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Abstract Objective Videoendoscopic evaluation of swallowing is an objective swallowing function evaluation method used in dysphagia rehabilitation. However, it is anatomically difficult to detect the entry of foreign substances through the posterior tracheal wall using a conventional endoscope (CE). In this study, we developed an endoscope that can observe the posterior tracheal wall and investigated its reliability and validity in healthy adults. Methods Twenty healthy adults were included. The trachea was observed from inside the larynx using a CE and a portable, flexible two‐step angulation endoscope (two‐AE) with a two‐step curved shaft tip. The visibility of the anterior and posterior walls was recorded. The time from the endoscope tip entering the larynx to the posterior tracheal wall was measured. Additionally, discomfort events were assessed after the examination. McNemar's test and a paired t‐test were used for statistical analysis. Kappa coefficients and concordance rates were calculated. Results The anterior tracheal wall was observed using both endoscopes. The posterior tracheal wall was significantly observed in 18 participants with the two‐AE (p

Abstract Pericarditis means inflammation in the pericardial sac. Pericarditis is divided into three categories based on morphology, including fibrinous, purulent, and constrictive. In the present study, a 7‐month‐old male Ghezel breed sheep was examined for low weighting rate for three months. Tachypnea, tachycardia, heart friction sound, absence of fever and normal appetite were recorded in the clinical examination. In the patient's history, there was a history of perforated chest trauma behind the left scapula about three months ago. After the echocardiography examination and bacteriology procedures, purulent pericarditis caused by Proteus mirabilis was diagnosed. The bacterium was analysed using genome sequencing and new strain called Abhar114 was diagnosed. This is the first report of pericarditis caused by Proteus mirabilis in sheep.

Abstract Twelve 30‐ to 75‐day‐old mixed breed lambs were examined in an intensive system because of sudden recumbency and death. Clinical examination revealed sudden recumbency, visceral pain, and auscultation of respiratory crackles. Lambs died shortly (between 30 minutes and 3 hours) after the onset of clinical signs. The lambs were necropsied, and after routine parasitology, bacteriology and histopathology procedures, the occurrence of acute cysticercosis caused by Cysticercus tenuicollis was confirmed. The use of the suspect infested feed (newly purchased starter concentrate) was discontinued and other lambs of the flock were treated with praziquantel (15 mg/kg, single dose, orally). After these actions, no new cases were observed. The present study showed the importance of preventive measures against cysticercosis in intensive sheep farming systems which include proper storage of feed, preventing feed and environmental access by potential definitive hosts, and implementing consistent parasite control programs in dogs that are in contact with sheep.

In the ballasted flocculation, high-speed sedimentation of suspensions is achieved using a microsand as a ballast material and a polymer flocculant combined with microflocs made of polyaluminum chloride (PAC) as an inorganic coagulant. In this study, three turbid water samples containing kaolin clay (kaolin concentration: 20, 200, and 500 mg/L) were treated by coagulation–sedimentation and ballasted flocculation. The effects of pH and PAC dosage, which are the controlling parameters for coagulation, and the microsand (silica sand) and polymer dosages, which are the controlling parameters for ballasted treatment, on the treatment efficiency and floc settling velocity were examined. The floc settling velocity under the optimum conditions was 17 times higher than that of the conventional coagulation–sedimentation process using PAC. The turbidity was 0.54 turbidity unit (TU) (TU as the kaolin standard), and its removal efficiency was 99.7%. Furthermore, turbid water samples with different kaolin concentrations (20 and 500 mg/L) were treated via the ballasted flocculation. In this study, fundamental information on the optimization of each dosage condition of coagulant, ballast, and polymer and pH condition in ballasted flocculation was obtained, and the removal mechanisms under optimal, underoptimistic and overoptimistic conditions were proposed. HIGHLIGHTS Conditions for ultrahigh-speed ballast flocculation were investigated.; Floc settling velocity increased and showed a peak at 10 g/L of microsand.; Excess addition of microsand significantly reduced the floc settling velocity.; Hugh floc settling velocity was achieved in the treatment of high-turbidity water.;

Combination chemotherapy with gemcitabine and cisplatin (GC) is recommended as the primary treatment for advanced bladder cancer (BC). However, the benefits of this approach are limited owing to the acquisition of drug resistance. Here, we found that gemcitabine‐resistant and cisplatin‐resistant BCs do not exhibit cross‐resistance, and that these BCs exhibit different mRNA patterns, as revealed using RNA sequence analysis. To overcome drug resistance, we used the newly developed pan‐RAS inhibitor Compound 3144. Compound 3144 inhibited cell viability through suppression of RAS‐dependent signaling in gemcitabine‐ and cisplatin‐resistant BCs. RNA sequencing revealed that several genes and pathways, particularly those related to the cell cycle, were significantly downregulated in Compound 3144‐treated BCs. These findings provide insights into potential therapeutic strategies for treating BC.

