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Irritable bowel syndrome (IBS) is a prevalent and complex gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. Observational studies have suggested a relationship between serum vitamin D levels and IBS symptoms. This systematic review and meta-analysis aimed to investigate the clinical effects of vitamin D supplementation on IBS symptom severity and quality of life (QoL) measures.Medline, Embase, Scopus, Web of Science, and The Cochrane Library databases were systematically searched. Data abstraction and quality assessment were conducted by four authors independently, and discrepancies were resolved through consensus from the senior author. Continuous data were pooled with standardized mean difference (SMD) using the DerSimonian and Laird's random-effects model. Sensitivity analysis by risk of bias and potentially "predatory" publication were performed as well.A total of 685 patients across eight studies were included in the meta-analysis. Vitamin D supplementation significantly improved IBS symptom severity scale scores, with a SMD of -0.77 (95% confidence interval [CI] -1.47 to -0.07, P = 0.04, IVitamin D supplementation could be part of our clinical armamentarium when managing IBS patients due to the potential efficacy and good safety profile. Further randomized, controlled trials are required to confirm the therapeutic effects.

In this study, we introduce an electronically controlled brake system (ECB) that can be applied to electric vehicles (EVs) and internal combustion engine vehicles (ICEVs). The main features of the ECB include maximizing the regenerative energy while maintaining vehicle stability and ensuring redundancy in automatic braking. The brake system consists of upper and lower units. The newly developed upper unit has a brake-by-wire configuration and can control the front and rear wheel pressures separately. Hereinafter, controlling the front and rear wheel pressures separately is referred to as two-channel pressure control. The regenerated energy can be maximized while appropriately maintaining the distribution of the front and rear braking forces based on the two-channel pressure control during regenerative cooperation. The lower unit is a conventional hydraulic unit for executing anti-lock brake control, electronic stability control and so on. Each of the upper and lower units has a pressure source and is connected via a communication bus. Thus, even if one of the pressure sources malfunctions during automatic braking, sufficient brake forces can be ensured by another brake system.

We investigated how the nutrient status of Matsushima Bay was affected when a wastewater plant was destroyed by a tsunami in March 2011. The nutrient concentrations in the seawater and the treated water from the wastewater plant increased just after the tsunami, but decreased again to pre-tsunami levels after 2013. The amount of untreated water that passed through the wastewater plant decreased just after the tsunami. It was estimated that approximately 40.7 × 103 m3/day of the treated water from the wastewater plant was discharged to Matsushima Bay; therefore, the quantity of effluent from the wastewater plant was less than one percent of the water inflow from Takagi River and Sendai Bay (which are outside Matsushima Bay) to Matsushima Bay. The nutrient concentrations of seawater in Sendai Bay were lower than those in Matsushima Bay. The results suggest that nutrient concentrations in Matsushima Bay after the tsunami did not increase because any untreated or poorly treated effluent was easily diluted by the river flow and the inflow of seawater. Many people were concerned about eutrophication, therefore, because of the decreased functioning of the wastewater plant in Matsushima Bay. Marked eutrophication in the bay was not observed after August 2011.

Objectives We performed a systematic review and meta-analysis of outcomes of lobectomy versus sublobar resection in elderly patients (≥65) with stage 1 nonsmall cell lung carcinoma (NSCLC). Methods We searched for relevant articles using a set of inclusion and exclusion criteria. Meta-analytic techniques were applied. Results Twelve studies (n = 5834) were chosen. Our results indicate that in the elderly, lobectomy for stage 1 NSCLC confers a survival advantage over sublobar resection. Lobectomy patients had a lower risk of death within 5 years and lower odds of local cancer recurrence. Our results show that lobectomy had a better 5-year cancer-specific survival and 5-year disease-free survival that trended toward significance. The sublobar resection group showed better 30-day operative mortality that trended toward significance. Subgroup analysis of stage 1A cancer demonstrated no difference in 5-year overall survival rates. However, for stage 1B tumors 5-year overall survival favored lobectomy. Conclusion Lobectomy for stage 1 NSCLC in elderly patients is superior to sublobar resection in terms of survival and cancer recurrence and should be afforded where possible. For stage 1A tumors, sublobar resection is noninferior and may be considered. Further randomized controlled trials in this topic is required.

