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In association with a large solar flare on November 7, 2004, the solar neutron detectors located at Mt. Chacaltaya (5,250 m) in Bolivia and Mt. Sierra Negra (4,600 m) in Mexico recorded very interesting events. In order to explain these events, we have performed a calculation solving the equation of motion of anti-protons inside the magnetosphere. Based on these results, the Mt. Chacaltaya event may be explained by the detection of solar neutrons, while the Mt. Sierra Negra event may be explained by the first detection of very high energy solar neutron decay protons (SNDPs) around 6 GeV.

A study by Moran et al. highlights the importance of avoiding the incorrect intrathecal injection of tranexamic acid (TA) during caesarean sections, as it has resulted in the deaths of pregnant women. The authors propose two methods to prevent this error: the use of a spinal needle with a specific connector called the Neuraxial and Regional block Fit (NRFit) connector, and the use of a prefilled syringe of TA. The NRFit connector complies with international standards and has been successfully implemented in Japan. Additionally, the use of a prefilled syringe of TA adds an extra layer of protection against the incorrect administration of the drug. The authors recommend implementing these strategies in a coordinated manner across institutions or even nationwide to improve patient safety. [Extracted from the article]

This article discusses a case of eosinophilic fasciitis (EF) in a 71-year-old female patient. EF is a rare disease characterized by edema and skin induration in the extremities. The groove sign, a linear depression along the superficial veins, is a characteristic physical finding of EF. The article emphasizes the importance of raising the arms to confirm the presence of the groove sign when EF is suspected. The patient in this case received oral prednisolone and methotrexate as treatment. [Extracted from the article]

Purpose: The objectives of this study were to clarify whether resection of primary tumor in the extremities for patients with metastatic soft-tissue sarcoma (STS) improves survival, and to clarify patient groups for whom primary tumor resection should be considered. Methods/patients: Using the surveillance, epidemiology, and end results database, we identified 1453 patients with metastatic STS of the extremities at initial presentation between 1983 and 2016. Of these 1453 patients, 898 patients underwent primary tumor resection (Surgery group), and 555 patients did not (No-surgery group). Results: After adjusting for patient background by propensity score matching, a total of 804 patients were included for analysis. Patients in the Surgery group showed improved survival (cancer-specific survival (CSS) hazard ratio (HR) = 0.59, 95% confidence interval (CI) 0.50–0.71 overall survival rate (OS) HR = 0.60, 95% CI 0.51–0.70). In subclass analysis, patients with high-grade STS, undifferentiated pleomorphic sarcoma, leiomyosarcoma, or synovial sarcoma showed improved survival in the Surgery group (high grade—CSS HR = 0.57, 95% CI 0.45–0.72, OS HR = 0.58, 95% CI 0.48–0.71; undifferentiated pleomorphic sarcoma—CSS HR = 0.60, 95% CI 0.42–0.84, OS HR = 0.61, 95% CI 0.46–0.82; leiomyosarcoma—CSS HR = 0.50, 95% CI 0.33–0.75, OS HR = 0.50, 95% CI 0.35–0.72; synovial sarcoma—CSS HR = 0.46, 95% CI 0.31–0.68, OS HR = 0.43, 95% CI 0.30–0.62). Conclusions: Our results indicated that primary tumor resection in metastatic STS exerts positive impacts on survival. Further clinical research is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Background: The loss of corneal epithelial stem cells from the limbus at the edge of the cornea has severe consequences for vision, with the pathological manifestations of a limbal stem-cell deficiency (LSCD) difficult to treat. Here, to the best of our knowledge, we report the world's first use of corneal epithelial cell sheets derived from human induced pluripotent stem cells (iPSCs) to treat LSCD., Methods: This non-randomised, single-arm, clinical study involved four eyes of four patients with LSCD at the Department of Ophthalmology, Osaka University Hospital. They comprised a woman aged 44 years with idiopathic LSCD (patient 1), a man aged 66 years with ocular mucous membrane pemphigoid (patient 2), a man aged 72 years with idiopathic LSCD (patient 3), and a woman aged 39 years with toxic epidermal necrosis (patient 4). Allogeneic human iPSC-derived corneal epithelial cell sheets (iCEPSs) were transplanted onto affected eyes. This was done sequentially in two sets of HLA-mismatched surgeries, with patients 1 and 2 receiving low-dose cyclosporin and patients 3 and 4 not. The primary outcome measure was safety, ascertained by adverse events. These were monitored continuously throughout the 52-week follow-up period, and during an additional 1-year safety monitoring period. Secondary outcomes, reflective of efficacy, were also recorded. This study is registered with UMIN, UMIN000036539 and is complete., Findings: Patients were enrolled between June 17, 2019 and Nov 16, 2020. We had 26 adverse events during the 52-week follow-up period (consisting of 18 mild and one moderate event in treated eyes, and seven mild non-ocular events), with nine recorded in the additional 1-year safety monitoring period. No serious adverse events, such as tumourigenesis or clinical rejection, occurred during the whole 2-year observational period. At 52 weeks, secondary measures of efficacy showed that the disease stage had improved, corrected distance visual acuity was enhanced, and corneal opacification had diminished in all treated eyes. Corneal epithelial defects, subjective symptoms, quality-of-life questionnaire scores and corneal neovascularisation mostly improved or were unchanged. Overall, the beneficial efficacy outcomes achieved for patients 1 and 2 were better than those achieved for patients 3 and 4., Interpretation: iCEPS transplantation for LSCD was found to be safe throughout the study period. A larger clinical trial is planned to further investigate the efficacy of the procedure., Funding: The Japan Agency for Medical Research and Development, the Ministry of Education, Culture, Sports, Science, and Technology-Japan, and the UK Biotechnology and Biological Sciences Research Council., Competing Interests: Declaration of interests KN reports receiving research funds from RAYMEI, a company for which he is a stockholder. KN was not directly involved with the evaluation of efficacy and safety, data management, monitoring, or statistical analysis. After the study's completion HT became an employee of RAYMEI, but during the study had no competing interests. All other authors declare no competing interests. A conflict of interest management plan was submitted to and approved by the First Certified Special Committee for Regenerative Medicine, Osaka University., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

