Rescue of exotropia subsequent to pulled-in-two syndrome of the medial rectus muscle occurring during surgery for high myopic strabismus fixus: A case report

Rationale: Pulled-in-two syndrome is one of the significant complications of strabismus surgery. This study aimed to report a case of pulled-in-two syndrome of the contractured medial rectus muscle (MR) that occurred during strabismus surgery for strabismus fixus due to high myopia, and to describe a rescue of this complication. Patient concerns: A woman in her 60s presented to our Ophthalmology Department with the main complaint of unilateral high myopia and severe myopic strabismus fixus. Esotropia exceeded 45° and hypotropia exceeded 15° in her right eye in the Hirschberg test. Right eye duction was markedly limited in every gaze direction. Orbital magnetic resonance images showed rupture of the superior rectus to lateral rectus band ligament and lengthening of the distance between the SR and LR muscles in the right eye. Diagnosis: Due to the patient's ophthalmic examination and imaging results, she was diagnosed with high myopic strabismus fixus. Interventions: We performed MR recession and Yokoyama surgery to correct right eye hypoesotropia. In the MR recession procedure, pulled-in-two syndrome (MR muscle tear) occurred. Thus, no additional procedure was performed on the MR. After the surgery, she presented 45 prism diopter exotropia and 18 prism diopter residual right hypotropia in a Krimsky test. We performed a second surgery, combining MR muscle advancement and inferior rectus (IR) muscle recession, 3 months after the first surgery. Outcomes: One and a half years after the second surgery, she presented exotropia of 14 prism diopters without hypotropia in the Krimsky test and was satisfied with her ocular position and improved motility. Lessons: We experienced pulled-in-two syndrome in a case with severe myopic strabismus fixus and achieved a good outcome by performing additional surgery 3 months later, in which the lost MR muscle was advanced. This case underscores that, if the lost muscle cannot be found during surgery, one should maintain composure and perform a reoperation a few months after the initial surgery, if necessary. This case report can aid in making rescue treatment decisions when pulled-in-two syndrome occurs

Wavefunction Analysis of STM Image: Surface Reconstruction of Organic Charge Transfer Salts

In this chapter, the wavefunction analysis is demonstrated, applied to the organic charge transfer salts composed of electron donor and electron acceptor molecules. Scanning tunneling microscopy (STM) images of the surface donor layers in the three charge transfer salts, α-(BEDT-TTF)2I3, β-(BEDT-TTF)2I3, and (EDO-TTF)2PF6, are analyzed with the atomic π electron orbitals of sulfur, oxygen, and carbon atoms. We have deduced three different kinds of surface molecular reconstructions as follows: (1) charge redistribution in α-(BEDT-TTF)2I3, (2) translational reconstruction up to 0.1 nm in β-(BEDT-TTF)2I3, and (3) rotational reconstruction transforming the 1D axis from the a axis to the b axis in (EDO-TTF)2PF6. Finally, it is concluded that the surface reconstruction is ascribed to the additional gain of the cohesive energy of the π electron system, provoked by the reduced steric hindrance with the anions of the missing outside double layer. The investigations of the surface states provide not only interesting behaviors of the surface cation layer, but also important insights into the electronic states of a lot of similar charge transfer crystals, as demonstrated in α-(BEDT-TTF)2I3

Secondary EML4?ALK-positive Lung Adenocarcinoma in a Patient Previously Treated for Acute Lymphoblastic Leukemia in Childhood: A Case Reportated for Acute Lymphoblastic Leukemia in Childhood: A Case Report

It is widely recognized that the risk of secondary neoplasms increases as childhood cancer survivors progress through adulthood. These are mainly hematological malignancies, and recurrent chromosome translocations are commonly detected in such cases. On the other hand, while secondary epithelial malignancies have sometimes been reported, chromosome translocations in these epithelial malignancies have not. A 33-year-old man who had been diagnosed with acute lymphoblastic leukemia and treated with chemotherapy almost 20 years earlier was diagnosed with lung adenocarcinoma. After chromosomal rearrangement of echinoderm microtubule- associated protein-like 4 gene and the anaplastic lymphoma kinase gene was detected in this adenocarcinoma, he responded to treatment with crizotinib. It was therefore concluded that this echinoderm microtubule-associated protein-like 4 gene-anaplastic lymphoma kinase gene-positive lung adenocarcinoma was a secondary epithelial malignancy

Robust and highly efficient hiPSC generation from patient non-mobilized peripheral blood-derived CD34+ cells using the auto-erasable Sendai virus vector

Background: Disease modeling with patient-derived induced pluripotent stem cells (iPSCs) is a powerful tool forelucidating the mechanisms underlying disease pathogenesis and developing safe and effective treatments. Patientperipheral blood (PB) cells are used for iPSC generation in many cases since they can be collected with minimuminvasiveness. To derive iPSCs that lack immunoreceptor gene rearrangements, hematopoietic stem and progenitorcells (HSPCs) are often targeted as the reprogramming source. However, the current protocols generally requireHSPC mobilization and/or ex vivo expansion owing to their sparsity at the steady state and low reprogrammingefficiencies, making the overall procedure costly, laborious, and time-consuming.Methods: We have established a highly efficient method for generating iPSCs from non-mobilized PB-derivedCD34+ HSPCs. The source PB mononuclear cells were obtained from 1 healthy donor and 15 patients and werekept frozen until the scheduled iPSC generation. CD34+ HSPC enrichment was done using immunomagnetic beads,with no ex vivo expansion culture. To reprogram the CD34+-rich cells to pluripotency, the Sendai virus vectorSeVdp-302L was used to transfer four transcription factors: KLF4, OCT4, SOX2, and c-MYC. In this iPSC generationseries, the reprogramming efficiencies, success rates of iPSC line establishment, and progression time wererecorded. After generating the iPSC frozen stocks, the cell recovery and their residual transgenes, karyotypes, T cellreceptor gene rearrangement, pluripotency markers, and differentiation capability were examined.Results：We succeeded in establishing 223 iPSC lines with high reprogramming efficiencies from 15 patients with 8 different disease types. Our method allowed the rapid appearance of primary colonies (~ 8 days), all of which were expandable under feeder-free conditions, enabling robust establishment steps with less workload. After thawing, the established iPSC lines were verified to be pluripotency marker-positive and of non-T cell origin. A majority of the iPSC lines were confirmed to be transgene-free, with normal karyotypes. Their trilineage differentiation capability was also verified in a defined in vitro assay.Conclusion：This robust and highly efficient method enables the rapid and cost-effective establishment of transgene-free iPSC lines from a small volume of PB, thus facilitating the biobanking of patient-derived iPSCs and their use for the modeling of various diseases