Introduction In the past decade, minimally invasive pancreaticoduodenectomy has been gaining interest. However, minimally invasive pancreaticoduodenectomy remains technically challenging and is associated with a steep learning curve. Additionally, the operating surgeon should be cognizant of replicating the same oncological steps as observed in the typical open approach. In view of this, there exist various maneuvers that are designed to achieve negative margins and a safer mesopancreatic dissection. One of these techniques is the superior mesenteric artery first approach, which is garnering interest among pancreatic surgeons. Material and Methods According to existing literature, there are several superior mesenteric artery dissections approaches. We describes 5 different minimally invasive approaches. Results This multimedia manuscript provide, for the first time in literature, a comprehensive step-by-step overview of the superior mesenteric artery first approach for minimally invasive pancreaticoduodenectomy by a team of expert surgeons from various international institutions. Conclusions Through the tips and indications presented in this article, we aim to guide the choice of this approach according to tumor location, type of minimally invasive approach and the operating surgeon's experience and increase familiarity with such a complex procedure.

What is known and objective Immune checkpoint inhibitors can cause immune‐related adverse events (irAEs). Improved monitoring systems for irAEs, which include laboratory tests by a qualified multidisciplinary team, might prevent patients from irAE‐associated events. Kobe City Medical Center General Hospital developed protocol‐based pharmacist‐facilitated laboratory tests named protocol‐based pharmacotherapy management (PBPM) to aid the administration of immunotherapy to patients with lung cancer. The protocol defines the laboratory test items and times at which they should be performed. It requires pharmacists to check laboratory orders initiated by physicians and enter additional test items if the orders are incomplete. We evaluated the efficacy of PBPM in irAE monitoring and compared it with those of conventional care systems. Methods From January 2016 to March 2018, 114 patients with lung cancer received immunotherapy, which was managed by conventional care (conventional group). From April to September 2018, 62 patients were managed by PBPM (PBPM group), among those 28 patients were transited from conventional group to PBPM group. Data on whether the laboratory tests were conducted or omitted were collected retrospectively for the conventional group and prospectively for the PBPM group. Results Within the conventional group, 4604 (87.6%) out of the 5253 laboratory test items were ordered by physicians. Of the remaining 649 test items, 224 (4.3%) items were added by physicians based on recommendations by pharmacists. However, of the 1581 (86.6%, from among 1826) test items that were previously ordered by physicians, only 231 (12.7%) test items were added by pharmacists. The execution rate was found to be significantly higher in the PBPM group (99.2% vs 91.9%, P, We developed protocol‐based pharmacist‐facilitated laboratory tests named protocol‐based pharmacotherapy management (PBPM) to aid the administration of immunotherapy to patients with lung cancer. Our monitoring systems provided higher executing rate of laboratory order to monitor irAEs during immunotherapy.

Cancer-related anorexia/cachexia is known to be associated with worsened quality of life and survival; however, limited treatment options exist. Although megestrol acetate (MA) is often used off-label to stimulate appetite and improve anorexia/cachexia in patients with advanced cancers, the benefits are controversial. The present meta-analysis aimed to better elucidate the clinical benefits of MA in patients with cancer-related anorexia/cachexia. A systematic search of PubMed, EMBASE, OVID Medline, Clinicaltrials.gov, and Google Scholar databases found 23 clinical trials examining the use of MA in cancer-related anorexia. The available randomized, controlled trials were appraised using Version 2 of the Cochrane risk-of-bias tool (RoB 2) and they had moderate-to-high risk of bias. A total of eight studies provided sufficient data on weight change for meta-analysis. The studies were divided into high-dose treatment (>320 mg/day) and low-dose treatment (≤320 mg/day). The overall pooled mean change in weight among cancer patients treated with MA, regardless of dosage was 0.75 kg (95% CI = −1.64 to 3.15, τ2 = 9.35, I2 = 96%). Patients who received high-dose MA tended to have weight loss rather than weight gain. There were insufficient studies to perform a meta-analysis for the change in tricep skinfold, midarm circumference, or quality of life measures. MA was generally well-tolerated, except for a clear thromboembolic risk, especially with higher doses. On balance, MA did not appear to be effective in providing the symptomatic improvement of anorexia/cachexia in patients with advanced cancer.

