Search

Background: Although minimally invasive total gastrectomy for gastric cancer is commonly performed, reports regarding late complications are limited. We have made several improvements each time we experienced severe late complications since 2009. This study aimed to evaluate the clinical efficacy of these improved procedures in preventing late complications. Methods: Between January 2009 and December 2019, 302 patients who underwent laparoscopic or robotic total gastrectomy for gastric cancer were enrolled. The patients were divided into two groups: Period-I (2009–2013, before established standardization of procedure, 166 patients) and Period-II (2014–2019, after established standardization of procedure, 136 patients). The standardized procedure comprised four major steps, including closure of the mesentery defects and diaphragm crus, circumferential fixation of the anastomotic site into the diaphragm, and linearization around the anastomotic site of esophagojejunostomy. The incidence of late complications was retrospectively compared between the two groups. Results: Late overall complications that occurred over 30 days after surgery were observed in 19 (6.3%) patients. In all, 14 of 24 (58.3%) patients admitted due to late intestinal complications eventually required reoperation for treatment. The most frequent complication was nonstenotic outlet obstruction of the distal jejunal limb. The incidence of late overall complications was significantly lower in Period-II than in Period-I (2.9 vs 9.0%, p= 0.030). Intestinal complications were reduced considerably in Period-II. The 3-year cumulative incidence rate of late overall complications was significantly lower in Period-II than in Period-I (0.03 vs 0.10, p= 0.035). Period-I as the only independent risk factor for the development of late intestinal complications. Conclusion: Late complications after laparoscopic total gastrectomy sometimes occurred, and more than half of the patients with intestinal complications required reoperation. Our standardized procedure was associated with a lower risk of late intestinal complications after minimally invasive total gastrectomy followed by intracorporeal esophagojejunostomy using linear staplers in a cohort of patients with gastric cancer.

Background: Although the da Vinci™ Surgical System is the most predominantly used surgical robot worldwide, other surgical robots are being developed. The Japanese surgical robot hinotori™ Surgical Robot System was launched and approved for clinical use in Japan in November 2022. We performed the first robotic gastrectomy for gastric cancer using hinotori in the world. Here, we report our initial experience and evaluation of the feasibility and safety of robotic gastrectomy for gastric cancer using hinotori. Methods: A single-institution retrospective study was conducted. Between November 2022 and October 2023, 24 patients with gastric cancer underwent robotic gastrectomy with hinotori. Five ports, including one for an assistant, were placed in the upper abdomen, and gastric resection with standard lymphadenectomy and intracorporeal reconstruction were performed. The primary endpoint was the postoperative complication rate within 30 days after surgery. The secondary outcomes were surgical outcomes, including intraoperative adverse events, operative time, blood loss, and the number of dissected nodes. Results: Of the 24 patients, 16 (66.7%) were male. The median age and body mass index were 73.5 years and 22.9 kg/m2, respectively. Twenty-three patients (95.8%) had tumors in the middle to lower stomach. Sixteen (66.7%) and seven (29.2%) patients had clinical stage I and II diseases, respectively. Twenty-three (95.8%) patients underwent distal gastrectomy. No patient had postoperative complications of Clavien–Dindo classification IIIa or higher, whereas two (8.3%) had the grade II complications (enteritis and pneumonia). No intraoperative adverse events, including conversion to other approaches, were observed. All patients received R0 resection. The median operative and console times were 400 and 305 min, respectively. The median blood loss was 14.5 mL, and the number of lymph nodes dissected was 51.5. Conclusions: This study found that robotic gastrectomy with standard lymphadenectomy for gastric cancer using hinotori can be safely performed.

Background: This study aimed to investigate the laparoscopic gastrectomy (LG) performance of non-Endoscopic Surgical Skill Qualification System (ESSQS)-qualified surgeons under the ESSQS-qualified surgeon guidance and compare oncological outcomes of gastric cancer to LG performed by the ESSQS-qualified surgeons. Methods: This study enrolled 1,030 patients diagnosed with both clinical and pathological stage ≤ III gastric cancer and undergoing LG from January 2009 to June 2019. ESSQS-qualified surgeons served as the operator or the instructive assistant in all LG procedures involving them. A propensity score-matched analysis was used to retrospectively compare the long-term outcomes between the ESSQS-qualified and non-ESSQS-qualified surgeons. Results: Each group included 315 pairs after propensity score matching. The 3-year recurrence-free survival rates were 84.4% and 81.7% in the non-ESSQS and ESSQS groups, respectively. The difference was 2.7% (95% confidence interval: − 3.20%–8.44%, P< 0.001), and the non-ESSQS group statistically demonstrated noninferiority as the lower 95% confidence limit was greater than the prespecified margin of -10%, indicating the achieved primary endpoint. No significant differences in 5-year recurrence-free survival (non-ESSQS: 78.5% vs. ESSQS: 77.4%, P= 0.627) and 5-year overall survival (non-ESSQS: 80.9% vs. ESSQS: 79.3%, P= 0.475) were found between the two groups. The oncological outcomes stratified according to the presence of pathological stage I, II, and III disease did not significantly differ between the two groups. Conclusions: LG performed by non-ESSQS-qualified surgeons achieved comparable oncological outcomes to the ESSQS-qualified surgeons, as long as ESSQS-qualified surgeons provided intraoperative instructions, in a high-volume center.

