Active control of plasmon coupling via simple electrochemical surface oxidation/reduction of Au nanoparticle agglomerates.

Reversible tuning of plasmon coupling of Au nanoparticle (AuNP) agglomerates containing dimers as the main component was achieved via electrochemical surface oxidation/reduction of the AuNP surface. The system required no reactant except for water and was almost finished within a unit second, which leads to novel active plasmonic devices.

Position-Dependent Symptoms of Pneumothorax During Mechanical Ventilation: A Case Report.

A 54-year-old male with severe hypoxia was transferred to our hospital after choking on a mochi. Chest computed tomography revealed negative pressure pulmonary edema without pneumothorax. Endotracheal intubation was performed, and pressure-controlled ventilation was initiated. Following admission to the intensive care unit, his respiratory condition was stable in both the supine and left decubitus positions. However, every time he was placed in the right decubitus position, the tidal volume decreased by half, and SpO2 dropped rapidly to 80%, which recovered soon after returning to the supine position. Chest radiography was performed the following day, revealing grade II right pneumothorax, and a chest tube placement stabilized his respiratory status in the right decubitus position. Air leakage ceased within a few hours. Extubation was successful on the fifth hospital day, and the chest tube was removed on the eighth hospital day. To our knowledge, there are no previous reports on position-dependent symptoms of pneumothorax during mechanical ventilation. Clinicians should consider the possibility of pneumothorax on that same side when respiratory deterioration is observed only in one lateral decubitus position during mechanical ventilation.

Laparoscopic repair for primary epigastric hernia containing falciform ligament: A case report and review of literature.

Falciform ligament herniation is a rare type of epigastric hernia. We report a case of a primary epigastric hernia containing a falciform ligament repaired using nonabsorbable barbed suture under laparoscopic surgery. A 74-year-old woman presented with discomfort in the upper abdomen. Physical examination revealed a 3-cm non-tender mass, and abdominal computed tomography revealed epigastric hernia with an incarcerated falciform ligament. By observation with a laparoscope, the fascial defect was single and 1.0 cm in diameter, thus sutured repair was selected. At 4 months follow-up, she had no complications or recurrence. The laparoscopic approach is useful for diagnosis and deciding a repair method of an epigastric hernia. The barbed suture closure system is convenient and effective for intracorporeal hernial defect closing. Both primary and incisional falciform ligament herniation have been reported in the past, and we reviewed six cases, including our case.

Prostaglandin E2 increases the expression of cyclooxygenase-2 in cultured rat microglia.

Prostaglandin E2 (PGE2) plays pivotal roles in controlling microglial activation with the EP2 receptor, a PGE2 receptor subtype. Activated microglia are often reported to increase cyclooxygenase (COX)-2 expression, followed by PGE2 production, but it is unclear whether extracellular PGE2 is involved in microglial PGE2 synthesis. In the present study, we report that PGE2 increases COX-2 protein in microglia. In a culture system, PGE2 at 10-6 M for 3 h increased COX-2 and microsomal PGE synthase (mPGES)-1 mRNA levels, and reduced mPGES-2, but did not affect COX-1 or cytosolic PGE synthase (cPGES) in microglia. PGE2 at 10-6 M for 3 h also increased the COX-2 protein level, but did not affect COX-1, mPGES-1, mPGES-2, or cPGES. An EP2 agonist, ONO-AE1-259-01, also increased COX-2 and mPGES-1 mRNA levels, and reduced mPGES-2, but did not affect COX-1 or cPGES, whereas an EP1 agonist, ONO-DI-004, an EP3 agonist, ONO-AE-248, and an EP4 agonist, ONO-AE1-329, had no effect. Similar to PGE2, ONO-AE1-259-01 increased the COX-2 protein level, but did not affect COX-1, mPGES-1, mPGES-2, or cPGES. In addition, the effects of PGE2 were inhibited by an EP2 antagonist, PF-04418948, but not by an EP1 antagonist, ONO-8713, an EP3 antagonist, ONO-AE3-240, or an EP4 antagonist, ONO-AE3-208, at 10-6 M. On the other hand, lipopolysaccharide (LPS) increased PGE2 production, but the LPS-induced PGE2 production was not affected by ONO-8713, PF-04418948, ONO-AE3-240, or ONO-AE3-208. These results indicate that PGE2 increases COX-2 protein in microglia through the EP2 receptor supporting the idea that extracellular PGE2 has a triggering aspect for microglial activation.

