Preserving the posterior cortex of the sternum during resection of a superficial anterior chest wall sarcoma

Following resection of a sternal tumor, respiratory dysfunction can occur and rigid reconstruction is necessary. An 82-year-old woman noted a mass in the anterior chest wall that was increasing in size. The tumor was located on the left aspect of the sternum at the level of the third rib. A radiation-induced malignant spindle cell tumor was diagnosed because of a history of irradiation for hilar lymph node carcinoma. The tumor was resected with the surrounding tissues of the second-to-fourth ribs and sternum. The posterior sternal cortex was preserved by cutting with a curved chisel under fluoroscopy. The chest wall defect was reconstructed with a 2-mm thick Gore-Tex® sheet and a local transpositional flap. Sternal resection with a chisel under fluoroscopy avoids damage to the internal thoracic artery. Preserving the posterior sternal cortex does not require rigid reconstruction. The procedure is minimally invasive

Current Insights into Atopic March

The incidence of allergic diseases is increasing, and research on their epidemiology, pathophysiology, and the prevention of onset is urgently needed. The onset of allergic disease begins in infancy with atopic dermatitis and food allergy and develops into allergic asthma and allergic rhinitis in childhood; the process is defined as "atopic march ". Atopic march is caused by multiple immunological pathways, including allergen exposure, environmental pollutants, skin barrier dysfunction, type 2 inflammation, and oxidative stress, which promote the progression of atopic march. Using recent evidence, herein, we explain the involvement of allergic inflammatory conditions and oxidative stress in the process of atopic march, its epidemiology, and methods for prevention of onset

Roles of Oxidative Injury and Nitric Oxide System Derangements in Kawasaki Disease Pathogenesis: A Systematic Review

Kawasaki disease (KD) is an acute febrile vasculitis that occurs mostly in children younger than five years. KD involves multiple intricately connected inflammatory reactions activated by a cytokine cascade. Despite therapeutic advances, coronary artery damage may develop in some patients, who will be at risk of clinical cardiovascular events and even sudden death. The etiology of KD remains unclear; however, it may involve both genetic and environmental factors leading to aberrant inflammatory responses. Given the young age of onset, prenatal or perinatal exposure may be etiologically relevant. Multisystem inflammatory syndrome in children, a post-infectious hyper-inflammatory disorder associated with severe acute respiratory syndrome coronavirus 2, has features that overlap with those of KD. Available evidence indicates that vascular endothelial dysfunction is a critical step in the sequence of events leading to the development of cardiovascular lesions in KD. Oxidative stress and the dysregulation of the nitric oxide (NO) system contribute to the pathogenesis of inflammatory responses related to this disease. This review provides current evidence and concepts highlighting the adverse effects of oxidative injury and NO system derangements on the initiation and progression of KD and potential therapeutic strategies for cardiovascular pathologies in affected children

Correlation between national surveillance and search engine query data on respiratory syncytial virus infections in Japan

Background The respiratory syncytial virus (RSV) disease burden is significant, especially in infants and children with an underlying disease. Prophylaxis with palivizumab is recommended for these high-risk groups. Early recognition of a RSV epidemic is important for timely administration of palivizumab. We herein aimed to assess the correlation between national surveillance and Google Trends data pertaining to RSV infections in Japan. Methods The present, retrospective survey was performed between January 1, 2018 and November 14, 2021 and evaluated the correlation between national surveillance data and Google Trends data. Joinpoint regression was used to identify the points at which changes in trends occurred. Results A strong correlation was observed every study year (2018 [r = 0.87, p < 0.01], 2019 [r = 0.83, p < 0.01], 2020 [r = 0.83, p < 0.01], and 2021 [r = 0.96, p < 0.01]). The change-points in the Google Trends data indicating the start of the RSV epidemic were observed earlier than by sentinel surveillance in 2018 and 2021 and simultaneously with sentinel surveillance in 2019. No epidemic surge was observed in either the Google Trends or the surveillance data from 2020. Conclusions Our data suggested that Google Trends has the potential to enable the early identification of RSV epidemics. In countries without a national surveillance system, Google Trends may serve as an alternative early warning system

Development of gelatin hydrogel nonwoven fabrics (Genocel®) as a novel skin substitute in murine skin defects

