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Abstract Background Corynebacterium striatum (C. striatum) is a gram-positive, anaerobic bacillus found both environmentally and in human skin and nasal mucosa flora. It is reportedly the etiologic agent of community-acquired and nosocomial diseases and is significantly associated with bacteremia and medical endovascular devices. This is the rare case of mitral valve native valve endocarditis (NVE) caused by C. striatum occurring in a young adult without underlying structural heart disease or indwelling cardiovascular medical devices successfully treated with multidisciplinary therapy. Case presentation The patient was a 28-year-old female with no medical history. She was transferred our hospital due to sudden onset of vertigo and vomit. A computed tomography on day 2 revealed the hydrocephalus due to the cerebellar infarction, and she underwent posterior fossa decompression for cerebellar infarction. An angiography on day 8 revealed a left vertebral artery dissection, which was suspected be the etiology. Afterwards, a sudden fever of 39 degrees developed on day 38. She was diagnosed with aspiration pneumonia and treated with ampicillin/sulbactam but was still febrile at the time of transfer for rehabilitation. Treatment continued with levofloxacin, the patient had no fever decline, and she was readmitted to our hospital. Readmission blood cultures (3/3 sets) revealed C. striatum, and an echocardiogram revealed an 11 mm long mitral valve vegetation, leading to NVE diagnosis. On the sixth illness day, cardiac failure symptoms manifested. Echocardiography revealed mitral valve rupture. She was transferred again on the 11th day of illness, during which time her mitral valve was replaced. C. striatum was detected in the vegetation. Following surgery, she returned to our hospital, and vancomycin administration continued. The patient was discharged after 31 total days of postoperative antimicrobial therapy. The patient experienced no exacerbations thereafter. Conclusions We report the rare case of C. striatum mitral valve NVE in a young adult without structural heart disease or indwelling cardiovascular devices. Clinical trial number Not applicable.

Abstract Background Laparoscopic rectopexy is an established treatment option for full-thickness rectal prolapse. Recently, reduced port surgery (RPS) has emerged as a novel concept, offering reduced postoperative pain and improved cosmetic outcomes compared with conventional multiport surgery (MPS). This study aimed to evaluate the feasibility and safety of RPS for full-thickness rectal prolapse. Methods From October 2012 to December 2018, 37 patients (MPS: 10 cases, RPS: 27 cases) underwent laparoscopic rectopexy for full-thickness rectal prolapse. Laparoscopic posterior mesh rectopexy (Wells procedure) is the standard technique for full-thickness rectal prolapse at our hospital. RPS was performed using a multi-channel access device, with an additional 12-mm right-hand port. Short-term outcomes were retrospectively compared between MPS and RPS. Results No significant differences were observed between MPS and RPS in the median operative time, the median blood loss volume, the postoperative complication rates, and median hospital stay duration after surgery. Conclusion Reduced port laparoscopic posterior mesh rectopexy may serve as an effective therapeutic option for full-thickness rectal prolapse. However, to establish the superiority of RPS over MPS, a prospective, randomized, controlled trial is warranted.

Introduction: We retrospectively analyzed convulsive patient outcomes transported by a physician-staffed Helicopter Emergency Medical Service (doctor helicopter [DH]) using the keyword-triggered dispatch with data from the Japan DH Registry System (JDRS). Upon receiving an emergency call containing critical keywords, such as an ongoing convulsion at the firefighting central command room, immediate dispatch of the DH is requested, in addition to dispatching an ambulance. The keyword-triggered dispatch relied on data obtained from the JDRS. Methods: Details from the JDRS database included patient age, sex, cardiac arrest presence upon DH contact, vital signs, DH dispatch timing (keyword-triggered dispatch/emergency medical technician [EMT]-triggered dispatch), medical intervention details, and 1-month outcomes (cerebral performance category [CPC]; CPC1, 2: Good; CPC 3–5: Poor). Subjects were divided into keyword (keyword-triggered dispatch) and control (EMT-triggered dispatch) groups for comparison. Results: Of 1201 patients, all evacuated from the scene, 617 were in the keyword group, and 584 in the control group. No significant differences existed between groups for cardiac arrest, respiratory and heart rates, CPC, or mortality. The keyword group had lower average age, systolic blood pressure, and medical intervention ratio but a higher median Glasgow Coma Scale and good outcome ratio. Conclusion: This first report on the keyword-triggered dispatch as a prognostic factor for convulsive patients evacuated by DH using the JDRS.

