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The purpose of this study was to analyze whether the type of preoperative pain affects the improvement in postoperative pain intensity in patients with a lumbar degenerative disease (LDD).We retrospectively reviewed 93 patients who underwent lateral lumbar interbody fusion (LLIF) without direct decompression. All patients were evaluated using Numeric Rating Scale (NRS) scores for low back pain (NRSThe Japanese version of the painDETECT identified NeP in 20.4% of patients with LDD prior to LLIF. Preoperative NRSAlthough LLIF was useful for relieving all types of preoperative pain in LDD patients, the NRS scores for preoperative pain were higher in the NeP group than those in the NocP group, and the postoperative NRS

Objective This study aimed to demonstrate the utility of power tools and intraoperative neuromonitoring of percutaneous pedicle screw (PPS) insertion (so-called PPS monitoring) by SINGLE-position surgery (SPS) after lateral lumbar interbody fusion. Methods A retrospective analysis of medical records from a single center was performed to identify patients who underwent SPS for lateral lumbar interbody fusion and posterior fixation using PPS during intraoperative computed tomography navigation from 2020 to 2021. We investigated the PPS insertion time and screw positional accuracy of patients who underwent SPS involving power tools and PPS monitoring during this period. In this technical note, we report on this surgical technique. Results Twenty-four patients (mean age 72.0 ± 8.5 years, range 53–81 years) were included in this study. There were no intraoperative complications in all cases. Posterior fixation using PPS was added in all cases, and a total of 106 PPSs were inserted. It took an average of 6.2 ± 2.4 seconds to insert the PPS from the PPS insertion point to the end using a power tool and PPS monitoring. Moreover, there were no cases of pedicle breaches. Conclusions Similar to previous reports related to power tools in the prone position, the lateral decubitus SPS technique can also use power tools to save PPS insertion time. Furthermore, we suggest that the use of PPS monitoring may prevent erroneous PPS insertions by using intraoperative computed tomography navigation in advance.

BackgroundRecently, transnasal endoscopy has become common in Japan. While transnasal endoscopy has many advantages, nasal pain and epistaxis are typical complaints. Consequently, we developed a new tube sheath system for transnasal endoscopy to reduce nasal pain and epistaxis. This new tube sheath system (outer sheath and inner tube) has been named Nasal Slider® and is produced by TOP Corporation, Japan.MethodsA tube sheath longer than the nasal concha is inserted to reduce pain along the nasal turbinate. Since the sheath is left in place, tubes can be passed through the nose multiple times without causing additional pain.A total of 34 consecutive patients (mean age 68.1 years, 22 males and 12 females) who had experienced transnasal endoscopy in the past, would undergo transnasal endoscopy with Nasal Slider® again. After the transnasal endoscopy was completed, patients who gave consent for use of the nasal slider® were interviewed using 3 questionnaires about nasal discomfort, nasal pain and epistaxis.ResultsSince the transnasal endoscope passes inside the sheath, epistaxis can be prevented. Thirty patients for whom trans nasal endoscopy using Nasal Slider® could be carried out. Twenty-seven and 28 patients of all patients used Nasal Slider® expressed feeling less nasal discomfort and pain compared to an examination without Nasal Slider®. No epistaxis was detected in all patients using Nasal Slider®.ConclusionsTo reduce nasal pain and epistaxis, Nasal Slider® for transnasal endoscopy was considerably available. It is currently in use at many hospitals in Japan.

A new formula containing terms for age and sagittal curvature reported by the International Spine Study Group is ideal lumbar lordosis (iLL) = pelvic incidence - 0.3 thoracic kyphosis - 0.5Age + 10. However, there are no reports of whether proximal junctional failure (PJF) can be predicted using this formula. We assessed the utility of this formula in PJF in patients with adult spinal deformity with global kyphosis using the Roussouly classification.Forty-four patients with adult spinal deformity global kyphosis (mean age 70.0 years) who underwent multiple levels of lateral lumbar interbody fusion combined with posterior instrumentation were included. Patients were divided into 2 groups: PJF and non-PJF. Demographic, surgical, and radiological parameters were compared. The iLL was calculated according to the new formula, and spinal parameters were compared preoperatively, immediately after, and at the final follow-up.PJF occurred in 11 of 44 (25.0%) patients. Patients with PJF had a large preoperative and postoperative TK, but there was no statistically significant difference in iLL between PJF and non-PJF patients (33.4° vs. 30.2°, P = 0.357). In addition, there was no statistically significant difference in LL and iLL changes (ΔiLL) immediately after surgery (19.0° vs. 23.4°, P = 0.379). Furthermore, there was no correlation between ΔiLL immediately after surgery and at the final follow-up and the proximal junctional angle at the final follow-up.The results of ΔiLL suggest that overcorrection needs to be addressed but that this new formula, including age adjustment, may not predict PJF.

