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Fertility control has traditionally been applied in zoos to control captive populations, and reversible contraception is important. However, contraceptive methods for male bears have not been reported. We aimed to establish a reversible contraceptive for male brown bears by investigating the effects of a gonadotropin-releasing hormone (GnRH) vaccine (Improvac®) that was developed for the immune castration of pigs. We vaccinated six bears with two sequential doses of 400 (n = 2) or 600 μg Improvac® (n = 4) with a 1-month interval during the pre-breeding season (February to April). We compared the reproductive parameters (testosterone levels and semen parameters) of the six vaccinated and four non-vaccinated (control) bears once during the breeding season (May or June). To investigate whether the reproductive performance could be restored in the following year of contraception, we also compared the reproductive parameters once during the breeding season in two bears between the year with GnRH vaccination and the following year without vaccination. Vaccination treatments suppressed reproductive parameters in 5 bears, although vaccination with 400 μg of Improvac® was not effective in one bear. Testosterone levels and the rate of progressive sperm motility were significantly lower, and total sperm count and testis size tended to be lower in vaccinated bears, compared with the controls. Blood biochemical findings and direct observations after Improvac® vaccination did not reveal side effects. Moreover, testosterone levels and spermatogenic scores of two bears were restored in the following year. We confirmed that the Improvac® vaccine elicited a reversible contraceptive effect in male brown bears., (© 2024 Wiley‐VCH GmbH. Published by John Wiley & Sons Ltd.)

Bone morphogenetic proteins (BMPs), regulators of bone formation, have been implicated in embryogenesis and morphogenesis of various tissues and organs. BMP signaling plays a role in the formation of appropriate synaptic connections and development of normal neural circuits in the brain. However, physiological roles of BMP signaling in postnatal neural functions, including synaptic plasticity, remain largely unknown. Long-term depression (LTD) of synaptic transmission at parallel fiber (PF)-Purkinje cell (PC) synapses in the cerebellum has been suggested one neuronal mechanism underlying cerebellar functions. Here, we explored the contribution of BMP signaling to the induction of mouse cerebellar LTD. We first demonstrated that BMP2 and/or 4 were expressed in GABAergic neurons in mature networks of the cerebellar cortex. mRNA encoding BMP receptor type 1B (Bmpr1b) was expressed in the PC layer. Exogenous application of noggin, a BMP ligand inhibitor, suppressed the induction of cerebellar LTD by conjunctive stimulation, which caused normal LTD under control condition. Furthermore, mice deficient in BMPR1B exhibited attenuation of the extent of LTD induction, whereas they showed normal excitatory synaptic transmission at PF-PC synapses. These results suggest that after postnatal development, BMP signaling activated by BMPR1B, expressed in the PC layer, plays a crucial role in the facilitation of cerebellar LTD, leading to the modulation of cerebellar functions and behaviors., (© 2024 International Society for Neurochemistry.)

The loss of a cyclic change with two peaks of increased endometrial epidermal growth factor (EGF) concentration on days 2-4 and 13-14 during the estrous cycle has been linked to low fertility in repeat breeder (RB) cows. We have shown that an intravaginal infusion of osteopontin (OPN) restored the EGF profile in RB cows. The present study aimed to determine a structural element of OPN to restore the normal EGF profile and fertility. Holstein RB cows were diagnosed the EGF profile by a single examination of the endometrial EGF concentration on day 3 of the estrous cycle. Those with an altered EGF profile were intravaginally infused with OPN and its fragments on the day of insemination (day 0); the concentration of endometrial EGF was measured on day 3, and pregnancy was diagnosed on days 30-35. In Study 1, recombinant OPN (rOPN) (16 nmol), thrombin-cleaved N- and C-terminal fragments of rOPN (N-rOPN and C-rOPN, respectively), and a combination of these fragments (Th-rOPN) were infused (n = 13-20). The restoration rate of the normal EGF profile of the N-rOPN group (25.0 %) was a level in between the C-rOPN group (7.7 %) and both the rOPN (55.6 %) and Th-rOPN (64.3 %) groups. In Study 2, PBS (n = 47), rOPN (9.5 nmol, n = 83), and peptides of integrin binding motifs, GRGDSVAYGLK (peptide 1; 32, 320, and 1600 nmol), GRGDS (peptide 2; 320 and 1600 nmol), and SVAYGLK (peptide 3; 320 and 1600 nmol), were infused (n = 20-25). Restoration rates of the normal EGF profile of peptide 1 (320 and 1600 nmol) and peptide 3 (1600 nmol) groups (44.0-56.3 %) were comparable with those of the rOPN group (63.9 %) and higher than those of the PBS group (15.6 %). Restoration rates of the other groups were similar to those of the PBS group. Additional cows received infusions to determine the effect on fertility. Conception rates of the peptide 1 (320 and 1600 nmol; n = 50 each), peptide 3 (1600 nmol; n = 55), and rOPN (n = 111) groups (41.8-50.0 %) were comparable and higher than that of the PBS group (21.6 %, n = 75). In Study 3, PBS (n = 24), peptide 1 (320 nmol; n = 78), and GRGESVAYGLK peptide (peptide 4; 320 and 1600 nmol; n = 50 and 26, respectively) were infused. Restoration rates of the normal EGF profile of peptide 4 and PBS groups (16.0-19.2 %) were comparable and lower than those of the peptide 1 group (44.9 %). Thus, the SVAYGLK motif may be an OPN structural element to restore the normal EGF profile and fertility in RB cows, and the RGD motif may enhance its effect., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The cortico-basal ganglia loop has traditionally been conceptualized as consisting of three distinct information networks: motor, limbic, and associative. However, this three-loop concept is insufficient to comprehensively explain the diverse functions of the cortico-basal ganglia system, as emerging evidence suggests its involvement in sensory processing, including the auditory systems. In the present study, we demonstrate the auditory cortico-basal ganglia loop by using transgenic mice and viral-assisted labelings. The caudal part of the external globus pallidus (GPe) emerged as a major output nucleus of the auditory cortico-basal ganglia loop with the cortico-striato-pallidal projections as its input pathway and pallido-cortical and pallido-thalamo-cortical projections as its output pathway. GABAergic neurons in the caudal GPe dominantly innervated the nonlemniscal auditory pathway. They also projected to various regions, including the substantia nigra pars lateralis, cuneiform nucleus, and periaqueductal gray. Considering the functions associated with these GPe-projecting regions, auditory cortico-basal ganglia circuits may play a pivotal role in eliciting defensive behaviors against acoustic stimuli., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 Tomioka et al.)

