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Abstract Background Organ-preserving surgery has recently gained increasing attention. However, performing the surgery for duplicated gastric and distal pancreatic tumors is difficult because of procedural complexity and concerns of remnant gastric necrosis. We present the first case of simultaneous robotic distal gastrectomy plus spleen-preserving distal pancreatectomy in a patient with overlapping gastric cancer and intraductal papillary mucinous neoplasm. Case presentation A 78-year-old man was diagnosed with gastric cancer in the middle stomach and intraductal papillary mucinous neoplasm of the pancreatic body. Radical cure surgery was performed using the da Vinci Xi robotic system. Conventional distal gastrectomy was initially completed using near-infrared ray guidance when transecting the stomach. After dividing the pancreas, the parenchyma of the distal pancreas was detached from the splenic artery and vein; multiple branches from these splenic vessels were dissected. Indocyanine green imaging confirmed sufficient blood flow in the splenic vessels and perfusion of the remnant stomach. Ultimately, gastrointestinal reconstruction was performed, and the postoperative course was uneventful. Conclusions The robotic distal gastrectomy plus spleen-preserving distal pancreatectomy procedure was safely performed. Compared to the total gastrectomy plus distal pancreatectomy with splenectomy procedure, this technique may improve the quality of dietary life, reduce weight loss, and prevent complications associated with splenectomy.

Finish blanking is a process that increases the burnished surface using rounded cutting edge of the tools. In this study, the double-sided blanking was carried out using dies with different radius of cutting edges to investigate the effect of the radius of die cutting edge on forming of the burnished surface. A high-speed camera was used to capture the material deformation during blanking process, and analysis was carried out using Digital Image Correlation (DIC). The following results were obtained from the observation of material deformation during blanking. The length of the burnished surface is increased with increasing the radius of die cutting edge, because the punch stroke when the crack is occurred near the die cutting edge becomes large. When the radius of the die cutting edge is further increased, the crack occurs in the sheet material in contact with the middle of the die cutting edge. Therefore, the burnished surface is increased. The relationship between the mechanism of increasing the burnished surface and the radius of the die cutting edge is clarified. When the radius of the die cutting edge is increased, it becomes difficult to increase the equivalent strain and the maximum principal strain. However, the maximum principal strain in the part of sheet material increases as the part of the sheet material approaches the side of the die.

The phrase “skin as a mirror of internal medicine,” which means that the skin reflects many of the diseases of the internal organs, is a well-known notion. Despite the phenotypic differences between the soft skin and hard bone, the skin and bone are highly associated. Skin and bone consist of fibroblasts and osteoblasts, respectively, which secrete collagen and are involved in synthesis, while Langerhans cells and osteoclasts control turnover. Moreover, the quality and quantity of collagen in the skin and bone may be modified by aging, inflammation, estrogen, diabetes, and glucocorticoids. Skin and bone collagen are pathologically modified by aging, drugs, and metabolic diseases, such as diabetes. The structural similarities between the skin and bone and the crosstalk controlling their mutual pathological effects have led to the advocacy of the skin–bone axis. Thus, the skin may mirror the health of the bones and conversely, the condition of the skin may be reflected in the bones. From the perspective of the skin–bone axis, the similarities between skin and bone anatomy, function, and pathology, as well as the crosstalk between the two, are discussed in this review. A thorough elucidation of the pathways governing the skin–bone axis crosstalk would enhance our understanding of disease pathophysiology, facilitating the development of new diagnostics and therapies for skin collagen-induced bone disease and of new osteoporosis diagnostics and therapies that enhance skin collagen to increase bone quality and density.

Nitrogen-doped carbon dots (NCDs) have been recognized as a promising supporting material for stabilizing metal nanoparticles. In this study, copper nanoparticles (CuNPs) decorated onto NCDs were easily prepared under mild conditions. Two types of Cu fabricated NCDs were prepared by using different Cu precursors – CuCl2 and N,N-dimethylformamide (DMF)-protected CuNPs, where DMF was employed as a multifunctional reagent serving as a reducing agent, stabilizer, and solvent for the synthesis of the CuNPs. The resulting NCDs with Cu species were characterized using ICP-AES, FT-IR, XPS, XRD, and STEM. We found that the Cu precursor greatly influence the fabrication of Cu species on NCDs, with the Cu content of the CuNPs/NCDs being almost twice that of CuCl2/NCDs. Furthermore, when DMF-protected CuNPs were used, nano-sized Cu particles ranging from 4 to 11 nm were immobilized on NCDs surface, whereas single-atom Cu were observed when using CuCl2. This indicates that DMF-protected CuNPs are a suitable source of Cu for the preparation of nano-sized Cu on NCDs.

