A first-in-human clinical study of laparoscopic autologous myoblast sheet transplantation to prevent delayed perforation after duodenal endoscopic mucosal dissection.

BACKGROUND: The detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) has recently been increasing. Large tumors may contain malignant lesions and early therapeutic intervention is recommended. Endoscopic mucosal dissection (ESD) is considered a feasible treatment modality, however, the anatomical and physiological characteristics of the duodenum create a risk of postoperative perforation after ESD. METHODS: To explore whether myoblast sheet transplantation could prevent delayed perforation after ESD, a first-in-human (FIH) clinical trial of laparoscopic autologous myoblast sheet transplantation after duodenal ESD was launched. Autologous myoblast sheets fabricated from muscle tissue obtained seven weeks before ESD were transplanted laparoscopically onto the serous side of the ESD. The primary endpoints were the onset of peritonitis due to delayed perforation within three days after surgery and all adverse events during the follow-up period. RESULTS: Three patients with SNADETs ≥ 20 mm in size underwent transplantation of a myoblast sheet onto the serous side of the duodenum after ESD. In case 1, The patient's postoperative course was uneventful. Endoscopy and abdominal computed tomography revealed no signs of delayed perforation. Despite incomplete mucosal closure in case 2, and multiple micro perforations during ESD in case 3, cell sheet transplantation could prevent the postoperative massive perforation after ESD, and endoscopy on day 49 after transplantation revealed no stenosis. CONCLUSIONS: This clinical trial showed the safety, efficacy, and procedural operability of this novel regenerative medicine approach involving transplanting an autologous myoblast sheet laparoscopically onto the serosa after ESD in cases with a high risk of delayed perforation. This result indicates the potential application of cell sheet medicine in treating various abdominal organs and conditions with minimal invasiveness in the future. TRIAL REGISTRATION: jRCT, jRCT2073210094. Registered November 8 2021, https://jrct.niph.go.jp/latest-detail/jRCT2073210094 .

Analysis of the Clinical Course in a Population of Patients with Biliary Tract Cancer Diagnosed as Unresectable After Portal Vein Embolization: A Case Series.

Portal vein embolization (PVE) is recommended as a preoperative procedure for patients with biliary tract cancer scheduled to undergo hepatic resection of more than 50%-60% of the liver. However, details and/or information regarding the follow-up of unresectable cases are often lacking, and the clinical course of unresectable cases is not well analyzed and reported. This study aimed to clarify the clinical prognosis of patients with unresectable biliary tract cancer after PVE. We retrospectively analyzed the clinical backgrounds of patients with biliary tract cancer who underwent PVE without subsequent resection between January 2011 and October 2022. Of the 21 patients with biliary tract cancer who underwent PVE during the study period, eight (38%) cases were unsuitable for resection after PVE for the following reasons: intraoperatively detected dissemination (n=2), para-aortic lymph node metastasis (n=1), liver metastasis (n=1), decreased liver function (n=2), development of liver metastasis while waiting (n=1), and insufficient residual liver volume (n=1). All patients received subsequent chemotherapy, including gemcitabine plus S-1 therapy in three cases, gemcitabine plus cisplatin plus S-1 in three cases, and gemcitabine plus cisplatin or S-1+cisplatin in one case each. As there is currently no curative treatment for biliary tract cancer other than surgery, multidisciplinary management and treatment of patient factors, including tumor factors and liver function, are essential to reducing the number of unresectable cases after PVE.

Large Tissue Debris Causing Cerebral Embolism After Transcatheter Aortic Valve Replacement.

Cerebral vascular embolism is one of the complications of transcatheter aortic valve replacement (TAVR). Thrombolytic therapy is not expected to be effective when embolic material consists of a large tissue fragment. Instead, mechanical aspiration may be more effective therapy for acute cerebral infarction after TAVR. Here, we describe the case of an 87-year-old woman with aortic valve stenosis and heart failure who underwent TAVR using a self-expandable valve. Acute cerebral infarction with left middle cerebral artery occlusion caused by a large tissue fragment developed after the procedure.