Objective: Acute aortic dissection (AAD) is a life-threatening condition that necessitates rapid medical intervention. In Japan, helicopter emergency medical services (HEMS) are deployed using either keyword-based early requests or standard requests from ground emergency medical services (GEMS). This study evaluates the impact of these request methods on patient outcomes., Methods: We conducted a retrospective cohort study using data from the Japanese Society for Aeromedical Services registry from April 2015 to March 2020. A total of 342 AAD patients transported by HEMS were analyzed, excluding those with out-of-hospital cardiac arrest. Patients were categorized based on whether HEMS was requested using a keyword method or after initial GEMS contact. We compared the groups on time intervals, prehospital interventions, and outcomes including Cerebral Performance Category., Results: The time from GEMS awareness to HEMS contact was significantly shorter in the keyword methods group compared with the control group (median 27 vs. 33 minutes, respectively; P < .001). No significant difference was observed in the time from contact to departure from the scene. Patient characteristics, vital signs at HEMS staff contact, and medical interventions provided by HEMS staff showed no statistically significant differences. Changes in vital signs from HEMS staff contact to hospital arrival included a significant decrease in the respiratory rate and systolic blood pressure. Patients in the keyword methods group had a significantly higher proportion of favorable outcomes in terms of Cerebral Performance Category compared with the control group (77.2% vs. 66.5%, P = .03). However, logistic analysis did not show significant differences (odds ratio = 1.007; 95% confidence interval, 0.987-1.016; P = .814)., Conclusion: Keyword methods for early HEMS requests may appear to reduce time to specialty care and suggest improvement of outcomes for patients with AAD., Competing Interests: Declaration of Competing Interest This work was supported in part by a Grant in-Aid for Special Research in Subsidies for the ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan., (Copyright © 2024 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

A 47-year-old woman with a history of substance abuse, depression, and insomnia experienced a collapse. Upon arrival at the hospital, the patient displayed low systolic blood pressure, confusion, dehydration, and renal failure. Urine tests confirmed an amphetamine and opioid overdose. Her condition fluctuated with reduced consciousness, myoclonic movements, fever, and suspected psychogenic seizures. Brain magnetic resonance imaging revealed abnormalities in the splenium of the corpus callosum, which later resolved. The patient's condition gradually improved without any specific treatment. This unique case represents the first report of mild encephalopathy/encephalitis with reversible splenial lesions associated with amphetamine and opioid use.

Spontaneous non-aneurysmal gastroepiploic arterial hemorrhage is a rare occurrence, and its association with celiac axis compression syndrome (CACS), also referred to as median arcuate ligament syndrome (MALS), is even more uncommon. Furthermore, nontraumatic intraperitoneal hemorrhage due to defecation strain is also rare. This study reports an extremely rare case of non-aneurysmal gastroepiploic arterial hemorrhage with CACS/MALS after defecation strain. A 24-year-old man presented with a sudden upper abdominal pain on the left side after defecation. The patient was diagnosed with bleeding from the gastroepiploic artery and CACS/MALS using contrast-enhanced computed tomography. The patient underwent urgent laparotomy, and subsequent pathogenic examination revealed no aneurysm. This was an atypical case of intraperitoneal hemorrhage with CACS/MALS, and hemorrhage may have occurred due to a combination of vascular fragility, elevated arterial blood pressure, and hemostatic disorder., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Nagasawa et al.)

