Surgically treated Zenker’s diverticulum： Diverticulectomy and cricopharyngeal myotomy

　Zenker's diverticulum is a very rare disease among gastorointestinal diverticulum. We report a case of Zenker's diverticulum successfully treated with diverticulectomy and cricophalyngial myotomy. A 71-year-old male complained of aspirating water for two years. He was diagnosed as Zenker's diverticulum. Due to his severe symptoms, the operation was performed in an open-neck approach. The left recurrent laryngeal nerve was identified and preserved. An incision was made in the diverticulum wall, and the internal diameter of normal cervical esophagus was measured. The diverticulum was then excised with an automatic suture device in the minor axis direction of the esophagus. A cricopharyngeal myotomy was conducted, because this muscle was fibrotic and stiffened. The patient's symptoms disappeared after the operation. Diverticulectomy and cricopharyngeal myotomy through an open-neck approach is a safe and reliable method that follows, direct access to the diverticulum and recurrent laryngeal nerve

Offshore-origin warm water inflows toward Totten Ice Shelf, East Antarctica

The Tenth Symposium on Polar Science/Ordinary sessions: [OM] Polar Meteorology and Glaciology, Thu. 5 Dec. / 2F Auditorium , National Institute of Polar Researc

Solitary Cardiac Metastasis of Hepatocellular Carcinoma

Cardiac metastasis originating from hepatocellular carcinoma (HCC) is a rare condition with a poor prognosis. No therapeutic standards for cardiac metastasis originating from HCC have been established. At 19 months after a curative hepatectomy, a 64-year-old Japanese hepatitis B virus-positive male patient experienced solitary cardiac metastasis originating from HCC. The cardiac tumor was discovered in the right ventricle. The patient received three courses of radiotherapy and chemotherapy and survived > 3 years after the initial diagnosis of cardiac metastasis. His case demonstrates that radiotherapy combined with chemotherapy can be an effective treatment for cardiac metastasis

The Late Phase/Early Phase Ratio of Pancreatic CT Values as a Novel Predictor of Pancreatic Fistula after Distal Pancreatectomy

Post-operative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy (DP). In this retrospective study, we reviewed the data from patients who underwent DP between 2008 and 2019 in our institute to determine whether the late phase/early phase ratio (L/E ratio) by preoperative computed tomography (CT) scan in the pancreas could predict POPF occurrence after DP. We examined the relationship between preoperative or intraoperative factors and the occurrence of POPF after DP using statistical methods in 23 males and 21 females with a mean age of 73. The mean L/E ratio was significantly lower in the POPF group than the non-POPF group (p=0.035). The L/E ratio had moderate diagnostic accuracy, with a calculated optimal cutoff value of 0.77. In univariate analysis, a significant association was noted between POPF and stump thickness ≥ 16.9, body mass index ≥ 27.5, and L/E ratio ≤ 0.77. In the multivariate analysis, the L/E ratio (odds ratio, 5.96; p=0.036) was an independent risk factor for POPF. Our findings suggest that the pancreatic L/E ratio may predict the occurrence of POPF after DP. This measure may be useful in preoperative risk stratification, patient counseling, and perioperative patient management, improving clinical outcomes after DP

KAT6B-related disorder in a patient with a novel frameshift variant (c.3925dup)

Heterozygous pathogenic variants in the KAT6B gene, which encodes lysine acetyltransferase 6B, have been identified in patients with congenital rare disorders, including genitopatellar syndrome and Say-Barber-Biesecker-Young-Simpson syndrome. Herein, we report another Japanese patient with a KAT6B-related disorder and a novel de novo heterozygous variant in exon 18 of KAT6B [c.3925dup, p.(Glu1309fs*33)], providing further evidence that truncating variants in exon 17 and in the proximal region of exon 18 are associated with genitopatellar syndrome-like phenotypes

Potent PPARα Activator Derived from Tomato Juice, 13-oxo-9,11-Octadecadienoic Acid, Decreases Plasma and Hepatic Triglyceride in Obese Diabetic Mice

