Search

Abstract Background Though laparoscopic gastrectomy (LG) has become the gold standard for gastric cancer treatment according to the Japanese treatment guidelines, its learning curve remains steep. Decreasing numbers of surgeons and transitions in the work environment have changed LG training recently. We analyzed LG training over the last decade to identify factors affecting the learning curve. Study Design Laparoscopic distal and pylorus‐preserving gastrectomies conducted between 2010 and 2020 were included. We assessed learning curves based on the standard operation time (SOT) defined by analysis of covariance. Then we divided the trainees into two groups based on the length of the learning curve and examined the factors affecting the learning curve with linear regression analysis. Results Among 2335 LGs, 960 cases treated by 27 trainees and 1301 cases treated by six attending surgeons were analyzed. The operation time was prolonged (p = 0.009) and postoperative morbidity rates were lower (p = 0.0003) for cases treated by trainees. Trainees experienced 38 (range, 9–81) cases as scopists and nine (range, 0–41) cases as first assistants to the first operator. The learning curve was approximately 30 cases. The SOT was calculated based on gender, body mass index, tumor location, reconstruction, and lymph node dissection. Trainees who had shorter learning curves had more experience (51–100 cases) with any laparoscopic surgery before LG training than the others (11–50 cases, p = 0.017). Conclusion Sufficient experience with laparoscopic surgery before starting LG training might contribute to the efficiency of LG training and shorten the learning curve.

Abstract Gold (Au), as one of the most precious metal resources that is used for both industrial products and private ornaments, is a global investment target, and mining companies are making huge investments to discover new Au deposits. Here, we report in situ Au adsorption in an acidic hot spring by a unique adsorption sheet made from blue-green algae with a high preferential adsorption ability for Au. The results of in situ Au adsorption experiments conducted for various reaction times ranging from 0.2 h to 7 months showed that a maximum Au concentration of 30 ppm was adsorbed onto the blue-green algal sheet after a reaction time of 7 months. The Au concentration in the hot spring water was below the detection limit (

The transition to renewable energy-dominated power generation heightens the vulnerability of frequency stability, impacting various modern power systems, including railways. While recent studies have investigated the role of railway systems in supporting frequency and inertia through methods such as traction motors, regenerative braking, and air conditioning, these approaches predominantly address frequency stability in isolation. The integration of virtual inertia control into Railway Power Conditioners (RPCs) has received limited attention. The existing Virtual Inertia-Integrating Railway Power Conditioner (VIIRPC) is designed for Scott transformers with 90-degree secondary-side phasor angles but encounters compatibility challenges with V/V transformers, exacerbating the imbalance issue at the Point of Common Coupling (PCC). This paper proposes an enhancement to the VIIRPC by incorporating a phase correction technique, allowing it to perform comparably with both Scott and V/V transformers. A comparative analysis is conducted under both unbalanced and balanced loading conditions on the secondary sides of the traction transformer, including the load characteristics of a 4-minute headway train schedule. The results from this train-running simulation demonstrate substantial enhancements in grid strength, including a 99.03% reduction in the Rate of Change of Frequency (RoCoF), a 0.34% decrease in the frequency nadir, a significant reduction in the Voltage Unbalance Factor (VUF) from 7.44% to 0.28%, and an optimized power factor of 1. Additionally, the study explores energy storage sizing and provides a comparative analysis of converter sizing for both Scott and V/V transformer configurations, further contributing to grid stability and resilience.

Various types of machine oil are used for analysis and utility equipment, and these organic liquid wastes are stored in nuclear facilities and laboratories due to a lack of appropriate treatment processes. Treatment of organic liquid waste is one of the principal tasks since radiolysis of organic material generates various hazardous products. Perfluoro oil, generally used in vacuum pumps, is difficult to decompose because of its chemical stability. Calcination of fluorine compounds is possible to generate toxic and corrosive gas products. In order to achieve complete mineralization of the organic liquid wastes, the application of a subcritical water reaction was examined. In this study, the effect of introducing a functional group into a perfluoro compound on its decomposition performance was experimentally evaluated. First, we carried out the transformation of perfluorohexane to perfluorohexyl iodide or perfluoroheptanoic acid based on reported procedures. Next, laboratory scale batch-wise decomposition tests with subcritical water on perfluorohexyl iodide and on perfluoro heptanoic acid were carried out. Analyses of degraded organic products remaining in the aqueous phase by atmospheric pressure ionization mass spectrometry and liquid chromatography-mass spectrometry were carried out. The decomposition products of each fluorine compound were identified, confirming that subcritical treatment is a promising treatment method.