Objective: To investigate the differences between doctor helicopters (DHs) and disaster medical assistance teams (DMATs), based on past examples and the current situation in Shizuoka Prefecture., Materials and Methods: First, we examined cases in Shizuoka Prefecture from 2014 to 2023, wherein incidents involving five or more injured individuals were managed using multiple DHs simultaneously. Next, we investigated the presence of DMATs in Shizuoka Prefecture and assessed their role in disaster responses within the prefecture., Results: Since 2014, there have been eight incidents in Shizuoka Prefecture wherein multiple DHs were deployed to respond to mass casualties. Shizuoka DMATs were placed on standby thrice during the same period, with one active deployment during a disaster caused by a landslide in Atami. The other two cases were managed solely by DHs and ambulance teams., Conclusion: Localized disasters in Shizuoka Prefecture have seen the effective use of multiple DHs for timely patient transportation, particularly when weather conditions were suitable. By contrast, DMATs are primarily deployed for extended medical activities lasting more than one day. This differentiation highlights the importance of choosing an appropriate medical response approach based on the nature and scope of a disaster., Competing Interests: The authors do not have conflicts of interest to declare., (©2024 The Japanese Association of Rural Medicine.)

There have been few reports concerning simulation drills for the relocation of severely ill or injured patients treated in intensive care units (ICUs). We herein report our experience of one such simulation drill. It is a Narrative method. A simulation drill was performed on a weekday 2 weeks prior to the actual relocation. We selected 3 mock patients. The first one was a severely ill and unstable patient, the second had severe stroke, and the third had severe trauma. After the simulation, the average transportation time was 15 minutes. The simulation revealed that mock patients with a percutaneous cardiopulmonary support system and intra-aortic balloon pumping in a standard ICU bed could not be accommodated in the elevator. Furthermore, working the elevator controls resulted in wasted time while transferring the patients. As a result, the number of people, who controlled the elevator, was therefore increased during the actual relocation. During the actual relocation, all patients were transported safely and more quickly than predicted based on the results of the simulation drill. Most physicians and paramedical staff have little experience with relocating ICUs, so a simulation drill was necessary to ensure the safe and prompt transport of patients., Competing Interests: The authors declare no conflicts of interest in association with the present study., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Macrophages polarize into alternatively activated M2 macrophages through interleukin (IL)-4, and they express high levels of arginase-1, which promotes anti-inflammatory responses. Several studies have confirmed the anti-inflammatory effects of cyclin-dependent kinase (CDK) 8/19 inhibition, and hence, numerous CDK8/19 inhibitors, such as BRD6989, have been developed. However, the effects of CDK8/19 inhibitors on arginase-1 expression in macrophages have not yet been elucidated. This study investigated the effects of CDK8/19 inhibitor on arginase-1 expression in IL-4-activated macrophages. The results showed that BRD6989 increased arginase-1 expression transcriptionally in murine peritoneal macrophages and the murine macrophage cell line RAW264.7 in an IL-4-dependent manner. In addition, the results indicated that BRD6989 enhances signal transducer and activator of transcription (STAT) 6 phosphorylation. Meanwhile, BRD6989 exhibited the capability to activate p38 mitogen-activated protein kinase (MAPK） even in the absence of IL-4 stimulation. Moreover, we observed that a p38 MAPK inhibitor suppressed the BRD6989-induced increase in arginase-1 expression. Besides, BRD6989 increased the surface expression of CD206, an M2 macrophage marker. Thus, this study demonstrated for the first time that CDK8/19 inhibition increases arginase-1 expression, suggesting that this mechanism involves the activation of STAT6 and p38 MAPK. This finding implies that CDK8/19 inhibition may facilitate the production of anti-inflammatory M2 macrophages., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Acute airway obstruction, whether partial or complete, requires immediate intervention to prevent fatal outcomes. An 81-year-old man with a history of pneumonia experienced respiratory distress after attempting to swallow a large piece of meat. Despite attempts by his daughter, back blows and abdominal thrusts failed to dislodge the obstruction, and he collapsed, prompting an emergency call. Upon the arrival of the emergency medical team, the patient was conscious with good oxygen saturation but deteriorated during transport, becoming unresponsive and unable to cough. Upon assessment by the doctor helicopter team, the patient's condition was critical with low oxygen saturation and unstable vital signs. Using a laryngoscope, the team identified a large meat fragment near the vocal cords and successfully removed it, relieving the obstruction. The patient's respiratory distress improved, and he was transported to the hospital without the need for intubation. Further examination at the hospital revealed sinus tachycardia and lung abnormalities on a computed tomography scan but no significant abnormalities in blood tests. The patient was admitted for observation and received antibiotics for prophylaxis. He recovered well, with no further need for oxygen by the second day and was discharged on the fourth day, highlighting the importance of prompt intervention in airway emergencies., Competing Interests: Declaration of competing interest The author(s) have no relevant disclosures. There was no grant funding or financial support for this manuscript., (Copyright © 2024 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.)