Minocycline hydrochloride (MINO) aspiration sclerotherapy (AS) has been widely used for treating hepatic cysts (HC). However, cyst recurrence remains problematic. Information on monoethanolamine oleate (EO) AS, another effective HC treatment, is currently limited. We investigated the efficacy of EO on ineffective MINO treatments and the relationship between MINO AS and cyst fluid pH.Twenty-two cases with symptomatic HC underwent AS with 500 mg of MINO from January 2016 to June 2021. Cyst fluid pH was measured before and after MINO injection. Cyst volume ratio (CVR, %) after 2 weeks was calculated as follows: cyst volume 2 weeks after MINO injection/pre-treatment cyst volume × 100. Treatment was completed if CVR after 2 weeks was ≤ 35% (MINO-group). For patients with CVR35%, 2 g of EO was added (MINO/EO-group). CVR was measured every 12 months thereafter.There were no recurrence symptoms in any of the patients during follow-up. Twenty-one of the 22 cases had CVR ≤ 20% after 12 months. The MINO/EO-group (n = 8) tended to have smaller CVRs after 12 months than the MINO-group (n = 14). CVR after 2 weeks was correlated to pH change (P = 0.012) and was larger in patients whose pH decreased by1.5 (P = 0.015). All adverse events were mild, including in elderly patients.Adding EO is an effective and safe treatment for symptomatic HC when MINO AS alone is insufficient. Patients with pH decreases of1.5 should be considered for additional EO treatment. This article is protected by copyright. All rights reserved.

The purposes of this study were (1) to investigate postoperative changes in cross-sectional area (CSA) and signal intensity (SI) of the psoas muscle (PS) using magnetic resonance imaging (MRI) and (2) to compare the CSA and SI of the PS between patients with and without motor weakness after single-level lateral lumbar interbody fusion (LLIF) at level L4–L5. Sixty patients were divided into two groups—those with postoperative motor weakness and those without—and the two groups were compared. Baseline demographics and clinical characteristics, such as operation time and blood loss, length of hospital stay, and postoperative complications, were recorded. The CSA and SI of the PS were obtained from the MRI regions of interest defined by manual tracing. Patients who developed motor weakness after surgery were significantly older (p = 0.040). The operation time (p = 0.868), LLIF operative time (p = 0.476), and estimated bleeding loss (p = 0.168) did not differ significantly between groups. In both groups, the CSA and SI of the left and right PS increased after surgery. The change in the CSA of the left PS was significantly higher in patients with weakness (247.6 ± 155.2 mm2) than without weakness (152.2 ± 133.1 mm2) (p = 0.036). The change in SI of the left PS did not differ between the two groups (p = 0.530). To prevent postoperative motor weakness regardless of the operation time, surgeons should be aware of the potential for surgical invasive of the PS during LLIF in older people.

Precursor electrons ahead of the shock wave are measured with a Langmuir probe using the hypervelocity shock tube of the Japan Aerospace Exploration Agency. The current–voltage curve of the probe i...

