Clinical value of fluorescent cholangiography for the infraportal type of right posterior bile duct.

BACKGROUND: The infraportal type of the right posterior bile duct (infraportal RPBD) is a well-known anatomical variation that increases the potential risk of intraoperative biliary injury. The aim of this study is to clarify the clinical value of fluorescent cholangiography during single-incision laparoscopic cholecystectomy (SILC) for patients with infraportal RPBD. MATERIAL AND METHODS: Our procedure for SILC utilized the SILS-Port, and another 5-mm forceps was inserted via an umbilical incision. A laparoscopic fluorescence imaging system developed by Karl Storz Endoskope was utilized for fluorescent cholangiography. Between July 2010 and March 2022, 41 patients with infraportal RPBD underwent SILC. We conducted retrospective reviews of patient data, focusing on the clinical value of fluorescent cholangiography. RESULTS: Thirty-one patients underwent fluorescent cholangiography during SILC, but the remaining ten did not. Only one patient who did not undergo fluorescent cholangiography developed an intraoperative biliary injury. The detectability of infraportal RPBD before and during the dissection of Calot's triangle was 16.1% and 45.2%, respectively. These visible infraportal RPBDs were characterized as connections to the common bile duct. The confluence pattern of infraportal RPBD significantly influenced its detectability during the dissection of Calot's triangle (p < 0.001). CONCLUSIONS: The application of fluorescent cholangiography can lead to safe SILC, even for patients with infraportal RPBD. Its benefit is emphasized when infraportal RPBD is connected to the common bile duct.

Tranexamic acid and blood loss in pancreaticoduodenectomy: TAC-PD randomized clinical trial.

BACKGROUND: Tranexamic acid (TXA) may reduce intraoperative blood loss, but it has not been investigated in pancreaticoduodenectomy (PD). METHODS: A pragmatic, multicentre, randomized, blinded, placebo-controlled trial was conducted. Adult patients undergoing planned PD for biliary, duodenal, or pancreatic diseases were randomly assigned to TXA or placebo groups. Patients in the TXA group were administered 1 g TXA before incision, followed by a maintenance infusion of 125 mg/h TXA. Patients in the placebo group were administered the same volume of saline as those in the placebo group. The primary outcome was blood loss during PD. The secondary outcomes included perioperative blood transfusions, operating time, morbidity, and mortality. RESULTS: Between September 2019 and May 2021, 218 patients were randomly assigned and underwent surgery (108 in the TXA group and 110 in the placebo group). Mean intraoperative blood loss was 659 ml in the TXA group and 701 ml in the placebo group (mean difference -42 ml, 95 per cent c.i. -191 to 106). Of the 218 patients, 202 received the intervention and underwent PD, and the mean blood loss during PD was 667 ml in the TXA group and 744 ml in the placebo group (mean difference -77 ml, 95 per cent c.i. -226 to 72). The secondary outcomes were comparable between the two groups. CONCLUSION: Perioperative TXA use did not reduce blood loss during PD. REGISTRATION NUMBER: jRCTs041190062 (https://jrct.niph.go.jp).

Removing part of the pancreas is an operation with a risk of major blood loss. Tranexamic acid is a drug thought to reduce blood loss. This study asked the question, 'Does tranexamic acid reduce blood loss during surgery on the pancreas?' Half of patients received tranexamic acid during surgery. The other half received only standard care. This study showed that tranexamic acid did not decrease the blood loss during the surgery and may have little effect in patients having a pancreaticoduodenectomy.

Association between eating behavior and the immediate neural activity caused by viewing food images presented in and out of awareness: A magnetoencephalography study.

Obesity is a serious health problem in modern society. Considering the fact that the outcomes of treatments targeting appetitive behavior are suboptimal, one potential reason proposed for these poor outcomes is that appetitive behavior is driven more by unconscious decision-making processes than by the conscious ones targeted by traditional behavioral treatments. In this study, we aimed to investigate both the conscious and unconscious decision-making processes related to eating behavior, and to examine whether an interaction related to eating behavior exists between conscious and unconscious neural processes. The study was conducted on healthy male volunteers who viewed pictures of food and non-food items presented both above and below the awareness threshold. The oscillatory brain activity affected by viewing the pictures was assessed by magnetoencephalography. A visual backward masking procedure was used to present the pictures out of awareness. Neural activity corresponding to the interactions between sessions (i.e., food or non-food) and conditions (i.e., visible or invisible) was observed in left Brodmann's areas 45 and 47 in the high-gamma (60-200 Hz) frequency range. The interactions were associated with eating behavior indices such as emotional eating and cognitive restraint, suggesting that conscious and unconscious neural processes are differently involved in eating behavior. These findings provide valuable clues for devising methods to assess conscious and unconscious appetite regulation in individuals with normal or abnormal eating behavior.