Nuclear fuel fabrication process has generated a large amount of wastes contaminated with enriched uranium, and those have been accumulated for long time in Japan. These waste hasn’t treated, because there is no protocol to treat and dispose these. Procedure is proposed; 1) Leaching Uranium from the waste, 2) recovering uranium from the leaching solution, 3) treating residue and secondary waste for disposing in the near field region. As concentration of uranium in the leaching solution must be far smaller than that of dissolving solution of the spent fuel, an efficient uranium recovery procedure which generates less secondary wastes than the solvent extraction technology is required. Temperature swing extraction technology is one of promising methods to recover uranium efficiently. In the technology, uranium ions are extracted by extraction, and complex with ligands are separated by a polymer with reversible hydrophilic-hydrophobic properties. Monoamides can be adopted to the procedure. However suitable structure of monoamide for the technology is unclear. Therefore, for deciding appropriate structure of monoamides, these with different alkyl chain structures were synthesized, and applicability of the extractants were evaluated by solvent extraction and temperature swing extraction experiments. In experiments, Ce(IV) was used as a simulant of U(IV). Three monoamides were synthesized, and solvent extraction experiments and Temperature swing extraction experiments were carried out. Monoamides with straight chain showed larger recovery ratios whereas the branching monoamide showed far smaller values on solvent extraction experiments, and separation factors of Ce was good on monoamides with straight chain on temperature swing extraction experiments. Therefore the monoamide with long straight chain can be favorable for uranium recovery.

In recent years, the proportion of solar power generation in Japan's power generation facilities has been increasing. The amount of solar power generation affects the JEPX (Japan Electric Power Exchange) spot prices. When the amount of solar power generation is excessive during the low demand period, the lowest prices sometimes appear in the spot market. On the other hand the existing forecasting method cannot forecast the lowest prices; hence the forecasting error of the existing method is large. In this study, the authors focused on the appearance of the lowest prices and analyzed the conditions under which the lowest prices are likely to appear. As a result, the authors identified the conditions where the lowest price is likely to appear by comparing with the season and past forecasted solar power generation. Then, the JEPX spot prices forecasting system was developed considering the appearance of the lowest prices. The system combined these conditions, and the authors developed the JEPX spot prices forecasting system. This system can accurately forecast the appearance of the lowest prices and spot prices.

Abstract The progression of precancerous lesions to malignancy is often accompanied by increasing complexity of chromosomal alterations but how these alterations arise is poorly understood. Here we perform haplotype-specific analysis of chromosomal copy-number evolution in the progression of Barrett’s esophagus (BE) to esophageal adenocarcinoma (EAC) on multiregional whole-genome sequencing data of BE with dysplasia and microscopic EAC foci. We identify distinct patterns of copy-number evolution indicating multigenerational chromosomal instability that is initiated by cell division errors but propagated only after p53 loss. While abnormal mitosis, including whole-genome duplication, underlies chromosomal copy-number changes, segmental alterations display signatures of successive breakage-fusion-bridge cycles and chromothripsis of unstable dicentric chromosomes. Our analysis elucidates how multigenerational chromosomal instability generates copy-number variation in BE cells, precipitates complex alterations including DNA amplifications, and promotes their independent clonal expansion and transformation. In particular, we suggest sloping copy-number variation as a signature of ongoing chromosomal instability that precedes copy-number complexity. These findings suggest copy-number heterogeneity in advanced cancers originates from chromosomal instability in precancerous cells and such instability may be identified from the presence of sloping copy-number variation in bulk sequencing data.

Japan Atomic Energy Agency is developing extraction chromatography technology to recover MA(III) from spent nuclear fuel. Developments in the extraction chromatography system especially focusing on safety and stable operation are required for practical application of the technology. This paper discusses the main tasks that have to be challenged preferentially based on achievements obtained by previous studies and potential MA(III) recovery process flow. For the safety assessment, removal of fine particles, optimization in adsorbent for a reduction in pressure drop of the column, degradation behavior of the adsorbents, and recycling of the adsorbents are topics for development. Enhancement in resistance against radiation and acid of material in pump and development of automated operation system is required to maintain product quality during long time operation. Those studies are carried out simultaneously in a research project of 2019-2024, and new technologies such as a filter with porous media, porous adsorbents for low-pressure drop column, used adsorbent recycling, radiation resistant pump, and automated valve switching system using online analysis are developed in this project. A demonstration of the total system with a large-scale apparatus will be carried out at the end of the project.

Japan Atomic Energy Agency has been working on development of extraction chromatography technology for recovery of trivalent minor actinides (MA(III): Am, Cm) from high-level radioactive waste generated in reprocessing of spent fuel. The technology utilizes porous silica particles with about 50μm diameter for support of adsorbents. The particles are coated by styrene-divinylbenzene copolymer, and an extractant for MA recovery is impregnated into the polymer. Pressure drop of the packed column depends on characteristics of the particle (diameter, uniformity and pore size). Large pressure drop of the column is not favorable for safety assessment of the technology although a certain level of the pressure drop is indispensable for excellent separation performance. In this study, we applied a granulation technique using a spray dryer that is widely used in industry, and conducted experiments to find the optimal specifications for silica support particles and conditions for the granulation operation. A basic characterization of the adsorbent prepared from the produced particles was carried out by an adsorption test of simulated high level liquid waste. As a result, it was first found that the uniformity of particle size could be improved by suppressing pulsation during supply of the feed slurry to the spray dryer. Next, by adjusting the viscosity of the feed slurry, it was possible to suppress the generation of particles with undesirable shapes such as hollow particles and depressed particles. It was also confirmed that these particles had a lower pressure drop than conventionally used particles.

A 73-year-old man visited our hospital for persistent cough. Chest high-resolution CT (HRCT) showed infiltration shadows in lower lobes and diffuse ground glass opacities in the upper lobes. Blood tests showed elevated white blood cell, C-reactive protein, surfactant protein D, and Krebs von den Lungen-6 levels. After an antigen avoidance test, his HRCT and blood test findings improved; we diagnosed him with hypersensitivity pneumonitis (HP). A culture of the rotting interior walls within his home revealed Paecilomyces, which we believe caused his HP. Given the few patients with Paecilomyces-induced HP, systematic approach was important to identify the inciting antigen.

