Background: Identifying dysmorphic red blood cells (RBCs) is critical for diagnosing glomerular diseases, as distinguishing glomerular from non-glomerular hematuria may reduce reliance on invasive diagnostics such as kidney biopsy. We aimed to enhance urinary RBC morphological classification by employing machine learning (ML) to analyze UF-5000 scattergram data. Methods: RBCs in urine samples (N = 185) were classified as dysmorphic or isomorphic based on microscopic findings. UF-5000 scattergrams were quantified to generate 20 statistical features and used to train a ML model in DataRobot (v9.1) with an automated pipeline, five-fold cross-validation, and LogLoss-based selection. Performance was evaluated in an independent cohort (N = 1,093). Accuracy was defined as concordance with microscopy findings. Areas under ROC curves (AUROCs) and diagnostic metrics are reported with 95% confidence intervals (CIs). Results: Among conventional UF-5000 parameters, the small RBC/total RBC ratio was the strongest predictor (AUROC 0.97, 95% CI 0.94–0.99). Scattergram-derived features indicated that RBC size-related parameters were crucial for identifying dysmorphic RBCs. The ML model alone demonstrated superior accuracy over UF-5000 RBC-Info alone (concordance 95.2% vs. 92.1%; AUROC 0.95 [0.94–0.97] vs. 0.92 [0.91–0.94]). Logical (OR/ AND) combinations of the ML model with RBC-Info outperformed RBC-Info alone (OR: concordance 92.7%, AUROC 0.93 [0.92–0.95]; AND: concordance 94.6%, AUROC 0.94 [0.93–0.96]). Conclusions A scattergram-based ML model improves the accuracy and reliability of urinary RBC morphological classification based on UF-5000 scattergrams and may help reduce reliance on invasive diagnostics. Prospective, multicenter studies should validate generalizability and assess integration into routine workflows.

Background/Aims: Colorectal polyp detection during colonoscopy is influenced by the lesion location, size, morphology, and histology. However, no studies have systematically assessed the difficulty of detection along the short axis of the intestinal lumen. This study aimed to evaluate the colorectal polyp detection rates on this axis during colonoscopy. Methods: This retrospective study analyzed 1,169 polyps in 513 patients who underwent colonoscopy at Showa University Hospital between November 2022 and February 2023. The short-axis lumen was divided into: upper right, lower right, lower left, and upper left. Each polyp detected was assigned to a quadrant. Detection rates were compared across quadrants and analyzed for associations with clinicopathological factors including lesion size, location, macroscopic type, and examiner experience. Results: The lesion detection rates varied significantly by quadrant. The upper left quadrant had the lowest detection rate (17.5%) compared with the expected 25.0% per quadrant. Subgroup analyses consistently confirmed the lower detection rates in this quadrant across most lesion types and patient groups, except for lesions in the cecum and rectum. Conclusions The lower detection rate in the upper left quadrant suggests that this orientation poses a challenge and may increase the number of missed lesions. Enhanced examination of this area may improve detection; however, further prospective studies are required.

Background: Multilocus sequence typing (MLST) is well-established for Pasteurella multocida but remains undeveloped for Pasteurella canis. We established MLST for P. canis using isolates from humans and companion animals in Japan and Korea to gain insights into its population biology. Methods: We analyzed 39 and 22 isolates from companion animals and humans, respectively. We selected seven housekeeping genes—adk, aroA, deoD, gdhA, g6pd, mdh, and pgi—used in P. multocida MLST. Primer pairs for PCR amplification and sequencing were designed based on conserved sites in 10 whole-genome sequences. We determined frag-ment sequences, variable sites, allelic profiles, and sequence types (STs) of each isolate. A phylogenetic tree of concatenated sequences was constructed using the goeBURST algo-rithm to identify STs and clonal complexes (CCs). ompAM, encoding outer membrane protein A, was genotyped for molecular characterization. Results: The sequenced fragment lengths and allele numbers of the seven genes wereHallym University College of Medicine, 424, 451, 483, 439, 429, 419, and 440 bp and 16, 13, 15, 18, 22, 19, and 18, respec-tively. ST1–ST47, including CC2, CC10, CC18, CC31, and CC33, were diversely distributed among the isolates from different hosts/countries. In the seven-gene phylogenetic tree, apart from P. multocida, all isolates clustered together. goeBURST diagrams revealed di-verse ST distributions among different hosts (animal/human) and countries (Japan/Ko-rea/others). We found clusters 1–4 in ompA genotyping, indicating that MLST discrimination is higher than ompA typing discrimination. Conclusions We established MLST for P. canis isolates from humans and companion ani-This is an Open Access article distributed under mals in Japan and Korea, thereby providing a robust tool for population biology studies.

