas membranous nephropathy (MN) is a major phenotype of paraneoplastic glomerulopathies. However, there is a lack of information regarding the remission from paraneoplastic NS due to MN in patients who achieve favorable long-term survival after the successful removal of malignant tissue. We, herein, describe a case of biopsy-proven MN in a 65-year-old male patient with bronchogenic carcinoma, which was found during the systemic workup for concurrent NS. He was successfully treated with thoracoscopic left lower lobectomy and achieved a complete remission from NS at approximately 10 months after radical surgery. In 10 years of follow-up, there has been no recurrence of the pulmonary cancer and the patient is doing well with no relapse of NS, despite having never received treatment with any type of immunomodulating agent. Several concerns, including diagnostic management and therapeutic strategies for paraneoplastic NS, are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients. [ABSTRACT FROM AUTHOR]