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Objectives: In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations. Methods: The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL. Results: Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) 1 (p=0.046) and number of stapler firings 3 (p=0.002) were associated with AL. In multivariate analysis, only GPS 1 was significantly associated with increased AL (p=0.033; OR=4.225; 95% CI 1.122 to 15.905). Conclusions: DS creation is effective for avoiding reoperation for AL. Preoperative GPS 1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS.

BackgroundUnderstanding the muscle synergies shared between pedaling and walking is crucial for elucidating the mechanisms of human motor control and establishing highly individualized rehabilitation strategies. This study investigated how pedaling direction and speed influence the recruitment of walking-like muscle synergies.MethodsTwelve healthy male participants pedaled at three speeds (60 RPM, 30 RPM, and 80 RPM) in two rotational directions (forward and backward). Additionally, they completed walking tasks at three different speeds (slow, comfortable, and fast). Surface electromyography (EMG) was recorded on 10 lower limb muscles during movement, and muscle synergies were extracted from each condition using non-negative matrix factorization. The similarities between the muscle synergies during walking and each pedaling condition were examined using cosine similarity.ResultsThe results confirmed that the composition of muscle synergies during pedaling varied depending on the rotational direction and speed. Furthermore, one to three muscle synergies, similar to those observed during walking, were recruited in each pedaling condition, with specific synergies dependent on direction and speed. For instance, synergy involving the quadriceps and hip extensors was predominantly observed during pedaling at 30 RPM, regardless of the direction of rotation. Meanwhile, synergy involving the hamstrings was more pronounced during forward pedaling at 60 RPM and backward pedaling at 80 RPM.ConclusionThese findings suggest that walking-like muscle synergies can be selectively recruited during pedaling, depending on the rotational direction and speed.

Based on the principles of micro-alloying and composite, the graphene reinforced Sn2.5Ag0.7Cu0.1Ce composite solder was designed. Ni nanoparticle-modified reduced graphene oxide (Ni-rGO) was prepared by thermal decomposition method, and the powder-melting method was proposed for the first time to prepare Ni-rGO reinforced Sn2.5Ag0.7Cu0.1Ce composite solder. The microstructure, wettability, electrical resistivity, and mechanical properties of the composite solder were systematically studied. Results indicated that the Ni nanoparticles uniformly adhered to the rGO with a size of 26.3 nm. The effective incorporation of Ni-rGO into the solder matrix was achieved. The result broke the technical difficulty that graphene cannot be effectively added to low melting point metals. With the addition of Ni-rGO, the grain size gradually decreased, and the eutectic structures increased. Deep etching results revealed that columnar β-Sn was stacked from layered β-Sn, the addition of 0.05 wt% Ni-rGO led to an increase in sheet-like Ag3Sn within the eutectics. Additionally, Ni-rGO was found at the grain boundaries of composite solder, serving as nucleation sites for Ag3Sn and Cu6Sn5. At an addition of 0.05 wt%, the tensile strength reaches a maximum of 58.1 MPa, with elongation of 33.8%, surpassing the strength of commercial Sn3.0Ag0.5Cu solder. Therefore, the high-strength and tough composite solder was obtained. This study offered a new approach for the development of low-melting-point composite materials.

Introduction: We aimed to implement the enhanced recovery after surgery (ERAS) protocol for pediatric neuromuscular scoliosis (NMS) surgery and to examine the effectiveness of this program in this study. Methods: Subjects were children with NMS who underwent scoliosis surgery at our department by a surgeon using a single posterior approach. A series of 27 cases before the introduction of ERAS and 27 cases during program stabilization were included in the study. Patient backgrounds did not show significant differences before and after introducing ERAS. Perioperative data, complications, length of hospital stay (LOS), and readmission within 90 days were investigated and statistically analyzed. Results: When the pre- and post-ERAS induction groups were compared, no significant differences in anesthesia induction time (p=0.979), pelvic fixation (p=0.586), fusion levels (p=0.479), intraoperative hypothermia duration (p=0.154), end-of-surgery body temperature (p=0.197), operative time (p=0.18), postoperative main Cobb angle (p=0.959), main Cobb angle correction rate (p=0.91), postoperative spino-pelvic obliquity (SPO) (p=0.849), and SPO correction rate (p=0.267) were observed. However, significant differences in using V-flap technique (p=0.041), intraoperative blood loss (p=0.001), and LOS (p=0.001) were observed. Intraoperative blood loss was weakly correlated with LOS (p=0.432 and 0.001). No statistically significant difference existed between the V-flap method and LOS (p=0.265). Multiple regression analysis using LOS as the objective variable and ERAS protocols and intraoperative blood loss as explanatory variables revealed that the effect of ERAS on LOS was greater than that of intraoperative blood loss. No statistically significant differences in the readmission rates within 90 days were found. Conclusions: After the introduction of ERAS, LOS decreased without an increase in complications or readmissions within 90 days.

