Search

Objective To characterize the relationship between industry payments and use of paranasal sinus balloon catheter dilations (BCDs) for chronic rhinosinusitis. Study Design Cross-sectional analysis of Medicare B Public Use Files and Open Payments data. Setting Two national databases, 2013 to 2014. Subjects and Methods Physicians with Medicare claims with Current Procedural Terminology codes 31295 to 31297 were identified and cross-referenced with industry payments. Multivariate linear regression controlling for age, race, sex, and comorbidity in a physician's Medicare population was performed to identify associations between use of BCDs and industry payments. The final analysis included 334 physicians performing 31,506 procedures, each of whom performed at least 11 balloon dilation procedures. Results Of 334 physicians, 280 (83.8%) received 4392 industry payments in total. Wide variation in payments to physicians was noted (range, $43.29-$111,685.10). The median payment for food and beverage was $19.26 and that for speaker or consulting fees was $409.45. One payment was associated with an additional 3.05 BCDs (confidence interval [95% CI],1.65-4.45; P < .001). One payment for food and beverages was associated with 3.81 additional BCDs (95% CI, 2.13-5.49; P < .001), and 1 payment for speaker or consulting fees was associated with 5.49 additional BCDs (95% CI, 0.32-10.63; P = .04). Conclusion Payments by manufacturers of BCD devices were associated with increased use of BCD for chronic rhinosinusitis. On separate analyses, the number of payments for food and beverages as well as that for speaker and consulting fees was associated with increased BCD use. This study was cross-sectional and cannot prove causality, and several factors likely exist for the uptrend in BCD use.

Fully three dimensional (3D) numerical simulation model of the heat and mass transfer in the silicon (Si) Czochralski growth with a transverse magnetic field (MCZ) was developed. Time transient calculation of heat and mass transfer in the industrial scale crystal growth of 300 mm diameter was performed under the quasi steady state assumption. The model predicts the completely asymmetrically 3D melt flow and off-centered temperature distributions, different from the previous works. The temperature distribution measured experimentally by thermocouples, beneath the melt surface along the azimuthal direction, was almost the same as the model prediction, providing a strong support for the 3D simulation model.

Background Treatment durations and factors associated with delays for oral cavity squamous cell carcinoma (SCC) have previously been described but are not fully understood. Impact of delays on overall survival (OS) remains unclear. Methods The National Cancer Data Base (NCDB) was used to analyze 4868 patients with oral cavity SCC from 1998 to 2011. Diagnosis-to-surgery, surgery-to-radiotherapy (RT)start, RT duration, total treatment package (surgery-to-RTend), and diagnosis-to-RTend were evaluated. Associations between delays and various factors were analyzed using binary logistic regression. Associations with OS were analyzed using the Cox proportional hazards model. Results Medians for diagnosis-to-surgery, surgery-to-RTstart, RT duration, total treatment package, and diagnosis-to-RTend were 30, 50, 49, 101, and 136 days, respectively. Age ≥60 years, uninsured or Medicaid insurance, comorbidity, late pT, and treatment at an academic/research institution were associated with diagnosis-to-surgery delays. Only delays in RT duration were significantly associated with decreased OS (hazard ratio [HR] = 1.21; p = .02). Conclusion Numerous factors are associated with treatment delays. RT duration is significantly associated with OS. © 2017 Wiley Periodicals, Inc. Head Neck 39: 639–646, 2017

We isolated a cold sensitive virescent1 (csv1) mutant from a rice (Oryza sativa L.) population mutagenized by carbon ion irradiation. The mutant exhibited chlorotic leaves during the early growth stages, and produced normal green leaves as it grew. The growth of csv1 plants displayed sensitivity to low temperatures. In addition, the mutant plants that were transferred to low temperatures at the fifth leaf stage produced chlorotic leaves subsequently. Genetic and molecular analyses revealed translocation of a 13-kb genomic fragment that disrupted the causative gene (CSV1; LOC_Os05g34040). CSV1 encodes a plastid-targeted oxidoreductase-like protein conserved among land plants, green algae, and cyanobacteria. Furthermore, CSV1 transcripts were more abundant in immature than in mature leaves, and they did not markedly increase or decrease with temperature. Taken together, our results indicate that CSV1 supports chloroplast development under cold stress conditions, in both the early growth and tillering stages in rice. We isolated and characterized the rice virescent mutant csv1. The mutant showed low temperature sensitivity not only early growth stages but also the tillering stage.

The existence of numerous chloroplasts in photosynthetic cells is a general feature of plants. Chloroplast biogenesis and inheritance involve two distinct mechanisms: proliferation of chloroplasts by binary fission and partitioning of chloroplasts into daughter cells during cell division. The mechanism of chloroplast number coordination in a given cell type is a fundamental question. Stomatal guard cells (GCs) in the plant shoot epidermis generally contain several to tens of chloroplasts per cell. Thus far, chloroplast number at the stomatal (GC pair) level has generally been used as a convenient marker for identifying hybrid species or estimating the ploidy level of a given plant tissue. Here, we report that Arabidopsis thaliana leaf GCs represent a useful system for investigating the unexploited aspects of chloroplast number control in plant cells. In contrast to a general notion based on analyses of leaf mesophyll chloroplasts, a small difference was detected in the GC chloroplast number among three Arabidopsis ecotypes (Columbia, Landsberg erecta, and Wassilewskija). Fluorescence microscopy often detected dividing GC chloroplasts with the FtsZ1 ring not only at the early stage of leaf expansion but also at the late stage. Compensatory chloroplast expansion, a phenomenon well documented in leaf mesophyll cells of chloroplast division mutants and transgenic plants, could take place between paired GCs in wild-type leaves. Furthermore, modest chloroplast number per GC as well as symmetric division of guard mother cells for GC formation suggests that Arabidopsis GCs would facilitate the analysis of chloroplast partitioning, based on chloroplast counting at the individual cell level.

