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Intestinal perfusion at the anastomotic site is thought to be one of the most influential risk factors for postoperative anastomotic leakage (AL). We evaluated the efficacy of indocyanine green (ICG) fluorescence imaging at the stump of the proximal colon in left-sided colectomy or rectal resection in terms of decreasing the incidence of AL. Prospectively collected data were retrospectively evaluated. Patients who underwent left-sided colectomy or rectal resection were enrolled (ICG group; n = 197), and patients who had undergone a similar procedure before the ICG group were enrolled from the charts as historical controls (HC group; n = 187). After ICG evaluation, anastomosis was performed where fluorescence was sufficient. The incidence of AL was compared between the ICG and HC groups. Propensity score (PS)-matched data were analyzed to clarify the risk of AL. AL occurred in 6 patients (3.3%) in the ICG group and 17 (10.7%) in the HC group. ICG evaluation revealed 179 patients with good fluorescence and 18 with poor/none perfusion (9.1%). The transection line was changed in all patients with poor/none fluorescence. Three of these 18 patients developed AL (16.7%), though transection line was changed at which is thought to be good. We hope AL in poor/none fluorescence can be prevented at the same rate of cases with good fluorescence. Actually, the rate of that was significantly higher compared with good fluorescence patients (P = 0.038). 93 patients in each group were compared by PS-matched data analysis, which showed the AL rate in the ICG group was significantly lower than that in the HC group (3.2% vs 10.8%, respectively; P = 0.046). Even though this study has limitations of comparison of data prospectively collected and retrospectively analyzed, intraoperative ICG fluorescence imaging evaluation could significantly decrease the incidence of AL.

Stoma creation through the extraperitoneal route reportedly reduces the risk of parastomal hernia and stomal prolapse after abdominoperineal resection (APR) for rectal cancer. We describe a new technique for laparoscopic extraperitoneal sigmoid colostomy following APR. After the rectus abdominis muscle is separated, Lap ProtectorTM and EZ AccessTM devices are placed. An extraperitoneal stoma tunnel is created laparoscopically as much as possible. Next, the peritoneum is separated from the inside of the abdominal cavity, and the extraperitoneal tunnel is opened. At the time of writing, we had performed laparoscopic extraperitoneal sigmoid colostomy in eight patients, without any complications or conversion to the conventional procedure. Thus, laparoscopic extraperitoneal sigmoid colostomy is a useful and safe technique for the laparoscopic creation of an extraperitoneal stoma tunnel after APR.

Introduction Robot-assisted laparoscopic surgery has been performed in various fields, especially in the pelvic cavity. However, little is known about the utility of robot-assisted laparoscopic rectal cancer surgery associated with robot-assisted radical prostatectomy (RARP). We herein report the clinical impact of robot-assisted laparoscopic rectal cancer surgery associated with RARP. Methods We experienced five cases of robot-assisted laparoscopic rectal cancer surgery associated with RARP. One involved robot-assisted laparoscopic abdominoperineal resection with en bloc prostatectomy for T4b rectal cancer, and one involved robot-assisted laparoscopic intersphincteric resection combined with RARP for synchronous rectal and prostate cancer. The remaining three involved robot-assisted laparoscopic low anterior resection (RaLAR) after RARP. For robot-assisted laparoscopic rectal cancer surgery, the da Vinci Xi surgical system was used. Results We could perform planned robotic rectal cancer surgery in all cases. The median operation time was 529 min (373-793 min), and the median blood loss was 307 ml (32-1191 ml). No patients required any transfusion in the intra-operative or immediate peri-operative period. The circumferential resection margin was negative in all cases. There were no complications of grade ≥III according to the Clavien-Dindo classification and no conversions to conventional laparoscopic or open surgery. Conclusion Robot-assisted laparoscopic surgery associated with RARP is feasible in patients with rectal cancer. The long-term surgical outcomes remain to be further evaluated.