The alkali–silica reaction (ASR), a major cause of cracks in concrete, is a critical issue in the maintenance of social infrastructure. In this study, a concrete mesoscale model was meticulously developed, and a coupled stress–moisture model was also developed to reproduce ASR degradation. The aim was to investigate the effect of ASR degradation on the bending load-carrying capacity of RC beams. The concrete mesoscale model, specifically designed to reproduce ASR degradation, was modeled from three phases: coarse aggregate, mortar, and ITZ (interfacial transition zone). ASR was considered as the expansion of the coarse aggregate, and the objective was to reproduce expansion cracks with numerical analysis using the mesoscale model. Uniaxial compression tests were carried out on cylindrical specimens with ASR-accelerated deterioration to clarify the relationship between ASR deterioration and compressive properties, and the experimental results were used to identify material parameters in the mesoscale analysis model. The results showed that the model proposed in this study can reproduce the change in compressive properties due to expansion cracking. Finally, RC beams were constructed using the mesoscale model, and the effect of ASR degradation on the bending load-carrying capacity of the RC beams was investigated. The results showed that the presence of expansion cracks caused the initial stiffness of the load-displacement curves to decrease, but the bearing capacity tended to increase. This suggests that factors other than cracks, such as chemical prestress and boundary conditions in this model, have a strong influence on the load-bearing capacity of deteriorated RC beams.

Chronic constipation is a common gastrointestinal disorder, and its management is critical. However, it is extremely difficult to assess its subjective symptoms when patients are unable to report them due to cognitive or physical disabilities, especially in cases of patients with incurable geriatric, pediatric, palliative, psychiatric, or neurological diseases. We had previously established a protocol for observing and assessing rectal fecal retention using ultrasonography and for classifying cases into three categories based on the rectal findings: no fecal retention, fecal retention without hard stools, and fecal retention with hard stools. However, although the detection of rectal fecal retention using ultrasonography would be expected to lead to better therapeutic management, there is no standard algorithm for selecting specific treatments and defecation care options based on ultrasonographic findings. Therefore, we organized an expert consensus meeting of multidisciplinary professionals to develop such an algorithm based on rectal ultrasonography findings for patients with constipation in both residential and hospital settings.

Although handheld ultrasound devices (HUDs) are commonplace, their ability to diagnose fecal retention (FR) remains unclear. This prospective observational study examined HUDs’ usefulness in diagnosing FR in patients with constipation in a palliative care setting. Between 10 December 2020 and 30 June 2022, we compared rectal ultrasonographic findings obtained using HUDs with clinical manifestations in 64 males and 70 females (48%, 52%, 68 ± 11 years old) with constipation who had undergone computed tomography (CT). FR was diagnosed using a HUD and compared with CT and digital rectal examination (DRE) results. In total, 42 (31%), 42 (31%), and 41 (31%) patients were diagnosed using HUDs, CT, and DRE, respectively. Thirty-nine (93%) patients in the CT group were also diagnosed with FR using HUDs. A total of 89 of 92 patients with a negative CT diagnosis also had a negative HUD diagnosis. Among the 41 patients in the DRE group, 37 were also diagnosed with FR using HUDs. Among 93 patients with a negative DRE diagnosis, 86 had a negative HUD diagnosis. The sensitivity, specificity, positive predictive value, and negative predictive value of HUDs for CT were 93%, 97%, 93%, and 97%, respectively. Those of HUDs for DRE were 88%, 94%, 86%, and 95%, respectively. The concordance rates for FR diagnosis were 128/134 for CT and HUDs and 123/134 for DRE and HUDs. HUD was useful for diagnosing FR in this setting. HUDs could provide valuable support for appropriate treatment selection. Developing a constipation treatment algorithm based on rectal ultrasonographic findings is warranted in the future.

