A multi-institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602).

BACKGROUND: Proximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven. METHODS: We conducted a multi-institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS-37 and EORTC-QLQ-C30 to evaluate the changes in body weight and QOL over a 3-year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery. RESULTS: We enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS-37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d -1.085) and total symptom score (p = 0.050, Cohen's d -0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC-QLQ-C30 detected no difference between the groups at any time point during 3-year postoperative period. CONCLUSIONS: This prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion.

Thirty-year outcomes of low-intensity anticoagulation for mechanical aortic valve.

The long-term safety, efficacy, and outcomes of low-intensity anticoagulation for mechanical heart valves remain unclear. This study aimed to evaluate the long-term outcomes of low-intensity anticoagulation therapy after aortic valve replacement (AVR) with a mechanical prosthesis. This retrospective cohort study consulted medical records and conducted a questionnaire to investigate 519 patients who underwent single AVR with the St. Jude Medical bileaflet valve and were in sinus rhythm. All patients were followed up with an international normalized ratio (INR) target of 1.6-2.5, and their INR values were checked throughout the follow-up period. The survival rate, incidence of major adverse cardiac and cerebrovascular events (MACCE), and risk factors for cardiac death and MACCE were investigated. The total follow-up was 9793 patient-years, and the follow-up periods were 19.9 (standard deviation [SD]: 7.9) years. The mean INR was 2.03 (SD: 0.54). Survival rates from cardiac death were 93.6% in 20 years and 85.2% in 30 years. Advanced age ≥ 70 years was the only significant risk factor for cardiac death and MACCE, and the INR < 2.0 was not significant risk factor for MACCE including thromboembolism or bleeding events. Low-intensity anticoagulation with an INR of 1.6-2.5 for patients with sinus rhythm after AVR with a bileaflet mechanical valve is safe and effective, even over 30 years.

Expanding the Frontier of Linear Drug Design: Cu-Catalyzed Csp -Csp 3 -Coupling of Electron-Deficient SF4 -Alkynes with Alkyl Iodides.

Despite the attractive properties of tetrafluorosulfanyl (SF4 ) compounds in drug discovery, medicinal research on SF4 molecules is hindered by the scarcity of suitable synthetic methodologies. Drawing inspiration from the well-established Sonogashira cross-coupling of terminal alkynes under Pd-catalysis, it is envisioned that SF4 -alkynes can serve as effective coupling partners. To overcome the challenges associated with the electron-deficient nature of SF4 -alkynes and the lability of the SF4 unit under transition-metal catalysis, an aryl radical mediated Csp -Csp 3 cross-coupling reaction is successfully developed under Cu catalysis. This methodology facilitates the coupling of SF4 -alkynes with alkyl iodides, leading to the immediate synthesis of SF4 -attached drug-like molecules. These findings highlight the potential impact of SF4 -containing molecules in the drug industry, paving the way for further research in this emerging field.

Taxifolin for Cognitive Preservation in Patients with Mild Cognitive Impairment or Mild Dementia.

