Both frame-based stereotaxy and frameless stereotaxy are established surgical procedures. However, they each have their respective disadvantages when used in the biopsy of a deep-seated lesion. To ...overcome the drawbacks associated with these procedures, we evaluated the feasibility of applying augmented reality (AR) to stereotactic biopsy. We applied our trans-visible navigator (TVN) to frame-based stereotactic biopsy in five cases of deep-seated lesions. This navigation system uses the AR concept, allowing surgeons to view three-dimensional virtual models of anatomical structures superimposed over the surgical field on a tablet personal computer. Using TVN, we could easily confirm a clear trajectory avoiding the important structures as well as the target point’s location in the lesion. Use of the stereotactic apparatus allowed the surgeon to easily advance the biopsy probe to the target point. Consequently, a satisfactory histopathological diagnosis without complication was achieved in all cases. In conclusion, applying AR to stereotactic biopsy is feasible and may improve the safety of the procedure.
Anaerobic treatment of sewage has many advantages; however, the effluent contains high levels of dissolved methane. In this study, we investigated the use of a closed-type downflow hanging sponge ...(DHS) reactor for application of the denitrifying anaerobic methane oxidation (DAMO) reaction for nitrogen and dissolved methane removal. When using nitrate, the DAMO reaction achieved a denitrification rate of 84.4 g N m
−3
day
−1
, which is close to that required for practical application of denitrification to anaerobic sewage treatment. The microbial community that developed in the DHS was investigated using16S rRNA, and novel species of DAMO bacteria affiliated with Group b of NC10 phylum were enriched. This contrasted with the results of previous studies in which the
Candidatus
Methylomirabilis oxyfera affiliated with Group a was enriched. The results obtained herein suggest that a post-treatment system for anaerobically treated sewage using a closed-type DHS reactor may become practical in the near future.
•Augmented reality is useful for tumor resection.•Tablet type augmented reality is suitable for macroscopic procedures.•Presurgical discussions is essential for augmented reality.
To date, several ...researchers have introduced augmented reality navigation (ARN) into neurological surgery. While its application in brain tumor surgery seems promising, reports on its utility have been limited, thus warranting further evaluation. To clarify the stages and approaches in which ARN is useful and assess the effect of presurgical discussion with surgeons, we assessed usefulness using a hand-held ARN system we had developed, which displays three-dimensional (3D) virtual structures overlaid on a real-time image of the surgical field via a tablet PC monitor. The system was tested in 20 patients undergoing various procedures, with the first 10 consecutive cases being unselected and the following 10 cases being selected, for whom 3D models were prepared per the surgeons’ request. Thereafter, the surgeons ranked its usefulness during each stage of surgery. Consequently, case selection and presurgical discussions with surgeons considerably improved the usefulness, with the “useful” gradings improving from 50% to 88% across all surgical stages. Accordingly, usefulness improved from 50% to 90%, 67% to 100%, and 40% to 80% during the skin incision and craniotomy, dura incision, and intradural procedure stages, respectively. ARN was useful for superficial tumor resection, but less so for deep-seated tumor resection, except when using the transcortical and interhemispheric approaches. In conclusion, a tablet-type ARN can be useful during skin incisions, craniotomy and dura incisions, superficial tumor resections, and transcortical and interhemispheric approaches for deep-seated tumors. Case selection and presurgical discussions with surgeons were essential for the efficacy of ARN.
Background
Pathophysiology of type 1 autoimmune pancreatitis (AIP) is still unclear. We previously reported that M2 macrophages might play an important role in type 1 AIP. Recently, it has been ...reported that basophils regulate differentiation to M2 macrophages. In this study, we investigated basophils from the pancreatic tissue and peripheral blood of individuals with type 1 AIP.
Methods
By using immunohistochemistry, we investigated basophils in pancreatic tissue from 13 patients with type 1 AIP and examined expression of toll-like receptors (TLRs) by these cells. Additionally, we obtained peripheral blood samples from 27 healthy subjects, 40 patients with type 1 AIP, 8 patients with alcoholic chronic pancreatitis, 10 patients with bronchial asthma, and 10 patients with atopic dermatitis, and analyzed activation of basophils by stimulating them with ligands of TLR1–9. We also compared TLR expression in basophils from the tissue and blood samples.
Results
Basophils were detected in pancreatic tissues from 10 of 13 patients with type 1 AIP. Flow cytometric analysis revealed that the ratios of basophils activated by TLR4 stimulation in type 1 AIP (9.875 ± 1.148%) and atopic dermatitis (11.768 ± 1.899%) were significantly higher than those in healthy subjects (5.051 ± 0.730%;
P
< 0.05). Levels of basophils activated by TLR2 stimulation were higher in seven type 1 AIP cases. Furthermore, stimulation of TLR2 and/or TLR4, which were expressed by basophils in pancreas, activated basophils in peripheral blood.