Effective use of the hybrid emergency Department system in the treatment of non-traumatic critical care diseases.

BACKGROUND: The hybrid emergency room (ER) system can provide resuscitation, computed tomography imaging, endovascular treatment, and emergency surgery, without transferring the patient. However, although several reports have demonstrated the effectiveness of the hybrid ER for trauma conditions, only a few case reports have demonstrated its usefulness for non-traumatic critical diseases. In this observational cohort study, we aimed to identify endogenous diseases that may benefit from treatment in the hybrid ER. METHODS: We retrospectively reviewed the clinical characteristics of patients with non-traumatic conditions treated in a hybrid ER between August 2017 and July 2022 at our institution. Patients who underwent surgery, endoscopy, or interventional radiology (IR) in the hybrid ER were selected and pathophysiologically divided into a bleeding and non-bleeding group. The rate of shock or cardiac arrest, blood transfusion, and death within 24 h of admission or in-hospital death were compared among the groups using Fisher's exact test. Multivariable logistic regression analysis was performed to confirm the relationships among in-hospital mortality, transfusion, and hemorrhagic conditions in patients who underwent endoscopy and IR. RESULTS: Among the 726 patients with non-traumatic conditions treated in a hybrid ER system, 50 (6.9%) experienced cardiac arrest at or before admission to the hybrid ER, 301 (41.5%) were in shock, 126 (17.4%) received blood transfusions, 42 (5.8%) died within 24 h of admission to the hybrid ER, and 141 (19.4%) died in the hospital. Emergency surgery was performed in 39 patients (7 in the bleeding group and 32 in the non-bleeding group). Significantly more blood transfusions were administered in the bleeding group (71.4% vs. 18.8%, P = 0.01); there were no significant differences in the rate of shock or cardiac arrest, death within 24 h, or in-hospital death between groups. Endoscopy was performed in 122 patients (80 in the bleeding group and 42 in the non-bleeding group). The bleeding group had a significantly higher rate of shock or cardiac arrest (87.5% vs. 66.7%, P = 0.008) and rate of blood transfusion (62.5% vs. 4.8%, P < 0.0001); there was no significant difference in death within 24 h and in-hospital death between groups. IR was performed in 100 patients (68 in the bleeding group and 32 in the non-bleeding group). Significantly more blood transfusions were administered in the hemorrhage group (67.7% vs. 12.5%, P < 0.0001); there was no difference in the rate of shock or cardiac arrest, death within 24 h, or in-hospital death between groups. Multivariable analysis in patients who underwent endoscopy showed a trend toward more in-hospital deaths in non-hemorrhagic conditions than in hemorrhagic conditions (odds ratio = 3.8, 95% confidence interval: 0.88-17, P = 0.073); however, no significant relationship with in-hospital death was observed for any of the adjusted variables. CONCLUSION: Among endogenous diseases treated in the hybrid ER, there is a possible association between in-hospital mortality and hemorrhagic conditions. Future studies are needed to focus on diseases to demonstrate the effectiveness of the hybrid ER.

Maturation of the medaka immune system depends on reciprocal interactions between the microbiota and the intestinal tract.

The interactions between the host immune system and intestinal microorganisms have been studied in many animals, including fish. However, a detailed analysis has not been performed in medaka, an established fish model for biological studies. Here, we investigated the effect of immunodeficiency on the microbiota composition and the effect of gut bacteria on intestinal epithelial development and immune responses in medaka. Chronological analysis of the intestinal microbiota of interleukin 2 receptor subunit gamma (il2rg) mutant medaka showed a gradual decrease in the evenness of operational taxonomic units, mainly caused by the increased abundance of the Aeromonadaceae family. Exposure of wild-type medaka to high doses of an intestine-derived opportunistic bacterium of the Aeromonadaceae family induced an inflammatory response, suggesting a harmful effect on adult il2rg mutants. In addition, we established germ-free conditions in larval medaka and observed large absorptive vacuoles in intestinal epithelial cells, indicating a block in epithelial maturation. Transcriptome analysis revealed a decrease in the expression of genes involved in the defense response, including the antimicrobial peptide gene hepcidin, whose expression is induced by lipopolysaccharide stimulation in normal larvae. These results show that reciprocal interactions between the microbiome and the intestinal tract are required for the maturation of the medaka immune system.

