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As the prognosis of cancer patients has been improved, comorbidity of heart failure (HF) in cancer survivors is a serious concern, especially in the aged population. This study aimed to examine the risk factors of HF development after treatment by anticancer agents, using a machine learning-based analysis of a massive dataset obtained from the electronic health record (EHR) in Japan. This retrospective, cohort study, using a dataset from 2008 to 2017 in the Diagnosis Procedure Combination (DPC) database in Japan, enrolled 140,327 patients. The structure of risk factors was determined using multivariable analysis and classification and regression tree (CART) algorithm for time-to-event data. The mean follow-up period was 1.55 years. The prevalence of HF after anticancer agent administration were 4.0%. HF was more prevalent in the older than the younger. As the presence of cardiovascular diseases and various risk factors predicted HF, CART analysis of the risk factors revealed that the risk factor structures complicatedly differed among different age groups. The highest risk combination was hypertension, diabetes mellitus, and atrial fibrillation in the group aged ≤ 64 years, and the presence of ischemic heart disease was a key in both groups aged 65–74 years and 75 ≤ years. The machine learning-based approach was able to develop complicated HF risk structures in cancer patients after anticancer agents in different age population, of which knowledge would be essential for realizing precision medicine to improve the prognosis of cancer patients.

Purpose The number of older adult patients with uterine cervical cancer is continuously increasing in Japan. This study aimed to investigate the patient characteristics, treatment outcomes, and adverse effects (AEs) of older adult patients with cervical cancer.Methods We retrospectively analyzed 89 patients who had undergone definitive radiation therapy (RT). Based on patient age at the time of study inclusion, patients were divided into the older (≥ 75 years [n = 21]) and younger (Results Histological type (adenocarcinoma) was associated with OS, whereas average Hb concentration during treatment was associated with PFS in older adult patients. Moreover, the external beam RT field, concurrent chemotherapy dose, and overall treatment time were not associated with a worsening of ECOG PS among older adult patients. Acute AEs of grade ≥ 3 were significantly more common in the younger adult group; however, three of the older adult patients (14%) had Grade 3 leukopenia, and two were concurrently receiving ≥ 200 mg of cisplatin.Conclusion Concurrent chemoradiation therapy may cause severe leukopenia in older adult patients; therefore, it should be considered carefully in older adult patients with cervical cancer.

Despite the growing population of long-term survivors with human immunodeficiency virus 1 (HIV) exhibiting asthma-like features worldwide, the pathogenesis underlying airway hyperresponsiveness (AHR) and airway inflammation remains unclear. We aimed to investigate AHR and airway inflammation in an HIV-infected Japanese population.Of 94 Japanese participants, 10 HIV-infected participants with asthma were excluded from the study. We compared the characteristics of HIV-infected (n = 34) and non-HIV-infected participants (n = 50). Eosinophilic, neutrophilic, mixed (eosinophilic and neutrophilic), and paucigranulocytic airway inflammatory phenotypes were classified based on induced sputum characteristics.The prevalence of AHR in HIV-infected participants (32.4%) was significantly higher than that in their non-HIV-infected counterparts (10.0%) (P = 0.0213). The multivariate nominal logistic regression analysis revealed HIV as an independent risk factor for AHR. HIV-infected participants were significantly more likely to have a neutrophilic airway inflammatory phenotype than non-HIV-infected participants (P = 0.0358). Furthermore, HIV-infected participants with AHR demonstrated a significant correlation between AHR levels and the percentage of sputum neutrophils (r = -0.65, P = 0.0316). The percentage of sputum neutrophils was negatively associated with the blood CD4 cell count (r = -0.66, P = 0.0266).We observed the high prevalence of AHR and neutrophilic airway inflammatory phenotype in Japanese participants with stable HIV infection. Our findings provide insight into the mechanisms of AHR and may facilitate the development of novel treatment for individuals with AHR and HIV infection.

