[A case of aortic thrombus during chemotherapy for esophageal cancer].

A 59-year-old man presented to our hospital with a chief complaint of epigastric pain. Pertinent history included a distal gastrectomy for gastric cancer and alcohol dependence. He underwent contrast-enhanced computed tomography (CT) and esophagogastroduodenoscopy, which led to a diagnosis of esophageal cancer (cT2N2M1, stage IVb). Subsequently, he underwent chemotherapy using 5-fluorouracil and cis-diamminedichloroplatinum and radiotherapy. A total of 44 days after treatment initiation, the patient experienced nausea and hepatobiliary enzyme elevation. CT and abdominal ultrasonography were performed, and he was diagnosed with an abdominal aortic thrombus. Intravenous heparin was administered as an anticoagulant therapy. Twenty-two days after treatment initiation, the thrombus was no longer visible on abdominal ultrasonography. The patient was then treated with warfarin. It cannot be ruled out that the patient's hepatobiliary enzyme elevation was induced by the anticancer drugs. However, enzyme elevation improved with the disappearance of the abdominal aortic thrombus, suggesting that the aortic thrombus may have contributed to the hepatobiliary enzyme elevation. No thrombus recurrence was observed until the patient's death after an initial treatment with antithrombotic agents. This case indicates that malignant tumors and chemotherapy can cause aortic thrombi, and thus, care should be exercised in monitoring this potential complication.

Association between visuo-spatial working memory and gait motor imagery.

Although motor imagery and working memory (WM) appear to be closely linked, no previous studies have demonstrated direct evidence for the relationship between motor imagery and WM abilities. This study investigated the association between WM and gait motor imagery and focused on the individual differences in young adults. This study included 33 participants (mean age: 22.2 ± 0.9 years). We used two methods to measure the ability of different WM domains: verbal and visuo-spatial WM. Gait motor imagery accuracy was assessed via the mental chronometry paradigm. We measured the times participants took to complete an actual and imagined walk along a 5 m walkway, with three different path widths. The linear mixed effects model analysis revealed that visuo-spatial WM ability was a significant predictor of the accuracy of gait motor imagery, but not of verbal WM ability. Specifically, individuals with lower visuo-spatial WM ability demonstrated more inaccuracies in the difficult path-width conditions. However, gait motor imagery was not as accurate as actual walking even in the easiest path width or in participants with high visuo-spatial WM ability. Further, visuo-spatial WM ability was significantly correlated with mental walking but not with actual walking. These results suggest that visuo-spatial WM is related to motor imagery rather than actual movement.

Comparison of peripersonal space in front and rear spaces.

The space immediately around the body, referred to as the peripersonal space (PPS), plays a crucial role in interactions with external objects and in avoiding unsafe situations. This study aimed to investigate whether the size of the PPS changes depending on direction, with a particular focus on the disparity between the front and rear spaces. A vibrotactile stimulus was presented to measure PPS while a task-irrelevant auditory stimulus (probe) approached the participant. In addition, to evaluate the effect of the probe, a baseline condition was used in which only tactile stimuli were presented. The results showed that the auditory facilitation effect of the tactile stimulus was greater in the rear condition than in the front condition. Conversely, the performance on tasks related to auditory distance perception and sound speed estimation did not differ between the two directions, indicating that the difference in the auditory facilitation effect between directions cannot be explained by these factors. These findings indicate that the strength of audio-tactile integration is greater in the rear space compared to the front space, suggesting that the representation of the PPS differed between the front and rear spaces.

Age-related differences in temporal binding and the influence of action body parts.

If voluntary action is followed by an effect with a short time delay, the time interval between action and effect is often perceived to be shorter than it actually is. This perceptual time compression is termed intentional binding or temporal binding. We investigated age-related changes in adulthood considering temporal binding and its dependence on action body parts (i.e., hand vs. foot). This experiment included 17 young adults (mean age: 21.71 ± 3.14 years) and 27 older adults (mean age: 74.41 ± 3.38 years). Participants performed a button press task using their index fingers (hand condition) or toes (foot condition). The results showed that older participants exhibited a strong time compression comparable to young participants in the voluntary condition. Older participants also showed a strong time compression in involuntary action, which was induced by a mechanical device, differently from young participants. In line with previous research, the present age-related differences in time compression considering involuntary action suggest that causal belief significantly influences event perception rather than the associated intention of action or sensory afferents. The present results also suggest that the nature of action body parts has no significant influence on temporal binding, independent of age group.

The safety and efficacy of Ringer's solution loading with rectal diclofenac for prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: The RESOLUTION-PEP study.