Genome-wide dissection of the genetic factors underlying food quality in boiled and pounded white Guinea yam.

BACKGROUND: Food quality traits related to the genetics of yam influence the acceptability for its consumption. This study aimed at identifying genetic factors underlying sensory and textural quality attributes of boiled and pounded yam, the two dominant food products from white Guinea yam. RESULTS: A genome-wide association study (GWAS) of a panel of 184 genotypes derived from five multi-parent crosses population was conducted. The panel was phenotyped for the qualities of boiled and pounded yam using sensory quality and instrument-based textural profile assays. The genotypes displayed significant variation for most of the attributes. Population differentiation and structure analysis using principal component analysis (PCA) and population structure-based Bayesian information criteria revealed the presence of four well-defined clusters. The GWAS results from a multi-random mixed linear model with kinship and PCA used as covariate identified 13 single-nucleotide polymorphic (SNP) markers significantly associated with the boiled and pounded yam food qualities. The associated SNP markers explained 7.51-13.04% of the total phenotypic variance with a limit of detection exceeding 4. CONCLUSION: Regions on chromosomes 7 and 15 were found to be associated with boiled and pounded yam quality attributes from sensory and instrument-based assays. Gene annotation analysis for the regions of associated SNPs revealed co-localization of several known putative genes involved in glucose export, hydrolysis and glycerol metabolism. Our study is one of the first reports of genetic factors underlying the boiled and pounded yam food quality to pave the way for marker-assisted selection in white Guinea yam. © 2023 Society of Chemical Industry.

Regulation of reactive oxygen species and phytohormones in osmotic stress tolerance during seed germination in indica rice.

Climate change due to global warming is now affecting agricultural production worldwide. In rice, one of the most important crops, water limitation due to irregular rainfall in rainfed lowlands during crop growth limits yield. Dry direct-sowing has been proposed as a water-efficient approach to cope with water stress during rice growth, but poor seedling establishment due to drought during germination and emergence is a problem. Here, we germinated indica rice cultivars Rc348 (drought tolerant) and Rc10 (drought sensitive) under osmotic stress induced by PEG to elucidate mechanisms of germination under drought. Rc348 had higher germination rate and germination index under severe osmotic stress of -1.5 MPa, above those of Rc10. Rc348 showed up-regulated GA biosynthesis, down-regulated ABA catabolism, and up-regulated α-amylase gene expression in imbibed seeds under PEG treatment compared to that of Rc10. During germination, reactive oxygen species (ROS) play important roles in antagonism between gibberellic acid (GA) and abscisic acid (ABA). Embryo of Rc348 treated with PEG had significantly greater expression of NADPH oxidase genes and higher endogenous ROS levels, together with significantly increased endogenous GA1, GA4 and ABA contents compared to that of Rc10. In aleurone layers treated with exogenous GA, expression of α-amylase genes was higher in Rc348 than in Rc10, and expression of NADPH oxidase genes was enhanced with significantly higher ROS content in Rc348, suggesting higher sensitivity of GA to ROS production and starch degradation in aleurone cells of Rc348. These results suggest that the osmotic stress tolerance of Rc348 is due to enhancement of ROS production, GA biosynthesis, and GA sensitivity, resulting in a higher germination rate under osmotic stress.

Vallitalea longa sp. nov., an anaerobic bacterium isolated from marine sediment.

