Virtual Reality Computed Tomography Evaluation　- Anatomy and Clinical Implications for Valve-Sparing Aortic Root Replacement.

BACKGROUND: Three-dimensional aortic root evaluation using virtual reality (VR) techniques for valve-sparing aortic root replacement (VSARR) preparation has not yet been implemented, so we demonstrated VR computed tomography (VR-CT) and assessed its utility for VSARR.Methods and Results: We enrolled 72 patients who underwent multidetector CT before elective VSARR for annuloaortic ectasia with tricuspid aortic valve. The geometries of their aortic roots were measured with a VR-CT workstation. The mean values of geometric height (GH), free margin length (FML), and commissural height (CH) were 17.2±2.4 mm, 36.0±5.2 mm, and 24.0±4.3 mm, respectively. The right coronary/noncoronary CH was significantly greater than the left coronary/right coronary and left coronary/noncoronary CH. The left coronary cusp had the shortest FML, intercommissural distances (ICD), and smallest central angle. Although the right coronary cusp had the largest values for FML, ICD, and central angle, the right coronary cusp had the lowest GH and EH. The VR-CT measurements strongly correlated with intraoperative alternatives, especially with mean GH (R2=0.75) and left coronary/noncoronary CH (R2=0.79). Furthermore, mean GH was observed to be significantly different among the selected graft size groups; therefore, the preoperative mean GH could play a significant role in graft sizing. CONCLUSIONS: VR-CT evaluation allows a thorough understanding of aortic root anatomy, which could facilitate VSAAR.

High-endurance micro-engineered LaB6 nanowire electron source for high-resolution electron microscopy.

The size tunability and chemical versatility of nanostructures enable electron sources of high brightness and temporal coherence, both of which are important characteristics for high-resolution electron microscopy1-3. Despite intensive research efforts in the field, so far, only conventional field emitters based on a bulk tungsten (W) needle have been able to yield atomic-resolution images. The absence of viable alternatives is in part caused by insufficient fabrication precision for nanostructured sources, which require an alignment precision of subdegree angular deviation of a nanometre-sized emission area with the macroscopic emitter axis4. To overcome this challenge, in this work we micro-engineered a LaB6 nanowire-based electron source that emitted a highly collimated electron beam with good lateral and angular alignment. We integrated a passive collimator structure into the support needle tip for the LaB6 nanowire emitter. The collimator formed an axially symmetric electric field around the emission tip of the nanowire. Furthermore, by means of micromanipulation, the support needle tip was bent to align the emitted electron beam with the emitter axis. After installation in an aberration-corrected transmission electron microscope, we characterized the performance of the electron source in a vacuum of 10-8 Pa and achieved atomic resolution in both broad-beam and probe-forming modes at 60 kV beam energy. The natural, unmonochromated 0.20 eV electron energy loss spectroscopy resolution, 20% probe-forming efficiency and 0.4% probe current peak-to-peak noise ratio paired with modest vacuum requirements make the LaB6 nanowire-based electron source an attractive alternative to the standard W-based sources for low-cost electron beam instruments.

[A Case of Meningeal Solitary Fibrous Tumour/Haemangiopericytoma WHO Grade III Metastasized to the Spleen Shortly After Tumor Resection].

Revision of WHO guidelines in 2016 led to the classification of solitary fibrous tumours(SFTs)and haemangiopericytomas(HPCs)as a single tumor entity characterized by NAB2-STAT6 fusion. Standard-of-care treatment involves surgery, but local recurrence and distant metastasis sometimes occur. The average latency to metastasis after surgery is 99 months. A 38-year-old female patient presented with a complaint of headache. An 8×5×2cm lesion showing Gd-T1 enhancement was detected near the superior sagittal sinus. Pathological assessment following resection revealed proliferating, polymorphic, atypical tumor cells with distinct nucleoli in a "patternless pattern." Cellularity was moderate to high, and mitotic figures were observed in 15/10 high power fields. Immunohistochemically, tumor cells tested positive for STAT6, and RT-PCR revealed a NAB2-STAT6 fusion gene(exons 6 and 17, respectively), supporting a diagnosis of SFT/HPC WHO grade III. Despite postoperative radiotherapy, multiple metastases to the spleen were detected 8 months after surgery, and distal pancreatectomy with splenectomy was performed. The pathology of the splenic tumor was similar to that of the intracranial tumor. Recurrent disease in a lymph node was detected 1 month later, and local radiation therapy was administered. The patient died of cancerous peritonitis 5 months later. In this case, exceedingly rapid metastasis to the spleen occurred, despite the administration of vigorous treatment. Here, we review SFT/HPC incidence, treatment, and outcomes to better understand this rare malignancy.