Background: Systematic lymph node dissection in patients with gastric cancer could be sufficiently and reproducibly achieved along the outermost layer of the autonomic nerves and similar concept has been extensively used for robotic esophagectomy (RE) since 2018. This study aimed to determine the surgical and oncological safety of RE using the outermost layer-oriented approach for esophageal cancer (EC). Methods: Sixty-six patients who underwent RE with total mediastinal lymphadenectomy for primary EC between April 2018 and December 2021 were retrospectively reviewed. All underwent the outermost layer-oriented approach with intraoperative nerve monitoring (IONM). Postoperative complications within 30 days were analyzed. Results: Among the patients, 51 (77.3%) were male. The median age was 64 years, and the body mass index was 21.8 kg/m2. Furthermore, 58 (87.9%) patients had squamous cell carcinoma and eight (12.1%) patients had adenocarcinoma. Clinical stages I, II, and III were seen in 23 (34.8%), 23 (34.8%), and 16 (24.2%) patients, respectively. Thirty-four (51.5%) patients received preoperative treatment. No patient shifted to conventional thoracoscopic or open procedure intraoperatively. The median operative time was 716 min with 119 mL of blood loss. Additionally, 64 (97%) patients underwent R0 resection. The morbidity rates based on Clavien–Dindo grades ≥ II and ≥ IIIa were 30.3% and 10.6%, respectively, within 30 postoperative days. None died within 90 days postoperatively. Three (4.5%) patients exhibited recurrent laryngeal nerve (RLN) palsy (CD grade ≥ II). The sensitivity and specificity of IONM for RLN palsy were 50% and 98.3% at the right RLN and 33.3% and 98.0% at the left RLN, respectively. Conclusion: RE with the outermost layer-oriented approach can provide safe short-term outcomes.

ABSTRACTBarley (Hordeum vulgareL.) growth is often inhibited under waterlogged fields. Under waterlogging, a higher C/N ratio in soil easily leads to low oxygen concentration and soil reduction. Although the tolerant varieties for waterlogging and soil reduction were previously reported, those root growth under hypoxia remains unknown. In this study, more than 90% of total leaf area in Deder 2, Hayakiso 2 and Akashinriki remained green even under waterlogged and reduced soil condition at seedling stage. The root elongation of Deder 2 and Hayakiso 2 was similar between aerobic and hypoxic conditions. In comparison, severe leaf necrosis was observed in Haruna Nijo and Houshun. Those root elongation was significantly inhibited under hypoxia, as compared with that under aerobic condition. In conclusion, it was considered that barley varieties tolerant to waterlogged reduced soil showed the better root growth in hypoxia in this study.

Cyclodehydrogenation is an essential synthetic method for the preparation of polycyclic aromatic hydrocarbons, polycyclic heteroaromatic compounds, and nanographenes. Among the many examples, anionic cyclodehydrogenation using potassium(0) has attracted synthetic chemists because of its irreplaceable reactivity and utility in obtaining rylene structures from binaphthyl derivatives. However, existing methods are difficult to use in terms of practicality, pyrophoricity, and lack of scalability and applicability. Herein, we report the development of a lithium(0)-mediated mechanochemical anionic cyclodehydrogenation reaction for the first time. This reaction could be easily performed using a conventional and easy-to-handle lithium(0) wire at room temperature, even under air, and the reaction of 1,1′-binaphthyl is complete within 30 min to afford perylene in 94% yield. Using this novel and user-friendly protocol, we investigated substrate scope, reaction mechanism, and gram-scale synthesis. As a result, remarkable applicability and practicality over previous methods, as well as limitations, were comprehensively studied by computational studies and nuclear magnetic resonance analysis. Furthermore, we demonstrated two-, three-, and five-fold cyclodehydrogenations for the synthesis of novel nanographenes. In particular, quinterrylene ([5]rylene or pentarylene), the longest nonsubstituted molecular rylene, was synthesized for the first time.

Background: Valvuloplastic esophagogastrostomy (VEG) using the double flap technique (DFT) after proximal gastrectomy (PG) represents a promising procedure for the prevention of reflux oesophagitis. We aimed to retrospectively investigate the efficacy of minimally invasive PG followed by VEG-DFT in preventing reflux oesophagitis among patients who require intra-mediastinal anastomosis. Methods: A total of 80 patients who underwent reconstruction with DFT after LPG from November 2013 to January 2021 were enrolled in the present study. Data were obtained through a review of our prospectively maintained database. At 1 year after surgery, multivariate analyses were performed to identify risk factors for gastroesophageal reflux disease of Los Angeles (LA) classification grade B or higher. Results: The incidence of LA grade B or higher reflux oesophagitis 1 year after surgery was 10%. Multivariate analyses revealed that the longitudinal length of the resected oesophagus of > 20 mm was the only significant risk factor for reflux oesophagitis. Patients with a longitudinal length of the resected oesophagus > 20 mm (group-L, n= 35) had a significantly longer total operative time and a higher rate of complications within 30 days of surgery than those with a length of ≤ 20 mm (group-S, n= 45). LA grade B or higher reflux oesophagitis was significantly higher in group-L than in group-S (20% vs. 2.2%; P= 0.011). Conclusions: There is a need for surgical procedures with improved efficacy for the prevention of reflux oesophagitis in patients requiring oesophageal resection of > 20-mm.

Background: Oncological benefits of robotic gastrectomy (RG) remain unclear. We aimed to determine and compare the 3-year outcomes of RG and laparoscopic gastrectomy (LG) for the treatment of gastric cancer. Methods: This was a multi-institutional retrospective study of patients who prospectively underwent RG in a previous study (UMIN000015388) and historical controls who underwent LG. Operable patients with cStage I/II primary gastric cancer were enrolled. The inverse probability of treatment weighting method based on propensity scores was used to balance patient demographic factors and surgeon volume between the RG and LG groups. The primary outcome measure was the 3-year overall survival rate (3yOS). Results: Of the 1,127 patients in the previous study, 326 and 752 patients in the RG and LG groups, respectively, completed the study. The standardized difference of all confounding factors was reduced to 0.09 or less after weighting. In the weighted population, 3yOS was 96.3% and 89.6% in the RG and LG groups, respectively (hazard ratio [HR] 0.34 [0.15, 0.76]; p= 0.009), whereas there was no difference in 3-year recurrence-free survival rate (3yRFS) between the two groups (HR 0.58 [0.32, 1.05]; p= 0.073). Sub-analyses showed that RG improved 3yOS (HR 0.05 [0.01, 0.38]; p= 0.004) and 3yRFS (HR 0.05 [0.01, 0.34]; p= 0.003) in patients with pStage IA disease. Recurrence rates and patterns were similar between the RG and LG groups. RG did not improve the morbidity rate, however, it attenuated some of the adverse events, including anastomotic leakage and intra-abdominal abscess. RG improved estimated blood loss and duration of postoperative hospitalization. Conclusion: This study showed surgical and oncological safety of RG for cStage I/II gastric cancer considering the 3-year outcomes, compared with those of LG. Graphical abstract:

Background: We hypothesized that the Endoscopic Surgical Skill Qualification System (ESSQS) can shorten operative time, resulting in a decrease in postoperative morbidity. Here, we aimed to clarify whether ESSQS-qualified surgeons could decrease the incidence of complications. Methods: Between January 2009 and June 2019, 1042 patients diagnosed with both clinical and pathological Stage ≤ III gastric cancer and undergoing LG were enrolled. In all LG procedures involving ESSQS-qualified surgeons, these served as the operator or the instructive assistant. The short-term outcomes were retrospectively compared between the ESSQS-qualified and the non-ESSQS-qualified surgeons using a propensity-score matched analysis. Results: After propensity-score matching, 321 patients were included in each group. No significant differences were observed in morbidity rate, and length of hospitalization following surgery, although the non-ESSQS-qualified surgeon group had a significantly longer total operative time (Non-ESSQS-qualified group, 368 [170–779] min vs.ESSQS-qualified group, 316 [147–772] min; p< 0.001), and larger estimated blood loss (Non-ESSQS-qualified group, 28 [0–702] mL vs. ESSQS-qualified group 25, [0–1069] mL; p= 0.042). Multivariate analysis revealed that operative time ≥ 360 min (OR 1.818 [1.069–3.094], p= 0.027) was identified as the only significant independent risk factor determining morbidity. Conclusions: The incidence of postoperative morbidity did not differ between patients operated by the qualified and nonqualified surgeons, as long as ESSQS-qualified surgeons provide intraoperative instructions.

Advances in genomics have expedited the improvement of several agriculturally important crops but similar efforts in wheat (Triticumspp.) have been more challenging. This is largely owing to the size and complexity of the wheat genome1, and the lack of genome-assembly data for multiple wheat lines2,3. Here we generated ten chromosome pseudomolecule and five scaffold assemblies of hexaploid wheat to explore the genomic diversity among wheat lines from global breeding programs. Comparative analysis revealed extensive structural rearrangements, introgressions from wild relatives and differences in gene content resulting from complex breeding histories aimed at improving adaptation to diverse environments, grain yield and quality, and resistance to stresses4,5. We provide examples outlining the utility of these genomes, including a detailed multi-genome-derived nucleotide-binding leucine-rich repeat protein repertoire involved in disease resistance and the characterization of Sm16, a gene associated with insect resistance. These genome assemblies will provide a basis for functional gene discovery and breeding to deliver the next generation of modern wheat cultivars.

Laparoscopic gastrectomy (LG) for remnant gastric cancer (RGC) remains controversial because of its rarity and heterogeneity of clinical characteristics. Based on our experience, we posited that our established methodology in LG could be applied to the laparoscopic procedure for RGC surgery and introduced LG for RGC at our institution in 2004.

Background Primary malignant melanoma of the esophagus is a rare tumor with a poor prognosis; the optimal treatment strategy has yet to be established. This study aimed to clarify clinical features, courses, and outcomes of patients undergoing surgical resection of primary malignant melanoma of the esophagus.Methods Six patients with primary malignant melanoma of the esophagus, in whom the absence of other primary melanomas had been confirmed, were selected from the medical database maintained in Toranomon Hospital. Their clinicopathological characteristics and long-term outcomes were retrospectively reviewed and analyzed.Results All 6 patients (five males and one female) underwent radical esophagectomy with three-field regional lymphadenectomy, and none received neoadjuvant therapy. Tumor invasion was classified into T1 in 5 (83%) cases and T3 in one (17%). Four (67%) patients had nodal metastases (one N1, one N2 and two N3). No distant metastatic lesions were detected preoperatively in any of our cases. Postoperative surveillance revealed recurrence in all 6 patients, and 5 (83%) died of the disease. The median overall survival was 24 months. One patient with a T3N3M0 tumor was treated after surgery with a dacarbazine-nimustine-vincristine regimen followed by irradiation for bone recurrence and survived for 87 months postoperatively. Another patient with a T1N3M0 tumor who survived for 27 months after liver and bone recurrence was treated with nivolumab, ipilimumab, and dacarbazine.Conclusion Although the courses of patients with primary malignant melanoma of the esophagus were consistently unfavorable, surgical resection with multidisciplinary therapeutic modalities may prolong survival in some cases.

Extant eukaryote ecology is primarily sustained by oxygenic photosynthesis, in which chlorophylls play essential roles. The exceptional photosensitivity of chlorophylls allows them to harvest solar energy for photosynthesis, but on the other hand, they also generate cytotoxic reactive oxygen species. A risk of such phototoxicity of the chlorophyll must become particularly prominent upon dynamic cellular interactions that potentially disrupt the mechanisms that are designed to quench photoexcited chlorophylls in the phototrophic cells. Extensive examination of a wide variety of phagotrophic, parasitic, and phototrophic microeukaryotes demonstrates that a catabolic process that converts chlorophylls into nonphotosensitive 132,173-cyclopheophorbide enols (CPEs) is phylogenetically ubiquitous among extant eukaryotes. The accumulation of CPEs is identified in phagotrophic algivores belonging to virtually all major eukaryotic assemblages with the exception of Archaeplastida, in which no algivorous species have been reported. In addition, accumulation of CPEs is revealed to be common among phototrophic microeukaryotes (i.e., microalgae) along with dismantling of their secondary chloroplasts. Thus, we infer that CPE-accumulating chlorophyll catabolism (CACC) primarily evolved among algivorous microeukaryotes to detoxify chlorophylls in an early stage of their evolution. Subsequently, it also underpinned photosynthetic endosymbiosis by securing close interactions with photosynthetic machinery containing abundant chlorophylls, which led to the acquisition of secondary chloroplasts. Our results strongly suggest that CACC, which allowed the consumption of oxygenic primary producers, ultimately permitted the successful radiation of the eukaryotes throughout and after the late Proterozoic global oxygenation.