SPring-8-II is a major upgrade project of SPring-8 that was inaugurated in October 1997 as a third-generation synchrotron radiation light source. This upgrade project aims to achieve three goals simultaneously: achievement of excellent light source performance, refurbishment of aged systems, and significant reduction in power consumption for the entire facility. A small emittance of 50 pm rad will be achieved by (1) replacing the existing double-bend lattice structure with a five-bend achromat one, (2) lowering the stored beam energy from 8 to 6 GeV, (3) increasing the horizontal damping partition number from 1 to 1.3, and (4) enhancing horizontal radiation damping by installing damping wigglers in long straight sections. The use of short-period in-vacuum undulators allows ultrabrilliant X-rays to be provided while keeping a high-energy spectral range even at the reduced electron-beam energy of 6 GeV. To reduce power consumption, the dedicated, aged injector system has been shut down and the high-performance linear accelerator of SACLA, a compact X-ray free-electron laser (XFEL) facility, is used as the injector of the ring in a time-shared manner. This allows the simultaneous operation of XFEL experiments at SACLA and full/top-up injection of the electron beam into the ring. This paper overviews the concept of the SPring-8-II project, the system design of the light source and the details of the accelerator component design., (open access.)

Although the liver of the lamprey, a group of cyclostomes that diverged the earliest among vertebrates, has abundant bile ducts in the larval stage, which degenerate during metamorphosis, there is no comparative study on its architecture with other early diverged vertebrates in terms of the morphological evolution of vertebrate livers. The present study was undertaken to compare the characteristics of the brook lamprey liver with those of the hagfish and banded houndshark, which have the portal triad type liver architecture, and to discuss its evolution. Although the liver of the brook lamprey had two-cell cords of hepatocytes lined by sinusoids in the ammocoetes larval stage, intrahepatic bile ducts around portal veins penetrated into the liver parenchyma with convolution and gradual reduction in diameter. They also faced dilated sinusoids. The epithelial cells had characteristic intercellular spaces. These characteristics were distinct from those of bile ducts in the hagfish and banded houndshark livers. Although the liver architectures of the hagfish and banded houndshark were similar, the latter penetrated the intrahepatic bile ducts more deeply along the portal veins than the former, in which intrahepatic bile ducts were restricted near the hilum. After metamorphosis, bile ducts degenerated in brook lampreys. These data indicate that the liver architecture of the ammocoetes larva is unique in the parenchymal distribution of bile ducts, their sinusoidal facing, and morphology among extant vertebrates. The periportal distribution of intrahepatic biliary structures may have been established prior to the divergence of the cyclostomes and gnathostomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Topographical disorientation is linked to lesions in the right hemisphere and typically resolves within a few months post-stroke. Persistent topographical disorientation is uncommon and frequently accompanied by impairments in visual memory, complicating the analysis of the underlying mechanisms. Herein, we report two cases of sustained pure topographical disorientation following cerebral hemorrhages in the left retrosplenial region. The patients exhibited disorientation in both familiar and unfamiliar settings, attributable to heading disorientation, a deficit in determining the directional relationship between one's current position and a target location or external frames. The patients struggled with reconstructing large-scale spatial frameworks and integrating new egocentric and allocentric perspectives upon changes in body orientation. There were no landmark agnosia, egocentric disorientation, or anterograde disorientation. Although mild verbal memory deficits were observed, no other cognitive impairments, including visual memory deficits, were detected. Our findings imply that lesions confined to the left retrosplenial