Background: Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS., Methods: The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians' interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed., Results: Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11-5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16-6.64) may have increased the return of spontaneous circulation (ROSC) rate., Conclusions: The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)

Cardiovascular disease is one of the most important complications in girls and women with Turner syndrome (TS). Although the latest international guideline provides useful suggestions for the management of cardiovascular diseases in TS, some unknown cardiac conditions warrant physicians' attention and awareness. Here, we have reported two adult cases wherein significant cardiovascular diseases were detected during the transition period. The first case patient was diagnosed with aortic crank deformity and left subclavian artery aneurysm at 14 years based on the report of cardiac catheterization, computed tomography angiography, and cardiac magnetic resonance imaging, which had remained undetected by annual evaluations using transthoracic echocardiography (TTE). This case emphasizes the importance of cardiac reevaluation during the transition period. The second case patient was diagnosed with moderate mitral valve regurgitation (MR) due to mitral valve prolapse at 18 years through TTE, although the first evaluation at 7 years by TTE detected slight MR without any clinical concerns. The condition however progressed to severe MR at 28 years, requiring mitral valvuloplasty. MR is the most common valve disease worldwide, which makes it challenging to comprehend whether the condition is a complication. However, the condition requiring surgery at this age is extremely rare, which implies the possibility of early progression. Because almost all literature on cardiovascular complications in TS is cross-sectional, further information about longitudinal cardiovascular conditions is vital for optimal care for girls and women with TS. The two cases reported in this article provide significant information for improving lifelong cardiovascular health issues in TS.

Introduction: We retrospectively analyzed convulsive patient outcomes transported by a physician-staffed Helicopter Emergency Medical Service (doctor helicopter [DH]) using the keyword-triggered dispatch with data from the Japan DH Registry System (JDRS). Upon receiving an emergency call containing critical keywords, such as an ongoing convulsion at the firefighting central command room, immediate dispatch of the DH is requested, in addition to dispatching an ambulance. The keyword-triggered dispatch relied on data obtained from the JDRS., Methods: Details from the JDRS database included patient age, sex, cardiac arrest presence upon DH contact, vital signs, DH dispatch timing (keyword-triggered dispatch/emergency medical technician [EMT]-triggered dispatch), medical intervention details, and 1-month outcomes (cerebral performance category [CPC]; CPC1, 2: Good; CPC 3-5: Poor). Subjects were divided into keyword (keyword-triggered dispatch) and control (EMT-triggered dispatch) groups for comparison., Results: Of 1201 patients, all evacuated from the scene, 617 were in the keyword group, and 584 in the control group. No significant differences existed between groups for cardiac arrest, respiratory and heart rates, CPC, or mortality. The keyword group had lower average age, systolic blood pressure, and medical intervention ratio but a higher median Glasgow Coma Scale and good outcome ratio., Conclusion: This first report on the keyword-triggered dispatch as a prognostic factor for convulsive patients evacuated by DH using the JDRS., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Emergencies, Trauma, and Shock.)

This case study describes a fatal head injury in a 1-year-old child involved in a motor vehicle accident in Japan. The child, secured in a rear-facing child seat, was a passenger in a car driven by their mother when the offset car-to-car collision occurred. The car rotated counterclockwise before coming to a stop. Despite remaining secured in the child seat, the child suffered severe head trauma, leading to cardiac arrest. Autopsy computed tomography revealed a right open depressed fracture, left head contusion, traumatic subarachnoid hemorrhage, intraventricular hemorrhage, and pneumocephalus. The injury mechanism involved the child's head striking the right headrest, followed by a swing to the left, induced by the initial impact and subsequent rotational movement. This case highlights the importance of age-specific data in understanding pediatric injuries in motor vehicle accidents and improving child seat safety measures., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Objective: To elucidate the actual circumstances of damage caused by Japanese Alocasia ( A ) odora . Materials and Methods: We investigated cases in Japan from our own hospital in the eastern part of Shizuoka Prefecture as well as published reports. Results: A. dora is found in western Japan, and plants of the Alocasia genus are cultivated often. A. odora is frequently associated with food poisoning because its aboveground parts resemble those of Satoimo ( Colocasia esculenta ). Moreover, A. odora contains insoluble calcium oxalate crystals, which cause poisoning symptoms, such as oral pain, nausea, vomiting, and laryngeal edema, resulting in near asphyxia, diarrhea following shock, and skin dermatitis. Calcium oxalate crystals are abundant in Araceae family plants, and cases of health damage owing to the accidental ingestion of Araceae plants have been reported worldwide. Conclusion: Due to the strong irritation felt in the mouth upon contact with the plant, it is advisable to immediately spit out the plant and rinse the mouth. In addition to drug administration, ensuring a secure airway may be necessary if there is a risk of asphyxiation., Competing Interests: We do not have conflict of interest to declare., (©2024 The Japanese Association of Rural Medicine.)

