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Thymic cancer associated with spontaneous regression of thymic cysts is a rare disease. A 47-yearold man was referred to our hospital for right chest pain and chest abnormal shadow. Chest computed tomography( CT) revealed a solid lesion 1.3 cm in diameter and a cystic lesion 1.0 cm in diameter at the right anterior mediastinum. A second CT study after six months showed a solid lesion increased to 1.7 cm in diameter and a cystic lesion reduced to 0.7 cm in diameter. A second magnetic resonance imaging (MRI) showed a cystic lesion reduced and high signal intensity region in the thymus enlarged on T2-weighted imaging. Under the diagnosis of thymoma associated with multilocular thymic cysts, total thymectomy was performed for these mediastinal lesions by video-assisted thoracic surgery. Histopathological finding was thymic squamous cell carcinoma (Masaoka stage II) associated with multilocular thymic cysts. Additional postoperative radiotherapy was performed, and there has been no recurrence after one postoperative year.

BackgroundDiffuse pulmonary ossification is a specific lung condition that is accompanied by underlying diseases. However, idiopathic dendriform pulmonary ossification (IDPO) is extremely rare, and the clinical features remain unclear. In this study, we aimed to report the clinical characteristics of IDPO.MethodsWe conducted a nationwide survey of patients with IDPO from 2017 to 2019 in Japan and evaluated the clinical, radiological, and histopathological findings of patients diagnosed with IDPO.ResultsTwenty-two cases of IDPO were identified. Most subjects (82%) were male, aged 22–56 years (mean (SD), 37.9 (9.1)) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted )) at diagnosis. Nearly 80% of the subjects were asymptomatic, and the condition was discovered during a medical check-up. However, 36% of the subjects showed a decline in forced vital capacity (%FVC) predicted ConclusionsIDPO develops at a young age with gradually progressive phenotype. Further research and long-term (>20 years) follow-up are required to clarify the pathogenesis and clinical findings in IDPO.

ATP-binding castle protein G2 (ABCG2) is thought to inhibit the activities of certain gefitinib transporters, thereby affecting drug pharmacokinetics. The C421A polymorphism affects the function and expression of ABCG2 on the cell membrane. Previous studies have shown that proton-pump inhibitors (PPIs) inhibit gefitinib absorption, as well as the function of ABCG2. We evaluated the plasma concentrations of gefitinib in patients with and without the ABCG2 C421A polymorphism, who were or were not taking PPIs. In total, 61 patients with advanced epidermal-growth-factor-positive non-small-cell lung cancer were enrolled in this study. They were treated with gefitinib at a dose of 250 mg per day. Plasma gefitinib concentration and ABCG2 C421A status were determined after 2 weeks. The patients were divided into CC- and CA/AA genotype groups. We compared the trough and peak gefitinib levels and the area under the curve (AUC) values for 24-h gefitinib concentrations. We also compared these parameters among four groups distinguished according to the presence or absence of the polymorphism and PPI use. The mean trough gefitinib level and AUC value for 24-h gefitinib concentration were significantly lower in the CA/AA group compared to the CC group (mean trough level: 333.2 vs. 454.5 ng/mL, respectively, P = 0.021; AUC: 9949.9 vs. 13,085.4 ng・h/mL, respectively, P = 0.034). Among patients taking PPIs, the mean trough gefitinib level was significantly lower in the CA/AA group than the CC group (220.1 vs. 340.5 ng/mL, respectively, P = 0.033). The CA/AA-type of ABCG2 C421A polymorphism may be associated with lower gefitinib plasma concentrations.