Intestinal parasites cause a significant public health problem worldwide due to the associated morbidities, mainly in infected school-aged children (SAC). The strategy of large-scale deworming in SAC to control the transmission of soil-transmitted helminths (STH) has been advocated by the World Health Organization and was recently adopted in Brazil; however, the long-term effects of mass deworming on the larger parasitological profile have been less studied. After a five-year period of school-based large-scale treatment for STH using an annual single dose of albendazole in a community of Sergipe state, Brazil, a marked reduction in prevalence was observed (15.4%% vs.7.4% for Ascaris sp., 6.0%% vs. 0.4% for hookworm, and 12.8%% vs. 4.5%% for Trichuris trichiura), with the exception of Strongyloides stercoralis, which had no statistically significant change in prevalence. There was, however, an increase in the prevalence of intestinal protozoans, specifically Entamoeba histolytica/E. dispar (0.0%% vs. 36.0%), Blastocystis hominis (0.0%% vs. 40.1%), and Giardia duodenalis (5.6%% vs. 14.5%). Although the findings showed a dramatic reduction in the prevalence of STH after four rounds of preventive chemotherapy, there was an increase in intestinal protozoan infections, indicating a change in the epidemiological profile.

Enzyme inactivation is a common industrial step of food preservation. Conventional method is based on heating, thus reduce organoleptic property and virtues of the products. We propose a non-thermal method of enzyme inactivation based on pulsed electric fields. By comparing the effect of electric fields, heating and oxidation on alpha-amylase, we have shown that the electric field targets the active site of the enzyme via the tryptophan, resulting in a conformational disruption. An electric pulse of 2.5–12.5 kV/cm, 10 μs and 0.02–0.6 J, repeated at 1–30 Hz for a total applied energy of 1440 J, partially denatured alpha-amylase, reducing activity by up to 70%; however, this was not followed by protein aggregation, as observed for heat treatment to 70 °C. Those results brought new understanding on the mechanism of pulsed electric fields action on proteins, and might lead in new application in food industry or in medicine.

BACKGROUND In Japan, students' poor adjustment to school life such as school refusals has been recognized as a nation-wide problem. In this study, we examined the link between the absence of mothers' active engagement with their infants at 6 months and children's risks of poor adjustment toward elementary school life at the ages of 5.5 and 11. METHODS We used a Japanese national longitudinal survey (n = 43 132) with 11 years of follow-up. Because of social patterning in how mothers engage with their infants, we employed propensity score matching analyses to control for confounding by socio-economic and other factors. We matched mothers with active engagement and those without on various social and parental characteristics such as educational attainment and household income. RESULTS AND CONCLUSIONS Among matched pairs, we observed higher risks of poor adjustment to school life at both 5.5 and 11 years among Japanese children who lacked mothers' active engagement at 6 months. For example, the relative risk was 1.46 [95% confidence interval: 1.10, 1.94] for inability to get along with others in a group setting at the age of 5.5 years and 1.29 [1.10, 1.51] for inability to get along with teachers at the age of 11 years. Our findings corroborate previous findings, which emphasize the importance of providing an enriched environment for infants' social development and may indicate the need for an intervention for caregivers who lack appropriate nurturing skills.

To characterize the association between industry payments and prescriptions of 2 brand-name proton-pump inhibitors (PPIs).Cross-sectional retrospective.Physicians nationwide.We identified all physicians receiving industry payments for Dexilant and Nexium 2014-2015 from the Open Payments database. We linked this to records of prescriptions for PPIs paid for by Medicare Part D these same years and compared the proportion of prescriptions written for Dexilant and Nexium in industry-compensated vs nonindustry compensated physicians. The number and dollar amount of payments were associated with the rate of drug prescriptions.We identified 254,452 physicians prescribing PPIs; 8586 and 2766 physicians received industry payments for Dexilant and Nexium, respectively. A total of 5052 of 7876 (64%) physicians compensated for Dexilant prescribed Dexilant vs 39,778 of 246,571 (16%) noncompensated physicians ( P.001). For Nexium, 2525 of 2654 (95%) compensated physicians prescribed Nexium, compared to 123,913 of 252,067 (49%) noncompensated physicians. For both Dexilant and Nexium, there was a significant correlation between the number (ρ = 0.22, P.001 and ρ = 0.12, P.001) and dollar amount (ρ = 0.22, P.001 and ρ = 0.13, P.001) of payments and the percentage of prescriptions written for the compensated drug. Industry payments for Nexium remained associated with rate of prescription even after generic esomeprazole became available.Both the number and dollar amount of industry payments were associated with increased prescriptions for both Dexilant and Nexium. Although unable to show causality, this study suggests that industry payments may increase physician prescriptions of costly, brand-name drugs.

Introduction The current study examines the effectiveness of a newly developed work-family intervention program on one’s own work-to-family and family-to-work spillovers (both positive and negative) and work-family balance self-efficacy among Japanese dual-earner workers with pre-school child(ren). Methods The study design was a single-group pre-post comparison. This intervention program was conducted as a pilot study of TWIN (Tokyo Work-life INterface) study III. Participants were eleven workers of a private company in Japan. They were all dual-earner workers with pre-school child(ren). The program consisted of seven 45 min sessions with a two-week interval between them. The outcomes were assessed by a questionnaire at baseline (Time 1) and post-intervention (Time 2). The paired t-test was conducted as an indicator of intervention effect. Effect sizes were calculated using Cohen’s d based on pre-post score differences (Trial registration: UMIN Clinical Trials Registry UMIN000025803). Results The program showed a medium and favourable intervention effect on work-to-family positive spillover (Cohen’s d=0.53), and small and favourable intervention effects on family-to-work positive spillover (Cohen’s d=0.33) and work-family balance self-efficacy (Cohen’s d=0.39). Unexpectedly, it showed a significantly small and adverse effect on work-to-family negative spillover (Cohen’s d=0.33). Conclusion The newly developed work-family intervention program was found effective in improving work-family positive spillover (both work-to family and family-to work) and work-family balance self-efficacy among Japanese dual-earner workers with pre-school child(ren).