Introduction In March 2019, cefazolin availability was limited owing to the contamination of the drug substance. In addition, there was a difficulty in supplying drugs alternative to cefazolin, such as cefotiam and cefmetazole. In our Department of Nephro-urology, we used fosfomycin-based drugs to substitute cefazolin as perioperative preventive antibacterial drugs. In this study, we aimed to evaluate the usage status of perioperative prophylactic antibacterial drugs before and after the period of limited cefazolin supply and to investigate the efficacy and safety of fosfomycin sodium in preventing infections following transurethral resection of bladder tumor. Methods We enrolled 346 patients who underwent transurethral resection of bladder tumor in our department from April 2018 to August 2020. The patients received the following perioperative antibacterial agents: cefotiam (n = 146), fosfomycin (n = 166), and other antibacterial agents (n = 34). There was no significant difference in the median age or surgery time. Results The median length of hospital stay was 6, 5, and 5 days in the cefotiam, fosfomycin, and other antibacterial groups, respectively, with significant difference. The median maximum postoperative temperature was 37.1 °C in all groups, with no significant difference. There were no differences in C-reactive protein, aspartate aminotransferase, and alanine aminotransferase levels determined by postoperative blood tests; preoperative and postoperative urinary white blood cell counts; preoperative urine bacterial counts; and surgery-related infection requiring additional antibiotic treatments among the groups. Conclusions The use of fosfomycin-based agents helped overcome the limited supply of cefazolin without worsening clinical outcomes.

To determine whether or not migrating cancer cells are present on the surgical plane after lateral lymph node dissection (LLND) for lower rectal cancer and related to lateral recurrence (LR), we evaluated the lavage of LLND areas by reverse-transcription polymerase chain reaction (RT-PCR) to check the expression of CEA mRNA in the residual cancer cells. Thirty patients who underwent curative LLND were enrolled. Lavage was collected after LLND and subjected to RT-PCR to detect CEA mRNA. The median follow-up to check for recurrence was 31.4 months. CEA mRNA was detected in 9 of the 46 dissected areas. Based on the receiver operating characteristic curves, the cut-off value of PCR was set at 0.025. This cut-off point classified five patients into the high-expression group for CEA mRNA. During follow-up, LR developed in 1 of 40 low-expression areas of CEA mRNA and 3 of 6 high-expression areas. The LR rate was higher in the high-expression group than in the low-expression group (p = 0.015). A multivariate analysis showed that the high expression of CEA mRNA was likely an independent prognostic factor of LR. The expression of CEA mRNA in the lavage of LLND areas indicates the presence of residual cancer cells that cause LR.

A 34-year-old female patient who had undergone surgical treatment for a cleft in the soft palate during childhood received orthodontic treatment for crowding. She had a straight type facial profile and facial asymmetry with a concave area on the left side of the philtrum and mandibular deviation to the left. The surgical scar was observed on the center of the palate. She also had a severely constricted maxillary arch and unilateral cross bite on the left side. In this report, we suggest a novel method for uneven maxillary lateral expansion using a dento-osseous-supported expansion appliance in the frontal side of the maxilla and a modified dental-supported expansion appliance in the mid-palatal area. With this method, we achieved the optimal maxillary expansion in the maxillary frontal and molar areas. As a result of the surgically-assisted orthodontic treatment, facial asymmetry, the facial midline, and severe malocclusion were corrected. Furthermore, the resulting occlusion and facial symmetry were maintained over a 2-year retention period. Although attention must be paid regarding the retention of the expanded maxillary bone, our findings in the present study suggest that differential maxillary lateral expand distraction osteogenesis, which is performed using combined expansion appliances, can be successfully performed in patients with cleft palate.

