An unusual case in which a perforated Meckel's diverticulum became trapped in a pericecal hernia: A rare complication of Meckel's diverticulum

AbstractAn 11-year-old boy had previously been diagnosed with repeated Meckel's diverticulitis at another hospital. Emergency laparoscopy was performed under general anesthesia, and an inflammatory mass was seen in the ileocecal region of the mesentery. However, no Meckel's diverticulum (MD) was observed, and so the patient was diagnosed with lymphadenitis. Three days after the operation, he developed anemia and gastrointestinal bleeding of unknown origin. Thus, he was transferred to our hospital for further investigation and to have his gastrointestinal bleeding treated. Based on imaging scans obtained at the previous hospital, a paraduodenal hernia was suspected, but no paraduodenal hernia was detected during emergency surgery, despite the fact that the full length of the normal small intestine could be traced. However, an inflammatory mass was observed, and the ileum appeared to be incarcerated in a pericecal hernia. We could not identify which portion of the intestine had become entrapped or reduce the hernia due to adhesion. The inflammatory mass was removed by ileocecal resection, and a pathological examination revealed that the entrapped portion of the intestine was an MD that had branched off from the small intestine immediately proximal to the ileocecal valve. The MD had perforated in the hernia sac, which had caused the patient's bleeding

Extracellular and intraneuronal HMW-AbetaOs represent a molecular basis of memory loss in Alzheimer's disease model mouse

<p>Abstract</p> <p>Background</p> <p>Several lines of evidence indicate that memory loss represents a synaptic failure caused by soluble amyloid β (Aβ) oligomers. However, the pathological relevance of Aβ oligomers (AβOs) as the trigger of synaptic or neuronal degeneration, and the possible mechanism underlying the neurotoxic action of endogenous AβOs remain to be determined.</p> <p>Results</p> <p>To specifically target toxic AβOs <it>in vivo</it>, monoclonal antibodies (1A9 and 2C3) specific to them were generated using a novel design method. 1A9 and 2C3 specifically recognize soluble AβOs larger than 35-mers and pentamers on Blue native polyacrylamide gel electrophoresis, respectively. Biophysical and structural analysis by atomic force microscopy (AFM) revealed that neurotoxic 1A9 and 2C3 oligomeric conformers displayed non-fibrilar, relatively spherical structure. Of note, such AβOs were taken up by neuroblastoma (SH-SY5Y) cell, resulted in neuronal death. In humans, immunohistochemical analysis employing 1A9 or 2C3 revealed that 1A9 and 2C3 stain intraneuronal granules accumulated in the perikaryon of pyramidal neurons and some diffuse plaques. Fluoro Jade-B binding assay also revealed 1A9- or 2C3-stained neurons, indicating their impending degeneration. In a long-term low-dose prophylactic trial using active 1A9 or 2C3 antibody, we found that passive immunization protected a mouse model of Alzheimer's disease (AD) from memory deficits, synaptic degeneration, promotion of intraneuronal AβOs, and neuronal degeneration. Because the primary antitoxic action of 1A9 and 2C3 occurs outside neurons, our results suggest that extracellular AβOs initiate the AD toxic process and intraneuronal AβOs may worsen neuronal degeneration and memory loss.</p> <p>Conclusion</p> <p>Now, we have evidence that HMW-AβOs are among the earliest manifestation of the AD toxic process in mice and humans. We are certain that our studies move us closer to our goal of finding a therapeutic target and/or confirming the relevance of our therapeutic strategy.</p

Strategy for acute DeBakey type I aortic dissection considering midterm results: a retrospective cohort study comparing ascending aortic replacement and total arch replacement with frozen elephant trunk technique