Long-term survivor who underwent surgical resections of repeated peritoneal oligometastases from colon cancer : a rare case report.

A 74-year-old woman underwent right hemicolectomy and partial ileal resection for ascending colon cancer with synchronous peritoneal metastasis. Histopathological examination showed moderately differentiated adenocarcinoma with mucinous component, pT4b N3 M1, and Stage IV. Postoperative chemotherapy comprising 36 courses of mFOLFOX6 with bevacizumab was administered. Twenty-two months after the surgery, computed tomography (CT) revealed a 20 mm nodular lesion adjacent to the gastric wall, and laparoscopic resection of the nodule was performed. Thirty-nine months after the second surgery, CT showed a 24 mm nodular lesion involving the liver parenchyma, and partial hepatectomy involving the nodule was performed. Histopathological examination of the nodules resected by the second and third surgeries showed the same features as the primary ascending colon cancer. The nodules were diagnosed as metachronous peritoneal metastases. The patient followed up without chemotherapy after the second and third surgery, showed no recurrence for 26 months after the third surgery. Fortunately, more than 7 years have passed since the primary tumor resection. Hence, surgical resection for synchronous and repeated metachronous peritoneal oligometastases from colon cancer can offer long-term survival. J. Med. Invest. 69 : 302-307, August, 2022.

Neural mechanism by which physical fatigue sensation suppresses physical performance: a magnetoencephalography study.

The right dorsolateral prefrontal cortex (DLPFC) has been proposed to be the brain region regulating performance through fatigue sensation in fatigue, but direct evidence has been lacking for right DLPFC activation when physical performance is suppressed in the presence of fatigue sensation. We examined whether the right DLPFC is activated when physical performance is suppressed by remembering a physical fatigue sensation. Eighteen healthy male volunteers participated. They performed a rest session followed by a handgrip session to induce physical fatigue sensation. Then, they were instructed to remember the state of the right hand with (i.e., the target condition) and without (i.e., the control condition) fatigue sensation as experienced in the handgrip and rest sessions, respectively while performing motor imagery of maximum handgrip of the right hand. Neural activity during both conditions was recorded using magnetoencephalography. The level of fatigue sensation was higher in the target condition than in the control condition. Decreases of handgrip strength and beta band power in the right Brodmann's area 46 were observed in the target condition, suggesting that the right DLPFC is involved in the regulation of physical performance through fatigue sensation. These findings may help elucidate the neural mechanisms regulating performance under fatigue conditions.

Neural correlates of the improvement of cognitive performance resulting from enhanced sense of competence: A magnetoencephalography study.

The alterations in neural activity related to the improvement of cognitive performance, which would be leading to better academic performance, remain poorly understood. In the present study, we assessed neural activity related to the improvement of task performance resulting from academic rewards. Twenty healthy male volunteers participated in this study. All participants performed four sessions of a 1-back-Stroop task under both target and control conditions. An image indicating that the task performance of each participant was above average and categorized as being at almost the highest level was presented immediately after each session under the target condition, whereas a control image did not indicate task performance. Neural activity during the 1-back-Stroop task was recorded by magnetoencephalography. The correction rate of the 1-back-Stroop task in the final session relative to that in the first under the target condition was increased compared with the control condition. Correlation analysis revealed that the decreases in alpha band power in right Brodmann's area (BA) 47 and left BA 7 were positively associated with the increased correction rate caused by the target condition. These findings are expected to contribute to a better understanding of the neural mechanisms underlying the improvement of cognitive performance.

Study of the Portal Branches Arising from the Cranial Part of the Umbilical Portion of the Left Portal Vein: Implications for Anatomic Right Hepatic Trisectionectomy.

BACKGROUND: In "anatomic" right hepatic trisectionectomy for advanced perihilar cholangiocarcinoma, the left hepatic duct is divided at the left side of the umbilical portion (UP) of the left portal vein (LPV). For this reason, the left hepatic duct is completely detached from the UP after all division of the portal branches arising cranially from the UP. However, little is known about these thin portal branches. METHODS: Using 3D imaging processing software, we examined the portal branches arising cranially from the UP of the LPV in 100 patients who underwent multidetector row computed tomography (MDCT). Special attention was paid to the portal branch running to the left lateral sector, designated as the left cranio-lateral branch. RESULTS: The left cranio-lateral portal branch number was 0 in 57 patients, 1 in 32 patients, and 2 in 11 patients. Thus, 54 left cranio-lateral branches were identified, arising from near the cul-de-sac of the UP, from near the elbow of the LPV, or from the UP trunk. The median volume of the territory supplied by the left cranio-lateral portal branch was 21 mL (range, 5-47 mL), and the median ratio to the left lateral sector was 11.8% (range, 1.7-25.0%). CONCLUSION: Approximately 40% of patients had the left cranio-lateral portal branches arising cranially from the UP and running to the left lateral sector. When planning anatomic right hepatic trisectionectomy, the presence or absence of this branch should be checked by using 3D imaging with MDCT.