Reports of zinc and selenium deficiencies accompanying inflammatory bowel disease (IBD) mostly have originated from Western countries and concerned adult patients. Whether Japanese children with IBD have similar deficiencies remained unclear. We aimed to elucidate differences in serum zinc and selenium concentrations in Japanese children between types of IBD. Children under 17 years old undergoing care at 12 Japanese pediatric centers were retrospectively enrolled between November 2016 and February 2018 to 3 groups representing Crohn’s disease (CD), ulcerative colitis (UC), and normal controls (NC) with irritable bowel syndrome or no illnesses. Serum zinc and selenium were measured by atomic absorption spectrophotometry. Zinc and selenium deficiencies were defined by serum concentrations

Two-stage switch networks are an emerging design option for relatively small-capacity space switches. They are classified into two categories: folded and unfolded. Although folded switches have been well studied, research on unfolded two-stage switch networks (UTSNs) remains limited. Here, non-blocking UTSNs are considered. First, a new UTSN design is presented that consists of input and output switch modules (ISMs and OSMs) using bidirectional switching techniques. The proposed UTSN is represented by B(n, m, r), where n, m, and r denote the number of input ports of the ISM, number of OSMs, and number of ISMs, respectively. Second, the maximum number of rearrangements for B(n, n, r) is proved to be L(r-1)/2(n-1) RIGHT FLOOR in general, whereas it is limited to two when n >= r. The strictly non-blocking condition for B(n, m, r) to be m >= n + 1 is also determined. Finally, it is shown that the switch hardware complexity becomes minimal at n=N/2 and saturates at N-2/2 as N -> infinity.

BACKGROUND AND AIM Serologic markers such as myeloperoxidase (MPO) antineutrophil cytoplasmic antibodies (ANCA) (MPO-ANCA) have been used to screen patients for ulcerative colitis (UC). However, MPO-ANCA shows limited accuracy in Asians. Proteinase 3 ANCA (PR3-ANCA) has performed better at UC diagnosis in Japanese adults than MPO-ANCA. The present study aimed to evaluate usefulness of PR3-ANCA for diagnosis of UC in Japanese pediatric practice. METHODS Patients under 17 years old undergoing assessment at 12 Japanese pediatric centers between November 2016 and February 2018 were prospectively enrolled and divided into groups with UC, Crohn's disease (CD), intestinal disease control (IC), and healthy control (HC). Serum PR3-ANCA and MPO-ANCA were analyzed using chemiluminescence enzyme immunoassay kits. RESULTS Sera from 367 patients (148 with UC at a median age of 12 years; 120 with CD, 13 years; 56 with IC, 10.5 years; and 43 with HC, 10 years) were examined. Median PR3-ANCA values in UC (1.6 U/mL) were greater than in CD (0.2; P

Although HER2-positive (HER2+) invasive breast carcinomas (BC) have a different clinical therapeutic responsiveness according to estrogen and progesterone receptor expression, the relationship with androgen receptors (AR), which are the same family of steroid hormones, is poorly understood. We investigated the relationship between AR expression in HER2 BCs and therapeutic responsiveness and prognosis in this study. We evaluated patients with HER2 (H) + invasive BC undergoing surgery after neoadjuvant chemotherapy (± HER2-targeted therapies) from 2007–2017, classified as hormone receptor-positive (Allred score: 2–8) (luminal B: LH) and receptor-negative groups (Allred: score 0) (non-luminal: NLH). AR expression was assessed by immunostaining pre-neoadjuvant chemotherapy biopsy specimens, positive with Allred score ≥ 4. The pathological complete response, disease-free survival, and overall survival rates were compared between AR-positive and AR-negative groups. We classified 82 patients with HER2 + invasive BC into LH (n = 45, 54.9%) and NLH groups (n = 37, 45.1%), and AR + was observed in 43 patients (52.4%) (LH: 23, 51.1%; NLH: 20, 54.1%; p = 0.79). Quasi-pathological complete response was observed in 40 patients (48.8%) (LH: 18, 40%; NLH: 22, 59.5%; p = 0.08) overall, and in 31 AR + patients (72.1%) (LH: 15, 34.9%; NLH: 16, 37.2%), significantly higher than in the AR − group for both subgroups (p

