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The COVID-19 pandemic has demanded a change in learning modalities, which led us to develop a remote personal training system for clinicians performing neuroendovascular procedures. A portable vascular model designed for practicing catheter navigation guidance, thrombus retrieval, and intracranial aneurysm coil embolisation was established. We created an environment that enabled interactive dialogue and communication across long distances using the Internet. The instructor conducted approximately 2 h of hands-on training with two to four trainees at a time. Despite the restrictions enforced by the Government of Japan due to the COVID-19 pandemic, 17 online hands-on training were successfully conducted throughout Japan over 1 year for a total of 48 trainees. The developed remote training programme, to avoid the aggregation of a large number of trainees at a developed time, proved to be at par with the conventional learning system. The training was well-received since the operation time was longer and the question and answer sessions were more fulfilling compared to the conventional format in which a group of trainees had got a brief opportunity to receive actual hands-on experience. [ABSTRACT FROM AUTHOR]

Crop models have suggested high sensitivity of soybean [Glycine max (L.) Merr.] to day length and the resultant extension of the growth period as a concept to overcome yield loss due to climate warming. However, experimental validation of this concept is incomplete. The E3 and E4 loci encode phytochrome A isoforms and enhance sensitivity to day length. Our previous study showed that the dominant E4 allele can mitigate yield loss due to warming. In this study, we similarly tested the hypothesis that the dominant E3 allele can reduce yield loss caused by warming. One of the leading Japanese cultivars Enrei (e3/E4) and near‐isogenic lines (NIL‐e3e4, NIL‐E3e4, and NIL‐E3E4) in the Enrei genetic background were grown at near ambient temperature or either 2.0°C or 4.7°C above ambient temperature in temperature‐gradient chambers (TGCs) in a cool region in Japan. The number of days from sowing to beginning of flowering (R1) decreased with increasing temperature, regardless of genotype. However, increasing temperature extended the period from R1 to beginning of pod filling (R3) and increased pod number per plant and seed yield per plant in all genotypes except NIL‐e3e4. Combined data from the TGC experiment and from field trials across three different latitudes showed that the decreased developmental rate during the R1–R3 period can be attributed to longer days, rather than by supra‐optimal temperatures. We conclude that E3, in addition to E4, could potentially increase seed yield in cool regions under future warming. [ABSTRACT FROM AUTHOR]

Background: Tumor fever and infection are common febrile etiologies among advanced cancer patients. To date, only few studies have been conducted to differentiate between tumor fever and infections. Objective: This study aimed to identify discriminating factors that provide rapid results and are feasible and minimally invasive for discriminating between tumor fever and infection in advanced cancer patients. Methods: This is a retrospective cohort study. Advanced cancer patients with clinically diagnosed tumor fever or infection, who received medical treatment from palliative care specialists in 10 nationwide Japanese hospitals, were consecutively identified during August 2012 and November 2014. The symptoms, physical findings, blood test results at baseline and during fever, imaging findings, and sociodemographic factors of these patients were retrospectively extracted. Results: Thirty-three patients with tumor fever and 72 patients with infection were identified. Their mean age was 68.8 years, 68 (64.8%) were men, and the median palliative performance status (PPS) was 50. Statistically significant factors predicting tumor fever by logistic regression analysis were as follows: deterioration of PPS (odds ratio, 0.078), shaking chills during fever (0.067), and change from baseline data of neutrophil/lymphocyte ratio of ≥5 (0.14). Conclusions: Shaking chills during fever, and changes from baseline of performance status and white blood cell differentiation can be useful to differentiate between tumor fever and infection among advanced cancer patients. Further confirmatory studies are needed. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal symptoms, including nausea, vomiting, bowel obstruction, ascites, constipation, and anorexia, are common and often refractory in advanced cancer patients. The palliation of gastrointestinal symptoms is important in improving the quality of life of cancer patients, as well as that of their families and caregivers. Currently published clinical guidelines for the management of gastrointestinal symptoms in cancer patients do not comprehensively cover the topics or are not based on a formal process for the development of clinical guidelines. Methods: The Japanese Society for Palliative Medicine (JSPM) developed comprehensive clinical guidelines for the management of gastrointestinal symptoms in cancer patients after a formal guideline development process. Results: This article summarizes the recommendations along with their rationale and a short summary of the development process of the JSPM gastrointestinal symptom management guidelines. We established 31 recommendations, all of which are based on the best available evidence and agreement of expert taskforce members. Discussion: Future clinical studies and continuous guideline updates are required to improve gastrointestinal symptom management in cancer patients. [ABSTRACT FROM AUTHOR]