region can induce enduring heading disorientation and suggest a significant role for this area in processing and integrating spatial information necessary for large-scale navigation. Clarifying the features of topographical disorientation will significantly impact the therapeutic approaches, enhancing the quality of life for affected patients by restoring their independence and mobility., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The consensus-based TOKYO criteria were proposed as a standardized reporting system for endoscopic transpapillary biliary drainage. The primary objective was to address issues arising from the inconsistent reporting of stent outcomes across studies, which has complicated the comparability and interpretation of study results. However, the original TOKYO criteria were not readily applicable to recent modalities of endoscopic biliary drainage such as biliary drainage based on endoscopic ultrasound or device-assisted endoscopy. There are increasing opportunities for managing hilar biliary obstruction and benign biliary strictures through endoscopic drainage. Biliary ablation has been introduced to manage benign and malignant biliary strictures. In addition, the prolonged survival times of cancer patients have increased the importance of evaluating overall outcomes during the period requiring endoscopic biliary drainage rather than solely focusing on the patency of the initial stent. Recognizing these unmet needs, a committee has been established within the Japan Gastroenterological Endoscopy Society to revise the TOKYO criteria for current clinical practice. The revised criteria propose not only common reporting items for endoscopic biliary drainage overall, but also items specific to various conditions and interventions. The term "stent-demanding time" has been defined to encompass the entire duration of endoscopic biliary drainage, during which the overall stent-related outcomes are evaluated. The revised TOKYO criteria 2024 are expected to facilitate the design and reporting of clinical studies, providing a goal-oriented approach to the evaluation of endoscopic biliary drainage., (© 2024 The Author(s). Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

Introduction: Disconnected pancreatic duct syndrome (DPDS) is a pathological condition that causes various symptoms due to the continuous secretion of pancreatic enzymes from the pancreas upstream, which has been separated due to disconnection of the pancreatic duct (DPD) for various reasons.Acute necrotizing pancreatitis includes a certain probability of DPDS appearance, which makes it necessary to provide various treatments for DPDS. Furthermore, DPDS can impact long-term results, such as recurrence and impaired pancreatic function. Although the development of various modalities has contributed to diagnosis and treatment, especially less invasive endoscopic therapy, DPDS is often overlooked, and the diagnosis can be delayed due to the lack of consensus on its definition and classification. This review summarizes the current knowledge and challenges of DPDS and discusses the optimal strategy for its diagnosis and treatment, as well as future perspectives., Areas Covered: Given the lack of established definition, diagnosis, and treatment of DPDS, we conducted a thorough review of the existing literature., Expert Opinion: It is emphasized that a standardized definition and classification of DPDS is essential for designing and conducting clinical studies to address current unmet needs in managing patients with DPDS.

The photosynthetic pigment "chlorophyll" possesses attractive photophysical properties, including efficient sunlight absorption, photoexcited energy transfer, and charge separation, which are advantageous for applications for photo- and electro-functional materials such as artificial photosynthesis and solar cells. However, these functions cannot be realized by individual chlorophyll molecules alone; rather, they are achieved by the formation of sophisticated supramolecules through the self-assembly of the pigments. Here, we present strategies for constructing and developing artificial light-harvesting systems by mimicking photosynthetic antenna complexes through the highly ordered supramolecular self-assembly of synthetic dyes, particularly chlorophyll derivatives.