Endoscopic transpapillary brush cytology and forceps biopsy during endoscopic retrograde cholangiopancreatology are generally used to obtain pathological evidence of biliary strictures. Recently, the new endoscopic scraper Trefle® has been reported and demonstrated high cancer detectability in malignant biliary strictures. This device is used to scrape the stricture over the guidewire, and, in the original method, the tissue and/or cell samples obtained are subjected to histological and/or cytological analysis separately. However, discrimination of chunks of tissue is hampered by the opacity of the surrounding fluid. We have developed a cell block technique for the Trefle® device without dividing obtained specimens into tissue and cellular components, which is the simplest method and enables immunohistochemical analysis. We present a case of obstructive jaundice diagnosed immunohistochemically as pancreatic metastasis from colon cancer using cell block sections obtained with the Trefle® device, which procedure is as easy as conventional brush cytology.

The aim of this study was to examine the depth of radiofrequency ablation on the rectum. Many elderly people have a rectal mucosal prolapse. The procedure combining radiofrequency ablation and plication of the rectal mucosa was reported as an effective means of treatment. However, no pathologic review of the technique has been reported thus far. This study was conducted from January 2012 to August 2013 at the authors' institution. Thirty rectal specimens obtained from 15 patients who underwent stapled transanal rectal resection were coagulated by radiofrequency ablation using TissueLink at power settings of 30 or 50 W and examined histologically. Mucosal epithelia of all specimens was desquamated after radiofrequency ablation. The distance from the mucosal surface to the lamina muscularis mucosae was significantly shorter in ablated specimens than that of normal mucosa and significantly shorter in proportion to coagulation power settings. This study demonstrated that at least mucosal epithelia disappeared histologically after radiofrequency ablation.

We evaluated the perioperative inflammatory mediators in a right hemicolectomy performed with single-incision laparoscopic surgery (SILS) and traditional multi-port laparoscopic surgery (MLS) to compare the postoperative inflammatory response and feasibility of SILS with that of MLS. In this retrospective study, we enrolled 56 consecutive colorectal cancer patients who underwent right hemicolectomy prospectively. Twenty patients underwent SILS, and 36 underwent MLS. The preoperative and postoperative levels of plasma vascular endothelial growth factor (VEGF), serum interleukin-6 (IL-6), and C-reactive protein (CRP) as well as the number of platelet cells were measured in all patients. The operation duration, number of harvested lymph nodes, length of the resected bowel, blood loss, and duration of hospital stay were also compared between the two groups. Neither SILS nor MLS had any conversion cases. The operation duration was longer for MLS than for SILS. Blood loss tended to be lower among patients who underwent SILS than among those who underwent MLS. However, the number of harvested LNs was significantly lower with SILS than with MLS. In both pre- and postoperative blood examinations, there was no marked difference in inflammatory mediators between MLS and SILS. There was no systemic inflammatory advantage associated with SILS compared with MLS.

Craniofacial morphology varies among individuals, which is regulated by the interaction between genes and the environment. Soft-diet feeding is a widely-used experimental model for studying the association between the skeletal morphology and muscle-related loading on the bone. Traditionally, these studies have been based on linear and angular measurements provided on two-dimensional (2D) radiographs in the lateral view. However, 2D observation is based on simplification of the anatomical structures and cannot detect three-dimensional (3D) changes in detail. In this study, we newly developed a modified surface-based analysis with micro-3D computed tomography (CT) to examine and detect the 3D changes in the mandible associated with soft-diet feeding. Mice at 3 weeks of age were fed a powdered soft-diet (SD) or hard-diet (HD) of regular rodent pellets until 9 weeks of age. Micro-CT images were taken at age 9 weeks to reconstruct the anatomical architecture images. A computer-generated averaged mandible was superimposed to directly visualize the morphological phenotypes. Gross observation revealed the apparent changes at the posterior body of the mandible, the angular process and the condyle between HD and SD mice. Significant differences in the mapping indicated the regions of significant displacement in the SD mice over the averaged 3D image of the HD mice. This map revealed that vertical displacement was most evident in 3D changes. We also noted a combination of vertical, transverse and anteroposterior directions of displacement in the condylar growth, resulting in complicated shape changes in the whole condylar process in SD mice. In contrast, transverse displacement was more significant in the coronoid process. The map analysis further showed the significant outward displacement of the inner surface of the alveolar process, which consequently resulted in thinning of the alveolar process.