Background/Aims: Taste is recognized as an important predictor of food choices. Thus, polymorphisms in genes encoding taste receptors may explain the variability in food preference and intake. Here, we aimed to determine whether genetic variation in the CD36 gene affects food intake and risk of obesity. Methods: A cross-sectional study was conducted with obese Brazilian children and adolescents (n = 466; BMI-for-age z-score [zBMI] 3.29 ± 0.61) and normal-weight children (n = 114; zBMI -0.11 ± 0.7). To assess the obesity risk according to genotypes, a logistic regression adjusted for age and gender was performed. Two 24-h food recalls assessed total energy (kcal/day) and macronutrient (% kcal and g/day) intake, consumption of sweet and fatty tasting foods (portion and g/day), as well as the most commonly consumed foods (mL or g/day). The food portion sizes were measured according to Brazilian guidelines. The genetic variant rs1761667 (A/G) in CD36 was genotyped by real-time PCR. Results: We found no relationship between rs1761667 genotypes and obesity risk. A significant genetic association between CD36 genotype and fat intake was observed for the A allele of rs1761667, which was associated with a decreased intake of total fat (g/day) (p = 0.01), polyunsaturated and monounsaturated fatty acids (% kcal and g/day), total sugars (g/day) (p = 0.01), fatty foods (portion and g/day) (p < 0.001 for both), and vegetable oils (mL/day) (p = 0.02) only in obese subjects. No differences were found between normal-weight children. Conclusion: The A allele of the rs1761667 single nucleotide polymorphism in CD36 is associated with decreased fat and sugar intake in obese children and adolescents.

Background: We hypothesized that children from lower income households and in households experiencing a negative income change in connection to the global economic crisis in 2008 would be at increased risk of adverse weight status during the subsequent years of economic downturn. Methods: Data were obtained from a nationwide longitudinal survey comprising all children born during 2 weeks of 2001. For 16,403 boys and 15,206 girls, information about anthropometric measurements and household characteristics was collected from 2001 to 2011 on multiple occasions. Interactions between the crisis onset (September 2008) and household income group, as well as the crisis onset and a >30% negative income change in connection to the crisis, were assessed with respect to risk of childhood over- and underweight. Results: Adjusted for household and parental characteristics, boys and girls in the lower household income quartiles had a larger increase in risk of overweight after the crisis onset relative to their peers in the highest income group. (Odds ratio (95% confidence interval) for interaction term in boys=1.23 (1.02–1.24); girls=1.35 (1.23–1.49) comparing the lowest with the highest income group.) Among girls, an interaction between the crisis onset and a >30% negative change in household income with respect to risk of overweight was observed (odds ratio for interaction term=1.23 (1.09–1.38)). Girls from the highest income group had an increased risk of underweight after the crisis onset compared with girls from the lowest income group. Conclusions: Boys and girls from lower household income groups and girls from households experiencing a negative income change in connection to the global economic crisis in 2008, may be at increased risk of overweight. Vulnerability to economic uncertainty could increase risk of overweight in preadolescence.

Polymorphisms near the MC4R gene may be related to an increased risk for obesity, but studies of variations in this gene and its relation to cardiometabolic profiles and food intake are scarce and controversial. The aim of this study is to evaluate the influence of the variants rs12970134 and rs17782313 near the MC4R gene in food intake, binge eating (BE) behavior, anthropometric parameters, body composition, metabolic profile, and cardiometabolic risk factors in obese children and adolescents. This is a cross-sectional study that included obese children and adolescents. We evaluated anthropometric, metabolic parameters and cardiometabolic risk factors, including hypertension, impaired fasting glucose, hypertriglyceridemia, and low HDL-cholesterol. BE was assessed through the BE scale, and a 24-h recall was used to evaluate total caloric intake and percentage of macronutrients and types of dietary fat. The MC4R variants rs12970134 and rs17782313 were genotyped using TaqMan assay. To assess the magnitude of risk, a logistic regression adjusted for Z-BMI, age, and gender was performed, adopting the significance level of 0.05. The study included 518 subjects (52.1 % girls, 12.7 ± 2.7 years old, Z-BMI = 3.24 ± 0.57). Carriers of the variant rs17782313 exhibit increased triglyceride levels (108 ± 48 vs. 119 ± 54, p = 0.034) and an increased risk of hypertriglyceridemia (OR 1.985, 95 % CI 1.288-3.057, p = 0.002). There was no association of the SNP rs12970134 with clinical, metabolic, or nutritional parameters. The variant rs12970134 and rs17782313 did not influence food intake or the presence of BE. The variant rs17782313 is associated with an increased risk of hypertriglyceridemia in obese children and adolescents.

To establish benchmarks for positive margin incidence in parotid cancers, associate positive margin status with patient, tumor, and institutional factors and overall survival, and characterize institutional variation in positive margin incidence.Retrospective database analysis.We identified patients surgically treated for a parotid malignancy 2004 to 2013 in the National Cancer Database. We associated positive margins with patient, tumor, and treatment factors by multivariable logistic regression and with overall survival by Cox proportional hazards regression. We characterized institutional variation in positive margin rates by facility type and volume.A total of 5,639 patients were identified. The overall positive margin rate was 31%. By institution, positive margin rates varied from 0% to 100%, with a median rate of 31% (interquartile range = 18%-43%). Adenoid cystic carcinoma was associated with increased, and low-grade mucoepidermoid carcinoma with decreased, odds of positive margins, (odds ratio [OR] = 1.91 [95% confidence interval {CI}: 1.54-2.38], P .001 and OR = 0.68 [95% CI: 0.53-0.87], P = .002, respectively). Treatment at academic or high-volume facilities was associated with decreased odds of positive margins (OR = 0.79 [95% CI: 0.68-0.91], P = .001 and OR = 0.76 [95% CI: 0.63-0.91], P = .004). Positive surgical margins were associated with decreased overall survival (62% vs. 79% 5-year overall survival, hazard ratio [HR] = 1.34 [95% CI: 1.20-1.49], P .001). Upon stratification by histology, this association was maintained for high-grade, but not low-grade, mucoepidermoid carcinoma (52% vs. 74%, HR = 1.56 [95% CI: 1.31-1.86], P .001 and 89% versus 91%, HR = 1.05 [95% CI: 0.60-1.83], P = .874, respectively).Tumor and institutional factors are associated with positive surgical margins. Positive margin rates vary substantially between facilities and are less likely at academic and high-volume facilities. Positive surgical margins are associated with decreased overall survival and could be considered quality indicators in parotid malignancies.2c Laryngoscope, 129:129-137, 2019.