Competing Interests: None

Competing Interests: None

Competing Interests: None

I have long harbored the impression that professors of clinical medicine specialties tend to produce fewer first-authored papers after their professorship appointments, despite their prior output of first-authored papers. This humble experiment attempted in providing some suggestions for this issue. I identified 11 chief professors of the obstetrics and gynecology departments of Japanese medical universities who were appointed professorships during 201X - 201X + 3 (covering 4 years). The numbers of PubMed-indexed first-authored papers were retrieved: 7-4 years prior (Period 1), 3-0 years prior (Period 2), and 1-4 years after (Period 3) their professorship appointments. 1) The "total" number of papers in Periods 1, 2, and 3 was 38, 33, and 4, respectively. 2) The "median" number of papers written by an individual professor in Periods 1, 2, and 3 was 3, 2, and 0, respectively. 3) "Annual average" paper numbers per person before (Periods 1 + 2) versus after (Period 3) was 0.81 ((38 + 33)/(11 persons × 8 years)) and 0.09 (4/(11 × 4))/person/year, respectively. I did the same for "corresponding-authored papers or last-authored papers." The results were as follows: 1) the "total" was 50, 74, and 143, respectively; 2) the "median" was 4, 5, and 7, respectively; and 3) the "annual average" was 1.41 versus 3.25/person/year. Thus, immediately after professorship appointments, the number of first-authored papers markedly decreased, although that of corresponding- or last-authored papers increased. The reason for this phenomenon may be multifactorial. However, societies should create an atmosphere where professors are relieved from excessive burdens and should be encouraged to engage in first-author paper writing as before if they desire. Societies want to hear professors' own voices which enrich academic discourse. Although the present experiment targeted only Japanese obstetrics and gynecology professors for a limited time, I hope to provoke some discussion regarding paper writing and professorship., Competing Interests: None, (Copyright © Japan Medical Association.)

"Letters to the Editor" that address original articles significantly contribute to medical literature. Utilizing letters published in obstetrics and gynecology journals as a study model, I aimed to classify letters according to their context, providing a valuable framework for readers to comprehend the significance of letters and for authors to effectively write them. Using a sample of 40 recent letters from the Journal of Obstetrics and Gynaecology Research (JOGR), I classified letters into three main categories based on their attitude to addressed articles: Disagreement, Agreement, and Complementary. I further subclassified each category into subcategories, including "Interpretation claim," "Data addition," and "Historical viewpoint." The same procedure was carried out for the 24 most recent letters from BJOG and the American Journal of Obstetrics and Gynecology and also for the JMA Journal. Disagreement letters were prevalent in all three OBGYN journals, accounting for 1/2 to 2/3 of all letters. The rest letters were categorized either as "Agreement" or "Complimentary." Subcategorizations demonstrated different ratios of letters of the three categories among journals. I believe that the attempt to categorize and subcategorize letters offers valuable insights into the letters, potentially enhancing clarity in medical literature communication., Competing Interests: None, (Copyright © Japan Medical Association.)

Aim: Endometriosis is a complex, multifactorial disease. Recent advances in molecular biology underscore that somatic mutations within the epithelial component of the normal endometrium, alongside aberrant epigenetic alterations within endometrial stromal cells, may serve as stimulators for the proliferation of endometriotic tissue within the peritoneal cavity. Nevertheless, pivotal inquiries persist: the deterministic factors driving endometriosis development in certain women while sparing others, notwithstanding comparable experiences of retrograde menstruation. Within this review, we endeavor to synopsize the current understanding of diverse pathophysiologic mechanisms underlying the initiation and progression of endometriosis and delineate avenues for future research., Methods: A literature search without time restriction was conducted utilizing PubMed and Google Scholar., Results: Given that aberrant clonal expansion stemming from cancer-associated mutations is common in normal endometrial tissue, only endometrial cells harboring mutations imparting proliferative advantages may be selected for survival outside the uterus. Endometriotic cells capable of engendering metabolic plasticity and modulating mitochondrial dynamics, thereby orchestrating responses to hypoxia, oxidative stress, inflammation, hormonal stimuli, and immune surveillance, and adeptly acclimating to their harsh surroundings, stand a chance at viability., Conclusion: The genesis of endometriosis appears to reflect the evolutionary principles of mutation, selection, clonal expansion, and adaptation to the environment., (© 2024 Japan Society of Obstetrics and Gynecology.)