BACKGROUND: The development of numerous disease-modifying drugs for age-related dementia has been attempted based on the amyloid-ß (Aß) hypothesis without much success. Taxifolin (TAX), a natural bioactive flavonoid, shows pleiotropic neuroprotective effects with inhibition of Aß aggregation, production, and glycation, antiinflammatory effects, and amelioration of the waste clearance system. We hypothesized that TAX intake is associated with the suppression of cognitive deterioration. OBJECTIVE: To investigate associations between TAX intake and cognitive changes. METHODS: We retrospectively identified patients who orally took TAX 300 mg/day and regularly underwent Alzheimer's Disease Assessment Scale-Cognitive Subscale 13 (ADAS-Cog) and Montreal Cognitive Assessment (MoCA) and compared the temporal changes in ADAS-Cog and MoCA between the non-treatment (pre-TAX) period (180±100 days) and following treatment (on-TAX) period (180±100 days) from June 2020 to November 2021. Since some additional patients underwent the Mini-Mental State Examination (MMSE) instead of the MoCA at the beginning of the pre-TAX period, the same comparison was performed using the MoCA total score converted from MMSE as a sensitivity analysis. RESULTS: Sixteen patients were identified. TAX intake was associated with significantly higher interval changes in the MoCA subscale scores of visuospatial/executive function (p = 0.016), verbal fluency (p = 0.02), and the total score (p = 0.034), but not with ADAS-Cog (total score, p = 0.27). In the sensitivity analysis, 29 patients were included. TAX intake was associated with a significantly higher interval change in the total MoCA score (p = 0.004) but not with ADAS-Cog (p = 0.41). CONCLUSION: Our findings provide a basis for TAX as a novel strategy for maintaining brain health during aging. A prospective cohort study is required to confirm these findings.

Low-Temperature Ammonia Synthesis on Iron Catalyst with an Electron Donor.

Haber-Bosch process produces ammonia to provide food for over 5 billion people; however, it is currently required to be produced without the use of fossil fuels to reduce global CO2 emissions by 3% or more. It is indispensable to devise heterogeneous catalysts for the synthesis of ammonia below 100-150 °C to minimize the energy consumption of the process. In this paper, we report metallic iron particles with an electron-donating material as a catalyst for ammonia synthesis. Metallic iron particles combined with a mixture of BaO and BaH2 species in an appropriate manner could catalyze ammonia synthesis even at 100 °C. The iron catalyst revealed that iron can exhibit a high turnover frequency (∼12 s-1), which is over an order of magnitude higher than those of other transition metals used in highly active catalysts for ammonia synthesis. This can be attributed to the intrinsic nature of iron to desorb adsorbed hydrogen atoms as hydrogen molecules at low temperatures.

The Impact of Nutritional Support on Survival Outcomes in Patients with Advanced Gastric Adenocarcinoma Treated with Chemotherapy.

Malnutrition and cachexia occur commonly in patients with advanced gastric cancer (AGC). This study elucidated the effect of nutritional support (NS) on survival outcomes among patients with AGC undergoing chemotherapy. We retrospectively evaluated new AGC cases at our institute between January 2015 and January 2021. Inclusion criteria were unresectable or recurrent chemotherapy-treated gastric adenocarcinoma, ECOG performance status (PS) 0-2, and adequate organ function. Time to treatment failure (TTF) and overall survival (OS) were evaluated, and univariate and multivariate analyses identified prognostic factors. A total of 103 eligible patients were separated into groups: 69 patients (67%) into NS and 34 (33%) into routine care (RC). The median follow-up time was 11.0 mo, (0.5-92). NS was offered to patients with poorer PS (p = 0.03), Glasgow prognostic score (GPS) positivity (p = 0.001), and high neutrophil-to-lymphocyte ratios (cut-off ≤ 3, p = 0.02). Median OS and TTF in the RC and NS groups were 11.6 and 10.4 mo, (p = 0.99) and 4.2 and 5.5 mo, (p = 0.07), respectively. Multivariate analyses identified NS (hazard ratio [HR] = 0.53, p = 0.01) and GPS positivity for TTF, and low body mass index (HR = 2.03, p = 0.007) and GPS positivity (HR = 2.25, p = 0.001) for OS as significant prognostic factors. Thus, NS with chemotherapy is a potentially effective intervention for AGC.

Nonsurgical treatment for asymptomatic pancreatolithiasis is meaning: A case report.