Study on the Segmentation of the Right Posterior Sector of the Liver.

BACKGROUND: The border between segments VI and VII of the right posterior sector of the liver is controversial owing to lack of anatomical landmarks. This study aimed to examine the segmentation of the right posterior sector. METHODS: Using three-dimensional software, ramification type of the right posterior portal vein (RPPV) was analysed in 100 patients. RESULTS: A bow-shaped anatomy, in which the RPPV exhibits a downward convex bow shape with several ramifications, was found in 50 patients. A bifurcation anatomy, in which the RPPV bifurcates into the cranial and caudal branches, was observed in 45 patients. In the bow-shaped anatomy, setting the segmentation was difficult due to lack of definite landmarks; thus, the downward portal branches were determined as segment VI branches, while horizontal and upward branches were determined as segment VII branches. In the bow-shaped anatomy, the incidence of full exposure of a thick branch of the right hepatic vein on virtual transection surface was 60.0%, while in the bifurcation anatomy, it was only 11.1%. No relations were observed between RPPV anatomy and main PV/right hepatic vein anatomy. The volumes of segments VI and VII were equal in both the bow-shaped and bifurcation anatomy. CONCLUSIONS: The bow-shaped and bifurcation types are commonly observed in RPPV anatomy. In the bifurcation anatomy, the right posterior sector is divided into segments VI and VII. In the bow-shaped anatomy, setting the segmentation was difficult, thus it may be compelled to be arbitrarily determined.

Multilocus sequence analysis of Vibrionaceae isolated from farmed amberjack and the development of a multiplex PCR assay for the detection of pathogenic species.

Since 2011, high mortality rates and symptoms consistent with vibriosis have been observed in farmed amberjack (Seriola dumerili) in Japan. To identify 41 strains isolated from diseased amberjack, a multilocus sequence analysis using nine concatenated genes (ftsZ, gapA, gyrB, mreB, pyrH, recA, rpoA, topA and 16S rRNA) was conducted. Twenty-seven strains were identified as Vibrio harveyi, suggesting an epidemic of V. harveyi infection in amberjack farms. Other strains were identified as Vibrio anguillarum, Vibrio owensii and Photobacterium damselae subsp. damselae. To develop an efficient diagnostic method for vibriosis in amberjack, a multiplex PCR system was developed to identify V. anguillarum, V. harveyi and P. damselae subsp. damselae. The method successfully discriminated between these three bacterial species, with amplification products of 350 bp for V. anguillarum, 545 bp for V. harveyi and 887 bp for P. damselae subsp. damselae and can be used for diagnosis in aquaculture farms.

Children who stutter at 3 years of age: A community-based study.

PURPOSE: Lack of social resources to support children who stutter may be due, in part, to the absence of epidemiological data regarding stuttering. This study investigated the proportion of three-year-old children who stutter in a city located in Hokkaido, a northern island of Japan. METHODS: The speech of individual children was assessed as part of a routine, government-conducted health care examination for 3-year-old children. The number of children screened was 2274, or 94.4% of all children in the city. The first author participated in the health care examination, and followed up all of the children who were found to stutter. RESULTS: At 3 years of age, 1.41% of the children exhibited stuttering; 82.8% of these children subsequently did not exhibit stuttering six months later. Boys were 1.57 times more likely to stutter than girls, but they had only 86% of the probability of reported or observed fluency seen in girls six months later. Significantly higher probability of later fluency was observed in children who exhibited normal, rather than delayed, language development at the 1.5-year health checkup preceding the 3-year health checkup. CONCLUSION: The proportion of three-year-old children who stutter and fluency status 6 months later are reported for a large cohort of Japanese children in Hokkaido. Language skills at 1;6 year may potentially be a factor in natural recovery or persistence; because of limitations in our study design, this assumption requires additional study. This is the first preliminary study to determine the proportion of three-year-old children who stutter in a Japanese community.