In southwestern Japan, soil water fluctuations from flooding to drought cause unstable soybean yields. Water table management (WTM) with sub-irrigation/drainage systems will overcome the soybean yield instability by inhibiting these fluctuations. Narrow row cultivation is expected to increase soybean yields. The effects of WTM and row width on soybean growth and yield in this region are not clear. We evaluated the effects of WTM with sub-irrigation/drainage systems and row widths (35 or 70 cm) on the growth and yield of one conventional (tall main stem) and two newly developed (short main stem) soybean cultivars. The WTM consisted of (1) fluctuation of the water table between the natural water table depth and that at 30 cm depth according to the growth stage and weather conditions, especially rainfall events (newly developed); (2) maintaining the water table at a 30 cm constant depth throughout the growth period (recommended in Japan); and (3) the natural water table with an underdrain (control). No significant interaction was observed between the WTM and cultivar or row width treatment, indicating that cultivars and row width treatments responded similarly to WTM. WTM 1 and 2 decreased the soybean yield by approx. 5% when the natural water table depth in control existed at 50–60 cm depths throughout the growing period, indicating that the natural water table depth in control was near optimum for soybean growth and yield. Before performing WTM, therefore, the natural water table depth should be measured and considered. The combination of newly developed cultivars with narrow rows had similar or greater yields than conventional cultivation (cultivar and row width), due mainly to an increase in pods m −2 and a decrease in yield loss without severe lodging. Thus, yield potential in southwestern Japan could be increased by narrow row cultivation, but cultivars with short main stem lengths should be cultivated. [ABSTRACT FROM AUTHOR]

Early planting contributed to increased soybean yields in the U.S. Because a double-cropping system dominates in southwestern Japan, early planting is not performed; it is thus unclear how much the yield potential could be increased by early planting. To address this question, we planted seven U.S. and five Japanese cultivars on around 20 May (early planting), measured the agronomic traits, including yield, yield components, and oil and protein contents, and compared these traits with those of the same cultivars planted on around 20 July (normal planting). In the early planting, the yields of the U.S. cultivars were 322–453 g m−2, whereas the highest yield among the Japanese cultivars was only 315 g m−2, which is significantly lower than those of the top five U.S. cultivars, indicating the adaptability of U.S. cultivars to early planting. The increases in yield obtained with early planting were 99–199 g m−2and −26–144 g m−2for the U.S. and Japanese cultivars, respectively. The yield obtained by early planting was positively correlated with the pods m−2, seeds pod−1, and oil contents, but negatively correlated with the sterile pod rate, 100 seed weight and protein content. In the early planting, the U.S. cultivars had greater pods m−2, seeds pod−1and oil content and less sterile pod rate, 100-seed weight, and protein content than the Japanese cultivars. These results suggest that early planting can increase the yield in southwestern Japan, if cultivars with agronomic traits observed in the U.S. cultivars of this study are grown. [ABSTRACT FROM AUTHOR]

Background: Although corticosteroids are commonly used for symptom relief in the treatment of patients with advanced cancer, few studies have addressed nationwide physician-reported practices and attitudes toward corticosteroid therapy in palliative care settings. Design and Subjects: To clarify physician-reported practices and attitudes toward corticosteroid therapy for anorexia, fatigue, and dyspnea, a 15-item questionnaire was mailed to all 178 certified palliative care units in Japan. Results: In total, 124 physicians returned questionnaires (response rate of 70%). The median percentage receiving corticosteroids among all terminally ill cancer inpatients was 80% (fatigue, 80%; anorexia, 80%; dyspnea, 80%). Physicians reported varying methods and attitudes regarding corticosteroid use in palliative care settings. Regarding withdrawal when patient death was imminent, 46% of respondents usually abruptly ceased corticosteroid use, while 33% reduced but did not stop administration, and 21% neither stopped nor reduced corticosteroids. As for dosage, 47% of physicians selected a minimum daily dose for fatigue <2 mg, while 51% chose 2-4 mg. As for administration period, 50% started administering corticosteroids for dyspnea regardless of the prognosis, while 30% regarded a predicted survival of less than 3 months to be an indication for corticosteroid treatment. For side effect management, 48% did not principally prescribe corticosteroids for patients with hyperactive delirium, while 44% cautiously prescribed corticosteroids. Conclusion: The use of corticosteroids is very common in Japanese palliative care units, but physicians reported varying practices and attitudes regarding administration protocols. Future studies are needed to determine the standard treatment protocol for corticosteroid use in the terminally ill. [ABSTRACT FROM AUTHOR]

