Outcome of Endoscopy-Assisted Microscopic Extended Transsphenoidal Surgery for Suprasellar Adult Craniopharyngiomas

Craniopharyngiomas are difficult to treat. The extended transsphenoidal approach has recently been described in several small series. We describe the usefulness of microscopy-assisted angled endoscopy for visualizing vital structures such as tumor attachment or tumor invasion to the pituitary stalk to achieve confident radical tumor removal. Between 2006 and 2010, 15 patients underwent the microscopy-assisted extended transsphenoidal approach for resection of entirely suprasellar craniopharyngiomas. Fourteen patients had the transinfundibular type, and one had the transinfundibular type with extension to the third ventricle. We observed color change within the pituitary stalk by endoscopy. The pituitary stalk was cut intentionally in 10 patients because of suspected tumor invasion surrounding the stalk. Total removal was accomplished in nine patients. Pathological specimens from the pituitary stalk showed tumor invasion spreading over the surface of the pituitary stalk, shown by a discolored pituitary stalk, and this was essential for confident radical tumor removal. Even after stalk resection, postoperative diabetes insipidus was minimal when a bright signal on T1 in the posterior lobe was not observed with preoperative magnetic resonance imaging. Confident radical tumor removal is possible with the introduction of the endoscopy-assisted microscopic extended transsphenoidal approach

新生児看護に従事する看護師の経験から導き出された看護の中心的価値 : テキストマイニングによるリフレクション記録分析

【Background】 Strong feelings about and enthusiasm for nursing care are reflected in nurses’ thoughts and behaviors in clinical practice and affect their profession. This study was conducted to identify the characteristics of core values in nursing care based on the experiences of nurses engaged in neonatal nursing through a process for recognizing the conceptualization of nursing. 【Methods】 We conceptualized nursing care in 43 nurses who were involved in neonatal nursing using a reflection sheet. We classified descriptions on a sheet based on the Three-Staged Recognition scheme and analyzed them using a text-mining approach. 【Results】 Nurses involved in neonatal nursing recognized that they must take care of the “child,” “mother,” and “family.” Important elements of nursing in nurses with less than 5 years versus 5 or more years of neonatal nursing experience were classified into seven clusters, respectively. These elements were mainly related to family members in both groups. In nurses with less than 5 years of experience, four clusters of one-way communication by nurses were observed in the analysis of the key elements in nursing. On the other hand, five clusters of mutual relationships between patients, their family members, and nurses were observed in nurses with 5 or more years of experience. 【Conclusion】 In conclusion, the core value of nurses engaged in neonatal nursing is family-oriented nursing. Nurses with 5 or more years of neonatal nursing experience understand patients and their family members well through establishing relationships and providing comfort and safety while taking care of them

Prospective and retrospective values integrated in frontal cortex drive predictive choice

予測に基づいて行動を選ぶ脳の回路の発見 --2次運動野が担う予測的な行動選択--. 京都大学プレスリリース. 2023-01-30.Animals must flexibly estimate the value of their actions (action-value) to successfully adapt to a changing environment. The brain is thought to estimate action-values from two different sources, namely the action-outcome history (retrospective value) and the knowledge of the environment (prospective value), but how different estimates of action-values are reconciled to make a choice is not well understood. Here we found that as mice learn the state-transition structure of a decision-making task, retrospective and prospective values become jointly encoded in the preparatory activity of neurons in ALM. Suppressing this preparatory activity in expert mice returned their behavior to a naïve state. These results reveal the neural circuit that injects structural knowledge into action selection to promote predictive decision-making

Factors Affecting Postoperative Hearing Results in Type IV Tympanoplasty: Preliminary Study of the Influence of External Auditory Canal Packing Material

[Background] Postoperative hearing results of type IV tympanoplasty have been shown to have poorer results than other reconstruction techniques. There are numerous reports evaluating the factors for hearing improvement. This preliminary study aimed to analyze and determine the factors that affect hearing results. [Methods] A total of 80 patients who underwent type IV tympanoplasty were evaluated to participate in this study. The medical records of the candidate patients were collected retrospectively. Fifty out of the 80 recruited patients were excluded due to the following reasons: they could not be followed-up for more than a year after the final operation, their initial surgery was not performed in our department, or they needed a revision surgery. The pre-, intra-, and postoperative factors were evaluated and analyzed using EZR software. Cases were divided into two groups according to postoperative hearing results, and each factor was analyzed univariately. The explanatory variables included in the multivariate analysis were the variables that satisfied P < 0.1 in the univariate analysis. Furthermore, all cases were divided into two groups according to the qualitative variables that showed significant difference in the multivariate analysis, and the background factors were evaluated. [Results] The results of univariate analysis showed P < 0.1 for ‘Age’ and ‘Material of external auditory canal (EAC) packing’. Multivariate analysis showed P < 0.05 for both. The comparison between the two packing material groups showed that the gauze group was more likely to have improved hearing than Spongel? group, and the ossicular chain condition of the gauze group was maintained better. [Conclusion] ‘Age’ and ‘Material of EAC packing’ were considered to be significant factors affecting the postoperative hearing results. The selection and use of packing materials that provide stability should be considered to obtain better postoperative hearing results in type IV tympanoplasty

S1.28 Mechanochemical coupling of F1-ATPase and intracellular ATP imaging

Editat anteriorment amb el títol: Guia de recurso

Test and Development of Prototype 1000W X-band Microwave Solid-State Power Amplifier for Small SAR Satellite

Our team has been developing an X-band SAR (Synthetic Aperture Radar) system on 75cm*75cm*75cm (paddles folding), 130kg class small satellite including folding flat antenna paddles under ImPACT program [1,2]. SAR observation has advantages under cloudy or bad weather conditions and directly obtaining three-dimensional data, however, requires a high power microwave transmitter. Therefore, we are developing a 1000W solid-state power amplifier (SSPA) that can be mounted on a small satellite by utilizing latest technologies such as GaN HEMT, power combiner, low impedance capacitor and the like. We tested and measured the performances of our manufactured amplifier EM (engineering model). The weight of our amplifier EM was approximately 12.8 kg (including structural panel 4.4kg). It was confirmed that its output capability exceeded 1000 W and continuous operation for more than 5 minutes, which is equivalent to 2000 km observation, was possible

A Rare Complication:Misdirection of an Indwelling Urethral Catheter into the Ureter

We report 3 patients with the rare complication of an indwelling urethral catheter misdirected into the ureter. This is the largest series to date. Patients were referred to us for a variety of reasons following exchange of their chronic indwelling urinary catheters. CT in all cases demonstrated the urinary catheters residing in the left ureter. The ages of the patients were 37, 67 and 81 years old. All patients suffered from neurogenic bladder. Two patients were female, one was male, and 2 of the 3 had a sensory disorder inhibiting their pain response. The catheters were replaced with open-end Foley catheters. Extensive follow-up CT scans were obtained in one case, demonstrating improvement of hydronephrosis and no evidence of ureteral stenosis. Cystoscopy in this patient demonstrated normally positioned and functioning ureteral orifices. Although the placement of an indwelling urethral catheter is a comparatively safe procedure, one must keep in mind that this complication can occur, particularly in female patients with neurogenic bladder. CT without contrast is a noninvasive, definitive diagnostic tool