[Three males with advanced prostate-specific membrane antigen (PSMA)-positive metastatic castration resistant prostate cancer were intravenously administered [After administration of [The results of this study confirmed that the airborne concentration of [

The purpose of this study was to compare clinical and radiological results of lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease in patients under the age of 80 years with those over the age of 80 years.One hundred two patients who underwent LLIF without direct decompression were enrolled, including 92 patients who were less than 80 years (group A) and 10 over 80 years (group B). All patients were evaluated using numerical evaluation scale scores for low back pain, leg pain, and leg numbness, as well as demographic data, surgical data, and imaging data before and after LLIF surgery.Patients over the age of 80 years were found to have longer hospital stays (P = 0.006) and more postoperative muscle weakness (P = 0.011) and endplate injuries (P = 0.038). In addition, each numerical evaluation scale score improved significantly from preoperative to postoperative (P0.001). However, the changes in scores between preoperative and postoperative for each numerical evaluation scale were not significantly different between the 2 groups. Statistically significant increases in lumbar lordosis preoperatively compared with postoperatively were observed in patients under 80 years but did not change in those over 80 years.These data suggest a need for awareness of intraoperative endplate injury and postoperative motor weakness. Critically, indirect decompression with LLIF in lumbar degenerative disease in patients over age 80 as well as those under age 80 has shown satisfactory clinical and radiological results. This study shows that age alone should not prevent older people from undergoing LLIF.

Endoscopic clipping closure after colorectal endoscopic submucosal dissection (ESD) did not reduce the incidence of post-ESD coagulation syndrome (PECS) in our recent randomized controlled trial (RCT); however, the definition of PECS is still controversial. The aim of this study is to establish optimal definition of PECS with additional analysis of RCT based on another definition. In this multicenter, single-blind RCT, individuals were randomly assigned to colorectal ESD followed by endoscopic clipping closure or non-closure. In this post hoc analysis, the definition of PECS was modified as both localized abdominal pain on visual analogue scale and inflammatory response (fever or leukocytosis), from either localized abdominal pain or inflammatory response in the original study. All participants underwent a computed tomography after ESD, and PECS was classified into type I, conventional PECS without extra-luminal air, and type II, PECS with peri-luminal air. A total of 155 patients (84 in the non-closure group and 71 in the closure group) were analyzed. As a result of criteria modification, 21 type I PECS and four type II PECS cases in the original study, which included patients with clear pain and inflammatory response, were downgraded to no adverse event and simple peri-luminal air, respectively. The frequency of PECS showed no significant difference between non-closure and closure groups. Clipping closure after colorectal ESD does not reduce the incidence of PECS regardless of the diagnostic criteria. Either localized abdominal pain or inflammatory response might be optimal criteria of PECS (UMIN000027031). UMIN000027031 April 18, 2017

The Japanese guidelines for the treatment of gastric cancer recommend nivolumab as third-line chemotherapy for metastatic gastric cancer. We report a case of gastric cancer exhibiting a durable response after the discontinuation of nivolumab due to the early onset of immune-related adverse event (irAE). A 64-year-old man with advanced HER2-positive gastric cancer and distant lymph node metastasis received nivolumab as fourth-line therapy. After two courses of nivolumab, the lymph nodes showed progression. However, the treatment was discontinued because of interstitial pneumonia as an irAE. Disease regression was sustained for approximately 11 months without the readministration of nivolumab.

The Japanese gastric cancer clinical practice guideline recommends FOLFOX as one of the first-line chemotherapy for advanced gastric cancer. Since FOLFOX is administered intravenously, it is helpful for patients who have difficulty in oral intake. Herein, we report a patient in which FOLFOX was significantly effective after failure to treatment with S-1 plus CDDP. A 75-year-old gastric cancer patient with paraaortic lymph node metastasis and multiple liver metastases(Stage ⅣB)was treated. Severe stomatitis and impaired consciousness due to dehydration appeared after administration of S-1 plus CDDP. After his general condition recovered, we changed his regimen to FOLFOX. No serious adverse events were observed, and partial response was achieved after 4 courses of treatment. Partial response was maintained until the onset of oxaliplatin drug allergy in the 10th course. FOLFOX is a promising option for patients with difficulties in oral intake.