Key Clinical Message In middle‐aged and older men, clinicians often suspect lumbar spine disease when gait is impaired with intermittent claudication, but spinal dural arteriovenous fistula (SDAVF) may be the etiology. An understanding of the key magnetic resonance imaging findings of SDAVF is necessary for early diagnosis, appropriate treatment, and minimization of complications.

Background: The adjustable shunt valves of ventriculoperitoneal shunts (VPS) produce magnetic artifacts, which could disturb magnetic resonance imaging (MRI), and should therefore be placed on the chest wall. However, some significant complications, including ventricular catheter migration, disconnection, and rupture, should be considered. This study proposed a novel method for VPS placement with the valve placed on the chest wall using a fixation technique that uses titanium screws for securing the reservoir to the cranium. Methods: After a right-angled ventricular catheter with reservoir was inserted into the lateral ventricle, a 4-mm self-tapping titanium screw was inserted directly through the collars of the reservoir to fix it to the cranium. Adjustable shunt valves were implanted in the infraclavicular fossa of the chest wall. The connection site between the valve and tube was fastened using 3–0 nonabsorbable braided nylon surgical sutures. Results: In this study, following VPS placement in 83 patients with normal-pressure hydrocephalus, the review of all postprocedural images showed that of the 83 patients, four patients (4.8%) had catheter placement complications: two patients (2.4%) had incorrect placement of the ventricular catheter and two patients (2.4%) had subcutaneous migration of the abdominal catheter. None of the patients complained of ventricular catheter migration, disconnection, or rupture. Conclusion: In adult patients, placing the VPS valve in the chest and fixing the proximal catheter to the cranium using surgical screws can be an effective way to avoid MRI artifacts and to counteract mechanical failure due to the dislodgment of the proximal catheter.

Abstract Background Cisplatin-induced acute kidney injury (AKI) is common during preoperative chemotherapy for esophageal cancer. The purpose of this study was to investigate the association between AKI after preoperative chemotherapy and postoperative complications in patients with esophageal cancer. Methods In this retrospective cohort study, we included patients who had received preoperative chemotherapy with cisplatin and underwent surgical resection for esophageal cancer under general anesthesia from January 2017 to February 2022 at an education hospital. A predictor was stage 2 or higher cisplatin-induced AKI (c-AKI) defined by the KDIGO criteria within 10 days after chemotherapy. Outcomes were postoperative complications and length of hospital stays. Associations between c-AKI and outcomes including postoperative complications and length of hospital stays were examined with logistic regression models. Results Among 101 subjects, 22 developed c-AKI with full recovery of the estimated glomerular filtration (eGFR) before surgery. Demographics were not significantly different between patients with and without c-AKI. Patients with c-AKI had significantly longer hospital stays than those without c-AKI [mean (95% confidence interval (95%CI)) 27.6 days (23.3–31.9) and 43.8 days (26.5–61.2), respectively, mean difference (95%CI) 16.2 days (4.4–28.1)]. Those with c-AKI had higher C-reactive protein (CRP) levels and prolonged weight gain after surgery and before the events of interest despite having comparable eGFR trajectories after surgery. c-AKI was significantly associated with anastomotic leakage and postoperative pneumonia [odds ratios (95%CI) 4.14 (1.30–13.18) and 3.87 (1.35–11.0), respectively]. Propensity score adjustment and inverse probability weighing yielded similar results. Mediation analysis showed that a higher incidence of anastomotic leakage in patients with c-AKI was primarily mediated by CRP levels (mediation percentage 48%). Conclusion c-AKI after preoperative chemotherapy in esophageal cancer patients was significantly associated with the development of postoperative complications and led to a resultant longer hospital stay. Increased vascular permeability and tissue edema due to prolonged inflammation might explain the mechanisms for the higher incidence of postoperative complications.