AIMS HER2-positive (HER2+) breast carcinoma (BC) cases are often treated similarly; however, they can be classified as either luminal B (LH) or non-luminal type (NLH) BC, which have different prognoses. In this study, we investigated the clinicohistomorphological features of each HER2+ BC subgroup. METHODS AND RESULTS We classified 166 patients with HER2+ invasive BC into LH (n = 110, 66.3%) and NLH groups (n = 56, 33.7%). We further subclassified LH into patients with carcinomas expressing high levels of hormone receptors [LH-high; Allred score, oestrogen receptor (ER) and/or progesterone receptor (PgR) 4-8, n = 89, 53.6%] or low levels (LH-low; Allred score, ER and/or PgR 2 or 3, n = 21, 12.7%) for clinicohistomorphological characterisation. Morphological review showed that NLH included a percentage of patients with comedo necrosis, while LH patients had significantly more central scarring. In terms of immune responsiveness, NLH showed significantly higher rates of tumour-infiltrating lymphocytes and healing. The LH-high and NLH groups showed distinct characteristics (by both models, P

We retrospectively analyzed the clinical and laboratory data of patients diagnosed with anti-transcriptional intermediary factor 1 (TIF-1γ) antibody-positive polymyositis (PM)/dermatomyositis (DM) to clarify the characteristics of this disease. We identified 14 patients with TIF-1γ antibody-positive DM (TIF-1γ DM), 47 with anti-aminoacyl-tRNA synthetase antibody (ARS)-positive PM/DM, and 24 with anti-melanoma differentiation-associated gene 5 antibody (MDA-5)-positive PM/DM treated at the Kurume University Hospital between 2002 and 2020. Patients with TIF-1γ DM were significantly older than the other two groups. Nine patients with TIF-1γ DM were female, thirteen patients had DM, and one had clinically amyopathic DM. Primary malignant lesions were lung (3), uterus (2), colon (2), breast (2), ovary (1), lymphoma (1), and unknown (2). Cutaneous manifestation and dysphagia were the most common symptoms in TIF-1γ DM. Erythema (9/14), the V-neck sign (8/14), heliotrope (9/14), and nailfold telangiectasia (14/14) were significantly more common in TIF-1γ DM. Furthermore, no patients with TIF-1γ DM had interstitial lung abnormality on high-resolution CT. In patients with TIF-1γ DM, the frequency of dysphagia and unusual erythema, particularly that which spreads from the trunk, and nailfold telangiectasia, were characteristic findings. In most patients with TIF-1γ DM, it is necessary to administer other immunosuppressive drugs along with glucocorticoids.

This study aimed to validate the Japanese version of the Child's Sleep Habits Questionnaire (CSHQ-J) and identify which factors affect the CHSQ-J total score.The participants were 3158 children (aged 4-12 years) and their parent/guardian, as community samples from large, medium-sized, and small cities. Each parent/guardian filled in the questionnaire set (CSHQ-J, Pittsburgh Sleep Quality Index, demographic data: family structure, sleep environment, participants' present illness, and economic information); we also collected 51 clinical samples from our facility to calculate the cutoff score. According to the age of the participants in the original CSHQ (4-10 years), validation was assessed statistically via exploratory and confirmatory factor analyses and internal consistency (verified by Cronbach's α). Multivariate analysis was conducted to identify factors affecting the CSHQ-J total score.We received responses from 2687 participants (response rate: 85%) and analyzed 1688 participants who were the age of the original CSHQ participants. The alpha coefficients of each subscale of the CSHQ-J ranged from 0.43 to 0.68. The cutoff score was 48 (sensitivity: 0.69, specificity: 0.79). The confirmatory and exploratory factor analyses did not converge. Multivariate analysis showed that the factors that significantly influenced the CSHQ-J total score were co-sleeping, supplemental sleep, and child's age. Present illness, especially adenoids, also significantly influenced CSHQ total score.The CSHQ-J has adequate internal consistency and is useful for screening for pediatric sleep disorders. Supplemental sleep, habit of co-sleeping, and child's age should be considered when using the CSHQ-J as a screening tool for sleep problems in children.