IntroductionNociplastic pain (NP), a third category of chronic pain, offers a framework for elucidating its pathophysiology and treatment strategies. One of the characteristics of NP is comorbidity of symptoms other than pain, such as psychological and cognitive problems; therefore, these can be clues to understanding NP. Recently, we reported several cases with comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD). Notably, ADHD medications, including methylphenidate (MP) and atomoxetine, improved chronic pain as well as the symptoms of ADHD. However, in clinical settings, identifying comorbid ADHD in patients with chronic pain is challenging, and underlying mechanisms have not been elucidated. To explore the common characteristics of brain function in patients with ADHD-comorbid NP, we identified brain regions where cerebral blood flow (CBF) distributions changed between pre- and post-treatment using single-photon emission computed tomography (SPECT). Additionally, we examined brain regions where CBF values correlated with clinical scores.MethodsWe retrospectively studied 65 patients (mean age 53 ± 14 years; 30 males and 35 females) with ADHD-comorbid NP who underwent CBF-SPECT before and after ADHD medication initiation. Clinical scores included the clinical global impression severity (CGI-S), pain numerical rating scale, hospital anxiety and depression scale, pain catastrophizing scale, and Conners’ adult ADHD rating scale-self report scores. Voxel-based statistical methods were used to compare pre- and post-treatment CBF-SPECT images to identify significant differences and investigate brain regions correlated with clinical scores.ResultsThe CBF was higher in the precuneus, insular gyrus, and thalamus before treatment than after treatment (paired t-test, cluster-definition p < 0.001, cluster-extent threshold p < 0.05, with family-wise error [FWE] correction). The hyperperfusion in the precuneus was positively correlated with the CGI-S score and significantly reduced after treatment with MP (paired t-test, cluster-definition p < 0.005, cluster-extent threshold p < 0.05, with FWE correction).ConclusionThe finding of precuneal hyperperfusion may provide insight into the mechanisms of NP and help identify patients who would benefit most from ADHD medications.

Magnetically trapped antihydrogen atoms can be cooled by expanding the volume of the trap in which they are confined. We report a proof-of-principle experiment in which antiatoms are deliberately released from expanded and static traps. Antiatoms escape at an average trap depth of 0.08±0.01K (statistical errors only) from the expanded trap while they escape at average depths of 0.22±0.01 and 0.17±0.01K from two different static traps. (We employ temperature-equivalent energy units.) Detailed simulations qualitatively agree with the escape times measured in the experiment and show a decrease of 38% (statistical error

IntroductionNociplastic pain (NP), classified as a third type of pain alongside nociceptive and neuropathic pain, is chronic pain arising from the amplification of nociceptive stimuli through central sensitization, despite the absence of tissue damage, sensory nerve damage, or disease. An important clinical feature of NP is that it is not only associated with pain but also with sensory hypersensitivity to sound and light and cognitive dysfunction, including mood and attention disorders. Recent studies have suggested that depression and developmental disorders, such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), coexist with NP at high frequency. Additionally, cognitive impairment in individuals with NP may be associated with these psychiatric comorbidities. However, to our knowledge, there are no reports on (1) multidimensional evaluation and diagnostic details of abdominal NP in adults with ADHD/ASD; (2) how ADHD drugs and antidepressants are administered when ADHD and depression coexist with NP; and (3) how central sensitization, brain function, and family relationship problems underlying NP are altered by treatments of ADHD and depression.Case presentationHerein, we present the case of a 51-year-old woman with abdominal NP. She developed severe right lower abdominal pain and underwent a thorough medical examination; however, the physical, medical cause remained unknown, making treatment challenging. Additionally, she took time off work as she began to complain of insomnia and anxiety. She was referred to our pain center, where a diagnosis of depression, ADHD, and ASD was confirmed, and treatment with ADHD medication was initiated. While ADHD medications alone did not yield sufficient improvement, a combination of methylphenidate and the antidepressant venlafaxine eventually led to improvements in abdominal NP, depression, ADHD symptoms, central sensitization, and family relationship issues. During treatment, cerebral blood flow in the anterior cingulate, prefrontal, and parietal cortices also improved.ConclusionThe treatment of comorbid depression is important while treating NP, and venlafaxine may be effective, especially in cases of comorbid ADHD/ASD. Screening for developmental disorders and depression is required in patients with abdominal NP.