Intermediate band solar cell materials through the doping of group-VA elements (N, P, As and Sb) in Cu2ZnSiSe4.

The electronic structure and optical properties of group-VA (N, P, As, and Sb)-doped Cu2ZnSiSe4 alloys have been studied using a hybrid functional through density functional theory calculations. The minor lattice distortion and small formation energy indicate that synthesis of these alloys is highly possible in experiment. For each doped alloy, an isolated and partially filled intermediate band (IB) appears in its band structure. The doping-induced IB is mainly contributed by the s states of the doped group-VA atom and the p states of four neighboring Se atoms, and slightly by the d states of eight Cu atoms. The existence of an IB obviously enhances the absorption coefficient with two additional absorption peaks in the visible light range. For P, As and Sb-doped Cu2ZnSiSe4 alloys, not only the bandgap between the valence band maximum and the conduction band minimum but also the sub bandgap between the valence band maximum and the IB are very close to the optimal values for visible light absorption. Therefore, these alloys are recommended as good candidates for IB solar cell materials.

Landau Quantization of a Narrow Doubly-Folded Wrinkle in Monolayer Graphene.

Folding can be an effective way to tailor the electronic properties of graphene and has attracted wide study interest in finding its novel properties. Here we present the experimental characterizations of the structural and electronic properties of a narrow graphene wrinkle on a SiO2/Si substrate using scanning tunneling microscopy/spectroscopy. Pronounced and nearly equally separated conductance peaks are observed in the d I/d V spectra of the wrinkle. We attribute these peaks to pseudo-Landau levels (PLLs) that are caused by a gradient-strain-induced pseudomagnetic field up to about 42 T in the narrow wrinkle. The introduction of the gradient strain and thus the pseudomagnetic field can be ascribed to the lattice deformation. A doubly-folded structure of the wrinkle is suggested. Our density functional theory calculations show that the band structure of the doubly folded graphene wrinkle has a parabolic dispersion, which can well explain the equally separated PLLs. The effective mass of carriers is obtained to be about 0.02 me ( me: the rest mass of electron), and interestingly, it is revealed that there exists valley polarization in the wrinkle. Such properties of the strained doubly folded wrinkle may provide a platform to explore some exciting phenomena in graphene, like zero-field quantum valley Hall effect.

Hepatectomy for Liver Metastases of Colorectal Cancer After Adoptive Chemoimmunotherapy Using Activated αß T-cells.

BACKGROUND/AIM: Various types of chemoimmunotherapies for malignant tumors have been reported. However, there are few reports on hepatectomy after chemoimmunotherapy. We evaluated the safety and efficacy of hepatectomy for patients with stage IV colorectal liver metastases (CLM) after chemoimmunotherapy using activated αß T-cells. PATIENTS AND METHODS: From June 2012 to December 2016, five patients who underwent hepatectomy after receiving capecitabine and oxaliplatin (XELOX) plus bevacizumab and ex vivo-expanded αß T-lymphocytes as first-line chemoimmunotherapy were included. RESULTS: The median age of the five patients (two men, three women) was 61.4 (range=56-75) years. The surgical procedure was partial hepatectomy in two, laparoscopic partial hepatectomy in two, and one case of partial hepatectomy with subsegmentectomy. There was no postoperative complication of Clavien-Dindo grade 3A or higher. One patient had multiple lung metastases. CONCLUSION: Hepatectomy after chemoimmunotherapy using activated αß T-cells for CLM can be performed safely.

Direct observation of site-selective hydrogenation and spin-polarization in hydrogenated hexagonal boron nitride on Ni(111).

We report the structural analysis and spin-dependent band structure of hydrogenated boron nitride adsorbed on Ni(111). The atomic displacement studied by using the normal incidence X-ray standing wave (NIXSW) technique supports the H-B(fcc):N(top) model, in which hydrogen atoms are site-selectively chemisorbed on boron atoms and N atoms remain on top of Ni atoms. The distance between the Ni plane and nitrogen plane did not change after hydrogenation, which implies that the interaction between Ni and N is 3d-π orbital mixing (donation and back-donation) even after hydrogenation of boron. The remaining π* peaks in near-edge X-ray absorption fine structure (NEXAFS) spectra are a manifestation of the rehybridization of sp2 into sp3 states, which is consistent with the N-B-N bonding angle derived from NIXSW measurement. The SPMDS measurement revealed the spin asymmetry appearing on hydrogenated h-BN, which was originated from a π related orbital with back donation from the Ni 3d state. Even though the atomic displacement is reproduced by the density functional theory (DFT) calculation with the H-B(fcc):N(top) model, the experimental spin-dependent band structure was not reproduced by DFT possibly due to the self-interaction error (SIE). These results reinforce the site-selective hydrogenation of boron and pave the way for efficient design of BN nanomaterials for hydrogen storage.