Major cardiology societies’ guidelines support integrating palliative care into heart failure (HF) care. This study aimed to identify the effectiveness of the HEart failure Palliative care Training program for comprehensive care providers (HEPT), a physician education program on primary palliative care in HF. We performed a pre- and post-test survey to evaluate HEPT outcomes. Physician-reported practices, difficulties and knowledge were evaluated using the Palliative Care Self-Reported Practices Scale in HF (PCPS-HF), Palliative Care Difficulties Scale in HF (PCDS-HF), and Palliative care knowledge Test in HF (PT-HF), respectively. Structural equation models (SEM) were used to estimate path coefficients for PCPS-HF, PCDS-HF, and PT-HF. A total of 207 physicians participated in the HEPT between February 2018 and July 2019, and 148 questionnaires were ultimately analyzed. The total PCPS-HF, PCDS-HF, and PT-HF scores were significantly improved 6 months after HEPT completion (61.1 vs 67.7, p

this paper proposes a new type of three stage Clos network with modified unidirectional crossbars. Nonblocking properties of the new architecture are investigated theoretically and a new result of improved performance is reported.

OBJECTIVE Dual-layer spectral detector computed tomography (DLCT) can detect noncalcified biliary stones. The diagnostic ability of DLCT for detecting biliary stones may be comparable to that of magnetic resonance cholangiopancreatography (MRCP). This study seeks to compare the diagnostic ability for biliary stones between these two imaging modalities. METHODS This retrospective study included 102 cases with a diagnosis of biliary stones including gallstones (n = 66) and common bile duct (CBD) stones (n = 25) or spontaneously passing CBD stones (n = 11). The reference standard used was operative findings, endoscopic retrograde cholangiopancreatography or follow-up over 6 months. In DLCT, 120-kVp images, 40-keV virtual monoenergetic images and material decomposition images were created. We compared the diagnostic ability of DLCT and MRCP for biliary stones using the McNemar's test. RESULTS The sensitivity and specificity of DLCT versus MRCP for biliary stones were 91.2% versus 95.6% and 90.9% versus 90.9%. Thus, the sensitivity and specificity were not significantly different (P = 0.25 and P = 1.0). Although in small stones (

BACKGROUND Night-shift lifestyles affect children as well as adults, and are associated with sleep and behavioral problems among children. This study aimed to investigate associations among sleep patterns, individual/environmental factors, and problematic behaviors in children at age 5 years. METHODS Data for sleep patterns, individual / environmental factors, and problematic behaviors for 8,689 5-year-old children were collected from health-checkup records. Problematic behaviors investigated were anxious behavior (being afraid, difficulty being separated from the mother), developmental behavior (violence, restlessness, rebellious behavior, restrictive diet, stereotypic play), personal habits (thumb-sucking, nail-biting, tic, masturbation), and excretory problems. The relationships between sleep patterns (bedtime, sleep duration) and the presence of these behaviors were analyzed. Individual / environmental factors that affected problematic behaviors were statistically identified using a tree-form model. RESULTS Late bedtime and short sleep duration showed significant adverse effects on children's problematic behaviors - odds ratio (OR): 1.07, 95% confidence interval (CI): 1.03-1.11 and OR: 0.92, 95% CI: 0.87-0.97, respectively. Long television watching time, abnormality at birth, and lack of father's support also showed significant adverse effects on problematic behaviors (OR: 2.34, 95% CI: 1.87-2.94), and significantly affected late bedtime and short sleep duration. CONCLUSIONS There were significant associations among sleep patterns, individual / environmental factors, and problematic behaviors in 5-year-old children. Improving children's sleep patterns, reducing the duration of television watching, and improving support from fathers may reduce problematic behaviors.

Two principal two-stage switch architectures (cascaded and parallel), both of which are composed of two identical optical crossbar switches with an extra set of inputs and outputs, are compared in terms of their number of crosspoints, switch control complexities, and key optical performances, such as insertion loss and crosstalk power, through theoretical analysis. The authors begin by briefly introducing a known N × N cascaded optical crossbar switch with N 2/2 crosspoints, where N is the switch size, and present a new functional perspective based on quasi-bitonic sorting. Subsequently, the authors derive two types of two-stage parallel optical crossbar switches with reduced crosspoints from a conventional single-stage parallel crossbar switch with N 2 + 2N crosspoints. The first type uses two N/2 × N asymmetric switches in parallel, both of which are embedded in a single N/2 × N/2 crossbar switch. It has (N 2 + 2N)/2 crosspoints and suffers from a complex switch control of O(N 2). The second type is equivalent to a three-stage Benes network and exploits bidirectional transmission to reduce the number of switching stages. It requires (N 2 + 3N)/2 crosspoints, but has a dramatically reduced switch control complexity of O(N), and significantly improved optical performance.