Chemosensitivity tests have long been a widely discussed research topic. Our group performed collagen gel droplet-embedded culture-drug sensitivity testing (CD-DST) of patients with advanced gastric cancer during the period from December 2012 to December 2017. To verify how CD-DST should be used, we invested correlations of sensitivities to cisplatin (CDDP), docetaxel (DOC), paclitaxel (PTX), and CPT11 with clinical outcome.Patients with advanced gastric cancer underwent gastrectomy with lymph node dissection at Nippon Medical School Tama Nagayama Hospital, and surgical samples were retrospectively examined by CD-DST to assess chemosensitivity. The patients later received adjuvant chemotherapy as standard adjuvant therapy or chemotherapy. The CD-DST test was not performed for S-1 because it is commonly used in chemotherapy for gastric cancer. Although oxaliplatin has also recently become a key drug for advanced gastric cancer, it had not been adopted for gastric cancer in 2012, so CD-DST testing was not performed. The χOf the tumors from gastric cancer patients, 67.0% (77/115) could be cultured. The rate of sensitivity was 41.1% (30/73) for CDDP, 82.6% (57/69) for DOC, 82.8% (58/70) for PTX, and 49.2% (33/67) for CPT11. CDDP sensitivity and outcome were not correlated in patients who received CDDP. Sensitivities to CDDP, DOC, PTX, and CPT11 were not correlated with any patient characteristic. Patients with poorly differentiated adenocarcinoma tended to be sensitive to CDDP (P=0.051).No difference between CDDP sensitivity or outcome was observed in patients receiving CDDP. The CD-DST showed a high sensitivity to DOC and PTX in the present patients.

MET mutations leading to exon 14 skipping (METΔex14) are strong molecular drivers for non–small‐cell lung cancer (NSCLC). Capmatinib is a highly potent, selective oral MET inhibitor that showed clinically meaningful efficacy and a manageable safety profile in a global phase II study (GEOMETRY mono‐1, NCT02414139) in patients with advanced METΔex14‐mutated/MET‐amplified NSCLC. We report results of preplanned analyses of 45 Japanese patients according to MET status (METΔex14‐mutated or MET‐amplified) and line of therapy (first‐ [1L] or second‐/third‐line [2/3L]). The starting dose was 400 mg twice daily. The primary endpoint was the objective response rate (ORR) assessed by a blinded independent review committee. A key secondary endpoint was duration of response (DOR). Among METΔex14‐mutated patients, in the 1L group, one patient achieved partial response (DOR of 4.24 months) and the other had stable disease. In the 2/3L group, the ORR was 36.4% (95% confidence interval [CI] 10.9%‐69.2%), median DOR was not evaluable, and progression‐free survival was 4.70 months. One patient (2/3L group) showed partial resolution of brain lesions per independent neuroradiologist review. In MET‐amplified patients with a MET gene copy number of ≥10, the ORR was 100% (2/2 patients) in the 1L group and 45.5% (5/11 patients) in the 2/3L group, with DOR of 8.2 and 8.3 months, respectively. Common treatment‐related adverse events among the 45 Japanese patients were blood creatinine increased (53.3%), nausea (35.6%), and oedema peripheral (31.1%); most were grade 1/2 severity. In conclusion, capmatinib was effective and well tolerated by Japanese patients with METΔex14/MET‐amplified NSCLC, consistent with the overall population., We describe results for Japanese patients enrolled in a global phase II study (GEOMETRY mono‐1, NCT02414139), which investigated the efficacy and safety of capmatinib in patients with advanced non–small‐cell lung cancer (NSCLC) harboring MET exon 14 skipping mutations (METΔex14). Capmatinib was effective and well tolerated by Japanese patients. The results are consistent with those observed in the overall population enrolled in GEOMETRY mono‐1.

Aim We report, herein, three cases of pleomorphic carcinoma of the lung treated with immune checkpoint inhibitors. Case 1: A 73-year-old man was diagnosed as having pleomorphic carcinoma of the lung and treated with pembrolizumab alone. However, he showed no response and died 4 months after the initiation of the treatment. Case 2: A 66-year-old man was diagnosed as having pleomorphic carcinoma of the lung. He was started on a combination regimen of pembrolizumab plus carboplatin plus nab-paclitaxel, and a remarkable response was observed. Case 3: A 49-year-old man was diagnosed as having pleomorphic carcinoma of the lung. He was started on pembrolizumab monotherapy as second-line treatment. Eleven months after the treatment initiation, computed tomography revealed the decrease of tumor diameter. Conclusion Immune checkpoint inhibitor therapy is expected to improve the prognosis of patients with pleomorphic carcinoma of the lung.