Introduction: Central venous occlusive disease (CVOD) is a complication that can occur in patients with end-stage renal disease who are receiving hemodialysis. When CVOD develops, patients often require multiple re-interventions to maintain their dialysis access. CVOD can be treated by various strategies such as balloon angioplasty, stenting, lower limb or extra-anatomical grafts, hybrid grafts or surgical bypasses such as right atrial (RA). In this systematic review, we aim to evaluate the indications, technical aspects, and outcomes after RA bypass grafting for the treatment of CVOD in hemodialysis patients. Methods: A systematic and comprehensive literature search was conducted using various electronic databases. We included articles that reported described and reported outcomes of RA bypass grafting for the treatment of CVOD in hemodialysis patients. A narrative review of the indications and technical aspects of RA bypass grafting was performed. We also pooled and reported the primary patency, secondary patency, postoperative complications, and 30-day mortality of RA bypass grafting. Results: A total of 21 studies with 55 patients who underwent RA bypass grafting were included in our systematic review. Follow-up period ranged from 0.5 to 84 months. The mean pooled primary patency and secondary patency of RA bypass grafting were 8.1 ± 4.9 and 21.7 ± 20.1 months, respectively. The incidence of early postoperative complications such as surgical site infection, bleeding, and access thrombosis was 0%, 4%, and 4%, respectively. The overall 30-day mortality was 4%. Conclusions: This systematic review summarizes the patient characteristics, technical features and outcomes of RA bypass grafting in the treatment of hemodialysis-related CVOD. RA bypass grafting may be a viable last-resort option when less invasive or conventional treatment options have been exhausted.

With a growing number of survivors of sudden cardiac arrest globally, their natural disease progression is of interest. This systematic review and meta-analysis aimed to determine the risk of recurrence after sudden cardiac arrest and its associated risk factors.Medline, Embase, Cochrane Library and Scopus were searched from inception to October 2021. Studies involving survivors of an out-of-hospital sudden cardiac arrest event of any non-traumatic aetiology were included. Meta-analyses of proportions using the random-effects model estimated the primary outcome of first recurrent sudden cardiac arrest incidence as well as secondary outcomes including cumulative incidence of recurrence at 1-year and incidence of second recurrence among survivors of first recurrence. A recurrent episode was defined as a sudden cardiac arrest that occurs 28 or more days after the index event. Subgroup and meta-regression analyses were conducted for predetermined variables. The Newcastle-Ottawa Scale was used to assess risk of bias for most studies.35 studies of moderate to high quality comprising a total of 7186 survivors were analysed. The pooled incidence of first recurrence was 15.24% (32 studies; 95%CI, 11.01-19.95; mean follow-up time, 41.3 ± 29.3 months) and second recurrence was 35.03% (3 studies; 95%CI, 19.65-51.93; mean follow-up time, 161.1 ± 54.3 months). At 1-year, incidence of recurrence was 10.62% (3 studies; 95%CI, 0.25-30.42). Subgroup analyses found no significant difference (p = 0.204) between incidence of first recurrence published from 1975-1992 and 1993-2021, and between studies with mean follow-up time of24 months, 24-48 months, and48 months. On meta-regression, initial shockable rhythm increased incidence of first recurrence (p = 0.01).15.24% of sudden cardiac arrest survivors experienced a recurrence, and of these, 35.03% experienced a second recurrence. Most recurrences occurred in the first year. Initial shockable rhythm increased this risk. Despite the limitations of inter-study heterogeneity, these findings can still guide intervention and follow-up of sudden cardiac arrest survivors.

