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Background: We present the case of a rare occurrence of an anterior mediastinal mature teratoma extending into the neck, commonly referred to as a cervicothoracic mature teratoma., Case Presentation: A 19-year-old female presented with right-sided neck pain and swelling, which were found to be attributed to a 14 cm cystic lesion originating from the right thyroid lobe and extending into the mediastinum. A diagnosis of mediastinal teratoma with extension to the neck was made. Robot-assisted thymectomy was initiated but was complicated by dense tumor adherence to the superior vena cava and brachiocephalic veins, prompting a switch to a midline sternotomy. Simultaneous resection of the right thyroid lobe was performed due to inflammation. The transition to a midline sternotomy allowed successful excision of the tumor, which was confirmed to be a mature teratoma confined to the thoracic region. The patient's favorable postoperative course led to discharge on day 5 with no recurrence at nine months., Conclusions: Emphasizing the challenges and the importance of prompt intervention in the management of mediastinal teratomas with neck extension., (© 2024. The Author(s).)

Background: Most recurrences of non-small cell lung cancer (NSCLC) after lung resection occur within 5 years, which is why 5-year overall survival rates are used to give prognoses for lung cancer. Elderly individuals also often show comorbidities and may die from other diseases. Few studies have examined the long-term prognosis of elderly patients with NSCLC, and no reports have investigated drop-out from follow-up after resection of NSCLC, including in elderly patients. This retrospective cohort study analyzed and surveyed long-term prognosis and drop-out from follow-up, including in elderly patients, after resection of lung cancer., Methods: We identified 349 consecutive patients after lung resection between January 2009 and March 2011. Twenty-two cases were excluded because of small cell lung cancer, past metachronous multiple lung cancers, recurrences of lung cancer, surgical biopsy, and other reasons. We investigated recurrences and causes of death in all patients and defined cases for which follow-up could not be conducted even by telephone or documentation from patients or the public office as cases of drop-out from follow-up., Results: Of the 327 cases analyzed, 81 cases dropped out from follow-up and 246 cases completed >10 years of follow-up. Multivariable analysis demonstrated age ≥75 years [odds ratio 1.83; 95% confidence interval (CI): 1.01-3.32] and female sex (odds ratio 1.87, 95% CI: 1.06-3.3) as independent risk factors for drop-out from follow-up. Recurrence was detected >5 years after surgery in 5 cases (2.0%, 5/246 cases). Five- and 10-year overall survival rates were 67.2% and 52.9% for patients <75 years of age, and 42.1% and 21.1% for patients of age ≥75 years (P<0.001). Overall survival was significantly better for those of age <75 years than for those of age ≥75 years. Disease-specific survival did not differ significantly between groups (5-year disease-specific survival rate: 71.9% vs. 73.4%; 10-year disease-specific survival: 66.0% vs. 61.2%, P=0.80). Using Cox proportional hazard regression, age ≥75 years (hazard ratio 2.221; 95% CI: 1.507-3.274; P<0.001) and stage ≥2 (hazard ratio 2.628; 95% CI: 1.868-3.698; P<0.001) were significantly associated with overall survival., Conclusions: In patients with NSCLC after lung resection, age ≥75 years and female sex were risk factors for dropping out from follow-up over 10 years. In addition, patients ≥75 years of age have a high possibility of dying from other diseases and sufficient consideration of and informed consent for surgical indications are necessary., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-909/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Lower back and lower limb pain can hamper the rehabilitation of cerebral stroke patients. We report that peripheral nerve blocks enabled two patients to continue rehabilitation. Case 1 was an 83-year-old female with left hemiparesis due to cerebral infarction of the right basal ganglia. Rehabilitation started on the day after the stroke onset. On the 7 th post-stroke day, she reported right buttock and dorsal thigh pain. Lumbar MRI demonstrated no lumbar spinal canal stenosis and no nerve impingement. The middle cluneal nerve block alleviated her buttock pain. On the 29 th post-stroke day, she suffered severe pain on the medial side of the right knee. Blocking the infrapatellar branch of the saphenous nerve lessened that pain, she was able to walk without assistance, and rehabilitation was resumed. Case 2 was an 87-year-old female with sudden-onset left hemiparesis due to cardiogenic cerebral infarction. Intravenous thrombolysis and mechanical thrombectomy were performed. She presented with left hemiparesis due to infarcts at the right basal ganglia and the right temporal and parietal lobes. Her chronic low back pain worsened after admission and walking was difficult. Bilateral superior and middle cluneal nerve blocks improved her right lower back pain. Left low back pain was alleviated by sacroiliac joint blockage and rehabilitation was possible due to the absence of back pain. The strain on the lower back and lower limbs attributable to paresis due to stroke may lead to entrapment neuropathy. Peripheral nerve blockage is relatively simple and safe and may be useful in acute stroke patients whose rehabilitation is difficult due to pain., 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, Dan et al.)