Abstract Human hematopoietic stem cell (HSC)-transferred humanized mice are valuable models for exploring human hematology and immunology. However, sufficient recapitulation of human hematopoiesis in mice requires large quantities of enriched human CD34+ HSCs and total-body irradiation for adequate engraftment. Recently, we generated a NOG mouse strain with a point mutation in the c-kit tyrosine kinase domain (W41 mutant; NOGW mice). In this study, we examined the ability of NOGW mice to reconstitute human hematopoietic cells. Irradiated NOGW mice exhibited high engraftment levels of human CD45+ cells in the peripheral blood, even when only 5,000–10,000 CD34+ HSCs were transferred. Efficient engraftment of human CD45+ cells was also observed in non-irradiated NOGW mice transferred with 20,000–40,000 HSCs. The bone marrow (BM) of NOGW mice exhibited significantly more engrafted human HSCs or progenitor cells (CD34+CD38− or CD34+CD38+ cells) than the BM of NOG mice. Furthermore, we generated a human cytokine (interleukin-3 and granulocyte-macrophage colony-stimulating factor) transgenic NOG-W41 (NOGW-EXL) mouse to achieve multilineage reconstitution with sufficient engraftment of human hematopoietic cells. Non-irradiated NOGW-EXL mice showed significantly higher engraftment levels of human CD45+ and myeloid lineage cells, particularly granulocytes and platelets/megakaryocytes, than non-irradiated NOGW or irradiated NOG-EXL mice after human CD34+ cell transplantation. Serial BM transplantation experiments revealed that NOGW mice exhibited the highest potential for long-term HSC compared with other strains. Consequently, c-kit mutant NOGW-EXL humanized mice represent an advanced model for HSC-transferred humanized mice and hold promise for widespread applications owing to their high versatility.

Spontaneous coronary artery dissection occurs predominantly in women and is associated with fibromuscular dysplasia. We illustrate a rare case of sudden coronary death as a result of cardiac rupture from spontaneous coronary artery dissection in a 54-year-old man without fibromuscular dysplasia. Cardiac rupture has been previously reported in 6 cases, mostly in women.

Abstract Chimeric TK-NOG mice with a humanized liver (normal Hu-liver) are a unique animal model for predicting drug metabolism in humans. However, residual mouse hepatocytes occasionally prevent the precise evaluation of human drug metabolism. Herein, we developed a novel humanized liver TK-NOG mouse with a conditional knockout of liver-specific cytochrome P450 oxidoreductase (POR cKO Hu-liver). Immunohistochemical analysis revealed only a few POR-expressing cells around the portal vein in POR cKO mouse livers. NADPH-cytochrome c reductase and cytochrome P450 (P450)-mediated drug oxidation activity in liver microsomes from POR cKO mice was negligible. After the intravenous administration of S-warfarin, high circulating and urinary levels of S-7-hydroxywarfarin (a major human metabolite) were observed in POR cKO Hu-liver mice. Notably, the circulating and urinary levels of S-4′-hydroxywarfarin (a major warfarin metabolite in mice) were much lower in POR cKO Hu-liver mice than in normal Hu-liver mice. POR cKO Hu-liver mice with minimal interference from mouse hepatic P450 oxidation activity are a valuable model for predicting human drug metabolism.

Plaque rupture, plaque erosion, and COVID-19 infection can cause acute coronary syndromes (ACS). We illustrate case examples demonstrating the distinctive and characteristic pathologic findings underlying each of these various causes of acute myocardial infarction. A deeper understanding of the pathophysiology of ACS is necessary for the development of newer agents and techniques to improve outcomes after ACS. (Level of Difficulty: Advanced.)

The purpose of this study is to quantitatively evaluate the effects of steam curing and internal curing on contribution of fly ash to strength development of mortar by using cementing efficiency factor (k-value) that represents strength development performance as a binder of fly ash. In addition, the pozzolanic reaction of fly ash was evaluated from the viewpoint of calcium hydroxide consumption by using thermogravimetry and differential thermal analysis as well as the degree of fly ash reaction by using selective dissolution method. The result indicated that steam curing improved early compressive strength and internal curing improved compressive strength and k-value at all ages. Also, a linearrelationship between the degree of fly ash reaction and the k-value was shown regardless of the age and the replacement ratio of fly ash.