Aim Combined hepatocellular cholangiocarcinoma, subtype with stem-cell features, intermediate-cell subtype (INT) shows various histological appearances and could be misdiagnosed as intrahepatic cholangiocarcinoma (iCCA). In the present study, we aimed to identify specific histological diagnostic markers of INT. Methods We extracted RNA from FFPE sections of six INT, five iCCA, and five hepatocellular carcinoma (HCC) cases and compared gene expression between INT, iCCA, and HCC by microarray analysis. We then undertook immunohistochemical (IHC) staining of potential key molecules identified by microarray analysis, the conventional hepatocytic marker, hepatocyte paraffin (HepPar)-1, and the cholangiocytic markers, keratin (K) 7 and K19, on 35 INT, 25 iCCA, and 60 HCC cases. Results Microarray analysis suggested that malic enzyme 1 (ME1) was significantly upregulated in INT. Immunohistochemical analysis revealed that the positive rates of ME1 in INT, iCCA, and HCC were 77.1% (27/35), 28.0% (7/25), and 61.7% (37/60), respectively. Analysis of classification and regression trees based on IHC scores indicated that HepPar-1 could be a good candidate for discriminating HCC from the others with high sensitivity (93.3%) and high specificity (96.7%). A multiple logistic regression model and receiver operating characteristic curve analysis based on the IHC scores of ME1, K7, and K19 generated a composite score that can discriminate between INT and iCCA. Using this composite score, INT could be discriminated from iCCA with high sensitivity (88.6%) and high specificity (88.0%). Conclusions We propose that ME1 is a useful diagnostic marker of INT when used in combination with other hepatocytic and cholangiocytic markers.

Summary Background & aims Elderly patients who receive enteral nutrition after stroke are at a high risk of malnutrition. However, there are few investigations of the changes in the nutritional status of very elderly tube-fed patients in the long-term. We aimed to clarify the improvement in the nutritional status of very elderly patients who receive long-term complete tube feeding after stroke. Methods Our subjects were 68 elderly bedridden patients who received complete enteral nutrition after stroke. All subjects had hypoalbuminemia and low body weight. The subjects were divided into the Elderly group ( n = 37) and the Very elderly group ( n = 31). Their nutritional indices were measured at the time of admission, and at 6 and 12 months after admission. Changes in the nutritional indices of each group were assessed. Results In both groups, the albumin, prealbumin, total cholesterol, and hemoglobin levels and body mass index, mid-arm circumference, and triceps skinfold thickness after 12 months were significantly higher than baseline levels. There was no significant difference between the C-reactive protein level and mid-upper-arm muscle circumference at baseline and after 12 months. The raise in albumin and prealbumin levels were significantly higher in the Elderly group as compared with in the Very elderly group. However, there were no significant differences in the change in other biochemical and anthropometric parameters between the Elderly and Very elderly groups. The BMI in both groups improved to within the normal range. However, the serum albumin levels in both groups did not improve to within the normal range. Both groups showed a mild inflammatory response during the study period. Albumin and prealbumin levels were negatively associated with age. Conclusions Long-term complete tube feeding after stroke is effective for improving the nutritional status of very elderly patients. Both in the elderly and in the very elderly patients, most of the biochemical parameters and anthropometric parameters improved. However, the change in albumin levels differed between elderly patients and very elderly patients, probably because albumin levels are influenced by aging. In addition, it was difficult to improve the low serum albumin levels of bedridden elderly patients who exhibited an inflammatory response to within the normal range. Especially, in the very elderly patients, serum albumin levels were hard to reflect improvement of malnutrition.