Introduction: Genocel is an emerging material, used in cell culture, with high mechanical strength and good cytocompatibility. Based on these characteristics, Genocel is considered a promising skin substitute for wound healing. In this study, we explored the possibility of using Genocel as a skin substitute for murine skin defects and compared it with a conventional skin substitute. Methods: Sheets of Genocel and Pelnac were applied to skin defects created on the backs of mice. On days 7, 14, and 21, the remaining wound area was evaluated and specimens were harvested for HE, Azan, anti-CD31, CD68, and CD163 staining to assess neoepithelialization, granulation tissue, capillary formation, and macrophage infiltration. Results: No significant differences in the wound area or neoepithelium length were observed between groups. The number of newly formed capillaries in the Genocel group was significantly higher than that in the Pelnac group on day 7 (p < 0.05). In contrast, granulation tissue formation in the Pelnac group was greater than that in the Genocel group on day 14 (p < 0.05). Regarding macrophage infiltration, the pan-macrophage number, M2 macrophage number, and M2 ratio in the Pelnac group were higher than those in the Genocel group on day 14 (p < 0.05). In other aspects, the two materials displayed comparable behavior. Conclusions: Genocel can be used as a skin substitute equivalent to the conventional one. In addition, Genocel accelerated capillary formation, which is more appropriate than conventional treatments for chronic skin ulcers, such as diabetic ulcers

Complete response to pembrolizumab in advanced hepatocellular carcinoma with microsatellite instability

Hepatocellular carcinoma (HCC) has limited systemic treatment options and a poor prognosis. The immune checkpoint inhibitor pembrolizumab was recently approved for the treatment of solid tumors with microsatellite instability (MSI). However, its clinical utility for the management of HCC remains to be clarified. Here, we present a case of unresectable HCC with MSI that showed an impressive response to pembrolizumab treatment. A 64-year-old man with chronic HCV infection was diagnosed with a large HCC. His severe liver dysfunction and poor performance status prevented any treatment option other than sorafenib. However, sorafenib failed after a few days due to the rapid progression of the tumor. Based on the finding of MSI in a biopsy specimen, immunotherapy using pembrolizumab was initiated. A dramatic improvement in his general condition and a reduction in tumor size were observed after the initiation of pembrolizumab treatment. Among a cohort of 50 consecutive patients with advanced HCC who were refractory to standard systemic therapy, MSI was found only in the present case. Immune checkpoint blockade therapy induced prominent anti-tumor effects in HCC with MSI. Screening for defects in DNA mismatch repair function may be warranted in HCC patients despite the low frequency of MSI

Chiral Ice Crystals in Space

We observed the formation of CO, CH3OH, and H2O ices using a cryogenic transmission electron microscope, to determine if chiral ice crystals could form under the conditions of interstellar molecular clouds and young stellar objects (protoplanetary disks) and to clarify the crystalline structure of these ices. Our results suggest that the following ice crystals are chiral: crystalline CO (α-CO) formed on amorphous H2O (a-H2O) grains in a 10-K molecular cloud, crystalline CH3OH formed by the heating of amorphous CH3OH on a-H2O grains at 40–60 K in young stellar objects, and several polymorphs of hydrogen-ordered cubic ice crystals formed by the heating of a-H2O at 80–100 K and direct condensation at 120–140 K in protoplanetary disks. We also investigated candidates for other chiral ices using published data. We found that NH3 I and NH3·H2O I are chiral at low temperature and pressure conditions. If one-handed circularly polarized light is irradiated during the nucleation of these chiral ice crystals, homochiral crystals can be formed. These results have important implications for the origin of interstellar organic molecule homochirality

〈研究論文〉意思の推察と本人・保護者との対話を含む意思決定支援を基盤とした合理的配慮の提供 : 重度知的障害児への合理的配慮が本人主体であるために

重度知的障害児へ本人主体の合理的配慮を提供するためには，人権の保護・促進を図ることを念頭に置き，本人の意思を推察・補充しながらその表明を補助することで，意思の表明に対する支援を行う必要がある。本研究では，自立活動とICFの視点に基づいた実態把握資料を作成・活用した意思の推察及び意思決定支援を行い，それを基にした合理的配慮の提供を実現する支援の在り方やプロセスを提案することを目的とした。事例研究を通じて提供した合理的配慮の適切性が評価されたことにより，作成した実態把握資料が事例児の意思を推察する上での根拠となり，情報を整理するツールとして機能し得ることが明らかになった。そして，意思の推察及び意思決定支援の有用性も示された。以上のことから，意思の推察及び本人・保護者との対話を要とし，意思の表明を補助することを目的とした意思決定支援，及びそれを起点とした合理的配慮提供のプロセスを提案する。In order to provide reasonable accommodations to a person with severe mental retardation, we need to help his or her expression of wish. To help his or her expression, we need to infer his intention considering his human rights．The purpose of this study is to propose how to provide reasonable accommodations based on decision support, using assessment sheets from the viewpoint of Independent activities and ICF. In our case studies, we revealed the following: 1) The reasonable accommodations that we provided were appropriate. 2) The assessment sheets were effective for decision support. 3) The assessment sheets were effective information arranging tools. 4) The importance of decision support was suggested．From the above, we propose the effective process of the decision support and the reasonable accommodations through dialogs and the inference of intention