Abstract Background and Aim Elobixibat is a triple mode of action laxative that increases water secretion into the colon, promotes colonic motility, and reestablishes the defecation desire. This study aims to evaluate the effectivity and safety of elobixibat in chronic constipation (CC) patients refractory to conventional laxatives. Methods A single‐center retrospective observational study was conducted in refractory CC patients diagnosed according to the Rome IV criteria and received elobixibat between April 2018 and June 2022 at Osaka Saiseikai Nakatsu Hospital. Data were collected for spontaneous bowel movement (SBM), Bristol stool form scale (BSFS) scores, abdominal symptoms, and adverse events. Results Eligible 311 patients were selected for the analysis. Two‐week Elobixibat treatment significantly increased SBM (times/week) from 2.9 ± 1.9 to 4.3 ± 1.9 (P

Abstract Background A diaphragmatic hernia is a prolapse of the abdominal organs into the thoracic cavity through a hole in the diaphragm. Traumatic diaphragmatic injuries are rare and usually occur after blunt or penetrating thoracic or abdominal traumas. Blunt diaphragmatic rupture rarely accounts for immediate mortality and may go clinically silent until complications occur which can be life threatening. It usually present late with intrathoracic herniation of abdominal viscera and carry a high mortality rate. We experienced a very rare case who showed repeated colon incarcerations 7 years after injury. And, we operated laparoscopically. Case presentation A 64-year-old man presented with multiple left rib fractures that occurred during an accident. After 7 years, he visited the emergency department with the chief complaint of left shoulder pain and epicardial pain after eating. He was diagnosed with transverse colon incarceration due to a left diaphragmatic hernia by computed tomography (CT) and X-ray imaging. Surgical repair was recommended, but he refused as the symptoms improved. Fourteen months later, the patient revisited the hospital in similar symptoms and improved spontaneously. He consulted our hospital for the surgical indication. We recommended that he undergo surgery, showing images of the X-ray and CT when his transverse colon was obstructed and he felt pain and when symptoms improved. Finally, he decided to undergo surgery. We performed diaphragmatic hernia repair with laparoscopic direct suturing in good view. The patient experienced an uneventful postoperative recovery period. The absence of diaphragmatic herniation recurrence was confirmed seven months after surgery. Conclusions We experienced a traumatic diaphragmatic hernia with repeated colon incarcerations 7 years after injury and performed surgical repair laparoscopically.

Abstract Background Severe scoliosis can cause reflux esophagitis, and is a risk factor for Barrett's adenocarcinoma of the esophagus. Severe scoliosis is associated with respiratory dysfunction, impaired operative tolerance, and anatomical difficulty in surgical manipulation, and is, therefore, considered a high surgical risk. In this report, we describe the case of a young patient with Barrett's esophageal adenocarcinoma with severe scoliosis who underwent salvage surgery after radical chemoradiotherapy. Case presentation The patient was a 39-year-old male. Although he had severe scoliosis and paraplegia of both lower limbs since childhood, he was independent in activities of daily living. His previous doctor, who diagnosed the esophageal cancer, determined that surgery was not indicated due to the coexistence of severe scoliosis, so he underwent chemoradiotherapy with curative intent. After chemoradiotherapy, the patient was referred to our hospital for a second opinion because of a tumor remnant. After various additional examinations, thoracoscopic and laparoscopic subtotal esophagectomy for esophageal cancer was performed, along with ante-thoracic route reconstruction using a narrow gastric tube. Although the patient had symptoms associated with postoperative reflux, he recovered well overall and was discharged home about 4 weeks after surgery. Conclusions We report the case of an esophageal cancer patient with severe scoliosis at high surgical risk who underwent successful minimally invasive esophagectomy.

In the original publication [...]

Abstract Background and Aim The purpose of this study was to analyze factors associated with the overall survival (OS) of atezolizumab/bevacizumab combination therapy for advanced hepatocellular carcinoma (aHCC). We also assessed the OS of patients with ineffective therapy and those who discontinued treatment owing to adverse events (AEs). Methods This retrospective multicenter study involved 139 patients with aHCC who received atezolizumab/bevacizumab combination therapy between November 2020 and September 2022. Results The median duration of treatment was 136.5 days, and the median observation period was 316 days. The overall response rate was 40%, and the disease control rate was 78% according to mRECIST criteria. Grade ≥2 AEs occurred in 63 patients (43%) and led to treatment discontinuation in 16 patients. Multivariate analysis revealed that treatment response and occurrence of grade ≥2 AEs after therapy, as well as low level of albumin‐bilirubin (ALBI) grade and low level of des‐gamma carboxy prothrombin (DCP) before therapy, were extracted as factors that contributed to OS. Log‐rank tests with the Kaplan–Meier method showed significant differences in OS among these factors. The OS of patients who discontinued owing to AEs was significantly shorter than that of other patients. Conclusion Not only factors before therapy but also treatment response and the appearance of AEs are involved in OS for atezolizumab/bevacizumab combination therapy. Although the development of AEs also contributed to OS, appropriate management of AEs is important to avoid discontinuing treatment with this combination.