Dyslipidemia is a major risk factor for development of several obesity-related diseases. The peroxisome proliferator-activated receptor α (PPARα) is a ligand-activated transcription factor that regulates energy metabolism. Previously, we reported that 9-oxo-10,12-octadecadienoic acid (9-oxo-ODA) is presented in fresh tomato fruits and acts as a PPARα agonist. In addition to 9-oxo-ODA, we developed that 13-oxo-9,11-octadecadienoic acid (13-oxo-ODA), which is an isomer of 9-oxo-ODA, is present only in tomato juice. In this study, we explored the possibility that 13-oxo-ODA acts as a PPARα agonist in vitro and whether its effect ameliorates dyslipidemia and hepatic steatosis in vivo. In vitro luciferase assay experiments revealed that 13-oxo-ODA significantly induced PPARα activation; moreover, the luciferase activity of 13-oxo-ODA was stronger than that of 9-oxo-ODA and conjugated linoleic acid (CLA), which is a precursor of 13-oxo-ODA and is well-known as a potent PPARα activator. In addition to in vitro experiment, treatment with 13-oxo-ODA decreased the levels of plasma and hepatic triglycerides in obese KK-Ay mice fed a high-fat diet. In conclusion, our findings indicate that 13-oxo-ODA act as a potent PPARα agonist, suggesting a possibility to improve obesity-induced dyslipidemia and hepatic steatosis

Two-Loop Superstrings IV, The Cosmological Constant and Modular Forms

The slice-independent gauge-fixed superstring chiral measure in genus 2 derived in the earlier papers of this series for each spin structure is evaluated explicitly in terms of theta-constants. The slice-independence allows an arbitrary choice of superghost insertion points q_1, q_2 in the explicit evaluation, and the most effective one turns out to be the split gauge defined by S_{\delta}(q_1,q_2)=0. This results in expressions involving bilinear theta-constants M. The final formula in terms of only theta-constants follows from new identities between M and theta-constants which may be interesting in their own right. The action of the modular group Sp(4,Z) is worked out explicitly for the contribution of each spin structure to the superstring chiral measure. It is found that there is a unique choice of relative phases which insures the modular invariance of the full chiral superstring measure, and hence a unique way of implementing the GSO projection for even spin structure. The resulting cosmological constant vanishes, not by a Riemann identity, but rather by the genus 2 identity expressing any modular form of weight 8 as the square of a modular form of weight 4. The degeneration limits for the contribution of each spin structure are determined, and the divergences, before the GSO projection, are found to be the ones expected on physical grounds.Comment: 58 pages, no figure

Two-Loop Superstrings II, The Chiral Measure on Moduli Space

A detailed derivation from first principles is given for the unambiguous and slice-independent formula for the two-loop superstring chiral measure which was announced in the first paper of this series. Supergeometries are projected onto their super period matrices, and the integration over odd supermoduli is performed by integrating over the fibers of this projection. The subtleties associated with this procedure are identified. They require the inclusion of some new finite-dimensional Jacobian superdeterminants, a deformation of the worldsheet correlation functions using the stress tensor, and perhaps paradoxically, another additional gauge choice, ``slice \hat\mu choice'', whose independence also has to be established. This is done using an important correspondence between superholomorphic notions with respect to a supergeometry and holomorphic notions with respect to its super period matrix. Altogether, the subtleties produce precisely the corrective terms which restore the independence of the resulting gauge-fixed formula under infinitesimal changes of gauge-slice. This independence is a key criterion for any gauge-fixed formula and hence is verified in detail.Comment: 64 pages, no figure

Two-Loop Superstrings I, Main Formulas

An unambiguous and slice-independent formula for the two-loop superstring measure on moduli space for even spin structure is constructed from first principles. The construction uses the super-period matrix as moduli invariant under worldsheet supersymmetry. This produces new subtle contributions to the gauge-fixing process, which eliminate all the ambiguities plaguing earlier gauge-fixed formulas. The superstring measure can be computed explicitly and a simple expression in terms of modular forms is obtained. For fixed spin structure, the measure exhibits the expected behavior under degenerations of the surface. The measure allows for a unique modular covariant GSO projection. Under this GSO projection, the cosmological constant, the 1-, 2- and 3- point functions of massless supergravitons all vanish pointwise on moduli space without the appearance of boundary terms. A certain disconnected part of the 4-point function is shown to be given by a convergent, finite integral on moduli space. A general slice-independent formula is given for the two-loop cosmological constant in compactifications with central charge c=15 and N=1 worldsheet supersymmetry in terms of the data of the compactification conformal field theory. In this paper, a summary of the above results is presented with detailed constructions, derivations and proofs to be provided in a series of subsequent publications.Comment: 21 pages, no figures, references added, minor typos correcte