SUCCESSFULLY COMPLETE EXCISION OF A HUGE SACROCOCCYGEAL TERATOMA: A CASE REPORT

A female infant was born with a huge sacrococcygeal teratoma (SCT) at 36 weeks of gestation with a weight of 4546g (combined weight of the infant and tumor). The patient's mother developed polyhydramnios and cesarean section was performed at 36 weeks of gestation. MRI showed Altman classification type Ⅱ SCT. We performed abdominoperineal resection at 3 days after birth. The mass was completely excised, and the size and the weight of the mass were 18×12×15cm and 1100g (Weight of SCT against body weight; 393 g/kg), respectively. The pathological findings revealed a grade Ⅱ immature teratoma with no malignant elements such as yolk sac tumor. The patient was discharged at 45 days after birth with fecal continence, but neurogenic bladder dysfunction. At 9 months after surgery, the patient was doing well with no evidence of tumor recurrence, and AFP levels had returned to normal values

慢性肺疾患の早産児におけるプロテインC経路 : 前向き研究

Background: Chronic lung disease (CLD) is a major neonatal pulmonary disorder associated with inflammation. Recent studies have shown that protein C anticoagulant pathways, such as those for protein C (PC), protein S (PS), and thrombomodulin (TM), could be useful indices for reflecting pulmonary injury. However, the involvement of these factors in preterm infants with very low birthweight (VLBW) who have developed CLD remains to be investigated. Here, we investigated whether PC pathway-related factors could predict the development of CLD in preterm infants with VLBW. Methods: We collected plasma samples from 26 preterm infants with VLBW (13 each from those with and without CLD) at the time of birth and measured TM, PC, and PS levels in their plasmas. We analyzed prospectively the relationship between these factors in infants with and without CLD. Results: There were significant differences in gestational age, birthweight, Apgar score (5 min), and duration of mechanical ventilation between the CLD and non-CLD groups. No significant differences in the PC and PS levels at birth were observed between the two groups, whereas the TM levels in the CLD group were significantly higher than those in the non-CLD group (P = 0.013). The TM levels correlated with gestational age and duration of mechanical ventilation. However, covariance analysis demonstrated that gestational age was significantly associated with TM levels, and consequently, development of CLD was not associated with TM level at birth. Conclusions: Thrombomodulin, PC, and PS levels at birth could not predict the development of CLD in preterm infants with VLBW.博士（医学）・甲第850号・令和4年9月28日© 2022 Japan Pediatric Society.This is the peer reviewed version of the following article: [https://onlinelibrary.wiley.com/doi/10.1111/ped.15221], which has been published in final form at [https://doi.org/10.1111/ped.15221]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.発行元が定める登録猶予期間終了の後、本文を登録予定（2023.01

Multiple emission lines of Hα\alpha emitters at z∼2.3z \sim 2.3 from the broad and medium-band photometry in the ZFOURGE Survey

We present a multiple emission lines study of $\sim$1300 H$\alpha$ emitters (HAEs) at $z \sim 2.3$ in the ZFOURGE survey. In contrast to the traditional spectroscopic method, our sample is selected based on the flux excess in the ZFOURGE-$K_s$ broad-band data relative to the best-fit stellar continuum. Using the same method, we also extract the strong diagnostic emission lines for these individual HAEs: [OIII]$\lambda\lambda4959,5007$, [OII]$\lambda\lambda3726,3729$. Our measurements exhibit good consistency with those obtained from spectroscopic surveys. We investigate the relationship between the equivalent widths (EWs) of these emission lines and various galaxy properties, including stellar mass, stellar age, star formation rate (SFR), specific SFR (sSFR), ionization states (O32). We have identified a discrepancy between between HAEs at $z\sim2.3$ and typical local star-forming galaxy observed in the SDSS, suggesting the evolution of lower gas-phase metallicity ($Z$) and higher ionization parameters ($U$) with redshift. Notably, we have observed a significant number of low-mass HAEs exhibiting exceptionally high $EW_{\mathrm{[OIII]}}$. Their galaxy properties are comparable to those of extreme objects, such as extreme O3 emitters (O3Es) and Ly$\alpha$ emitters (LAEs) at $z\simeq2-3$. Considering that these characteristics may indicate potential strong Lyman continuum (LyC) leakage, higher redshift anaglogs of the low-mass HAEs could be significant contributors to the cosmic reionization. Further investigations on this particular population are required to gain a clearer understanding of galaxy evolution and cosmic reionization.Comment: 24 pages, 13 figures, submitted to Ap