This Paper presents the simulations of CO2 and CO infrared radiation behind shock waves and in expansion flows. This work is motivated by the little amount of characterizations of CO2 infrared radi...

Background The subcutaneous screw rod system, commonly known as the internal pelvic fixator (INFIX), is useful in managing unstable pelvic ring fractures. Conventional INFIX and transiliac–transsacral (TITS) screw techniques are performed using C-arm fluoroscopy. There have been problems with medical exposure and screw insertion accuracy with these techniques. This work describes new INFIX and TITS techniques using intraoperative computed tomography (CT) navigation and C-arm fluoroscopy for pelvic ring fracture. Methods A typical case is presented in this study. An 86-year-old woman suffered from an unstable pelvic ring fracture due to a fall from a height. INFIX and TITS screw fixation with intraoperative CT navigation were selected to optimize surgical invasiveness and proper implant placement. Results The patient was placed in a supine position on a Jackson table. An intraoperative CT navigation was imaged, and screws were inserted under the navigation. Postoperative X-rays and CT confirmed that the screw was inserted correctly. This technique was less invasive to the patient and had little radiation exposure to the surgeon. Rehabilitation of walking practice was started early after the surgery, and she was able to walk with the assistance of a walker by the time of transfer. Conclusions The technique employed in our case study has the cumulative advantages of safety, accuracy, and reduced radiation exposure, together with the inherent advantages of functional outcomes of previously reported INFIX and TITS screw techniques. Further experience with this approach will refine this technique to overcome its limitations and facilitate its wider use.

Dilated vessels at the ulcer floor of the second part of the duodenum can be signs of pancreatic arteriovenous malformation; contrast‐enhanced computed tomography should be performed, and surgical treatment should be considered.

In this study, methods of completing the structural conversion of partly crystalline cellulose II were studied by solid-state 13C CP/MAS NMR spectroscopy and X-ray diffraction. The study incorporated post-treatments of samples that had been mercerized or regenerated to yield somewhat crystalline cellulose II. These post-treatments used different temperatures, lower concentrations of NaOH than used in, for example, the original mercerization, and different neutralization methods. The cellulose employed was originally filter paper from wood pulp that was subsequently mercerized or dissolved and regenerated to create partly crystalline cellulose II. The variations in rate of each component were monitored at different NaOH concentrations and reaction temperatures during the treatment; these components include the crystalline and accessible surface as well as the inaccessible surface/amorphous region. Subsequently, neutralization was performed for the crystallization of cellulose II and the effects of the acid employed were also evaluated. It can be thought that controlling the partial Na-cellulose construction is important for improving the assembly of cellulose II; this is achieved by optimizing the concentration of NaOH, treatment temperature, and selection of acid for neutralization. NMR spectroscopy of the intermediate state of the NaOH detected the partial generation of Na-cellulose; further, another domain exhibited the spectrum of highly crystallized cellulose II. It is believed that the selective Na-cellulose construction in the inaccessible surface cellulose is the result of an increase in the size of cellulose II crystals. During the NaOH treatment, at a concentration of 10%, the crystallinity index evaluated by both NMR and X-ray was maximized; further, at the treatment temperature of 80 °C the crystallinity of the cellulose II evaluated by NMR improved. Moreover, the neutralization, which was conducted after the alkaline treatment with H2SO4, established the most suitable conditions for the crystallization of cellulose II.