Plug-in Hybrid Vehicles (PHEVs) have multiple driving modes, and it is possible to proper driving energy management by a combination of driving modes. In this research, the authors obtained driving data and made it possible to estimate the driving energy consumption for each driving mode. The authors focused on the difference in power generation efficiency depending on the driving road by driving the series hybrid mode. Therefore, pre-charging method on roads with high power generation efficiency was proposed for reducing fuel consumption. Finally, the PHEV energy management system using the Geographic Information System (GIS) was constructed to optimal energy consumption and driving cost by the combination of multiple driving modes. The authors showed that fuel consumption and driving cost are reduced compared to not using this system.

Simulated debris was synthesized using UO2, Zr, and stainless steel and a heat treatment method under inert or oxidizing conditions. The primary U solid phase of the debris synthesized at 1473 K under inert conditions was UO2, whereas a (U, Zr)O2 solid solution formed at 1873 K. Under oxidizing conditions, a mixture of U3O8 and (Fe, Cr)UO4 phases formed at 1473 K, whereas a (U, Zr)O2+x solid solution formed at 1873 K. The leaching behavior of the fission products from the simulated debris was evaluated using two methods: the irradiation method, for which fission products were produced via neutron irradiation, and the doping method, for which trace amounts of non-radioactive elements were doped into the debris. The dissolution behavior of U depended on the properties of the debris and aqueous solution for immersion. Cs, Sr, and Ba leached out regardless of the primary solid phases. The leaching of high-valence Eu and Ru ions was suppressed, possibly owing to their solid-solution reaction with or incorporation into the uranium compounds of the simulated debris.

Abstract Background Neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Chemoradiotherapy (CRT) is an alternative treatment approach. However, both treatments are associated with toxicity, and the optimal treatment for older patients with ESCC is unknown. This study aimed to evaluate the treatment strategies and prognosis of older patients with locally advanced ESCC in a real-world setting. Methods We retrospectively evaluated 381 older patients (≥ 65 years) with locally advanced ESCC (stage IB/II/III, excluding T4) who received anticancer therapy at 22 medical centers in Japan. Based on age, performance status (PS), and organ function, the patients were classified into two groups: clinical trial eligible and ineligible groups. Patients aged ≤ 75 years with adequate organ function and a PS of 0–1 were categorized into the eligible group. We compared the treatments and prognoses between the two groups. Results The ineligible group had significantly shorter overall survival (OS) than the eligible group (hazard ratio [HR] for death, 1.65; 95% confidence interval [CI], 1.22–2.25; P = 0.001). The proportion of patients receiving NAC followed by surgery was significantly higher in the eligible group than in the ineligible group (P = 1.07 × 10–11), whereas the proportion of patients receiving CRT was higher in the ineligible group than in the eligible group (P = 3.09 × 10–3). Patients receiving NAC followed by surgery in the ineligible group had comparable OS to those receiving the same treatment in the eligible group (HR, 1.02; 95% CI, 0.57–1.82; P = 0.939). In contrast, patients receiving CRT in the ineligible group had significantly shorter OS than those receiving CRT in the eligible group (HR, 1.85; 95% CI, 1.02–3.37; P = 0.044). In the ineligible group, patients receiving radiation alone had comparable OS to those receiving CRT (HR, 1.13; 95% CI, 0.58–2.22; P = 0.717). Conclusions NAC followed by surgery is justified for select older patients who can tolerate radical treatment, even if they are old or vulnerable to enrollment in clinical trials. CRT did not provide survival benefits over radiation alone in patients ineligible for clinical trials, suggesting the need to develop less-toxic CRT.

This paper applies a method for reducing frequency fluctuations in power system by using Fuel Cell cogeneration system (FC cogeneration). Frequency fluctuation in power system is used as a feedback signal to a controller of FC cogeneration. In addition, the potential of power system for controlling frequency is estimated from the supply and demand record, and the timing, when power system requires the control from FC cogeneration, is determined. Thus, the effectiveness of the method is analyzed, considering the conditions in Kyushu area. The impact of the proposed method is high since the available capacity for the frequency control in power system is small in the evening. Even if 13.7% of the capacity for regulating frequency which is the pumped storage power generation on 22nd May 2019 is reduced, the FC cogeneration can regulate the frequency in power system.

Japan Electric Power Exchange (JEPX) is the only electricity market in Japan that allows transactions for electric power established in 2005. Several commodities are traded there, such as the spot market and the forward market. In particular, the spot market is a major trading market. The price of the spot market changes depending on the relationship between supply and demand. Therefore, it is important to forecast spot market prices to make a supply and demand plan for the next day. This research focused on the factors that determine supply and demand are related to geospatial information—first, deriving the explanatory variables for JEPX spot prices using Geographic Information System (GIS). Then, constructing the spot price forecasting system by machine learning using the derived explanatory variables. By using this system, it is possible to forecast electricity prices with higher accuracy than existing methods.