Vascular calcification (VC) is concomitant with atherosclerosis, yet it remains uncertain why rupture-prone high-risk plaques do not typically show extensive calcification. Intraplaque hemorrhage (IPH) deposits erythrocyte-derived cholesterol, enlarging the necrotic core and promoting high-risk plaque development. Pro-atherogenic CD163+ alternative macrophages engulf hemoglobin:haptoglobin (HH) complexes at IPH sites. However, their role in VC has never been examined to our knowledge. Here we show, in human arteries, the distribution of CD163+ macrophages correlated inversely with VC. In vitro experiments using vascular smooth muscle cells (VSMCs) cultured with HH-exposed human macrophage — M(Hb) — supernatant reduced calcification, while arteries from ApoE–/– CD163–/– mice showed greater VC. M(Hb) supernatant–exposed VSMCs showed activated NF-κB, while blocking NF-κB attenuated the anticalcific effect of M(Hb) on VSMCs. CD163+ macrophages altered VC through NF-κB–induced transcription of hyaluronan synthase (HAS), an enzyme that catalyzes the formation of the extracellular matrix glycosaminoglycan, hyaluronan, within VSMCs. M(Hb) supernatants enhanced HAS production in VSMCs, while knocking down HAS attenuated its anticalcific effect. NF-κB blockade in ApoE–/– mice reduced hyaluronan and increased VC. In human arteries, hyaluronan and HAS were increased in areas of CD163+ macrophage presence. Our findings highlight an important mechanism by which CD163+ macrophages inhibit VC through NF-κB–induced HAS augmentation and thus promote the high-risk plaque development.

BackgroundA deeper understanding of coronary medial thickness is important for coronary intervention because media thickness can limit the safety and effectiveness of interventional techniques. However, there is a paucity of detailed data on human coronary medial thickness so far.Materials and methodsWe investigated the thickness of the media by histologic analysis. A total of 230 sections from 10 individuals from the CVPath autopsy registry who died from non-coronary deaths were evaluated. We performed pathological analysis on 13 segments of the following primary vessels from coronary arteries: the left main trunk, proximal left anterior descending artery (LAD), mid LAD, distal LAD, proximal left circumflex artery (LCX), mid LCX, distal LCX, proximal right coronary artery (RCA), mid RCA, and the distal RCA. The following side branches were also evaluated: diagonal, obtuse margin, and posterior descending artery branches.ResultsThe average age of the studied individuals was 60.4±12.3 years. The median medial thickness for all sections was 0.202 (0.149-0.263) mm. The median medial thickness of the main branches was significantly higher compared to that of the side branches (pConclusionsThe human coronary arteries demonstrate variation in medial thickness which tends to vary depending upon an epicardial coronary artery itself, as well as its segments and branches. Understanding these variations in medial thickness can be useful for both the interventionalists and interventional product development teams.

IntroductionDentatorubral-pallidoluysian atrophy (DRPLA) is an autosomal dominant neurodegenerative disease with various neurological manifestations. Corneal endothelial degeneration and optic atrophy have been reported separately; however, there are no reports of corneal endothelial degeneration with optic atrophy.CasesHerein, we present four related patients with DRPLA: two patients (69-year-old woman and 80-year-old man) who exhibited both corneal endothelial degeneration and optic atrophy and another two (49- and 51-year-old women, respectively) who exhibited only corneal endothelial degeneration. We quantified the reduction in corneal endothelial cell density (ECD) and hexagonality using specular microscopy and thinning of the circumpapillary retinal nerve fiber layer (RNFL) using optical coherence tomography (OCT).ConclusionThis is the first report of DRPLA accompanied by corneal endothelial degeneration and/or optic atrophy, which were both quantified based on the corneal ECD and the circumpapillary RNFL thickness using specular micrography and OCT, respectively. The pathophysiological mechanism is unclear; however, the involvement of the nuclear receptor TLX interacting with atrophin-1 may be implicated in ophthalmic manifestations of DRPLA. Therefore, we recommend performing specular micrography and/or OCT when patients with DRPLA experience visual disturbances.

