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To reveal the origin of the mini-starbursts in the Milky Way, we carried out large-scale CO observations toward the RCW 106 giant molecular cloud (GMC) complex using the NANTEN2 4 m radio telescope operated by Nagoya University. We also analyzed the Mopra Southern Galactic Plane CO survey and Herschel infrared continuum archival data. The RCW 106 GMC complex contains the radial velocity components of −68 km s−1 and −50 km s−1 reported by H. Nguyen et al. (2015). Focusing on the RCW 106 East and West region with the massive star formation having the bright infrared dust emission, we found that these regions have three different velocity components with ∼10 km s−1 differences. The two out of three velocity components show morphological correspondence with the infrared cold dust emission and connect with the bridge feature on a position–velocity diagram. Therefore, two molecular clouds with ∼10 km s−1 differences are likely to be physically associated with massive star-forming regions in the GMC complex. Based on these observational results, we argue that mini-starbursts and massive star/cluster formation in the RCW 106 GMC complex are induced by supersonic cloud–cloud collisions in an agglomerate of molecular gas on the Scutum–Centaurus arm.

INTRODUCTION: Malignant insulinomas are rare, and lymph node metastases are particularly uncommon in small, low-grade tumors. We report an asymptomatic insulinoma of the pancreatic body with multiple lymph node metastases confined to the transverse mesocolon, which remained radiologically stable for at least 3 years prior to the diagnosis. This case highlights the potential for metastatic disease, even in indolent insulinomas.CASE PRESENTATION: A 75-year-old man was referred after repeated findings of low fasting glucose levels during annual health screenings over 3 years. Despite persistent hypoglycemia, the patient remained asymptomatic and untreated. On admission, the fasting blood glucose level was 45 mg/dL, the immunoreactive insulin level was 8.7 μU/mL, and the serum C-peptide level was 2.0 ng/mL, with insulin secretion indices within normal limits. Dynamic contrast-enhanced CT revealed a 1-cm hypervascular lesion in the pancreatic body and 3 similar lesions in the transverse mesocolon. A retrospective review of earlier scans confirmed their long-term stability. Selective arterial calcium injection testing revealed insulin secretion from both the dorsal pancreatic and accessory middle colic arteries, corresponding to the pancreatic and mesocolonic lesions, respectively. Central pancreatectomy with en bloc mesocolon resection was performed. Intraoperative portal venous insulin levels declined from 102 μU/mL before resection to 10 μU/mL before closure, confirming the complete tumor removal. Histopathological analysis revealed a well-differentiated neuroendocrine tumor composed of islet cell–like neoplastic cells with a Ki-67 labeling index below 1%. Four metastatic lymph nodes were identified in the patient. The patient has remained recurrence-free for 7 years, with normal fasting glucose and insulin levels.CONCLUSIONS: This case demonstrates that even small, low-grade insulinomas can metastasize to the lymph nodes through atypical drainage pathways. Favorable tumor biology may mitigate the adverse prognostic implications of nodal disease in well-differentiated pancreatic neuroendocrine tumors. Comprehensive lymph node assessment combined with functional localization techniques, such as selective arterial calcium injection testing and intraoperative insulin monitoring, may be essential for achieving curative resection and long-term disease control.

We present the results of ALMA-ACA 7 m array observations in 12CO(J = 2–1), 13CO(J = 2–1), and C18O(J = 2–1) line emission toward the molecular-gas disk in the Local Group spiral galaxy M33 at an angular resolution of 7.″31 × 6.″50 (30 × 26 pc). We combined the ACA 7 m array 12CO(J = 2–1) data with the IRAM 30 m data to compensate for emission from diffuse molecular-gas components. The ACA+IRAM combined 12CO(J = 2–1) map clearly depicts the cloud-scale molecular-gas structure over the M33 disk. Based on the ACA+IRAM 12CO(J = 2–1) cube data, we cataloged 848 molecular clouds with a mass range from 103–106 M ⊙. We found that high-mass clouds (≥105 M ⊙) tend to associate with the 8 μm bright sources in the spiral arm region, while low-mass clouds (<105 M ⊙) tend to be apart from such 8 μm bright sources and to exist in the inter-arm region. We compared the cataloged clouds with GMCs observed by the IRAM 30 m telescope at 49 pc resolution (IRAM GMC), and found that a small IRAM GMC is likely to be identified as a single molecular cloud even in ACA+IRAM CO data, while a large IRAM GMC can be resolved into multiple ACA+IRAM clouds. The velocity dispersion of a large IRAM GMC is mainly dominated by the line-of-sight velocity difference between small clouds inside the GMC rather than the internal cloud velocity broadening.