Background: After placement of the spinal catheter into the spinal canal during lumboperitoneal shunt (LPS) placement, the spinal catheter needs to be connected to the programmable valve. Although surgeons always try to secure the spinal catheter position during procedures, it may be accidentally pulled and displaced. This article aimed to introduce a “one-piece method” of LPS using fluoroscopy and peel-away sheath without connecting the spinal catheter to the programmable valve. Methods: An abdominal shunt catheter, valve, and spinal shunt catheter were connected and tunneled to the back for insertion into the lumbar spinal subarachnoid space. The spinal catheter was cut to a length of 15 cm. Lumbar puncture was performed using a 14-gauge Tuohy needle inserted at the L2-3 intervertebral space using an image-guided paramedian technique, and a 0.035-inch guidewire was passed gently through the Tuohy needle under fluoroscopic guidance. The Tuohy needle was withdrawn, and a 5-Fr peel-away sheath was advanced over the wire. The dilator and guide wire were removed, the distal end of the 5-Fr peel-away sheath was checked to ensure that the cerebrospinal fluid flowed out, and the spinal shunt catheter was passed down the sheath. After confirming under fluoroscopic guidance that the catheter was properly positioned, the peel-away sheath was removed. Results: LPS was performed using this method in seven patients without complications. Conclusion: This simple “one-piece method” using fluoroscopy and peel-away sheath is safe and effective for positioning the spinal catheter.

The Japan Neurotrauma Data Bank is a source of epidemiological data for patients with severe traumatic brain injury (TBI) and is sponsored by the Japan Society of Neurotraumatology. In this report, we examined the changes in the treatment of severe TBI in Japan based on data of the Japan Neurotrauma Data Bank. Controlling and decreasing intracranial pressure (ICP) are the primary objective of severe TBI treatment. Brain-oriented whole-body control or neurocritical care, including control of cerebral perfusion pressure, respiration, and infusion, are also increasingly considered important because cerebral tissues require oxygenation to improve the outcomes of patients with severe TBI. The introduction of neurocritical care in Japan was delayed compared with that in Western countries. However, the rate of ICP monitoring increased from 28.0% in 2009 to 36.7% in 2015 and is currently likely to be higher. Neurocritical care has also become more common, but the functional prognosis of patients has not significantly improved in Japan. Changes in the background of patients with severe TBI suggest the need for improvement of acute-phase treatment for elderly patients. Appropriate social rehabilitation from the subacute to chronic phases and introduction of cellular therapeutics are also needed for patients with TBI.

Pedicle or lateral mass screws, which are usually used to fix atlantoaxial instability, increase the risk of vertebral artery (VA) injury in patients with bone or arterial anomalies or osteoporotic bone. Here, we report the use of a unilateral C1 posterior arch screw-C2 laminar screw posterior fixation with a contralateral C1 lateral mass screw for VA preservation in a patient with bow hunter’s syndrome (BHS). A 65-year-old male presented with recurrent loss of consciousness in the right rotational and backward-bending head positions for 1 year. Cerebral angiography in the same head position showed that the left VA was disrupted at C1/2 and the right VA was hypoplastic. The patient was diagnosed with BHS. C1-2 posterior fixation and iliac bone grafting were performed. The left VA was on the dominant side, and the VA was in a high position; thus, a C1 posterior arch screw was selected for the left side, a C1 lateral mass screw was selected for the right side, and a C2 laminar screw with O-arm navigation and a C-arm was used to prevent arterial injury. Intraoperative findings revealed no VA injury, and postoperative computed tomography showed the screw at the planned site. In a patient with BHS, posterior fixation with a unilateral C1 posterior arch screw-C2 laminar screw prevented VA injury because the screw could be inserted while avoiding the VA.

Acute ischemic stroke is a rare complication resulting from an unruptured intracranial aneurysm (UIA). Ischemic stroke adjacent to the aneurysms is considered the risk of rupture of aneurysms. However, there is presently no consensus on the optimal strategy for the management of UIAs with ischemic stroke. A 27-year-old woman presented with sudden onset left hemiparesis. Acute infarction of the right basal ganglia and an aneurysm of the right middle cerebral artery were discovered on brain imaging. Antiplatelet therapy was used to treat her. The diagnosis revealed ischemic stroke caused by a thrombosed aneurysm due to the change in the shape of the aneurysm on day 4. The UIA clipping procedure was performed on day 21 due to the risk of subarachnoid hemorrhage (SAH). The findings of the surgery and indocyanine green imaging revealed a partially thrombosed aneurysm and occlusion of a perforating artery. As is well known, enlargement of aneurysm size indicates increasing rupture risk. In the present case, after ischemic events developed, magnetic resonance angiography revealed enlargement of the aneurysm. The findings of the surgery revealed possible pathogenic mechanisms were perforating artery occlusion due to local extension of the luminal thrombus. Clinicians should be aware of the risk of ischemic stroke due to luminal thrombosis of the UIA and SAH and should consider urgent treatment of the UIA even immediately after ischemic stroke.