BACKGROUND: Many guidelines for nonsurgical treatment of pancreatolithiasis suggest little guidance for patients with pancreatolithiasis who do not have abdominal pain. Some patients with pancreatolithiasis whom we have treated nonsurgically with extracorporeal shock-wave lithotripsy did not have abdominal pain, and we describe one of them here. METHODS AND RESULTS: A 42-year-old man complaining of an 8-kg weight loss over 6 months was admitted to a nearby hospital, where fasting blood sugar and hemoglobin A1c values were 500 mg/dL and 11.8%. Computed tomography showed stones in the head of the pancreas and dilation of the main pancreatic duct. He was referred to our hospital to be considered for nonsurgical treatment of pancreatolithiasis. His height and weight were 160 cm and 52 kg (body mass index, 20.31). No tenderness or other abdominal findings were evident. After obtaining informed consent for nonsurgical treatment despite absence of abdominal pain, we performed extracorporeal shock wave lithotripsy. Computed tomography showed disappearance of stones from the pancreatic head. At discharge, his weight had increased to 62 kg and hemoglobin A1c was 6.8%, though antidiabetic medication has since become necessary. CONCLUSION: We believe that nonsurgical treatment of pancreatolithiasis was helpful for this patient, and could improve exocrine and endocrine function in other patients without abdominal pain.

Late-onset spinal subdural hematoma following cerebrospinal fluid drainage tube removal.

Cerebrospinal fluid drainage is recommended for high-risk patients to prevent spinal cord ischemia during aortic surgery; however, it is associated with complications. We report a case of a late-onset spinal subdural hematoma that developed after removal of the cerebrospinal fluid drainage tube from a patient who undergon thoracic endovascular aortic repair. Spinal hematoma usually develop 2 to 3 days after tube removal; however, in our patient's case, it developed after 7 days. Therefore, a spinal subdural hematoma can occur ≤1 week after drainage tube removal, necessitating prompt magnetic resonance imaging for patients with lower limb weakness or back pain.

Interfacial Ammonia Selectivity, Atmospheric Passivation, and Molecular Identification in Graphene-Nanopored Activated Carbon Molecular-Sieve Gas Sensors.

Graphene's inherent nonselectivity and strong atmospheric doping render most graphene-based sensors unsuitable for atmospheric applications in environmental monitoring of pollutants and breath detection of biomarkers for noninvasive medical diagnosis. Hence, demonstrations of graphene's gas sensitivity are often in inert environments such as nitrogen, consequently of little practical relevance. Herein, target gas sensing at the graphene-activated carbon interface of a graphene-nanopored activated carbon molecular-sieve sensor obtained via the postlithographic pyrolysis of Novolac resin residues on graphene nanoribbons is shown to simultaneously induce ammonia selectivity and atmospheric passivation of graphene. Consequently, 500 parts per trillion (ppt) ammonia sensitivity in atmospheric air is achieved with a response time of ∼3 s. The similar graphene and a-C workfunctions ensure that the ambipolar and gas-adsorption-induced charge transfer characteristics of pristine graphene are retained. Harnessing the van der Waals bonding memory and electrically tunable charge-transfer characteristics of the adsorbed molecules on the graphene channel, a molecular identification technique (charge neutrality point disparity) is developed and demonstrated to be suitable even at parts per billion (ppb) gas concentrations. The selectivity and atmospheric passivation induced by the graphene-activated carbon interface enable atmospheric applications of graphene sensors in environmental monitoring and noninvasive medical diagnosis.

Massive hemorrhage from the posterior intercostal artery following lower partial sternotomy.