Serological tests are beneficial for recognizing the immune response against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). To identify protective immunity, optimization of the chemiluminescent reduction neutralizing test (CRNT) is critical. Whether commercial antibody tests have comparable accuracy is unknown. Serum samples were obtained from COVID-19 patients (n = 74), SARS-CoV-2 PCR-negative (n = 179), and suspected healthy individuals (n = 229) before SARS-CoV-2 variants had been detected locally. The convalescent phase was defined as the period after day 10 from disease onset or the episode of close contact. The CRNT using pseudotyped viruses displaying the wild-type (WT) spike protein and a commercial anti-receptor-binding domain (RBD) antibody test were assayed. Serology for the B.1.1.7 and B.1.351 variants was also assayed. Both tests concurred for symptomatic COVID-19 patients in the convalescent phase. They clearly differentiated between patients and suspected healthy individuals (sensitivity: 95.8% and 100%, respectively; specificity: 99.1% and 100%, respectively). Anti-RBD antibody test results correlated with neutralizing titers (r = 0.31, 95% confidence interval [CI] 0.22–0.38). Compared with the WT, lower CRNT values were observed for the variants. Of the samples with ≥100 U/mL by the anti-RBD antibody test, 77.8% and 88.9% showed ≥50% neutralization against the B.1.1.7 and the B.1.351 variants, respectively. Exceeding 100 U/mL in the anti-RBD antibody test was associated with neutralization of variants (P < 0.01). The CRNT and commercial anti-RBD antibody test effectively classified convalescent COVID-19 patients. Strong positive results with the anti-RBD antibody test can reflect neutralizing activity against emerging variants. IMPORTANCE This study provides a diagnostic evidence of test validity, which can lead to vaccine efficacy and proof of recovery after COVID-19. It is not easy to know neutralization against SARS-CoV-2 in the clinical laboratory because of technical and biohazard issues. The correlation of the quantitative anti-receptor-binding domain antibody test, which is widely available, with neutralizing test indicates that we can know indirectly the state of acquisition of functional immunity against wild and variant-type viruses in the clinical laboratory.

Cell-free circulating DNA (cfDNA), extracted by liquid biopsy, has been studied as a noninvasive biomarker for various diseases. The potential of cfDNA fragment size and level as a marker in lumbar canal stenosis (LCS) patients has never been studied. We investigated whether cfDNA is a biomarker of low back pain, leg pain, leg numbness severity in patients with an LCS. Blood samples were obtained from patients with LCS (n = 22) before and immediately after spinal surgery. Plasma DNA was isolated and examined for cfDNA fragment size and concentration. A cohort of healthy volunteers (n = 5) constituted the control group. The cfDNA fragment size tended to be shorter in patients than in healthy controls, but this difference was not significant (

The biological functions of Hyaluronic acid are related to its molecular weight and binding to its receptor, Toll-like receptor4 (TLR4) or CD44. Recent studies have shown that low-molecular-weight Hyaluronic acid (LMW-HA) exhibits proinflammatory effects, while high-molecular-weight Hyaluronic acid (HMW-HA) functions as an anti-inflammatory factor. UVB-induced epidermal inflammation is mainly mediated by endogenous molecules, such as damage-associated molecular patterns (DAMPs), that cause severe skin damage by activating TLR signaling pathways.Since both LMW- and HMW-HA have inhibitory functions on TLR-mediated macrophage inflammation, HA is assumed to suppress UVB-induced DAMP-mediated inflammation in the skin. In this study, both Ultra- low-molecular-weight Hyaluronic acid (uLMW-HA) and HMW-HA were found to inhibit UVB-induced keratinocyte inflammation.HaCaT cells were treated with medium containing Hyaluronic acid at the appropriate concentration after 15 mJ/cmBy competitively binding to TLR4, uLMW-HA downregulated Calprotectin-induced TRAF6 expression, which might be the direct process by which uLMW-HA decreased UVB-induced IL-6 secretion. Reduced CD44 variant (CD44v) expression in keratinocytes attenuated the inhibitory effect of both uLMW-HA and HMW-HA on UVB-induced inflammation, which indicated the involvement of CD44v in HA-regulated anti-inflammatory activity.Overall, this research indicates that Hyaluronic acid is more than a moisturizer; it is also a biologically effective material that can prevent the excessive skin inflammation caused in daily life, especially in the late stages after sunburn.

Genetic testing using reverse transcriptase real-time polymerase chain reaction (rRT-PCR) is the mainstay of diagnosis of COVID-19. However, it has not been fully investigated whether infectious viruses are contained in SARS-CoV-2 genome-positive specimens examined using the rRT-PCR test. In this study, we examined the correlation between the threshold Cycle (Ct) value obtained from the rRT-PCR test and virus isolation in cultured cells, using 533 consecutive clinical specimens of COVID-19 patients. The virus was isolated from specimens with a Ct value of less than 30 cycles, and the lower the Ct value, the more efficient the isolation rate. A cytopathic effect due to herpes simplex virus type 1 contamination was observed in one sample with a Ct value of 35 cycles. In a comparison of VeroE6/TMPRSS2 cells and VeroE6 cells used for virus isolation, VeroE6/TMPRSS2 cells isolated the virus 1.7 times more efficiently than VeroE6 cells. There was no significant difference between the two cells in the mean Ct value of the detectable sample. In conclusion, Lower Ct values in the PCR test were associated with higher virus isolation rates, and VeroE6/TMPRSS2 cells were able to isolate viruses more efficiently than VeroE6 cells.

