A Comparison of the Efficacy of Plastic Stent Placement Above and Across the Sphincter of Oddi for Benign Biliary Hilar Stricture

We investigated the efficacy and safety of endoscopic plastic stent (PS) placement for hilar benign biliary strictures (BBSs) and compared cases with PS placement above (inside stent, IS) and across (usual stent, US) the sphincter of Oddi. Patients who underwent initial endoscopic PS placement for hilar BBSs between August 2012 and December 2021 were retrospectively analyzed. Hilar BBSs in 88 patients were investigated. Clinical success was achieved in 81 of these cases (92.0%), including 38 patients in the IS group and 43 patients in the US group. Unexpected stent exchange (uSE) before the first scheduled PS exchange occurred in 18 cases (22.2%). The median time from first stent placement to uSE was 35 days. There was no significant difference in the rate and median time to uSE between the two groups. The rates of adverse events such as pancreatitis or cholangitis in the two groups did not significantly differ. However, the rate of difficult stent removal in the IS group (15.8%) was significantly higher than that in the US group (0%) (p=0.0019). US placement is preferable to IS placement for scheduled stent exchange, as it offers the same effectiveness and risk of adverse events with easier stent removal

Curved-Tip Disposable Injector (OUReP Injector) to Insert Photoelectric Dye-Coupled Polyethylene Film (OUReP) as Retinal Prosthesis into Subretinal Space of Rabbit Eyes

The photoelectric dye-coupled thin polyethylene film functions as a novel type of retinal prosthesis in subretinal space of the eye. We previously reported a novel disposable injector to insert the thin film into subretinal space of the rabbit eye by vitreous surgery. The injection system composed of two separate parts, injector and loader. A circular film in 5 mm to 10 mm diameter was pulled into a transparent tube of the loader with a commercial 25-gauge forceps. The loader tube was joined with a sleeve to tube tip of the injector. The film in the loader was pushed with a plunger for the loader into the injector tube tip. The loader with the sleeve was removed from the injector tip, and the tube tip with the film was filled with solution. This study reported a small-bore curved-tip disposable injector with outer diameter of 1.6 mm. A curved-tip polypropylene tube was formed by the process of heating and cooling of the tube inserted with a curved guide wire. The plunger for the curved-tip tube was made of a polyphenylsulfone tip connected with a press-fitting inner polypropylene tube to a nylon rod. Bleb retinal detachment in 4 surgically aphakic eyes of rabbits were induced by infusing solution into subretinal space with a 38-gauge polyimide tip, and a retinal tear was made at the edge of retinal detachment with 25-gauge diathermy. The injector tip with the rolled film in 6 mm diameter was inserted from 2 mm wide scleral incision into vitreous and then into subretinal space. The rolled films were released into subretinal space with the tip end inserted into the retinal tear, and the released films were confirmed to stay under the retina with no additional aid. Dissection one month after surgeries confirmed successful implantation of 4 films into subretinal space of each rabbit eye. The curved-tip injector could release the rolled film into the subretinal space without additional effort, compared with the straight-tip injector, and would help surgeons implant photoelectric dye-coupled thin film retinal prosthesis easily at vitreous surgery

Transmesocolic Hernia of the Ascending Colon with Intestinal Obstruction

An internal hernia may be either congenital or acquired. The reported incidence of such hernias is 1–2%. In rare cases, internal hernias are the cause of small bowel obstruction, with a reported incidence of 0.2–0.9%. Transmesocolic hernia of the ascending colon is especially rare. We report a case of transmesocolic hernia of the ascending colon with intestinal obstruction diagnosed preoperatively. A 91-year-old Japanese female was admitted to our hospital with abdominal distention and vomiting of 3 days duration. She had no past history of any abdominal surgery. Abdominal examination revealed distention and tenderness in the right iliac fossa. Abdominal computed tomography revealed ileus in the sac at the left side of the ascending colon and dilatation of the oral side of the intestine. We diagnosed a transmesocolic hernia of the ascending colon with intestinal obstruction and performed emergency surgery. At the time of operation, there was internal herniation of ileal loops through a defect in the ascending mesocolon, without any strangulation of the small bowel. The contents were reduced and the tear in the ascending mesocolon was closed. The postoperative course was uneventful and the patient was discharged 14 days after surgery. In conclusion, preoperative diagnosis of bowel obstruction caused by a congenital mesocolic hernia remains difficult despite the techniques currently available, so it is important to consider the possibility of a transmesocolic hernia when diagnosing a patient with ileus with no past history of abdominal surgery

Helicobacter pylori induces somatic mutations in TP53 via overexpression of CHAC1 in infected gastric epithelial cells

Infection with Helicobacter pylori is known to decrease the level of glutathione in gastric epithelial cells and increase the production of reactive oxygen species (ROS), which can lead to DNA damage and the development of gastric cancer. Cation transport regulator 1 (CHAC1) has γ-glutamylcyclotransferase activity that degrades glutathione. We found that cagA-positive H. pylori infection triggered CHAC1 overexpression in human gastric epithelial (AGS) cells leading to glutathione degradation and the accumulation of ROS. Nucleotide alterations in the TP53 tumour suppressor gene were induced in AGS cells overexpressing CHAC1, whereas no mutations were detected in cells overexpressing a catalytically inactive mutant of CHAC1. A high frequency of TP53 mutations occurred in H. pylori-infected AGS cells, but this was prevented in cells transfected with CHAC1 siRNA. These findings indicate that H. pylori-mediated CHAC1 overexpression degrades intracellular glutathione, allowing the accumulation of ROS which subsequently causes mutations that could contribute to the development of gastric cancer.This work was supported by the Japan Society for the Promotion of Science KAKENHI (16K19077) and Project Grant 525458 from the Australian National Health and Medical Research Council

