Spontaneous esophageal perforation within a hiatal hernia : A case report

Introduction: Spontaneous esophageal perforation, also commonly referred to as Boerhaave's syndrome, is one of the most lethal diseases causing an acute abdomen. Though rare, emergent surgical intervention is often required and management can be various based upon the site of the perforation. This literature has been written in line with the SCARE criteria (Agha et al., 2020) [1]. Presentation of case: A 76-year-old man presented with acute abdominal pain. Computed tomography (CT) revealed and an emergent esophagogastroduodenoscopy (EGD) was performed carefully, which revealed a 7 cm all-layer esophageal laceration in the left lower esophageal wall. In our case, a hiatal hernia was protruding into the mediastinum, and the perforation site was inside of it, but there was no invasion into the thoracic cavity, thus a transabdominal approach was performed without thoracotomy. Discussion: This type of esophageal perforation within a hiatal hernia is quite rare and provides a unique clinical challenge. In addition, A review reported the average length of spontaneous esophageal perforation to be around 2 cm while our case had a perforation with a length of 7 cm. We chose the combination of the simple suture with omental buttress and wide drainage, but a complete fundoplication was impossible due to its large size of perforation. Conclusion: We chose the open abdominal approach because the case had high inflammation, a hiatal hernia and possibility of retro-gastric perforation. However, MIS should have been considered first if a situation or human resources allow it

Medical Curriculum to Motivate Students

Despite advancements in the pedagogy of medical education in various fields, Japan has no standardized medical English education. The U.S. Medical Licensing Examination (USMLE) Study Group of Tokushima is an extracurricular activity in which medical students and recent graduates meet every 1–2 months. The aim is to stimulate students’ curiosity ; cultivate their initiative, self-efficacy, and English learning goals ; and motivate them to be self-regulated learners. Accordingly, we conducted near-peer teaching style lectures that focused on sharing medical English-related experiences, so students could have regular opportunities to visualize the benefits of learning medical English. Following the activities, we observed increased motivation and self-study among students, resulting in a high USMLE passing rate. Furthermore, five members started their training at American hospitals and pursued careers in English-speaking environments. Thus, near-peer teaching style leads to shared medical English-related experiences that help students to visualize English-related opportunities. This education style taught by similar generations aids in setting a specific goal by providing access to role models, cultivating their initiative and self-efficacy, motivating them to learn English, and producing positive outcomes. Modifying the curriculum to actively create opportunities for students to visualize themselves in an international environment can motivate them to continue learning English

Increased amyloidogenic processing of transgenic human APP in X11-like deficient mouse brain

<p>Abstract</p> <p>Background</p> <p>X11-family proteins, including X11, X11-like (X11L) and X11-like 2 (X11L2), bind to the cytoplasmic domain of amyloid β-protein precursor (APP) and regulate APP metabolism. Both X11 and X11L are expressed specifically in brain, while X11L2 is expressed ubiquitously. X11L is predominantly expressed in excitatory neurons, in contrast to X11, which is strongly expressed in inhibitory neurons. <it>In vivo </it>gene-knockout studies targeting X11, X11L, or both, and studies of X11 or X11L transgenic mice have reported that X11-family proteins suppress the amyloidogenic processing of endogenous mouse APP and ectopic human APP with one exception: knockout of X11, X11L or X11L2 has been found to suppress amyloidogenic metabolism in transgenic mice overexpressing the human Swedish mutant APP (APPswe) and the mutant human PS1, which lacks exon 9 (PS1dE9). Therefore, the data on X11-family protein function in transgenic human APP metabolism <it>in vivo </it>are inconsistent.</p> <p>Results</p> <p>To confirm the interaction of X11L with human APP ectopically expressed in mouse brain, we examined the amyloidogenic metabolism of human APP in two lines of human APP transgenic mice generated to also lack X11L. In agreement with previous reports from our lab and others, we found that the amyloidogenic metabolism of human APP increased in the absence of X11L.</p> <p>Conclusion</p> <p>X11L appears to aid in the suppression of amyloidogenic processing of human APP in brain <it>in vivo</it>, as has been demonstrated by previous studies using several human APP transgenic lines with various genetic backgrounds. X11L appears to regulate human APP in a manner similar to that seen in endogenous mouse APP metabolism.</p

Distribution of Polysulfide in Human Biological Fluids and Their Association with Amylase and Sperm Activities

Intracellular polysulfide could regulate the redox balance via its anti-oxidant activity. However, the existence of polysulfide in biological fluids still remains unknown. Recently, we developed a quantitative analytical method for polysulfide and discovered that polysulfide exists in plasma and responds to oxidative stress. In this study, we confirmed the presence of polysulfide in other biological fluids, such as semen and nasal discharge. The levels of polysulfide in these biological fluids from healthy volunteers (n = 9) with identical characteristics were compared. Additionally, the circadian rhythm of plasma polysulfide was also investigated. The polysulfide levels detected from nasal discharge and seminal fluid were approximately 400 and 600 μM, respectively. No correlation could be found between plasma polysulfide and the polysulfide levels of tear, saliva, and nasal discharge. On the other hand, seminal polysulfide was positively correlated with plasma polysulfide, and almost all polysulfide contained in semen was found in seminal fluid. Intriguingly, saliva and seminal polysulfide strongly correlated with salivary amylase and sperm activities, respectively. These results provide a foundation for scientific breakthroughs in various research areas like infertility and the digestive system process