Comparison of TGSE-BLADE DWI, RESOLVE DWI, and SS-EPI DWI in healthy volunteers and patients after cerebral aneurysm clipping

Diffusion-weighted magnetic resonance imaging is prone to have susceptibility artifacts in an inhomogeneous magnetic field. We compared distortion and artifacts among three diffusion acquisition techniques (single-shot echo-planar imaging [SS-EPI DWI], readout-segmented EPI [RESOLVE DWI], and 2D turbo gradient- and spin-echo diffusion-weighted imaging with non-Cartesian BLADE trajectory [TGSE-BLADE DWI]) in healthy volunteers and in patients with a cerebral aneurysm clip. Seventeen healthy volunteers and 20 patients who had undergone surgical cerebral aneurysm clipping were prospectively enrolled. SS-EPI DWI, RESOLVE DWI, and TGSE-BLADE DWI of the brain were performed using 3 T scanners. Distortion was the least in TGSE-BLADE DWI, and lower in RESOLVE DWI than SS-EPI DWI near air–bone interfaces in healthy volunteers (P < 0.001). Length of clip-induced artifact and distortion near the metal clip were the least in TGSE-BLADE DWI, and lower in RESOLVE DWI than SS-EPI DWI (P < 0.01). Image quality scores for geometric distortion, susceptibility artifacts, and overall image quality in both healthy volunteers and patients were the best in TGSE-BLADE DWI, and better in RESOLVE DWI than SS-EPI DWI (P < 0.001). Among the three DWI sequences, image quality was the best in TGSE-BLADE DWI in terms of distortion and artifacts, in both healthy volunteers and patients with an aneurysm clip

Complications Associated With Spine Surgery in Patients Aged 80 Years or Older: Japan Association of Spine Surgeons with Ambition (JASA) Multicenter Study

Study Design:Retrospective study of registry data.Objectives:Aging of society and recent advances in surgical techniques and general anesthesia have increased the demand for spinal surgery in elderly patients. Many complications have been described in elderly patients, but a multicenter study of perioperative complications in spinal surgery in patients aged 80 years or older has not been reported. Therefore, the goal of the study was to analyze complications associated with spine surgery in patients aged 80 years or older with cervical, thoracic, or lumbar lesions.Methods:A multicenter study was performed in patients aged 80 years or older who underwent 262 spinal surgeries at 35 facilities. The frequency and severity of complications were examined for perioperative complications, including intraoperative and postoperative complications, and for major postoperative complications that were potentially life threatening, required reoperation in the perioperative period, or left a permanent injury.Results:Perioperative complications occurred in 75 of the 262 surgeries (29%) and 33 were major complications (13%). In multivariate logistic regression, age over 85 years (hazard ratio [HR] = 1.007, P = 0.025) and estimated blood loss ≥500 g (HR = 3.076, P = .004) were significantly associated with perioperative complications, and an operative time ≥180 min (HR = 2.78, P = .007) was significantly associated with major complications.Conclusions:Elderly patients aged 80 years or older with comorbidities are at higher risk for complications. Increased surgical invasion, and particularly a long operative time, can cause serious complications that may be life threatening. Therefore, careful decisions are required with regard to the surgical indication and procedure in elderly patients

Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study

Study Design:Retrospective database analysis.Objective:Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions.Methods:A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined.Results:Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss (P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium.Conclusions:Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target