Background: Comparative analysis of virulence factors (VFs) between Pasteurella canis and Pasteurella multocida are lacking, although both cause zoonotic infections. We determined the virulence-associated genome sequence characteristics of P. canis and assessed the toxin gene prevalence unique to P. canis among clinical isolates of P. canis and P. multocida. Methods: We selected 10 P. canis and 16 P. multocida whole-genome sequences (WGSs) from the National Center for Biotechnology database. The VFanalyzer tool was used to estimate P. canis-characteristic VFs. Amino acid sequences of VFs were compared with multiple-aligned sequences. The genome structure containing P. canis-characteristic and adjacent loci was compared to the corresponding P. multocida genome structure. After designing primer sequences and assessing their accuracy, we examined the gene prevalence of the P. canis-characteristic VFs using PCR among clinical isolates of P. multocida and P. canis. Results: Using VFanalyzer, we found virulence-associated cytolethal distending toxin (cdt)A–cdtB–cdtC loci common to all P. canis WGSs that were not found in P. multocida WGSs. Similarities in the multiple alignments of CdtA–CdtB–CdtC amino acid sequences were found among the 10 P. canis WGSs. Shared or similar loci around cdtA–cdtB–cdtC were identified between the P. canis and P. multocida genome structures. The PCR-based cdtA–cdtB–cdtC prevalence differed for P. canis and P. multocida clinical isolates. Conclusions P. canis-specific cdtA–cdtB–cdtC prevalence was identified among clinical isolates. These three loci may be unique toxin genes and promising targets for the rapid identification of P. canis in clinical settings.

The abscopal effect refers to the phenomenon in which local radiotherapy is associated with the regression of metastatic cancer that is distantly located from the irradiated site.Here, we present a case of a patient with advanced gastric cancer and brain metastases who was successfully treated with brain radiotherapy and anti-programmed death-1 (PD-1) therapy-induced abscopal effect. Although anti-PD-1 therapy alone could not prevent disease progression, the metastatic lesions in the brain and also in the abdominal lymph node showed a drastic response after brain radiotherapy and anti-PD-1 therapy. To our knowledge, this is the first reported case of successful treatment of advanced gastric cancer with multiple brain and abdominal lymph node metastases, possibly through anti-PD-1 therapy combined with brain radiotherapy-induced abscopal effect. We suggest that the combination of brain radiotherapy and anti-PD-1 therapy may be considered as a therapeutic option for advanced gastric cancer, especially when there is brain metastasis.

　　Capnocytophaga canimorsus is a spindle-shaped facultatively anaerobic Gram-negative rod in the oral cavity of dogs and cats. C. canimorsus rarely infects humans through an animal bite or scratch. However, it leads to severe sepsis once infection occurs, and the fatality rate is estimated to be up to 30%. The patient was a 56-year-old man with fatigue and fever. Sepsis with thrombocytopenia was suspected from the blood examination results. We decided to conduct microscopic examination of a non-stained peripheral blood smear and identified bacteria; therefore, Gram stain was immediately performed and spindle-shaped Gram-negative bacilli were detected. Additionally, the patient had a history of a bite and scratch by his cat. We suspected C. canimorsus infection from the microscopic examination findings and history. Moreover, we determined early that the pathogenic bacterium was C. canimorsus by blood culture. With immediate and proper treatment based on these results, we could rescue this septic patient with disseminated intravascular coagulation. Microscopic examination of non-stained peripheral blood smear is helpful for the early diagnosis of C. canimorsus infection.

With the progressive aging of the Japanese population, cardiac surgeons are increasingly faced with elderly patients. We have studied 29 consecutive patients, 80 years of age or older, who underwent aortic valve replacement at our institution between January 2000 and December 2003. Mortality, morbidity and late follow-up results were compared to those in 36 patients aged from 64 to 75 years old undergoing the same procedure over the same time period. The older patient group had a significantly higher incidence of calcified aortic stenosis and emergency operations and a higher score of NYHA functional class. Hospital mortality was 2 of 29 (6.9%) in the older patient group and 2 of 36 (5.6%) in the control group (ns). Postoperative renal failure and respiratory failure which needed prolonged ventilator support occured significantly more often in the older patient group. However, there was no significant difference between the 2 groups in terms of hospital stay. Almost all octogenarians showed improved NYHA functional class to class I or II after the operations. The actuarial survival rate was 89% in the older patient group and 78% in the control group at 3 years. The late survival rate and cardiac event-free rate were not significantly different between these 2 groups. Following aortic valve replacement, octogenarians, despite more compromised pre-operative status had good relief of symptoms, a favorable quality of life and a similar late survival to the younger patient groups. These findings support the recommendation that valve replacement should be performed in octogenarians with symptomatic aortic valvular disease.