BACKGROUND: Median sternotomy remains the most common approach in cardiovascular surgery. Recently, minimally invasive procedures, such as minimally invasive cardiac surgery, robot surgery, and catheter therapy have been developed in cardiovascular surgery. However, all these surgeries cannot be performed by minimally invasive approaches. Several complications associated with median sternotomy have been reported, although post-sternotomy hemorrhage from the posterior intercostal artery is extremely rare. CASE PRESENTATION: We present a case of posterior intercostal artery bleeding following lower partial sternotomy. A 79-year-old man underwent aortic valve replacement using lower partial median inverted L-shaped sternotomy that cut into the right second intercostal space. A postoperative chest radiograph indicated a hematoma in the right upper chest wall and pleural effusion. Hence, we inserted a drainage tube immediately. Approximately 2 hours after the surgery, his blood pressure gradually decreased. Blood drainage was observed from the tube, and the amount of blood drainage was not large. Contrast-enhanced computed tomography revealed a huge hematoma and hemorrhage from the fourth right posterior intercostal artery. Immediately, we performed emergency surgery. The lower partial sternotomy was repeated. We detected the origin of the bleeding that was identified in the right fourth posterior intercostal artery, and the bleeding was stopped. The postoperative course was uneventful. CONCLUSIONS: This case highlights the possibility of intraoperative bleeding from the intercostal artery, even in the absence of clearly rib fracture. In our case, we did not identify the cause of bleeding, although we suggest the inhomogeneous stress on the posterior ribs upon attaching the sternal retractor for lower partial sternotomy may have affected the posterior intercostal artery.

Effects of endoscopy-related procedure time on musculoskeletal disorders in Japanese endoscopists: a cross-sectional study.

Background and study aims There has been little evidence assessing the prevalence of musculoskeletal disorders (MSDs) among endoscopists performing recent diagnostic and therapeutic endoscopic procedures requiring prolonged procedural times. We evaluated the prevalence and identified the risk factors for developing MSDs, focusing on procedural time. Methods An electronic survey of endoscopists (n = 213) employed at the Nagoya University Hospital and its affiliated hospitals was developed by a multidisciplinary group.  Results Of the 110 endoscopists (51.6 %) who responded to the survey, eighty-seven endoscopists (79.1 %) had experienced endoscopy-related MSDs during the previous 1 year, and 49 endoscopists (44.5 %) had experienced these MSDs during the previous week. Nineteen endoscopists (17.3 %) reported absence from work due to severe MSDs. The most frequent sites of MSDs were neck, low back, and shoulders. Logistic regression analyses showed that longer upper endoscopic submucosal dissection ESD, (odds ratio: 5.7; 95 %CI: 1.3-25.0), lower ESD (odds ratio 4.9; 95 %CI: 1.1-22.0), and lower gastrointestinal treatment (odds ratio: 5.6; 95 %CI: 2.3-13.3) were significantly associated with the development of MSDs in the low back area. Moreover, longer lower ESD (odds ratio: 5.0; 95 % CI: 1.2-20.2) was a risk factor for symptoms in the left shoulder. Conclusion This study suggests a correlation between the volume of therapeutic endoscopic procedures including ESD and the risk of MSDs mainly low back area and left shoulder. Managing monthly total endoscopic time, in light of organizational ergonomics, could contribute to minimizing such risks of endoscopy-related MSDs.

[Mobile Thrombus in the Ascending Aorta Detected Incidentally in the Patient with Fever before Surgery for Esophageal Cancer:Report of a Case].

A mobile thrombus in the ascending aorta is extremely rare. A 57-year-old man was referred to our hospital with suspected esophageal cancer. Following thorough evaluation, he was diagnosed with esophageal cancer( UtMt type0-Ⅱa T1b, Mt type0-Ⅱc T1a N0M0 cStageⅠ) and tongue cancer in situ. He was administered preoperative chemotherapy comprising fluorouracil and cisplatin. The patient developed fever on day four of the first course of the chemotherapy. Contrast-enhanced chest and abdominal computed tomography revealed a mobile thrombus in the ascending aorta with bilateral partial renal infarction. We initiated intravenous unfractionated heparin and oral warfarin as anticoagulant therapy. The thrombus did not disappear despite ten-day treatment;therefore, he underwent aortic thrombectomy under hypothermic circulatory arrest with retrograde cerebral perfusion. Intraoperatively, we detected a pedunculated mobile thrombus attached to the aorta. His postoperative course was uneventful and he was treated at discharge with warfarin. He underwent video-assisted thoracoscopic esophagectomy postoperatively and was discharged without any complication. Currently, he showed no recurrent thrombus or cancer.