Extant eukaryote ecology is primarily sustained by oxygenic photosynthesis, in which chlorophylls play essential roles. The exceptional photosensitivity of chlorophylls allows them to harvest solar energy for photosynthesis, but on the other hand, they also generate cytotoxic reactive oxygen species. A risk of such phototoxicity of the chlorophyll must become particularly prominent upon dynamic cellular interactions that potentially disrupt the mechanisms that are designed to quench photoexcited chlorophylls in the phototrophic cells. Extensive examination of a wide variety of phagotrophic, parasitic, and phototrophic microeukaryotes demonstrates that a catabolic process that converts chlorophylls into nonphotosensitive 132,173-cyclopheophorbide enols (CPEs) is phylogenetically ubiquitous among extant eukaryotes. The accumulation of CPEs is identified in phagotrophic algivores belonging to virtually all major eukaryotic assemblages with the exception of Archaeplastida, in which no algivorous species have been reported. In addition, accumulation of CPEs is revealed to be common among phototrophic microeukaryotes (i.e., microalgae) along with dismantling of their secondary chloroplasts. Thus, we infer that CPE-accumulating chlorophyll catabolism (CACC) primarily evolved among algivorous microeukaryotes to detoxify chlorophylls in an early stage of their evolution. Subsequently, it also underpinned photosynthetic endosymbiosis by securing close interactions with photosynthetic machinery containing abundant chlorophylls, which led to the acquisition of secondary chloroplasts. Our results strongly suggest that CACC, which allowed the consumption of oxygenic primary producers, ultimately permitted the successful radiation of the eukaryotes throughout and after the late Proterozoic global oxygenation.

Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes.

Circulating tumor cells (CTCs) are potential precursors of metastatic cancer, and genomic information obtained from CTCs have the potential to provide new insights into the biology of cancer metastasis. We previously developed a technique for single-cell manipulation based on the encapsulation of a single cell in a photopolymerized hydrogel that can be used for subsequent genetic analysis. However, this technique has limitations in terms of throughput because light irradiation must be performed on each individual cell from the confocal laser-scanning microscopy. Here, we present a high-throughput cell manipulation technique using a multiple single-cell encapsulation system with a digital micromirror device. This system enables rapid cell imaging within a microcavity array, a microfilter for the recovery of CTCs from blood samples, as well as the simultaneous encapsulation of several CTCs with hydrogels photopolymerized using a multiple light-irradiation system. Furthermore, single-cell labeling using two differently shaped hydrogels was examined to distinguish between NCI-H1975 cells and A549 cells, demonstrating the utility of the system for single-cell gene mutation analysis. In addition to CTCs, our system can be widely applied for analyses of mammalian cells and microorganisms.

Limited evidence suggests that multifactorial interventions for control of glucose, blood pressure, and lipids reduce macrovascular complications and mortality in patients with type 2 diabetes. However, safe and effective treatment targets for these risk factors have not been determined for such interventions.

Diatoms contribute 20% of global primary production and form the basis of many marine food webs. Although their species diversity correlates with broad diversity in cell size, there is also an intraspecific cell-size plasticity owing to sexual reproduction and varying environmental conditions. However, despite the ecological significance of the diatom cell size for food-web structure and global biogeochemical cycles, our knowledge about genes underpinning the size of diatom cells remains elusive. Here, a combination of reverse genetics, experimental evolution and comparative RNA-sequencing analyses enabled us to identify a previously unknown genetic control of cell size in the diatom Thalassiosira pseudonana. In particular, the targeted deregulation of the expression of the cell-wall protein silacidin caused a significant increase in valve diameter. Remarkably, the natural downregulation of the silacidin gene transcript due to experimental evolution under low temperature also correlated with cell-size increase. Our data give first evidence for a genetically controlled regulation of cell size in T. pseudonana and possibly other centric diatoms as they also encode the silacidin gene in their genomes.

Diatoms contribute 20% of global primary production and form the basis of many marine food webs. Although their species diversity correlates with broad diversity in cell size, there is also an intraspecific cell-size plasticity owing to sexual reproduction and varying environmental conditions. However, despite the ecological significance of the diatom cell size for food-web structure and global biogeochemical cycles, our knowledge about genes underpinning the size of diatom cells remains elusive. Here, a combination of reverse genetics, experimental evolution and comparative RNA-sequencing analyses enabled us to identify a previously unknown genetic control of cell size in the diatom Thalassiosira pseudonana.In particular, the targeted deregulation of the expression of the cell-wall protein silacidin caused a significant increase in valve diameter. Remarkably, the natural downregulation of the silacidin gene transcript due to experimental evolution under low temperature also correlated with cell-size increase. Our data give first evidence for a genetically controlled regulation of cell size in T. pseudonanaand possibly other centric diatoms as they also encode the silacidin gene in their genomes.

Introduction:The lateral window approach for maxillary sinus augmentation is a delicate procedure that can be tedious and time consuming. This case report introduces and describes a novel approach to sinus augmentation using dense medical grade polyurethane sponges to elevate the Schneiderian membrane in a simplified manner with reduced risk for sinus membrane perforation. Case Presentation:A 55‐year‐old female patient was referred for evaluation to replace retained tooth #A with a dental implant. Clinical and radiographic assessment indicated a retained deciduous tooth, pneumatization of the maxillary sinus, and a buccal ridge deformity. Tooth #A was extracted, and sinus elevation was performed via a lateral approach by gradually introducing medical grade dense polyurethane sponges. Expansion of the sponges allowed elevation of the sinus membrane from the lateral, inferior, and medial sinus walls. Bovine bone mineral xenograft was placed into the subantral cavity and the buccal deficiency. A resorbable collagen membrane was positioned over the grafted material, covering the lateral osteotomy window. A total lift of 13.7 mm was achieved according to the cone beam computed tomography images obtained, permitting placement of a 4.1 × 10 mm dental implant. Conclusion:This case report describes a novel approach of elevating the sinus membrane by using dense polyurethane sponges to safely and gently elevate the Schneiderian membrane.