Proximity-Induced Spin Polarization of Graphene in Contact with Half-Metallic Manganite.

The role of proximity contact with magnetic oxides is of particular interest from the expectations of the induced spin polarization and weak interactions at the graphene/magnetic oxide interfaces, which would allow us to achieve efficient spin-polarized injection in graphene-based spintronic devices. A combined approach of topmost-surface-sensitive spectroscopy utilizing spin-polarized metastable He atoms and ab initio calculations provides us direct evidence for the magnetic proximity effect in the junctions of single-layer graphene and half-metallic manganite La0.7Sr0.3MnO3 (LSMO). It is successfully demonstrated that in the graphene/LSMO junctions a sizable spin polarization is induced at the Fermi level of graphene in parallel to the spin polarization direction of LSMO without giving rise to a significant modification in the π band structure.

The Results of a Propensity Score Matching Analysis of the Efficacy of Abdominal Fascia and Skin Closure Using PDS® Plus Antibacterial (Polydioxanone) Sutures on the Incidence of Superficial Incisional Surgical Site Infections after Gastroenterologic Surgery.

BACKGROUND: Surgical site infections (SSIs) lead to prolonged hospitalization and increased cost of hospital stay after surgery. Therefore, the prevention of SSIs is one of the most critical tasks facing surgeons and nursing staff. In the present study, the efficacy of using triclosan-coated polidioxanone sutures (PDS® Plus Antibacterial Suture, (Ethicon Inc., Somerville, NJ) for abdominal closure was analyzed retrospectively using a propensity score matching analysis. PATIENTS AND METHODS: Of 1,768 patients who underwent gastroenterologic surgery at Fukuoka University Hospital between January 2009 and September 2013, 812 underwent abdominal closure using PDS Plus. These patients were compared retrospectively regarding the incidence of SSIs using a propensity score matching method with 956 patients treated in the previous period without abdominal closure using PDS Plus sutures. The propensity score was calculated from the age, gender, body mass index, smoking status, diabetes mellitus, use of steroid medication, malignant or benign disease, organ location, emergency or planned surgery, wound classification, the American Society of Anesthesiologists score, open or laparoscopic surgery, the length of the operation, and blood loss. RESULTS: Nine hundred sixty-six patients (483 matched sets) were enrolled by the propensity score matching method. No parameter used for the propensity score was different between the PDS Plus and control groups. Closure using PDS Plus could reduce the incidence of SSIs compared with that in the control group (p = 0.022). Of the parameters used for the propensity score, malignant disease (p = 0.0002), open surgery (p = 0.0020), a prolonged operation (p < 0.0001), high blood loss (p < 0.0001), the need for a transfusion (p = 0.019), and gastrointestinal tract surgery (p = 0.0059) were significant risk factors for the development of SSIs in the univariable analysis. In a multivariable regression model, open surgery (p < 0.0001), prolonged operation (p < 0.0001), gastrointestinal tract surgery (p = 0.001), and abdominal closure without PDS Plus (p < 0.0001) were the independent risk factors for the development of an SSI. The development of an SSI prolonged the hospital stay (p < 0.0001) and the use of antibiotic medication (p < 0.0001); abdominal closure using PDS Plus affected the antibiotic medication period (p = 0.013) but not the hospital stay (p = 0.40). CONCLUSION: Although abdominal fascia and skin closure using PDS Plus was compared with variable abdominal closure, the present findings suggest that abdominal fascia and skin closure using PDS Plus sutures could help prevent the development of SSIs after gastroenterologic surgery, as determined by a propensity score matching analysis.

An ultrabright and monochromatic electron point source made of a LaB6 nanowire.