The long gamma-ray burst GRB 161017A was detected by Fermi and Swift, and its afterglow was observed by the MITSuME 50-cm optical telescope promptly about 50 s after the burst. Early optical observations revealed that the optical lightcurve exhibits a plateau and rebrightening in the early afterglow phase about 500 and 5000 s after the trigger, respectively. By investigating the behavior of the spectral and temporal flux variation, it was found that the plateau and re-brightening cannot be explained in the context of the simple standard afterglow model. These observational features can be explained with two independent refreshed shocks, which indicate the long-acting central engine. We evaluated the physical parameters of the subsequent shells, and we then determined the kinetic energy ratio of the two colliding shells to the leading shell to be roughly 1 and 8, respectively. In addition, two prominent X-ray flares about 200 s after the trigger may be signatures of delayed ejections of the energetic jets responsible for the refreshed shocks. Such late activity of the central engine and X-ray flares play a crucial role in understanding the mechanisms for jet formation and photon emission.

After several experimental campaigns in the Kyushu University Experiment with Steady-state Spherical Tokamak (QUEST), the originally stainless steel plasma-facing wall (PFW) becomes completely covered with a deposited film composed of mixture materials, such as iron, chromium, carbon, and tungsten. In this work, an innovative colorimetry-based method was developed to measure the thickness of the deposited film on the actual QUEST wall. Because the optical constants of the deposited film on the PFW were position-dependent and the extinction coefficient k1 was about 1.0–2.0, which made the probing light not penetrate through some thick deposited films, the colorimetry method developed can only provide a rough value range of thickness of the metal-containing film deposited on the actual PFW in QUEST. However, the use of colorimetry is of great benefit to large-area inspections and to radioactive materials in future fusion devices that will be strictly prohibited from being taken out of the limited area.

Chloroplasts, or photosynthetic plastids, multiply by binary fission, forming a homogeneous population in plant cells. In Arabidopsis thaliana, the division apparatus (or division ring) of mesophyll chloroplasts includes an inner envelope transmembrane protein ARC6, a cytoplasmic dynamin-related protein ARC5 (DRP5B), and members of the FtsZ1 and FtsZ2 families of proteins, which co-assemble in the stromal mid-plastid division ring (FtsZ ring). FtsZ ring placement is controlled by several proteins, including a stromal factor MinE (AtMinE1). During leaf mesophyll development, ARC6 and AtMinE1 are necessary for FtsZ ring formation and thus plastid division initiation, while ARC5 is essential for a later stage of plastid division. Here, we examined plastid morphology in leaf epidermal pavement cells (PCs) and stomatal guard cells (GCs) in the arc5 and arc6 mutants using stroma-targeted fluorescent proteins. The arc5 PC plastids were generally a bit larger than those of the wild type, but most had normal shapes and were division-competent, unlike mutant mesophyll chloroplasts. The arc6 PC plastids were heterogeneous in size and shape, including the formation of giant and mini-plastids, plastids with highly developed stromules, and grape-like plastid clusters, which varied on a cell-by-cell basis. Moreover, unique plastid phenotypes for stomatal GCs were observed in both mutants. The arc5 GCs rarely lacked chlorophyll-bearing plastids (chloroplasts), while they accumulated minute chlorophyll-less plastids, whereas most GCs developed wild type-like chloroplasts. The arc6 GCs produced large chloroplasts and/or chlorophyll-less plastids, as previously observed, but unexpectedly, their chloroplasts/plastids exhibited marked morphological variations. We quantitatively analyzed plastid morphology and partitioning in paired GCs from wild-type, arc5, arc6, and atminE1 plants. Collectively, our results support the notion that ARC5 is dispensable in the process of equal division of epidermal plastids, and indicate that dysfunctions in ARC5 and ARC6 differentially affect plastid replication among mesophyll cells, PCs, and GCs within a single leaf.

Symmetric division of leaf mesophyll chloroplasts requires MinD and MinE, which work together to suppress division other than at the mid-chloroplast. arc11 is a MinD loss-of-function mutant of Arabidopsis thaliana. In arc11 plants, asymmetric chloroplast division, as well as its delay or arrest, results in extreme size polymorphism of chloroplasts in mature mesophyll cells. The current study examined chloroplast phenotypes in the epidermis of arc11 leaves. Fluorescence microscopy analysis revealed that epidermal chloroplasts in mature leaves exhibited moderate heterogeneity in size. This probably resulted from completion of many of the previous non-equatorial or multiple division events in expanding leaves. Additionally, analyses of plastids found that epidermal chloroplasts in arc11 mutants showed several phenotypes that have not previously been described.

To assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps.Retrospective single-institution study, April 2015 to March 2017.Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback. Sensitivity, specificity, and false positive rate (FPR) were recorded for each device. Logistic regression was conducted to identify user trends over time.Eleven of 120 patients (9.2%) required takeback, 10 from venous thrombosis and one from arterial thrombosis. Permanent signal loss (PSL) occurred in the flow coupler in all takebacks; PSL occurred in the arterial Doppler only in the case of arterial thrombosis. Salvage rate was 9/11 (81.8%). For the flow coupler, sensitivity was 100%, specificity 86.4%, and FPR 13.6%. For the arterial probe, sensitivity was 9.1%, specificity 97.1%, and FPR 2.9%. A 4.1% decrease in false positives with each additional flow coupler use was observed.Monitoring the vein via flow coupler has high sensitivity in identifying vascular compromise compared to the arterial probe, especially for venous thrombosis. There is moderate FPR; this decreases with increased usage and, when supplemented with physical examination, does not result in unnecessary takebacks. The flow coupler can be a valuable tool in postoperative monitoring of head and neck free flaps.4. Laryngoscope, 128:812-817, 2018.