冷水強制水泳誘発抗侵害作用の発現における脳内β-endorphinならびにεオピオイド受容体の関与

The involvement of endogenous opioid peptides and opioid receptors in supraspinal site on the antinociception induced by cold water swimming was determined using the mouse tail-flick test. The mice forced to swim in cold water for 3 min, showed the marked antinociception. The antinociception induced by cold water swimming was significantly attenuated by intracerebroventricularly (i.c.v.) pretreatment with antiserum against β-endorphin, but not against dynorphin A or [Leu^5] enkephalin. On the other hand, the antinociception was not affected by i.c.v. pretreatment with μ-opioid receptor antagonists β-funaltrexamine and D-Phe-cyclo-(Cys-Tyr-D-Trp-Orn-Thr-Pen)-Thr-NH_2, δ-opioid receptor antagonists naltrindole, 7-benzylidene naltrexone and naltriben, or κ-opioid receptor antagonist nor-binaltorphimine. The present results suggest that the antinociception induced by cold water swimming may be mainly mediated through the release of β-endorphin in the supraspinal site, which act on β-endorphin-sensitive non-μ-, non-δ-, and non-κ-opioid receptor, so called putative ε-opioid receptor

Dermorphin tetrapeptide誘導体Tyr-D-Arg-Phe-β-AlaおよびTyr-D-Arg-Phe-β-Ala-NH_2の鎮痛作用発現におけるμ1受容体の関与

Involvement of μ1-opioid receptor on the antinociception induced by dermorphin tetrapeptide analogues Try-D-Arg-Phe-β-Ala (TAPA) and Tyr-D-Arg-Phe-β-Ala-NH_2 (TAPA-NH_2) were determined in mice, using a tail-pressure test and formalin test. TAPA and TAPA-NH_2 injected i. c. v. and i. t. produced dose-dependent antinociception in both assays. In the tail-pressure test, the antinociception induced by i. c. v. and i. t. injected TAPA, but not TAPA-NH_2, was significantly attenuated by the pretreatment with naloxonazine, selective antagonist for μ1-opioid receptor. Moreover, naloxonazine also significantly attenuated the antinociception induced by i. c. v. injected TAPA, but not TAPA-NH_2 in formalin test. In contrast, the antinociception induced by both TAPA and TAPA-NH_2 given i. t. was significantly attenuated by the pretreatment with naloxonazine in formalin test. The present results suggest that TAPA and TAPA-NH_2 should be considered to be selective agonist for μ1-and μ2-opioid receptors, respectively. The C-terminal amidation may be the critical portion for TAPA-NH_2 to distinguish μ1-and μ2-opioid receptors

Role of Water Molecules to the Electronic States of M-DNA

Various kinds of roles of the water molecules in the electronic states of the complexes of metal ions (M) and deoxyribonucleic acid (DNA) are reviewed. Divalent metal ions M like Fe, Mn, Zn and so on, form Metal-DNA complexes (M-DNA) with each metal ion between the bases of a base pair of DNA. The electronic states of the complexes depend on the species of ions in M-DNA. Metal ions in Fe-DNA and Mn-DNA possess 3d magnetic moments, but those in Zn-DNA do not. Interestingly, the magnetic property of the complexes, especially the magnetic interaction between the metal ions, is dominated by water molecules in the complexes. In Fe-DNA, the water molecules play a role of ligands for the iron ions, which controls the spin states of Fe3+, whereas they govern the magnetic interaction between the Mn2+ ions in Mn-DNA. In contrast, Zn-DNA has no 3d magnetic moment, but the water molecules dominate the bonding states of the Zn ions and the magnetic states of the Zn-DNA system

Local coordination state of rare earth in eutectic scintillators for neutron detector applications.

Atomic distribution in phosphors for neutron detection has not been fully elucidated, although their ionization efficiency is strongly dependent on the state of the rare earth in the matrix. In this work, we examine optical properties of Eu-doped 80LiF-20CaF2 eutectics for neutron detector applications based on the Eu distribution. At low concentrations, aggregation of Eu cations is observed, whereas homogeneous atomic dispersion in the CaF2 layer, to substitute Ca(2+) ions, is observed in the eutectics at high concentrations. Eu LIII edge X-ray absorption fine structure (XAFS) analysis suggests that neutron responses do not depend on the amount of Eu(2+) ions. However, transparency, which depends on an ordered lamellar structure, is found to be important for a high light yield in neutron detection. The results confirm the effectiveness of the basic idea concerning the separation of radiation absorbers and activators in particle radiation scintillation and present potential for further improvement of novel bulk detectors