Electron sources in the form of one-dimensional nanotubes and nanowires are an essential tool for investigations in a variety of fields, such as X-ray computed tomography, flexible displays, chemical sensors and electron optics applications. However, field emission instability and the need to work under high-vacuum or high-temperature conditions have imposed stringent requirements that are currently limiting the range of application of electron sources. Here we report the fabrication of a LaB6 nanowire with only a few La atoms bonded on the tip that emits collimated electrons from a single point with high monochromaticity. The nanostructured tip has a low work function of 2.07 eV (lower than that of Cs) while remaining chemically inert, two properties usually regarded as mutually exclusive. Installed in a scanning electron microscope (SEM) field emission gun, our tip shows a current density gain that is about 1,000 times greater than that achievable with W(310) tips, and no emission decay for tens of hours of operation. Using this new SEM, we acquired very low-noise, high-resolution images together with rapid chemical compositional mapping using a tip operated at room temperature and at 10-times higher residual gas pressure than that required for W tips.

Upregulation of des-gamma-carboxy-prothrombin after portal vein embolization in a cirrhotic patient with hepatocellular carcinoma.

A 73-year-old female with hepatocellular carcinoma (HCC) received percutaneous transhepatic portal vein embolization (PTPE) before extensive right lobe hepatectomy. Serum levels of des-gamma-carboxy-prothrombin (DCP) were increased and remained at a high level until hepatectomy. Immunohistochemical examination revealed that an increased expression of DCP was demonstrated not only in HCC tissues, but also in the non-cancerous liver of the right lobe, where portal blood flow was blocked off as a result of PTPE. The serum level of DCP is known to be greatly increased in patients with HCC accompanied by portal vein invasion. We speculate that this increased DCP level is caused by both increased DCP production in HCC tissue and the surrounding non-cancerous liver, where portal flow is blocked off as a result of portal invasion by HCC.

Spin correlation in O(2) chemisorption on Ni(111).

Molecular oxygen (O(2)) is a paramagnetic linear molecule, yet how its electron spin affects the chemisorption probability remains unclear. We here present the first spin- and alignment-resolved O(2) chemisorption experiment conducted with a single spin-rotational state-selected O(2) beam and a magnetized Ni(111) surface. The results show that the O(2) sticking probability is higher when its spin is oriented antiparallel to the majority spin direction of the Ni substrate. The spin dependence becomes more significant at low translational energy, and amounts to over 40% at thermal energy. This strong spin effect suggests that incident O(2) molecules keep high spin polarizations even at the position of the dissociation barrier.

Procalcitonin as a useful biomarker for determining the need to perform emergency biliary drainage in cases of acute cholangitis.

BACKGROUND: It is important to identify biomarkers for sepsis and organ damage in acute cholangitis patients. We investigated the usefulness of procalcitonin (PCT) as a biomarker of inflammation based on the Tokyo Guidelines 2013 (TG13). METHODS: A total of 110 acute cholangitis patients were categorized based on TG13, and the PCT levels and common laboratory inflammatory markers were measured. The cases undergoing hemoculture (n = 72) at the time of diagnosis also correlated with the PCT levels. RESULTS: The PCT and C-reactive protein levels were significantly higher in grade III cases versus grade I. The mean PCT levels for positive hemoculture cases (8.6 ng/ml) were significantly higher than those for negative cases (0.7 ng/ml). In hemoculture positive cases or when purulent bile was obtained from the duodenal papilla, i.e., cases clearly requiring emergency biliary drainage and necessitating categorization as grade III, three cases were categorized as grade I and 13 as grade II. Only PCT showed statistically significant increases in severe cases underestimated as grade I or II despite them being fundamentally grade III cases. CONCLUSIONS: Acute cholangitis with high PCT levels can signify the need to perform emergency biliary drainage and institute intensive care even if categorized by TG13 as not being severe cases.

Smart Dry Lab: An Augmented Reality (AR) Based Surgical Training Box.

Smart Dry Lab (SDL) is a low-cost, AR-based surgical training box, using the ARToolKit API. This is an add-on function for existing surgical training box, which enables quantitative evaluation of forceps maneuver and simulation of soft tissue deformation. In this paper we demonstrate functionality of our prototype system.

Communication: fully alignment-specified O2 chemisorption on vicinal Si(100).

A fully alignment-resolved O2 sticking experiment on a single domain Si(100)-(2×1) surface is presented. This provides the first experimental evidence that the reactivity of O2 depends on both the polar and azimuthal angles of the molecular axis relative to a surface. It has been found that, in case of side-on collision, an O2 molecule perpendicular to the dimer on Si(100) is about 40% more reactive than that parallel to the dimer. Comparison of the O2 sticking on flat and vicinal Si(100) surfaces indicates that barrierless dissociation channels exist at the double layer step.

Two rare metachronous metastases of hepatocellular carcinoma after liver transplantation.