Abstract Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), a rare condition, is characterized by pathological proliferation of neuroendocrine cells. Some of them are localized to the airway mucosa, and others locally infiltrate to form tumorlets and nodules. Here, we present a patient with lung adenocarcinoma accompanied by DIPNECH, making the latter difficult to distinguish from multiple pulmonary metastases. The patient, a 72‐year‐old Japanese woman, was diagnosed as having stage IVA lung adenocarcinoma because she had multiple nodules in both lungs. Mutation of epidermal growth factor receptor gene having been found in the primary tumor, treatment with osimertinib was started. This resulted in shrinkage of the primary tumor, but not the multiple pulmonary nodules. To determine whether these lung nodules were indeed lung metastases, we performed right upper lobectomy with lymphadenectomy and wedge resection of the right lower lobe. On pathological examination, the primary tumor was diagnosed as invasive adenocarcinoma, whereas the multiple pulmonary nodules were diagnosed as DIPNECH manifesting as tumorlets. Therefore, the final diagnosis was stage IA1 lung adenocarcinoma accompanied by DINPECH. The patient had no recurrences 1 year after the operation without any additional treatment. This is a rare case of lung adenocarcinoma accompanied by DIPNECH presenting as multiple pulmonary nodules. DIPNECH should be included in the differential diagnosis of multiple pulmonary nodules.

Abstract Large cell neuroendocrine carcinoma of the lung (LCNEC) is a rare and highly progressive tumor with a poor prognosis. Although immune checkpoint inhibitors have been approved for treatment of both small cell and non–small cell lung cancers, their role in the treatment of LCNEC is unclear. We describe a patient with postoperative recurrence of LCNEC who maintained complete remission for 4 years after a single administration of pembrolizumab. A 68‐year‐old Japanese man underwent thoracoscopic right lower lobectomy for LCNEC (pathological stage pT1bN0M0, stage IA2). Epidermal growth factor receptor and anaplastic lymphoma kinase were negative, and the programmed death ligand 1 expression rate in tumor cells was 5% (clone 22C3). Eight months later, the patient developed recurrence with mediastinal lymph node metastasis and pleural dissemination. Therefore, chemotherapy with cisplatin and etoposide was administered. However, relapse occurred 6 months later. Pembrolizumab was administered as second‐line chemotherapy, which was discontinued after first dose because of interstitial pneumonia 1 month later. Thereafter, however, both the lymph node metastasis and pleural dissemination disappeared and did not relapse for 4 years. Pembrolizumab may be used as a treatment option for pulmonary LCNEC.

This paper reports on the status of technology development under a national project launched in 2019 to address the problem of decreased system inertia associated with the large-scale integration of renewable energy. The project comprises two parts: the development of a system inertia observation technology using a continuous monitoring system to observe inertia and development of an inverter equipped with a function to provide virtual inertia as a countermeasure device. Utilizing both these efforts, the project aims to facilitate the introduction of renewable energy in the future with minimum restrictions. It was confirmed that the trend of inertia observed with the developed method was generally the same as that of the total inertia of synchronous machines observed by an electric utility. The effectiveness of the countermeasure device in reducing the frequency swing during a disturbance was confirmed through evaluation tests.

Currently, the substantial renewable penetration brings a low inertia issue to the Japanese power system, threatening stability and resiliency than ever. The inertia estimation based on transient events provides a reliable basis for system control and operation. However, the poor rate of change of frequency extraction from different types and locations of phasor measurement units (PMUs) could significantly lead to inertia estimation errors. As a remedy with a lesson learned, this paper analyzes effective inertia estimations based on transient measurements of the Japanese wide-area monitoring in both distribution and transmission levels. Due to the longitudinally interconnected configuration of the 60 Hz Japanese power system, the polynomial approximation technique is proposed to restrain the strong effect of oscillatory components. To enhance the estimation performance considering an existing center of inertia, the comprehensive mode-shape analysis is performed via geographical measurement locations, indicating sufficient PMUs with precise estimation. The effectiveness of inertia estimation techniques is verified through actual system events corresponding to various transient sites. The numerical results demonstrate that recent inertia of the 60 Hz Japanese system with existing renewables ranges around 7.12 - 8.13 s in its system load base.

Abstract The objective of this single-center retrospective cohort study was to investigate the relationship between blood transfusion and persistent inflammation, immunosuppression, and catabolism syndrome (PIICS). The study was conducted at the Critical Care Center at Toho University Omori Medical Center, Japan. We included 391 patients in the PIICS group (hospitalization for > 15 days, C-reactive protein > 3.0 mg/dL or albumin 15 days and not meeting the PIICS criteria). We performed univariate and multivariate logistic regression analyses using PIICS as the objective variable and red blood cell (RBC) or fresh frozen plasma or platelet (PLT) transfusion and other confounding factors as explanatory variables. In addition, we conducted a sensitivity analysis using propensity score matching analysis. The multivariate and propensity score analyses showed that RBC and PLT transfusions were significantly associated with PIICS. This is the first study to report an association between RBC and PLT transfusions and PIICS. Our findings have contributed to better understanding the risk factors of PIICS and suggest that physicians should consider the risk of PIICS occurrence when administering blood transfusions in intensive care unit (ICU) patients.