Tomoki Nakamura,1 Kunihiro Asanuma,1 Motoshi Takao,2 Takashi Yamanaka,3 Hiroshi Koike,4 Toyofumi F Chen-Yoshikawa,5 Satoshi Tsukushi,6 Hiroaki Kuroda,7 Eiji Kozawa,8 Masaaki Sano,9 Hisaki Aiba,10 Ryoichi Nakanishi,11 Akihito Nagano,12 Kenji Yamada,13 Yoji Shido,14 Katsuhisa Kawanami,15 Yuya Izubuchi,16 Akihiro Sudo,1 Yoshihiro Nishida4,17 1Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan; 2Department of Thoracic Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan; 3Department of Radiology, Mie University Graduate School of Medicine, Tsu, Mie, Japan; 4Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; 5Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan; 6Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan; 7Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan; 8Department of Orthopedic Surgery, Nagoya Memorial Hospital, Nagoya, Aichi, Japan; 9Department of Thoracic Surgery, Nagoya Memorial Hospital, Nagoya, Aichi, Japan; 10Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan; 11Department of Oncology, Immunology and Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan; 12Department of Orthopedic Surgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan; 13Department of Musculoskeletal Oncology, Okazaki City Hospital, Okazaki, Aichi, Japan; 14Department of Orthopedic Surgery, Hamamatsu Medical University, Hamamatsu, Sizuoka, Japan; 15Department of Orthopedic Surgery, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan; 16Department of Orthopedics and Rehabilitation Medicine, University of Fukui Faculty of Medical Sciences, Eiheiji, Fukui, Japan; 17Department of Rehabilitation, Nagoya University Hospital, Nagoya, Aichi, JapanCorrespondence: Tomoki NakamuraDepartment of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, JapanTel +81592315022Fax +81592315211Email tomoki66@med.mie-u.ac.jpPurpose: Here, we investigated the oncological outcomes of lung metastasectomy and/or radiofrequency ablation (RFA) of 92 patients with soft tissue sarcoma (STS) at nine institutions.Methods: The study cohort included 65 men and 27 women with a mean age of 59 years at the time of metastasis. The mean follow-up duration was 51 months. All patients underwent metastasectomy and/or RFA for lung metastasis.Results: The mean maximum size of the initial lung metastasis was 14.6 mm. At the initial evaluation, 41 patients had a single metastasis, whereas 51 patients had multiple metastases. The mean number of metastasectomies and/or RFA was 2 per patient. A total of 70 patients underwent lung metastasectomy, whereas the other 13 underwent lung RFA. The remaining nine patients underwent both RFA and metastasectomy. The 5-year post-metastatic survival rate was 52%. The patients who underwent complete treatment for the initial metastasis had better post-metastatic survival rates than those who underwent incomplete treatment. A univariate analysis of all possible prognostic factors for complete treatment confirmed the predictive value of disease-free interval, metastasis at initial presentation, distribution, tumor size, and number of lung metastases. Of the 92 patients, 74 underwent complete treatment for initial metastasis; in these patients, univariate and multivariate analyses showed that a smaller tumor size and single-lung metastasis were prognostic factors for superior post-metastatic survival. The patients with a smaller (< 11.5 mm) single metastasis had better post-metastasis survival. The 5-year post-metastatic survival rates were 89.9% for patients with a smaller (< 11.5 mm) single metastasis versus 22.7% for patients with larger (> 11.5 mm) and multiple metastases.Discussion: We propose that complete treatment for lung metastasis in patients with STS may improve post-metastatic survival rates. Furthermore, tumor number and size are important variables for clinical decision-making.Keywords: lung metastasis, metastasectomy, radiofrequency ablation, soft tissue sarcoma

Surgery remains the best curative treatment option for non-small cell lung cancer (NSCLC), but is of benefit only to patients with localized disease. A meta-analysis showed a significant beneficial effect of induction chemotherapy on survival, but there is still no clear evidence. This phase II study was conducted to establish whether induction chemotherapy with carboplatin (CBDCA) and paclitaxel (PTX) plus bevacizumab prior to surgery reduces the risk of progression. The subjects of this study were 29 patients with treatment-naive nonsquamous NSCLC (clinical stages IIIA to IV). Patients received PTX (200 mg/m2), CBDCA (area under the curve, 5), and bevacizumab (15 mg/kg) followed by surgery. Chemotherapy was repeated every 3 weeks for up to six cycles. The overall response rate was 72.4%. Of the 29 patients, ten underwent surgery after the induction chemotherapy and complete resection was achieved in 7 (70%). The median progression-free-survival (PFS) time and the 3-year PFS rate were 0.92 years and 16.2%, respectively. The median overall survival (OS) time and the 3-year OS rate were 1.96 years and 44.9%, respectively. Combined modality therapy with surgery after induction chemotherapy with CBDCA and PTX plus bevacizumab is clinically feasible and tolerable for patients with unknown or negative molecular profiles.