Background and Methods: Corticosteroids are commonly used for symptom relief in the treatment of patients with advanced cancer. Consistent efficacy of corticosteroid treatment in palliative care remains controversial. A cross-sectional anonymous survey was mailed to representative managing physicians in certified palliative care units in Japan to clarify the physician-perceived efficacy of steroid treatment on anorexia, fatigue, and dyspnea in terminal cancer patients, to clarify physicians' experience of side effects of corticosteroid use, and to determine the Japanese palliative care physician-reported predictive factors for efficacy and lack of efficacy. Results and Conclusions: Many Japanese palliative care specialists perceived that corticosteroids are effective for each of the symptoms, are aware of the prevalence and importance of serious adverse effects, and predict the effectiveness of steroid therapy by etiological factors. [ABSTRACT FROM AUTHOR]

Nausea and vomiting are among the most common and distressing symptoms in patients with advanced cancer. Olanzapine, an antipsychotic agent, is known to have an affinity for multiple neurotransmitter receptors. Previous studies have reported olanzapine to be efficacious in the treatment of nausea and vomiting. Although it has been administered at a number of facilities, its applicability to treat nausea and vomiting in patients with advanced cancer is poorly understood. We investigated the use of olanzapine for nausea and vomiting in patients with advanced cancer at multiple centers. This retrospective study was carried out at seven palliative care units and three facilities with palliative care teams in Japan from 2013 to 2015. The dosage of olanzapine, treatment duration, and duration from initial use until death were collected from the medical records. One hundred and eight patients met our inclusion criteria. The average dose of olanzapine was 3.6 mg (2.5 mg, n = 61; 5 mg, n = 46; 10 mg, n = 1) and average treatment duration was 18.7 days. The average duration from initial use until death was 39.0 days. There were no differences in the duration of administration until death between olanzapine doses (2.5 and 5 mg). Our results suggest that olanzapine have been used in patients with poor prognoses for nausea and vomiting in patients with advanced cancer. Conducting a prospective trial would further yield promising results. [ABSTRACT FROM AUTHOR]

Abstract: Storm surges and floods around bays in Japan frequently result in water disasters. Both dikes and estuary gates can be constructed in urban areas near bays as counter measures. Estuary gates at the mouth of a river are intended to protect the upstream areas from storm surges and tsunamis. The sewer systems in urban areas also decrease the inundation. In this study, a numerical simulation is carried out to examine the effectiveness of the estuary gate and performance of the sewer system. A synthetic analysis model of inundation phenomena is developed and applied to the behavior of water in the urban area near the Nagoya Port and the estuary region of the Hori River. The developed model consists of models for the sea, river, sewer, overland flood flow, and typhoon. The inundation analysis model is validated by a comparison of analytical and observed results. The features of the inundations in the urban area caused by various conditions are discussed. [Copyright &y& Elsevier]