Abstract Aim Digestive reconstruction after pharyngolaryngectomy with total esophagectomy (PLTE) remains challenging, with the optimal method remaining unclear. The current study aimed to clarify the short‐term outcomes after PLTE and determine the optimal digestive reconstruction method. Methods Based on a nationwide survey of 151 patients who underwent PLTE, outcomes of digestive reconstruction methods are described. Results Among digestive reconstruction methods, a simple gastric tube was most frequently used (37.1%), followed by gastric tube combined with free graft transfer (FGT) (35.1%), gastric tube with microvascular anastomosis (22.5%), and other procedures (5.3%). Intraoperative evaluation of microcirculation (IOEM) was utilized in 29 patients (19.2%). Among the included patients, 66.9% developed any‐grade complications, 41.0% developed severe complications, and 23.8% developed digestive reconstruction‐related complications (DRRCs; leakage or necrosis). Reoperation within 30 days for any complications and DRRCs was required in 13.9% and 8.6% of the patients, respectively. Mortality within 90 days was observed in 4.6%. Among the three major methods, gastric tube combined with FGT promoted the least DRRCs in the gastric tube (P = .005), although the overall incidence of DRRCs was comparable. The use of IOEM was significantly associated with a reduction of severe DRRCs (P = .005). Conclusions Pharyngolaryngectomy with total esophagectomy is a high‐risk surgery significantly associated with the occurrence of postoperative morbidity and mortality. Nonetheless, the addition of FGT can help prevent gastric tip complications, while IOEM can be an effective method for improving outcomes.

Environmental noise affects significantly our health and quality of life. Simple techniques, such as A-weighted decibels, have been applied commonly to the real issues of environmental noise. More elaborate techniques, considering mechanisms in the central nervous system, have also been developed continuously and approved by the international organization of standardization (e.g., ISO 532-3; hereafter, ISO loudness model). These techniques have advanced our knowledge of perceptual noisiness, but still have some limitations to account for a variety of psychophysical phenomena and our empirical experiences in acoustic engineering. Here, we propose that perceptual noisiness can be explained better by considering auditory attention. Attention driven by sensory input has been modeled originally as “saliency” in vision. This algorithm has also been applied to capture spectral-temporal dynamics of auditory attention (hereafter, spectral saliency). It has been suggested that the central auditory system contains two pathways identifying what and where a sound source is. The above spectral saliency corresponds only to the what-pathway. We therefore created a new auditory spatial saliency model to capture attentional effects along the where-pathway based on an algorithm of horizontal sound localization. We found that our spatial saliency model accounted for perceptual phenomena that cannot be explained by the ISO loudness model. Furthermore, the prediction of perceptual noisiness of environmental sounds (driving sounds of passenger cars) was improved significantly by integrating spatial saliency with ISO loudness. We conclude that spatial saliency can be used to capture sound features affecting perceptual noisiness in everyday life.

Substituting conventional energy sources with new renewable sources is crucial issue nowadays in energy generation systems to face climate changes and increased load demands. Due to the increased penetration levels of renewable sources in power systems, the benefits of the high-inertia of conventional sources are being insufficient. The resulting low-inertia power systems introduce several stability, reliability, and coordination problems for power system operation and control. Therefore, this paper tackles the coordination assessment and enhancement between digital frequency relays using a new fractional order load frequency controller equipped with superconducting magnetic energy storage (SMES) virtual inertia system. The improved coordination method is established using optimized fractional order controller based on slime mould optimization algorithm (SMA). The proposed SMA-based design method benefits the adaptive weights of SMA algorithm. The proposed design is generalized to be applied on single area and multi-area interconnected power systems as well. Compared to existing literature, this paper presents an advanced fractional order controller with coordinated operation with existing protection relays. The obtained results show the coordination shortcomings of renewable energy based microgrids with traditional control systems. However, improved design and coordination are obtained using the proposed SMA-optimized fractional order controllers. The superiority and feasibility of the proposed analysis and methods are verified on different case studies using single and multiple interconnected areas.

Esophageal cancer (EC) remains a public health concern with a high mortality and disease burden worldwide. Esophageal squamous cell carcinoma (ESCC) is a predominant histological subtype of EC that has unique etiology, molecular profiles, and clinicopathological features. Although systemic chemotherapy, including cytotoxic agents and immune checkpoint inhibitors, is the main therapeutic option for recurrent or metastatic ESCC patients, the clinical benefits are limited with poor prognosis. Personalized molecular-targeted therapies have been hampered due to the lack of robust treatment efficacy in clinical trials. Therefore, there is an urgent need to develop effective therapeutic strategies. In this review, we summarize the molecular profiles of ESCC based on the findings of pivotal comprehensive molecular analyses, highlighting potent therapeutic targets for establishing future precision medicine for ESCC patients, with the most recent results of clinical trials.

Abstract Background The adapted systemic inflammation score (aSIS), calculated from serum albumin and the lymphocyte‐to‐monocyte ratio, has been reported to be a novel prognostic marker for some types of cancers. However, the prognostic impact of aSIS in patients with esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to examine the prognostic effects of aSIS in a large cohort of 509 ESCC patients. Methods Preoperative aSIS was retrospectively calculated for 509 ESCC patients who underwent curative resection. Time‐dependent receiver operating characteristics (t‐ROC) curves were used for comparing the prognostic impact. Results Patients with high aSIS showed significantly poorer overall survival (OS) than patients with low aSIS (log rank P

Abstract We discuss a case in which urinary L‐FABP measurements were used to manage a 46‐year‐old male patient receiving V‐A ECMO support. His mean blood pressure was ≥75 mmHg for the first 24 h after the initiation of V‐A ECMO, and he experienced a rapid decrease in urinary L‐FABP levels.