Pain is an exceedingly common complaint in the pre-hospital setting. Despite advancements in organizational protocols and guidelines, many emergency medical services (EMS) systems still fail to provide optimal pain management. This scoping review thus aimed to map the body of qualitative literature pertaining to factors influencing pre-hospital analgesia administration and practice in order to clarify concepts and understanding as well as to identify any knowledge gaps.The review protocol was guided by the framework outlined by Arksey and O'Malley and ensuing recommendations made by Levac and colleagues. Five databases were searched from inception till October 26, 2021, namely MEDLINE, EMBASE, CINAHL, The Cochrane Library, and Scopus. The search strategy was developed in consultation with a medical information specialist. A total of 5848 records were screened by abstract and title by four independent researchers. 199 records were included for full text review. From these, 15 articles were eligible for thematic analysis based on pre-defined inclusion criteria.Included studies found that practitioner, patient, and environmental factors influenced the administration and practice of pre-hospital analgesia. Key barriers included the difficulty in assessing pain, poor inter-professional relationship, knowledge deficits, stress and anxiety, and miscellaneous factors, such as concerns over drug-seeking behaviours. Some possible solutions were proposed, and pre-hospital EMS systems and healthcare institutions could consider bridging some of these gaps. There was a notable paucity of Asian studies, and a variety of EMS settings with different protocols and workflows were examined, hence systemic factors including guidelines and legislations cannot and should not be generalized across every healthcare system.The factors influencing pre-hospital analgesia administration and practice remain incompletely understood. Existing tools and practice guidelines were also inadequate. This scoping review provided an overarching perspective of the extant literature, highlighting some of the significant barriers, enablers, and areas for further research.

Historically , liver metastases due to melanoma have been associated with dismal prognosis. Moreover, the actual survival benefit from the treatment of melanoma liver metastases is still controversial. Hence, this study aims to evaluate the difference in surgical versus non-surgical options for melanoma liver metastases.Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to July 17, 2022. Studies were included if they compared outcomes between surgical and non-surgical treatment for patients with liver metastases from resectable melanoma. Meta-analyses were performed for the outcomes of 1-year, 2-year, 3-year and 5-year OS. Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity. To account for possible moderators that might contribute to statistical heterogeneity, univariate meta-regression with mixed-effects models and subgroup analyses were conducted for the outcome of 2-year OS.The search yielded 6610 articles; 13 studies were included in our analysis. Meta-analyses showed that survival outcomes were in favour of patients undergoing surgery as compared to non-surgery: 1-year OS (HR = 0.29, 95%CI 0.19-0.44, p 0.00001), 2-year OS (HR = 0.19, 95%CI 0.09-0.38, p 0.00001), 3-year OS (HR = 0.07, 95%CI 0.03-0.19, p 0.00001) and 5-year OS (HR = 0.07, 95%CI 0.02-0.22, p 0.00001). All included studies were of high quality. There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses. Subgroup analyses and univariate meta-regression revealed neoadjuvant therapy and age as statistically significant subgroup and moderator respectively.This study suggests that surgical treatment of melanoma liver metastases could offer better OS outcomes compared with non-surgical treatment.

ObjectivesMore patients are being diagnosed with exertional rhabdomyolysis secondary to indoor spinning. We conducted a systematic review to characterize the clinical characteristics of this new clinical entity.MethodsWe conducted a thorough literature search on PubMed, Embase, Web of Science, Scopus and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published from inception till 23rd June 2021 were considered for inclusion. A two-stage article selection process was performed. Articles that reported clinical characteristics and outcomes for patients with SIER were included. Quality assessment was performed using the Joanna Briggs Institute checklists.ResultsThere was a total of 22 articles and 97 patients with SIER. Most patients were healthy females who had attended their first spinning session. The average time to clinical presentation was 3.1 ± 1.5 days. The most common presenting symptoms were myalgia, dark urine and muscle weakness involving the thigh. Seven patients (7.2%) developed acute kidney injury, and two patients (2.1%) required temporary inpatient haemodialysis. Four patients (4.1%) developed thigh compartment syndrome and required fasciotomies. There were no long-term sequelae or mortality observed. The average length of stay was 5.6 ± 2.9 days.ConclusionsHealthcare professionals must have a high index of suspicion of SIER if any patient presents with myalgia, dark urine or weakness after a recent episode of indoor spinning. Fitness centre owners, spinning instructors and participants should also be better educated about the clinical characteristics and manifestations of SIER.