Routine prophylaxis for venous thromboembolism (VTE) has been recommended after surgery not only in the West but also in Asia recently. The primary objective of this study was to investigate the safety and effectiveness of enoxaparin as a prophylaxis in patients undergoing distal, proximal, or total gastrectomy (TG) for gastric cancers. A total of 565 patients who underwent gastrectomy for gastric cancer were reviewed retrospectively. About 256 patients received postoperative prophylaxis with enoxaparin (2000 international unit twice daily for at least six days) and compression stockings; these patients were assigned to the enoxaparin group. About 257 patients comprised a historical control group, who used only compression stockings as a thromboprophylaxis. All patients underwent the same rehabilitation programs during the perioperative period. None of the patients developed symptomatic venous thromboembolism in either the enoxaparin group or the control group. The complication rate of bleeding was not significantly different between the two groups. Only one patient who used three antiplatelet agents concomitantly with enoxaparin required reoperation for anastomotic site bleeding. The usage of enoxaparin for venous thromboembolism prophylaxis is safe for Japanese patients after gastrectomy. But, cautious application is still needed especially when used concomitantly with other antiplatelet agents.

This case report describes a novel method of combining lingual appliances and lingual arches to control horizontal problems. The patient, who was 25 years of age at her first visit to our hospital with a chief complaint of crooked anterior teeth, was diagnosed with skeletal Class II and Angle Class II malocclusion with anterior deep bite, lateral open bite, premolar crossbite, and severe crowding in both arches. She was treated with premolar extractions and temporary anchorage devices. Conventionally, it is ideal to use labial brackets simultaneously with appliances, such as a lingual arch, a quad-helix, or a rapid expansion appliance, in patients with complex problems requiring horizontal, anteroposterior, and vertical control; however, this patient strongly requested orthodontic treatment with lingual appliances. A limitation of lingual appliances is that they cannot be used with other conventional appliances. In this report, we present the successful orthodontic treatment of a complex problem using modified lingual appliances that enabled combined use of a conventional lingual arch.

Introduction: Cleidocranial dysplasia (CCD) is a rare inherited skeletal dysplasia, often with prolonged retention of deciduous teeth and several impacted permanent successors and supernumerary elements. Methods: This article demonstrates the usefulness of titanium screws for orthodontic anchorage to induce eruption of the impacted teeth in a patient with CCD. A boy, aged 10 years 11 months, had a number of impacted permanent teeth. After the supernumerary teeth were extracted and the incisors were surgically exposed, 2 titanium screws were placed in the palate without incisions or flap surgery. After implantation, a lingual arch appliance was placed, and orthodontic load began 4 weeks after surgery with an elastic chain. Results: After 4 months of traction, 3 impacted incisors had erupted into the mouth. Conclusions: This new method for retraction of impacted teeth can reduce the patient’s treatment time and psychological stress. Treatment with titanium screws for traction of impacted teeth might be a new treatment strategy for managing CCD patients.

We herein describe a novel procedure for dentin regeneration that mimics the biological processes of tooth development in nature. The canonical Wnt signaling pathway is an important regulator of the Dentin sialophosphoprotein (Dspp) expression. Our approach mimics the biological processes underlying tooth development in nature and focuses on the activation of canonical Wnt signaling to trigger the natural process of dentinogenesis. The coronal portion of the dentin and the underlying pulp was removed from the first molars. We applied lithium chloride (LiCl), an activator of canonical Wnt signaling, on the amputated pulp surface to achieve transdifferentiation toward odontoblasts from the surrounding pulpal cells. MicroCT and microscopic analyses demonstrated that the topical application of LiCl induced dentin repair, including the formation of a complete dentin bridge. LiCl-induced dentin is a tubular dentin in which the pulp cells are not embedded within the matrix, as in primary dentin. In contrast, a dentin bridge was not induced in the control group treated with pulp capping with material carriers alone, although osteodentin without tubular formation was induced at a comparatively deeper position from the pulp exposure site. We also evaluated the influence of LiCl on differentiation toward odontoblasts in vitro. In the mDP odontoblast cell line, LiCl activated the mRNA expression of Dspp, Axin2 and Kallikrein 4 (Klk4) and downregulated the Osteopontin (Osp) expression. These results provide a scientific basis for the biomimetic regeneration of dentin using LiCl as a new capping material to activate dentine regeneration.