Conclusions
Basophils activated via TLR signaling may play an important role in the pathophysiology of type 1 AIP.
A mesophilic, anaerobic, cellulolytic and xylanolytic strain, UasXn-3T, was isolated from anaerobic granular sludge in a mesophilic upflow anaerobic sludge blanket reactor, which was used to treat ...municipal sewage. The cells were Gram-stain-negative, non-motile, and non-spore-forming rods. The optimal temperature for growth was 37-40 °C and the optimal pH for growth was pH 6.5-7.0. Strain UasXn-3T could grow on several polysaccharides and sugars, including cellulose, cellobiose, xylan, xylose, glucose, fructose, arabinose, mannose, raffinose, trehalose and starch. The DNA G+C content was 44.4 mol%. On the basis of comparative 16S rRNA gene sequence analysis, strain UasXn-3T was identified as a member of the genus Bacteroides and most closely related to Bacteroides oleiciplenus, B. intestinalis, B. cellulosilyticus and B. graminisolvens (sequence similarities of 91.3-91.6%). Since the genetic and phenotypic properties suggest that strain UasXn-3T represents a novel species, we propose the name Bacteroides luti sp. nov. The type strain is UasXn-3T (=JCM 19020T=DSM 26991T).
The main objective of this study was to investigate the cause of gel fouling in membrane bioreactors (MBRs) treating real sewage in terms of soluble microbial products (SMPs) and microbial aspects. ...Two anoxic/oxic-MBRs were operated as the control reactor (S1) and the sludge loading rate increased reactor (S2). The reactors were operated under low-temperature around 11 °C conditions. Membrane permeability substantially decreased in S2, and gel layer biofilm was formed on membrane surface. In contrast, the permeability of S1 gradually decreased and cake layer formed. When gel fouling occurred, the protein and polysaccharide of SMP in S2 were 47 and 23 mg L−1, which were significantly lower than those recorded in S1 accounted for 118 and 68 mg L−1, respectively. Furthermore, the total organic carbon concentration of SMPs was 24 mg L−1, which was lower than the influent in S2, accounted for 62 mg L−1. Finally, Campylobacteraceae which exists in sewage and uncultured OD1, dominated the gel layer biofilm in S2, unlike the cake layer biofilm in S1. These results indicated that the gel layer biofilm might be composed of influent substances, demonstrating the importance of influent decomposition in MBR for gel fouling mitigation.
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•Low temperature and sludge loading rate change induced gel fouling.•The lowest SMP concentration exhibited at the highest sludge loading rate.•Sludge filterability was not associated with gel fouling occurrence.•Sewage derived bacteria was dominant in gel layer on membrane surface.
Active defense against a conspecific aggressor is essential for survival. Previous studies revealed strong c-Fos expression in the ventrolateral part of the ventromedial hypothalamus (VMHvl) in ...defeated animals. Here, we examined the functional relevance and in vivo responses of the VMHvl during conspecific defense. We found that VMHvl cells expressing estrogen receptor α (Esr1) are acutely excited during active conspecific defense. Optogenetic inhibition of the cells compromised an animal’s ability to actively defend against an aggressor, whereas activating the cells elicited defense-like behaviors. Furthermore, the VMHvl is known for its role in aggression. In vivo recording and c-Fos mapping revealed differential organization of the defense and aggression-responsive cells in the VMHvl. Specifically, defense-activated cells are concentrated in the anterior part of the VMHvl, which preferentially targets the periaqueductal gray (PAG). Thus, our study identified an essential neural substrate for active conspecific defense and expanded the function of the VMHvl.
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•VMHvl, especially its anterior part, is highly excited during active social defense•Inhibiting the VMHvl Esr1+ cells compromises active defense against an aggressor•Activating the anterior VMHvl Esr1+ cells elicits defense-like behaviors•Anterior and posterior VMHvl Esr1+ cells show differential projection patterns
Active defense against conspecific aggressors is essential for survival, but its underlying neural substrates remain largely unknown. Through a series of in vivo recordings and functional manipulations, Wang et al. demonstrate that cells expressing estrogen receptor α in a small medial hypothalamic nucleus are essential for defense against a bully.