There are no reports comparing fluoroscopy and intraoperative computed tomography (CT) navigation in lateral single-position surgery (SPS) in terms of surgical outcomes or implant-related complications. Therefore, the purpose of this study was to use radiological evaluation to compare the incidence of instrument-related complications in SPS of lateral lumbar interbody fusion (LLIF) using fluoroscopy with that using CT navigation techniques. We evaluated 99 patients who underwent lateral SPS. Twenty-six patients had a percutaneous pedicle screw (PPS) inserted under fluoroscopy (SPS-C group), and 73 patients had a PPS inserted under intraoperative CT navigation (SPS-O group). Average operation time was shorter in the SPS-C group than in the SPS-O group (88.4 ± 24.4 min versus 111.9 ± 35.3 min, respectively, P = 0.003). However, there was no significant difference between the two groups in postoperative thigh symptoms or reoperation rate. The screw insertion angle of the SPS-C group was smaller than that of the SPS-O group, but there was no significant difference in the rate of screw misplacement (4.6% versus 3.4%, respectively, P = 0.556). By contrast, facet joint violation (FJV) was significantly lower in the SPS-O group than in the SPS-C group (8.4% versus 21.3%, respectively, P 0.001). While fluoroscopy was superior to intraoperative CT navigation in terms of mean surgery time, there was no significant difference in the accuracy of PPS insertion between fluoroscopy and intraoperative CT navigation. The advantage of intraoperative CT navigation over fluoroscopy is that it significantly decreases the occurrence of FJV in SPS.

Endoscopic clipping closure after colorectal endoscopic submucosal dissection (ESD) did not reduce the incidence of post-ESD coagulation syndrome (PECS) in our recent randomized controlled trial (RCT); however, the definition of PECS is still controversial. The aim of this study is to establish optimal definition of PECS with additional analysis of RCT based on another definition.In this multicenter, single-blind RCT, individuals were randomly assigned to colorectal ESD followed by endoscopic clipping closure or non-closure. In this post hoc analysis, the definition of PECS was modified as both localized abdominal pain on visual analogue scale and inflammatory response (fever or leukocytosis), from either localized abdominal pain or inflammatory response in the original study. All participants underwent a computed tomography after ESD, and PECS was classified into type I, conventional PECS without extra-luminal air, and type II, PECS with peri-luminal air.A total of 155 patients (84 in the non-closure group and 71 in the closure group) were analyzed. As a result of criteria modification, 21 type I PECS and four type II PECS cases in the original study, which included patients with clear pain and inflammatory response, were downgraded to no adverse event and simple peri-luminal air, respectively. The frequency of PECS showed no significant difference between non-closure and closure groups.Clipping closure after colorectal ESD does not reduce the incidence of PECS regardless of the diagnostic criteria. Either localized abdominal pain or inflammatory response might be optimal criteria of PECS (UMIN000027031).UMIN000027031 DATE OF REGISTRATION: April 18, 2017.

The working space in the upper mediastinum is limited and lymphadenectomy along the left recurrent laryngeal nerve is difficult and anastomosis by a circular stapler in the narrow neck field is also difficult in VATS-E. We report our technique of the lymphadenectomy along the left recurrent laryngeal nerve. Methods (1) Patients. One hundred forty seven patients with esophageal carcinomas underwent VATS-E. (2) Methods. i) VATS-E in prone position. Esophagectomy is performed in prone position with 5 ports those are used at the intercostal space (ICS) and pneumothorax by maintaining CO2 insufflation. ii) Lymphadenectomy around left recurrent laryngeal nerve. Working space at the left upper mediastinal area for lymphadenectomy around the recurrent laryngeal nerve is limited in prone position. To obtain the space the residual esophagus is stripped in the reverse direction and retracted toward the neck after the stomach tube is removed through the nose. Results 1. The rate of permanent and transient recurrent laryngeal nerve paralysis were 2.6% and 20%, respectively. 2. The rate of anastomotic leak and postoperative pneumonia was 3.9% and 2.9%. Conclusion Lymphadenectomy along the left recurrent laryngeal nerve after esophageal stripping is available in prone position of VATS-E.