Patients who have neurological dysphagia induced by cerebrovascular disease are at high risk of malnutrition and aspiration pneumonia. Since trace elements in serum bind to serum protein, serum trace elements concentration is influenced by serum protein concentration. In addition, serum protein concentration is influenced by malnutrition and inflammation. Therefore, evaluation of serum trace elements concentration has to consider influence of malnutrition and inflammation. In recent years, enteral formula including rich trace elements were developed to prevent trace elements deficiency. However, serum trace elements concentration showed a low level even if patients were receiving enough trace elements intake. We thought that it was effective in nutritional management of patients with malnutrition and inflammation to clarify about correlation among nutritional indices, serum trace elements, and the amount of trace element intake in tube-fed patients. In this study, we aimed to determine nutritional indices that are predictors of serum trace elements in patients with neurological dysphagia on long-term tube feeding.Subjects were 40 elderly bedridden patients with neurological dysphagia induced by cerebrovascular disease. All subjects were fed total enteral nutrition via nasogastric tube. We investigated serum trace elements (iron, copper, zinc) and nutritional indices (body mass index, albumin, transferrin, ceruloplasmin, C-reactive protein, hemoglobin, lymphocyte, trace elements intake), and analyzed by multiple regression analysis. In addition, we divided subjects into two groups based on inflammatory response. The first group was 20 patients with inflammation (inflammation group), and another group was 20 patients without pneumonia (control group).Subjects were malnourished and showed inflammatory response: low body weight (55%), hypoalbuminemia (58%), moderate or severe inflammation (53%), anemia (38%). Ratio of low serum iron concentration was 43%. Ratio of high serum copper concentration was 45%. Ratio of low serum zinc concentration was 65%. Mean of trace elements intake was slightly more than requirements. In multiple regression analysis in all subjects, predictor of serum iron was hemoglobin (P0.01) and transferrin (P0.05), predictor of serum copper was ceruloplasmin (P0.001) and C-reactive protein (P0.05), predictor of serum zinc was albumin (P0.05). In comparisons of nutritional status between inflammation group and control group, serum zinc concentration in inflammation group was significantly lower than control group. On the other hand, ceruloplasmin, C-reactive protein and serum copper concentration in inflammation group were significantly higher than control group. There was no significant difference in daily trace elements intake between inflammation group and control group.In tube-fed patients with neurological dysphagia, serum trace elements concentration was influenced by malnutrition and inflammation. It was suggested that serum trace elements concentration might not be normalized if malnutrition and inflammation are not treated. We recommend periodical monitoring of trace elements for long-term tube-fed patients with neurological dysphagia.

In-band crosstalk due to Rayleigh backscattering (RB) can be avoided in bidirectional wavelength-division multiplexed (WDM) transmission systems when using two identical sets of wavelengths in opposite directions over a single fiber. We describe this by using such sets in a disjoint manner and eliminating the RB crosstalk with the help of simple optical edge filters instead of the WDM comb filters previously employed in interleaved bidirectional systems. We also provide a practical application example and describe the power penalty due to the interferometric RB crosstalk, taking into account recent polarized optical noise research because RB light is partially polarized. Numerical results for externally modulated intensity-modulation/direct-detection (IM/DD) optical systems show that the power penalty can be kept less than 0.5 dB with moderate edge filters, even for more than several tens of optically amplified repeater segments

A new design principle of optical burst switching (OBS) networks of ring configuration cooperating with static wavelength-division multiplexed (WDM) optical add/drop multiplexers (OADMs) is described. The paper indicates that wavelength-bypassing provided by the OADMs improves burst transport in several ways. For example, the bypassing makes the size of OBS switch fabric and mean hop-counts small. The paper focuses on burst loss rate performance. An optimum design to minimize burst loss rate in an OBS ring network under a given WDM level and the number of nodes is formulated through theoretical analysis. Simulation results show good agreement with the theory.

The effect on the nutritional status of elderly patients with chronic dysphagia was assessed of a diet with the texture modified by gelatin. The subjects were 26 chronic stage rehabilitation inpatients (18 males and 8 females with a mean age±SD of 73.0±13.0). We assessed the hematological and biochemical data, anthropometric measurements, nutritional intake and occurrence of aspiration pneumonia before and after intervention with the modified-texture diet.There were no significant changes in any of the nutritional parameters over a 6-month period before the dietary intervention. However, the albumin, pre-albumin and total cholesterol levels during the 6-month period after the dietary intervention were significantly higher than those at the starting point. Similarly, BMI, arm circumference and energy intake adequacy during the 6-month period after the dietary intervention were significantly higher than those at the starting point. The occurrence of aspiration pneumonia during the 6-month period after the intervention was significantly lower than that at the starting point.These results show that the nutritional status was improved by the dietary intervention, while the occurrence of aspiration pneumonia was prevented. It is suggested that the diet with the texture modified by gelatin was effective for the treatment of chronic dysphagia.

