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When resecting the internal jugular veins bilaterally in surgery for head and neck cancer, it is necessary to perform neck dissection in two stages or to reconstruct the internal jugular veins in one stage. Reconstruction of the internal jugular vein using grafting or direct anastomosis to the external jugular vein have both been reported. We report the case of a 53-year-old man with accidental injury to the left internal jugular vein after resection of the right internal jugular vein for supraglottic cancer. The left internal jugular vein was damaged near the inflow of the subclavian vein, making vein grafting difficult. Therefore, internal jugular venous return was reestablished by end-to-side anastomosis of the left internal jugular vein to the left external jugular vein system. In this surgical procedure, by incising the internal jugular vein obliquely, it was not necessary to match the calibers of the internal jugular vein and the external jugular vein system, and a smooth hemodynamic body was reconstructed. In addition, we were able to reconstruct the internal jugular vein while preserving blood flow in the external jugular vein system. End-to-side anastomosis of the internal jugular vein to the external jugular system is an option for internal jugular vein reconstruction.

Structural maintenance of chromosomes (SMC) protein complexes are essential for the spatial organization of chromosomes1. Whereas cohesin and condensin organize chromosomes by extrusion of DNA loops, the molecular functions of the third eukaryotic SMC complex, Smc5/6, remain largely unknown2. Using single-molecule imaging, we show that Smc5/6 forms DNA loops by extrusion. Upon ATP hydrolysis, Smc5/6 reels DNA symmetrically into loops at a force-dependent rate of one kilobase pair per second. Smc5/6 extrudes loops in the form of dimers, whereas monomeric Smc5/6 unidirectionally translocates along DNA. We also find that the subunits Nse5 and Nse6 (Nse5/6) act as negative regulators of loop extrusion. Nse5/6 inhibits loop-extrusion initiation by hindering Smc5/6 dimerization but has no influence on ongoing loop extrusion. Our findings reveal functions of Smc5/6 at the molecular level and establish DNA loop extrusion as a conserved mechanism among eukaryotic SMC complexes.

[Background:] Patients with osteosarcoma who experience relapse or progression [R/P] have a poor prognosis. [Methods:] Data from 30 patients who experienced R/P among 59 with a diagnosis of high-grade osteosarcoma, who were younger than 40 years old between 2000 and 2019, were retrospectively analyzed to identify prognostic and therapeutic factors influencing their outcomes. [Results:] The 5-year overall survival [OS] rates after the last R/P of patients experiencing first [n=30], second [n=14], and third [n=9] R/P were 50.3%, 51.3%, and 46.7%, respectively. Multivariate analysis did not identify any independent risk factors affecting OS. The 5-year PFS rate of the 30 patients after first R/P was 22.4%, and multivariate analysis identified histologic subtype and curative local surgery as independent risk factors influencing PFS. Long [>6 mo] partial response was observed in three patients treated using temozolomide+etoposide, irinotecan+carboplatin, or regorafenib. [Conclusions:] OS rate in the patients with osteosarcoma experiencing R/P included in this study was markedly higher than that reported previously, mainly due to the surgical total removal of tumors, even after subsequent R/P. The recent establishment of salvage chemotherapy or molecular targeted therapy may also increase survival rates in a subgroup of patients.

胃全摘術後に縫合不全を発症すると唾液や腸液などの消化液が漏出するが，稀に胸腔内に穿破することがある．今回，われわれは縫合不全による胸腔内穿破を胸腔内の穿刺ドレナージと洗浄で保存的に治療し，再手術を回避できたので報告する． 症例は48歳，男性．食道胃接合部癌に対して開腹下に胃全摘術を施行した．術後3日目に急激な呼吸困難を認めた．全身状態が悪く胃X線透視検査が困難であった．そのためガストログラフィン内服直後にCT撮影を施行し，縫合不全による左胸腔内穿破と診断した．穿刺ドレナージと生理食塩水の洗浄で保存的に治療し，術後25日目に縫合不全は治癒していることを確認した． 胃全摘術後の縫合不全による胸腔内穿破の報告は少なく，再手術をするか穿刺ドレナージをするか議論の余地がある．自験例では穿刺ドレナージと洗浄で保存的に治療し再手術を回避することができた．ただし，胸腔内は腹腔内に比べて適切なドレナージと瘻孔形成が不利な条件下にあるため，手術を施行するタイミングを逸しないよう慎重に経過をみる必要があると考えられた．, Intestinal fluid could leak into the abdominal cavity after total gastrectomy; however, in rare cases intestinal fluid could leak into the thoracic cavity. We report a case where an intrathoracic puncture caused by leakage was treated conservatively using intrathoracic drainage and saline perfusion lavage. A 48-year-old man with an esophagogastric junction cancer underwent open total gastrectomy. Three days postoperatively, the patient had sudden respiratory failure. Computed tomography was performed after administering oral gastrografin. The patient was diagnosed with an intrathoracic perforation caused by leakage. The intrathoracic fluid collection was drained and the thoracic cavity perfused with saline. The patient recovered fully 25 days after operation. There are few reports of cases of intrathoracic leakage after total gastrectomy. Such cases should be followed-up closely as they are likely to become severe. Furthermore, reoperation can be avoided by drainage and saline perfusion lavage.