Distal advanced gastric cancer (AGC) occasionally causes gastric outlet obstruction (GOO). We developed a laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ) to restore the ability of food intake. This was a retrospective study performed at a single institution. Of consecutive 78 patients with GOO caused by AGC between 2006 and 2012, 43 patients who underwent LSPGJ were enrolled. The procedure was performed in an antiperistaltic Billroth II fashion, and the afferent loop was elevated and fixed along the staple line of the proximal partitioned stomach. Then, patients for whom R0 resection was planned received chemotherapy prior to laparoscopic gastrectomy. The primary end point was food intake at the time of discharge, which was evaluated using the GOO scoring system (GOOSS). Short- and long-term outcomes were assessed as secondary end points. Overall survival was estimated and compared between the groups who received neoadjuvant chemotherapy followed by surgery (NAC group), definitive chemotherapy followed by curative resection (Conversion group), and best supportive care (BSC group). The median operative time was 92 min, blood loss did not exceed 30 g in any patient, and postoperative complications (Clavien–Dindo grade ≥2) were only seen in four patients (9.3 %). The median time to food intake was 3 days, and GOOSS scores were significantly improved in 41 patients (95.3 %). Chemotherapy was administered to 38 patients (88.4 %), of whom 11 later underwent radical resection, and 4 of 11 patients underwent conversion surgery following definitive chemotherapy. Median survival times were significantly superior in the NAC (n= 7; 46.8 months) and Conversion (n= 4; 35.9 months) groups than in the BSC group (n= 26; 12.2 months); however, the difference was not significant between the Conversion and NAC groups. LSPGJ is a feasible and safe minimally invasive induction surgery for patients with GOO from surgical and oncological perspectives.

Electrochemical sensing systems have been utilized in biosensors because it is easy to integrate the electrodes and electric circuits on miniaturized devices. In contrast, it was hard to integrate photo-sensing systems consisting of advanced optical components (e.g., condensing lenses and optical filters) in small devices due to the difficulties in miniaturization and cost-cutting of those optical components. However, recent efforts overcame this technical barrier, and thus a huge number of two-dimensional (2D) photosensors are equipped in digital cameras and smartphones, and widely used around the world. Technical development of such photosensors led to creation of novel biosensing systems enabling rapid, sensitive, and easy detection of biomolecules and microorganisms. This article summarized our recent achievement on wide-field imaging-based biosensors in which complementary metal oxide semiconductor (CMOS) image sensors were used for detection of various biological objects. In particular, high content analysis of single cells based on the developed photo-biosensing systems is introduced.

A delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy could be performed easily and sufficiently using only laparoscopic linear staplers. However, the restricted maneuverability and severe blurring of these staplers along with their limited hemostability induced strain. In this study, we determined the feasibility and safety of performing delta-shaped anastomosis using the Endo GIA™ Reloads with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler (Tri-Staple) with a particular focus on short-term surgical outcomes. We performed a single-institutional prospective interventional study (UMIN 000008014). The Tri-Staple was prospectively used on 23 consecutive patients who underwent a curative totally laparoscopic Billroth I gastrectomy with delta-shaped anastomosis. These patients were matched with the 19 patients previously treated using the ENDOPATH®ETS Articulating Linear Cutters (ETS) on clinical and demographic characteristics. There were no differences between the groups in anastomosis-related local complications, morbidity, non-anastomosis-related local complications, total systemic complications, and short-term outcomes with the exception of significantly reduced blood loss in the Tri-Staple group (ETS vs. Tri-Staple: 37 [10–306] vs. 15 [5–210] mL, p= 0.02). Intraoperative bleeding from the staple line was significantly reduced in the Tri-Staple group. The postoperative drain indwelling period (ETS vs. Tri-Staple, 6 [4–10] vs. 4 [2–43] days, p= 0.032), fasting period (5 [3–7] vs. 3 [3–24] days, p= 0.022), and hospital stay (14 [10–47] vs. 11 [6–58] days, p= 0.025) were significantly shorter in the Tri-Staple group. There was no mortality in this series. Acceleration assessed as indices of blurring of stapler tip might have a significant adverse influence on staple-line bleeding at stapling sites. Totally laparoscopic Billroth I distal gastrectomy using Tri-Staple was feasible and safe with favorable short-term surgical outcomes. Reduced blurring while stapling may be a novel endpoint which newly developed stapling devices should target.

This Paper proposes a method to improve plastic deformation capacity of the welded wide flange beam-to-column connections in existing steel buildings by using supplemental H-section haunches jointed by high-strength bolts and welding which expected to secure construction quality. By attaching supplemental haunches to upper and lower flanges of the beam end, the critical section is moved from the beam end to the beam cross-section corresponding to the tip of the supplemental haunch. As a result, it could prevent the fracture of beam flange initiated from toe of weld access hole. Cumulative plastic deformation capacities of retrofitted specimens were 1.5 to 2.0 times larger than that of un-retrofitted specimen.

In totally laparoscopic distal gastrectomy, determining the resection line with safe proximal margins is often difficult, particularly for tumors located in a relatively upper area. This is because, in contrast to open surgery, identifying lesions by palpating or opening the stomach is essentially impossible. This study introduces a useful method of tumor identification that is accurate, safe, and rapid. On the operation day, after inducing general anesthesia, a mixture of sodium hyaluronate and patent blue is injected into the submucosal layer of the proximal margin. When resecting stomach, all marker spots should be on the resected side. In all cases, the proximal margin is examined histologically by using frozen sections during the operation. From October 2009 to September 2011, a prospective study that evaluated this method was performed. A total of 34 patients who underwent totally laparoscopic distal gastrectomy were enrolled in this study. Approximately 5 min was required to complete the procedure. Proximal margins were negative in all cases, and the mean ± standard deviation length of the proximal margin was 23.5 ± 12.8 mm. No side effects, such as allergy, were encountered. As a method of tumor identification for totally laparoscopic distal gastrectomy, this procedure appears accurate, safe, and rapid.

