Antineutrophil Cytoplasmic Antibody-associated Vasculitis after COVID-19 Vaccination with Pfizer-BioNTech.

The extent of rare side effects of mRNA vaccines for coronavirus disease 2019 (COVID-19) remains unclear. Several cases of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) following COVID-19 vaccination have been reported. We herein report a 72-year-old man who presented with a fever after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. He was diagnosed with acute kidney injury due to myeloperoxidase-ANCA-associated vasculitis and was treated with intermittent hemodialysis, high-dose prednisolone, and intravenous rituximab. His general symptoms and renal impairment subsequently improved. When systemic symptoms are prolonged or renal abnormalities appear after COVID-19 vaccination, the possibility of AAV should be considered.

Development of a robotic system with six-degrees-of-freedom robotic tool manipulators for single-port surgery.

BACKGROUND: Current robotic systems have limitations for single-port surgery (SPS) because the instruments are large, the arms collide and the field of vision requires manual readjustment. We have developed an SPS robotic system that manipulates the vision field. METHODS: The master-slave system included a six degrees of freedom (DOFs) tool manipulator, an easy set-up mechanism, a flexible shaft drive with sufficient DOFs and a vertical arrangement for improved vision. The robot manipulates an endoscope within the body. After assembly, the system was tested in vitro and in vivo. RESULTS: In vitro testing showed that the tool manipulators resected tissue precisely, with the range of motion required. In vivo testing indicated that an abdominal organ is accurately approached and diseased tissue removed by combined endoscopy and robotics. CONCLUSIONS: Our robotics allowed the operator to adjust the vision field intuitively. The tool manipulator approached and resected diseased tissue precisely.

Pial arteries respond earlier than penetrating arterioles to neural activation in the somatosensory cortex in awake mice exposed to chronic hypoxia: an additional mechanism to proximal integration signaling?

The pial and penetrating arteries have a crucial role in regulating cerebral blood flow (CBF) to meet neural demand in the cortex. Here, we examined the longitudinal effects of chronic hypoxia on the arterial diameter responses to single whisker stimulation in the awake mouse cortex, where activity-induced responses of CBF were gradually attenuated. The vasodilation responses to whisker stimulation under prehypoxia normal conditions were 8.1% and 12% relative to their baselines in the pial arteries and penetrating arterioles, respectively. After 3 weeks of hypoxia, however, these responses were significantly reduced to 5.5% and 4.1%, respectively. The CBF response, measured using laser-Doppler flowmetry (LDF), induced by the same whisker stimulation was also attenuated (14% to 2.6%). A close linear correlation was found for the responses between the penetrating arteriolar diameter and LDF, and their temporal dynamics. After 3 weeks of chronic hypoxia, the initiation of vasodilation in the penetrating arterioles was significantly extended, but the pial artery responses remained unchanged. These results show that vasodilation of the penetrating arterioles followed the pial artery responses, which are not explainable in terms of proximal integration signaling. The findings therefore indicate an additional mechanism for triggering pial artery dilation in the neurovascular coupling.

Development of a 6-DOF manipulator driven by flexible shaft for minimally invasive surgical application.

This paper presents a 6-DOF manipulator which consists of four parts, 1-DOF translational joint, two 2-DOF bending joints (segment1 and segment2), and 1-DOF rotational gripper. The manipulator with "flexible shaft and Double Screw Drive (DSD) mechanism" structure can obtain omni-directional bending motion through rotation of flexible shafts. In the first prototype, the flexible shafts were connected directly with the actuators in the manipulator. Compared with the first prototype, in the second prototype, flexible shafts for power transmission are connected to the base of the manipulator. Universal joints are used for power transmission to realize distal motion. The improvement done with the design of the second prototype reduced the torque necessary to drive the flexible shafts during motion in surgical interventions. Experiment results show that the manipulator has enough range of movement for surgical intervention.

Measuring the vascular diameter of brain surface and parenchymal arteries in awake mouse.