[Secondary Dementia Due to Leptomeningeal Metastasis of Breast Cancer Improved by Whole Brain Radiation].

A 62-year-old woman received chemotherapy for breast cancer with bone metastasis and malignant pleural and pericardial effusion. She was examined by imaging for progressive cognitive impairment and headache. Enhanced MRI findings showed multiple solid tumors on brain surface, and brain perfusion scintigraphy showed blood flow decrease in both parietal lobes. She was diagnosed with secondary dementia due to leptomeningeal metastases of breast cancer, and whole brain external irradiation was performed(30 Gy/15 Fr). After treatment, multiple tumors were decreased in size and her cognitive impair- ment was improved.

Nuclear termination of STAT3 signaling through SIPAR (STAT3-Interacting Protein As a Repressor)-dependent recruitment of T cell tyrosine phosphatase TC-PTP.

STAT3 is associated with embryo development and survival as well as proliferation and metastasis of tumor cells. In a previous study, we demonstrated that STAT3-Interacting Protein As a Repressor (SIPAR) enhances the dephosphorylation of STAT3 and negatively regulates its activity. However, it remains unclear how SIPAR inhibits phosphorylation of STAT3. Here we demonstrate that SIPAR directly interacts with T cell protein tyrosine phosphatase TC45 and enhances its association with STAT3. This interaction triggers an accelerated dephosphorylation process for STAT3. Furthermore, SIPAR inhibits the transcriptional activity of STAT3 in wild-type MEF cells but not in TC45 null MEF cells. These results suggest that SIPAR terminates the activation of STAT3 through a dephosphorylation process that is dependent upon interaction with TC45 in the nucleus.

[Surgical resection of a huge gastric gastrointestinal stromal tumor after preoperative adjuvant chemotherapy].

A 73-year-old man was referred to our hospital because of positive results on a fecal occult blood test. He had severe anemia, and abdominal computed tomography (CT) revealed a huge 18 × 11 cm tumor in the lower gastric corpus. Pathological analysis of a biopsy sample revealed a gastrointestinal stromal tumor (GIST). We improved the nutritional and physical statuses via total parenteral and enteral nutrition. At the same time, we initiated preoperative adjuvant chemotherapy with 300 mg/day of imatinib. After 4 weeks' of treatment, CT revealed a drastic reduction in the tumor size, regarded a partial response (PR). The patient underwent partial gastrectomy, distal pancreatectomy, and partial resection of the transverse colon. His postoperative course was uneventful. The patient received postoperative treatment with imatinib for 1 year, and remained recurrence free for 10 months after surgery.

Expression of the serum opacity factor gene and the variation in its upstream region in Streptococcus dysgalactiae isolates from fish.

Group C Streptococcus dysgalactiae (GCSD) is a pathogen of farmed fish. Almost all GCSD isolates from Asian countries, including Japan, Taiwan, Malaysia, and China, have a serum opacity factor (SOF-FD). Although the SOF-FD sequences in different GCSD isolates are identical, different opacification activities are observed. Three types of variations were observed in the upstream sequence of the sof-FD gene in GCSD isolates with different SOF-FD activities. Type 1 was characterized by insertion of an IS981-like element into the upstream region of the sof-FD gene. In Type 2, an IS981-like element was inserted into the upstream region in a direction opposite to that in Type 1. In Type 3, no IS element was inserted. Type 1 was predominant among Japanese isolates (129 of 133). Isolates from other Asian countries were generally Type 3 (13 of 16). Except for 1 strain, Type 1 strains exhibited opacification activities with optical densities (ODs)>0.6, while Type 2 and Type 3 strains have low opacification activities (ODs >0.2). Only Type 1 strains have putative -10 and -35 promoter regions upstream of the sof-FD gene, and the expression level of the sof-FD gene was higher in Type 1 strains than in Type 2 and Type 3 strains.

Differential gene expression of HSC70/HSP70 in yellowtail cells in response to chaperone-mediated autophagy.

A cell line derived from the tailfin of the marine teleost yellowtail fish Seriola quinqueradiata was established to examine cellular temperature regulation in an ectothermic animal. Three cytosolic members of the HSP70 family, heat-shock cognate proteins HSC70-1, HSC70-2 and heat-shock protein HSP70, were isolated from cultured yellowtail cells as stress-responsive biomarkers. Expression of hsp70 was heat-inducible, in contrast to the hsc70-1 gene product, which was expressed constitutively. In addition, expression of hsc70-2 was only induced under severe heat-shock conditions. Subcellular fractionation and immunocytochemistry showed localization of HSC70/HSP70 in the lysosomes, indicating that chaperone-mediated autophagy is induced by heat shock. Thus, chaperone-mediated autophagy is assisted by HSC70/HSP70, and heat-inducible expression of the genes encoding these proteins may be responsible for survival and adaptation under heat-shock conditions in fish cells.