Aim: Artificial intelligence, especially ChatGPT, has been used in various aspects of medicine; however, whether ChatGPT can be used in case report writing is unknown. This study aimed to provoke discussion and provide a platform for it., Methods: I wrote a theoretical case report where cyst aspiration cured a twisted ovarian cyst (Manuscript 4). I tasked ChatGPT with generating case reports by inputting information at three different levels: (1) key message and case profile, (2) addition of key introduction information (including known facts and problems to be solved), and (3) further addition of main discussion points. These inputs resulted in the creation of Manuscripts 1-3, which were subjected to analysis. Manuscript 3, generated by ChatGPT with the deepest information input, was compared with Manuscript 4, the human-authored counterpart., Results: With the least information, Manuscript 1 can stand on its own, but its content is superficial. The more detailed data input, the more readable and reasonable the manuscripts become. A human-written manuscript involves personal experience and viewpoints other than obstetrics-gynecology., Conclusions: Better input produced more reasonable and readable case reports. Human-written paper, compared with ChatGPT-generated one, can involve "human touch." Whether such human touch enriches the case report awaits further discussion. Whether ChatGPT can be used in case report writing, and if it can, to what extent, should be worthy of further study. I encourage every doctor to form their own stance towards ChatGPT use in medical writing., (© 2024 Japan Society of Obstetrics and Gynecology.)

In recent years, new concepts have emerged regarding the nomenclature, functions, and relationships of different peptide families of the gonadotropin-releasing hormone (GnRH) superfamily. One of the main driving forces for this originated from the emerging evidence that neuropeptides previously called molluscan GnRH are multifunctional and should be classified as corazonin (CRZ). However, research articles still appear that use incorrect nomenclature and attribute the same function to molluscan CRZs as vertebrate GnRHs. The aim of the present study was to further support the recent interpretation of the origin and function of the GnRH superfamily. Towards this goal, we report the characterization of CRZ signaling system in the molluscan model species, the great pond snail (Lymnaea stagnalis). We detected a CRZ-receptor-like sequence (Lym-CRZR) by homology-searching in the Lymnaea transcriptomes and the deduced amino acid sequence showed high sequence similarity to GnRH receptors and CRZ receptors. Molecular phylogenetic tree analysis demonstrated that Lym-CRZR is included in the cluster of molluscan CRZRs. Lym-CRZR transiently transfected into HEK293 cells was found to be localized at the plasma membrane, confirming that it functions as a membrane receptor, like other G protein-coupled receptors. The signaling assays revealed that the previously identified Lym-CRZ neuropeptide stimulated intracellular Ca 2+ mobilization in a dose-dependent manner, but not cyclic AMP production, in HEK293 cells transfected with Lym-CRZR. Finally, we demonstrated a wide tissue distribution of Lym-CRZR. These results suggest that Lym-CRZ is a multifunctional peptide and provide further insights into the evolution of the GnRH neuropeptide superfamily. The present study also supports the notion that previously termed molluscan "GnRH" should be classified as "CRZ"., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the effect of emergency medicine training credentials and years of medical experience on various clinical parameters in emergency medicine practice., Methods: A cross-sectional study was conducted at Juntendo University Nerima Hospital between 1 April 2019 and 31 March 2020. All patients who were transported by ambulance, were examined by emergency physicians, and underwent computed tomography (CT) or magnetic resonance imaging (MRI) in the emergency department were included. For these cases, data on the attending physician's qualification status and experience (specialist, nonspecialist with 1-2 years of experience, or nonspecialist with 3-4 years of experience), clinical parameters, and imaging were collected. The primary outcome was the patient's total length of stay (LOS) in the emergency department., Results: A total of 3,784 patients were included in the study. Patients attended by nonspecialists with 1-2 years of experience had a significantly longer time from arrival to assessment and LOS, especially in mild and severe cases and cases requiring head and abdominal CT imaging., Conclusion: Our findings suggest that for physicians with minimal work experience, mentorship and effective training using triage flow and medical examination protocols may help to reduce LOS in the emergency department., Competing Interests: We declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 The Juntendo Medical Society.)

