A case series title: femoral nerve injury with an episode of motor neuropathy caused by gynecological surgery: a case series.

Background: Although iatrogenic nerve injury is sometimes diagnosed after gynecological surgery, its incidence is underestimated because most cases are self-limiting and underreported. Herein, we report on six cases of femoral nerve injury after gynecological surgery with both sensory and motor neuropathy. Methods: We retrospectively analyzed 785 patients with gynecological cancer requiring surgery, including lymph node dissection, between 2012 and 2016 at our center. The functional damage due to femoral nerve injury was postoperatively assessed and classified according to the Medical Research Council (MRC) scale by an orthopedist and a physiatrist. The eligibility criteria were grade 3 or less hip joint bending and muscular weakness due to nerve injury. Patients were excluded if they had been diagnosed with an isolated sensory disorder. Results: We found six cases (0.76%) of femoral motor neuropathy resulting from gynecological surgery. All six patients underwent laparotomy using energy devices under general anesthesia with epidural anesthesia in the lithotomy position. Four of them recovered fully within 8 months from surgery with either physical therapy or no treatment, while the other two died within a year post-treatment; thus, recovery evaluation could not be accurately performed. Conclusion: Postoperative femoral nerve injury can be diagnosed based on gait disturbances and difficulties climbing stairs. It is difficult to identify risk factors for femoral nerve injury as they may involve a combination of features, such as intraoperative compression with self-retaining retractors, the lithotomy position, and the use of energy devices. The surgeon should be familiar with the nature of energy devices, make every effort to understand the necessary anatomy, and make every effort to avoid femoral nerve injury. Iatrogenic femoral nerve injury caused by gynecological surgery should be further investigated regarding the patients' quality of life postoperatively.

Endometrioid Endometrial Carcinoma With NKX3.1 Expression in a Transgender Man: A Case Report.

Endometrial cancer in transgender men is rare, and its histopathologic features remain unknown. A 30-yr-old transgender man with an intrauterine tumor, an ovarian mass, and a 2-yr history of testosterone use was referred to us for treatment. The presence of the tumors was confirmed via imaging, and the intrauterine tumor was identified as an endometrial endometrioid carcinoma via endometrial biopsy. The patient underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection. Pathologic examination revealed grade 3 endometrioid endometrial carcinoma, and the synchronous endometrial and ovarian tumors were collectively characterized as primary endometrial carcinoma. Metastatic carcinomas were discovered in both ovaries and the omentum, pelvic peritoneum, and a para-aortic lymph node. On immunohistochemistry, the tumor cells diffusely expressed p53, retained expression of PTEN, ARID1A, PMS2, and MSH6, and focally expressed estrogen receptors, androgen receptors, and NKX3.1. NKX3.1 was also expressed in glandular structures within the exocervical squamous epithelium. Prostate-specific antigen and prostatic acid phosphatase were focally positive. In conclusion, we describe a transgender man with NKX3.1-expressing endometrioid endometrial carcinoma who provides valuable suggestions regarding the effects of testosterone on endometrial cancer and appropriate gynecological care for transgender men.

Iris-like eye closure of the fine-patterned pufferfish, Takifugu flavipterus.

Unlike many tetrapods and elasmobranchs, eye-closing ability is absent in bony fishes, with the single-known exception of the family Tetraodontidae. We observed the eye-closing response of the tetraodontid fine-patterned puffer, Takifugu flavipterus, which provides the first detailed data on the kinematics and mechanism of this ability in this family. During eye-closing behavior, the skin around the eye converges toward the center of the iris. This is very different to the reversing uni-directional (e.g., upward then downward) movement of the eyelids of other vertebrates. Electrical stimulation of a freshly dead specimen showed that this movement occurs due to the contraction of a sheet of muscle located just beneath the skin around the eye, which is characteristic of Family Tetraodontidae. Eye-closing is accompanied by simultaneous retraction of the eyeball away from the surface, which is initiated just before the skin of the eye begins to move. The eye-closing ability observed in this study appears to have been acquired independently in the Tetraodontidae.

New records of Philometra pellucida (Jägerskiöld, 1893) (Nematoda: Philometridae) from the body cavity of Arothron mappa (Lesson) and Arothron nigropunctatus (Bloch et Schneider) reared in aquariums, with synonymisation of Philometra robusta Moravec, Möller et Heeger, 1992.

We encountered two cases of infection with large female nematodes of the genus Philometra Costa, 1845 in the body cavity of a map puffer Arothron mappa (Lesson) caught off Okinawa, Japan, and a blackspotted puffer Arothron nigropunctatus (Bloch et Schneider) caught off Queensland, Australia, both reared in aquariums in Japan. No morphological difference was observed between the nematodes from A. mappa and A. nigropunctatus. We identified the nematodes as Philometra pellucida (Jägerskiöld, 1893) based on their morphology. The sequences of the nematodes from both hosts were identical to each other (1,643 bp) and formed a clade with other 17 nematodes belonging to the genera Philometra and Philometroides Yamaguti, 1935 with high bootstrap value (bp = 100). It is the first time that the genetic data on P. pellucida are provided. Philometra robusta Moravec, Möller et Heeger, 1992 is synonymised with the former species.

Slingshot feeding of the goblin shark Mitsukurina owstoni (Pisces: Lamniformes: Mitsukurinidae).

Five striking and prey capture events of two goblin sharks were videotaped at sea for the first time, showing their extraordinary biting process. The goblin sharks swung their lower jaw downward and backward to attain a huge gape and then rapidly protruded the jaws forward a considerable distance. The jaws were projected at a maximum velocity of 3.1 m/s to 8.6-9.4% of the total length of the shark, which is by far the fastest and greatest jaw protrusion among sharks. While the jaws were being retracted, the mouth opened and closed again, which was considered a novel feeding event for sharks. Phylogenetic evidence suggested that their feeding behavior has evolved as an adaptation to food-poor deep-sea environments, possibly as a trade-off for the loss of strong swimming ability.