In this paper, we have proposed a simple buckling evaluation method for plate structures of which original shapes and boundary conditions do not change before buckling, and buckling modes of the ...plates are uniform along longitudinal directions of the plates. Buckling forces of the plates in the structures are derived from the product of the Euler buckling forces and buckling coefficients of the plates. For the establishment of a relationship between the buckling coefficient and support stiffness of plates elastically supported by adjoining plates, buckling analyses by FE models were executed under conditions of different support stiffness for the adjoining plates, and then an approximate function between the support stiffness and the buckling coefficient was derived. This function was applied to examples with another moment ratio, a plurality of adjoining plates and asymmetric adjoining plates, and the buckling coefficients predicted by the function. It was then found that the buckling coefficients obtained by the proposed method matched those of the buckling analysis results. Furthermore, this buckling evaluation method was applied to plate structures, and a buckling force of a buckling plate was compared with a buckling analysis result. It was found that the buckling force could be evaluated within a difference of 6.8 %.
•Process performance of a full-scale DHS reactor was evaluated over 1800 days.•The DHS reactor consistently produced effluent with a BOD of 6mgL−1.•Sludge yield of the DHS was estimated to be ...0.04kgSSkg−1 COD removed.•Power consumption of the UASB+DHS system was 0.82kWhkg−1 BOD removed.•UASB+DHS systems may be the most cost- and energy-efficient sewage treatment methods.
A down-flow hanging sponge (DHS) reactor is a novel, unaerated, aerobic, biofilm reactor that is used to polish effluent received from an up-flow anaerobic sludge blanket (UASB) reactor for treating municipal sewage. A full-scale DHS reactor was constructed for post-treatment of a full-scale UASB reactor at a municipal sewage treatment plant in India. Performance of the DHS reactor was evaluated with respect to organic removal over 1800days of continuous operation. The UASB+DHS system consistently produced effluent with chemical oxygen demand (COD), biochemical oxygen demand (BOD), and suspended solids (SS) values of 37, 6.0 and 19mgL−1, on average, respectively. The sludge yield of the DHS reactor was estimated to be 0.04kgSSkg−1 COD removed or 0.12kgSSkg−1 BOD removed, which is considerably lower than other aerobic treatment methods that have been employed for polishing UASB effluent.
Summary Background Mesorectal excision is the international standard surgical procedure for lower rectal cancer. However, lateral pelvic lymph node metastasis occasionally occurs in patients with ...clinical stage II or stage III rectal cancer, and therefore mesorectal excision with lateral lymph node dissection is the standard procedure in Japan. We did a randomised controlled trial to confirm that the results of mesorectal excision alone are not inferior to those of mesorectal excision with lateral lymph node dissection. Methods This study was undertaken at 33 major hospitals in Japan. Eligibility criteria included histologically proven rectal cancer of clinical stage II or stage III, with the main lesion located in the rectum with the lower margin below the peritoneal reflection, and no lateral pelvic lymph node enlargement. After surgeons had confirmed macroscopic R0 resection by mesorectal excision, patients were intraoperatively randomised to mesorectal excision alone or with lateral lymph node dissection. The groups were balanced by a minimisation method according to clinical N staging (N0 or N1, 2), sex, and institution. Allocated procedure was not masked to investigators or patients. This study is now in the follow-up stage. The primary endpoint is relapse-free survival and will be reported after the primary analysis planned for 2015. Here, we compare operation time, blood loss, postoperative morbidity (grade 3 or 4), and hospital mortality between the two groups. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov , number NCT00190541. Findings 351 patients were randomly assigned to mesoretcal excision with lateral lymph node dissection and 350 to mesorectal excision alone, between June 11, 2003, and Aug 6, 2010. One patient in the mesorectal excision alone group underwent lateral lymph node dissection, but was analysed in their assigned group. Operation time was significantly longer in the mesorectal excision with lateral lymph node dissection group (median 360 min, IQR 296–429) than in the mesorectal excision alone group (254 min, 210–307, p<0·0001). Blood loss was significantly higher in the mesorectal excision with lateral lymph node dissection group (576 mL, IQR 352–900) than in the mesorectal excision alone group (337 mL, 170–566; p<0·0001). 26 (7%) patients in the mesorectal excision with lateral lymph node dissection group had lateral pelvic lymph node metastasis. Grade 3–4 postoperative complications occurred in 76 (22%) patients in the mesorectal excision with lateral lymph node dissection group and 56 (16%) patients in the mesorectal excision alone group. The most common grade 3 or 4 postoperative complication was anastomotic leakage (18 6% patients in the mesorectal excision with lateral lymph node dissection group vs 13 5% in the mesorectal excision alone group; p=0·46). One patient in the mesorectal excision with lateral lymph node dissection group died of anastomotic leakage followed by sepsis. Interpretation Mesorectal excision with lateral lymph node dissection required a significantly longer operation time and resulted in significantly greater blood loss than mesorectal excision alone. The primary analysis will help to show whether or not mesorectal excision alone is non-inferior to mesorectal excision with lateral lymph node dissection. Funding National Cancer Center, Ministry of Health, Labour and Welfare of Japan.
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