A 72-year-old man with idiopathic pulmonary fibrosis (IPF) was on home oxygen therapy at 1 L/min. He fell approximately 3 m onto a concrete surface while painting the roof of his home and was emergently transported to a local hospital due to pain in his lower back and right lower limb. His initial Krebs von den Lungen level decreased with medical treatments but has shown an increasing trend over the past three respiratory outpatient visits. His other medical conditions, including dyslipidemia, lumbar pain, and allergic rhinitis, were treated with several drugs prescribed by a nearby clinic. At the previous hospital, an increased oxygen demand of around 5 L via mask was noted, although other vital signs were stable. A plain whole-body computed tomography (CT) scan revealed pulmonary edema, a fracture of the right femoral neck, and a fracture of the third lumbar vertebral body. During transfer to our hospital for surgery, crossing the Amagi Pass at an elevation of approximately 830 m, the patient's respiratory condition rapidly deteriorated. Upon arrival, the cardiac wall movement was hyperdynamic, and PaO 2 was 29 mmHg under supplemental oxygen at 15 L/min, necessitating oral endotracheal intubation and initiation of mechanical ventilation. A chest CT scan showed worsening diffuse ground-glass opacities in both lungs compared to the previous CT scan at the referring hospital. Despite positive pressure ventilation with the mechanical ventilator, the patient's condition did not improve, and he died in the emergency room. Acute respiratory distress syndrome (ARDS) can occur following severe trauma but the onset of ARDS due to moderate trauma is extremely rare. Considering the possibility of an acute exacerbation of IPF prior to the injury, this report discusses the possibility of developing ARDS due to trauma-induced cytokines and lung damage from damage-associated molecular patterns, the possibility of inhaling dust while working on the roof, pneumonia caused by prescribed medication, viral infections, exposure to pollen and/or high altitude while passing through the mountain pass, and hypoxemia-inducing pulmonary edema., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Juntendo Shizuoka Hospital IRB issued approval 298. Examinations were conducted according to the standards of good clinical practice and the Declaration of Helsinki. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hirooka et al.)

Heat stress reduces the developmental competence of bovine oocytes during the growth phase; however, the detailed mechanisms remain unclear. Amino acids play various critical roles in follicular development, including protein synthesis and as energy sources. We performed in vitro growth (IVG) culture of oocyte-cumulus-granulosa complexes (OCGCs) to assess the amino acid metabolism of small follicles at high temperatures. We isolated OCGCs from early antral follicles (0.5-1.0 mm) and subjected them to IVG culture for 12 days. OCGCs in the heat shock group were cultured under a temperature cycle of (38.5°C: 5 h, 39.5°C: 5 h, 40.5°C: 5 h, and 39.5°C: 9 h) to reproduce the body temperature of lactating cows under a hot environment. OCGCs in the control group were cultured at a constant temperature of 38.5°C for 24 h. Of the surviving OCGCs, those showing similar morphology and size between the groups were selected for amino acid analysis. We analyzed the free amino acids and their metabolites in the culture medium and calculated the depletion or appearance of molecular species. The depletion of three essential amino acids (isoleucine, leucine, and valine), two non-essential amino acids (aspartic acid and glycine), and ornithine was higher in the heat shock group (P < 0.05). Alanine depletion was lower in the heat shock group (P < 0.05). We concluded that heat exposure alters the amino acid metabolism of OCGCs isolated from early antral follicles, which might be involved with the diminished developmental potential of oocytes during summer.

Objective: The present study aimed to report on the activity of a medical relief team from Juntendo Shizuoka Hospital that was dispatched to the Noto Peninsula Earthquake in Reiwa 6., Design: Narrative report., Results: The activities conducted on-site in the Noto Peninsula involved multiple deployments of the Juntendo University Shizuoka Hospital Disaster Medical Assistance Team (JS-DMAT). The first deployment from January 2nd to January 6th faced challenges due to damaged infrastructure, particularly roads, affecting mobility. The team focused on hospital medical support, patient transportation, and DMAT headquarters assistance. The second deployment, from January 8th to January 12th, encountered persistently damaged roads, leading to incidents but no significant vehicle damage. The team engaged in screening, zoning, medical examinations, and DMAT headquarters support in evacuation shelters. The third team's planned activities in early February were canceled by Shizuoka Prefecture.Additionally, on January 7, 2024, personnel from Juntendo Shizuoka Hospital participated in the Shizuoka Prefectural DMAT Coordination Headquarters activity, documenting DMAT activities and assessing team members' health. The Ministry of Health, Labour and Welfare's request for the fourth Shizuoka Prefecture DMAT dispatch led to the selection of the second JS-DMAT for deployment., Conclusion: The activities related to the Noto Peninsula earthquake by JS-DMAT were reported. Lessons from this disaster are being sought to guide future disaster response preparations., Competing Interests: The authors declare that there are no conflicts of interest., (© 2024 The Juntendo Medical Society.)

