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BackgroundThis study aimed to evaluate the effects of sarcopenia and inflammation on the prognosis of patients with pancreatic cancer after pancreaticoduodenectomy.MethodsEighty patients who had undergone pancreaticoduodenectomy for pancreatic cancer between July 2010 and December 2023 were included in this study. The psoas muscle index was used to assess sarcopenia. The C-reactive protein-to-albumin ratio, prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were used to calculate the preoperative inflammatory marker levels. The prognostic factors for overall survival were determined using Cox regression analysis.ResultsTwenty-four patients were diagnosed with sarcopenia. Sarcopenia showed a significant association with advanced tumor stage. Univariate analysis revealed a significant reduction in overall survival in patients with a prognostic nutritional index of ConclusionSarcopenia and a high C-reactive protein-to-albumin ratio are independent prognostic factors in patients with pancreatic cancer after pancreaticoduodenectomy. Thus, sarcopenia may have a better prognostic value when combined with the C-reactive protein-to-albumin ratio.

Abstract Aims/Introduction Glucagon, a peptide hormone produced from proglucagon, is involved in the pathophysiology of diabetes. Plasma glucagon levels are currently measured by sandwich enzyme‐linked immunosorbent assay (ELISA), but the currently used sandwich ELISA cross‐reacts with proglucagon‐derived peptides, thereby providing incorrect results in subjects with elevated plasma proglucagon‐derived peptide levels. We aimed to develop a more broadly reliable ELISA for measuring plasma glucagon levels. Materials and Methods A new sandwich ELISA was developed using newly generated monoclonal antibodies against glucagon. After its validation, plasma glucagon levels were measured with the new ELISA and the currently used ELISA in subjects who underwent laparoscopic sleeve gastrectomy (LSG) and in outpatients with suspected glucose intolerance. The ELISA results were compared with those from liquid chromatography‐high resolution mass (LC‐HRMS) analysis, which we previously established as the most accurate measuring system. Results The new ELISA has high specificity (

Abstract Background Drug-drug interaction management is complex. Nirmatrelvir/ritonavir is a potent cytochrome P450 (CYP) 3A inhibitor and influences pharmacokinetics of co-administered drugs. Although there are several reports about drug-drug interactions of nirmatrelvir/ritonavir, an influence of a concomitant use of nirmatrelvir/ritonavir and another potent CYP3A inhibitor on tacrolimus remains unclear. Here, we experienced a lung transplant patient with the novel coronavirus disease 2019 (COVID-19). In this patient, nirmatrelvir/ritonavir was administered, and the inhibitory effect of itraconazole on CYP3A was prolonged. Case presentation We present a case in forties who had undergone lung transplantation. He was administered itraconazole and tacrolimus 1.0 mg/d, with a trough value of 8–12 ng/mL. The patient contracted the COVID-19, and a nirmatrelvir/ritonavir treatment was initiated. During the antiviral treatment, tacrolimus administration was discontinued for 5 d. Tacrolimus was resumed at 1.0 mg/d after completion of the nirmatrelvir/ritonavir treatment, but the trough value after 7 d was high at 31.6 ng/mL. Subsequently, the patient was placed on another 36-h tacrolimus discontinuation, but the trough value decreased to only 16.0 ng/mL. Conclusions Co-administration of ritonavir caused a prolonged decrease in tacrolimus clearance through its inhibitory effects on CYP3A in a patient taking itraconazole. Management of drug-drug interaction by pharmacists can be important for patients with multiple medications.

We analyzed the possibility of TRU generation reduction fuel using HALEU as the initial enrichment to reduce the radiotoxicity and decay heat of TRU when using the LWR fuels that can suppress radiotoxicity and decay heat in HLW. Fade-out time was defined as the period required to decay to the level of natural uranium ore, focusing on the radiotoxicity, and decay heat up to one million years, which is generated from the reduced TRU generation type fuel (FORSETI) consisting of uranium fuel of HALEU enrichment. The decay characteristics of TRU nuclides in HLW after plutonium removal by reprocessing and the effect of shortening the fade-out time were mainly discussed. The level of 241Am on both radiotoxicity and decay heat is significant. However, the effect of 239Pu and 240Pu, which are produced as daughter nuclides of 243Am and 244Cm after reprocessing, significantly lengthens the fade-out time to 100,000 years for radiotoxicity and to 40,000 years for decay heat, compared to several thousand years for 241Am alone. When TRU generation reduction fuel is adopted, the production rate of 243Am and 244Cm is reduced by more than 90% when the enrichment is increased from 3.8 wt% to 20 wt%, and the generation of 239Pu and 240Pu as daughter nuclides are also reduced almost correspondingly. As a result, increasing the initial 235U enrichment from 3.8 wt% to 20 wt% reduces the fade-out time of radiotoxicity from 100,000 to 3,000 years and the fade-out time of decay heat from 40,000 to 2,000 years for HLW, respectively by FORSETI-type TRU generation reduction fuel. As described above, it is shown that using TRU generation reduction fuel can significantly accelerate the decay of TRU radiotoxicity and decay heat in HLW without transmutation of TRU.