A Case of Strangulation Ileus Due to a Low-Grade Appendiceal Mucinous Neoplasm.

BACKGROUND Strangulation ileus is caused by external obstruction to the small bowel, which results in ischemia and loss of bowel peristalsis. Low-grade appendiceal mucinous neoplasm (LAMN) is a low-grade adenocarcinoma that arises in the appendix. LAMN is usually asymptomatic but can present with appendiceal rupture and pseudomyxoma peritonei (PMP). This report is of a rare presentation of LAMN with strangulation ileus in a 92-year-old man. CASE REPORT A 92-year-old man was admitted to the emergency room with sudden onset of lower abdominal pain and abdominal distension. Laboratory investigations showed a leukocytosis with a white blood cell (WBC) count of 14.6×10³/µL with 85.5% neutrophils, blood urea nitrogen (BUN) of 26.6 mg/dL, and serum creatinine of 2.6 mg/dL, consistent with acute renal failure. Arterial blood gas analysis showed lactic acidosis (pH of 7.11) with a base excess of -20.8 mmol/L and lactate of 13.7 mmol/L. Abdominal computed tomography (CT) showed ascites and a dilated obstructed closed loop of the distal ileum associated with an external mass (3.9×2.8 cm). An initial diagnosis was of strangulation ileus due to Meckel's diverticulum. Emergency ileocecal resection was performed. Histopathology showed a low-grade mucinous tumor arising from the mucosa of the appendix, consistent with LAMN. At a 13-month follow-up, the patient was well with no tumor recurrence. CONCLUSIONS This report is of a rare case of LAMN that presented as a surgical emergency with strangulation ileus.

Microscope Observation of Morphology of Colloidally Dispersed Niobate Nanosheets Combined with Optical Trapping.

Although inorganic nanosheets prepared by exfoliation (delamination) of layered crystals have attracted great attention as 2D nanoparticles, in situ real space observations of exfoliated nanosheets in the colloidally dispersed state have not been conducted. In the present study, colloidally dispersed inorganic nanosheets prepared by exfoliation of layered niobate are directly observed with bright-field optical microscopy, which detects large nanosheets with lateral length larger than several micrometers. The observed nanosheets are not strictly flat but rounded, undulated, or folded in many cases. Optical trapping of nanosheets by laser radiation pressure has clarified their uneven cross-sectional shapes. Their morphology is retained under the relation between Brownian motion and optical trapping.

A case of a gastrostomy fistula reopening 21 years after spontaneously closure.

Here we report a rare case of a reopened gastrostomy fistula 21-years after spontaneous closure. A male newborn underwent gastrostomy by laparotomy because of esophageal atresia shortly after birth. The gastrostomy tube was removed at 7 months old because he could consume enough oral nutrition. At the age of 21, however, the fistula reopened to form a labial fistula. When he consulted to our hospital, we observed a large skin sore with redness at the site of the fistula, which was caused by gastric outflow. We chose to resect the fistula by open surgery as a reliable therapeutic method in consideration of his future social life. The postoperative course was unremarkable.

Evaluation of the effects of gastrectomy on the development of metabolic bone disease.

BACKGROUND: Metabolic bone disease after gastrectomy is one of the complications leading to deterioration in quality of life. The exact mechanism of the metabolic bone disease remains unclear. To clarify the cause of metabolic bone disease after gastrectomy, we evaluated the associations between the method of gastrectomy and the development of metabolic bone disease in a rat model. METHODS: Rats were assigned to four groups as follows: (1) sham operation (control group); (2) resection of the glandular stomach with Billroth I reconstruction (RGBI group); (3) Roux-en-Y anastomosis preserving the secretory function of the whole stomach (PSRY group); and (4) total gastrectomy with Roux-en-Y reconstruction (TGRY group). In all groups, body weight, serum biochemistry (total protein, albumin, calcium, phosphorus, tartrate-resistant acid phosphatase, and bone alkaline phosphatase), bone density, and bone breaking strength were measured. RESULTS: Body weights and serum calcium levels were significantly lower in the three operation groups compared with the control group. Bone density was significantly lower in the PSRY and TGRY groups compared with the control group. Bone breaking strength was significantly lower in the three operation groups compared with the control group. CONCLUSIONS: Surgical methods led to metabolic bone disease. However, exclusion of the duodenum from food passage had major influence to reduction in bone density and breaking strength. A stomach-preserving procedure and physiological reconstruction which enable food passage through duodenum and proximal jejunum contribute to mitigation of metabolic bone disease.