Objectives: We evaluated the safety and efficacy of aggressive hydration with rectal non-steroidal anti-inflammatory drugs for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: This prospective, single-arm, multicenter trial was conducted at 12 institutions between October 2020 and August 2021. We enrolled 231 patients who had intact papillae and were scheduled to undergo ERCP. All patients were administered rectal diclofenac before ERCP. They received aggressive hydration with intravenous lactated Ringer's solution in an initial bolus of 5 ml/kg at the start of ERCP, followed by 3 ml/kg/h for 8 h after the procedure. The primary outcome was the occurrence of PEP. Secondary outcomes included PEP severity, hyperamylasemia, and adverse events. Results: The mean age of the patients was 68.8 ± 13.7 years, and 81 patients (35.1%) were 75 years or older. Thirteen patients developed PEP (5.6%, 95% confidence interval 3.0%-9.4%). There were 11 cases (4.8%) of mild pancreatitis and two cases (0.9%) of severe pancreatitis. Forty-five patients (19.5%) developed hyperamylasemia and one patient developed non-severe peripheral edema. Conclusions: Aggressive hydration combined with rectal diclofenac may be a promising strategy for the prevention of PEP. Furthermore, it is safe even for older individuals.

Inhibition of intentional binding by an additional sound presentation.

When a voluntary action is followed by an effect after a short delay, the time distance between the action and its effect is perceived to be shorter than the actual time distance. This phenomenon is known as intentional binding (IB). We investigated the influence of presentation of an additional effect on IB between the action and the target effect, and investigated the influence of the presentation timing of the additional effect. One sound (target sound) was constantly presented 250 ms after the button was pressed, and the other sound (additional sound) was presented simultaneously when the button was pressed (Experiment 1) or at one of various timings that included moments both before and after the target sound (Experiment 2). The results showed that IB between the action and target sound was significantly inhibited only when the additional sound was presented prior to the target sound. This suggests that the prior effect has a greater advantage in connecting to the action compared to the posterior sound.

Visual self-motion information contributes to passable width perception during a bike riding situation.

Previous studies have shown that space perception around the body is altered by self-motion, and that several self-motion cues from different modalities, including vision, proprioception, the vestibular system, and the motor system (motor commands) contribute to it. However, studies on how online self-motion information affects the perception of a passable width of a narrow aperture is largely overlooked by existing literature. Therefore, this study investigated this issue during virtual bike riding. Participants observed a narrow doorway aperture with varied widths in a virtual environment through a head-mounted display while riding a stationary bike. Visual self-motion information was presented by optical flow, while motor commands and proprioceptive feedback (non-visual information) was provided by having participants pedal the bike. The participants were then required to judge whether the presented aperture was passable. Experiment 1, where both visual and non-visual cues were provided, confirmed that the perceived passable width significantly increased with increasing self-motion speed, as previously shown during walking. Experiment 2, where self-motion cues were manipulated, showed that expansion of the perceived passable width was mainly induced by visual self-motion information. These results suggest that online self-motion information can affect passable width perception during bike riding and that visual self-motion information plays a significant role in this perception.

Contribution of motor and proprioceptive information to visuotactile interaction in peripersonal space during bike riding.

The space immediately around the body, known as the peripersonal space (PPS), plays an important role in interactions with the environment. Specific representations are reported to be constructed in the brain. PPS expansion reportedly occurs during whole-body self-motions, such as walking; however, little is known regarding how dynamic cues in proprioceptive/motor information contribute to such phenomena. Thus, we investigated this issue using a pedaling bike situation. We defined PPS as the maximum distance at which a visual probe facilitated tactile detection at the chest. Experiment 1 compared two conditions where participants did or did not pedal the bike at a constant speed while observing an optic flow that simulated forward self-motion (pedaling and no pedaling). Experiment 2 investigated the effect of pedal resistances (high and low) while presenting the same optic flow as in Experiment 1. The results revealed that the reaction time (RT) difference (probe RT - baseline RT) was larger for the pedaling than for the no-pedaling condition. However, pedal resistance differences hardly affected the visuotactile interaction, although the participants clearly experienced differences in force. These results suggest that proprioceptive/motor cues can contribute to the modulation of PPS representation, but dynamic information included in these cues may have little influence.

Irbesartan, an angiotensin II type 1 receptor blocker, inhibits colitis-associated tumourigenesis by blocking the MCP-1/CCR2 pathway.