本論文では、バリ島東部カランガッスム県アムラプラ周辺で演奏されている日本の大正琴を起源とするプンティン pentingとよばれる楽器と、2007年に設立されたプンティンのアンサンブルのグループ「ムルドゥ・コマラ Merdu Komala」の活動を研究対象としている。そしてこのグループの活動を通して、2つの点を明らかにした。一つは、この楽器やアンサンブルがカランガッスム県に独特な芸能であることが強調され、その後、歴史性が付与されていき、この芸能が「創られた伝統」となったことである。そしてもう一つは、バリの伝統音楽を演奏するために変容した楽器を使って、全音階の西洋音楽を演奏する試みが行われる中で、プンティンが、再び全音階を基本にしている日本の大正琴へと回帰しつつある現状についてである。, The subject of this paper is an instrument called penting, which originates from the Japanese Taisho-goto. It is played in the Amlapura region in Karangasem, East Bali, and the activities of the penting ensemble Merdu Komala, which was established in 2007. Two points are made evident in this paper. The first is that the instruments and the ensemble were emphasized as a performing art unique to the Karangasem district and were given a historical character, resulting in the 'traditionalization' of this performing Arts, hence becoming 'The invention of tradition.' Another point concerns the current situation where the penting is returning to the Japanese Taisho-goto, based on a diatonic scale, as attempts are made to use the penting to play Western music.

人工肛門脱出は人工肛門造設後の合併症の一つであり，疼痛や出血，パウチ貼付困難といった症状が出現すると手術が必要になる．ところが，人工肛門脱出に対する標準的な手術や治療法は確立していないのが現状である．過去の文献では自動縫合器を用いた手術の報告が散見され，良好な治療経過をえている．今回，われわれは人工肛門脱出に対して自動縫合器を用いて非開腹下に手術を施行した．症例１は81歳の男性．原因不明のS状結腸狭窄に対して横行結腸で双孔式人工肛門を造設した．術後１か月目から口側腸管から人工肛門脱出を認めた．さらに１か月経過し増悪するため手術を施行した．症例2は82歳の女性．閉塞性S状結腸癌に対して横行結腸で双孔式人工肛門を造設した．術後3か月目に肛門側から人工肛門脱出を認め，手術を施行した．自動縫合器を用いた術式では，縫合部が直視困難な位置に自然に還納するため，縫合部出血の確認と止血を念頭に置き切離前から縫合部を牽引して術野に牽引しておくことが重要であると考えられた．, Stoma prolapse is one of the complications after colostomy, and we have to operate it if symptoms such as pain, bleeding, and difficulty in attaching the pouch occur. However, we have no standard surgery or treatment for stoma prolapse. In the past literature, there have been some reports of surgery using automatic sutures. We performed non-laparotomy surgery using automatic sutures for incarcerated colostomy. Case 1 was an 81-year-old man. A biperal colostomy was constructed in the transverse colon for sigmoid colon stenosis of unknown cause. From the first month after surgery, a stoma prolapse was observed from the mouth intestinal tract. After another month, we performed operation for worsen the disease. Case 2 was an 82-year-old woman. A biperal colostomy was constructed in the transverse colon for obstructive sigmoid colon cancer. Three months after surgery, a stoma prolapse was observed from the side. And we performed operation. While the usefulness of surgery using automatic sutures has been found in some places, it may also be useful in incarcerated cases. In this surgical procedure, since the suture is naturally returned to a position where it is difficult to see directly, it is important to tow the proboscis suture to the surgical field before dissection, keeping in mind the confirmation of suture bleeding and hemostasis.