The 2017 National Comprehensive Cancer Network Clinical Practice Guidelines recommend surgical resection or definitive radiation therapy for early-stage oral cavity malignancies, and surgical resection or multimodality clinical trials for late-stage disease. Few studies have been conducted to identify predictors of choice of treatment modality for oral cavity malignancies.All patients in the National Cancer Data Base (NCDB) diagnosed with oral cavity squamous cell carcinoma (OCSCC) between 1998 and 2011 were identified. Chi-square and binary logistic regression were used to identify factors predictive of surgical or nonsurgical treatment; multiple imputation was used for missing data. Cox proportional hazards models were generated to identify associations between treatment modality and overall survival (OS).Of 23,459 patients, 4139 (17.6%) underwent primary nonsurgical treatment. Among NCDB-registered facilities, there has been a decrease in use of nonsurgical treatment for OCSCC (OR 0.97, p0.001). Older age, non-white race, Medicaid insurance, low income, low education, and later-stage disease were associated with nonsurgical therapy, while patients at academic/research programs were more likely to undergo surgery (OR 0.38, p0.001). Nonsurgical treatment was associated with decreased OS (HR=2.02, p0.001); this was upheld on subgroup analysis of early- and late-stage disease.Use of primary nonsurgical treatment for OCSCC has decreased over time among NCDB-registered facilities and is associated with factors related to access to care. Surgical resection for the primary treatment of oral cavity cancer may be associated with improved OS, though conclusions regarding survival are limited by the non-randomized nature of the data.

This research aims to develop a direct-contact manganese silicon p/n multilayer-type thermoelectric power generation block. p-type MnSi1.74 and n-type Mn0.7Fe0.3Si1.68 ball-milled powders with diameter of about 10 μm or less were mixed with polyvinyl butyl alcohol diluted with methylbenzene at pigment volume concentration of approximately 70%. The doctor-blade method produced 45-μm-thick p- and n-type pigment plates. The insulator, i.e., powdered glass, was mixed with cellulose to form insulator slurry. Lamination of manganese silicide pigment layers and screen-printed insulator layers was carried out to fabricate multilayer direct-contact thermoelectric devices. Hot pressing and spark plasma sintering were carried out at 450°C and 900°C, respectively. Four to 30 thermoelectric (TE) p/n pairs were fabricated in a 10 mm × 10 mm × 10 mm sintered TE block. The maximum output was 11.7 mW/cm2 at a temperature difference between 20°C and 700°C, which was about 1/85 of the ideal power generation estimated from the thermoelectric data of the bulk MnSi1.74 and Mn0.7Fe0.3Si1.68 materials. A power generation test using an engine test bench was also carried out.

Factors affecting the distribution of continuous thoracic paravertebral block have never been examined. We designed this prospective, double-blind study to check whether continuous thoracic paravertebral block with a higher ropivacaine concentration would provide a wider segmental sensory block spread. Sixty consecutive patients undergoing pulmonary lobectomy or segmentectomy were randomly allocated to receive continuous paravertebral infusion of either 0.2% or 0.5% ropivacaine (6 ml.h(-1) ). The primary outcome was the number of anaesthetised dermatomes as determined by loss of cold sensation 24 h after surgery. Twenty-seven patients per group were included in the final analysis. The median (IQR [range]) number of anaesthetised dermatomes 24 h after surgery was 4 (3-6 [1-9]) with ropivacaine 0.2% and 4 (3-6 [2-11]) with ropivacaine 0.5% (p = 0.66). Contrary to our expectation, the segmental spread of sensory block produced by continuous thoracic paravertebral block does not depend on ropivacaine concentration.

Tree ring analysis is one of the most useful methods in volume and biomass estimation especially of the conifer trees. Ring width and ring density are important parameters in dendrochronological research. The present research was carried out with the aim of estimating the radial and volumetric growth of the Japanese Cypress trees (Chamaecyperis obstusa and C. pisifera). Destructive method was used while collecting the wood samples from the selected trees. Ring width and ring density were measured using soft X-ray densitometry method using micro-densitometer. Computer programme, developed by the Forestry and Forest Products Research Institute, Japan was used to analyze the ring with and ring density data. The average ring width of the Chamaecyparis spp. was found to be about 3.4 mm at the age of 30 years. However, two types of growth pattern were observed in the trees. Average radial growth was about 5% every year during the first 20 years of the tree age, whereas, the average radial growth was negative during the age of 20–30 years. Average density of the tree rings were increased by about 11% in each height of the trees starting from the ground. Similarly, the stem density decreased by about 3.4% annually along the radial direction from the pith. DOI: http://dx.doi.org/10.3126/banko.v22i2.9197 Banko Janakari : A Journal of Forestry Information for Nepal Vol. 22, No. 2, 2012 November Page: 36-42 Uploaded date: 12/1/2013

Steady state (1973 K, 180 s) and repeated (723 K–1524 K, 380 times) heat loading experiments of ITER grade W and toughened, fine-grained, recrystallized W–1.1TiC (TFGR W–1.1TiC) have been performed using an electron beam irradiation system. In ITER grade W, the irradiation around 1973 K causes recrystallization and grain growth up to the average diameters of 50–100 μm. Repeated irradiations cause significant surface roughening, cracking at grain boundaries and surface exfoliation. On the other hand, TFGR W–1.1TiC does not exhibit any surface roughening or cracking after repeated heat loading although grain boundaries on the surface of TFGR W–1.1TiC can be observed after irradiation at around 1973 K 180 s by steady state heat loading.

Be-seeded, high-flux, deuterium/helium mixture plasma exposure experiments on tungsten target materials have been performed to simulate ITER all tungsten divertor erosion/modification and deposition phenomena. The exposure conditions are kept fixed at a typical low-ion-energy of 60 eV and a flux of 3–6 × 10 22 /m 2 /s. Sample temperature is 1123 K and plasma exposure times spanning 1050–10,100 s are explored. The typical ratio of He/D ions is 0.2 and Be content is 0.2%. A He-induced nanostructure layer is formed on the exposure surfaces of tungsten materials and the surface of the nanostructure is covered by a thin layer of Be and O. A fraction of the re-eroded Be from the target is deposited on a glassy carbon plate with line of sight to the tungsten target. Rutherford backscattering spectrometry analyses show that the Be redeposit layer is in the form of laminae. Small amounts of Mo, W and C are also found in the redeposited Be layer. Elastic recoil detection analyses show that D, He and H are also included in the redeposited Be layer.