The introduction of anti-inflammatory therapies has enabled substantial improvement of disease activity in patients with inflammatory bowel diseases (IBD). However, IBD can lead to serious complications such as intestinal fibrosis and colorectal cancer. Therefore, novel therapies reducing the development of these complications are needed. Angiotensin II (Ang II) promotes tissue inflammation by stimulating the production of monocyte chemoattractant protein-1 (MCP-1) or proinflammatory cytokines. It plays a pivotal role in IBD progression. Although blockade of Ang II has been reported to ameliorate experimental colitis and reduce colorectal cancer risk, the cellular and molecular mechanisms remain poorly understood. Our previous work showed that irbesartan, an Ang II type 1 receptor blocker, reduced the number of C-C chemokine receptor 2-positive (CCR2+) monocytic cells in the inflamed pancreas. This study aimed to investigate the possible antifibrotic and antitumour effects of irbesartan using the azoxymethane/dextran sodium sulphate mouse model. Irbesartan suppressed MCP-1 production and the accumulation of Ly6C+CCR2+ monocytes and fibrocytes in the inflamed colon, downregulated the expression of type 1 collagen and matrix metalloproteinase 9 and inhibited the development of intestinal fibrosis and tumours. Our observations suggest that blocking the MCP-1/CCR2 pathway using irbesartan might be beneficial in preventing colitis-associated colon tumours.

Automatic gaze to the nose region cannot be inhibited during observation of facial expression in Eastern observers.

Humans can extract a great deal of information about others very quickly. This is partly because the face automatically captures observers' attention. Specifically, the eyes can attract overt attention. Although it has been reported that not only the eyes but also the nose can capture initial oculomotor movement in Eastern observers, its generalizability remains unknown. In this study, we applied the "don't look" paradigm wherein participants are asked not to fixate on a specific facial region (i.e., eyes, nose, and mouth) during an emotion recognition task with upright (Experiment 1) and inverted (Experiment 2) faces. In both experiments, we found that participants were less able to inhibit the initial part of their fixations to the nose, which can be interpreted as the nose automatically capturing attention. Along with previous studies, our overt attention tends to be attracted by a part of the face, which is the nose region in Easterner observers.

Expansion of space for visuotactile interaction during visually induced self-motion.

Peripersonal space (PPS), which refers to space immediately around an individual's body, plays an important role in interacting with external objects and avoiding unsafe situations. Studies suggest that, during self-motion perception, PPS expands in the direction in which a person perceives himself/herself to be traveling. In the present study, we built on this by investigating, using visually induced self-motion (vection), how visual self-motion information modulates PPS representation. In our experiment, large-field visual motion was presented through a head-mounted display that caused observers to perceive themselves as moving forward in a tunnel (LF condition). To clarify the effects of self-motion information, we compared the findings for this condition with those of another condition, in which small-field visual motion was presented; here, only the central visual field represented motion, which caused the observers to perceive relatively little self-motion (SF condition). Two speeds were tested for both conditions: 1.5 m/s and 6.0 m/s. For measurement, we used a visuotactile-interaction task in which participants, while observing a visual probe object approaching from various distances, were instructed to press a response key as soon as they detected tactile stimuli delivered to their chest. We measured the distance at which the visual approaching probe object facilitated tactile detection (visual-facilitation effect); this was determined through comparisons with trials when no probe was presented. The results showed that the visual facilitation effects were observed for larger distance in the LF than SF conditions, irrespective of tested speeds. These results suggest that visual self-motion information can modulate PPS representation. This finding fits well with the view that PPS representation contributes to protecting the body from potential threats in the environment.

Usefulness of an additional lead shielding device in reducing occupational radiation exposure during interventional endoscopic procedures: An observational study.

Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation.An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures.The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations.An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.

Infiltrating CCR2+ monocytes and their progenies, fibrocytes, contribute to colon fibrosis by inhibiting collagen degradation through the production of TIMP-1.

Intestinal fibrosis is a serious complication in inflammatory bowel disease (IBD). Despite the remarkable success of recent anti-inflammatory therapies for IBD, incidence of intestinal fibrosis and need for bowel resection have not significantly changed. To clarify the contribution of haematopoietic-derived cells in intestinal fibrosis, we prepared bone marrow (BM) chimeric mice (chimeras), which were reconstituted with BM cells derived from enhanced green fluorescent protein (EGFP)-transgenic mice or CC chemokine receptor 2 (CCR2)-deficient mice. After 2 months of transplantation, BM chimeras were treated with azoxymethane/dextran sodium sulphate. During chronic inflammation, CCR2+ BM-derived monocyte and fibrocyte infiltration into the colon and CC chemokine ligand 2 production increased, leading to colon fibrosis in EGFP BM chimeras. In CCR2-deficient BM chimeras, monocyte and fibrocyte numbers in the colonic lamina propria significantly decreased, and colon fibrosis was attenuated. In colon tissue, mRNA expression of tissue inhibitor of metalloproteinase (TIMP)-1 but not of collagen I, transforming growth factor-ß1 or matrix metalloproteinases was significantly different between the two chimeras. CCR2+ monocytes and fibrocytes showed high Timp1 mRNA expression. Our results suggest that infiltrating CCR2+ monocytes and their progenies, fibrocytes, promote colon fibrosis by inhibiting collagen degradation through TIMP-1 production.