OBJECTIVE Retrograde leptomeningeal venous drainage (RLVD) of a dural arteriovenous fistula (dAVF) is associated with neurological morbidity and unfavorable outcomes. However, the direct damage to cortical neurons by dAVF with RLVD has not been elucidated. 123I-iomazenil (123I-IMZ) SPECT can reveal cerebral blood flow and cortical neuronal damage in early and late images, respectively. This study aimed to assess the cerebral venous congestive encephalopathy caused by dAVF using 123I-IMZ SPECT. METHODS Based on the pre- and posttreatment MRI findings, patients were divided into three groups: a normal group, an edema group, and an infarction group. Radioactive counts in the early and late images of 123I-IMZ SPECT were investigated using the affected-to-contralateral side asymmetry ratio (ACR). RESULTS None of the patients in the normal group showed any symptoms related to venous congestion. In contrast, all the patients in the edema and infarction groups developed neurological symptoms. The ACR in early images in the edema group was significantly lower than that in the normal group and significantly higher than that in the infarction group. The ACR in the late images of the infarction group was significantly lower than those of the normal and edema groups. After treatment, the neurological signs disappeared in the edema group, but only partial improvement was observed in the infarction group. The ACR in early images significantly improved after treatment in the edema group, but the ACR in late images did not change in any groups. CONCLUSIONS 123I-IMZ SPECT is useful for evaluating hemodynamic disturbances and neuronal damage in dAVFs. The reduction in early images was correlated with the severity of venous congestive encephalopathy, and the significant reduction in late images is a reliable indicator of irreversible venous infarction caused by RLVD.

This paper describes the whole-rock geochemical composition, clinopyroxene (Cpx) chemical composition, and the hornblende K-Ar age of the mafic rocks in the Carboniferous accretionary complex of the Khangai-Daur belt, Central Asian Orogenic belt, exposed at the Uubulan area of Mongolia. The geochemical nature of the mafic rocks, enriched in large ion lithophile elements and light rare-earth elements compared with high field-strength elements (HFSE) and heavy rareearth elements, suggest that they are alkaline basalts. The (La/Yb)cn vs. HFSE diagrams show that the samples are oceanic island basalts. Therefore, the mafic rocks are concluded to be oceanic-island alkaline basalts. The comparatively high concentrations of Al, Ti, Na, and Ca in the Cpx of the mafic rocks strongly support this view. The mafic rocks just beside the Upper Silurian radiolarian chert give a hornblende K-Ar age of 412.7±8.6 Ma. The fact that Upper Silurian chert strongly suggests that the oceanic-island alkaline basalts are conformably underlain by the radiolarian chert formed at the pelagic region as a base of oceanic plate stratigraphy.

Background: There is a need for quick skin blood flow tests that can be performed in the wound healing field. Antera 3D® is a compact scanner using multispectral imaging. It can perform quick assessment of skin conditions. The purpose of the present study was to investigate the ability of the Antera 3D® to assess skin blood flow in comparison with transcutaneous partial pressure of oxygen (TcPO2) measurements. Methods: This study was conducted on 13 patients with a history of lower extremity ulcers. Measurements of hemoglobin average level (hereafter, Hb score) measured by Antera 3D® and TcPO2 measured by a transcutaneous blood gas monitor were obtained at the same sites on the dorsal foot and lower leg. Differences in Hb score and TcPO2 were analyzed by t-test for each measurement site and for the presence of peripheral arterial disease (PAD). The correlation between TcPO2 and Hb score was analyzed by Pearson’s correlation coefficient. Results: Twenty-four limbs were tested. Hb score was higher (P < 0.001) and TcPO2 was lower (P = 0.056) in the dorsal foot compared to the lower leg. In the dorsal foot, Hb score was higher (P = 0.023) and TcPO2 was lower (P = 0.046) in patients with PAD compared to those without PAD. A significant negative correlation (r = –0.68; 95% confidence interval –0.85 to –0.38, P < 0.001) between TcPO2 and Hb score was observed in the dorsal foot. Conclusion: The negative correlation between TcPO2 and Hb score may reflect compensatory peripheral vasodilation due to occlusion or stenosis of central arteries. This study showed that Hb score measured by Antera 3D® may be related to skin blood flow.

Given inevitable age-related decreases in physical or mental capacity, studies on health-related behaviour (HRB) clustering in older people provide an opportunity to reduce health-care costs and promote healthy ageing. This study explores the clustering of HRBs and transition probabilities of cluster memberships over time, and compares sociodemographic characteristics of these clusters among Chinese and Japanese middle-aged and older adults. Using the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 (N = 19614) and the Japanese Study of Ageing and Retirement (JSTAR) from 2007 to 2011 (N = 7,080), Latent Transition Analysis was applied to investigate the clustering and change in clustering memberships of smoking, alcohol consumption, physical activity and body mass index. Multivariate logistic regression was used to explore the sociodemographic characteristics of these longitudinal HRB cluster members. We identified four common clusters in CHARLS and JSTAR: ‘smoking’, ‘overweight or obese’, ‘healthy lifestyle’ and ‘current smoking with drinking’, and an additional cluster named ‘ex-smoking with drinking’ in JSTAR. Although HRB cluster members were largely stable in both cohorts, participants in China tended to move towards an unhealthy lifestyle, while participants in Japan did the opposite. We also found that participants who smoked and drank were more likely to be male, younger, less educated and unmarried in both cohorts, but the overweight or obese participants were female, urban and higher income in CHARLS but not JSTAR. Our study not only contributes to the knowledge of longitudinal changes in health-related behavioural clustering patterns in an Asian elderly population, but may also facilitate the design of targeted multi-behavioural interventions to promote healthy lifestyles among older people in both countries.