Although the deuterium fraction is known to be a powerful evolutionary tracer, its variation within individual molecular cloud cores is still poorly understood. The northern ∫-shaped filament and 20 individual starless cores in the Orion A and B clouds were mapped in the deuterated molecules of DNC and DCO+ with the receiver 7BEE installed on the Nobeyama 45 m radio telescope. In a ∼5′×30′ map of the northern ∫-shaped filament in the Orion A cloud, the DNC emission is detected over the filament, whereas the DCO+ emission is localized toward OMC-3, the northernmost region of the filament. The difference in distribution between DNC and DCO+ can be attributed to that between N- and C-bearing molecules as previously suggested by K. Tatematsu et al. (2008). High DNC/HN13C column density ratios were observed in OMC-2 and OMC-3, and low ratios in OMC-1. It seems that OMC-2 and OMC-3 still contain molecular gas close to the onset of star formation. In 3′×3′ maps of the individual starless cores in Orion, the column density ratios of DNC/HN13C and DCO+/H13CO+ were found to be rather constant locally within each core, although the core-to-core variation is not small. Similar timescales of deuterization, depletion, and dynamical evolution might explain the locally constant ratio.

Abstract In recent years, natural orifice specimen extraction surgery (NOSES) in the treatment of colorectal cancer has attracted widespread attention. The potential benefits of NOSES including reduction in postoperative pain and wound complications, less use of postoperative analgesic, faster recovery of bowel function, shorter length of hospital stay, better cosmetic and psychological effect have been described in colorectal surgery. Despite significant decrease in surgical trauma of NOSES have been observed, the potential pitfalls of this technique have been demonstrated. Particularly, several issues including bacteriological concerns, oncological outcomes and patient selection are raised with this new technique. Therefore, it is urgent and necessary to reach a consensus as an industry guideline to standardize the implementation of NOSES in colorectal surgery. After three rounds of discussion by all members of the International Alliance of NOSES, the consensus is finally completed, which is also of great significance to the long-term progress of NOSES worldwide.

PurposeThe relevance of transvaginal specimen extraction (TVSE) combined with reduced port surgery (RPS) remains unknown. This study investigated the feasibility of TVSE with RPS according to short-term outcomes and cosmesis.MethodsThis prospective multicenter study enrolled ten patients at three institutions. For the semi-quantification of each parameter, we administered questionnaires to assess pain (visual analogue scale), subjective/objective wound healing esthetics [photo series questionnaires (PSQ)], and quality of life (QOL).ResultsNo operative complications occurred, except one case of urinary tract infection, which was promptly cured with antibiotics. On day 0, pain was rated at 2.3 ± 0.67 at rest and 4.9 ± 0.82 during sneezing; these ratings gradually declined over time. The PSQ showed that the patient ratings of wound esthetics after TVSE were not inferior to ratings from patients after conventional laparoscopy or single incision laparoscopic surgery, and they were significantly higher than the patient ratings of wounds after laparotomy (P < 0.05). The QOL scores showed that, in comparison to before surgery, after surgery, patients reported significant deterioration of their physical function (96.67 ± 1.49 vs. 87.33 ± 2.71), emotional function (93.33 ± 2.72 vs. 86.67 ± 2.22), fatigue (7.78 ± 3.72 vs. 26.67 ± 8.31), and pain (6.67 ± 3.69 vs. 18.33 ± 4.61).ConclusionTVSE with RPS for colorectal cancer was feasible and was associated with a low degree of postoperative pain.

Background Intestinal fatty acid-binding protein (I-FABP) is a low-molecular-mass (15 kDa) cytosolic protein found exclusively in the epithelial cells of the small bowel mucosa. We aimed to evaluate the clinical usefulness of serum I-FABP measurement for the diagnosis of ischemic small bowel disease. Methods Patients with a clinical diagnosis of acute abdomen were recruited for this multicenter trial at one university hospital and nine city hospitals over a 13-month period. Serum I-FABP levels were measured in 361 eligible patients by an enzyme-linked immunosorbent assay using a specific monoclonal antibody. Results Of the 361 patients, 242 underwent surgery, and small bowel ischemia was diagnosed in 52 patients. The mean serum I-FABP level in the patients with small bowel ischemia was 40.7 ± 117.9 ng/ml, which was significantly higher than that in patients with non-ischemic small bowel disease (5.8 ± 15.6 ng/ml) and those with non-small bowel disease (1.8 ± 1.7 ng/ml). The serum I-FABP cutoff level for the diagnosis of small bowel ischemia was 3.1 ng/ml. Serum I-FABP was more efficient than conventional biochemical markers, in terms of sensitivity and positive and negative predictive values, in the diagnosis of small bowel ischemia. However, its specificity was slightly lower than that of creatinine phosphokinase or lactate dehydrogenase. The positive and negative likelihood ratios of serum I-FABP were 3.01 and 0.29, respectively. Conclusion Serum I-FABP measurement is a non-invasive method that is potentially useful for the efficient identification of patients with acute abdomen who are at risk of small bowel ischemia.