Aim: Reducing the blood transfusion volume is important in severe trauma. We hypothesized that carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) would reduce blood transfusions in severe trauma., Methods: From April 2017 to March 2023, data were collected from patients (aged ≥16 years) admitted to our hospital for trauma and administered packed red blood cells (pRBC) and plasma transfusions within 12 h postinjury. Patients infused with CSS and TXA (CSS + TXA group) were compared with those infused with TXA alone (TXA group). The outcomes were blood product transfusion volumes within and after 24 h, the number of patients receiving >6 units of pRBC transfusion after 24 h, duration of intensive care unit and in-hospital stays, and 28-day in-hospital mortality., Results: In total, 138 patients were included in the study. In the univariate analyses, the CSS + TXA group ( n  = 62) showed a significant reduction in the total pRBC transfusion volume, in-hospital days, and number of patients receiving >6 units of pRBCs in the delayed phase. Based on the multivariate logistics regression analysis, only the CSS + TXA group had a significantly lower adjusted odds ratio for receiving >6 units of pRBC transfusion after 24 h. During the in-hospital days, the CSS + TXA group did not experience an increased incidence of major complications when compared with the TXA group., Conclusion: In patients with trauma, treatment with CSS with TXA may reduce the requirement for blood transfusion after 24 h. Moreover, this treatment can improve admission outcomes without increasing complications., Competing Interests: Youichi Yanagawa is an Editorial Board member of AMS Journal and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication. The authors declare no conflict of interest for this article., (© 2024 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)

Gamma-aminobutyric acid (GABA) is a major inhibitory neurotransmitter in the central nervous system, synthesized by two isoforms of glutamate decarboxylase (GAD): GAD65 and GAD67. GABA may act as a trophic factor during brain development, but its contribution to the development and maturation of cerebellar neural circuits is not known. To understand the roles of GABA in cerebellar organization and associated functions in motor coordination and balance, we examined GAD65 conventional knock out (KO) mice and mice in which GAD67 was eliminated in parvalbumin-expressing neurons (PV-Cre; GAD67 flox/flox mice). We found aberrant subcellular localization of the Shaker-type K channel Kv1.1 in basket cell collaterals of PV-Cre; GAD67 flox/flox mice and abnormal projections from basket cells to Purkinje cells in both mouse strains. We also found that altered synaptic properties of basket cell terminals to Purkinje cells in PV-Cre; GAD67 flox/flox mice. Furthermore, PV-Cre; GAD67 flox/flox mice exhibited abnormal motor coordination in the rotarod test. These results indicate that GABA signaling in the cerebellum is critical for establishing appropriate connections between basket cells and Purkinje cells and is associated with motor coordination in mice., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Competing Interests: There are no conflicts of interest.

Endometrial epidermal growth factor (EGF) shows a cyclic change with two peaks on days 2-4 and days 13-14 of the estrous cycle. In repeat breeder cows, loss of the peaks has been associated with reduced fertility. By infusing seminal plasma (SP) and osteopontin (OPN) derived from SP and milk into the vagina, their EGF profile and fertility are restored. However, SP is difficult to obtain, and both SP and OPN can transmit infectious diseases. While OPN can be sourced from recombinant protein without this risk, recombinant bovine OPN (rOPN) expressed in Escherichia coli should be examined for its effects on the EGF profile, since it does not undergo posttranslational modification, which is important for its biological activity. In study 1, PBS, SP (0.5 mL), and rOPN (0.3 mg) were infused into the vagina at estrus (day 0) in 74, 37, and 105 repeat breeder Holstein cows, respectively, with an altered EGF profile. The endometrial EGF concentrations were measured on day 3. Some cows (n = 58, 20, and 83, respectively) were inseminated immediately before the infusion and then diagnosed for pregnancy between days 30 and 35. The normalization rate of the EGF profile and conception rate in the rOPN group (58.1 % and 47.0 %, respectively) were not significantly different from those in the SP group (62.2 % and 45.0 %, respectively) but higher than those in PBS group (29.7 % and 28.1 %, respectively) (P < 0.05). In study 2, repeat breeder cows with an altered EGF profile were infused with PBS (n = 18) and rOPN (n = 17), while fertile controls with a normal EGF profile (n = 18) were infused with PBS. Two or three embryos were transferred into cows on day 7 and then recovered on day 14. Embryo recovery rates of the rOPN and fertile groups were comparable (58.7 % vs. 58.3 %) but higher than that of the PBS group (58.7 % vs. 32.0 %) (P < 0.05). The embryo recovery rate of cows with normalized EGF profile was higher than that of cows with unnormalized EGF profile (64.4 % vs. 16.7 %) (P < 0.05). The embryo sizes of cows in the rOPN and fertile groups were comparable but larger than those in the PBS group (P < 0.05). However, the embryo size was not correlated to the corresponding endometrial EGF concentrations. In conclusion, rOPN without posttranslational modifications normalized the EGF profile in repeat breeder cows. Improved fertility by normalization of the EGF profile could be attributed partly to the increased embryo viability up to day 14., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective In this study, we investigated the factors related to anemia and platelet reduction in patients with moderate to severe trauma to gain a deeper understanding of these phenomena. Methods Our study spanned the period from April 2021 to September 2023, and it involved a retrospective review of the hospital medical charts of all emergency outpatients of all ages who were transported by a physician-staffed helicopter and treated at our hospital and were diagnosed with an Injury Severity Score (ISS) of >8 by CT on arrival. The following data were analyzed: sex; age; mechanism of injury; vital signs upon arrival at the hospital; ISS; hemoglobin level and platelet count on arrival and day two; fibrin degradation product (FDP) level, lactate dehydrogenase (LDH) level, and diameter of the inferior vena cava (IVC) on arrival; and infusion volume on day one. We then statistically calculated the independent risk factors for differences between hemoglobin levels and platelet counts on arrival and those on day two. Results The study included a total of 209 subjects, with an average age of 58 years and a male predominance. Multivariate analysis showed that the FDP level, IVC diameter, and age were significantly associated with changes in hemoglobin levels on arrival and day two, whereas the IVC diameter, LDH, age, systolic blood pressure, and sex were significantly associated with changes in the platelet count on arrival and day two. Conclusions A noteworthy correlation was found between certain factors and changes in hemoglobin levels and platelet counts between the initial assessment and the second day in our cohort. We recommend further prospective research to determine whether our findings hold true for a larger population of trauma patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Yanagawa et al.)

