The diagnosis of delayed expanding traumatic pseudoaneurysm of thoracic aorta caused by self-inflicted penetrating injury with crossbow bolt: A case report

Introduction and importance: Penetrating chest trauma caused by a crossbow bolt is very rare. Herein, we report a successfully treated patient who attempted suicide by directing a crossbow to the chest cavity and developed an expanding pseudoaneurysm of the thoracic aorta during eight-day follow up. Case presentation: A 51-year-old male was admitted to the emergency department after firing a crossbow bolt twice into his left chest. At admission, the patient was hemodynamically stable and maintaining oxygenation. The bolt had already been removed from the body. Contrast-enhanced computed tomography (CT) revealed a cavity pseudoaneurysm 2.5 mm in size in the aortic arch. Three-dimensional reconstruction of the CT demonstrated wound tracts showing probable damage by the bolt. The patient was admitted to the emergency department for careful observation and transferred to the psychiatric ward on day two. Follow-up contrast-enhanced CT on day eight demonstrated rapid expansion of the pseudoaneurysm from 2.5 mm to 4.0 mm in size. We performed thoracic endovascular aortic repair (TEVAR) on day 13. The patient was uneventfully discharged on the 20th hospital day. Clinical discussion: Emergency physicians should be aware that damage to the surrounding tissue may be accompanied by delayed expansion of an aortic pseudoaneurysm, even if the bolts do not cause direct aortic wall injury. Conclusion: This case suggests that understanding the injury mechanism, confirming the tract of the bolts, and carefully exploring traumatic pseudoaneurysm can lead to a less invasive operation due to early detection

Parkinsonian Rigidity Depends on the Velocity of Passive Joint Movement

Background. It has been long believed that Parkinsonian rigidity is not velocity-dependent based on the neurological examination. However, this has not been verified scientifically. Methods. The elbow joints of 20 Parkinson’s disease patients were passively flexed and extended, and two characteristic values, the elastic coefficient (elasticity) and the difference in bias (difference in torque measurements for extension and flexion), were identified from a plot of the angle and torque characteristics. Flexion and extension were done at two different velocities, 60°/s and 120°/s, and a statistical analysis was performed to determine whether the changes in these characteristic values were velocity-dependent. Results. The elastic coefficient was not velocity-dependent, but the difference in bias increased in a velocity-dependent manner (P=0.0017). Conclusions. The features of rigidity may differ from the conventional definition, which states that they are not dependent on the velocity of joint movement

The treatment effect of endovascular therapy for chronic limb‐threatening ischemia with systemic sclerosis

Systemic sclerosis (SSc) is a collagen disease with immune abnormalities, vasculopathy, and fibrosis. Ca blockers and prostaglandins are used to treat peripheral circulatory disturbances. Chronic limb-threatening ischemia (CLTI) is a disease characterized by extremity ulcers, necrosis, and pain due to limb ischemia. Since only a few patients present with coexistence of CLTI and SSc, the treatment outcomes of revascularization in these cases are unknown. In this study, we evaluated the clinical characteristics and treatment outcomes of seven patients with CLTI and SSc, and 35 patients with uncomplicated CLTI who were hospitalized from 2012 to 2022. A higher proportion of patients with uncomplicated CLTI had diabetes and male. There were no significant differences in the age at which ischemic ulceration occurred, other comorbidities, or in treatments, including antimicrobial agents, revascularization and amputation, improvement of pain, and the survival time from ulcer onset between the two subgroups. EVT or amputation was performed in six or two of the seven patients with CLTI and SSc, respectively. Among those who underwent EVT, 33% (2/6) achieved epithelialization and 67% (4/6) experienced pain relief. These results suggest that the revascularization in cases with CLTI and SSc should consider factors such as infection and general condition, since revascularization improve the pain of these patients

Mirizzi Syndrome with a Biliobiliary Fistula : a case report

Mirizzi syndrome is a rare complication of cholelithiasis, which is defined as a common bile duct obstruction due to stones impacted in Hartman’s pouch or the cystic duct of the gallbladder. The impacted stones and surrounding inflammation can lead to a biliobiliary fistula. We herein present the case of a 73-year-old Japanese man with a biliobiliary fistula that was diagnosed peroral cholangiography (POCS). We performed partial cholecystectomy and choledochoplasty as the stone had eroded almost the entire circumference of the bile duct. Postoperative complications included a minor bile leak from the repaired common bile duct apparent on postoperative day 1, which was managed conservatively. The patient was discharged on postoperative day 9. Based on this experience, POCS is useful for detecting the existence of a biliobiliary fistula in cases of Mirizzi syndrome. Once a biliobiliary fistula is confirmed, it is important to select an appropriate surgical procedure based on the extent of common bile duct involvement in the inflammatory process

C₄ monocots and C₄ dicots exhibit rapid photosynthetic induction response in contrast to C₃ plants.

Considering the prevalence of ever-changing conditions in the natural world, investigation of photosynthetic responses in C₄ plants under fluctuating light is needed. Here, we studied the effect of dynamic illumination on photosynthesis in totally 10 C₃, C₃-C₄ intermediate, C₄-like and C₄ dicots and monocots at CO₂ concentrations of 400 and 800 μmol mol¹. C₄ and C₄-like plants had faster photosynthetic induction and light-induced stomatal dynamics than C₃ plants at 400 μmol mol¹, but not at 800 μmol mol¹ CO₂, at which the CO₂ supply rarely limits photosynthesis. C₄ and C₄-like plants had a higher water use efficiency than C₃ plants at both CO₂ concentrations. There were positive correlations between photosynthetic induction and light-induced stomatal response, together with CO₂ compensation point, which was a parameter of the CO₂-concentrating mechanism of C₄ photosynthesis. These results clearly show that C₄ photosynthesis in both monocots and dicots adapts to fluctuating light conditions more efficiently than C₃ photosynthesis. The rapid photosynthetic induction response in C₄ plants can be attributed to the rapid stomatal dynamics, the CO₂-concentrating mechanism or both