Abstract Background In gastrectomies, especially subtotal gastrectomies and operations on the gastroesophageal junction, identifying the exact location of the tumor and establishing the appropriate resection line is very important. Accurate resection lines have a major impact on the preservation of organ function and curability. Preservation of as much as possible of the remaining stomach, including the fornix, may be an important surgical goal for maintaining an adequate postoperative quality of life. In adenocarcinoma of the gastroesophageal junction, the height of the esophageal dissection may affect reconstruction of the transhiatal approach. Methods We perform a new technique, near infrared ray-guided surgery, for the accurate localization of a tumor using the Firefly technology of the daVinci Xi system and intra-operative upper gastrointestinal endoscopy. We used this new technique for cases of upper gastric cancer or adenocarcinoma of the gastroesophageal junction. In this retrospective study, we examined to determine the extent (mm) of the tumor invasion of the esophagus, visualization of near infrared ray contained within endoscopic light, and distance from the proximal margin of the tumor to the surgical cut line on rapid histopathology and in the permanent preparation, including the operative videos and extracted specimens. Results We performed near infrared ray-guided surgery for 12 patients with gastric cancer or adenocarcinoma of the gastroesophageal junction, and the near infrared ray was clearly seen as green light with Firefly mode in all the patients. Near infrared ray-guided surgery was useful for obtaining localization of the tumor. In addition, it was possible to resect organ with adequate margins from tumor. Rapid intraoperative histopathological examinations confirmed that the resected specimens had negative margins. None of the patients required additional resection. Conclusions We believe that because near infrared ray-guided surgery can provide an accurate resection line, it will be useful for the resection of upper gastric cancer and adenocarcinoma of the gastroesophageal junction. It will also provide patients with a good postoperative quality of life after surgery.

Abstract Objective The treatment for nonampullary duodenal adenoma remains to have no consensus and established methods. Although endoscopic treatment is minimally invasive, it was reported to cause delayed perforation in more than 20% of cases. For adenomas in the duodenum, we performed endoscopic submucosal dissection (ESD)-aid surgery, which is a procedure to prophylactically suture the seromuscular structure of the duodenum after ESD. In this procedure, we did not perform Kocher mobilization prior to ESD to facilitate endoscopic resection and full-thickness resection to prevent spread of the tumor and infection to the abdominal cavity. The duodenal wall was reinforced in planes using a suture clip. Results Of the 13 cases of duodenal adenoma that underwent ESD-aid surgery at our hospital between April 2018 and December 2020, 1 developed postoperative bleeding, but there was no late perforation. For duodenal adenomas, ESD-aid surgery was considered a safe and minimally invasive treatment.

Abstract Background Despite the established oncological benefits of neoadjuvant chemotherapy for esophageal squamous cell cancer, not all cases demonstrate benefit. Hence, predicting the response to chemotherapy before treatment is desirable. Some reports have shown that immune factors are related to the chemotherapy response. This study aimed to investigate the utility of serum IgG levels for predicting chemotherapy response. Methods Among the patients who underwent esophagectomy after neoadjuvant chemotherapy at Nagoya City University Hospital between December 2012 and June 2019, 130 cases were included in this study. Response to chemotherapy and pretreatment serum IgG levels were examined in 77 cases. FP (5-fluorouracil and cisplatin) therapy or DCF (docetaxel, cisplatin, and 5-FU) therapy was performed as neoadjuvant chemotherapy. DCF therapy was selected for patients aged

Obesity is an important health problem, which can be prevented through appetite control. Ghrelin is an appetite-stimulating hormone considered to promote obesity. Thus, we examined whether gastric stretching affects ghrelin secretion. We investigated the role of transient receptor potential vanilloid 4 (TRPV4) in gastric glands in the regulation of ghrelin secretion. TRPV4 immunostaining was performed in tissue samples from 57 patients who underwent gastrectomy. TRPV4 expression was compared between patients with (body mass index (BMI) ≥ 30) and without (BMI