Endotoxins, or lipopolysaccharides (LPS), are potent immunostimulatory molecules of critical concern in bacterial recombinant protein expression systems. The gram-negative bacterium Acinetobacter baumannii exhibits an interesting and unique phenotype characterized by the complete loss of LPS. In this study, we developed a novel system for producing recombinant proteins completely devoid of endotoxin contamination using LPS-deficient A. baumannii . We purified endotoxin-free functional green fluorescent protein, which reduced endotoxin contamination by approximately three orders of magnitude, and also purified the functional cytokine tumor necrosis factor (TNF)-α. Additionally, utilization of the Omp38 signal peptide of A. baumannii enabled the extracellular production of variable domain of heavy chain of heavy chain (VHH) antibodies. With these advantages, mNb6-tri-20aa, a multivalent VHH that specifically binds to the spike protein of severe acute respiratory syndrome coronavirus 2, was purified from the culture supernatant, and endotoxin contamination was reduced by a factor of approximately 2 × 10 5 compared with that in conventional expression systems. A virus neutralization assay demonstrated the functionality of the purified antibody in suppressing viral infections. Moreover, we applied our system to produce ozoralizumab, a multispecific VHH that binds to human TNF-α and albumin and are marketed as a rheumatoid arthritis drug. We successfully purified a functional antibody from endotoxin contamination. This system establishes a new, completely endotoxin-free platform for the expression of recombinant proteins, which distinguishes it from other bacterial expression systems, and holds promise for future applications., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

We propose surface-enhanced optical-mid-infrared photothermal (MIP) microscopy using highly crystalline silver nanowires, acting as a Fabry-Perot resonator, and demonstrate its applicability to enhanced mid-infrared surface sensing of thin polymer layers as thin as 20 nm.

Foods possess a range of unexplored functionalities; however, fully identifying these functions through empirical means presents significant challenges. In this study, we have proposed an in silico approach to comprehensively predict the functionalities of foods, encompassing even processed foods. This prediction is accomplished through the utilization of machine learning on biomedical big data. Our focus revolves around disease-related protein pathways, wherein we statistically evaluate how the constituent compounds collaboratively regulate these pathways. The proposed method has been employed across 876 foods and 83 diseases, leading to an extensive revelation of both food functionalities and their underlying operational mechanisms. Additionally, this approach identifies food combinations that potentially affect molecular pathways based on interrelationships between food functions within disease-related pathways. Our proposed method holds potential for advancing preventive healthcare.