For biodiesel production from microalgae, it is desirable to understand the entire triacylglycerol (TAG) metabolism. TAG accumulation occurs in oil bodies, and although oil body-associated proteins could play important roles in TAG metabolism, only a few microalgal species have been studied by a comprehensive analysis. Diatoms are microalgae that are promising producers of biodiesel, on which such proteomics analysis has not been conducted to date. Herein, we identified oil body-associated proteins in the oleaginous diatom Fistuliferasp. strain JPCC DA0580. The oil body fraction was separated by cell disruption with beads beating and subsequent ultracentrifugation. Contaminating factors could be removed by comparing proteins from the oil body and the soluble fractions. This novel strategy successfully revealed 15 proteins as oil body-associated protein candidates. Among them, two proteins, which were parts of proteins predicted to have transmembrane domains, were indeed confirmed to specifically localize to the oil bodies in this strain by observation of GFP fusion proteins. One (predicted to be a potassium channel) was also detected from the ER, suggesting that oil bodies might originate from the ER. By utilizing this novel subtraction method, we succeeded in identifying the oil body-associated proteins in the diatom for the first time.

Use of Si substrates for the fabrication of microwave AlGaN/GaN heterojunction field effect transistors (HFETs) has been strongly desired for the low cost fabrication. The performance so far has never been satisfactory in view of the output power and the gain as compared with those on SiC substrates. In this paper, AlGaN/GaN HFETs on Si with high output power of 203 W and high linear gain of 16.9 dB at 2.5 GHz are demonstrated. The HFETs have field plates to reduce the feedback capacitance leading to higher gain, of which a new design of the field plates enables high power as well. The structural design is based on the equivalent circuit model using the device parameters extracted from the small signal RF performances. Here, it is found that shortening the field plate length down to 0.6 μm results in the high output power owing to the stable output impedance for various drain voltage. Note that the conditions of the epitaxial growth are optimized to achieve high current density of 850 mA/mm with both the high mobility and high sheet carrier concentration. The device processing is established so as to achieve the high power operation free from the current collapse. The device can be operated at the drain voltage as high as 50 V, which enables the 200 W output power. The presented AlGaN/GaN HFETs are very promising for various microwave applications including cellular base stations, which would lower the system cost taking advantage of cost-effective Si substrates.

DNA recovery using solid-phase extraction is a fundamental technique in molecular biology and biotechnology. Our research group developed a novel DNA recovery method using amine-modified magnetic nanoparticles (MNPs) as a solid support. The use of MNPs simplifies the DNA recovery processes and permits their use in automated systems. In this study, we prepared polyamidoamine-modified superparamagnetic particles (PAMAM–SpMNPs) with 10-nm magnetite cores and used them for DNA recovery. To improve the DNA-release efficiency, the surface amine numbers on the particles were evaluated to modify each generation of PAMAM. With this optimization, the PAMAM–SpMNPs maintained a high DNA adsorption capacity and high dispersivity in solution. As a result, the DNA release from the PAMAM–SpMNPs of every generation was highly efficient. In particular, the release of DNA from the G4 to G6 PAMAM–SpMNPs was greater than 95%. Furthermore, an alternating magnetic field (AMF) was applied to expedite the DNA release from the PAMAM–SpMNPs. Complete DNA release was achieved using AMF treatment for 10?min. The DNA recovery method using the PAMAM–SpMNPs will permit various types of testing using DNA from a low volume sample, such as in a micro total analytical system.

In the semiconductor technology using the 193nm ArF excimer laser, the problem of radiation damage on photomask becomes more serious. This phenomenon is regarded as serious issue for semiconductor device fabrication. Some approaches have been tried to prevent the radiation damage. One of reports indicates that the radiation damage can be reduced by using an exposure tool with ultra clean extreme dry air [1]. However, it is difficult to adopt dry air into all exposure tools due to high cost. In our previous work, two facts were ascertained; radiation damage is caused by MoSi film oxidation, and depends on MoSi film composition [2]. In this paper, radiation damage was tried to decrease by MoSi film modification of att. PSM. MoSi film composition for PSM is optimized in consideration of cleaning durability, mask defect repair and processability. The new PSM is named AID (Anti Irradiation Damage). Radiation damage of AID PSM can be improved by 40[%] from conventional PSM. Cleaning durability can be also improved by AID PSM. The other evaluation items such as CD performance, cross section, defect level and repair, are equal between the AID PSM and conventional one. Additionally, the lithography performances by simulation of AID PSM are equivalent with that of conventional PSM. Therefore, it can be expected that there is no difficulty in converting conventional PSM into AID PSM. From these evaluation results, development of AID PSM was completed, and preparation for production is now going.

Recent progress in GaN-based power electron devices and advanced thermal management techniques for high performance GaN power devices are described. Recent advances in high performance GaN-based transistors are reviewed. The reduction of junction temperatures in low-pressure direct liquid cooling of GaN power devices for high-power and high-voltage applications are demonstrated using perfluorocarbon and perfluoroether as a working fluid, for the first time.