The relationship was investigated between the swallowing ability and nutritional index of long-term hospitalized patients to clarify the influence of dysphagia on the nutritional status.55 chronic-stage rehabilitation patients under long-term hospitalization who were feeding orally were divided to two groups. One group consisted of 22 patients who had normal swallowing function (12 males and 10 females with an average age of 69.7±14.1 years) and received a solid diet, this group being regarded as the normal swallowing group, while the other group consisted of 33 patients who had mild dysphagia (21 males and 12 females with an average age of 75.5±11.3 years) and received a diet prepared for dysphagia, this group being regarded as the dysphagia group. The serum albumin level, body mass index (BMI) and energy intake adequacy of both groups were compared, and the relationship between dysphagia and nutritional index investigated.There was a significant difference in the serum albumin level between the normal swallowing group and dysphagia group, i.e., 4.0±0.3g/dl in the normal swallowing group and 3.4±0.4g/dl in the dysphagia group. The ratio of hypoalbuminemia was also significantly lower in the normal swallowing group than in the dysphagia group (i.e., 9.1% and 48.5%). BMI was significantly different between the normal swallowing group and the dysphagia group, i.e., 22.6±4.3kg/m2 in the normal swallowing group and 19.4±3.5kg/m2 in the dysphagia group. The incidence of low weight tended to be lower in the normal swallowing group than in the dysphagia group (i.e., 18.2% and 42.4%), while the incidence of obesity tended to be higher in the former than in the latter (i.e., 31.8% and 12.1%). The energy intake adequacy was significantly different between the normal swallowing group and the dysphagia group, i.e., 107.3±11.3% and 92.7±16.4%, respectively, there being a significant negative correlation between dysphagia and nutritional index.These results show that the dysphagia group was suffering from malnutrition, the nutritional status of this group being worse than that of the normal swallowing group. It is therefore suggested that dysphagia is a risk factor in the decline of nutritional status in chronic-stage rehabilitation patients during long-term hospitalization.

The objective of the present study was to clarify the influence of introduction of clinical pathways on the nutritional status of patients undergoing distal gastrectomy. We investigated changes in the nutritional status of the patients at admission and discharge, before and after the introduction of clinical pathways.A group consisted of 32 patients who had undergone distal gastrectomy before introduction of clinical pathways (22 males and 10 females with the average age of 66.2±12.0) was regarded as the control group, and another group consisted of 31 patients who had undergone distal gastrectomy after introduction of clinical pathways (21 males and 10 females with the average age of 64.2±9.2) was regarded as the pathway group. Both groups were compared on body weight, body mass index (BMI), body weight reduction rate, serum albumin, hemoglobin, energy intake and energy intake adequacy.While body weight and BMI at the time of discharge significantly reduced in both groups as compared with those at the time of admission (p

A bit error correction and cell loss recovery method is proposed to provide high-quality virtual paths in an asynchronous transfer mode (ATM) transport system. This method arranges the cells into a two-dimensional array and performs error correction coding along both dimensions of the array. The error correction code applied in the horizontal direction corrects bit errors and detects lost cell positions. The error correction code applied in the vertical direction restores lost cells. This compensation method requires no processing at the intermediate nodes of the transport system but can be performed after reception of the coded array at the virtual path terminating nodes. Performance estimates are given for this compensation method. It is shown that when a BCH code is used for the horizontal code and a (15, 14) parity code is used for the vertical code on one-tenth of the virtual paths, then improvements of approximately seven and ten orders of magnitude are achieved in cell loss and bit error rates, respectively. In this case, the communication efficiency is reduced by 10 percent on those paths that employ error correction coding.

Reduced crossbar switches (RXBSs) with crosspoints between N2 and N(N-1)/2, where N is the switch size, were investigated from an architectural point of view. Conventional RXBSs have been created by removing parts of 2×2 switching cells from crossbar switches, while maintaining the switches' planar structure and wide-sense nonblocking property. In this paper, we consider an extended class of RXBSs that has a 3D structure or a rearrangeably nonblocking capability. We introduce such new RXBSs and discuss their performance.