A novel bacterium, strain SH18-1T, was isolated from marine sediment collected near Sado Island in the Sea of Japan. This strain was strictly anaerobic, Gram-stain-negative, non-spore-forming, rod-shaped, motile, and mesophilic. It grew at 15-40 °C (optimum, 30-35 °C), at a NaCl concentration of 0.2-5.0 % (w/v; optimum, 1.5-2.5 %), and at pH 5.5-8.5 (optimum, pH 7.0). Results of 16S rRNA gene phylogenetic analysis showed a similarity value of 97.49 % between strain SH18-1T and Vallitalea guaymasensis Ra1766G1T, which was the most closely related species. The genome size of strain SH18-1T was 5.71 Mb and its G+C content was 30.2 mol%. Genome sequence analyses for comparison between strain SH18-1T and V. guaymasensis Ra1766G1T showed values lower than the threshold for species demarcation determined using the Genome-to-Genome Distance Calculator and the Average Nucleotide Identity Calculator. Elemental sulphur, sulphate, thiosulphate, sulphite, fumarate, nitrate, and nitrite were not used as terminal electron acceptors. The major fatty acids in strain SH18-1T were iso-C15 : 0, anteiso-C15 : 0, and C16 : 0, and the detected polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphoglycolipid, glycolipid, three unidentified phospholipids, and one unidentified polar lipid. From these results, strain SH18-1T (=NBRC 115488T=DSM 114058T) is suggested to represent a novel species of the genus Vallitalea and the name Vallitalea longa sp. nov. is proposed.

Predictors and preventers of postoperative bedridden status in the elderly ages over 75 after emergency general surgery: a retrospective cohort study.

Aim: We investigated the proportion of bedridden patients after emergency surgery among the elderly ages over 75; defined as the latter-stage elderly in Japan, the associated factors, and interventions used to prevent it. Methods: Eighty-two latter-stage elderly patients who underwent emergency surgery for non-traumatic illness between January 2020 and June 2021 in our hospital were included in the study. Backgrounds and various perioperative factors were compared retrospectively between the groups including patients who became bedridden from Performance Status Scale 0 to 3 before admission (Bedridden group) and those who did not (Keep group). Results: Three cases of death and seven patients who were bedridden before admission were excluded. The 72 remaining patients were divided into the Bedridden group (n = 10, 13.9%) and the Keep group (n = 62, 86.1%). There were significant differences in the prevalence of dementia, pre- and postoperative circulatory dynamics, renal dysfunction, coagulation abnormality, length of stay in the high care unit/intensive care unit, and number of hospital days, with a relative risk of 13 (1.74-96.71), a sensitivity of 1.00, and a specificity of 0.67 for a preoperative shock index of 0.7 or higher being associated with the Bedridden group. Among patients with a preoperative shock index of 0.7 or higher, there was a significant difference in SI at 24 h postoperatively between the two groups. Conclusion: Preoperative shock index may be the most sensitive predictor. Early circulatory stabilization seems to be protective against patients becoming bedridden.

Synthesis and Characterization of a Trigonal Layered Compound AgInS2.

Depending on thermal and pressure conditions, AgInS2 exhibits various crystal structures. In this study, we synthesized a high-purity polycrystalline sample of trigonal AgInS2, which is a layered compound, using a high-pressure synthesis technique. The crystal structure was investigated by synchrotron powder X-ray diffraction and the Rietveld refinement. On the basis of band calculation, X-ray photoelectron spectroscopy, and electrical resistance measurements, we found that the obtained trigonal AgInS2 is a semiconductor. Temperature dependencies of electrical resistance of AgInS2 were measured by a diamond anvil cell up to 31.2 GPa. Although semiconducting behavior was suppressed with pressure, metallic behavior was not observed within the pressure range investigated in this study.

Biomass production and nutrient use efficiency in white Guinea yam (Dioscorea rotundata Poir.) genotypes grown under contrasting soil mineral nutrient availability.