MI is a leading cause of morbidity and mortality worldwide. Coronary artery thrombosis is the final pathologic feature of the most cases of acute MI primarily caused by atherosclerotic coronary artery disease. The concept of vulnerable plaque has evolved over the years but originated from early pioneering work unveiling the crucial role of plaque rupture and subsequent coronary thrombosis as the dominant cause of MI. Along with systemic cardiovascular risk factors, developments of intravascular and non-invasive imaging modalities have allowed us to identify coronary plaques thought to be at high risk for rupture. However, morphological features alone may only be one of many factors which promote plaque progression. The current vulnerable-plaque-oriented approaches to accomplish personalized risk assessment and treatment have significant room for improvement. In this review, the authors discuss recent advances in the understanding of vulnerable plaque and its management strategy from pathology and clinical perspectives.

Upwelling mantle plumes often instigate extensional stress within the continental crust of Earth. When stress exceeds crustal strength, extensional structures develop, reducing the effective stress and trigger magmatic processes at the crust–mantle boundary. However, such processes and their relationship to the formation of many surface structures remain poorly characterized on Mars. We identified a series of extensional structures in the southern highlands of Mars which collectively resemble continental rift zones on Earth. We further characterized these extensional structures and their surrounding region (area of ~1.8 M km2) by determining the surface mineralogy and bulk regional geochemistry of the terrain. In turn, this constrains their formation and yields a framework for their comparison with extensional structures on Earth. These terrains are notable for olivine and high-Ca pyroxene with a high abundance of potassium and calcium akin to alkali basalts. In the case of Mars, this Earth-like proto-plate tectonic scenario may be related to the plume-induced crustal stretching and considering their distribution and temporal relationship with the Hellas basin, we conclude that the plume is impact-induced. Overall, the findings of this work support the presence of mantle plume activity in the Noachian, as suggested by thermal evolution models of Mars.

Objective: To evaluate the optical performance of plate-haptic rotationally asymmetric refractive multifocal intraocular lenses (IOLs) with + 1.5 D addition power by reproducing calcium deposition using rabbit eyes. Methods: Five IOLs (LS-313 MF15 [Santen/Teleon], W-60R [Santen], NS1 [KOWA], SY60WF [Alcon], and NS-60YS [NIDEK]) with varying water content were randomly implanted in rabbit eyes. Cell proliferation in the lens capsule and deposits on the IOL surface were confirmed with a slit lamp. The surface deposits were stained with alizarin red, and IOL transmittance was measured with a spectrophotometer. IOL storage solutions were analyzed using inductively coupled plasma mass spectrometry to confirm the presence of calcium. Results: Slit-lamp observations revealed abundant cellular proliferation on all IOLs. Granular deposits, unlike proliferating cells, were observed on LS-313 MF15 lenses two months after surgery, increasing over time, and stained red. The transmittance of LS-313 MF15 decreased in correlation with the stained area. Calcium was detected in all IOL storage solutions; however, deposits were confirmed only on the LS-313 MF15 surface, indicating decreased transmittance. Conclusion: These findings can facilitate predicting deposition on IOLs in clinical settings and selecting IOL materials for long-term stability. The long-term use of LS-313 MF15 IOLs requires further verification to avoid post-surgical extraction. [ABSTRACT FROM AUTHOR]

A persistent descending mesocolon is defined as a congenital fixation anomaly caused by the defective membrane fusion of the descending colon and the lateral abdominal wall. Anatomically, in persistent descending mesocolon, the left colonic artery is often shortened, and joins the marginal artery soon after its bifurcation from the inferior mesenteric artery, while the colonic mesentery often adheres firmly to the mesentery of the small intestine. As a result of these characteristics, anatomical knowledge of the persistent descending mesocolon and preservation of bowel blood flow are important during surgery for left-sided colorectal cancer to avoid adverse events. Moreover, indocyanine green based blood flow assessment is useful for the detailed evaluation of bowel ischemia at the anastomotic site. Here we report the usefulness of blood flow evaluation using indocyanine green fluorescence in laparoscopic or robot-assisted surgery for three patients with colorectal cancer and persistent descending mesocolons. [ABSTRACT FROM AUTHOR]