Ship-to-ship transfer operations, primarily used to transfer crude oil, petroleum, and other chemical products between ocean going ships (i.e., lightering operations), are commonly conducted worldwide because a deep draft of a large ship limits its access to ports. In areas where the water depth is too great for anchoring, cargo is transferred to another rigidly moored ship running slowly. This operation is called “underway transfer.” During this process, the maneuvering service ship (SS) approaches and berths from the port side to the starboard side of the large ship to be lightered (STBL). After mooring, the SS stops its engine and behaves as a towed ship. Meanwhile, the STBL maintains its steerage on a steady course, responsible for all maneuvers. To reduce the possibility of accidents, the maneuverability of this unique combined two-ship unit should be further investigated. In this study, a very-large crude carrier (VLCC) and an Aframax tanker are used as the STBL and SS. Two scenarios are considered for the two-ship unit: the full-load STBL with the ballasted SS, and the half-load STBL with the full-load SS. These are assumed to be different stages of the cargo transfer process. Free-running model tests and captive model tests are conducted, and a mathematical model for maneuvering simulation of such a front-back and left-right asymmetric two-ship unit is presented. Additionally, full-scale simulations are performed. Based on the results of experiments and simulations, the change in maneuverability, according to the progress of the cargo transfer, is assessed. The combined two-ship unit needs a large advance and transfer when turning to port, especially in the case of the half-load STBL with the full-load SS. The difference of left- and right-turning abilities is significant. In terms of the directional stability, the combined unit condition during underway transfer would be preferable to running alone.

In this study, the improvement of maneuverability of a Very Large Crude oil Carrier (VLCC) with small engine output under a condition involving 30% reduced EEDI [IMO (2012)] was performed by attaching a high lift rudder. A high lift rudder (HL rudder) with a fishtail section and end plates was newly designed to increase the rudder force under a restriction that minimizes the increase in rudder resistance. Tank tests were performed by using a scaled ship model with a HL rudder to capture propulsive performance and rudder force characteristics of the ship with a HL rudder. The results indicated that the designed HL rudder increased the effective rudder force by approximately 10% when compared to a conventional mariner rudder (MN rudder). The incorporation of the test results into the MMG simulation model [Yasukawa and Yoshimura (2015a)] allowed the performance of maneuvering simulations in calm water and adverse weather conditions for a ship with HL and MN rudders. The results indicated that the HL rudder presented in this study is useful in improving maneuverability while maintaining almost the same level as the propulsive performance of a ship with a mariner rudder.

Previous studies have reported that the expressions of specific proteins may predict the efficacy of chemotherapy agents for non-small cell lung cancer (NSCLC) patients. The present study evaluated the expression of proteins hypothesized to be associated with the effect of chemotherapeutic agents in 38 NSCLC patients with pathological stage II and IIIA. The subjects received carboplatin plus paclitaxel (CP) or S-1 as adjuvant chemotherapy following complete resection. The protein expressions evaluated were those of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phsphoribosyltransferase (OPRT), which were suspected to be associated with the effect of S-1 agents, excision repair cross-complementation group 1 (ERCC1), which was suspected to be associated with the effect of platinum-based agents, and class III β-tubulin (TUBB3), which was suspected to be associated with the effect of taxane-based agents. The positive rate of TS was 55.3% (n=21/38), DPD was 57.9% (n=22/38), OPRT was 42.1% (n=16/38), ERCC1 was 47.4% (n=18/38) and TUBB3 was 44.7% (n=17/38). Among the patients who received S-1 adjuvant chemotherapy, TS-negative cases demonstrated a significantly better disease-free survival than positive cases. Thus, TS protein expression may have been a factor that predicted the effect of S-1 agent as adjuvant chemotherapy.

OBJECTIVES Ultrasound (US) lung comets are often observed in patients with interstitial lung disease or congestive heart failure, but few studies have explored the clinical importance of US lung comets in patients with the former condition. We explored whether the US lung comet number could be used to assess the severity of interstitial pneumonia. METHODS Forty stable patients with interstitial pneumonia were examined. Lung comets evident on transthoracic US imaging in 12 selected regions of the posterior chest wall were analyzed. We defined lung comets accompanied by thickened and irregular pleural lines as interstitial US lung comets; these predominated in patients with interstitial pneumonia. The total number of interstitial US lung comets was correlated with the data from chest high-resolution computed tomography, pulmonary function tests, serologic tests, and the 6-minute walk test. RESULTS The 40 patients included 16 with idiopathic pulmonary fibrosis and 24 with nonspecific interstitial pneumonia. Thirty-four patients had interstitial US lung comets, which were more common in the lower than the upper lung area. Good correlations were evident between the lung comet number and the extent of the reticular pattern on chest high-resolution computed tomography (r = 0.710; P

A pusher–barge system (P/B) has been one of the main transportation systems particularly for rivers and inland waterway services. Since a P/B normally sails in restricted waters such as a sharp bend in a river, the maneuverability is important for safe navigation. Although the barge draft changes drastically with an increase of the amount of cargo, the draft of the pusher which normally equips a small ballast tank does not change so much. It indicates that the step appears or disappears around the pusher–barge connection due to the load condition of the barge. This phenomenon is a unique and interesting characteristic of a P/B. Therefore, this study aims to discuss the effect of the barge load condition on the maneuverability. For this purpose, the towing tank experiments were conducted under the empty and full load conditions of the barge, and the mathematical model to simulate maneuvering motions of the P/B was established. At that time, the hydrodynamic force data in the range of high yaw rate was made up by the CFD method. We found that the course stability of the P/B deteriorated with an increase of the barge draft. It is related to the change of the pressure filed spread over the pusher bow which is influenced by the wake shed from the barge. Besides, the simulation study revealed that the turning ability due to small steering was worse under the empty load condition than the full load condition of the barge. However, it appears to be improved with an increase of the steering angle.