This paper presents a new construction of the distributively controlled homogeneous self-routing space switch network, which is composed of single-kind 2 × 2 unit modules. The feature of the proposed method is that the order is defined among the destination addresses according to their binary representation by the bitwise comparison. The bionic sort is executed based on the order. In the conventional space switch network composed of a single kind of module, the total number of unit modules is of the order of N2 at the minimum, where N is the number of I/0 ports. In the space switch network proposed in this paper, the total number of unit modules is of the order of (N log3N). The total number of unit modules in the proposed method is equal to that of the conventional method for N ≦ 8 but is less for ′N≧16. When N = 1024, for example, the total number of unit modules in the proposed method is approximately one-sixth that of the conventional method. Another point is that the processing speed within the 2 × 2 unit module is independent of N, as in the conventional method, and is small. This is advantageous in the high-speed operation.

A high-speed multiplex transmission system has recently been proposed based on ATM, where the information is divided into fixed-length blocks called cells, and transmitted on asynchronous multiplexing basis. As the switch to be used in the transit node in such a transmission system, various kinds of switching networks have been proposed, composed of two-input × two-output switch elements with internal buffers. Among those, the multistage buffered Banyan structure, which is a cascade connection of two Banyan networks as the distribution and routing networks, is of a distributed structure, being suited to LSI implementation. The network is a promising candidate since it realizes the self-routing and is stable against a variety of traffic. However, this switching network has a problem in that the delay is increased with the scale of the network, and the in-service expansion of the switching network is not easy. This paper proposes a new network topology of the Banyan network with bypass links, together with the self-routing method, and describes its performance. The network is composed of the distribution and routing networks with bypass links between individual unit switches. By transferring cells from the distribution network to the routing network through the bypass links at appropriate stages, the delay is reduced. The in-service expansion of the system is made easy.

As a technique for constructing the switch fabric in the ATM (asynchronous transfer mode) communication system, the self-routing switching network has been proposed where the buffered Banyan network is used as the distribution network as well as the routing network. The features of this kind of switch are that it is of a distributed structure, being suited to the modular construction, the large capacity system can easily be realized, and the performance is stable for diversified traffic. On the other hand, it has a problem in that the order of the transmitted information (cells) is not preserved. This paper proposes anew a switch construction with time stamps attached to the cells. The cell sequence is preserved by controlling the sequence of the time stamps, and the system can be controlled in a distributed way. The feature of the method is that the cell sequence is preserved while maintaining the self-routing property of the traditional multistage buffered switch. Also, the principle and the optimal construction are described. Basic system parameters such as the required word length for the time stamp signal are determined. The delay characteristics of the proposed system for various kinds of traffic are evaluated by a computer simulation.

The time slot interchanger (TSI) is employed widely in practice as the switch fabric of digital cross-connect systems or exchange systems in the digital synchronized network. With the increasing need for ISDN with the fundamental rate of 64 kbit/s as the background, it is desired to realize a large-capacity TSI. This paper discusses the optimum design of the pipelined TSI which has been proposed in the past, aiming at the realization of a large-capacity TSI. First, the TSI configuration is proposed which realizes the time slot integrity in multislot connection, which has been a problem in the traditional pipelined TSI. The proposed method corresponds to the traditional TSI using RAM, where the time slot sequence integrity is realized by employing the double-buffer structure. Then the optimum design method for the proposed pipelined TSI is presented, where the evaluation measure is the performance index, defined as the product of memory capacity and the operation speed. For comparison based on the defined performance index, the pipelined TSI optimized by the proposed method has several tens to several hundred times better performance than the conventional TSI using RAM or shift registers. Thus, it is demonstrated that the proposed construction is effective in realizing a large-capacity TSI.

This work describes how a bidirectional WDM transmission technique on a single fiber gives a new opportunity to improve reconfigurability of WDM add-drop networks with a help of simple edge filters. These filters also make power penalty due to Rayleigh backscattering small enough for optically amplified WDM transmission over multiple spans. The paper emphasizes our design concept and preliminary numerical results rather than strict analytical processes and experimental results.

The upper bound on the minimum number of switching cells in crossbar switches was investigated. It was determined that the bound is given by N(N−1), where N is the switch size. Crossbar switches were embedded into ILLIAC(N, N−1) torus networks with cell counts given by the above formula and a simple routing control algorithm for the switches is introduced.