GINS, a heterotetramer of SLD5, PSF1, PSF2, and PSF3 proteins, is an emerging chromatin factor recognized to be involved in the initiation and elongation step of DNA replication. Although the yeast and Xenopus GINS genes are well documented, their orthologous genes in higher eukaryotes are not fully characterized.In this study, we report the genomic structure and transcriptional regulation of mammalian GINS genes. Serum stimulation increased the GINS Mrna levels in human cells. Reporter gene assay using putative GINS promoter sequences revealed that the expression of mammalian GINS is regulated by 17β-Estradiolstimulated estrogen receptor α, and human PSF3 acts as a gene responsive to transcription factor E2F1. The goal of this study is to present the current data so as to encourage further work in the field of GINS gene regulation and functions in mammalian cells.

We encountered 15 cases of surgical site infection (SSI) by Methicillin-resistant Staphylococcus aureus (MRSA) among 153 patients who underwent a cardiovascular operation in 2000. SSIs consisted of 5 mediastinal infections, 9 surface wound infections and 1 artificial graft infection after an abdominal aortic surgery. All infected cases had been operated on between June and December 2000. Eighty-three cases, which underwent cardiovascular operations during this period, were divided into SSI or no-SSI groups and their clinical data were analyzed. The data included age, gender, preoperative diabetes, urgency, preoperative usage of a device like Swan-Ganz catheter or IABP, preoperative albumin level, preoperative physical state by ASA score, National Nosocominal Infections Surveillance index, duration of operation, usage of a cardiopulmonary bypass, duration of bypass, type of operation, and number of distal anastomoses in CABG operations. Multivariate analysis showed gender (male), diabetes, and emergency operation as independent risk factors for the incidence of SSI by MRSA. One patient, who suffered a mediastinal infection after CABG, had confirmed as demonstrating the colonization of MRSA in sputum preoperatively. Microbiological screening of medical staff showed 2 of the 6 surgical doctors and 3 of the 25 ward nurses exhibited colonization with MRSA. DNA analysis of MRSA, harvested from 5 infected patients, indicated at least 2 strains of MRSA and 1 of the 2 strains was identical to the MRSA that was detected in a doctor. We applied prophylactic measures with reference to the guideline for prevention of surgical site infection announced by CDC in 1999, which included the following: routine work-up of MRSA-colonization, and treatment of all MRSA colonized patients and those undergoing emergency operations with Mupirocin. Preoperative patients were isolated from MRSA-infected or colonized patients. MRSA-colonized surgical personnel were treated with Mupirocin ointment. Cephazoline was administered shortly before and after the operation as a prophylactic antibiotic. Vancomycin was added to Cephazoline in patients with a history of MRSA-colonization or infection. Through hand washing before and after daily contact with patients was emphasised to all medical staff. SSI surveillance conducted by an infection control team was implemented. After the introduction of the prophylactic measurements, one MRSA-SSI was observed among 113 cases who underwent a cardiovascular operation between January and September 2001.

A 74-year-old man was admitted to our hospital to undergo an operation for distal aortic arch aneurysm with chronic aortic dissection. The first operation was attempted through left lateral thoracotomy. Since the aorta had a severely calcified false lumen, conventional aortic replacement was considered to entail greater risk and graft replacement was given up. As an another option, endovascular stent grafting via the aortic arch through median sternotomy was selected as a second operation. Deep hypothermic circulatory arrest with selective cerebral perfusion was used during delivery and deployment of the stented graft through the aortotomy site. The distal stented graft was deployed into the true lumen at the ninth thoracic vertebral level. Neither endoleaks nor complications were observed. Postoperative computed tomography showed complete thrombosis of the distal aortic arch aneurysm and the false lumen. The postoperative course was uneventful. Transaortic endovascular stent grafting is an effective and less invasive treatment for aortic arch aneurysms with severely calcified aorta.