Yam (Dioscorea spp.) is of great importance to food security, especially in West Africa. However, the loss of soil fertility due to dwindling fallow lands with indigenous nutrient supply poses a challenge for yam cultivation. This study aimed to determine shoot and tuber biomass and nutrient use efficiency of white Guinea yam (Dioscorea rotundata) grown under low- and high-NPK conditions. Six white Guinea yam genotypes were used in field experiments conducted at Ibadan, Nigeria. Experiments were conducted with low soil NPK conditions with zero fertilizer input and high soil NPK conditions with mineral fertilizer input. Differences in response to soil NPK conditions, nutrient uptake, and nutrient use efficiency (apparent nutrient recovery efficiency) were observed among the tested genotypes. The genotypes TDr1499 and TDr1649, with high soil fertility susceptibility index (SFSI>1) and an increase in shoot and tuber biomass with fertilizer input, were recognized as susceptible to soil NPK conditions. There was a marked difference in apparent nutrient recovery efficiency; however, there was no varietal difference in physiological efficiency. Differences in apparent nutrient recovery efficiency among genotypes affected the fertilizer response (or susceptibility to soil NPK conditions) and the nutrient uptake. In contrast, the genotype TDr2029, with SFSI<1 and low reduction in shoot and tuber production between non-F and +F conditions, was recognized as a less susceptible genotype to soil NPK status. It was revealed that NPK fertilization did not reduce tuber dry matter content, regardless of genotype differences in susceptibility to soil NPK conditions. Hence, this could be helpful to farmers because it implies that yield can be increased without reducing tuber quality through a balanced application of soil nutrients. Our results highlight genotypic variation in sensitivity to the soil NPK availability, nutrient uptake, and nutrient use efficiency white Guinea yam. Differences in susceptibility to soil NPK conditions could be due to the genotypic variations in nutrient recovery efficiency white Guinea yam. Our findings could contribute to breeding programs for the development of improved white Guinea yam varieties that enhance productivity in low soil fertility conditions with low and high-input farming systems.

Variability of Flowering Sex and Its Effect on Agronomic Trait Expression in White Guinea Yam.

White Guinea yam (Dioscorea rotundata) is mainly a dioecious tuberous crop that produces flowers of varying sex phenotypes. Agronomic traits in Guinea yam differ according to the sex phenotype, but the precise interaction between the traits and sex phenotype is not clearly understood. This might be due to the high heterozygosity of yam where cultivars with different flowering sex have different genetic backgrounds, which mask the sole effect of sex phenotype on the agronomic traits. This study used F1-derived clonal progenies from a bi-parental cross to minimize the impact of different genetic backgrounds among the plants with different sex phenotypes. The impact of plant sex on agronomic traits, specifically tuber yield, was evaluated through field trials conducted for four years. The results showed that only plants with a female genotype exhibited varying sex phenotypes even within the clones of same accession grown in the same experimental field. The significant effects of sex genotype and phenotype on agronomic traits were detected. Our results revealed that the flowering date was delayed in the plants with female genotypes compared to male genotypes, even when compared only among the plants with male phenotypes. The flowering date is the most important reason for the sexual differences in tuber yield. A high tuber yield was obtained when plants with the female phenotype flowered before tuber enlargement. This result can be attributed to the fact that the low flowering intensity in female plants increases the availability of carbon resources for leaf development. Female plants also showed a large negative effect of late flowering on tuber yield owing to resource competition between flowering and tuber enlargement. These findings demonstrate the feasibility of yield improvement by controlling the flowering time, with a higher effectiveness achieved in female than in male plants.

Robustness of superconductivity to external pressure in high-entropy-alloy-type metal telluride AgInSnPbBiTe5.

High-entropy-alloy (HEA) superconductors are a new class of disordered superconductors. However, commonality of superconducting characteristics of HEA materials is unclear. Here, we have investigated the crystal and electronic structure, and the robustness of superconducting states in a HEA-type metal telluride (MTe; M = Ag, In, Sn, Pb, Bi) under high pressure, and the results were compared with the pressure effects for a middle-entropy system (AgPbBiTe3) and a reference system of PbTe. When the crystal structure is CsCl-type, all phases show superconductivity under high pressure but exhibit different pressure dependences of the transition temperature (Tc). For PbTe, its Tc decreases with pressure. In contrast, the Tc of HEA-type AgInSnPbBiTe5 is almost independent of pressure, for pressures ranging from 13.0 to 35.1 GPa. Those results suggest that the robustness of superconductivity to external pressure is linked to the configurational entropy of mixing at the M site in MTe. Since the trend is quite similar to previous work on a HEA (Ti-Zr-Hf-Nb-Ta), where the robustness of superconductivity was observed up to ~ 200 GPa, we propose that the robustness of superconductivity under high pressure would be a universal feature in HEA-type superconductors.