The relationship between emotional understanding and social skills in young children <Research papers>

This study investigated the relationships between emotional understanding and social skills in young children. Participants were 111 children (4-6 years old), 59 of whom were boys and 52 were girls. The investigator told a story and asked each child to answer with what kind of emotion (happy, sad, or angry) the protagonist would feel. The results showed that there was a significant correlation between children’s emotional understanding and social skills in the elder age group (ages 61-72 months), but no equivalent significant correlation in the younger age group (ages 48-60 months). These results suggest that the relationship between emotional understanding and social skills in children could be distinguished according to age group

The leucine-rich repeat receptor kinase QSK1 is a novel regulator of PRR-RBOHD complex and is employed by the bacterial effector HopF2Pto_{Pto} to modulate plant immunity

Plants detect pathogens using cell-surface pattern recognition receptors (PRRs) like EFR and FLS2, which recognize bacterial EF-Tu and flagellin, respectively. These PRRs, belonging to the leucine-rich repeat receptor kinase (LRR-RK) family, activate the production of reactive oxygen species via the NADPH oxidase RBOHD. The PRR-RBOHD complex is tightly regulated to prevent unwarranted or exaggerated immune responses. However, certain pathogenic effectors can subvert these regulatory mechanisms, thereby suppressing plant immunity. To elucidate the intricate dynamics of the PRR-RBOHD complex, we conducted a comparative co-immunoprecipitation analysis using EFR, FLS2, and RBOHD. We identified QSK1, an LRR-RK, as a novel component of the PRR-RBOHD complex. QSK1 functions as a negative regulator of PRR-triggered immunity (PTI) by downregulating the abundance of FLS2 and EFR. QSK1 is targeted by the bacterial effector HopF2$_{Pto}$, a mono-ADP ribosyltransferase, resulting in the reduction of FLS2 and EFR levels through both transcriptional and transcription-independent pathways, thereby inhibiting PTI. Furthermore, HopF2$_{Pto}$ reduces transcript levels of PROSCOOP genes encoding important stress-regulated phytocytokines and their receptor MIK2. Importantly, HopF2Pto requires QSK1 for its accumulation and virulence functions within plants. In summary, our results provide novel insights into the mechanism by which HopF2$_{Pto}$ employs QSK1 to desensitize plants to pathogen attack. One Sentence Summary: QSK1, a novel component in the plant immune receptor complex, downregulates these receptors and phytocytokines, and is exploited by bacterial effector HopF2$_{Pto}$ to desensitize plants to pathogen attack

Endometriosis of the ileum treated by laparoscopic ileocecal resection

A ２９-year-old female was admitted due to abdominal pain. Abdominal computed tomography showed a tumor in terminal ileum and expanded jejunum, and colonoscopy showed a collection of lymph follicles. Biopsy finding showed a lymphoid tissue hyperplasia and no malignant finding. Therefore, we performed a laparoscopic ileocecal resection for diagnosis and treatment. Histopathological findings showed endometrial tissue in the muscular layer, and we diagnosed endometriosis of ileum. We performed a laparoscopic ileocecal resection with lymph node dissection, because the possibility of malignant tumor could not be ruled out. Laparoscopic operation is useful for the diagnosis and treatment of intestinal endometriosis, because it prevents the adhesion and abdominal wall destruction possibly

Study of learning environment development of the way to become the foundation of inclusive education system : From teaching practice in a special classroom by teachers in regular class

本校では特別支援学級と複式学級の教科による交流及び共同学習の導入や，学級交流や縦割り学習，運動会等の校内行事での交流などに取り組んできている。本研究は，これまでの成果を基に，通常の学級に在籍する児童の多様性や障害の理解を促す実践を交流及び共同学習や教科学習の中で行い，その効果を検証することを目的とした。特別支援学級の担任ではない教員が，特別支援学級の指導案を作成することを通して，日頃の交流だけではとらえられない特別支援児童の実態に気づき，支援の在り方について検討する。また実際に授業を行うことで特別支援領域に関する見方・考え方を活用し，それぞれの学級の児童支援に生かし，共有できるようにした。授業を行う教員の研究教科が算数科であることから算数科で授業を行うこととし，都合５時間の特別支援学級教員による算数科の授業を観察，児童の実態把握を行い，聞き取りも含め授業構想を行っていった。実際の授業から，子どもたちの中に価値に関する概念が育成されているかどうかの違いがあることに気付く。価値概念の育成や獲得方法を明らかにしていくことによって小学校の教科の指導をより充実させていくことができると考えた。Do the practice of promoting an understanding of the children of diversity and disorder enrolled in regular classes in the exchange and collaborative learning and subject learning, was aimed to verify the effect. Special support is not a homeroom class faculty, through to create a lesson plan of the special support class, noticed the actual situation of the special support children that cannot be captured only daily exchanges, as well as consider the way of support, the teaching plan actually take advantage of the special support area on the perspective, the concept by making the class alive, it was decided to continue making the child support of each class. It was thought to be able to go to enrich more the guidance of the subjects of elementary school by going to reveal the development and acquisition method of one person a child of the value of the concept