The plasma membrane (PM) serves multiple functions to support cell activities with its heterogeneous molecular distribution. Fatty acids (FAs) are hydrophobic components of the PM whose saturation and length determine the membrane’s physical properties. The FA distribution contributes to the PM’s lateral heterogeneity. However, the distribution of PM FAs is poorly understood. Here, we proposed the FA cluster hypothesis, which suggested that FAs on the PM exist as clusters. By the optogenetic tool translocating the endoplasmic reticulum (ER), we were able to manipulate the distribution of PM FAs. We used time-of-flight combined secondary ion mass spectrometry (TOF-SIMS) to image PM FAs and discovered that PM FAs were presented and distributed as clusters and are also manipulated as clusters. We also found the existence of multi-FA clusters formed by the colocalization of more than one FA. Our optogenetic tool also decreased the clustering degree of FA clusters and the formation probability of multi-FA clusters. This research opens up new avenues and perspectives to study PM heterogeneity from an FA perspective. This research also suggests a possible treatment for diseases caused by PM lipid aggregation and furnished a convenient tool for therapeutic development.

Abstract The 2016 Kumamoto earthquake, whose main shock was an M7.3 event on April 16, 2016, 28 h after a foreshock of M6.5, caused severe damage in and around Kumamoto Prefecture, Japan. It also caused postseismic hydrological changes in Kumamoto Prefecture. In this study, we analyzed daily streamflow data collected by eight observation stations from 2001 to 2017 in regions that experienced strong ground motion during the 2016 Kumamoto earthquake. We also surveyed 11 water springs in the region several times after the main shock. Streamflow had no or slight change immediately after the earthquake; however, large increases were recorded at some of the eight stations following a heavy rainfall that occurred 2 months after the earthquake. A decrease in the water-holding capacity of the catchment caused by earthquake-induced landslides can explain this delayed streamflow increase. Conversely, earthquake-related changes to the spring flow rate were not so clear. Water temperature and chemical composition of spring waters were also hardly changed. Only the concentration of NO3 −, which is usually considered to be supplied from the surface, changed slightly just after the earthquake. These results show that the postseismic hydrological changes were caused mainly by earthquake-induced surface phenomena and that there was little contribution from hydrothermal fluid.

Boerhaave syndrome (BS) is frequently reported in cases of esophageal perforation; however, there are relatively few studies on non–Boerhaave syndrome (nBS). This study clarifies the appropriate diagnosis and treatment for patients with nBS among those with esophageal ruptures. Twelve patients with esophageal ruptures who underwent surgery at our department over 14 years were classified into 2 groups: 4 in the nBS group and 8 in the BS group. Patient characteristics, surgical methods, surgical outcomes, and complications were compared between the groups. The chief complaints varied between the groups. The nBS group had significantly higher preoperative C-reactive protein ( P = .007) and required 5 days (median) from onset to surgery. Moreover, the perforation diameter was significantly smaller in the nBS group than in the BS group ( P = .013). Suturing of the perforation site was performed during the initial surgery in 8 BS group patients (100%) and 1 nBS group patient (25%; P = .018). Only drainage was performed during the initial surgery for 3 nBS group patients (75%). The complications did not significantly differ between the groups ( P = 1.000), and no deaths were reported. The chief complaints of patients with nBS are diverse, and esophageal perforation should be cited as a differential diagnosis even in the absence of vomiting or chest pain symptoms. In the initial surgery for patients with nBS, the perforation site does not necessarily need to be closed. It is treatable by second-stage surgery or by natural closing.

Severe plastic deformation (SPD) can fabricate high-strength materials by forming an ultrafine grained (UFG) microstructure. Low elongation to failure of UFG materials in tensile tests, which has often been regarded as a measure of ductility of materials, has been attributed to low strain hardening of UFG structures where dislocation slip and its accumulation is very limited. In the present work, it is shown that the compressive extensibility of UFG materials can be comparable or potentially superior to that of annealed materials by using a parallel round-bar compression (PRBC) test which was designed for imposing an appropriate stress state preferable for high ductility using the shear mode. The high compressive extensibility of UFG materials can be a result of high accommodation of local strain incompatibility at non-equilibrium grain boundaries and a grain boundary-mediated deformation mechanism, which result in high damage tolerance against void formation and growth. Low strain rate sensitivity indicated that the superplastic viscous nature of deformation is not involved in the high compressive ductility of UFG materials using SPD.