Abstract Background Carcinoid tumors can on rare occasions ectopically produce adrenocorticotropic hormone (ACTH), causing Cushing's syndrome, and patients could become immunocompromised. Care must therefore be taken regarding infectious complications. In particular, ACTH‐producing pulmonary carcinoid is not easy to diagnose by itself, and when combined with pulmonary nodules as infectious foci, each is very difficult to diagnose. Case The patient was a 71‐year‐old woman with refractory diabetes. She showed clinical symptoms of Cushing's syndrome during treatment for diabetes and ectopic ACTH production was suspected based on biochemical and imaging tests. Nodules were identified in the left lung apex and lingual segment. Examination of resected nodules revealed that the nodule in the apex was pulmonary cryptococcosis, while the nodule in the lingual segment represented typical carcinoid. After surgery, clinical symptoms, laboratory findings, and diabetes all improved. Conclusion We present this very instructive case in terms of the difficulty of diagnosing ACTH‐producing tumors, the possibility of infection complicating the immunodeficiency caused by ACTH‐producing tumors, and the surgical strategy.

Abstract Echinoderm microtubule‐associated protein‐like 4‐anaplastic lymphoma kinase (EML4‐ALK) rearrangements are found in ~ 5% of patients with non‐small cell lung cancer (NSCLC). Several tyrosine kinase inhibitors (TKIs) have been developed for treatment of so‐called ALK‐positive NSCLC. In cases of tumor progression during treatment with second‐generation ALK‐TKIs, such as alectinib, brigatinib, or ceritinib, National Comprehensive Cancer Network guidelines propose a switch to lorlatinib, a third‐generation ALK‐TKI, or to cytotoxic chemotherapy. However, they do not mention switching to other second‐generation ALK‐TKIs. Here, we present a rare case of a 53‐year‐old Japanese woman, who had never smoked, with ALK‐positive lung adenocarcinoma who survived alectinib‐resistant postoperative recurrence for 4 years by switching to ceritinib. She underwent curative resection for lung adenocarcinoma, but the cancer recurred at the bronchial stump and mediastinal lymph nodes. After platinum‐doublet chemotherapy, the patient still had a single growing liver metastasis, but the tumor was found to harbor EML4‐ALK rearrangement. Therefore, the patient started to take ALK‐TKIs. Alectinib was the second ALK‐TKI used to treat this patient. Alectinib shrank the liver metastasis, which was surgically resected. The tumor relapsed again during continued treatment with alectinib, which was switched to ceritinib. Ceritinib was effective for the relapsed tumor and treatment continued well for 4 years. This case report suggests that, in case of tumor progression during treatment with a second‐generation ALK‐TKI, switching to another second‐generation ALK‐TKI may be one of the treatment options. Further analyses are warranted to find robust markers to determine which ALK‐TKI is best for each patient.

Abstract Malignant mesothelioma is a cancer with a poor survival rate. It is difficult to diagnose mesotheliomas because they show a variety of histological patterns similar to those of various other cancers. However, since currently used positive markers for mesotheliomas may show false positives or false negatives, a novel mesothelial positive marker is required. In the present study, we screened 25 claudins and found that claudin-15 is expressed in the mesothelial cells. We made new rat anti-human claudin-15 (CLDN15) monoclonal antibodies that selectively recognize CLDN15, and investigated whether CLDN15 is a good positive marker for malignant pleural mesotheliomas (MPMs) using MPM tissue samples by immunohistochemistry and semi-quantification of the expression level using an immunoreactive score (IRS) method. Of 42 MPM samples, 83% were positive for CLDN15. The positive ratio was equal to or greater than other positive markers for MPMs including calretinin (81%), WT-1 (50%), and D2-40 (81%). In 50 lung adenocarcinoma sections, four cases were positive for CLDN15 and the specificity (92%) was comparable with other markers (90–100%). Notably, CLDN15 was rarely detected in 24 non-mesothelial tumors in the tissue microarray (12/327 cases). In conclusion, CLDN15 can be used in the clinical setting as a positive marker for MPM diagnosis.

Objective While greater body mass index (BMI) is associated with increased risk of developing atrial fibrillation (AF), the impact of BMI on outcomes in newly diagnosed AF is unclear. We examine the influence of BMI on outcomes and whether this is modified by sex and evaluate the effect of non-vitamin K oral anticoagulants (NOACs) in patients with high BMI.Methods GARFIELD-AF is a prospective registry of 52 057 newly diagnosed AF patients. The study population comprised 40 482 participants: 703 underweight (BMI

Abstract We experienced a case of iatrogenic intramucosal esophageal dissection in a patient who had difficulty inserting a gastric tube. CT is useful for diagnosis.