High density W coatings on reduced activation ferritic martensitic steel (RAF/M) have been produced by Vacuum Plasma Spraying technique (VPS) and heat flux experiments on them have been carried out to evaluate their possibility as a plasma-facing armor in a fusion device. In addition, quantitative analyses of temperature profile and thermal stress have been carried out using the finite element analysis (FEA) to evaluate its thermal properties. No cracks or exfoliation has been formed by steady state and cyclic heat loading experiments under heat loading at 700 °C of surface temperature. In addition, stress distribution and maximum stress between interface of VPS-W and RAF/M have been obtained by FEA. On the other hand, exfoliation has occurred at interlayer of VPS-W coatings near the interface between VPS-W and RAF/M at 1300 °C of surface temperature by cyclic heat loading.

Background Chronic allograft dysfunction (CAD) is a main cause of graft failure in kidney transplantation. Methods We retrospectively analyzed 279 kidney transplant recipients who survived with a functioning graft for at least 2 years. CAD was defined as chronic graft deterioration, excluding other specific causes. We defined the pattern of decline in estimated glomerular filtration rate (eGFR), as follows: (1) “plateau” was defined as decline in eGFR ≤2 mL/min/1.73 m 2 /year; “long plateaus” were those lasting more than 5 years; (2) “rapid decline” was a decrease in eGFR ≥20 mL/min/1.73 m 2 /year. Patients diagnosed with CAD were categorized according to the occurrence of rapid decline and/or long plateau as follows: group 1, neither rapid decline nor long plateau; group 2, rapid decline only; group 3, long plateau only; and group 4, both rapid decline and long plateau. Results From a total of 81 graft losses, 51 (63%) failed because of CAD, with a median of 9.4 years. Sixteen patients belonged to group 1, 14 to group 2, 12 to group 3, and nine to group 4. Mean graft survival times in the four groups were 7.7 ± 1.1, 6.1 ± 3.1, 16.2 ± 2.5, and 10.8 ± 3.6 years, respectively ( P Conclusions The results indicate that this cohort of kidney transplant recipients who had CAD comprised subgroups with different clinical courses.

Cadmium oxide (CdO) nanostructures of various shapes were successfully grown on gold (Au) nanocolloid coated c -plane sapphire substrates by atmospheric-pressure CVD using Cd powder and H 2 O as source materials. CdO nanorods (NRs) exhibited tapered shapes and the degree of the tapering became larger with increasing substrate temperature. One of the possible reasons for the tapering behavior is the competition between the axial growth due to the vapor–liquid–solid (VLS) mechanism and the radial growth due to the vapor–solid (VS) mechanism. The influence of the competition between the two different growth mechanisms was also confirmed on the appearance of “seaweed-like” NRs. Moreover, we cannot neglect the influence of the shrinkage of catalyst particles during the growth process on the tapering behavior. In addition, there is a possibility that the temporal evolution of catalyst particles, such as diffusion, splitting, migration and coalescence, contributes not only to the disappearance of catalyst particles on the tips of the NRs, resulting in the enhancement of the radial growth relative to the axial growth, but also to the formation of nanobelts (NBs) and nanotrees (NTs). Photoacoustic measurements revealed that the absorption edge shifts towards lower energies and the absorption band below the absorption edge becomes larger with increasing T S . This tendency may be due to the increase of intrinsic defects and/or the decrease in residual impurities.

Evidence of the ${K}^{+}\ensuremath{\rightarrow}{\ensuremath{\mu}}^{+}\ensuremath{\nu}\overline{\ensuremath{\nu}}\ensuremath{\nu}$ decay was searched for using E949 (Brookhaven National Laboratory, USA) experimental data with an exposure of $1.70\ifmmode\times\else\texttimes\fi{}1{0}^{12}$ stopped kaons. The data sample is dominated by the background process ${K}^{+}\ensuremath{\rightarrow}{\ensuremath{\mu}}^{+}{\ensuremath{\nu}}_{\ensuremath{\mu}}\ensuremath{\gamma}$. An upper limit on the decay rate $\mathrm{\ensuremath{\Gamma}}({K}^{+}\ensuremath{\rightarrow}{\ensuremath{\mu}}^{+}\ensuremath{\nu}\overline{\ensuremath{\nu}}\ensuremath{\nu})l2.4\ifmmode\times\else\texttimes\fi{}{10}^{\ensuremath{-}6}\mathrm{\ensuremath{\Gamma}}({K}^{+}\ensuremath{\rightarrow}\text{all})$ at 90% confidence level was set assuming the standard model muon spectrum. The data are presented in such a way as to allow calculation of rates for any assumed ${\ensuremath{\mu}}^{+}$ spectrum.

Taste is recognized as an important predictor of food choices. Thus, polymorphisms in genes encoding taste receptors may explain the variability in food preference and intake. Here, we aimed to determine whether genetic variation in the CD36 gene affects food intake and risk of obesity.A cross-sectional study was conducted with obese Brazilian children and adolescents (n = 466; BMI-for-age z-score [zBMI] 3.29 ± 0.61) and normal-weight children (n = 114; zBMI -0.11 ± 0.7). To assess the obesity risk according to genotypes, a logistic regression adjusted for age and gender was performed. Two 24-h food recalls assessed total energy (kcal/day) and macronutrient (% kcal and g/day) intake, consumption of sweet and fatty tasting foods (portion and g/day), as well as the most commonly consumed foods (mL or g/day). The food portion sizes were measured according to Brazilian guidelines. The genetic variant rs1761667 (A/G) in CD36 was genotyped by real-time PCR.We found no relationship between rs1761667 genotypes and obesity risk. A significant genetic association between CD36 genotype and fat intake was observed for the A allele of rs1761667, which was associated with a decreased intake of total fat (g/day) (p = 0.01), polyunsaturated and monounsaturated fatty acids (% kcal and g/day), total sugars (g/day) (p = 0.01), fatty foods (portion and g/day) (p0.001 for both), and vegetable oils (mL/day) (p = 0.02) only in obese subjects. No differences were found between normal-weight children.The A allele of the rs1761667 single nucleotide polymorphism in CD36 is associated with decreased fat and sugar intake in obese children and adolescents.

