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Robot-assisted thoracoscopic resection of a posterior mediastinal tumor with immunoglobulin G4-related disease : a case report
No full textBackground Immunoglobulin (Ig)G4-related disease affects nearly every organ, and its clinical course varies depending on the involved organ; however, its occurrence in the mediastinum is rarely reported.
Case presentation A 58-year-old woman presented with a posterior mediastinal tumor along the thoracic spine on imaging. Based on her elevated serum IgG4 level of 349.7 mg/dL, IgG4-related disease was suspected. Since the tumor was growing and malignancy could not be excluded, surgical resection was performed for definitive diagnosis. Robot-assisted thoracoscopic surgery was performed via the left semipronation and right thoracic approaches. The irregularly-shaped tumor was located on the level of the seventh to ninth thoracic vertebra, along the sympathetic nerve. A malignancy was not excluded based on the appearance of the tumor. The tumor had poor mobility. The sympathetic nerves, intercostal arteries, and veins were also excised. In this case, the articulated forceps, used during the robotic surgery, were useful in achieving complete tumor resection along the vertebral body. The pathological examination revealed IgG4-positive plasma infiltration, which fulfilled the criteria for IgG4-related diseases. The postoperative course was uneventful, and the patient underwent follow-up on an outpatient basis without additional medications.
Conclusion The clinical presentation of IgG4-related disease varies, based on the involved organs. This case was rare because the mediastinum was involved, and it emphasized the effectiveness of surgical resection.journal articl
Surface-Enhanced Raman Scattering from Tungsten Disulfide Nanosheets Attached to Gold Nanoparticle Array Substrates
Get PDFIn recent years, semiconductor nanosizing has found diverse applications, although reduced light interaction poses a challenge. Metallic nanoparticles exhibit localized surface plasmon resonance, enhancing the light–matter interaction. Surface-enhanced Raman scattering (SERS) quantitatively evaluates the electric field enhancement. Target molecules in “hot spots” between metallic nanostructures amplify SERS signals. While single molecules show remarkable enhancement, nanosheets face challenges due to their size. This study presents a method involving high-density gold nanoparticle arrays, tungsten disulfide (WS2) nanosheets, and additional gold nanoparticles to enhance SERS beyond previous reports. Characterization involved scanning electron microscopy and optical measurements, offering insights into future plasmon-enhanced semiconductor nanodevice design.journal articl
Elements of a nurse-coordinated post-stroke home care rehabilitation in the Philippines : A cross-sectional study
Get PDFBackground: Stroke is the leading cause of disability and the second leading cause of death worldwide. In the Philippines, there is a lack of a unified system for the care of community-dwelling patients with stroke. Furthermore, rehabilitation facilities are underutilized, and human resources and financial support policies are lacking. Nurses have become valuable human resources in rehabilitation. Current literature has inconsistent and weak evidence on the effectiveness of home-based post-stroke rehabilitation.
Objective: This study aimed to determine essential elements that constitute a nurse-coordinated post-stroke home care rehabilitation in the Philippines.
Methods: A literature review was conducted to generate items for a tool that would elicit important elements of post-stroke home care rehabilitation in terms of structure, process, and outcome domains. Two rounds of the modified e-Delphi technique were conducted with a panel of 10 experts, and the content validity index (CVI) was calculated. Using the developed tool, a cross-sectional survey was conducted among nurses in the Philippines in March 2024. The responses were subjected to principal component analysis.
Results: The validated tool contains 55 items with an item level CVI range of 0.9-1.0 and a scale level CVI of 0.99. Online survey responses were received from 326 participants. The first principal component for each domain was analyzed. Structure elements involve an interdisciplinary team that integrates policy and funding for home visits and telehealth services, ensuring culturally responsive home environments. Process elements involve collaborative planning and evidence-based treatment processes coordinated by nurses, prioritizing patient and family engagement. Nurses may perform therapies delegated by rehabilitation specialists. Outcomes elements focus on achieving patient- and family-centered goals, enhancing daily activities, and improving overall quality of life.