Objective:. This comprehensive analysis aimed to elucidate the mechanism underlying how high pretreatment red blood cell distribution width (RDW) reflects poor prognosis after esophagectomy for esophageal cancer. Background:. Several cohort studies have reported that preoperative RDW might be a predictive marker for poor prognosis after esophagectomy; however, the underlying mechanism of this relationship has not been elucidated. Methods:. This study included 626 patients with esophageal cancer who underwent esophagectomy between April 2005 and November 2020. A retrospective investigation of the association between pretreatment RDW and clinicopathological features, blood data, short-term outcomes, and prognosis was conducted using a prospectively entered institutional clinical database and the latest follow-up data. Results:. Of 626 patients, 87 (13.9%) had a high pretreatment RDW. High RDW was significantly associated with several disadvantageous characteristics regarding performance status, the American Society of Anesthesiologists physical status, respiratory comorbidity, and nutritional status. Similarly, high RDW correlated with frequent postoperative morbidities (respiratory morbidity and reoperation; P = 0.022 and 0.034, respectively), decreased opportunities for adjuvant chemotherapy (P = 0.0062), and increased death from causes other than esophageal cancer (P = 0.046). Finally, RDW could be an independent predictor of survival after esophagectomy (hazard ratio, 1.47; 95% confidence interval, 1.009–2.148; P = 0.045). Conclusion:. High pretreatment RDW reflected various adverse backgrounds and it could be a surrogate marker of poor prognosis in patients who have undergone esophagectomy for esophageal cancer.

Abstract Pulmonary large cell carcinoma (LCC) is classified as a poorly defined entity among non‐small cell lung cancers (NSCLCs). At present, there are no effective anticancer drugs, such as molecular targeted drugs, for LCC, and it has been reported that patient prognosis is poor. Recently, the development of immune checkpoint inhibitors (ICIs) has changed the therapeutic strategies for patients with NSCLC. Here, we present a case of LCC successfully treated with pembrolizumab. A 58‐year‐old man who was a former smoker was diagnosed with LCC. The postoperative stage was T3N2M0. During postoperative adjuvant chemotherapy, swelling of the supraclavicular lymph node was observed and the patient was diagnosed with recurrence. The patient was treated with two regimens of conventional cytotoxic chemotherapy; however, he experienced some hoarseness. Imaging confirmed swelling of the hilar and mediastinal lymph nodes and the patient was subsequently diagnosed with disease progression. Previous surgical specimens when immunostained showed that a high proportion of the tumor cells were positive for expression of programmed death‐ligand 1 (PD‐L1), and it was decided to commence treatment with pembrolizumab. This treatment resulted in rapid regression of the hilar and mediastinal lymph nodes, and a progression‐free period maintained for at least 24 treatment cycles. The patient's hoarseness improved, and the lymph nodes decreased in size. Immunotherapy targeting PD‐1/PD‐L1 may be an option for patients with PD‐L1 positive LCC. This case report suggests that treatment with ICIs may be important in the selection of treatment for not only LCC but also relatively rare NSCLC with high PD‐L1 expression.

Abstract The virtual synchronous machine technology is considered as an important technique to effectively control the shortcomings of renewable energy‐based power electronics interfaces, providing backup inertia and regulating grid stability. Conventionally, the virtual synchronous machine with a large capacity is responsible for controlling the entire grid stability against renewable penetration. It is usually operated as a centralised control system. But what if virtual synchronous machines with small capacities are independently operated by their additional droop control schemes, and will they present better performance than the single virtual synchronous machine? This study proposes the multiple virtual synchronous machine system with different active power‐frequency (P‐f) droop characteristics to improve inertia support regarding frequency stability improvement. The comprehensive small‐signal modelling of the multiple virtual synchronous machine unit is designed to include the additional P‐f droop characteristics. Then, the dynamic characteristics (steady‐state and transient responses) and static stability of the multiple virtual synchronous machines are compared with the single virtual synchronous machine at the same rated capacity in both eigenvalue/sensitivity‐domain and time‐domain analysis. The obtained results reveal that the system with the presence of several virtual synchronous machines is more stable than the system with single virtual synchronous machine, maintaining stable and secure system operation during the contingency.

Abstract Extracorporeal membrane oxygenation for cardiopulmonary arrest due to left ventricular free wall rupture is considered effective, because it enables rapid cardiopulmonary support and introduction of targeted temperature management.

Abstract The use of plasma filtration with dialysis (PDF) may be considered when treating the acute phase of capillary leak syndrome (CLS). To the best of our knowledge, this is the first report using PDF for CLS.

Renewable energy systems (RESs) have introduced themselves as vital solutions for energy supply in remote regions, wherein main utility supply systems are not available. The construction of microgrid (MG) systems is useful candidate for proper control and management with hybrid RESs. However, RESs-based MGs face reduced power system inertia due to the dependency of RESs on power electronic converter systems. Accordingly, preserving nominal operating frequency and reduced deviations in tie-line power are crucial elements for proper operation of interconnected MGs in remote areas. To overcome this problem, load frequency control (LFC) systems have proven featured solutions. Therefore, this paper proposes a new non-integer LFC method based on the fractional order (FO) control theory for LFC in interconnected MGs in remote areas. The proposed control is based on the three degree of freedom (3DoF) cascaded 1+proportional-integral-derivative-accelerated (PIDA) controller with FOPI controller, namely 3DoF 1+PIDA/FOPI LFC scheme. The proposed 3DoF 1+PIDA/FOPItakes the advantages of the accelerated term of PIDA control to improve power system transients, regarding maximum overshoot/undershoot and settling times. Additionally, it employs outer loop to reduce errors and faster inner loop to mitigate disturbances effects. The contribution of plug-in controlled electric vehicles (EVs) are considered to enhance the frequency regulation functions. An optimized design of the proposed 3DoF 1+PIDA/FOPI LFC scheme is proposed using the newly developed hybrid equilibrium optimizer (EO)-slime mould optimization (SMA) algorithm (namely EOSMA optimizer). The EOSMA combines the features of the EO and SMA powerful optimization algorithms. A two interconnected MGs in remote areas with RESs and EVs inclusions with high penetration levels is selected to verify the proposed 3DoF 1+PIDA/FOPI LFC scheme and the EOSMA optimizer. The results show high ability of the proposed controller and design scheme to minimize MGs’ frequency and tie-line power fluctuations and to preserve frequency stability and security.