In Japan, students' poor adjustment to school life such as school refusals has been recognized as a nation-wide problem. In this study, we examined the link between the absence of mothers' active engagement with their infants at 6 months and children's risks of poor adjustment toward elementary school life at the ages of 5.5 and 11.We used a Japanese national longitudinal survey (n = 43 132) with 11 years of follow-up. Because of social patterning in how mothers engage with their infants, we employed propensity score matching analyses to control for confounding by socio-economic and other factors. We matched mothers with active engagement and those without on various social and parental characteristics such as educational attainment and household income.Among matched pairs, we observed higher risks of poor adjustment to school life at both 5.5 and 11 years among Japanese children who lacked mothers' active engagement at 6 months. For example, the relative risk was 1.46 [95% confidence interval: 1.10, 1.94] for inability to get along with others in a group setting at the age of 5.5 years and 1.29 [1.10, 1.51] for inability to get along with teachers at the age of 11 years. Our findings corroborate previous findings, which emphasize the importance of providing an enriched environment for infants' social development and may indicate the need for an intervention for caregivers who lack appropriate nurturing skills.

This study was aimed to investigate etiology and clinical profiles of recurrent acute pancreatitis (RAP), particularly from the morphology of the pancreaticobiliary duct system.Pancreaticobiliary morphology was examined in 230 of 381 patients with acute pancreatitis (AP) using endoscopic retrograde cholangiopancreatography. We analyzed factors associated with RAP including the pancreaticobiliary duct system.RAP was diagnosed in 74 patients (19%). Major etiologies of RAP were alcoholic (38%), idiopathic (26%) and pancreaticobiliary malformation (22%). Patients with alcoholic RAP were significantly younger (47.2±11.6 years) than those with gallstone RAP (67.3±16.8; p0.05). RAP with pancreaticobiliary malformation (male-to-female ratio: 1:4.3; p0.01) and gallstone RAP (1:1.7; p0.05) occurred predominantly in females in comparison with alcoholic RAP (1:0.2). Recurrence rate was 80% for AP with pancreaticobiliary malformation, significantly higher than for the others (p0.01). Pancreas divisum was suspected as the etiology of mild RAP in 7 patients. Four RAP patients with pancreas divisum underwent endoscopic minor papilla sphincterotomy and improved. Pancreaticobiliary maljunction with biliary dilatation (choledochal cyst) was suspected as the etiology of mild RAP in 3 patients. The 3 RAP patients with choledochal cyst underwent prophylactic flow diversion surgery with complete resection of the dilated common bile duct, and achieved improvement. High confluence of pancreaticobiliary ducts was suspected as the etiology of mild RAP in 6 patients.Pancreaticobiliary malformation is one of the major causes of RAP. As some of them benefit from endoscopic or surgical treatment, morphology of the pancreaticobiliary duct system should be examined where possible in RAP patients.

The Lichtenstein inguinal hernia repair is commonly performed and suitable for teaching basic surgical skills. The objective of this study is to evaluate the feasibility of this procedure for surgical training, particularly in regard to patient outcomes.Retrospective case review after introduction of an integrated teaching program.University teaching hospital.The Lichtenstein inguinal hernia repair is the standard procedure for adult primary unilateral inguinal hernia since 2003 at Jichi Medical University. We introduced an integrated teaching system of lectures, skill training. and videos to teach the skills for Lichtenstein inguinal hernia repair to residents and junior faculty in 2003. Cases were retrospectively divided into 4 groups based on the experience of the operating surgeon; junior residents (PGY 1-2, group A), senior residents (PGY 3-5, group B), junior faculty (PGY 6-10, group C), and senior faculty (PGY 11 or more, group D). Background, perioperative factors, and outcomes were evaluated among the groups.A total of 246 elective inguinal hernia repairs (group A: 136, group B: 49, group C: 42, group D: 19) were performed. There was a significant difference in the frequency of concomitant diseases (p = 0.012) and anticoagulant therapy (p = 0.031). Average operating time was 80.7 ± 24.9, 72.6 ± 20.8, 63.5 ± 22.0, and 54.7 ± 27.9 (min ± SD) in groups A, B, C, and D, respectively, with a significant difference between groups A and D (p0.001). No significant differences were observed in estimated blood loss (p = 0.216) or morbidity (p = 0.294).The Lichtenstein inguinal hernia repair can be safely performed by residents and junior faculty with the appropriate supervision of senior faculty without any disadvantage to patients. This integrated teaching program for Lichtenstein inguinal hernia repair is effective and feasible for training residents and junior faculty.

From the initial stages of immersion lithography development, through mainstream manufacturing today, topcoat processes have been utilized. However, the complexity and extra cost associated with the topcoat layer has motivated the industry as a whole to transition to topcoat-less (TC-less) resist processes. By switching to TC-less resists, track suppliers are able to achieve higher throughput using smaller and less costly equipment. In addition, scanner suppliers can increase the scanning speed of their litho scanners with minimized risk of defects, while end-users will eliminate a process step and gain increased output at a lower cost. These factors become increasingly critical as a result of the heightened processing complexities associated with the introduction of double patterning (DP) lithography. Although the motivations for topcoat-less processing are significant, there are numerous technical challenges. One is the potential for added defects, and the correlation between dynamic receding contact angle (D-RCA) and defectivity performance will be discussed. In addition, due to continuous pattern size shrinkage, smaller defects that may not have been problematic or even existed in the past, now can contribute to yield loss. To better understand the defectivity-generation mechanisms, defect review before and after development is necessary. Detailed results of these experiments will also be discussed in this paper. In addition to having defectivity benefits, a topcoat-less process must also satisfy the other critical performance criteria. Results for overlay, autofocus, and imaging will be discussed in this paper. To justify transition to a new technology, there also should be demonstration of associated cost reduction or productivity improvements, and a comparison of topcoat and topcoat-less processes will again be shown.