Heat insulation by a wall material which has low heat capacity and heat conductivity is one of the effective ways to reduce heat transfer. By the heat insulated coating, wall temperature is fluctuated following the behavior of in-cylinder gas temperature, which decreases the gap between gas and wall temperature. In order to suppress wall heat transfer in wide engine operation range, Model Based Development is required. In this study, wall heat transfer mechanism under wall temperature fluctuated condition by heat insulation was investigated by simultaneous measurement of wall heat flux and flow behavior in wall boundary layer in RCEM. As a result, it was clarified that turbulent energy was influenced by wall temperature behavior, which impact on heat transfer coefficient. In addition, non-dimensional velocity distribution in wall boundary layer was not changed drastically by wall temperature behavior. In terms of modeling under heat insulated condition, wall heat flux was able to be predicted well by wall heat transfer model taking into account of density change in wall boundary layer.

In recent years, manufacturing industries are required to provide various kinds of products in a short time while reducing burden on the environment. To achieve such requirement, optimization techniques incorporated with ICT are attracting a rising attention. In sheet metal processing, reducing wastes of material and managing production schedule are considered to be very important for the efficient manufacturing. To work with these problems, we attempt to simultaneously minimize wastes of material and total tardiness through nesting and scheduling. The nesting and scheduling in sheet metal processing are affected with each other and there occurs certain conflicts in their decisions. For entire efficiency of manufacturing activities, therefore, they should be decided through managing trade-off between them. Under such understanding, in our previous study, we proposed an integrated method of nesting and scheduling. This method determines a schedule under the condition that the operational sequence of punching process as the first process of sheet metal processing is fixed. In order to realize more efficient manufacturing, in this paper, we have included the punching process in our consideration. Then, this study has proposed a hybrid heuristic approach to the scheduling problem of sheet metal processing. Genetic algorithm, dispatching rule and local search technique are applied to create a schedule together with a bottom left algorithm for nesting. Finally, in order to validate the effectiveness of the proposed method, we implemented prototype of nesting scheduling system and carried out a few computational experiments.

We previously reported on a method for X-ray single-crystal structure determination from a powder sample via a magnetically oriented microcrystal suspension (MOMS). The method was successfully applied to orthorhombic microcrystals (L-alanine, P212121). In this study, we apply this method to monoclinic microcrystals. Unlike most of the orthorhombic MOMSs, monoclinic MOMSs exhibit two or four orientations with the same magnetic energy (we refer to this as twin orientations), making data processing difficult. In this paper, we perform a MOMS experiment for a powder sample of monoclinic microcrystal (α-glycine, P21/n) to show that our method can also be applied to monoclinic crystals. The single-crystal structure determined in this work is in good agreement with the reported one performed on a real single crystal. Furthermore, the relationship between the crystallographic and magnetic susceptibility axes is determined.

Transcription factors organize gene expression profiles by regulating promoter activity. However, the role of transcription factors after transcription initiation is poorly understood. Here, we show that the homeoprotein Nkx2-5 and the 5’-3’ exonuclease Xrn2 are involved in the regulation of alternative polyadenylation (APA) during mouse heart development. Nkx2-5 occupied not only the transcription start sites (TSSs) but also the downstream regions of genes, serving to connect these regions in primary embryonic cardiomyocytes (eCMs). Nkx2-5 deficiency affected Xrn2 binding to target loci and resulted in increases in RNA polymerase II (RNAPII) occupancy and in the expression of mRNAs with long 3’untranslated regions (3’ UTRs) from genes related to heart development. siRNA-mediated suppression of Nkx2-5 and Xrn2 led to heart looping anomaly. Moreover, Nkx2-5 genetically interacts with Xrn2 because Nkx2-5+/-Xrn2+/-, but neither Nkx2-5+/-nor Xrn2+/-, newborns exhibited a defect in ventricular septum formation, suggesting that the association between Nkx2-5 and Xrn2 is essential for heart development. Our results indicate that Nkx2-5 regulates not only the initiation but also the usage of poly(A) sites during heart development. Our findings suggest that tissue-specific transcription factors is involved in the regulation of APA.