Introduction: Bystander cardiopulmonary resuscitation (B-CPR) with early defibrillation and immediate emergency medical services (EMS) care significantly increases a victim's chance of survival from out-of-hospital sudden cardiac arrest (OHCA). Few studies have assessed the overall effect of the COVID-19 pandemic on the prehospital chain of survival. Objectives: We sought to quantify the effect of the COVID-19 pandemic on prehospital processes including B-CPR, bystander defibrillation, community characteristics, and EMS process measures. We hypothesized that B-CPR rates would decrease and OHCA occurring in the home would increase during the pandemic. Methods: We conducted a systematic review and meta-analysis of studies identified through 05/03/2021. We examined 5 bibliographic databases and searched terms including cardiac arrest, OHCA, and COVID-19. Data were abstracted and independently coded. Subgroup analysis and meta-regression analysis were performed. Our primary outcome was B-CPR; our secondary outcomes were community processes and EMS characteristics. Results: The original search yielded 966 articles; 20 articles were included in our analysis. Studies originated from 10 different countries and were retrospective in study design. There was no difference in B-CPR rates during COVID-19 compared to Pre-COVID-19 (OR: 0.94 (0.80-1.11), p=0.46). Patients had a 1.38 (1.11-1.71) higher likelihood of having an OHCA at home during COVID-19 compared to Pre-COVID-19 (p=0.01). Receipt of bystander defibrillation was significantly lower during COVID-19 compared to Pre-COVID-19 (OR: 0.65 (0.48-0.88), p=0.01). There was a significant increase in EMS call to arrival time during COVID-19 compared to Pre-COVID-19 (Mean difference in minutes= 0.27 (0.13-0.40), p Conclusion: B-CPR rates remained unchanged during the pandemic, while OHCA in the home increased. Bystander defibrillation decreased, while EMS response time increased during the pandemic. These findings may inform future public programing, particularly to consider interventions to improve the prehospital chain of survival.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has influenced epidemiology through direct and indirect effects, yet the impact on out-of-hospital cardiac arrest (OHCA) is unclear. We aimed to evaluate the impact of the pandemic on the incidence, characteristics, and clinical outcomes of OHCA. Hypothesis: We hypothesized that compared to the pre-pandemic period, the COVID-19 pandemic period was associated with increased incidence and case fatality rate (CFR) of OHCA, as well as decreased rates of intermediate clinical outcomes (termination of resuscitation [TOR], return of spontaneous circulation [ROSC], survival to hospital admission, and survival to hospital discharge). We further postulated that there was a change in the etiologies of OHCA during the pandemic as well as a decline in the rate of shockable rhythm as the initial presenting rhythm. Methods: In this systematic review and meta-analysis, five scientific databases were searched from inception to May 3, 2021. Meta-analyses were performed for the primary outcomes, secondary outcomes, and clinical characteristics. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results: The search yielded 966 articles. 20 articles were included for analysis. The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p Conclusions: The COVID-19 pandemic was associated with significant changes in OHCA epidemiology. Compared to the pre-pandemic period, the pandemic period was associated with increased OHCA incidence and worse outcomes.

AIMS Recent studies have provided the concept of invasive intramucosal colorectal carcinoma (CRC), and a case of intramucosal CRC with lymphatic invasion has been reported; however, the characteristics of such cases and the risk of lymph node metastasis have never been investigated. Therefore, we aimed to assess the pathological characteristics of intramucosal CRCs with lymphovascular invasion as well as the possibility of lymph node metastasis as an indication for additional surgery. METHODS AND RESULTS To delineate the histological features of intramucosal CRCs with lymphovascular invasion, we analysed several histological features and compared their incidence among nine such cases, as well as 20 other cases of intramucosal CRCs without lymphovascular invasion. High-grade tumour budding and a pattern of 'eosinophilic cytoplasm and round nuclei with inflammatory reaction (ERI)' were morphological characteristics of intramucosal CRCs with lymphovascular invasion, compared with those without lymphovascular invasion (both P