A heterozygous CGG repeat expansion in 5' untranslated region (5' UTR) of GIPC1 is one of the causative factors of oculopharyngodistal myopathy (OPDM), an adult-onset hereditary muscle disease characterized by progressive ptosis, ophthalmoplegia, and facial, bulbar, and distal limb muscle weakness. CGG repeat expansion in GIPC1 has also been reported to be associated with Parkinson's disease, but these patients did not exhibit myopathic symptoms. We experienced two unrelated cases of oculopharyngeal type myopathy with CGG repeat expansion in GIPC1 presenting parkinsonism after exhibiting myopathic symptoms. Both cases showed p62-positive intranuclear inclusions in the skin, similar to those in NOTCH2NLC-related disorders. Our cases suggest that GIPC1-related repeat expansions may be associated with a broad spectrum and tissue-differential neuromuscular manifestations, indicating a common mechanism between OPDM2 and other CGG-repeat expansion diseases. It is important to note OPDM2 patients' central neurological symptoms, as myopathic symptoms may obscure central nervous system manifestations., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objectives: The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment., Methods: Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010-2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010-2020., Results: In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (P trend  < 0.001). Compared to patients with CCI = 0, patients with CCI of 1-2, 3-5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22-2.54), 5.39 (1.74-16.7), and 8.77 (2.36-32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90-1.64), 1.52 (0.92-2.49), and 4.84 (2.63-8.88), respectively (P trend  < 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (P trend  < 0.001), but not in the clinical cohort (P trend  = 0.18). CCI was not associated with the risk of procedure-related adverse events., Conclusions: Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk., Trial Registration: The research based on the clinical data from the WONDERFULcohort was registered with UMIN-CTR (registration number UMIN000044130)., (© 2024 The Author(s). Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

An 81-year-old man was admitted to our hospital with left hemiplegia after treatment for herpes zoster of the first branch of the right trigeminal nerve. CSF examination revealed an elevated varicella-zoster virus (VZV) antibody index. Brain MRI showed cerebral infarction in the right middle cerebral artery (MCA) territory and vessel wall thickening and enhancing effects at the ipsilateral MCA. Despite the standard treatment, the MCA stenosis progressed with recurrent infarcts. Percutaneous cerebral angioplasty was performed to the distal portion of the right MCA without deterioration. This case can provide a treatment option for refractory progressive VZV vasculopathy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Matsubara et al.)

We herein report a case of VPS13D-related disorder with a novel homogeneous variant. A 58-year-old Japanese woman was referred to our hospital with slowly progressive gait disturbance and cognitive impairment. A neurological examination revealed decreased spontaneity, recent memory impairment, parkinsonism, cerebellar ataxia, pyramidal signs, and autonomic dysfunction. Dopamine transporter single-photon-emission computed tomography showed a markedly reduced uptake in the striatum bilaterally. Whole-exome sequencing revealed a novel homozygous missense variant of the VPS13D gene (Arg3267Pro). Our case suggests that mutations in VPS13D may cause parkinsonism, in addition to the previously reported cerebellar ataxia and spastic paraplegia.

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., (© 2024. The Author(s).)

Correspondence and Opinion provide a 'human voice,' serving as the captivating elements that grab readers' attention and stimulate contemplation. The extent of ChatGPT's involvement in writing raises controversy. We tested ChatGPT's capability to generate readable Correspondence or Opinion, producing an English Opinion from a Japanese abstract. We also tasked ChatGPT with creating Correspondence and Reply for an English→German translated Opinion. Opinion, Correspondence, and Reply output here were found to be readable and reasonable. While preliminary, these results suggest that ChatGPT can generate such articles, prompting serious concern about AI taking over the 'human voice.' Some regulatory measures may be needed., (© 2024 Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Competing Interests: Y. Nakai has received research grants and honoraria from Boston Scientific Japan – this paper was not funded by this company. T. Saito, S. Matsubara, A. Maruta, and I. Yasuda declare that they have no conflicts of interest.