BackgroundIn Japan, the escalating demand for anesthesia services has resulted in a shortage of anesthesiologists, presenting a societal challenge. Urgent measures involve the imperative task shifting to nurses. The perspectives of anesthesiologists on perianesthesia nurses (PANs) and the PAN system significantly influence the collaboration between anesthesiologists and PANs.MethodsTwenty-four anesthesiologists initially approached in writing among a pool of 304, ultimately agreed to participate in interviews. Verbatim transcripts from these interviews were analyzed using the framework method. In this procedure, data analysis was facilitated by MAXQDA software (version 22.7.0) to construct a case-code matrix, enhancing the reliability of our findings.ResultsFive themes and fifteen categories related to PAN and its system emerged. Participants provided insights into the diverse social conditions accompanying the implementation of the PAN system. They highly regarded PANs as colleagues, expecting a spectrum of capabilities. Nevertheless, the analysis revealed considerable variation in role expectations across institutions and individuals, with some perspectives being mutually critical. Conflicting opinions emerged on two crucial aspects: assigning anesthesia management conducted by PANs and substituting PANs for anesthesiologists. Multiple suggestions were put forth for enhancing and evolving the PAN system.ConclusionThis qualitative study is the first to reveal that Japanese anesthesiologists hold diverse perspectives on PANs and the system. The approach was well-suited for exploring diverse perspectives, showing significant differences among institutions and individuals. Our data provided crucial insights, including findings suggesting potential barriers to task shifting of anesthesia duties to PANs.

Abstract Cysticercosis develops in lambs following a Cysticercus tenuicollis infestation, which is the larval stage of Taenia hydatigena. A 7‐day‐old lamb was examined for depression, anorexia, fever (40.5°C), congested mucus membranes, reluctance to move, and a hunched back. Upon necropsy, congestion was noted in the intestines and brain, and the heart had a loose consistency. Soft and pulpy kidneys were evident coupled with watery intestinal contents. Epsilon toxin (Clostridium perfringens type D toxin) was detected using enzyme‐linked immunosorbent assay. A transparent cystic structure was incidentally found attached to the pancreas, within which a scolex was well demonstrated upon histopathology. Chronic active peritonitis was diagnosed at the cyst attachment site. C. tenuicollis was confirmed by polymerase chain reaction and genome sequencing. This report describes prenatal transmission of C. tenuicollis in the present lamb, although this condition is quite rare.

T2 relaxation time in magnetic resonance imaging (MRI), which is determined by magnetic dipole interactions, has been employed as a parameter for tumor detection. However, owing to the lack of MRI detection sensitivity, nuclear medicine imaging is currently the basic option for tracking low concentrations of chemical probes. Previous studies utilizing cascade radionuclides have focused on the relaxation due to electric quadrupole interactions. However, magnetic dipole interactions, which are crucial in MRI, remains to be elucidated. In this study, we determined the magnetic relaxation rate by using 111In, a cascade radionuclide used in clinical single-photon emission computed tomography (SPECT) scans. As the angle between the gamma rays from the nuclei is affected by the electrical and magnetic interactions acting on the nuclei, we measured the angular correlation ratio by using eight gadolinium gallium garnet (GAGG) multi-pixel photon counter (MPPC) 8 × 8 array detectors and extracted the magnetic relaxation rate. Consequently, we obtained a rate that increased with the Fe concentration, similar to the T2 relaxation rate, although it was influenced by the inhomogeneity of the external magnetic field. This study utilized low concentrations of the liquid-state radionuclide, which is commonly used in clinical nuclear medicine imaging scans and is expected to provide much higher sensitivity and more selective detection of tumors than conventional MRI.

ABSTRACTObjectives and Methods This single-center retrospective study was performed to evaluate the safety and efficacy of FMS-like tyrosine kinase 3 (FLT3) inhibitors before and after allogeneic hematopoietic cell transplantation (HCT) in relapsed/refractory patients with FLT3-mutation positive acute myeloid leukemia (AML).Results Ten patients who met the eligibility criteria were included. Eight of them achieved hematological remission at HCT, within a median span of 79 days (range: 43–197). In post-HCT, patients started maintenance therapy (MT; median time-to-start 79 days, range: 43–197), and the median duration of MT was 390 days (range: 67–815). Grade 3 hematological adverse events (AEs) were found in two patients, and non-hematological AEs were found in five patients. Nine patients underwent either dose reduction, discontinuation of therapy, or a switch to another FLT3 inhibitor due to AEs. Disease relapse occurred in one patient during MT. At the time of the last follow-up, seven patients are alive and disease-free, while three have died due to infection or transplant complications.Conclusion In relapsed/refractory FLT3 mutation-positive AML, the use of FLT3 inhibitors can lead to high response rates and provide a safe bridge from HCT to MT. If sufficient attention is paid to safety, this therapy is expected to prevent disease relapse even with reduced dosages.

