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Whether in ant-aphid mutualism the ants exert evolutionary selection pressure on aphid morphology has not yet been fully tested. Here, we tested whether the long proboscises of Stomaphis yanonis (Aphididae Lachninae) aphids confer an advantage in preventing predation by the tending ants. Specifically, we tested the hypothesis that aphids with a shorter proboscis would excrete less honeydew, making them more likely to be preyed upon by ants. Our results showed that aphid individuals with a shorter proboscis took up less phloem sap and excreted less honeydew than individuals with a longer proboscis. In addition, among aphids with a similar body size, those with a shorter proboscis were more susceptible to predation by ants than those with a longer proboscis. These results suggest that predation by tending ants, by exerting selection pressure on aphid proboscis morphology, has caused the aphids to evolve longer proboscises.
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Formigas , Afídeos , Comportamento Predatório , Animais , Afídeos/fisiologia , Formigas/fisiologia , Comportamento Predatório/fisiologia , Simbiose/fisiologiaRESUMO
Neuroleptic malignant syndrome (NMS) is a rare but life-threatening medical condition often characterized by altered consciousness and clinical features resembling seizures. This case report presents a unique and successful diagnosis of NMS in an unconscious patient with an unknown medical history. We demonstrate the potential utility of amplitude-integrated electroencephalography (aEEG) as a valuable tool for the differential diagnosis of seizure-like medical conditions, including NMS. The application of aEEG allowed for early diagnosis and prompt initiation of appropriate treatment, potentially contributing to improved patient outcomes.
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INTRODUCTION: Intramedullary spinal cord abscesses (ISCA) are rare and caused by central nervous system infections. Although polymicrobial infections are rarely seen in ISCAs, isolation of the causative pathogen is important for treatment. Here, we describe a very rare case of ISCA resulting from a mixed Streptococcus and Actinomyces infection. CASE PRESENTATION: An 82-year-old man presented with acute posterior cervical pain and progressive quadriplegia. Radiological investigations revealed a mass lesion showing marginal enhancement at the level of the C3-4 vertebrae. Microsurgical drainage was performed, and Streptococcus and Actinomyces were identified as causative agents. Subsequent antibiotic treatment was noted to be beneficial to the patient. DISCUSSION: This case suggests that mixed infection can develop into ISCA depending on the causative agents such as Actinomyces. Prompt pathogen-directed antibacterial therapy is required for ISCA treatment.
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Abscesso , Doenças da Medula Espinal , Masculino , Humanos , Idoso de 80 Anos ou mais , Abscesso/diagnóstico por imagem , Abscesso/terapia , Actinomyces , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/cirurgia , Streptococcus , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: This study proposed an automatic surgical planning system for high tibial osteotomy (HTO) using deep learning-based artificial intelligence and validated its accuracy. The system simulates osteotomy and measures lower-limb alignment parameters in pre- and post-osteotomy simulations. METHODS: A total of 107 whole-leg standing radiographs were obtained from 107 patients who underwent HTO. First, the system detected anatomical landmarks on radiographs. Then, it simulated osteotomy and automatically measured five parameters in pre- and post-osteotomy simulation (hip knee angle [HKA], weight-bearing line ratio [WBL ratio], mechanical lateral distal femoral angle [mLDFA], mechanical medial proximal tibial angle [mMPTA], and mechanical lateral distal tibial angle [mLDTA]). The accuracy of the measured parameters was validated by comparing them with the ground truth (GT) values given by two orthopaedic surgeons. RESULTS: All absolute errors of the system were within 1.5° or 1.5%. All inter-rater correlation confidence (ICC) values between the system and GT showed good reliability (>0.80). Excellent reliability was observed in the HKA (0.99) and WBL ratios (>0.99) for the pre-osteotomy simulation. The intra-rater difference of the system exhibited excellent reliability with an ICC value of 1.00 for all lower-limb alignment parameters in pre- and post-osteotomy simulations. In addition, the measurement time per radiograph (0.24 s) was considerably shorter than that of an orthopaedic surgeon (118 s). CONCLUSION: The proposed system is practically applicable because it can measure lower-limb alignment parameters accurately and quickly in pre- and post-osteotomy simulations. The system has potential applications in surgical planning systems.