We report two cases of carcinoid tumor of the gallbladder. Case 1 was a 59-year-old woman who presented with epigastric pain. Abdominal ultrasonography and computed tomography (CT) revealed a 16 mm polypoid lesion in the neck of the gallbladder. Tumor markers were within normal limits. Open cholecystectomy was performed with a preoperative diagnosis of early cancer of the gallbladder. Case 2 was a 45-year-old man. A polyp in the gallbladder was incidentally detected on annual checkup. Ultrasound and CT showed an 18 mm protruding lesion in the neck of the gallbladder. Laparoscopic cholecystectomy was performed and the tumor diagnosed as a carcinoid tumor based on the findings of funicular and tubular cells in the lamina propria mucosa, homogeneous nuclei, basophilic cytoplasm, and positive staining with chromogranin A and synaptophysin. The postoperative course of both patients was uneventful, with no recurrence at 44 and 41 months after surgery. In this literature review of 39 cases, classical carcinoid of the gallbladder has a favorable postoperative outcome. Of cases reviewed, 60% are located in the neck of the gallbladder and 50% have a polypoid shape.

Ultra-fine grain W-(0.5, 1.5)wt%TiC alloys and stress relieved powder metallurgy W have been exposed to D-He mixed plasmas, some with added Be. The fixed exposure conditions are ion energy 60 eV and flux 3 to 6 × 1022/m2 s. Sample temperature is 1123 K and exposure times scanned 1000–11,000 s. Typical He/D ion is 0.2 and Be is 0.2% of the plasma. A remarkable change of the tungsten surfaces results from the plasma exposures. Formation of a nano-structured layer on the exposure surfaces is observed and believed to be related to He bubble formation. In addition, the growth rate of the nano-structured layer depends on the microstructure of the samples. In the case of a D-He plasma with Be, at 60 eV, plasma sputters away most of Be deposits with little effect on the He induced nano-structured layer formation.

Urahashi T, Mizuta K, Sanada Y, Wakiya T, Umehara M, Hishikawa S, Hyodo M, Sakuma Y, Fujiwara T, Yasuda Y, Kawarasaki H. Pediatric liver retransplantation from living donors can be considered as a therapeutic option for patients with irreversible living donor graft failure. Pediatr Transplantation 2011: 15: 798–803. © 2011 John Wiley & Sons A/S. Abstract: Liver retransplantation (re-LT) is required in patients with irreversible graft failure, but it is a significant issue that remains medically, ethically, and economically controversial, especially in living donor liver transplantation (LDLT). The aim of this study was to evaluate the outcome, morbidity, mortality, safety and prognostic factors to improve the outcome of pediatric living donor liver retransplantation (re-LDLT). Six of 172 children that underwent LDLT between January 2001 and March 2010 received a re-LDLT and one received a second re-LDLT. The overall re-LDLT rate was 3.5%. All candidates had re-LDLT after the initial LDLT. The overall actuarial survival of these patients was 83.3% and 83.3% at one and five yr, respectively. These rates are significantly worse than the rates of pediatric first LDLT. Vascular complications occurred in four patients and were successfully treated by interventional radiologic therapy. There were no post-operative biliary complications. One case expired because of hemophagocytic syndrome after re-LDLT. Although pediatric re-LDLT is medically, ethically, and economically controversial, it is a feasible option and should be offered to children with irreversible graft failure. Further investigations, including multicenter studies, are therefore essential to identify any prognostic factors that may improve the present poor outcome after re-LDLT.

Background To assess the impact of childhood abuse history, domestic violence experiences and mental health symptoms on the parenting behaviour of mothers in Japan who have separated from violent husbands or partners. Methods A self-administered questionnaire survey was conducted on a sample of mothers (n= 304) and their children (n= 498) residing in 83 mother-child homes in Japan. The survey assessed the mothers' childhood abuse history (physical, psychological and sexual abuse and neglect history), domestic violence experiences, current mental health symptoms (dissociative, depressive and traumatic symptoms) and parenting behaviours after moving into the homes to separate from a violent husband or partner. Results The mothers' childhood abuse history and experience of domestic violence were not associated with their not playing with their children. In contrast, the mothers' dissociative and depressive symptoms were significantly associated with not playing with their children. Although there was no association between the mothers' total childhood abuse history and not praising their children, their childhood physical abuse history was significantly associated with their not praising their children. The dissociative and depressive symptoms were also associated with no praise. Interestingly, the experience of domestic violence showed an inverse association with no praise. Conclusions Mental health symptoms, more specifically dissociative and depressive symptoms, are associated with a decrease in parenting quality. Mothers who were physically abused as children are less likely to praise their own children, independent of maternal mental health symptoms. In contrast, mothers who experienced domestic violence but subsequently separated from their violent husbands or partners are more likely to praise their children. The treatment of mental health symptoms, particularly dissociative and depressive symptoms, therapy for childhood abuse history and separation from violent husbands or partners might be effective ways to enhance the quality of parenting in Japan. Language: en

Ornithine transcarbamylase deficiency, the most common urea cycle disorder, causes hyperammonemic encephalopathy and has a poor prognosis. Recently, LT was introduced as a radical OTCD treatment, yielding favorable outcomes. We retrospectively analyzed LT results for OTCD at our facility. Twelve children with OTCD (six boys and six girls) accounted for 7.1% of the 170 children who underwent LDLT at our department between May 2001 and April 2010. Ages at LT ranged from nine months to 11 yr seven months. Post-operative follow-up period was 3-97 months. The post-operative survival rate was 91.7%. One patient died. Two patients who had neurological impairment preoperatively showed no alleviation after LT. All patients other than those who died or failed to show recovery from impairment achieved satisfactory quality-of-life improvement after LT. The outcomes of LDLT as a radical OTCD treatment have been satisfactory. However, neurological impairment associated with hyperammonemia is unlikely to subside even after LT. It is desirable henceforth that more objective and concrete guidelines for OTCD management be established to facilitate LDLT with optimal timing while avoiding the risk of hyperammonemic episodes.