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Background Regulatory T cells (Tregs) are activated during anergy in response to T cell receptor ( TCR) activation and functional immune suppression. Anergy of paediatric Tregs is partially dependent on intracellular calcium mobility; following TCR activation, Tregs do not exhibit increased intracellular Ca2+ concentration ([Ca2+]i). Objective We determined whether [Ca2+]i in adult Tregs defined their anergy, if intracellular Ca2+ movement was linked to regulatory functions, whether [Ca2+]i was indicative of asthma pathology, and the potential molecular mechanism responsible for Ca2+ movement in Tregs. Methods Tregs were purified by the magnetic bead method, and their regulatory functions were assessed by monitoring carboxyfluorescein succinimidyl ester-labelled responder T cell proliferation. The Ca2+ response of Fura-2-labelled cells was measured using a video image analysis system. To analyse the functions of Tregs at the molecular level, we generated Jurkat Tet-On® clones with doxycycline (Dox)-induced forkhead box P3 ( FOXP3) protein expression. Results CD4+ CD25+ CD127−/low Tregs from participants without asthma did not elicit Ca2+ influx in response to TCR activation, exhibited little proliferation and suppressed proliferation of CD4+ CD25− T cells. In contrast, under similar conditions, Tregs from patients with asthma exhibited increased [Ca2+]i and robust proliferation with partial loss of regulatory functions. FOXP3 protein levels in Tet-On® clones were high after both 2- and 5-day Dox treatment; however, 5-day cells were comparable with Tregs from patients with asthma, whereas 2-day cells were similar to Tregs from participants without asthma. Increasing [Ca2+]i induced a high level of receptor for activated C kinase 1 ( RACK1) expression in 5-day cells. Conclusions and Clinical Relevance We confirmed that Tregs in patients with asthma are functionally impaired and that the abnormal regulatory functions of these cells can be analysed by [Ca2+]i following TCR engagement. Furthermore, the impaired functioning of Tregs evident in patients with asthma may be due to a high level of RACK1. [ABSTRACT FROM AUTHOR]

Study Objective: To investigate the efficacy of video-assisted thoracoscopic sterilization to treat patients with exacerbation of chronic empyema thoracis.Design: Case reports and literature review.Setting: Academic department of surgery.Patients: Two elderly, debilitated patients with worsening, chronic empyema thoracis as diagnosed by radiographs, CT, and thoracentesis. Both patients had a history of therapeutic pneumothorax for tuberculosis without bronchopleural fistulas.Interventions: Video-assisted thoracoscopic sterilization of the thoracic cavity.Measurements and Results: There was no recurrence of empyema during a 6-year follow-up period for one patient and a 2.5-year follow-up period for the other patient.Conclusions: Video-assisted thoracoscopic sterilization is a minimally invasive useful treatment for elderly or debilitated patients with exacerbation of chronic empyema thoracis. [ABSTRACT FROM AUTHOR]

Abstract Background The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. Methods The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. Results At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. Conclusions ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Introduction and Hypothesis: Laparoscopic sacrocolpopexy(LSC) is widely performed and has been reported to safe and effective. However, statistical data on this technique are unavailable. Therefore, we designed the Japanese-style LSC, a further evolution of the French-style LSC, and initiated this multicenter study to prospectively evaluate its efficacy and safety. If the Japanese-style LSC is successful, we may be able to propose a more reliable and standardized procedure., Methods: This is a prospective study of Japanese-style LSC. The Japanese-style LSC is characterized by the dissection of the vaginal walls as distally as possible and fixation of the mesh with multiple sutures; fixation of the mesh on the promontory without traction; and closure of the peritoneum with high-level peritoneal sutures. We examined the primary (anatomical recurrence, adverse events, and quality of life) and secondary endpoints (voiding symptoms and sexual function) at 3 years postoperatively., Results: In anatomical recurrence, 24 patients (9.2%) were ≥ stage2 in the Pelvic Organ Prolapse Quantification system at 3 years postoperatively, of which 4 (1.5%) and 20 (7.7%) were stages III and II respectively. No mesh-related complications were observed, and each questionnaire showed predominant improvement, except for sexual and evacuation functions., Conclusions: The Japanese-style LSC demonstrated superior anatomical and functional results and we propose it to be an effective procedure., (© 2024. The International Urogynecological Association.)