A 59-year-old male with hepatocellular carcinoma (HCC) due to liver cirrhosis caused by the hepatitis C virus underwent cadaveric whole liver transplantation. Two years later, he had a metastatic HCC in the superior mediastinum. Over the following postoperative year, he underwent transcatheter arterial chemoembolization (TACE) for 4 tumors in the implanted liver. In the third post-TACE month, he was emergently hospitalized due to intracerebral hematoma with a tumor invading the bone in the medial frontal segment. He underwent emergency intracranial tumorectomy and hemorrhage removal. The histopathologic diagnosis was metastatic HCC. He regained consciousness as well as the ability to speak and to feed himself, resulting in an improved quality of life. The incidence of HCC recurrence after liver transplantation is observed in approximately 8% to 11% of selected cases, with frequent relapses observed in the implanted liver, bones, adrenal glands, and lungs. Mediastinal and intracranial metastases from HCC post-liver transplantation are very rare.

Coaxial needle insertion assistant for epidural puncture effect of lateral force on needle.

We validated the effectiveness of a coaxial needle insertion assistant under the condition that the needles were laterally deformed. The coaxial needle insertion assistant separates the cutting force at the needle tip from shear friction on the needle shaft, and haptically display it to a user in order to assists her/his perception during epidural puncture. An outer needle covers the side of an inner needle, preventing the shear friction from acting on the inner needle. However when the needles are laterally deformed and make contact to each other, it is concerned that the effect of the separation is degraded. In this paper, the users punctured an artificial tissue with variable insertion angles, so that the needle is intentionally laterally deformed. The overshoot and user confidence in detecting puncture was examined.

A study of the efficacy of antibacterial sutures for surgical site infection: a retrospective controlled trial.

To reduce bacterial adherence to surgical sutures, triclosan-coated polyglactin 910 suture materials with antiseptic activity were developed. The aim of this study was to evaluate whether the incidence of surgical site infections can be reduced when triclosan-coated sutures are used. Until December 2009, we used conventional polyglactin 910 sutures (VICRYL, Ethicon) for the closure of the fascia in digestive tract surgery. Therefore, for the control group we retrospectively collected surveillance data for 1.5 years. In the control group, 611 patients underwent digestive tract surgery with VICRYL sutures. Beginning in July 2010, we used triclosan-coated polyglactin 910 sutures (VICRYL Plus, Ethicon, Tokyo, Japan) for the closure of the fascia in all digestive surgeries. So, we collected data for the study group from July 2010 until June 2011. In the study group, 467 patients underwent digestive tract surgery with triclosan-coated VICRYL Plus sutures. In the control group, 75 patients (12.2%) developed wound infections. In the study group, 31 patients (6.6%) developed wound infections, which was significantly lower. Emergency cases; laparoscopic cases, including some cholecystectomy and colectomy cases; American Society of Anesthesiologists classification; the use of immunosuppressive therapy; colostomy cases; wound classification; and suture material were identified as the risk factors for wound infections. In both groups, as the wound classification worsened, the wound infection rate increased. Triclosan-coated polyglactin 910 antimicrobial sutures lead to a significant decrease in the incidence of surgical site infections, especially in clean/contaminated cases.

A Successfully Resected Case of Recurrent Lung and Liver Metastases of Rectal Cancer Treated with XELIRI + Bevacizumab Therapy.

It has been reported that many colorectal cancer (CRC) patients with synchronous or metachronous liver metastases underwent surgery subsequent to neoadjuvant combination chemotherapy with folinic acid, fluorouracil, and oxaliplatin (FOLFOX), folinic acid, fluorouracil, and irinotecan (FOLFIRI), or capecitabine and oxaliplatin (XELOX). However, there are very few reports of the use of capecitabine and irinotecan (XELIRI). We herein report a successfully resected case of recurrent lung and liver metastases of rectal cancer treated with combination chemotherapy with XELIRI + bevacizumab (BV) therapy. A 63-year-old male developed recurrence of a solitary nodule in the right lower lobe of the lung and multiple liver metastases after low anterior resection for rectal cancer 1 year previously. Partial resection of the right lower lobe of the lung was performed and treatment with XELIRI + BV was initiated. A computed tomography scan revealed a reduction in tumor size without any new lesions after four cycles of XELIRI + BV therapy. Partial hepatectomy of S1, S5, and S7 was safely performed. The patient is now undergoing adjuvant chemotherapy and has been free from recurrence for 18 months following surgery. There are only few studies with relatively low patient numbers reporting on the outcome after resection of both pulmonary and hepatic metastases of CRC. We therefore report a patient who underwent sequential resection of pulmonary and hepatic metastases with XELIRI + BV therapy.