Conclusion: Given the complexity of community-based rehabilitation, this study determined the essential elements of post-stroke home care rehabilitation. These elements are crucial in providing guidance to policymakers, clinicians, and patients in the delivery of home-based post-stroke care.doctoral thesi
Insights into the Mechanism of Catalytic Activity of Plasmodium Parasite Malate-Quinone Oxidoreductase
Get PDFPlasmodium malate-quinone oxidoreductase (MQO) is a membrane flavoprotein catalyzing the oxidation of malate to oxaloacetate and the reduction of quinone to quinol. Recently, using a yeast expression system, we demonstrated that MQO, expressed in place of mitochondrial malate dehydrogenase (MDH), contributes to the TCA cycle and the electron transport chain in mitochondria, making MQO attractive as a promising drug target in Plasmodium malaria parasites, which lack mitochondrial MDH. However, there is little information on the structure of MQO and its catalytic mechanism, information that will be required to develop novel drugs. Here, we investigated the catalytic site of P. falciparum MQO (PfMQO) using our yeast expression system. We generated a model structure for PfMQO with the AI tool AlphaFold and used protein footprinting by acetylation with acetic anhydride to analyze the surface topology of the model, confirming the computational prediction to be reasonably accurate. Moreover, a putative catalytic site, which includes a possible flavin-binding site, was identified by this combination of protein footprinting and structural prediction model. This active site was analyzed by site-directed mutagenesis. By measuring enzyme activity and protein expression levels in the PfMQO mutants, we showed that several residues at the active site are essential for enzyme function. In addition, a single substitution mutation near the catalytic site resulted in enhanced sensitivity to ferulenol, an inhibitor of PfMQO that competes with malate for binding to the enzyme. This strongly supports the notion that the substrate binds to the proposed catalytic site. Then, the location of the catalytic site was demonstrated by structural comparison with a homologous enzyme. Finally, we used our results to propose a mechanism for the catalytic activity of MQO by reference to the mechanism of action of structurally or functionally homologous enzymes.journal articl
Solving multi-armed bandit problems using a chaotic microresonator comb
Get PDFThe Multi-Armed Bandit (MAB) problem, foundational to reinforcement learning-based decision-making, addresses the challenge of maximizing rewards amid multiple uncertain choices. While algorithmic solutions are effective, their computational efficiency diminishes with increasing problem complexity. Photonic accelerators, leveraging temporal and spatial-temporal chaos, have emerged as promising alternatives. However, despite these advancements, current approaches either compromise computation speed or amplify system complexity. In this paper, we introduce a chaotic microresonator frequency comb (chaotic comb) to tackle the MAB problem, where each comb mode is assigned to a slot machine. Through a proof-of-concept experiment, we employ 44 comb modes to address an MAB with 44 slot machines, demonstrating performance competitive with both conventional software algorithms and other photonic methods. Furthermore, the scalability of decision making is explored with up to 512 slot machines using experimentally obtained temporal chaos in different time slots. Power-law scalability is achieved with an exponent of 0.96, outperforming conventional software-based algorithms. Moreover, we find that a numerically calculated chaotic comb accurately reproduces experimental results, paving the way for discussions on strategies to increase the number of slot machines.journal articl
Clinical Investigation of the Inhibitory Effects of Tooth-Coating Materials on Initial Active Root Caries : A Pilot Randomized Controlled Trial
Get PDFBackground and Objectives: Caredyne ZIF-C is a novel, capsule-mixed zinc-containing prototype glass ionomer cement (GIC). Zinc ions are reported to inhibit root dentin demineralization, dentin collagen degradation, bacterial growth, acid production, and in vitro bacterial biofilm formation. However, the effectiveness of GICs against initial root caries lesions is unclear. Therefore, this study aimed to evaluate the efficacy of GICs, especially the new zinc-containing Caredyne ZIF-C GIC, as tooth-coating materials in patients with initial active root caries. Materials and Methods: A total of 58 lesions in 47 older adults (age > 65 years) were randomly allocated to one of the following three groups: Caredyne ZIF-C, Fuji VII (a conventional GIC), and sodium fluoride (NaF). All the lesions were treated with the assigned materials without removing the infected dentin, and the rates of dental plaque attachment and coating material fall-out were evaluated after 3, 6, and 12 months. The failure rate was defined as the number of teeth that needed restoration due to caries progression. Results: The plaque attachment rates tended to be lower in the material-coated root surfaces than in the healthy exposed root surfaces after 3, 6, and 12 months, although the differences among the three groups were not significant. Moreover, the coating material fall-out rate tended to be lower in the Caredyne ZIF-C group than in the Fuji VII group. There was no significant difference in the failure rate among the three groups at the 12 months mark. Conclusions: Though this pilot study offers a new direction for suppressing the progression of initial active root caries by controlling plaque attachment using GICs including Caredyne ZIF-C, clinical studies with a larger sample size are needed.journal articl
Impact of Participant Characteristics on Clinical Outcomes with iGlarLixi in Type 2 Diabetes : Post Hoc Analysis of SPARTA Japan
Get PDFIntroduction: The real-world SPARTA Japan study confirmed the effectiveness and safety of the fixed-ratio combination of insulin glargine 100 U/mL plus lixisenatide (iGlarLixi) once daily over 6 months in Japanese people with type 2 diabetes (T2D). This post hoc analysis examined the impact of participant characteristics on the achievement of age-defined glycaemic targets with iGlarLixi therapy.