Ship performance in shallow water where the rigid bottom is covered by a mud layer is a crucial topic to be investigated. In such muddy areas, a two-layer fluid is stratified according to the properties of the sediments. The water–mud interface behaves similar to a sheet on which the internal waves propagate after the ship's passage. Therefore, for safe navigation, it is necessary to clearly understand the influence of the internal waves on the ship's hydrodynamic force characteristics. In this study, the steady wave-making problem of a ship in a two-layer fluid was solved using the Rankine source panel method. The boundary value problem was formulated using a newly proposed double-model linearised interface condition. After the present method was validated via a comparison with results of a Wigley hull solved by the author's existing method, it was applied to solve the ship-wave problem of KVLCC2. The unique changes in wave-making resistance, sinkage and trim according to the ship's speed and two...

Machining of high quality surface of glass materials is difficult in conventional machining such as milling machines. Generally, in the case of end milling of glass materials, chippings occur on the machined surface, and the surface roughness becomes not so well, and the tool life becomes short. However, if machining is possible by cutting work with excellent general versatility and accuracy, it becomes a very effective means for prototyping Micro-TAS devices and fabricating TGV substrates. Therefore, the purpose of this research is to improve the quality of machined surface by adopting ultrasonic assisted end milling method. In this method, ultrasonic vibration is applied to a rotating tool during cutting work, and an ultrasonic vibration with a built-in Langevin transducer is attached to a three-axis machining center and experimented. For the experiments, using a soda lime glass plate, the groove shape is machined using a square end mill tool with a diameter of 0.3 mm. Cutting resistance and edge chippings reduce in ultrasonic assisted end milling as compared to conventional machining.

In this paper it is reported the possibility of the maneuvering test of the model ship in Circulating Water Channel (CWC). The wall effect on the model ship with the drift angle in CWC is researched by using model test and Computational Fluid Dynamics (CFD) analysis. Then a condition/criterion is studied for drift angle of the model and the distance between ship model and the side wall of CWC. Hydrodynamic force acting on the turning hull is measured in Yawing test by Planar Motion Mechanism (PMM)．The frequency dependency is shown in the test data result from the setting condition (period and r’). To avoid the frequency dependency, reasonable period range is proposed. Oblique towing test and Yawing test are carried out with keeping the above criterion. The analyzed data agrees with the results by towing tank. Then the maneuvering test in CWC has enough accuracy for course stability criterion of the ship practically.

When sailing in shallow water, the special attention should be given to the sinkage and trim of a ship. In order to prevent her from grounding, the amount of them have to be estimated well and the water depth should be kept enough deep for safe navigation. From this reason, a lot of estimated formulas based on the experimental and numerical studies have been proposed until now. Although they have a big advantage in the practical view point, there seem to be no universal formulas which are applicable to any type of ships with qualitative accuracy. Besides, there is little information about the effect of maneuvering motion on the sinkage and trim despite there are many situations in which a ship passes a curve of a waterway or is drifted by tidal currents or river flow.In this study, the numerical analysis of the sinkage and trim of a ship in steady maneuvering motion in shallow water is made by using a free and open source computation fluid dynamics (CFD) software. The amount of them is estimated with a variety of the hull drift angle, yaw rate and water depth. The pressure distributions on the hull are also shown for discussing the hydrodynamic mechanism. The bow squat in steady maneuvering motion is estimated finally. Such kind of information would be also important as well as that in running straight.

The majority of patients with completely resected stage II or IIIA non-small-cell lung cancer (NSCLC) require adjuvant chemotherapy to improve survival following surgery. In the present trial, the 2-year disease-free survival (DFS), and the feasibility and safety of S-1 as an adjuvant chemotherapy for advanced lung cancer were evaluated. A total of 40 patients with completely resected stage II or IIIA NSCLC were enrolled and randomized to receive postoperative chemotherapy with either up to 4 cycles of paclitaxel plus carboplatin (arm A) or with up to 1 year of S-1 (arm B). The primary endpoint was 2-year DFS. The secondary endpoints were feasibility and toxicity. A total of 40 patients were enrolled, but 3 were excluded in accordance with the exclusion criteria. The remaining 37 patients were analyzed. The 2-year DFS rate was 54.2% in arm A and 84.2% in arm B. Overall, 15/18 (83.3%) patients completed 4 cycles of paclitaxel plus carboplatin and 13/19 (68.4%) completed 1-year of S-1adjuvant chemotherapy. Of the 18 (16.7%) patients in arm A, 3 experienced grade 3 or 4 adverse events, while none in arm B experienced such events. Therefore, S-1 chemotherapy for patients with completely resected stage II or IIIA NSCLC was a feasible and safe regimen, and it may therefore be considered as a potential adjuvant chemotherapy option for advanced NSCLC.

