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Accumulating evidences suggest that M2 macrophages are involved with repair processes in the nervous system. However, whether M2 macrophages can promote axon regeneration by directly stimulating axons nor its precise molecular mechanism remains elusive. Here, the current study demonstrated that typical M2 macrophages, which were generated by IL4 simulation, had the capacity to stimulate axonal growth by their direct effect on axons and that the graft of IL4 stimulated macrophages into the region of Wallerian degeneration enhanced axon regeneration and improved functional recovery after PNI. Importantly, uPA (urokinase plasminogen activator)-uPA receptor (uPAR) was identified as the central axis underlying the axon regeneration effect of IL4 stimulated macrophages. IL4 stimulated macrophages secreted uPA, and its inhibition abolished their axon regeneration effect. Injured but not intact axons expressed uPAR to be sensitive to uPA. These results unveil a cellular and molecular mechanism underlying the macrophage related axon regeneration and provide a basis of a novel therapy for PNI.

The aim of this study was to evaluate the joint contact area of the dominant side and that of the non-dominant side without valgus instability in symptomatic pitchers. Ten symptomatic elbow medial ulnar collateral ligament (UCL) deficient baseball pitchers participated in this study. Computed tomography (CT) data from the dominant and non-dominant elbows were obtained with and without elbow valgus stress. The CT imaging data of each elbow joint were reconstructed using a 3D reconstruction software package, and the radiocapitellar and ulnohumeral joint contact areas were calculated. The center of the contact area and the translation from the position without stress to the position with valgus stress were also calculated. With elbow valgus stress, the contact area changed, and the center of the radiocapitellar joint contact area translated significantly more laterally in the dominant elbow than in the non-dominant elbow (p = 0.0361). In addition, the center of the ulnohumeral joint contact area translated significantly more posteriorly in the dominant elbow than in the non-dominant elbow (p = 0.0413). These changes in contact areas could be the reason for cartilage injury at the posterior trochlea in pitchers with UCL deficiency.

A 62‐year‐old man underwent partial nephrectomy for right renal cell carcinoma (RCC). Four years later, esophagogastroduodenoscopy revealed gastric mucosal redness with a smooth surface. Two more years later, the red lesion showed a morphological change to a reddish elevation, which prompted a biopsy. Histopathological examination led to the diagnosis of gastric metastasis of RCC. As the tumor resided within the submucosa and no other organ metastasis was found after nephrectomy by that time, endoscopic submucosal dissection (ESD) was performed and successfully resected. No evidence of local recurrence was noted for 7 years after ESD. Topical resection, such as ESD, can be considered an option to treat the gastric metastasis of RCC for which there are no established treatment guidelines. In this case report, we aimed to investigate a rare case of gastric metastasis of RCC, which was monitored endoscopically, showing morphological changes over several years, and was successfully resected by ESD.

INTRODUCTION: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare, low-grade malignant tumor. Although SPNs generally exhibit indolent behavior, spontaneous regression detected on CT imaging is exceedingly rare, and to the best of our knowledge, regrowth following regression has not been previously reported.CASE PRESENTATION: A 33-year-old woman was referred to Kansai Medical University following the detection of liver dysfunction during a routine medical checkup. Imaging revealed a well-demarcated 20-mm mass in the pancreatic body, and an endoscopic US-guided biopsy confirmed SPN. Surgical resection was initially planned but postponed because of a COVID-19 infection in a fellow inpatient. During follow-up, the tumor showed spontaneous regression and became undetectable on imaging at 4 months. However, MRI at 16 months revealed tumor regrowth, which became clearly visible on T2-weighted imaging by 23 months, measuring 15 mm. At 24 months, a laparoscopic spleen-preserving distal pancreatectomy was performed. Histopathology confirmed SPN with intratumoral hemorrhage and characteristic pseudopapillary architecture. Complete resection was achieved, and the patient’s postoperative course was uneventful.CONCLUSIONS: This case illustrates that SPN can regress spontaneously, yet subsequently regrow, underscoring the need for careful long-term imaging surveillance even after apparent tumor shrinkage.