Methods: The retrospective, observational SPARTA Japan study included adults with T2D who initiated iGlarLixi. In this analysis, data from insulin-naïve and insulin-experienced participants were separately assessed to compare glycated haemoglobin (HbA1c), body weight and safety outcomes between those who achieved (‘achieved’ group) and those who did not achieve (‘not-achieved’ group) age-defined glycaemic targets after 6 months of iGlarLixi. The not-achieved group was further stratified by whether or not their iGlarLixi dose was increased during treatment.
Results: In total, 418 participants were included in this analysis (138 insulin naïve and 280 insulin experienced). Among both insulin-naïve and insulin-experienced participants, those in the achieved group were older and had lower baseline HbA1c than those in the not-achieved group. Compared with the not-achieved group, the achieved group showed significantly greater HbA1c reductions from baseline (in both insulin-naïve and insulin-experienced participants) and significantly greater body weight reductions (in insulin-naïve participants), despite some participants in the not-achieved group receiving significantly higher insulin glargine doses than those in the achieved group. In both insulin-naïve and insulin-experienced participants, the incidence of hypoglycaemia and gastrointestinal-related adverse events was similar in the achieved and not-achieved groups. In a multivariate analysis, glycaemic target achievement was significantly more likely in older individuals and those who lost weight during iGlarLixi treatment.
Conclusions: Achievement of age-defined glycaemic targets with iGlarLixi treatment for 6 months was significantly affected by increased age and body weight loss, regardless of prior insulin exposure.journal articl
A novel treatment strategy for bladder hypoplasia : A case of megaureter in a functional solitary kidney
Get PDFIntroduction: We report a case of megaureter in a functional solitary kidney in which surgery was performed after bladder capacity was increased by home bladder cycling.
Case presentation: A 6-day-old girl with a left megaureter, a right multicystic dysplastic kidney, and bladder hypoplasia underwent percutaneous left nephrostomy for obstructive renal failure. At 8 months, home bladder cycling was initiated to increase bladder capacity before the planned ureterocystoneostomy. Surgery was performed after bladder capacity increased. The left ureter was compressed by the left umbilical ligament, so ureteral end-to-end anastomosis was performed at 1 year and 4 months. At 2 years and 8 months, cystometry showed age-appropriate bladder capacity and improved bladder compliance.
Conclusion: To the best of our knowledge, this is the first report of bladder hypoplasia treated by home bladder cycling.journal articl
THE CATASTROPHIC PERCEPTION OF PAIN IN BURNING MOUTH SYNDROME MAY BE ASSOCIATED WITH SYMPATHETIC TONE AS INDICATED BY THE QTc INTERVAL
No full textjournal articl
Attitudes and Preferences of Nursing Undergraduates Towards Working Abroad : A Cross-Sectional Study in Vietnam
Get PDFThis cross-sectional study investigates the attitudes of undergraduate nursing students in Vietnam towards international study and work opportunities, as well as the factors influencing their preferences. Data was collected through a web-survey questionnaire in April 2023, targeting students from a university in Vietnam, including participants in the Japanese language special program and regular program. The study findings emphasize the significance of international experiences, particularly in enhancing communication and cross-cultural skills, fostering personal development, and improving career prospects for nursing undergraduates. Moreover, students in the special program revealed distinct preferences when considering their ideal destinations for studying or working abroad. They placed a greater emphasis on factors like a clean and beautiful living environment, long-term job prospects, and festivities. Additionally, for those interested in pursuing postgraduate study abroad, the students favored universities that offered job hunting support, tuition exemption, and modern infrastructure. This study sheds light on the attitudes and preferences of Vietnamese undergraduate nursing students towards international study and work opportunities, highlighting the importance of such experiences for personal growth and career advancement in the nursing profession. The findings carry practical implications for educational institutions and policymakers, emphasizing the need to design programs that cater to the unique needs and preferences of nursing students seeking international opportunities.journal articl