BACKGROUND/AIM To investigate the association between the number of circulating endothelial progenitor cells (EPCs) in non-squamous non-small cell lung cancer (NSCLC) and disease outcome, in combination chemotherapy with and without bevacizumab. MATERIALS AND METHODS We retrospectively identified 25 non-squamous NSCLC cases, and divided them into high-EPC and low-EPC groups. Within each group, we compared disease outcomes, with or without the administration of bevacizumab. RESULTS In the high-EPC group, chemotherapy with bevacizumab produced a significantly higher tumor reduction rate and objective response rate, with significantly longer progression-free survival, compared to chemotherapy without bevacizumab (p

Ultrasound (US) lung comets are often observed in patients with interstitial lung disease or congestive heart failure, but few studies have explored the clinical importance of US lung comets in patients with the former condition. We explored whether the US lung comet number could be used to assess the severity of interstitial pneumonia.Forty stable patients with interstitial pneumonia were examined. Lung comets evident on transthoracic US imaging in 12 selected regions of the posterior chest wall were analyzed. We defined lung comets accompanied by thickened and irregular pleural lines as interstitial US lung comets; these predominated in patients with interstitial pneumonia. The total number of interstitial US lung comets was correlated with the data from chest high-resolution computed tomography, pulmonary function tests, serologic tests, and the 6-minute walk test.The 40 patients included 16 with idiopathic pulmonary fibrosis and 24 with nonspecific interstitial pneumonia. Thirty-four patients had interstitial US lung comets, which were more common in the lower than the upper lung area. Good correlations were evident between the lung comet number and the extent of the reticular pattern on chest high-resolution computed tomography (r = 0.710; P .01), predicted forced vital capacity (r = -0.614; P .01), and lung diffusion capacity for carbon monoxide (r = -0.577; P .01). Notably, the lung comet number had a strong negative correlation with the percutaneous oxygen saturation level after the 6-minute walk test (r = -0.751; P .01).The number of interstitial US lung comets evident on transthoracic US imaging may be a valuable marker of disease severity in patients with interstitial pneumonia.

The relationship between the pharmacokinetics and effects of gefitinib in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) is unknown. In this study, we examined the correlation between gefitinib plasma concentration and progression-free survival (PFS) in patients with two common types of EGFR mutations: a deletion in exon 19 and point mutations in exon 21 L858R. The retrospective analysis examined 40 patients who were administered 250 mg of gefitinib daily. All patients were diagnosed with and treated for advanced non-small cell lung carcinoma with sensitive EGFR mutations between January 2011 and November 2013 at Akita University Hospital, Akita, Japan. The 40 patients were divided into four groups by trough plasma concentration (high or low) and mutation type (exon 19 deletions or exon 21 L858R point mutations). PFS, response rate, and toxic effects were analyzed in all four groups. After excluding 5 patients, the remaining 35 were successfully analyzed. For the patients with exon 19 deletions, there was no significant difference in PFS between the high and low plasma concentration groups (median survival: 12.0 vs. 17.0 months, P = 0.9548). In contrast, the PFS was significantly shorter for patients with exon 21 point mutations and low vs. high concentrations of gefitinib (median survival: 8.0 vs. 16.0 months, P

Ship maneuvering motions are affected by so-called bank suction forces when proceeding in close proximity to channel wall. In fact, some rudder angles would be required to maintain the course and proper rudder activities are needed to be directionally stable. The authors conducted captive model tests in a channel with variations in water depth, off-centerline displacement, ship speed, hull drift angle and rudder angle. The shallow water and bank effects on the hydrodynamic force characteristics were investigated. Based on the regression mathematical model, the rudder angle and hull drift angle required at equilibrium conditions were estimated and the limiting off-centerline displacement for safe operation was proposed. Directional stability in the channel was also studied based on the eigenvalue analysis and dynamic maneuvering motion simulations. The stable/unstable zone for course keeping according to control system characteristics would be important for the maneuvering operation.