Aim The incidence of cholelithiasis after gastrectomy is higher than that in the general population; however, the incidence and risk factors for choledocholithiasis have not been well reported. We aimed to assess the association between a history of gastrectomy and choledocholithiasis. Methods A total of 3025 patients who underwent cholecystectomy with or without choledocholithotomy between January 2006 and December 2020 at Kansai Medical University, Japan were included in this study. Patients were divided into a gastrectomy group with a history of gastrectomy (173 patients, 5.7%) and a control group having no history of gastrectomy (2852 patients, 94.3%). Results The incidence of choledocholithiasis was 61.8% and 22.2% in the gastrectomy and control groups, respectively, with a significantly higher incidence in the gastrectomy group (p < 0.0001). Multivariate analysis showed that age, sex, history of gastrectomy, and previous surgery except gastrectomy were risk factors for the development of choledocholithiasis, with a history of gastrectomy being the strongest risk factor (Odds Ratio 3.78, 95% Confidence Interval 2.71–5.27). The incidence values of choledocholithiasis in the Billroth I, Billroth II, and Roux‐en‐Y methods were 44.7%, 70.6%, and 69.7%, respectively, and were significantly lower in the Billroth I group than in the Roux‐en‐Y group (p = 0.009). The median time from gastrectomy to development of choledocholithiasis was 5.5 years for Roux‐en‐Y, which was significantly faster than 20 years for Billroth I and 35 years for Billroth II. Conclusion Gastrectomy is a known risk factor for choledocholithiasis. Concomitant cholecystectomy during gastrectomy may be indicated in older men. This retrospective study suggests that gastrectomy is a risk factor for choledocholithiasis. Especially in terms of the differences in reconstruction methods, the median time from gastrectomy to development of choledocholithiasis was 5.5 years for Roux‐en‐Y, which was significantly faster than 20 years for Billroth I and 35 years for Billroth II.

The flexible job shop scheduling problem (FJSSP) is an extension of the classical job shop scheduling problem (JSSP) that allocates jobs to resources while minimizing the maximum completion time of all the jobs. Machine assignment and job sequence are determined in the FJSSP. To efficiently solve the FJSSP, which is a non-deterministic polynomial-time hard problem, a heuristic method must be used. In previous studies, the FJSSP has been solved using neighborhood algorithms that employ various metaheuristic methods. These approaches constrain the neighborhood operation to jobs on a critical path and simultaneously change the machine assignment and job sequence. Branches on the critical path are easily generated in the FJSSP search processes; this branch structure can improve the efficiency of the FJSSP. This study investigates two neighborhood search algorithms used for changing the machine assignment and job sequence via a critical path. The first method changes the machine assignment and job sequence simultaneously, whereas the second method changes them independently. In this study, we propose an efficient neighborhood generating method using a branch block of critical path.

Background Guideline for Pharmacological Therapy for Schizophrenia was published by the Japanese Society of Neuropsychopharmacology in 2015. “Effectiveness of Guidelines for Dissemination and Education in psychiatric treatment (EGUIDE)” project aimed to standardize medical practice using quality indicators (QIs) as indices to evaluate the quality of medical practice. In this study, we have reported the quality indicator values of prescription before the beginning of the guideline lectures in the EGUIDE project to ascertain the baseline status of treating patients with schizophrenia. Methods A cross‐sectional, retrospective case record survey was conducted, involving 1164 patients with schizophrenia at the time of discharge. We checked all types and dosage of psychotropic drugs. Results Forty‐three percent of patients had antipsychotic polypharmacy, and substantial concomitant medication was observed (antidepressants; 8%, mood stabilizers: 37%, anxiolytics or hypnotics: 68%). Conclusions In the results obtained in this study, we plant to report changes in the effectiveness of education in the EGUIDE project near the future. This study reports the prescription pattern in schizophrenia in Japan from EGUIDE (Effectiveness of Guideline for Dissemination and Education in psychiatric treatment) project. A cross‐sectional, case record survey conducted, involving 1164 patients with schizophrenia at the time of discharge. Forty‐three percent of patients received antipsychotic polypharmacy. Based on the results, we plan to report changes in the effectiveness of education in the EGUIDE project in the future.