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Inteligência Artificial , Osteotomia , Tíbia , Humanos , Osteotomia/métodos , Tíbia/cirurgia , Tíbia/diagnóstico por imagem , Feminino , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Adulto , Cirurgia Assistida por Computador/métodos , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Idoso , Aprendizado Profundo , RadiografiaRESUMO
Background: The impact of the sex of bystanders who initiate cardiopulmonary resuscitation (CPR) on out-of-hospital cardiac arrest (OHCA) patients has not been fully elucidated. This study aims to investigate the association between the sex of bystanders who perform CPR and the clinical outcomes of OHCA patients in real-world clinical settings. Methods: We conducted a retrospective, observational study using data from the Okayama City Fire Department in Japan. Patients were categorized based on bystanders' sex. Our primary outcomes were return of spontaneous circulation (ROSC). Our secondary outcome was 30-day survival and 30-day favorable neurological outcome, defined as Cerebral Performance Category score of 1 or 2. Multivariable logistic regression analysis was used to examine the association between these groups and outcomes. Results: The study included 3,209 patients with a comparable distribution of male (1,540 patients: 48.0%) and female bystanders (1,669 patients: 52.0%) between the groups. Overall, 221 (6.9%) ROSC at hospital arrival, 226 (7.0%) patients had 30-day survival, and 121 (3.8%) patients had 30-day favorable neurological outcomes. Bystander sex (female as reference) did not contribute to ROSC at hospital arrival (adjusted OR [aOR] 1.11, 95% CI: 0.76-1.61), 30-day survival (aOR 1.23, 95% CI: 0.83-1.82), or 30-day favorable neurological outcomes (aOR 0.66, 95% CI: 0.34-1.27). Basic life support education experience was a bystander factor positively associated with ROSC. Patient factors positively associated with ROSC were initial shockable rhythm and witness of cardiac arrest. Conclusion: There were no differences in ROSC, 30-day survival, or 30-day neurological outcomes in OHCA patients based on bystander sex.
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BACKGROUND/AIM: Risk classification for recurrence in stage III colorectal cancer (CRC) is not as well established as it is for stage II. This study aimed to identify high-risk factors for stage III colorectal cancer and to investigate their clinical significance. PATIENTS AND METHODS: We retrospectively analyzed data from 120 patients with stage III CRC who had undergone curative colectomy at our institution between 2014 and 2020. We used logistic regression analysis to identify risk factors for recurrence and subsequently explored their clinical significance. RESULTS: We identified three high-risk factors in stage III CRC: preoperative bowel obstruction [odds ratio (OR)=5.39; 95% confidence interval (CI)=1.61-18.03; p=0.007], N2 disease (OR=3.12; 95%CI=1.05-9.29; p=0.041), and having fewer than 17 examined lymph nodes (OR=3.17; 95%CI=1.11-8.99; p=0.031). The prognosis of patients was clearly stratified by the number of these risk factors, and furthermore, the effectiveness of adjuvant therapy depended on their number. CONCLUSION: Tumor obstruction, N-stage, and the number of lymph nodes examined are important high-risk features for recurrence. This study provides clinicians with valuable insights to predict and stratify patient outcomes in stage III CRC.
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Neoplasias Colorretais , Humanos , Estudos Retrospectivos , Estadiamento de Neoplasias , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/tratamento farmacológico , Prognóstico , Linfonodos/cirurgia , Linfonodos/patologia , Recidiva Local de Neoplasia/patologiaRESUMO
BACKGROUND: Balloon aortic valvuloplasty (BAV) has gained renewed interest as a bridge to transcatheter aortic valve replacement (TAVR) for patients with aortic stenosis (AS). However, it is unclear whether they patients should undergo TAVR directly or receive a staged bridge to BAV before TAVR is unclear. We used a national database to examine the association between BAV and TAVR in patients with TAVR and its effect on in-hospital mortality. METHODS: Using the nationwide inpatient database of the Japanese registry of all cardiac and vascular diseases and the combination of the diagnosis procedure combination, we retrospectively analyzed 27,600 patients with AS who underwent TAVR between October 2013 and March 2021. Outcomes of the direct TAVR group (n = 27,387) were compared with those of the BAV bridge to TAVR group (n = 213), which received BAV at least 1 day before TAVR. RESULTS: The median age was 85 (interquartile range: 82-88) years, with 33.3% (n = 9188) being male. Unplanned/emergent admissions increased with TAVR, whereas the use of BAV bridge to TAVR decreased. The in-hospital mortality rate was 1.3% and decreased over time. However, the BAV bridge to TAVR had a significantly higher in-hospital mortality than direct TAVR (5.6% vs. 1.3%; p < .0001). Factors associated with in-hospital mortality included age, body mass index, chronic renal disease, percutaneous coronary intervention, and BAV bridge to TAVR. CONCLUSIONS: In unplanned/emergent and planned admission settings, the in-hospital mortality rate for BAV bridge to TAVR is worse than that for direct TAVR. Practical criteria for BAV bridge to TAVR should be proposed to improve outcomes.