[Thoracic Endovascular Aortic Repair for Idiopathic Aortic Rupture].

Idiopathic aortic rupture is a rare but often fatal condition that requires urgent attention and repair. I have performed thoracic endovascular aortic repair ( TEVAR) in two cases of idiopathic aortic rupture and have achieved positive results. It can be difficult to identify the site of rupture in these cases. Therefore, it is necessary to lengthen treatment and to determine the potential for spinal cord ischemia and associated paralysis of the lower extremities. Given its association with a favorable postoperative recovery, TEVAR can be considered as a minimally-invasive option that can be used early to treat this condition, including those associated with hemodynamic instability and in patients who are at high risk for complications.

Determining Factor on the Polarization Behavior of Magnesium Deposition for Magnesium Battery Anode.

To clarify the origin of the polarization of magnesium deposition/dissolution reactions, we combined electrochemical measurement, operando soft X-ray absorption spectroscopy (operando SXAS), Raman, and density functional theory (DFT) techniques to three different electrolytes: magnesium bis(trifluoromethanesulfonyl)amide (Mg(TFSA)2)/triglyme, magnesium borohydride (Mg(BH4)2)/tetrahydrofuran (THF), and Mg(TFSA)2/2-methyltetrahydrofuran (2-MeTHF). Cyclic voltammetry revealed that magnesium deposition/dissolution reactions occur in Mg(TFSA)2/triglyme and Mg(BH4)2/THF, while the reactions do not occur in Mg(TFSA)2/2-MeTHF. Raman spectroscopy shows that the [TFSA]- in the Mg(TFSA)2/triglyme electrolyte largely does not coordinate to the magnesium ions, while all of the [TFSA]- in Mg(TFSA)2/2-MeTHF and [BH4]- in Mg(BH4)2/THF coordinate to the magnesium ions. In operando SXAS measurements, the intermediate, such as the Mg+ ion, was not observed at potentials above the magnesium deposition potential, and the local structure distortion around the magnesium ions increases in all of the electrolytes at the magnesium electrode|electrolyte interface during the cathodic polarization. Our DFT calculation and X-ray photoelectron spectroscopy results indicate that the [TFSA]-, strongly bound to the magnesium ion in the Mg(TFSA)2/2-MeTHF electrolyte, undergoes reduction decomposition easily, instead of deposition of magnesium metal, which makes the electrolyte inactive electrochemically. In the Mg(BH4)2/THF electrolyte, because the [BH4]- coordinated to the magnesium ions is stable even under the potential of the magnesium deposition, the magnesium deposition is not inhibited by the decomposition of [BH4]-. Conversely, because [TFSA]- is weakly bound to the magnesium ion in Mg(TFSA)2/triglyme, the reduction decomposition occurs relatively slowly, which allows the magnesium deposition in the electrolyte.

Solid solution for catalytic ammonia synthesis from nitrogen and hydrogen gases at 50 °C.

The lack of efficient catalysts for ammonia synthesis from N2 and H2 gases at the lower temperature of ca. 50 °C has been a problem not only for the Haber-Bosch process, but also for ammonia production toward zero CO2 emissions. Here, we report a new approach for low temperature ammonia synthesis that uses a stable electron-donating heterogeneous catalyst, cubic CaFH, a solid solution of CaF2 and CaH2 formed at low temperatures. The catalyst produced ammonia from N2 and H2 gases at 50 °C with an extremely small activation energy of 20 kJ mol-1, which is less than half that for conventional catalysts reported. The catalytic performance can be attributed to the weak ionic bonds between Ca2+ and H- ions in the solid solution and the facile release of hydrogen atoms from H- sites.

Magnetic anchor-guided endoscopic submucosal dissection for colorectal tumors (with video).