Competing Interests: There are no conflicts of interest.

Background and Aims: Men who have sex with men (MSM) are vulnerable to contracting HBV as a sexually transmitted infection. We evaluated the incidence of HBV infection (HBI) and the prophylactic effect of tenofovir-based pre-exposure prophylaxis (PrEP) on HBI in an MSM cohort., Methods and Results: MSM who were older than 16 years were enrolled from January 2018 and followed up until June 2021 and tested for HIV, bacterial sexually transmitted infections, and HBsAg/ HBsAb and HBcAb every 3 months based on inclusion criteria, including HBsAg, HBcAb, HBsAb, and HIV negativity at enrollment. HBI was defined as seroconversion of HBsAg or HBcAb status. The log-rank test was used to evaluate the prophylactic effect of PrEP against HBI. As a substudy, individuals excluded from the main study due to HBs Ab positivity were evaluated for HBI incidence. Among 1577 MSM, 786 participants (546 PrEP nonusers, 131 daily PrEP users, and 109 event-driven PrEP users) met the criteria and were included. The annual incidence of HBV among PrEP nonusers (3.8%, 21 infections, with 559.5 person-years) was significantly higher ( p = 0.018, log-rank test) than that among daily PrEP users [0.77%, 1 infection (admitted nonadherence), with 129.3 person-years] and event-driven PrEP users (no infection with 93.8 person-years). Although the incidence of HBI and HIV infection decreased with PrEP use, the incidence of other sexually transmitted infections was higher in both daily and event-driven PrEP users. The annual incidence of HBV among HBsAb-positive and HBcAb-negative PrEP nonusers was 1.8% (3 infections, with 167.5 person-years)., Conclusions: Tenofovir-based PrEP prevented HBI among MSM in a real-world setting., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Competing Interests: There are no conflicts of interest.

A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor's helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted., Competing Interests: The authors of this paper declare no conflicts of interest exist with this submission., (Copyright© Undersea and Hyperbaric Medical Society.)

Competing Interests: There are no conflicts of interest.

Amebiasis, which is caused by Entamoeba histolytica ( E. histolytica ), is the second leading cause of parasite-related death worldwide. It manifests from asymptomatic carriers to severe clinical conditions, like colitis and liver abscesses. Amebiasis is commonly seen in developing countries, where water and food are easily contaminated by feces because of the poor sanitation. However, a recently challenge in many developed countries is the increase in domestic cases of invasive amebiasis as a sexually transmitted infection (STI amebiasis). In contrast to food-/ waterborne transmission of E. histolytica in developing countries, transmission of STI amebiasis occurs directly through human-to-human sexual contact ( e.g. , men who have sex with men and people who engage in oral-anal sex); in this setting, asymptomatic infected individuals are the main reservoir of E. histolytica . The Development of screening methods for the early diagnosis of asymptomatic E. histolytica infection is the key to epidemiologic control. Moreover, delay in diagnosis of severe cases ( e.g. , fulminant amebiasis) leads to death even in developed countries. It is also important to increase clinical awareness of domestically transmitted STI amebiasis in the clinical settings. This review considers the changing epidemiology and clinical manifestations of STI amebiasis, and finally discusses the future strategies for the better practice., Competing Interests: The authors have no conflicts of interest to disclose., (2023, National Center for Global Health and Medicine.)

Background There have so far been no reports regarding whether or not the jugular veins remain distended even in cases of cardiac arrest, which is the worst form of shock. We focused on the diameter of the jugular vein in neck computed tomography (CT) in cases of thoracic aortic disease resulting in cardiac arrest to determine whether or not cardiac tamponade increased the diameter. Methodology From January 2014 to December 2021, patients were eligible for inclusion when they were transported to our hospital, judged to be in cardiac arrest at the emergency department, and then diagnosed with thoracic aortic disease as the cause of cardiac arrest according to CT. Patients were divided into two groups according to the presence (tamponade (+)) or absence (tamponade (-)) of cardiac tamponade. Comparisons between the two groups were also conducted after excluding cases in which relief of cardiac tamponade was obtained before CT or that had hemothorax. Results There were 52 cases in the cardiac tamponade (+) group and 16 in the cardiac tamponade (-) group. The diameters of both the right and left internal jugular veins were significantly larger in the cardiac tamponade (+) group than in the cardiac tamponade (-) group. After excluding cases with relief of cardiac tamponade before CT and hemothorax complications, the right and left internal and external jugular vein diameters in the cardiac tamponade (+) group were still significantly greater than those in the cardiac tamponade (-) group. Conclusions The present study showed that the cardiac tamponade induced by thoracic aortic cases tended to display larger internal jugular vein diameters compared to cases without cardiac tamponade, even in patients experiencing cardiac arrest. Additionally, cardiac tamponade consistently presented with larger diameters in the right-sided jugular vein., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Hamada et al.)