In order to reduce Minor Actinides (MA), the transmutation of MA in a fast reactor has been studied in Japan. In the transmutation in the fast reactor, MAs are mixed in the ordinary MOX fuel and they are burned up. For the design of a fast reactor with inherent safety characteristics, it is necessary to secure negative void reactivity and cooling via a natural convection under the situation of the severe accident. Therefore, this study aims to fundamentally design the fast reactor for the MA transmutation with inherent safety characteristics. First, in order to clarify the design range of the core design parameter, the parametric study was conducted using four design parameters determining the core configuration. As the result of this parametric study, the feasible combination of each four parameters satisfying the negative void reactivity was clarified. Among parameters satisfying the negative void reactivity, the condition that results in the maximum reduction of MA amount was obtained. Secondly, the CFD simulation focused on the sodium coolant channel between fuel pins was conducted. In this CFD simulation, as the first step for the design activity, the confirmation of the occurrence condition of a natural convection due to the decay heat after shifting to the transient situation was confirmed. Temperature and velocity distribution were evaluated. And the heat transfer efficiency was summarized using Ra number and Nu number.

Background: Cardiac amyloidosis (CA) progresses rapidly with a poor prognosis. Therefore, methods for early diagnosis that are easily accessible in any hospital, are required. We hypothesized that based on the pathology of CA, morphological left ventricular hypertrophy (LVH) without electrical augmentation, namely paradoxical LVH, could be used to diagnose CA. This study aimed to investigate whether paradoxical LVH has diagnostic significance in identifying CA in patients with LVH. Methods: Patients who presented with left ventricular (LV) wall thickness ≥ 12 mm on cardiac magnetic resonance (CMR) were enrolled from a multicentre CMR registry. Paradoxical LVH was defined as a LV wall thickness ≥ 12 mm on CMR, SV1 + RV5

Abstract This study aimed to investigate whether phosphate contributes to the pathogenesis of chronic kidney disease (CKD) in dolphins. Renal necropsy tissue of an aged captive dolphin was analyzed and in vitro experiments using cultured immortalized dolphin proximal tubular (DolKT-1) cells were performed. An older dolphin in captivity died of myocarditis, but its renal function was within the normal range until shortly before death. In renal necropsy tissue, obvious glomerular and tubulointerstitial changes were not observed except for renal infarction resulting from myocarditis. However, a computed tomography scan showed medullary calcification in reniculi. Micro area X-ray diffractometry and infrared absorption spectrometry showed that the calcified areas were primarily composed of hydroxyapatite. In vitro experiments showed that treatment with both phosphate and calciprotein particles (CPPs) resulted in cell viability loss and lactate dehydrogenase release in DolKT-1 cells. However, treatment with magnesium markedly attenuated this cellular injury induced by phosphate, but not by CPPs. Magnesium dose-dependently decreased CPP formation. These data support the hypothesis that continuous exposure to high phosphate contributes to the progression of CKD in captive-aged dolphins. Our data also suggest that phosphate-induced renal injury is mediated by CPP formation in dolphins, and it is attenuated by magnesium administration.

Clinical congenital anophthalmia causes facial asymmetry and difficulty in wearing ocular prostheses due to underdevelopment of the orbits. Orbital expansion must be started early after birth for treatment, but consensus regarding the treatment for clinical congenital anophthalmia has not been established. We report a successful orbital expansion using a thermoplastic splint. A one-month-old boy had left clinical congenital anophthalmia (ophthalmatrophia), right congenital glaucoma, and right anterior segment ocular dysgenesis. Two months after birth, left orbital expansion was initiated using a custom-made thermoplastic splint. The splint was replaced with larger ones in steps as the infant grew, and the orbit was successfully expanded. There is no appreciable size difference between the left and right orbit after 5 years of follow up. Treatment using a splint for the conjunctival sac is a simple and effective procedure that can be performed on an outpatient basis. Safer and simpler material should be widely used for the treatment.