Foot injuries, particularly degloving injuries, can lead to segmental loss of neurovascular structures in the toes, making simultaneous reconstruction of both the foot and toes challenging. This case report presents a technique using the superficial circumflex iliac artery perforator (SCIP) flap for immediate reconstruction of the dorsal foot and revascularization of multiple toes. A 28-year-old man suffered a degloving injury on the dorsum of his foot resulting in a 9 × 6cm skin defect, open fracture dislocations, exposure of tendons, and neurovascular injury, which included a 6-7.5 cm segmental defect of the vessels supplying the first, second, and third toes leaving all three toes ischemic. Immediate reconstruction was performed by harvesting a 12.5 × 5cm SCIP flap including both the superficial and deep branches and incorporating the superficial inferior epigastric vein (SIEV). The SCIP deep branch was used to revascularize the third and second toes and the SIEV vein graft used for the first toe. The patient recovered well, no complications were observed at the 2-year follow-up, preserving all three toes and regaining mobility. The use of the SCIP flap as a flow-through flap provides thin skin flap cover, good vessel caliber size match with digital vessels and reduces the need for vein grafts from distant sites improving surgical efficiency. These attributes make the flow-through interposition SCIP flap an excellent choice for reconstructing foot defects and revascularizing toes. We report this case to demonstrate the utility of the SCIP flap in immediate soft tissue cover and digit revascularization., (© 2024 The Author(s). Microsurgery published by Wiley Periodicals LLC.)

While some barriers for managing menstruation have been mitigated for cisgender women, trans, non-binary, and gender non-conforming people still struggle to navigate menstruation in a gendered society. With an increasing number of young people identifying outside of the gender binary, there is an immediate need to identify and address the barriers to managing menstruation. This review sets out to explore how trans, non-binary, and gender non-conforming people experience and navigate menstruation. Using critical interpretive synthesis methodology, nine pieces of literature including peer-reviewed journal articles, graduate theses, a book chapter, and a conference poster presentation were reviewed using thematic analysis. Four primary themes were identified: (1) menstruation is strongly gendered; (2) there exists inadequate trans, non-binary, and gender non-conforming education and healthcare training; (3) the gendering of public toilets/washrooms poses a barrier to the management of menstruation; and (4) there exists a lack of diverse participants and attention to intersectional menstruation concerns. A set of recommendations, specific to a variety of stakeholders is provided, and implications for future research are discussed.

Background: Hepatopancreatoduodenectomy (HPD) is a high-risk surgical procedure. Delayed division of the pancreatic parenchyma (DDPP) was reported as a novel technique in HPD for reducing postoperative pancreatic fistula. However, it is often difficult to dissect the pancreatic head nerve plexus while leaving the pancreatic parenchyma intact, particularly in patients with a bulky tumor with vascular invasion. Of the various reported approaches to the superior mesenteric artery, the right lateral approach can provide a useful surgical field to conduct DDPP in HPD., Case Presentation: A 78-year-old man visited a local clinic with itching and jaundice. Laboratory tests revealed elevated hepatobiliary enzyme, total bilirubin, and tumor markers. Enhanced computed tomography, endoscopic retrograde cholangiopancreatography, and intraductal ultrasonography of the bile duct were performed, and he was diagnosed with perihilar cholangiocarcinoma with invasion to the right hepatic artery (40 × 15 mm, Bismuth IIIa, cT3N0M0 cStage III). After neoadjuvant chemotherapy, he underwent left hepatectomy with caudate lobectomy, pancreatoduodenectomy, and combined resection of right hepatic artery using DDPP with a right lateral approach to the superior mesenteric artery. The pathological diagnosis was perihilar cholangiocarcinoma ypT3N1M0 ypStage IIIC, R0 resection. He was discharged on postoperative day 57 in good health and has been doing well for 6 months since the surgery., Conclusions: We present an effective application of the right lateral approach to the superior mesenteric artery in DDPP during HPD. This procedure can provide a clear surgical field to easily divide the pancreatic head nerve plexus before transection of the pancreatic parenchyma., (© 2024. The Author(s).)