Background: Interferon (IFN)-γ and interleukin (IL)-4 are considered to be important factors to regulate immune responses. Although the effects of IFN-γ or IL-4 on macrophage functions are well established, their cooperative action is not fully understood., Objective: Inducible nitric oxide synthase (iNOS) or arginase (Arg)-1 is a representative marker of M1 or M2 macrophages and plays a role in the acceleration or suppression of inflammatory responses. In the present study, we examined the effect of simultaneous treatment with IFN-γ and IL-4 on macrophage expression of iNOS and Arg-1 using the murine macrophage cell line RAW264.7., Methods: Protein production and mRNA expression of iNOS and Arg-1 were measured using immunoblotting and reverse transcription-polymerase chain reaction. Cell surface expression of CD86 and programmed death ligand (PD-L) 2 was analyzed using flow cytometry., Results: IFN-γ or IL-4 increased iNOS or Arg-1 protein production, respectively. Of note, IL-4 combined with IFN-γ synergistically increased Arg-1 protein production, whereas IL-4 inhibited IFN-γ-induced iNOS production. This phenomenon was consistent with the mRNA levels. In addition, IL-4 combined with IFN-γ synergistically increased cell surface expression of PD-L2, which is involved in T cell suppression, whereas IL-4 completely inhibited IFN-γ-induced expression of CD86, which is responsible for T cell activation., Conclusions: In the present study, we found the synergy of IFN-γ and IL-4 in Arg-1 and PD-L2 expression. Thus, macrophages highly expressing Arg-1 and PD-L2 may be induced by both IFN-γ and IL-4 at the inflammatory site, and might play a role in the regulation of inflammatory immune responses.

Inadequate exposure to estradiol (E 2 ) and progesterone (P 4 ) may be the main causes of altered endometrial epidermal growth factor (EGF) profile, leading to reduced fertility in dairy cows. We hypothesized that PGF 2α administration at different timings of the estrous cycle and stages of follicular development could change the profile of steroid hormones between luteolysis and estrus. This results in reduction in the peak concentration of endometrial EGF on day 3 (day 0 = estrus) in the next estrous cycle. In study 1, lactating Holstein cows were treated with PGF 2α either on days 12-14 (selection phase group, n = 20) or on days 16-17 (control group, n = 24) of the estrous cycle. Blood samples were obtained before PGF 2α treatment, 24 and 48 h after treatment, and on the day of estrus and ovulation for E 2 and P 4 assays. Endometrial tissues were collected by biopsy on day 3 for EGF assays. The duration from PGF 2α treatment to both estrus and ovulation was longer in the selection phase group than in the control group (P < 0.05). The time between estrus and ovulation was longer in the selection phase group (P < 0.05). E 2 concentrations were higher in the control group on the day of estrus (P < 0.05). P 4 concentrations were not different between the groups. Endometrial EGF concentrations were lower in the selection phase group than in the control group (P < 0.05). In study 2, lactating Holstein cows were treated with PGF 2α either on day 12 (selection phase group, n = 76) or day 16 (control group, n = 80). They were subjected to artificial insemination (AI) at estrus, and those that failed to ovulate by 24h after the first AI were subjected to second AI. On day 3, endometrial EGF concentration was determined. At estrus and on days 3 and 7, blood was collected for E 2 and P 4 assay from 20 randomly selected cows in each group before PGF 2α treatment. The cows in the selection phase group exhibited lower EGF concentration, proportion of cows with normal EGF profile, and conception rate than cows in the control group (P < 0.05). On the day of estrus, E 2 concentrations tended to be lower in the selection phase group than in the control group (P = 0.08). P 4 concentrations were not different between the groups. These findings suggest that low E 2 concentrations at estrus and low P 4 concentrations for a prolonged period due to premature termination of CL in the absence of a dominant follicle are potential causes of altered endometrial EGF profile in dairy cows., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aim: We retrospectively investigated the current status of poisoned patients who had been transported by a physician-staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM., Methods: The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups., Results: A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation., Conclusion: The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients., Competing Interests: We do not have conflict of interest to declare. Dr. Youichi Yanagawa is an Editorial Board member of AMS Journal and the corresponding author of this article. To minimize bias, the author was excluded from all editorial decision making related to the acceptance of this article for publication., (© 2023 The Authors. Acute Medicine & Surgery published by John Wiley & Sons Australia, Ltd on behalf of Japanese Association for Acute Medicine.)