Abstract Macrophages are a major population of immune cells in solid cancers, especially colorectal cancers. Tumor-associated macrophages (TAMs) are commonly divided into M1-like (tumor suppression) and M2-like (tumor promotion) phenotypes. Vasoactive intestinal peptide (VIP) is an immunoregulatory neuropeptide with a potent anti-inflammatory function. Inhibition of VIP signaling has been shown to increase CD8+ T cell proliferation and function in viral infection and lymphoma. However, the role of VIP in macrophage polarization and function in solid tumors remains unknown. Here, we demonstrated that conditioned medium from CT26 (CT26-CM) cells enhanced M2-related marker and VIP receptor (VPAC) gene expression in RAW264.7 macrophages. VIP hybrid, a VIP antagonist, enhanced M1-related genes but reduced Mrc1 gene expression and increased phagocytic ability in CT26-CM-treated RAW264.7 cells. In immunodeficient SCID mice, VIP antagonist alone or in combination with anti-PD-1 antibody attenuated CT26 tumor growth compared with the control. Analysis of tumor-infiltrating leukocytes found that VIP antagonist increased M1/M2 ratios and macrophage phagocytosis of CT26-GFP cells. Furthermore, Vipr2 gene silencing or VPAC2 activation affected the polarization of CT26-CM-treated RAW264.7 cells. In conclusion, the inhibition of VIP signaling enhanced M1 macrophage polarization and macrophage phagocytic function, resulting in tumor regression in a CT26 colon cancer model.

In clinical practice, unidentified Mycobacterium species are sometimes detected in respiratory specimens. Few Mycobacterium species can be identified by using methods available in clinical practice, although there are [approximately equal [...]

Mud volcanoes are topographic features through which over-pressurized sediments are intruded upward and erupted, transporting fluids and sediments from the deep subsurface to the surface/seafloor. To understand material and biogeochemical cycling through mud volcanoes, we investigated the origins of sediments and fluids erupted by four submarine mud volcanoes off Tanegashima Island, along the northern Ryukyu Trench: MV#1–3 and MV#14. We estimated the ages of the source sequences of the mud volcano sediments to be middle to late Miocene based on nannofossils and 10Be ages. The sediments were characteristically enriched in illite. The similar mineral compositions and vitrinite reflectance values (0.42%–0.45%) of sediments erupted by the mud volcanoes strongly suggest that each is rooted in the same source sequence. Pore waters had Cl− concentrations ∼40% that of seawater and were proportionally enriched in 18O and depleted in D, indicating the addition of freshwater from the dehydration of clay minerals. However, the smectite and illite contents (

Key Clinical Message Invasive mucinous adenocarcinoma often presents with pneumonia‐like findings on imaging, which complicates its diagnosis. This case demonstrates that aggressive bronchoscopy is useful for examining infiltrating shadows in the lung field and large tumors occupying the entire lung lobe should be treated cautiously when lung parenchyma develops.

An internal strengthening system involving the embedding of a post-tensioned prestressing tendon in a wedge-shaped anchorage of an existing concrete member was developed previously. The previous study confirmed the adequate load capacity of the prestressing tendon for the internal strengthening technique. The tendons used in the previous investigation were steel-rigid bar and steel-wire cables. These steel tendons are prone to corrosion under severe environmental conditions, such as bridge deck slabs sprayed with deicers. Carbon fiber composite cables (CFCC) are occasionally employed as tendons in prestressed concrete bridges. This study focused on the non-metallic material and examined the load capacity of CFCC tendon in internal strengthening systems to achieve the feasibility of the technique under corrosive environment. The main concern of the novel strengthening system was the anchoring system of the CFCC in the internal wedge. In general, both ends of the CFCC tendon can be gripped with external fasteners and be provided a tensile force using a hydraulic jack. In an internal prestressing system, a CFCC end must be anchored without any external fastener. It is preferable to simply fix the CFCC in a small wedge anchor made of existing concrete. This study focused on developing a CFCC anchoring method in a wedge-shaped hole and examined the tensile load capacity of the CFCC tendon fixed in the anchorage. The end of the CFCC tendon was reversely twisted to improve the pullout resistance by increasing the diameter of the cable. To examine the load-bearing capacity of the developed CFCC tendon, a mock-up reinforced concrete (RC) block with an internal wedge-shaped anchorage was used. A CFCC tendon equipped with a reverse-twisted tip was inserted into a wedge-shaped hole filled with high-strength grout. A pull-out test of the CFCC tendon was conducted to examine its load-bearing capacity. The test results revealed that the CFCC tendon with a reverse-twisted tip embedded in the anchorage exhibited adequate load-bearing capacity. This study confirmed that the post-tensioned prestressing system using the CFCC tendon is appropriate for strengthening RC members having the thickness of at least 200 mm, such as bridge deck slabs.