In this paper, recent advances in GaNbased transistors for power switching and millimeter wave communications are reviewed. These two applications are emerging in addition to the widely developed power amplifiers at microwave frequencies mainly for cellular base stations. Reduction of the fabrication cost is strongly required for power switching GaN transistors, which is enabled by our epitaxial growth technology on large area Si substrates. Another requisite for the application is to achieve normallyoff operation and our novel device structure called Gate Injection Transistors GIT enables it with low enough specific onresistance Ron· A and high drain current. Here, we also present the world highest breakdown voltage of 10400 V in AlGaNGaN HFETs, extracting full advantage of the high breakdown strength of GaN. The used poly AlN passivation works as a surface heat spreader with its high thermal conductivity, which effectively relieves the channel temperature resulting in lower thermal resistances. The GaN device for future millimeter wave communication consists of MIStype gate using socalled “insitu” deposited SiN as a gate insulator, which exhibits high fmaxof 203 GHz and low noise figure of 1.4 dB at 28 GHz. The presented GaN transistors are promising for the two future emerging applications demonstrating high enough potential of the material systems. © 2009 WILEYVCH Verlag GmbH & Co. KGaA, Weinheim

Coordinated transcriptional modulation of large gene sets depends on the combinatorial use of cis-regulatory motifs in promoters. We postulate that promoter content similarities are diagnostic for co-expressing genes that function coherently during specific cellular responses. To find the co-expressing genes we propose an ab initio method that identifies motif families in promoters of target gene groups, map these families to the promoters of all genes in the genome, and determine the best matches of each of the target group gene promoters with all other promoters. When the method was tested in rice starting from a group of co-expressing Late Embryogenesis Abundant (LEA) genes, we obtained a promoter similarity-based network that contained candidate genes that could plausibly complement the function of LEA genes. Importantly, 73.36% of 244 genes predicted by our method were experimentally confirmed to co-express with the LEA genes in maturing rice embryos, making this methodology a promising tool for biological systems analyses.

State-of-the-art technologies of GaN-based power switching transistors are reviewed, in which normally-off operation and heat spreading as technical issues. We demonstrate a new operation principle of GaN-based normally-off transistor called Gate Injection Transistor (GIT). The GIT utilizes hole-injection from p-AlGaN to AlGaN/GaN hetero-junction which increases electron density in the depleted channel resulting in dramatic increase of the drain current owing to conductivity modulation. The fabricated GIT on Si substrate exhibits the threshold voltage of +1.0V with high maximum drain current of 200mA/mm. The obtained on-state resistance (Ron·A) and off-state breakdown voltage (BVds) are 2.6mΩ·cm2 and 800V, respectively. These values are the best ones ever reported for GaN-based normally-off transistors. In addition, we propose the use of poly-AlN as surface passivation. The AlN has at least 200 times higher thermal conductivity than conventional SiN so that it can effectively reduce the channel temperature.

Summary:Alternating copolymers between substituted 1,3,5‐triazine (substituent = alkyl or amine) and thiophene or bithiophene are synthesized. The copolymer of amino‐1,3,5‐triazine with thiophene is soluble in organic solvents, transparent in most parts of the visible region, and photoluminescent. The copolymer receives electrochemical n‐doping with an Epcof −2.08 V vs Ag+/Ag and shows a time‐of‐flight electron drift mobility of 2.0 × 10−4cm2· V−1· s−1, which is larger than that of widely used Al(8‐quinolinolato)3.

Magnetic particles have been studied with much interest with reference to many engineering applications. Much effort has been devoted to the preparation of nano-sized magnetite particles with well-controlled size and shape. Magnetic bacteria synthesize uniform and nano-sized magnetite particles enveloped by organic lipid membranes. This review discusses recent advances in bacterial magnetite particles. Especially, the tremendous biotechnological potential of bacterial magnetite particles BMPs and our recent understanding of mechanism of magnetite particle formation in Magnetospirillum magneticumstrain AMB-1 were highlighted.

Magnetic particles have been studied with much interest with reference to many engineering applications. Much effort has been devoted to the preparation of nano-sized magnetite particles with well-controlled size and shape. Magnetic bacteria synthesize uniform and nano-sized magnetite particles enveloped by organic lipid membranes. This review discusses recent advances in bacterial magnetite particles. Especially, the tremendous biotechnological potential of bacterial magnetite particles (BMPs) and our recent understanding of mechanism of magnetite particle formation in Magnetospirillum magneticum strain AMB-1 were highlighted.

Cadmium recovery by a sulfate-reducing magnetotactic bacterium, Desulfovibrio magneticusstrain RS-1, was investigated. D. magneticusprecipitated >95% of cadmium at an initial concentration of 1.3 ppm in the growth medium. Electron microscopic analysis revealed that D. magneticusformed electron-dense particles on its surface when cultivated in the presence of cadmium ions (Cd2+). Sulfide was also found in the precipitate, and the composition ratio of sulfide/cadmium was 0.7. Sixty percent of viable RS-1 cells was recovered by a simple magnetic separation revealing the removal of 58% cadmium from the culture medium.

Growth conditions for mass production of luciferase-bacterial magnetic particles (BMPs) by a recombinant Magnetospirillum magneticumAMB-1 were investigated in a pH-regulated fed-batch culture system. Enrichment of growth medium with L-cysteine, yeast extract and polypeptone enhanced both bacterial growth and BMP production. The presence of L-cysteine in the medium was useful for induction of cell growth. Strict anaerobic conditions led to a prolonged lag phase and limited the final cell density. Trace oxygen enhanced cell growth with increasing BMP production. As iron sources, ferrous sulfate and ferric gallate dramatically enhanced BMP yield as compared with ferric quinate, an iron chelate conventionally used. The optimized conditions increased cell density to 0.59 ± 0.03 g cell dry weight/liter and BMP production to 14.8 ± 0.5 mg dry weight/liter in fed-batch culture for four days.

Abstract: We investigated the relationship between the synthesis of bacterial magnetic particles (BMPs) and the transcription of magA gene-encoding iron transport protein using synchronous culture of Magnetospirillum magneticum AMB-1. Synchronously cultured cells were subjected to transmission electron microscopic observation and fluorescence in situ hybridization. The average number of BMPs slowly increased in the cell with increasing cell size. A sharp increase in BMPs occurred just before cell division and resulted in maximum BMP production of 30 particles/cell. The transcription of magA was regulated immed iately before and after cell division

Abstract: A high-performance and rapid chemiluminescence immunoassay for model food allergen lysozyme, one of the major allergenic components in egg white, using antibody-conjugated bacterial magnetic particles and a fully automated system was developed. This system contians a reaction station, tip rack, and an eight-tip pipettor that is alble to attach and detach a strong magnet to the tip surface. The immunoreaction time was shortened to 5 min, and the assay was completed within 20 min. The lower detection limit for lysozyme was 10 ng/mL. This system can be used to perform 24 samples in 60 min within 10% coefficient of variation.