We propose two technologies, vertical transfer gate (VTG) and buried shielding metal (BSM), that can be applied to 1.20 μm pixel back-illuminated CMOS image sensor (BI-CIS). With the VTG and BSM, the new pixel design exhibited 60% higher saturation signals and 50% lower crosstalk at wide chief ray angle (CRA). Even though both technologies have a three-dimensional structure formed on Si substrate, our process technology enabled them to be applied without increasing white blemish count or dark current degradation.

Granulosa cell tumors (GCTs) of the ovary account for 2 to 5 of ovarian malignancies. We present two patients with malignant ovarian adult GCT. In one patient, a combination of bleomycin, etoposide, and cisplatin was effective after initial surgery for malignant GCT. In the other, an aromatase inhibitor was effective for recurrent malignant GCT. We also review the literature for further management of this tumor. Because GCT of the ovary is rare, it will be necessary to elucidate the clinical phenotype and establish treatment protocols by accumulating and analyzing more patients.

This case report illustrates the use of miniscrews to treat a patient with an open bite caused by mandibular condylar fractures. The patient was 36 years old when she visited our hospital with a chief complaint of difficulty with chewing. She had suffered condylar and maxillary bone fractures in a traffic accident 6 months before her visit. She had an anterior open bite and Angle Class II molar relationships. Her mandibular midline was deviated to the right relative to the maxilla. The cephalometric analysis showed a skeletal Class II relationship. Titanium miniscrews were implanted in the bilateral maxillary buccal areas. The maxillary dentition was retracted and intruded by using elastomeric chains and miniscrews. After this treatment, an Angle Class I molar relationship was achieved, her overjet and overbite became ideal, and a good facial appearance was obtained. The total active orthodontic treatment period was 33 months. Treating an open bite with molar intrusion often leads to counterclockwise rotation of the mandible; however, in this patient, the mandible was moved anteriorly and upward. We believe that this movement was caused by the patient's condylar fractures and the subsequent remodeling. Although there was some relapse, our results suggest that implant anchorage is useful for correcting anterior open bites originating from condylar fractures.

In this article, we report the successful use of miniscrews in a patient with an Angle Class III malocclusion, lateral open bite, midline deviation, and severe crowding. Simultaneously resolving such problems with conventional Class III treatment is difficult. In this case, the treatment procedure was even more challenging because the patient preferred to have lingual brackets on the maxillary teeth. As a result, miniscrews were used to facilitate significant asymmetric tooth movement in the posterior and downward directions; this contributed to the camouflage of the skeletal mandibular protrusion together with complete resolution of the severe crowding and lateral open bite. Analysis of the jaw motion showed that irregularities in chewing movement were also resolved, and a stable occlusion was achieved. Improvements in the facial profile and dental arches remained stable at the 18-month follow-up.

The initial growth mechanism of Bi2VO5.5 thin films on SrTiO3(100) has been studied using atomic force microscopy (AFM), and c-axis oriented ultra-thin films have been prepared by laser ablation. The Bi2VO5.5 films are constructed at various growth temperatures. The films deposited at 500° C grow by the step-flow mode, whereas the films deposited at 400° C grow by homogeneous nucleation. From these results, it is evident that Bi2VO5.5 grows in multiples of 0.8 nm as complete molecular units and that the top-most layer is Bi2O2. The dielectric constant of Bi2VO5.5 thin films formed on Si(100) is about 35, and a C-V plot of a Bi2VO5.5-SiO2 MIS capacitor subjected to dc polarizing voltages shows memory windows of 0.1 V against a ±2 V gate bias.