High-speed atomic force microscopy (HS-AFM) is a unique approach that allows direct real-time visualization of biological macromolecules in action under near-physiological conditions, without any chemical labeling. Typically, the temporal resolution is sub-100 ms, and the spatial resolution is 2–3 nm in the lateral direction and ∼0.1 nm in the vertical direction. A wide range of biomolecular systems and their dynamic processes have been studied by HS-AFM, providing deep mechanistic insights into how biomolecules function. However, the level of mechanistic detail gleaned from an HS-AFM experiment critically depends on the spatiotemporal resolution of the system. In this review article, we explain the principle of HS-AFM and describe how the resolution is determined. We also discuss recent attempts to improve the resolution of HS-AFM to further extend the observable range of biological phenomena.

Since tumors in different human organs may have different tumor microenvironments, we evaluate time-course changes in all tumor locations after pembrolizumab treatment in urothelial carcinoma (UC) to examine the differences in efficacy of pembrolizumab per organ. Further, we uncover the usefulness of inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), CRP, and kinetics of these markers to predict pembrolizumab success and relation to overall survival (OS) in UC.A total of 115 cancerous lesions from 44 UC patients were measurable based on RECIST 1.1 criteria. The serum CRP and NLR levels were measured at baseline prior to pembrolizumab treatment and at least every 3 weeks just prior to pembrolizumab administration.Site-specific success (ie, patients with CR/PR/SD by RESIST 1.1) rates for pembrolizumab treatments were as follows: primary tumors: 67%, lymph node: 70%, lung: 44%, liver: 40%, and peritoneal metastasis: 56%. Focusing on the major metastasis sites, lymph nodes and lungs, we examined the relationships between NLR, CRP, or that kinetics and pembrolizumab success. In lymph nodes, both early NLR kinetics (P = .005) and CRP kinetics (P = .035) was a predictor for pembrolizumab success. On the other hand, none of 4 was not in lung metastases. Regarding to the mortality, the multivariate analysis revealed that early NLR kinetics was a prognostic biomarker for OS among the 4, independent of performance status and liver metastasis.We revealed that site-specific pembrolizumab success in UC. Early NLR kinetics was a predictor for lymph node pembrolizumab success and OS in our cohorts.

Somatic polyploidization often increases cell and organ size, thereby contributing to plant biomass production. However, as most woody plants do not undergo polyploidization, explaining the polyploidization effect on organ growth in trees remains difficult. Here we developed a new method to generate tetraploid lines in poplars through colchicine treatment of lateral buds. We found that tetraploidization induced cell enlargement in the stem, suggesting that polyploidization can increase cell size in woody plants that cannot induce polyploidization in normal development. Greenhouse growth analysis revealed that radial growth was enhanced in the basal stem of tetraploids, whereas longitudinal growth was retarded, producing the same amount of stem biomass as diploids. Woody biomass characteristics were also comparable in terms of wood substance density, saccharification efficiency, and cell wall profiling. Our results reveal tetraploidization as an effective strategy for improving woody biomass production when combined with technologies that promote longitudinal stem growth by enhancing metabolite production and/or transport.

It recently has been reported that partial-epithelial–mesenchymal transition (p-EMT) program is associated with metastasis in head and neck squamous cell carcinoma (HNSCC). We previously have identified POSTN (which encodes periostin) as an invasion-promoting molecule in HNSCC. Interestingly, POSTN expression is frequently observed in cancer cells with higher p-EMT score by using a previous single-cell transcriptomic data of HNSCC cases. Although it is known that POSTN has 11 splicing variants, the role of them has not been determined in HNSCC. Here, we found that HNSCC cells with EMT features expressed POSTN isoforms, Iso3 (lacking exon 17 and 21) and Iso5 (lacking exon 17), whereas fibroblast expressed Iso3 and Iso4 (lacking exon 17, 18, and 21). The expression of POSTN Iso3 and Iso4 are known to be widely observed in various cell types including stromal cells. Therefore, we focused on the role of novel cancer cell-derived POSTN isoform, Iso5, in HNSCC. Single overexpression of POSTN Iso5 as well as Iso3 promoted invasion. Surprisingly, Iso5 synergistically promoted invasion together with Iso3. Notably, Iso5 as well as Iso3 upregulated p-EMT-related genes. We suggest that a novel cancer-specific POSTN isoform lacking exon 17 (Iso5) can be a useful marker for detecting cancer cells undergoing p-EMT. Moreover, a POSTN Iso5 can be a novel target for diagnosis and therapy in HNSCC.