Organic mediator-induced structural transformation in superlattices of monolayer-protected gold nanoparticles.

N-acetylglutathione (NAG)-protected gold nanoparticles self-assemble into three-dimensional (3D) face-centered cubic (fcc)-type superlattices at an air/water interface under highly acidic conditions. To prepare the well-defined superlattices, 1month's incubation is at least necessary since the size growth of the as-prepared nanoparticles is essential. Addition of 4-pyridinecarboxyic acid (PyC), a bifunctional hydrogen-bonding mediator, promotes the formation of the superlattices, which are created for about 2weeks' storage. Interestingly, PyC-induced nanoparticle superlattices are in a body-centered tetragonal (bct) structure. The fcc-to-bct phase transformation would be due to stronger interaction between NAG and PyC than that between NAG molecules on the gold nanoparticle surfaces.

Role of CX3CL1/fractalkine in osteoclast differentiation and bone resorption.

The recruitment of osteoclast precursors toward osteoblasts and subsequent cell-cell interactions are critical for osteoclast differentiation. Chemokines are known to regulate cell migration and adhesion. CX3CL1 (also called fractalkine) is a unique membrane-bound chemokine that has dual functions for cells expressing its receptor CX3CR1: a potent chemotactic factor in its soluble form and a type of efficient cell adhesion molecule in its membrane-bound form. In this paper, we demonstrate a novel role of CX3CL1 in osteoblast-induced osteoclast differentiation. We found that osteoclast precursors selectively expressed CX3CR1, whereas CX3CL1 is expressed by osteoblasts. We confirmed that soluble CX3CL1 induced migration of bone marrow cells containing osteoclast precursors, whereas immobilized CX3CL1 mediated firm adhesion of osteoclast precursors. Furthermore, a blocking mAb against CX3CL1 efficiently inhibited osteoclast differentiation in mouse bone marrow cells cocultured with osteoblasts. Anti-CX3CL1 also significantly suppressed bone resorption in neonatal mice by reducing the number of bone-resorbing mature osteoclasts. Collectively, CX3CL1 expressed by osteoblasts plays an important role in osteoclast differentiation, possibly through its dual functions as a chemotactic factor and adhesion molecule for osteoclast precursors expressing CX3CR1. The CX3CL1-CX3CR1 axis may be a novel target for the therapeutic intervention of bone resorbing diseases such as rheumatoid arthritis, osteoporosis, and cancer bone metastasis.

Inducible capillary formation in lymphatic endothelial cells by blocking lipid phosphate phosphatase-3 activity.

Lymphangiogenesis plays critical roles under normal and/or pathological conditions; however, the molecular contributors to this event were unknown until recently. In the present study, we first employed gene chip analysis and confirmed that lipid phosphate phosphatase-3 (LPP3) expression was increased until capillary formation in the conditionally immortalized rat lymphatic endothelial cell line. Signaling responses occur when several lipids induce acute biological functions; further, lipid phosphate phosphatases (LPPs) control their functions via dephosphorylation; however, there is no report on the association between LPP3 and lymphangiogenesis. siRNA-targeted LPP3 significantly increased capillary formation of human lymphatic endothelial cells; in contrast, it decreased cell adhesion to the basement membrane matrix. Furthermore, the inducible effect of the LPP inhibitor on capillary formation was observed. For the first time, we report that LPP3 abolishes accelerated abnormal lymphangiogenesis. Blocking LPP3 activities may aid in the development of novel therapy for lymph vessel defects.

Spontaneous formation of super water-repellent fractal surfaces in mixed wax systems.

Alkylketene dimers (AKDs) and triglyceride waxes form fractal surfaces spontaneously and show super water-repellent property. Spontaneous formation of fractal structures on their surfaces takes place when the meta-stable crystalline phase of the waxes transforms to the thermodynamically stable form of crystal. The triglyceride waxes form the meta-stable alpha-phase in whole specimen when solidified from their melt. In the case of AKD, on the other hand, only a small portion of the specimen solidifies in the meta-stable form of crystal. The surface of the AKD, however, becomes fractal in the whole part. We have, thus, examined the fractal structure formation in the mixed wax systems in which one wax forms fractal surfaces and the other one does not. In the stearic acid/tristearin mixed system as a typical one, the super water-repellent fractal surfaces form in the higher composition region of tristearin than that of the eutectic point in their mixture.