A 63-year-old man suffered from multisystem trauma including pelvic bone fracture and lung contusion caused by a traffic accident. Chest CT revealed mediastinum and periaortic hematoma. Because of hemorrhagic complications, a emergency operation was avoided, and conservative therapy was decided on. Though his blood pressure was controlled strictly, re-bleeding appeared. An urgent operation was performed 4 days after the injury. Under partial cardiopulmonary bypass, the aortic isthmus disruption was resected and replaced with an artificial graft. The postoperative course was uneventful. In cases of traumatic aortic disruption with multisystem trauma, the delayed operation is more common than urgent operation. However, there is always the possibility of rupture. It is extremely important to appropriately judge the timing of the operation.

Objective: Breast cancer susceptibility gene 1 (BRCA1)-associated ovarian cancer patients have been treated with A poly (ADP-ribose) polymerase (PARP) inhibitor, extending the progression-free survival; however, they finally acquire therapeutic resistance. Interleukin (IL)-34 has been reported as a poor prognostic factor in several cancers, including ovarian cancer, and it contributes to the therapeutic resistance of chemotherapies. IL-34 may affect the therapeutic effect of PARP inhibitor through the regulation of tumor microenvironment (TME). Methods: In this study, The Cancer Genome Atlas (TCGA) data set was used to evaluate the prognosis of IL-34 and human ovarian serous carcinoma. We also used CRISPR-Cas9 genome editing technology in a mouse model to evaluate the efficacy of PARP inhibitor therapy in the presence or absence of IL-34. Results: We found that IL34 was an independent poor prognostic factor in ovarian serous carcinoma, and its high expression significantly shortens overall survival. Furthermore, in BRCA1-associated ovarian cancer, PARP inhibitor therapy contributes to anti-tumor immunity via the XCR1+ DC-CD8+ T cell axis, however, it is canceled by the presence of IL-34. Conclusion These results suggest that tumor-derived IL-34 benefits tumors by creating an immunosuppressive TME and conferring PARP inhibitor therapeutic resistance. Thus, we showed the pathological effect of IL-34 and the need for it as a therapeutic target in ovarian cancer.