Bone Block Grafting for Posterior Instability After Anatomical Total Shoulder Arthroplasty: A Case Report.

CASE: A 60-year-old woman with avascular necrosis of the right humeral head underwent anatomical total shoulder arthroplasty (TSA); however, recurrent posterior dislocation occurred 13 months postoperatively. We performed bone block grafting of an autologous iliac crest to the posterior glenoid and posterior capsular plication, after which satisfactory postoperative shoulder function without residual joint instability was achieved. CONCLUSION: The presented case had recurrent posterior dislocation after TSA without any abnormal findings in the prosthetic components. Posterior bone block grafting with capsular plication should be considered a viable option for posterior instability after anatomical TSA.

Synthetic Route of Layered Titanium Nitride Chloride TiNCl Using Sodium Amide.

A synthetic route in a closed system for layered titanium nitride chloride TiNCl has been developed using sodium amide NaNH2 as a nitrogen source. A highly crystalline sample is obtained by an appropriate thermal decomposition of aminated titanium chloride. The obtained TiNCl was also characterized using electronic resistivity measurement and photoemission spectroscopy. TiNCl showed hopping conduction compatible with an in-gap state revealed by photoelectron spectroscopy. However, it appeared highly electron-doped, albeit without showing superconductivity. Comparison with the spectrum of superconducting sodium-doped samples suggests the presence of the microstructure required to exhibit superconductivity.

High-Pressure Synthesis of Superconducting Sn3S4 Using a Diamond Anvil Cell with a Boron-Doped Diamond Heater.

High-pressure techniques open exploration of functional materials in broad research fields. An established diamond anvil cell with a boron-doped diamond heater and transport measurement terminals has performed the high-pressure synthesis of a cubic Sn3S4 superconductor. X-ray diffraction and Raman spectroscopy reveal that the Sn3S4 phase is stable in the pressure range of P > 5 GPa in a decompression process. Transport measurement terminals in the diamond anvil cell detect a metallic nature and superconductivity in the synthesized Sn3S4 with a maximum onset transition temperature (Tconset) of 13.3 K at 5.6 GPa. The observed pressure-Tc relationship is consistent with that from the first-principles calculation. The observation of superconductivity in Sn3S4 opens further materials exploration under high-temperature and -pressure conditions.

Hybrid emergency rooms reduce the requirement of blood transfusion in patients with severe trauma.

BACKGROUND: A hybrid emergency room (ER) is defined as an emergency unit with four functions-performing resuscitation, computed tomography (CT), surgery, and angiography. However, the safety and efficacy of performing CT in a hybrid ER are unclear in primary surveys. Therefore, this study aimed to evaluate the safety and clinical effects of hybrid ERs. METHODS: This retrospective observational study used data from the Shimane University Hospital Trauma Database from January 2016 to February 2019. Hospitalized patients with severe trauma and an injury severity score of ≥ 16 were divided into the non-hybrid ER group (n = 134) and the hybrid ER group (n = 145). The time from arrival to CT and interventions and the number of in-hospital survivors, preventable trauma deaths (PTD), and unexpected survivors (US) were assessed in both groups. Further, the amount of blood transfused was compared between the groups using propensity score matching. RESULTS: The time from arrival to CT and interventions was significantly reduced in the hybrid ER group compared to that in the non-hybrid ER group (25 vs. 6 min; p < 0.0001 and 101 vs. 41 min; p = 0.0007, respectively). There was no significant difference in the rate of in-hospital survivors (96.9% vs. 96.3%; p = 0.770), PTD (0% vs. 0%), and US (9.0 vs. 6.2%; p = 0.497) between the groups. The amount of blood transfused was significantly lower in the hybrid ER group than in the non-hybrid ER group (whole blood 14 vs. 8, p = 0.004; red blood cell 6 vs. 2, p = 0.012; fresh frozen plasma 9 vs. 6, p = 0.021). This difference was maintained after propensity score matching (whole blood 28 [10-54] vs. 6 [4-16.5], p = 0.015; RBC 8 [2.75-26.5] vs. 2 [0-8.5], p = 0.020, 18 [5.5-27] vs. 6 [3.5-7.5], p = 0.057). CONCLUSIONS: The study results suggest that trauma treatment in a hybrid ER is as safe as conventional treatment performed in a non-hybrid ER. Further, hybrid ERs, which can reduce the time for trauma surveys and treatment, do not require patient transfer and can reduce the amount of blood transfused during resuscitation.