Management of the late effects of disconnected pancreatic duct syndrome: A case report.

BACKGROUND: There have been few reports about the late effects of disconnected pancreatic duct syndrome (DPDS). Although few reports have described the recurrence interval of pancreatitis, it might be rare for recurrence to occur more than 5 years later. Herein, we describe a case of recurrence in an 81-year-old man after the treatment of walled-off necrosis (WON) with pancreatic transection 7 years ago. CASE SUMMARY: An 81-year-old man visited our hospital with chief complaints of fever and abdominal pain 7 years after the onset of WON due to severe necrotic pancreatitis. His medical history included an abdominal aortic aneurysm (AAA), hypertension, dyslipidemia, and chronic kidney disease. Computed tomography (CT) scan showed that the pancreatic fluid collection (PFC) had spread to the aorta with inflammation surrounding it, and CT findings suggested that bleeding occurred from the vasodilation due to splenic vein occlusion. First, we attempted to perform transpapillary drainage because of venous dilation around the residual stomach and the PFC. However, pancreatic duct drainage failed because of complete main pancreatic duct disruption. Second, we performed endoscopic ultrasound-guided drainage. After transmural drainage, the inflammation improved and stenting for the AAA was performed successfully. The inflammation was resolved, and he has been free from infection for more than 2 years after the procedure. CONCLUSION: This case highlights the importance of continued follow-up of patients for recurrence after the treatment of WON with pancreatic transection.

High load of Merkel cell polyomavirus DNA detected in the normal skin of Japanese patients with Merkel cell carcinoma.

BACKGROUND: Although Merkel cell polyomavirus (MCPyV) has the potential to cause Merkel cell carcinoma (MCC), it is also found in the normal skin of healthy individuals. However, the mechanism for transformation of MCPyV to an oncogenic form is unknown. OBJECTIVES: To investigate the levels of MCPyV infection in the normal skin patients with MCC compared with those in a control cohort. STUDY DESIGN: We studied a total of six Japanese patients with cutaneous MCC. Sun-exposed and sun-unexposed skin swabs were obtained and analyzed for MCPyV loads using quantitative real-time polymerase chain reaction. RESULTS: At first, we found a patient with MCC carrying an extremely high load of MCPyV DNA in normal skin. This unique case prompted us to further explore the levels of MCPyV as skin microbiota in patients with MCC. We showed that MCPyV DNA levels were significantly higher in swabs obtained from normal skin samples of six patients with MCC compared with those from 30 age-matched healthy individuals and 19 patients with other cutaneous cancers. Whereas MCPyV strains obtained from the normal skin of patients with MCC had gene sequences without structural alterations, sequences of the tumor-derived strains showed truncating mutations or deletions. CONCLUSIONS: Although the number of patients with MCC studied was small, our findings suggest that MCC may occur with a background of high MCPyV load in the skin, and are expected to stimulate further studies on whether such skin virome levels could be one of predictive markers for the development of MCC.

[Clinical usefulness of the new Japanese glomerular filtration rate equation for initial and individualized dosage adjustment concentrations of vancomycin].

To clarify whether the new Japanese glomerular filtration rate (eGFR) equation was able to accurately determine the initial and individualized dosage adjustment concentrations of vancomycin (VCM), the predictive performance for VCM concentrations using the eGFR and Cockcroft-Gault (CG) equations was compared. Data were retrospectively collected from clinical records of 90 patients with MRSA infection whose trough and peak VCM concentrations had been determined. The predicted VCM initial and individualized dosage adjustment concentrations were performed with the 2-compartment linear model using pharmacokinetic parameter means and their individual values via Bayesian estimation, respectively. The prediction error (PE) and its absolute value (APE) between the observed and predicted VCM concentrations were calculated as indices of bias and accuracy in predictive performance, respectively. In the initial dosage adjustment of VCM, the PE value, calculated with the eGFR equation in trough and peak VCM concentrations of patients whose BMI were 18.5 kg/m(2) and higher, was significantly smaller than that calculated with the CG equation. In particular, both PE and APE values obtained from the eGFR calculated concentrations from nonelderly patients (younger than 65 years old) were significantly improved compared with those from the CG equation. In the individualized dosage adjustment of VCM, the eGFR equation gave a significantly smaller PE value in nonelderly patients' trough concentrations than the CG equation. These findings provide useful information for adjusting the VCM dosage to achieve optimal therapeutic efficacy in patients with MRSA infection.