Background/Objectives: Pembrolizumab demonstrates a high response rate in patients with mismatch repair-deficient (dMMR) metastatic colorectal cancer (mCRC), with responses often sustained even after treatment cessation. However, the pathological complete response (pCR) rate in clinically responding cases remains unknown. This study aimed to evaluate the relationship between the radiological and pathological responses in patients with dMMR mCRC who responded to pembrolizumab. Methods: This retrospective study included 27 patients with dMMR mCRC treated with pembrolizumab. The radiological response was assessed using RECIST version 1.1 criteria. The pathological response was evaluated in patients who underwent metastasectomy, with pCR defined as the absence of residual cancer cells. Results: The median progression-free survival (PFS) of the cohort was 19 months. Among the 27 patients, 3 achieved clinical complete response (cCR), and 10 had clinical partial response (cPR), resulting in a response rate of 48%. All three patients with cCR maintained their responses without metastasectomy (2-year PFS: 100%). Among patients with cPR, eight maintained their responses, while two experienced progression (2-year PFS: 75%). Five patients with cPR underwent curative-intent metastasectomy, and four of them (80%) achieved pCR. Thus, at least 40% of patients with cPR in this cohort had no residual cancer histologically. Conclusions: Our findings demonstrate the significant discordance between the radiological and pathological responses to pembrolizumab in dMMR mCRC patients, with 80% of those with cPR achieving pCR upon metastasectomy. These observations highlight the need for improved response assessment methods for precision immunotherapy.

A new stepped septum-type waveguide circular polarizer (SST-CP) was developed to operate in the 230 GHz band for radio astronomy, especially submillimeter-band VLBI observations. For previously reported SST-CP models, the 230 GHz band is too high to achieve the design characteristics in manufactured devices because of unexpected machining errors. To realize a functional SST-CP that can operate in the submillimeter band, a new method was developed, in which the division surface is shifted from the top step of the septum to the second step from the top, and we simulated the expected machining error. The SST-CP using this method can compensate for specified machining errors and suppress serious deterioration. To verify the proposed method, several test pieces were manufactured, and their characteristics were measured using a VNA. These results indicated that the insertion losses were approximately 0.75 dB, and the input return losses and the crosstalk of the left- and right-hand circular polarization were greater than 20 dB at 220–245 GHz on 300 K. Moreover, a 230 GHz SST-CP was developed by the proposed method and installed in a 1.85-m radio telescope receiver systems, and then had used for scientific observations during one observation season without any problems. These achievements demonstrate the successful development of a 230 GHz SST-CP for radio astronomical observations. Furthermore, the proposed method can be applicable for observations in higher frequency bands, such as 345 GHz.

Several randomized controlled trials and meta-analyses have demonstrated the potential advantages of intracorporeal over extracorporeal anastomosis. However, the heterogeneity and small samples of these studies complicate drawing clear conclusions regarding such advantages. In this nationwide, multicenter, retrospective cohort study, we aimed to clarify the benefits of intracorporeal over extracorporeal anastomosis in patients undergoing laparoscopic colectomy for colon cancer. This study included 46 institutions. Patients with clinical stage 0-III colon adenocarcinoma who underwent laparoscopic colectomy between January 2020 and December 2021 were evaluated. The effect of intracorporeal anastomosis on short-term outcomes compared to extracorporeal anastomosis was assessed using propensity score matching. A total of 1245 patients (intracorporeal,  = 615; extracorporeal,  = 630) were included in the final analysis. The operative time was longer (228 vs. 207 min,  < 0.001), but blood loss was also lower (5.0 vs. 10.0 mL,  < 0.001) and the incidence of intraoperative vascular injury appeared lower (0.5% vs. 1.6%,  = 0.091) in the intracorporeal group than those in the extracorporeal group. The time to first passage of stool (2.9 vs. 3.5 days,  < 0.001) and length of hospital stay (9.3 vs. 10.2 days,  = 0.008) were shorter in the intracorporeal group. Intracorporeal anastomosis showed advantages over extracorporeal anastomosis in terms of blood loss, intraoperative vascular injury (potentially), bowel recovery, and length of hospital stay, despite the longer operative time.