Pulmonary pleomorphic carcinoma is a rare tumor with a poor prognosis and has no standard chemotherapy. We herein report a case of small intestinal metastasis of pulmonary pleomorphic carcinoma that resulted in intestinal bleeding and was successfully treated with pembrolizumab monotherapy.A 54-year-old man with a history of pulmonary pleomorphic carcinoma resection was referred to our hospital due to a 1-month history of a fever and general fatigue.Laboratory investigation revealed microcytic anemia. Hematochezia was also noted after admission. Computed tomography (CT) and positron emission tomography (PET)/CT at the time of this admission revealed intraperitoneal masses alongside the small intestine with no significant ascites.Pembrolizumab (400 mg/body) was introduced as the first-line chemotherapy.By the 15th day after the initial pembrolizumab administration, the fever had disappeared, and the intraperitoneal masses were markedly reduced. Hematochezia had also disappeared, and he no longer needed to receive blood transfusions.To our knowledge, this is the first report in which small intestinal metastasis of pulmonary pleomorphic carcinoma was successfully controlled by pembrolizumab monotherapy. Immune checkpoint inhibitors may be promising therapeutic agents against pulmonary pleomorphic carcinoma.

Bystander cardiopulmonary resuscitation (BCPR) and early defibrillation can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of COVID-19 on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR=1.38, 95%CI 1.11-1.71, p=0.0069). BCPR did not differ between COVID-19 and Pre-COVID-19 populations (OR=0.94, 95%CI 0.80-1.11, p=0.4631), although bystander defibrillation was significantly lower during the COVID-19 period (OR=0.65, 95%CI 0.48-0.88, p=0.0107). EMS call-to-arrival time was significantly higher in COVID-19 populations (SMD=0.27, 95%CI 0.13-0.40, p=0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.

BACKGROUND Eccrine porocarcinoma (EP) is a rare malignant skin neoplasm, and there are still many unknowns regarding its natural history and treatment. Due to its scarcity, associated brain metastasis is a far rarer condition. OBSERVATIONS A 71-year-old-woman with a history of EP was diagnosed with brain metastasis. In her clinical course, the patient underwent tumor removal surgery twice and Gamma Knife radiosurgery (GKRS) four times. The tumor showed a good response to radiotherapy. The histopathological findings of the brain tumor were consistent with those of the primary skin tumor. LESSONS There are only a few case reports referring to the detailed treatment, especially with GKRS, of brain metastasis from EP. Few reports have presented a detailed histopathological comparison between the primary skin lesion and the metastatic brain lesion. Herein, the authors have described the clinical course, histological features, and results of multidisciplinary treatment for brain metastasis of EP.

Subsurface chlorophyll maxima are widely observed in the ocean, and they often occur at greater depths than maximum phytoplankton biomass. However, a consistent mechanistic explanation for their distribution in the global ocean remains lacking. One possible mechanism is photoacclimation, whereby phytoplankton adjust their cellular chlorophyll content in response to environmental conditions. Here, we incorporate optimality-based photoacclimation theory based on resource allocation trade-off between nutrient uptake and light harvesting capacity into a 3D biogeochemical ocean circulation model to determine the influence of resource allocation strategy on phytoplankton chlorophyll to carbon ratio distributions. We find that photoacclimation is a common driving mechanism that consistently explains observed global scale patterns in the depth and intensity of subsurface chlorophyll maxima across ocean regions. This mechanistic link between cellular-scale physiological responses and the global scale chlorophyll distribution can inform interpretation of ocean observations and projections of phytoplankton responses to climate change. Trade-offs in the cellular allocation of resources in response to environmental conditions consistently explain the depths of subsurface chlorophyll maxima across the global ocean, according to simulations with a biogeochemical ocean circulation model.