Background This study evaluated the safety and efficacy of pazopanib in patients with metastatic soft tissue sarcoma in routine clinical use in Japan. Methods It was a multicentre, centrally registered and uncontrolled observational study in patients who received pazopanib for metastatic soft tissue sarcoma, with an observation period of 1 year after the start of drug administration. The study was conducted at 378 investigational sites in Japan from September 2012 to September 2019. Progression-free survival (PFS) and overall survival (OS) were the efficacy endpoints of the study. Results A total of 1970 patients were enrolled. Of these, 680 with finalized study forms were included in the analysis. Overall, 649 patients were included in the safety analysis set, and 569 were included in the efficacy analysis set. Most of the patients (81.97%) experienced at least one adverse drug reaction (ADR); 22.34% of patients reported serious ADRs and 34.98% of patients experienced grade ≥ 3 ADRs in the safety set. Hypertension (40.37%) and hepatic dysfunction (26.50%) were the two most common ADRs. A total of 262 deaths were reported, of which 12 were due to ADRs. The median PFS was 3.09 months, whereas the median OS was not reached at the end of the 1-year observation period. Conclusions The safety and efficacy profiles in this postmarketing observational study were consistent with prior data and registration clinical trials. No new safety signals were observed while treating patients with metastatic soft tissue sarcoma with pazopanib.

MS-271, produced by Streptomyces sp. M-271, is a lasso peptide natural product comprising 21 amino acid residues with a d-tryptophan at its C terminus. Because lasso peptides are ribosomal peptides, the biosynthesis of MS-271, especially the mechanism of d-Trp introduction, is of great interest. The MS-271 biosynthetic gene cluster was identified by draft genome sequencing of the MS-271 producer, and it was revealed that the precursor peptide contains all 21 amino acid residues including the C-terminal tryptophan. This suggested that the d-Trp residue is introduced by epimerization. Genes for modification enzymes such as a macrolactam synthetase (mslC), precursor peptide recognition element (mslB1), cysteine protease (mslB2), disulfide oxidoreductases (mslE, mslF), and a protein of unknown function (mslH) were found in the flanking region of the precursor peptide gene. Although obvious epimerase genes were absent in the cluster, heterologous expression of the putative MS-271 cluster in Streptomyces lividans showed that it contains all the necessary genes for MS-271 production including a gene for a new peptide epimerase. Furthermore, a gene-deletion experiment indicated that MslB1, -B2, -C and -H were indispensable for MS-271 production and that some interactions of the biosynthetic enzymes were essential for the biosynthesis of MS-271.

2,5-Dihydroxy-[1,4]-benzoquinone (DHBQ) and 5,8-dihydroxy-[1,4]-naphthoquinone (DHNQ) are two key chromophores which are almost ubiquitous in cellulosic materials. Their fate under conditions of alkaline peroxide bleaching (P stage) has been established previously, but the intermediacy of cyclic peroxides, which so far had only been postulated, remained an open issue. By means of 17O NMR spectroscopy, additionally supported by other NMR techniques, it was demonstrated that both DHBQ and DHNQ form cyclic peroxides as primary intermediates in the reaction with hydrogen peroxide under alkaline conditions. These intermediates are subsequently further degraded to products already known. The experimental confirmation of the cyclic peroxides is an important step in the understanding of reaction mechanisms in pulp bleaching chemistry.

This paper presents the first efforts in measuring carbon dioxide infrared radiation under nonequilibrium expansion, such as encountered in wakes, when carbon dioxide undergoes recombination. This ...

This paper presents the simulations of equilibrium CO2 infrared radiation measurements. Transmission measurements and line-of-sight intensity measurements from microwave plasma torches and shock tu...

形態: カラー図版あり, Physical characteristics: Original contains color illustrations, Accepted: 2017-09-05, 資料番号: PA1810044000