Damage control surgery for spontaneous perforation of pyometra with septic shock: a case report.

BACKGROUND: Although spontaneous perforation of pyometra is very rare, it sometimes causes severe peritonitis, leading to lethal conditions. Damage control surgery reportedly improves the survival of critically ill patients; however, there has been no report describing damage control surgery for ruptured pyometra. CASE PRESENTATION: An 83-year-old postmenopausal woman with generalized peritonitis and septic shock was admitted and underwent emergency laparotomy. Abbreviated surgery was carried out because of progressing septic shock, and planned reoperation was carried out 2 days after the initial surgery. Histopathological examination revealed the perforation of pyometra with no evidence of malignancy. The patient was discharged on the 32nd postoperative day in stable condition. CONCLUSION: We report a case of spontaneous perforation of pyometra with severe septic shock successfully treated by damage control surgery. Damage control surgery is a useful treatment option for hemodynamically unstable patients with diseases in the field of obstetrics and gynecology.

Crystal Growth and High-Pressure Effects of Bi-Based Superconducting Whiskers.

Three growth methods were tested for producing high-transition temperature superconducting Bi2Sr2Ca n-1Cu n O2n+4+δ whiskers, employing different ways to focus a compressive stress and size effect of the precursors. First, thermographic imaging was used to investigate thermal stress from temperature distribution in the precursors during growth annealing. To enhance thermal stress in the precursors, a thermal cycling method and a Ag-paste coating method were proposed and found to significantly accelerate the whisker growth. The use of pulverized precursors also promoted whisker growth, possibly due to contribution from the vapor-liquid-solid growth mechanism. The obtained whiskers revealed the typical composition, diffraction patterns, and superconducting properties of the Bi-2212 phase. The proposed methods were able to stably produce longer whiskers compared to the conventional method. Using the obtained whiskers, electrical transport measurements under high pressure were successfully performed up to around 50 GPa.

A case of total hysterectomy due to massive maternal bleeding immediately after fetoscopic laser surgery for twin-twin transfusion syndrome.

Twin-twin transfusion syndrome (TTTS) complicates approximately 10% of monochorionic twin pregnancies and is associated with almost 90% mortality if left untreated. Fetoscopic laser photocoagulation (FLP) is the first-line therapy for TTTS, and an overall twin survival rate of 75% and at least one survival rate of 90% have been established. We report a case of TTTS complicated with bleeding from the uterine wall by inserting the procedure after FLP. The patient consequently underwent emergency caesarean section. The bleeding was uncontrollable due to atonic bleeding and emergency hysterectomy was performed. To detect the possibility of amniotic fluid embolism (AFE), biochemical blood samples demonstrated that there was no inflow of fetal ingredients in blood vessels of uterine tissue. There was no evidence of damage to any specific vessels by histopathological staining. These findings indicated that the cause of massive bleeding was unlikely to have been AFE. It was concluded that atonic bleeding was likely caused by uncontrollable hemorrhage from an injury lesion where an endoscope had been inserted.