We describe the management of a tracheoesophageal fistula due to a damaged tracheal stent, which was first inserted to treat tracheal stenosis. A 29-year-old woman with a history of treated epilepsy had a seizure and suffered from smoke inhalation during a fire. Breathing difficulties appeared and gradually worsened; consultation was obtained two years afterward. After undergoing a thorough examination, the patient was diagnosed with tracheal strangulation. A noncovered, metallic stent was inserted. When the patient was 37 years old, she was admitted to our hospital for the treatment of a tracheoesophageal fistula. We diagnosed it as a tracheoesophageal fistula due to the collapse of the damaged tracheal stent toward the esophageal side, and we decided to perform a mediastinal tracheostomy. Granulation may be formed in the circumference of a stent that has been present for a prolonged period, and removal of the stent may become difficult. This case suggests that insertion of a noncovered, metallic stent is contraindicated for a benign disease.

Background: Adjustable shunt valves that have been developed for managing hydrocephalus rely on intrinsically magnetic components; thus, artifacts with these valves on magnetic resonance imaging (MRI) are inevitable. No studies on valve-induced artifacts in lumboperitoneal shunt (LPS) surgery have been published. Therefore, this study aimed to evaluate valve-induced artifacts in LPS. Methods: We retrospectively reviewed all MRIs obtained between January 2023 and June 2023 in patients with an implanted Codman CERTAS Plus adjustable shunt valve (Integra Life Sciences, Princeton, New Jersey, USA). The valve was placed < 1 cm subcutaneously on the paravertebral spinal muscle of the back, with its long axis perpendicular to the body axis. The scans were performed using a Toshiba Medical Systems 1.5 Tesla scanner. The in-plane artifact sizes were assessed as the maximum distance of the artifact from the expected region of the back. Results: All spinal structures or spinal cords can be recognized, even with valve-induced artifacts. The median maximum valve-induced artifact distance on T1-weighted axial imaging was 25.63 mm (mean, 25.98 mm; range, 22.24-30.94 mm). The median maximum valve-induced artifact distance on T2-weighted axial imaging was 25.56 mm (mean, 26.27 mm; range, 21.83-29.53 mm). Conclusion: LPS surgery with adjustable valve implantation on paravertebral muscles did not cause valve-induced artifacts in the spine and spinal cord. We considered that LPS could simplify the postoperative care of these patients. [ABSTRACT FROM AUTHOR]

Background: Hemorrhagic meningiomas are rare. We report a rare case of nontraumatic convexity and interhemispheric acute subdural hematoma (ASDH) caused by a falx meningioma. Case Description: An 84-year-old woman with a history of atrial fibrillation and hypertension who was taking warfarin presented to our emergency department with a sudden disorder of consciousness. The patient had no traumatic events associated with her symptoms. Computed tomography (CT) revealed right convexity and interhemispheric ASDH, mass lesions in the left frontal lobes, and brain herniation. Contrast-enhanced CT revealed vascular structures within the mass lesion. CT angiography (CTA) revealed no aneurysm or arteriovenous malformation, and the venous phase revealed occlusion in the anterior portion of the superior sagittal sinus. The patient had her right convexity and interhemispheric ASDH removed endoscopically. A mass lesion located on the falx, which was easily bleeding, soft, and suctionable, was immediately detected. Histopathological examination revealed fibrous meningioma, a benign meningioma of the World Health Organization grade 1. Despite undergoing aggressive treatment, the patient's general condition deteriorated. Conclusion: Hemorrhagic meningiomas can easily be missed with plain CT, and the enhancement effect of CTA and tumor shadow on digital subtraction angiography may not be observed during the acute phase. Surgery for nontraumatic ASDH should be performed considering the possibility that a meningioma causes it. [ABSTRACT FROM AUTHOR]

Background: Treatment of calcified lesions with conventional angioplasty balloons can be difficult due to insufficient lumen expansion, high dissection rates, and repeated revascularization. We report a case in which a scoring balloon was used in lesions resistant to angioplasty with a semi-compliant balloon. Case Description: A 72-year-old man presented with severe stenosis and a highly calcified lesion in the right cervical internal carotid artery. Right carotid artery stenting (CAS) was planned to prevent future ischemic stroke events. Conventional semi-compliant balloon angioplasty was unsuccessful. Three inflations of a non-slip element (NSE) percutaneous transluminal angioplasty (PTA) scoring balloon (Nipro, Osaka, Japan) successfully achieved CAS without complications. Conclusion: This is the first report to describe the use of this scoring balloon in de novo carotid artery disease. NSE PTA scoring balloon catheters can be a useful option for refractory, highly calcified stenosis. [ABSTRACT FROM AUTHOR]