Analyzing the biomechanics of the thumb carpometacarpal (CMC) joint is essential for elucidating the etiology of osteoarthritis (OA) and for developing a mechanics-based treatment. This study aimed to identify the areas where the peak stress in the cortical bone is likely to occur during thumb motion. We also investigated whether the stress in the first metacarpal and trapezium differ. CT scan was performed on 11 healthy adult men during flexion and abduction. 3D CMC joint models were created from CT images and then finite element (FE) models under the static compressive force in the bone axial direction of the first metacarpal were constructed. As a result, the peak stress in the cortical bone of the first metacarpal tended to be concentrated in the volar–central region, and that of the trapezium was uniformly distributed across the entire articular surface. Furthermore, the trapezium had higher stress in the cortical bone than the first metacarpal. These results suggest that the volar–central region of the first metacarpal is easily worn, and that the trapezium is evenly worn. These results also suggest that wear is likely to progress from the trapezium.

TERT promoter mutations are commonly associated with 1p/19q codeletion in IDH-mutated gliomas. However, whether these mutations have an impact on patient survival independent of 1p/19q codeletion is unknown. In this study, we investigated the impact of TERT promoter mutations on survival in IDH-mutated glioma cases. Detailed clinical information and molecular status data were collected for a cohort of 560 adult patients with IDH-mutated gliomas. Among these patients, 279 had both TERT promoter mutation and 1p/19q codeletion, while 30 had either TERT promoter mutation (n = 24) or 1p/19q codeletion (n = 6) alone. A univariable Cox proportional hazard analysis for survival using clinical and genetic factors indicated that a Karnofsky performance status score (KPS) of 90 or 100, WHO grade II or III, TERT promoter mutation, 1p/19q codeletion, radiation therapy, and extent of resection (90-100%) were associated with favorable prognosis (p

Therapy resistance in leukemia may be due to cancer cell-intrinsic and/or -extrinsic mechanisms. Mutations within BCR-ABL1, the oncogene giving rise to chronic myeloid leukemia (CML), lead to resistance to tyrosine kinase inhibitors (TKI), and some are associated with clinically more aggressive disease and worse outcome. Using the retroviral transduction/transplantation model of CML and human cell lines we faithfully recapitulate accelerated disease course in TKI resistance. We show in various models, that murine and human imatinib-resistant leukemia cells positive for the oncogene BCR-ABL1T315I differ from BCR-ABL1 native (BCR-ABL1) cells with regards to niche location and specific niche interactions. We implicate a pathway via integrin β3, integrin-linked kinase (ILK) and its role in deposition of the extracellular matrix (ECM) protein fibronectin as causative of these differences. We demonstrate a trend towards a reduced BCR-ABL1T315I+ tumor burden and significantly prolonged survival of mice with BCR-ABL1T315I+ CML treated with fibronectin or an ILK inhibitor in xenogeneic and syngeneic murine transplantation models, respectively. These data suggest that interactions with ECM proteins via the integrin β3/ILK-mediated signaling pathway in BCR-ABL1T315I+ cells differentially and specifically influence leukemia progression. Niche targeting via modulation of the ECM may be a feasible therapeutic approach to consider in this setting.

Abstract Background Exposure to environmental carcinogens, such as through smoking, is a major factor in the carcinogenesis of non‐small cell lung cancer (NSCLC). However, genetic factors may also contribute. Methods To identify candidate tumor suppressor genes for NSCLC, we included 23 patients (10 related pairs and 3 individuals) with NSCLC who had other NSCLC‐affected first‐degree relatives in a local hospital. Exome analyses for both germline and somatic (NSCLC specimens) DNA were performed for 17 cases. Germline exome data of these 17 cases revealed that most of the short variants were identical to the variants in 14KJPN (a Japanese reference genome panel of more than 14 000 individuals) and only a nonsynonymous variant in the DHODH gene, p.A347T, was shared between a pair of NSCLC patients in the same family. This variant is a known pathogenic variant of the gene for Miller syndrome. Results Somatic genetic alterations in the exome data of our samples showed frequent mutations in the EGFR and TP53 genes. Principal component analysis of the patterns of 96 types of single nucleotide variants (SNVs) suggested the existence of unique mechanisms inducing somatic SNVs in each family. Delineation of mutational signatures of the somatic SNVs with deconstructSigs for the pair of germline pathogenic DHODH variant‐positive cases showed that the mutational signatures of these cases included SBS3 (homologous recombination repair defect), SBS6, 15 (DNA mismatch repair), and SBS7 (ultraviolet exposure), suggesting that disordered pyrimidine production causes increased errors in DNA repair systems in these cases. Conclusion Our results suggest the importance of the detailed collection of data on environmental exposure along with genetic information on NSCLC patients to identify the unique combinations that cause lung tumorigenesis in a particular family.