Effects of rabeprazole on bone metabolic disorders in a gastrectomized rat model.

Proton pump inhibitors (PPIs) are frequently prescribed to patients with gastroesophageal reflux disease; however, the number of bone fractures reportedly increased in these patients. Although PPIs have been shown to inhibit the bone resorption by osteoclasts, the effect of PPIs on skeletal metabolism remains controversial. The aim of the present study was to determine the effect of the PPI rabeprazole on skeletal metabolism using gastrectomized rats. Male Wistar rats were divided into four groups: i) Sham-surgery (n=15); ii) total gastrectomy (TG) control (n=20); iii) TG plus rabeprazole (n=20); and iv) TG plus the bisphosphonate minodronic acid (n=20). Twenty-two weeks after TG, the rats were sacrificed, and bone mineral density (BMD), bone strength and markers for bone metabolism were measured. Compared with the control group (50.0±8.1%), the TG-induced decrease in BMD was significantly ameliorated in the rabeprazole group (56.5±7.5%) and the minodronic acid group (59.0±6.0%). However, rabeprazole did not improve bone strength. In conclusion, rabeprazole does not appear to exacerbate bone metabolic disorders in gastrectomized rats, but rather ameliorates the TG-induced BMD decrease.

[Bone metabolic disorder after gastrectomy].

Bone metabolic disorder after gastrectomy is a silent complication, and has potential of severely disturbing quality of life. However, the awareness of this complication is not enough in clinicians. We examined the influence of gastrectomy on bone metabolism using the investigation of clinical cases and experiments with rat surgical models. We discussed the influence of the volume of resected stomach and the reconstructed route of food passage. Bone metabolic disorders were observed in 30% of patients after gastrectomy. They were milder in cases after proximal gastrectomy compared with total gastrectomy(p=0.110), and segmental/local gastrectomy compared with distal gastrectomy(p=0.080), in cases with physiological route of foods passing compared with non- physiological route(p=0.091). Similar results were observed in the experiments with rat surgical models. Both of the volume of the remnant stomach and the reconstructed food passing route are correlated with bone metabolic disorders after gastrectomy.

Single-incision laparoscopic appendectomy for treating appendicitis in a patient with gastrointestinal malrotation.

INTRODUCTION: Intestinal malrotation is a rare congenital anomaly, and acute appendicitis associated with intestinal malrotation is extremely rare. PRESENTATION OF CASE We report a rare case of a 47-year-old Japanese woman diagnosed with barium-related perforated appendicitis associated with intestinal malrotation. We used a transumbilical single-incision laparoscopic approach to resect the appendix, and the procedure was completed successfully without perioperative complications. DISCUSSION: To our knowledge, single-incision laparoscopic surgery for appendicitis associated with intestinal malrotation has not been reported yet. In cases with mobile cecum such as this one, mobilization from inflammatory adhesion of the surrounding structures is easy. CONCLUSION: We conclude that transumbilical single-incision laparoscopic appendectomy is a simple and less invasive method for treating appendicitis associated with intestinal malrotation.

[Anesthesia for nephrectomy in a patient suspected of spurious polycythemia].

A 46-year-old man suspected of spurious polycythemia received nephrectomy. Spurious polycythemia patients with high blood pressure as a complication have a high possibility of developing cerebral vascular disease. For its prevention, it is important to decrease blood viscosity by phlebotomy and to perform anticoagulation therapy. It is also necessary to deal with these patients as a high-risk group of cerebral vascular disease even if there is no symptoms. We were able to manage this case safely without any complication by aggressive perioperative phlebotomy and anticoagulation therapy.