Zenker憩室はKillian’s間隙に発生した憩室であり，全消化管憩室の0.1%の頻度と稀である．今回われわれは，術中神経モニタリングシステムであるNIMシステム(NERVE INTEGRITY MONITORING SYSTEM；以下，NIMと略記)をZenker憩室の手術で使用し，反回神経を容易に同定することが可能であったので報告する． 症例は67歳，女性．数年前から咽頭部の違和感を自覚し，２カ月前から増悪したため当院外来を受診した．精査の結果，症状を認めるZenker憩室と診断し，手術を施行した．NIMを使用して反回神経の走行を確認しつつ憩室を同定した．憩室を切除後，二層縫合(Albert-Lembert吻合)して閉鎖した．術中内視鏡検査を施行し，食道に狭窄や漏れがないことを確認した．輪状咽頭筋切開を追加し，甲状腺を縫合部の前面で固定して縫合部を補強した．ドレーンを留置して手術を終了した．術後経過は良好で手術から14日目に退院とし，退院後１ヶ月の時点で症状は改善していることを確認した． Zenker憩室の手術で反回神経損傷は回避すべき合併症のひとつである．甲状腺手術で使用するNIMはZenker憩室の手術においても反回神経の同定に使用することで，神経損傷のリスクを下げる可能性がある．, Zenker’s diverticulum is a diverticulum that develops in the Killian’s gap. The frequency of its occurrence is 0.1% of all digestive tract diverticulum. The present study reports that the NIM system can be useful during Zenker’s diverticulum surgery for easily identifying recurrent laryngeal nerve. The present case is of a 67-year-old woman. She was aware of discomfort in her pharyngeal region for several years. She had been aggrieved for the past 2 months, and therefore was admitted to our hospital’s outpatient clinic. Following examination, we diagnosed Zenker’s diverticulum and performed surgery. We identified recurrent laryngeal nerve using NIM. We dissected the diverticulum and sutured in layers and closed. Intraoperative endoscopy was performed to confirm that there was no stenosis or leakage in the esophagus. We performed ring pharyngeal muscle incision. We fixed the thyroid gland in front of the suture to reinforce it. There was no untoward event postoperatively, and the patient was discharged from the hospital on day 14 after the surgery. We confirmed that the symptom had improved at 1 month after discharge. NIM used in thyroid surgery is also useful in identifying the recurrent laryngeal nerve during Zenker’s diverticula surgery and may help reduce the risk of nerve damage.

Background: TMS-007, an SMTP family member, modulates plasminogen conformation and enhances plasminogen-fibrin binding, leading to promotion of endogenous fibrinolysis. Its anti-inflammatory action mediated by soluble epoxide hydrolase inhibition contributes to the efficacy. Evidence suggests that TMS-007 can effectively treat experimental thrombotic and embolic strokes with a wide time window while reducing hemorrhagic transformation. Aims: To evaluate the safety, pharmacokinetics, and pharmacodynamics of TMS-007 in healthy volunteers. Methods: A randomized, placebo-controlled, double blind, dose-escalation study, administered as a single intravenous infusion of TMS-007 in cohorts of healthy male Japanese subjects. There were 6 cohorts planned, but 5 were completed. In each cohort (n = 8), individuals were randomized to receive one of 5 doses of TMS-007 (3, 15, 60, 180, or 360 mg; n = 6) or placebo (n = 2). Results: TMS-007 was generally well-tolerated, and no serious adverse events attributed to the drug. A linear dose-dependency was observed for plasma TMS-007 levels. No symptoms of bleeding were observed in brain MRI analysis, and no bleeding-related responses in laboratory testing were found. The plasma levels of the coagulation factor fibrinogen and the anti-fibrinolysis factor 2-antiplasmin levels were unchanged after the TMS-007 dosing. A slight increase in the plasma level of plasmin-α-antiplasmin complex, an index of plasmin formation, was observed in some subjects who received 360 mg of TMS-007 (≈ 6 mg kg). Conclusions: TMS-007 is generally well-tolerated and exhibits favorable pharmacokinetic profiles that warrant further clinical development.