Nodal metastatic foci of colorectal carcinoma are usually solid nodules. Serous inclusions are occasionally found in lymph nodes, particularly in female patients, and they occasionally form cysts. An 86-year-old woman was treated with laparoscopic low anterior resection and D3 lymph node dissection for advanced rectal carcinoma. A cyst with serous fluid and no necrotic debris was found within one of the dissected pararectal lymph nodes. Histologically, the cyst was lined by low columnar-to-cuboid epithelium with mild nuclear atypia, mimicking a serous inclusion cyst. Immunohistochemically, the epithelial cells were positive for caudal type homeobox 2 and negative for Wilms’ tumor suppressor gene1. Immunohistochemistry for p53 showed a diffuse strong positivity, indicating a mutant TP53 as seen in primary rectal carcinoma. Thus, the nodal cystic lesion was confirmed to be a metastatic lesion. It is important to carefully assess a nodal cystic lesion to confirm whether it is benign or malignant.

The age and growth of Japanese jack mackerel Trachurus japonicus from Oita and Miyagi Prefectures were investigated by means of otolith sectioning. Different types of opaque zones were formed in summer and winter, respectively. The age composition and growth formulas were examined and compared for Oita (2007–2008) and Miyagi (2016–2017) Prefectures from individual age data. We determined that the age–length relationships and parameters for the von Bertalanffy growth function from Oita and Miyagi Pref. were, respectively, L∞ = 342 and 305 mm and k = 0.673 and 0.634 year−1. In Oita Pref., most fish with a fork length (FL) of approximately 180–200 mm were 1+ years of age, while older fish (7+) were rare. In Miyagi Pref., many fish were 3–6+ years of age. Older fish (over 7+ years) accounted for approximately one quarter of the total. These differences in the growth curve and age composition may be reflected by discrepancies in the fishing gears, and multiple life cycle patterns of the Pacific stock which has been unknown.

Production of furfural by means of xylose degradation was investigated at 423 K with zeolites or an ion-exchange resin as a solid acid catalyst in water, water/toluene, or water/CO2. All the catalysts gave higher xylose conversions than did hydrothermal conditions without a catalyst. When the ion-exchange resin (Amberlyst 70) was used as the catalyst, furfural extraction with toluene effectively increased the yield relative to that of the reaction in water alone. The furfural yield obtained with the water/CO2 batch system was lower than that with the biphasic water/toluene system because the solubility of furfural in supercritical CO2 was lower than that in toluene. The furfural yield was increased by using a semibatch reactor system with continuous CO2 flow. The maximum furfural yield (52.3%) was achieved with Amberlyst 70 and a CO2 flow rate of 3.77 g min–1 at 423 K.

Metastatic diseases rarely develop in the colorectum, and diagnosing colorectal metastasis by biopsy without history of a malignant tumor or clinical information of a primary tumor is challenging. A 65-year-old woman with a 6-month history of constipation and diarrhea was admitted to our hospital and diagnosed with rectosigmoid colonic micropapillary carcinoma. Low anterior resection was performed after neoadjuvant chemotherapy. Because the lipoleiomyoma in the uterus obstructed the operator’s vision, total hysterectomy and bilateral salpingo-oophorectomy were performed. Examination of the colon and adnexa, together with immunohistochemical studies, revealed that the colonic tumor was actually serous carcinoma that had metastasized from the left fimbria of the fallopian tube. Retrospective immunohistochemical examination of the colon biopsy specimen suggested carcinoma with a Müllerian immunophenotype. When a colon biopsy reveals carcinoma with an invasive micropapillary pattern without a component of conventional tubular adenocarcinoma, immunohistochemical examination should be performed to rule out the possibility of metastasis.

Here, we report the development of catalysts comprising highly dispersed Au on an alumina (Al2O3) support for the oxidation of glycerol to high-value carboxylic acids in a liquid-phase flow reactor. The catalysts were prepared by means of a deposition–precipitation method. To ensure that the catalysts could be used for long-term catalytic conversions in a liquid-phase flow reactor, we chose an alumina support with high temperature stability and a particle size (50–200 μm) large enough to prevent leakage of the catalyst from the reactor. One of the five catalysts had a high catalytic activity for the conversion of glycerol to the high-value carboxylic acids, glyceric acid and tartronic acid (conversion of glycerol >70%), and the catalyst retained its catalytic activity over long-term use (up to 1770 min). Pretreatment of the catalyst with fructose, a mild reductant, increased the activity of the catalyst. Scanning transmission electron microscopy revealed three Au species highly dispersed on the surface of the alumina support—Au nanoparticles (mode = 7.5–10 nm), Au clusters (1–2 nm), and atomic Au.