Abstract Background Acute type A aortic dissection is treated with an emergency procedure that uses ascending aortic replacement (AAR). However, to avoid a residual dissected aorta with a false lumen, total arch replacement (TAR) is required. The frozen elephant trunk (FET) technique is a promising surgical approach that promotes false lumen obliteration in a single step. Therefore, this retrospective single-center study aimed to evaluate the operative outcomes of AAR and TAR with FET. Methods Between 2007 and 2021, 143 patients with acute DeBakey type I aortic dissection underwent a central repair using AAR (n = 95) or TAR with FET (n = 43). All perioperative variables, the duration of all-cause mortality, and aortic events defined as dilatation of the distal aorta > 5 cm, new occurrences of aortic dissection, distal aortic surgery, and distal aortic rupture were recorded. We compared these perioperative variables and mid-term results with an additional focus on distal aortic events. Results Patient background data did not differ between the two groups. Perioperative results for the TAR with FET group vs the AAR group showed similar operative times (306 vs 298 min, P = 0.862), but the TAR group had longer cardiopulmonary bypass times (154 vs 179 min, P < 0.001). The freedom from all-cause death for the TAR vs AAR groups using the Kaplan–Meier method was 81.9% vs 85.4% and 78.0% vs 85.4% (P = 0.407) at 1 and 3 years, respectively. Freedom from aorta-related events was 90.6% vs 97.6% and 69.3% vs 87.0% (P = 0.034) at 1 and 3 years, respectively. Conclusions TAR with FET had comparable perioperative results to AAR in acute DeBakey type I aortic dissection and was considered a valuable method to avoid aorta-related events in the midterm

Revascularization for controlling hypertension and improving cardiorenal failure in Leriche syndrome

Abstract Leriche syndrome usually occurs when atherosclerotic obstructions result in luminal narrowing of the abdominal aorta or iliac arteries and leads to thrombosis; it rarely causes heart or renal failure. We report the case of a 58‐year‐old Asian man with heart and renal failure as the dominant clinical manifestations of renovascular hypertension caused by Leriche syndrome. We performed an aorto‐bifemoral bypass and unilateral renal artery stenting. Post‐operative echocardiography showed improved cardiac function, with the left ventricular ejection fraction increasing from 30% before surgery to 54.2% after surgery. Moreover, his heart rate and blood pressure became stable, and his serum creatinine and brain natriuretic peptide levels decreased from 3.46 to 1.08 mg/dL and 685 to 4 pg/mL, respectively. Our case report shows that aorto‐bifemoral bypass and unilateral renal artery stenting can effectively treat heart and renal failure resulting from renovascular hypertension caused by Leriche syndrome

X-ray structure determination and deuteration of nattokinase.

Nattokinase (NK) is a strong fibrinolytic enzyme, which is produced in abundance by Bacillus subtilis natto. Although NK is a member of the subtilisin family, it displays different substrate specificity when compared with other subtilisins. The results of molecular simulations predict that hydrogen arrangements around Ser221 at the active site probably account for the substrate specificity of NK. Therefore, neutron crystallographic analysis should provide valuable information that reveals the enzymatic mechanism of NK. In this report, the X-ray structure of the non-hydrogen form of undeuterated NK was determined, and the preparation of deuterated NK was successfully achieved. The non-hydrogen NK structure was determined at 1.74 Å resolution. The three-dimensional structures of NK and subtilisin E from Bacillus subtilis DB104 are near identical. Deuteration of NK was carried out by cultivating Bacillus subtilis natto in deuterated medium. The D2O resistant strain of Bacillus subtilis natto was obtained by successive cultivation rounds, in which the concentration of D2O in the medium was gradually increased. NK was purified from the culture medium and its activity was confirmed by the fibrin plate method. The results lay the framework for neutron protein crystallography analysis

Purification and structural characterization of water-soluble menaquinone-7 produced by Bacillus subtilis natto

Vitamin K is essential for osteogenesis, and vitamin K deficiency causes osteoporosis, leading to hip fracture and coronary disease. Menaquinone-7 (MK-7), one of vitamin K subtypes, is abundantly contained in Japanese traditional fermented food natto. Bacillus subtilis natto secretes a water-soluble macromolecular complex consisting of MK-7 and peptides (natto-MK-7), although MK-7 itself is water-insoluble. However, structural properties of natto-MK-7 have not been well elucidated. In the present study, natto-MK-7 was purified from a liquid culture medium of Bacillus subtilis natto by fast protein liquid chromatography. The protein assay and electrophoresis suggest that natto-MK-7 is a complex composed of multi components including amphiphilic compounds. ‎The hydrodynamic radius of natto-MK-7 determined by the dynamic light scattering experiment suggests that natto-MK-7 has a more compact shape than that predicted in the previous size-exclusion chromatography