Background: Although intravenous midazolam and flunitrazepam are frequently administered for primary insomnia in Japan, there is no empirical study on their efficacy and safety. Design and subjects: To compare the efficacy, safety, and cost-effectiveness of midazolam and flunitrazepam, a multicenter retrospective audit study was performed on 104 and 59 patients receiving midazolam and flunitrazepam, respectively, from 18 certified palliative care units. Results: Median administration periods were 6 days and 9 days for midazolam and flunitrazepam, respectively. The median initial and maximum doses were 10 mg per night and 18 mg per night for midazolam, and 2 mg per night and 2 mg per night for flunitrazepam, respectively. There were no significant differences in the efficacy (91% in the midazolam group versus 81% in the flunitrazepam group, p = 0.084), hangover effect (34% versus 19%, p = 0.094), delirium at night (12% versus 10%, p = 1.0) and delirium next morning (11% versus 15%, p = 0.33), treatment withdrawal (4.8% versus 1.7%, p = 0.41), and treatment-related death (0% versus 0%, p = 1.0). Flunitrazepam caused respiratory depression defined as physician or nurses records such as apnea, respiratory arrest, decreased respiratory rate, and respiratory depression significantly more frequently than midazolam (17% versus 3.8%, p = 0.0073). The maximum dose was more highly correlated with the administration period in the midazolam group than in the flunitrazepam group (ρ = 0.52, versus ρ = 0.39), and, for patients treated for 14 days or longer, the daily escalation dose ratio required for maintaining adequate sleep was significantly higher in the midazolam group than in the flunitrazepam group (11% versus 2.6%, p = 0.015). The costs of the initial and maximum administration were significantly higher in the midazolam group than in the flunitrazepam group ( p < 0.001). Conclusion: Intravenous midazolam and flunitrazepam appeared to be almost equal about efficacy and safety for primary insomnia, but flunitrazepam is less expensive and shows lower risk of tolerance development. A future prospective comparison study is necessary. [ABSTRACT FROM AUTHOR]

To obtain basic information for evaluating critical levels of O3 under different nitrogen loads for protecting Japanese beech forests, two-year-old seedlings of Fagus crenata Blume were grown in potted andisol supplied with N as NH4NO3 solution at 0, 20 or 50 kg ha−1 year−1 and exposed to charcoal-filtered air or O3 at 1.0, 1.5 and 2.0 times the ambient concentration from 16 April to 22 September 2004. The O3 induced significant reductions in the whole-plant dry mass, net photosynthetic rate at 380 μmol mol−1 CO2 ( A 380), carboxylation efficiency ( CE) and concentrations of ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) and total soluble protein (TSP) in the leaves. The concentrations of Rubisco and TSP were negatively correlated with the concentration of leaf acidic amino acid, suggesting that O3 enhanced the degradation of protein such as Rubisco. The N supply to the soil did not significantly change the whole-plant dry mass and A 380, whereas it significantly increased the CE and concentrations of Rubisco and total amino acid. No significant interactive effects of O3 and N supply to the soil were detected on the growth, photosynthetic parameters and concentrations of protein and amino acid in the leaves. In conclusion, N supply to the soil at ≤50 kg ha−1 year−1 does not significantly change the sensitivity to O3 of growth and net photosynthesis of Fagus crenata seedlings. [ABSTRACT FROM AUTHOR]

Abstract Advances in techniques of image diagnosis have enabled the detection of minute or small cancer lesions in the stomach. Patients with such cancer, in principle, were treated surgically, but accumulated histopathological data on surgical cancer specimens revealed that many of these patients did not have any metastatic lesions. For those localized cancers, local treatment of primary lesions by endoscopy gives curative results. It has been demonstrated that endoscopic therapy is curative in mucosal well-differentiated adenocarcinoma not more than 20 mm in diameter without ulceration. Efforts to cure early gastric cancer without surgery yielded fruitful results and a new treatment concept was established. Even if there is a recurrence of the residual or metachronous lesions, they can be treated by further endoscopic treatment. [ABSTRACT FROM AUTHOR]

Initiator codon mutations are relatively uncommon and less well characterized compared to other types of mutations. We identified a novel initiator codon mutation (c.2T>C) heterozygously in a Japanese patient (Patient GK30) with mitochondrial acetoacetyl-CoA thiolase (T2) gene deficiency (ACAT1 deficiency); c.149delC was on the other allele. We examined translation efficiencies of nine mutant T2 cDNAs harboring one-base substitutions at the initiator methionine codon using in vivo transient expression analysis. We found that all the mutants produced wild-type T2 polypeptide, to various degrees (wild type (100%) > c.1A>C (66%) > c.2T>C, c.3G>C, c.3G>T (22%) > c3G>A, c.1A>G (11%) > c.2T>A, c.2T>G, c.1A>T (7.4%)). T2 mRNA expression levels in Patient GK08 (a homozygote of c.2T>A) and Patient GK30 fibroblasts, respectively, were almost the same as in control fibroblasts, when examined using semiquantitative PCR. This means that initiator codon mutations did not affect T2 mRNA levels. We propose that all one-base substitutions at the initiator methionine codon in the T2 gene could be mutations, which retain some residual T2 activity., (Copyright 2003 Wiley-Liss, Inc.)