Background: The influence of long-term loading conditions on the articular surfaces of the glenohumeral joint can be determined by measuring stress-distribution patterns. Long-term pitching activity changes the stress distribution across the glenohumeral joint surface; however, the influence of competitive level on stress-distribution patterns remains unclear. Purpose: To use computed tomography (CT) osteoabsorptiometry (CTOAM) to evaluate the distribution of subchondral bone density across the glenohumeral joint in collegiate and professional baseball players as well as to determine the effects of pitching activity on the articular surfaces. Study Design: Descriptive laboratory study. Methods: We evaluated 73 shoulders in 50 baseball players. CT imaging data were obtained from the dominant-side shoulder of 12 professional pitchers (PP group) and 15 professional fielders (PF group). CT imaging data were also obtained from both shoulders of 12 asymptomatic collegiate pitchers (CP group) and 11 collegiate fielders (CF group). The pattern of distribution of subchondral bone density across the articular surfaces of each glenohumeral joint was assessed by CTOAM. As a measure of bone density, the mean Hounsfield units (HU) were obtained for each joint surface, and the absolute values of the dominant shoulder were compared for each group. Results: Stress-distribution patterns over the articular surfaces differed between the dominant and nondominant sides in the CP group as well as between both collegiate groups versus the PP group. In the CP group, the mean HU of the humeral head surface were greater on the nondominant versus dominant side (P = .035). On the dominant side, the mean HU of the humeral head surface and glenoid were greater in the CP versus the PP group (P = .001 and .027, respectively). Conclusion: Stress distribution on the articular surface of the glenohumeral joint was affected by pitching ability and competitive level. Our analysis indicates that the traction force on the glenohumeral joint surface might be greater than compression force during pitching. Clinical Relevance: The present findings suggest that pitching activity results in low stress to the articular surfaces of the glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the etiology of disorders specific to pitching activity.

Introduction In patients with pancreatic ductal adenocarcinoma (PDAC) in the pancreatic body (Pb) and tail (Pt), the appropriate area for lymphadenectomy is controversial. This study aimed to reevaluate the extent of lymph node (LN) metastasis in Pb‐ and Pt‐PDAC, and to define the optimal area of LN dissection. Patients and methods This single‐center retrospective study evaluated patients with Pb‐ and Pt‐PDAC who underwent distal pancreatectomy with extended lymphadenectomy between 2006 and 2020. LN metastasis in >3.0% of patients were defined as new regional LN. Results The study cohort included 135 patients with Pb‐PDAC and 42 patients with Pt‐PDAC. In patients with Pb‐PDAC, LNs around the splenic artery (SPA) had the highest metastasis‐positive rate (54.1%). LNs along the left gastric artery, common hepatic artery, celiac axis (CA), superior mesenteric artery (SMA), and splenic hilus were defined as new regional LNs. In patients with Pt‐PDAC, LNs at the splenic hilum had the highest metastasis‐positive rate (38.1%). The station and LN around the SPA were defined as new regional LNs in those with Pt‐PDAC. Metastasis beyond the newly defined regional LNs was not associated with survival. The incidence of LN metastasis was lower in patients who received preoperative chemotherapy than in those who underwent upfront surgery in both Pb‐ and Pt‐PDAC. Conclusion Although it needs to be verified in future multicenter studies, LN of both the CA and SMA systems should be dissected in patients with Pb‐PDAC. However, only those around the SPA and splenic hilus should be dissected routinely in those with Pt‐PDAC. This study indicated that LN of both the CA and SMA systems should be dissected in patients with Pb‐PDAC. However, only those around the SPA and splenic hilus should be dissected routinely in those with Pt‐PDAC.