The present study reports a semiautomatic image analysis method for measuring the spatiotemporal dynamics of the vessel dilation that was fluorescently imaged with either confocal or two-photon microscope. With this method, arterial dilation induced by whisker stimulation was compared between cortical surface and parenchymal tissue in the vibrissae area of somatosensory cortex in awake Tie2-GFP mice in which the vascular endothelium had genetically expressed green fluorescent protein. We observed that a mean arterial diameter during a pre-stimulus baseline state was 39 ± 7, 19 ± 1, 16 ± 4, 17 ± 4, and 14 ± 3 µm at depths of 0, 100, 200, 300, and 400 µm, respectively. The stimulation-evoked dilation induced by mechanical whisker deflection (10 Hz for 5 s) was 3.4 ± 0.8, 1.8 ± 0.8, 1.8 ± 0.9, 1.6 ± 0.9, and 1.5 ± 0.6 µm at each depth, respectively. Consequently, no significant differences were observed for the vessel dilation rate between the cortical surface and parenchymal arteries: 8.8 %, 9.9 %, 10.9 %, 9.2 %, and 10.3 % relative to their baseline diameters, respectively. These preliminary results demonstrate that the present method is useful to further investigate the quantitative relationships between the spatiotemporally varying arterial tone and the associated blood flow changes in the parenchymal microcirculation to reveal the regulatory mechanism of the cerebral blood flow.

Layer-specific dilation of penetrating arteries induced by stimulation of the nucleus basalis of Meynert in the mouse frontal cortex.

To clarify mechanisms through which activation of the nucleus basalis of Meynert (NBM) increases cerebral cortical blood flow, we examined whether cortical parenchymal arteries dilate during NBM stimulation in anesthetized mice. We used two-photon microscopy to measure the diameter of single penetrating arteries at different depths (~800 µm, layers I to V) of the frontal cortex, and examined changes in the diameter during focal electrical stimulation of the NBM (0.5 ms at 30 to 50 µA and 50 Hz) and hypercapnia (3% CO2 inhalation). Stimulation of the NBM caused diameter of penetrating arteries to increase by 9% to 13% of the prestimulus diameter throughout the different layers of the cortex, except at the cortical surface and upper part of layer V, where the diameter of penetrating arteries increased only slightly during NBM stimulation. Hypercapnia caused obvious dilation of the penetrating arteries in all cortical layers, including the surface arteries. The diameters began to increase within 1 second after the onset of NBM stimulation in the upper cortical layers, and later in lower layers. Our results indicate that activation of the NBM dilates cortical penetrating arteries in a layer-specific manner in magnitude and latency, presumably related to the density of cholinergic nerve terminals from the NBM.

In vivo experiments of a surgical robot with vision field control for Single Port Endoscopic Surgery.

Recently, robotics systems are focused to assist in Single Port Endoscopic Surgery (SPS). However, the existing system required a manual operation of vision and viewpoint, hindering the surgical task. We proposed a surgical endoscopic robot for SPS with dynamic vision control, the endoscopic view being manipulated by a master controller. The prototype robot consists of a manipulator for vision control, and dual tool tissue manipulators (gripping: 5DOFs, cautery: 3DOFs) can be attached at the tip of sheath manipulator. In particular, this paper focuses on an in vivo experiment. We showed that vision control in the stomach and a cautery task by a cautery tool could be effectively achieved.

Design of a surgical robot with dynamic vision field control for Single Port Endoscopic Surgery.

Recently, a robotic system was developed to assist Single Port Endoscopic Surgery (SPS). However, the existing system required a manual change of vision field, hindering the surgical task and increasing the degrees of freedom (DOFs) of the manipulator. We proposed a surgical robot for SPS with dynamic vision field control, the endoscope view being manipulated by a master controller. The prototype robot consisted of a positioning and sheath manipulator (6 DOF) for vision field control, and dual tool tissue manipulators (gripping: 5DOF, cautery: 3DOF). Feasibility of the robot was demonstrated in vitro. The "cut and vision field control" (using tool manipulators) is suitable for precise cutting tasks in risky areas while a "cut by vision field control" (using a vision field control manipulator) is effective for rapid macro cutting of tissues. A resection task was accomplished using a combination of both methods.

A surgical robot with vision field control for single port endoscopic surgery.

BACKGROUND: Robotic end-effectors for single port endoscopic surgery (SPS) require a manual change of vision field that slows surgery and increases the degrees of freedom (DOFs) of the manipulator. METHODS: A new surgical prototype robot has dynamic vision field control and a master controller to manipulate the endoscopic view. It uses positioning (4 DOF) and sheath (2 DOF) manipulators for vision field control, and dual tool tissue manipulators (gripping, 5 DOF; cautery, 3 DOF). RESULTS: The robot is feasible in vitro. 'Cut and vision field control' (using tool manipulators) was suitable for precise cutting tasks in risky areas; 'cut by vision field control' (using the vision field control manipulator) was effective for rapid macro cutting of tissues. A resection was performed using a combination of both methods. CONCLUSIONS: The novel robotic system is feasible, but further studies are needed to address its performance in vivo.