Introduction: Morphological differences in the trunk muscles between adolescent athletes with lumbar spondylolysis (LS) and nonspecific low back pain (NSLBP) have not been fully elucidated. This study aimed to investigate the differences in physiological cross-sectional areas (CSA) of the trunk muscles between athletes with acute LS and those with acute NSLBP., Methods: Magnetic resonance images of 48 patients aged 13-14 years diagnosed with acute LS or NSLBP were retrospectively evaluated. The CSA of the paraspinal, psoas major, and rectus abdominis muscles at the L4-5 intervertebral disc level were measured., Results: CSA of the left and right paraspinal muscles in the acute LS group were significantly larger than those in the acute NSLBP group (left: mean difference, 276.0 mm 2 ; 95% confidence interval [CI], 68.5-483.6 mm 2 ; P = 0.01; right: mean difference, 228.8 mm 2 ; 95% CI, 7.6-450.1 mm 2 ; P = 0.04). The ratio between the left paraspinal muscles and left psoas major in the acute LS group was significantly larger than that in the acute NSLBP group (mean difference, 0.2; 95% CI, 0.0-0.4; P = 0.03)., Conclusions: Trunk muscle size may differ between adolescent athletes with acute LS and those with NSLBP. Future research involving healthy controls is required to better understand the morphological characteristics of these injuries., Competing Interests: Declaration of competing interest We Dr. Masashi Aoyagi, Mr. Kei Naito, Dr. Koji Morimoto, and Dr. Atsushi Kobayashi declare no conflict of interest related to this project., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Although a fifth metatarsal stress fracture is the most frequent stress fracture in soccer players, awareness of fifth metatarsal stress fractures among soccer coaches is unclear. Therefore, we performed an online survey of soccer coaches affiliated with the Japan Football Association to assess their awareness of fifth metatarsal stress fractures. A total of 150 soccer coaches were invited for an original online survey. Data on participants' age, sex, types of coaching licence, coaching category, types of training surface, awareness of fifth metatarsal stress fractures, and measures employed to prevent fifth metatarsal stress fractures were collected using the survey. Data from 117 coaches were analysed. Eighty-seven of the 117 coaches were aware of fifth metatarsal stress fractures; however, only 30% reported awareness of preventive and treatment measures for fifth metatarsal stress fractures. Licensed coaches (i.e., licensed higher than level C) were also more likely to be aware of fifth metatarsal stress fractures than unlicensed coaches were. Furthermore, although playing on artificial turf is an established risk factor for numerous sports injuries, soccer coaches who usually trained on artificial turf were more likely to be unaware of the risks associated with fifth metatarsal stress fractures than coaches who trained on other surfaces were (e.g., clay fields). Soccer coaches in the study population were generally aware of fifth metatarsal stress fractures; however, most were unaware of specific treatment or preventive training strategies for fifth metatarsal stress fractures. Additionally, coaches who practised on artificial turf were not well educated on fifth metatarsal stress fractures. Our findings suggest the need for increased awareness of fifth metatarsal stress fractures and improved education of soccer coaches regarding injury prevention strategies.　., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Miyamori et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in female athletes with low back pain (LBP) and a history of LBP., Design: Randomized crossover trial., Setting: Academic institution., Participants: Twenty female university athletes with LBP or a history of LBP were included., Interventions: All participants received CRMF, hotpack, and sham (CRMF without power) in a random order on the right side of the lumbar region. More than 2 days were allocated between the experiments to eliminate any residual effects., Main Outcome Measures: The shear elastic moduli of the right multifidus and erector spinae were evaluated in the prone (rest) position while sitting with 35° trunk flexion (stretched) using shear wave ultrasound imaging equipment. The moduli were measured before, immediately after, and 30 minutes after the intervention., Results: Repeated-measures 2-way analysis of variance and post hoc analysis showed that the moduli of the CRMF group were significantly lower than those of the sham group in the stretched position immediately after intervention (P = .045). This difference diminished 30 minutes after the intervention (P = .920)., Conclusions: CRMF can be used to reduce the shear elastic modulus of the multifidus muscle in the short term. Further studies are warranted to determine how to provide longer effects., Trial Registration: None., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

In the last two decades, remarkable progress has been done in singular learning machine theories on the basis of algebraic geometry. These theories reveal that we need to find resolution maps of singularities for analyzing asymptotic behavior of state probability functions when the number of data increases. In particular, it is essential to construct normal crossing divisors of average log loss functions. However, there are few examples for obtaining these for singular models. In this paper, we determine the resolution map and normal crossing divisors for multiple-layered neural networks with linear units. Moreover, we have the exact values for the learning efficiency, which is so called learning coefficients. Multiple-layered neural networks with linear units are simple, however, very important models because these models give the essential information from data of input-output pairs. Moreover, these models are very close to multiple-layered neural networks with rectified linear units (ReLU). We show the learning coefficients of multiple-layered neural networks with linear units are bounded even though the number of layers goes to infinity, which means that the main term of asymptotic expansion of the free energy and generalization error of singular models are much smaller than the dimension of its parameter space., 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 Elsevier Ltd. All rights reserved.)

Background: Eosinophilic gastroenteritis (EGE) is a rare eosinophilic infiltrative disorder. In Japan, EGE is diagnosed using clinical symptoms as well as microscopic, haematologic and histopathological findings. In this study, we examined the usefulness of laboratory data in the diagnosis of EGE., Methods: Patients who were diagnosed with EGE at Fujita Health University Bantane Hospital between April 2015 and December 2020 were enrolled in this study and their data was retrospectively analysed. We evaluated their medical history, laboratory data including leukocyte count, eosinophil count, immunoglobulin (Ig) E, thymus and activation-regulated chemokine (TARC), C-reactive protein (CRP), etc. and histopathological data were collected from the electronic medical records., Results: One hundred twelve of 168 patients who were treated for EGE could be analysed. The peripheral eosinophil count was correlated with the duodenal or ascending colon eosinophil count; moreover, the blood lymphocyte count and the TARC were correlated with the transverse colon eosinophil count. Multivariate regression analysis showed correlations only in the oesophagus, stomach and duodenum. Specifically, correlations were noted between blood eosinophils and gastric eosinophils, blood eosinophils and duodenal eosinophils, blood lymphocytes and gastric eosinophils, blood IgE and oesophageal, gastric and duodenal eosinophils and CRP and oesophageal eosinophils., Conclusion: The extent of blood eosinophil count, lymphocyte count, IgE and CRP elevation together with clinical features and pathology can be incorporated into a diagnostic scoring criteria system to improve the accuracy of diagnosing this uncommon condition in the future., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)