ABSTRACTIn Lake Biwa, located in Shiga Prefecture, Japan, the overgrowth of waterweeds has become a significant environmental and human-life problem. Therefore, the waterweeds are systematically harvested and composted. In order to consider the effective use of waterweed compost for carbon neutrality and resource recycling, we clarified the characteristics of the waterweed compost by cultivation experiments with Komatsuna (Brassica rapa var. perviridis). When the waterweed compost (20%) was applied alone, the growth of plants was promoted about 1.7 times compared to a control containing the same amount of fertilizer components. However, the plant showed yellowing of leaves and a high C/N ratio, indicating obvious symptoms of nitrogen deficiency. The application of the waterweed compost (20%) with chemical fertilizer remarkably enhanced plant growth up to about 3.5 times without nitrogen deficiency compared to a control containing only chemical fertilizer. Interestingly, the coexistence of the waterweed compost and chemical fertilizer activated nitrification and diversified soil bacteria (Chao1 index, 213.0; Shannon index, 6.50) rather than the waterweed compost alone (Chao1 index, 41.3; Shannon index, 4.34). Our results indicate that the waterweed compost functions effectively as an organic fertilizer and a soil amendment, contributing to sustainable agriculture.

Chlamydophila psittaci is found in pigeons worldwide. The abundance of feral pigeons living in close contact with humans and livestock are considered a significant risk factor for human and farm animal infections. In Iran, little is known about the prevalence of C. psittaci and its genotypes in pigeons. The present cross-sectional study aimed to investigate the prevalence of C. psittaci in feral pigeons and to genotype the detected strains. In total, 384 fresh faecal samples were collected from different areas in Semnan (Iran). Out of all samples, 0.52% were positive for C. psittaci genome in Real Time-PCR. The partial ompA gene sequencing revealed that detected strains were identified as genotypes A and E. This is the first report of C. psittaci genotypes A and E in feral pigeons in Iran. The occurrence of C. psittaci genotypes A and E in the faeces of feral pigeons suggests potential environmental contamination with C. psittaci by pigeons and raise a public health concern.

Abstract To disseminate, educate, and validate psychiatric clinical practice guidelines, the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project was launched in 2016. In this study, we investigated whether the web‐based courses offered by this project would be as effective as the face‐to‐face courses. We analyzed and compared survey answers about overall participant satisfaction with the course and answers regarding clinical knowledge of schizophrenia and major depressive disorder between 170 participants who took the web‐based courses in 2020 and 689 participants who took the face‐to‐face courses from 2016 to 2019. The web‐based course participants completed the survey questions about satisfaction with the web‐based courses. The web‐based courses were conducted using a combination of web services to make it as similar as possible to the face‐to‐face courses. The degree of satisfaction assessed by the general evaluation of the web‐based courses was higher than what was expected from the face‐to‐face courses. The degree of satisfaction was similar for the courses on schizophrenia and major depressive disorder. In addition, there were no significant differences in overall satisfaction and clinical knowledge between web‐based and face‐to‐face courses. In conclusion, the web‐based courses on clinical practice guidelines provided by the EGUIDE project were rated as more satisfying than the face‐to‐face course that the participants expected to take and no differences in the effectiveness of either course. The results suggest that, after the COVID‐19 pandemic, it would be possible to disseminate this educational material more widely by adopting web‐based courses additionally face‐to‐face courses.

Introduction Small‐cell carcinoma of the urinary bladder has a poor prognosis, and no standard treatment has been established. We encountered a case of a patient with metastasis in which complete response and long‐term survival were obtained by treating the primary lesion with a combination of irinotecan, carboplatin chemotherapy, and radiation therapy. Case presentation An 83‐year‐old man was diagnosed with a bladder tumor with liver metastasis. Small‐cell carcinoma was diagnosed via transurethral resection. Second‐line chemotherapy with irinotecan and carboplatin and irradiation of the primary lesion were significantly effective. The imaging evaluation showed a complete response. The therapeutic effect was maintained for 1 year, even after the discontinuation of chemotherapy. Conclusion Irinotecan and carboplatin should be considered for the treatment of small‐cell carcinoma of the bladder. Irradiation of the primary lesion may also be useful if the extent of metastasis is low.