In this paper, we describe three morphotypes of large parasitic copepods identified as Pennella Oken, 1815 (Siphonostomatoida, Pennellidae), which are found on the commercial fish Pacific saury Cololabis saira (Brevoort, 1856) (Beloniformes, Scomberesocidae). Of three morphotypes (Pennella sp. (PSP), parasite A (PA), and indeterminate individuals (IDI)), PSP had feather-like abdominal brushes and egg sacs which were characters typical of Pennella, PA lacked abdominal brushes and egg sacs, and IDI had few abdominal brushes but no egg sacs. Nucleotide sequence differences of mitochondrial cytochrome oxidase subunit I (COI) and nuclear ribosomal internal transcribed spacer 1 (ITS1) regions between types were small and comparable with differences within a type, indicating that the three types were conspecific. Mean body length of PSP was significantly larger than those of PA and IDI, suggesting types PA and IDI were immature morphs of PSP or individuals that had ceased development prior to maturation.

Ecosystem models are used to understand ecosystem dynamics and ocean biogeochemical cycles and require optimum physiological parameters to best represent biological behaviours. These physiological parameters are often tuned up empirically, while ecosystem models have evolved to increase the number of physiological parameters. We developed a three-dimensional (3-D) lower-trophic-level marine ecosystem model known as the Nitrogen, Silicon and Iron regulated Marine Ecosystem Model (NSI-MEM) and employed biological data assimilation using a micro-genetic algorithm to estimate 23 physiological parameters for two phytoplankton functional types in the western North Pacific. The estimation of the parameters was based on a one-dimensional simulation that referenced satellite data for constraining the physiological parameters. The 3-D NSI-MEM optimized by the data assimilation improved the timing of a modelled plankton bloom in the subarctic and subtropical regions compared to the model without data assimilation. Furthermore, the model was able to improve not only surface concentrations of phytoplankton but also their subsurface maximum concentrations. Our results showed that surface data assimilation of physiological parameters from two contrasting observatory stations benefits the representation of vertical plankton distribution in the western North Pacific.

Background Irinotecan (CPT-11) is the key drug used in chemotherapy for many malignant tumors. CPT-11 has cholinergic activity and induces perspiration during intravenous administration. In this study, concentrations of CPT-11 and its active metabolite, SN-38, released during perspiration were measured and risk of exposure of these drugs was assessed. Method Beads of sweat were collected using a dropper from four patients undergoing a chemotherapy regimen involving intravenous administration of CPT-11. The concentrations of CPT-11 and SN-38 in sweat were measured using liquid chromatography tandem mass spectrometry. Result Chemotherapy regimens were capecitabine and irinotecan plus bevacizumab (n = 1), CPT-11 monotherapy (n = 1), and oxaliplatin–irinotecan–leucovorin–5-fluorouracil (n = 2). Uridine diphosphate-glucuronosyltransferase 1A1 phenotypes were *6 homo-type (n = 1), *6 hetero-type (n = 1), and wild type (n = 2). CPT-11 dose was 292.3 ± 75.5 mg/body weight (mean ± standard deviation). CPT-11 was detected in sweat secreted by all the four patients, and its mean (±standard deviation) concentration was 252.6 (±111.9) ng/ml. SN-38 was detected in only one of the patients who received oxaliplatin–irinotecan–leucovorin–5-fluorouracil treatment and who had the wild-type uridine diphosphate-glucuronosyltransferase 1A1 phenotype at a concentration of 74.37 ng/ml. Conclusion CPT-11 and SN-38 are detected in sweat released during intravenous CPT-11 administration. Beads of sweat or linen clothes that absorb the sweat might be the source of CPT-11 and SN-38 exposure.