BACKGROUND: The feasibility of magnetic anchor-guided endoscopic submucosal dissection (MAG-ESD) using a neodymium magnet for colorectal tumors has not been evaluated. The aim of this study was to clarify the feasibility of MAG-ESD for colorectal tumors. METHODS: This prospective trial was conducted at Yamashita Hospital. MAG-ESD was performed for 49 colorectal tumors. The magnetic anchor comprised an internal magnet attached to an endoclip with 3-0 silk. Both external and internal magnets were made using neodymium magnets. The feasibility of traction achieved using MAG-ESD, en bloc resection rate, complete en bloc resection rate, time required for preparation and attachment of the magnetic anchor, procedure time, rate of retrieval of magnetic anchors, and adverse events were evaluated. RESULTS: MAG-ESDs were successfully performed for 48 colorectal tumors except for a rectal case in which the internal magnet stuck to the endoscope. En bloc resections and complete en bloc resections were achieved in all cases. Attaching the magnetic anchor required a median of 8 min (range 3-37 min). Median procedure time was 76 min (range 28-283 min) and the magnetic anchors were retrieved in all cases without adverse events. CONCLUSION: MAG-ESD is feasible and safe in the colon and may facilitate the treatment of all difficult lesions. (UMIN000024100).

The Prevalence of Mixed Hepatitis C Virus Genotype Infection and Its Effect on the Response to Direct-Acting Antivirals Therapy.

BACKGROUND: The incidence of mixed hepatitis C virus (HCV) genotype infection is variable, and a few reports exist regarding the efficacy of direct-acting antivirals (DAA) therapy for mixed genotype. We aimed to investigate the prevalence of mixed genotype and its impact on the virologic response to DAA therapy. METHODS: A total of 365 patients with chronic HCV infection who completed antiviral therapy were recruited. Nested polymerase chain reaction with universal and specific primers of genotypes 1b and 2 and direct sequencing were used for HCV genotyping. RESULTS: Direct sequencing with universal primers defined genotypes 1b (n = 230), 2a (n = 95), and 2b (n = 40). Direct sequencing of genotype 2 was performed in patients with genotype 1b, and direct sequencing of genotype 1b in patients with genotype 2. Four patients with genotype 1b underwent amplification for genotype 2, and direct sequencing identified genotypes 1b (n = 1), 2a (n = 1), and 2b (n = 2). None with genotype 2 underwent amplification for genotype 1b. Three cases were confirmed to have mixed genotype. CONCLUSIONS: Mixed genotype was rare, and hence the impact of mixed genotype on treatment outcome with DAA therapy is expected to be minimal.

Randomized Phase II Study of Consecutive-Day versus Alternate-Day Treatment with S-1 as Second-Line Chemotherapy in Advanced Pancreatic Cancer.

OBJECTIVE: To evaluate the efficacy and safety of alternate-day administration of S-1 as second-line chemotherapy for unresectable pancreatic cancer in a multicenter, randomized, phase II study. METHODS: Patients with histologically proven, unresectable pancreatic cancer treated with chemotherapy not including S-1 as first-line therapy were randomly assigned to receive either daily or alternate-day treatment with S-1. The primary end point was overall survival (OS), and the secondary end points were progression-free survival (PFS), time to treatment failure (TTF), response rate, and adverse events. RESULTS: A total of 77 patients were enrolled, of which 75 were included in the final analysis. The median OS was 4.5 months in the daily group and 4.4 months in the alternate-day group (HR 1.178; 95% CI 0.741-1.875), with no significance in PFS and TTF. The response rate was 2.8% in the daily group and 0% in the alternate-day group. Grade 3 or higher adverse events occurred with significantly higher incidence in the daily group (47.2 vs. 25.6%, p = 0.044). CONCLUSION: As a second-line chemotherapy for unresectable pancreatic cancer, although the efficacy in both groups was comparable and we can expect fewer toxicities with alternate-day administration of S-1, the noninferiority of alternate-day treatment to daily treatment with S-1 was not verified.