Developments of the high field ESR system in Kobe University is presented. Using Gunn oscillators and backward traveling oscillators (BWO), we can cover the frequency region from 30 to 1183.6 GHz with the use of InSb detector. Pulsed magnetic field up to 30 T is available and we are now trying to extend the field up to 40 T. Temperature range is from 1.8 to 300 K. Using this system, we studied S=1/2 ladder like system Cu2(C5H12N2)2Cl4, and found a new magnetic transition at 10.1 T at 1.8 K. The temperature dependence of ESR in Cu2(C5H12N2)2CI4shows g-shift below 8 K which corresponds to the maximum of the magnetic susceptibility. The g-shift below 8 K suggests the increase of the quantum fluctuation in the system, and the role of the quantum fluctuation in Cu2(C5H12N2)2CI4is discussed.

Silicon carbide (SiC) ceramics reinforced with 10∼50 mass% of chopped Si-Al-C fibre (average length; 394µm) and 5 mol% of A1₄C₃ as a sintering aid were fabricated by hot pressing at 1800°C for 30 min under a pressure of 31 MPa. The hot-pressed SiC compact with 40 mass% of chopped Si-Al-C fibre addition showed a maximum relative density (96.8%) among the specimens examined and a Vickers hardness (H_v) of 28.3 GPa. The highest fracture toughness (K_IC) (3.9 MPa • m^1/2) was achieved at 30 mass% of Si-Al-C fibre addition. These H_v and K_IC values were higher than those (H_v ;17.0 GPa and K_IC 2.1 MPa • m^1/2

A GaAs power FET employing a spike-gate structure was developed for the high efficiency and low distortion operation under the extremely low supply voltage of 1.5 V. This spike-gate FET is featured by an unique gate structure that has almost zero effective gate length. The spike-gate provides both the low on-resistance of 2.2Ω mm−1and the low drain conductance of 5 mS mm−1. Maximum frequency of oscillation (fmax) is over 30 GHz that is estimated from S-parameter under the supply voltage of 1.5 V. The decrease of the fmaxis smaller for the spike-ate FET than for the conventional one as the decrease of supply voltage. In π/4-shift QPSK modulation system, the implemented device achieved the output power of 31.0 dBM with 52% power-added efficiency and −51 dBc adjacent channel leakage power at the frequency of 925 MHz under the drain supply voltage of 1.5 V.

The effects of gamma-ray irradiation on water-rock reactions are investigated by comparing leaching experiments with and without irradiation. Basaltic rock fragments were leached for 887 h with distilled, deionized water, while moderately flushing with air. During the leaching a total of 10 aliquots were removed and analysed by ion chromatography and instrumental neutron activation analysis (INAA).

Rare earth elements (REE), Ba, Sr as well as major elements in 47 pre-Cenozoic geosynclinal volcanics in Japan have been determined. The types of chondrite-normalized REE patterns can be classified into two large groups viz. log-linear REE pattern group and convex REE pattern group. Each group thus classified is also closely related to major element features. Although the REE pattern of the latter group is observed in the island arc tholeiite as well as abyssal tholeiite, the relative content of Ba to La indicates that the Japanese geosynclinal volcanics of this group are more akin to those of abyssal tholeiites than are the island arc ones. Two distinct types of REE fractionation are found in the volcanics of the Japanese geosyncline.

Strontium isotopic compositions were determined for silicate detritus in 152 deep-sea and continental shelf surface sediment samples from the Pacific Ocean to trace their provenance. The major characteristics of the spatial variation of the Sr isotopes and the interpretation of this variation may be summarized as follows: (1) Sediments in the Pacific have a lower average87Sr/86Sr ratio (0.7112) with a narrower range (0.703–0.724) than in the Atlantic (0.7166; 0.704–0.743). Many western Pacific volcanoes together with young continental crust supply material with low87Sr/86Sr ratios to the Pacific, in contrast to the large old cratonic crust that supplies material with high Sr ratio to the Atlantic. (2) The87Sr/86Sr ratio is high in the north central Pacific (0.711–0.719). The Izu-Ogasawara and Mariana arcs supply low87Sr/86Sr material to the western Pacific, but farther to east the abundant supply of loess carried by middle-latitude westerlies from the Asian continent (87Sr/86Sr=ca.0.720) dominates the north central Pacific.

From the mathematical analysis of the rare-earth data on some of the Apollo 12 samples studied by Hubbard et al. (1971), the possible europium-normal primitive rare-earth pattern, in which europium is normal with respect to the adjacent rare-earth elements, has been estimated. A fact that the igneous rocks (Japanese geosynclinal basalts) appearing to reflect the analogous effect occur locally on the earth enhances our interests in the pattern resulting from the above estimation.

Two foliated metagabbros from the Mid-Atlantic Ridge near 30° N were analyzed for rare earth elements. The chondrite-normalized rare earth pattern for one of them is quite similar to those for abyssal tholeiites. The pattern for another sample, however, is somewhat different from the above one. A new set of bulk partition coefficients for rare earth elements has been estimated correspondingly. This set throws a new light on the interpretation that many alkali olivine basalts were produced by a zone melting or partial melting of primary-liquid-type material. Also the same partition coefficients lead us to an inference that the high-temperature peridotite intrusion in the Lizard area, Cornwall, England, is a secondary-solid-type material which was once in equilibrium with a primary-solid-type material, whereas the pyroxenite, Canyon Mountain, Oregon, is a primary-solid-type material.