Cerebral air embolism as a complication of peptic ulcer in the gastric tube: case report

<p>Abstract</p> <p>Background</p> <p>The reported incidence of ulcer formation in the gastric tube in esophageal replacement is rare.</p> <p>Case Presentation</p> <p>This is the first report of a case of cerebral air embolism as a result of spontaneous perforation of an ulcer in the constructed gastric tube into the pulmonary vein during post-operative follow-up in a patient with esophageal cancer.</p> <p>Conclusions</p> <p>Cerebral air embolism is a rare complication of penetrating gastric ulcer, but should be considered in patients with a history of esophagectomy with gastric conduit that present with acute neurologic findings.</p

First Data Release of the Hyper Suprime-Cam Subaru Strategic Program

The Hyper Suprime-Cam Subaru Strategic Program (HSC-SSP) is a three-layered imaging survey aimed at addressing some of the most outstanding questions in astronomy today, including the nature of dark matter and dark energy. The survey has been awarded 300 nights of observing time at the Subaru Telescope and it started in March 2014. This paper presents the first public data release of HSC-SSP. This release includes data taken in the first 1.7 years of observations (61.5 nights) and each of the Wide, Deep, and UltraDeep layers covers about 108, 26, and 4 square degrees down to depths of i~26.4, ~26.5, and ~27.0 mag, respectively (5sigma for point sources). All the layers are observed in five broad bands (grizy), and the Deep and UltraDeep layers are observed in narrow bands as well. We achieve an impressive image quality of 0.6 arcsec in the i-band in the Wide layer. We show that we achieve 1-2 per cent PSF photometry (rms) both internally and externally (against Pan-STARRS1), and ~10 mas and 40 mas internal and external astrometric accuracy, respectively. Both the calibrated images and catalogs are made available to the community through dedicated user interfaces and database servers. In addition to the pipeline products, we also provide value-added products such as photometric redshifts and a collection of public spectroscopic redshifts. Detailed descriptions of all the data can be found online. The data release website is https://hsc-release.mtk.nao.ac.jp/.Comment: 34 pages, 20 figures, 7 tables, moderate revision, accepted for publication in PAS

A市市民の健康習慣とはつらつ感の実態 2016年の調査から(第3報)

　A市市民の健康習慣とはつらつ感の実態を明らかにするため，年齢階級別かつ性別で市民3000 人を無作為に抽出し，郵送による自記式質問紙調査を行った．その結果，1248 件（回収率41.6%）を回収し，性別，年齢，はつらつ感の記載のないものを除外し，1207 件を分析対象とした（有効回答率96.7%）．はつらつ感は「毎日はつらつ」155 人（12.8%），「まあまあはつらつ」727 人（60.2%），「あまりはつらつとしていない」261人（21.6%），「はつらつとしていない」64 人（5.3%）であった．はつらつ群と非はつらつ群の2 群間で有意差がみられたのは，「心や精神の病気」，「主観的健康観」と，健康習慣では，「30 分以上の早歩き」「エスカレーター・エレベーターの使用」「運動不足の自覚」「運動する仲間」「主食・主菜・副菜のそろった食事」「家族や仲間との楽しい食事」「よく噛むことの心がけ」「食生活の問題意識」「地元の食材の利用」「定期的な体重測定」「自分のBMI の認識」「年1 回の健康診査の受診」「身近に相談できる人・環境」「睡眠による休養」「近所の人のお互いに助け合う気持ち」「近所の人との会話」等の30 項目であった．　A市市民がはつらつと生活するためには，適切な運動や栄養バランスの良い食事等を啓蒙するとともに，健康管理では体重管理や健康診査の受診の勧奨が重要であり，また，はつらつ感は心の状態が反映されていることが推察され，近所の人との会話やつながり等ソーシャル・キャピタルの醸成や心の健康支援の取り組みの充実が示唆された

The Quiescent Intracluster Medium in the Core of the Perseus Cluster

Clusters of galaxies are the most massive gravitationally-bound objects in the Universe and are still forming. They are thus important probes of cosmological parameters and a host of astrophysical processes. Knowledge of the dynamics of the pervasive hot gas, which dominates in mass over stars in a cluster, is a crucial missing ingredient. It can enable new insights into mechanical energy injection by the central supermassive black hole and the use of hydrostatic equilibrium for the determination of cluster masses. X-rays from the core of the Perseus cluster are emitted by the 50 million K diffuse hot plasma filling its gravitational potential well. The Active Galactic Nucleus of the central galaxy NGC1275 is pumping jetted energy into the surrounding intracluster medium, creating buoyant bubbles filled with relativistic plasma. These likely induce motions in the intracluster medium and heat the inner gas preventing runaway radiative cooling; a process known as Active Galactic Nucleus Feedback. Here we report on Hitomi X-ray observations of the Perseus cluster core, which reveal a remarkably quiescent atmosphere where the gas has a line-of-sight velocity dispersion of 164+/-10 km/s in a region 30-60 kpc from the central nucleus. A gradient in the line-of-sight velocity of 150+/-70 km/s is found across the 60 kpc image of the cluster core. Turbulent pressure support in the gas is 4% or less of the thermodynamic pressure, with large scale shear at most doubling that estimate. We infer that total cluster masses determined from hydrostatic equilibrium in the central regions need little correction for turbulent pressure.Comment: 31 pages, 11 Figs, published in Nature July