Abstract The incidence of esophagogastric junction (EGJ) adenocarcinoma has been gradually increasing in Asia, just like in Western countries a few decades ago. Despite recent advances in next‐generation sequencing and multimodal treatments, EGJ adenocarcinoma is still an aggressive malignancy with poor outcomes. Clinically, EGJ adenocarcinoma can be separated into Barrett's adenocarcinoma and cardiac adenocarcinoma, with frequent similarities observed. Barrett's adenocarcinoma is likely to be of gastric origin in terms of its premalignant background, risk factors, and stem cell regulators. Recent comprehensive genomic analyses suggest that immunotherapy may be essential for high‐level microsatellite instability (MSI‐H)‐ and Epstein‐Barr virus (EBV)‐associated subtypes, and against the immunosuppressive phenotype in genomically stable (GS) subtypes, in the treatment of EGJ and gastric adenocarcinoma. Although the chromosomal instability (CIN) subtype dominates EGJ adenocarcinoma, there is still a need to investigate the other molecular subtypes and their targets. Because of the distinctive characteristics of tumor location of EGJ adenocarcinoma, we also described the results of a multicenter cohort study of EGJ adenocarcinoma, comparing Siewert type I (distal esophagus), II (cardia of the stomach), and III (subcardia) tumors. We show that type I tumors were frequently accompanied by Barrett's esophagus (78%, P

Background Predicting the prognosis of intensive care unit (ICU) patients is crucial because it may lead to patient stratification that would in turn help in appropriately distributing limited medical resources. This study, therefore, aimed to investigate the use of the urinary liver-type fatty acid-binding protein (L-FABP) semi-quantitative kit in rapidly predicting the prognosis of patients admitted to the ICU. Methods We conducted a single-center, prospective, observational study wherein 100 consecutive patients admitted to the ICU with an indwelling bladder catheter were enrolled between April and October 2020. Urine specimens were collected at the time of admission (T1) and after 6 h (T2), and urinary L-FABP levels were semi-quantitatively measured. Based on the results, an L-FABP variation was defined as the change in L-FABP (negative, weakly positive, or strongly positive) from T1 to T2. Patients were divided into three groups (L-FABP decreased group, unchanged group, or increased group), following which we compared their 14-day mortality. Results Finally, a total of 79 patients were included in the analysis. In multivariate analysis, urinary L-FABP variation [Odds ratio (OR) = 14.327, 95% confidence interval (CI) = 1.819–112.868, p = 0.01] and lactate (OR = 1.234, 95%CI = 1.060–1.437, p = 0.01) were significantly associated with 14-day mortality. Conclusion Urinary L-FABP variation at 6 h after admission was significantly associated with 14-day mortality.

Introduction It is important to prevent the deterioration of activities of daily living to improve the long-term prognoses of patients in the intensive care unit (ICU). The patients’ conditions, along with the lack of human and technical resources, often become barriers to achieving early mobilisation after the introduction of mechanical ventilation. We plan to verify the usefulness of a mobile patient lift for early mobilisation.Methods and analysis We will conduct a single-centre, open-label, randomised controlled trial. The inclusion criteria are as follows: age ≥18 years, independent walking before admission and expected mechanical ventilation for at least 48 hours. The participants will be randomly divided into groups with (intervention group) or without (control group) a mobile lift protocol. A mobile lift will be used in the intervention group. The primary endpoint will be the number of days required to achieve an ICU mobility scale of ≥4 (standing position). The results of the two groups will be analysed using the Student’s t-test.Ethics and dissemination This study will be conducted in accordance with the Declaration of Helsinki and with the approval of the Toho University Omori Medical Center Ethics Committee (approval number M20259). The results of this study will be presented internationally at academic conferences and published in the literature.Trial registration number UMIN000044965.

Lung cancer is the leading cause of cancer-related deaths worldwide. The standard of care for advanced non-small-cell lung cancer (NSCLC) without driver-gene mutations is a combination of an anti-PD-1/PD-L1 antibody and chemotherapy, or an anti-PD-1/PD-L1 antibody and an anti-CTLA-4 antibody with or without chemotherapy. Although there were fewer cases of disease progression in the early stages of combination treatment than with anti-PD-1/PD-L1 antibodies alone, only approximately half of the patients had a long-term response. Therefore, it is necessary to elucidate the mechanisms of resistance to immune checkpoint inhibitors. Recent reports of such mechanisms include reduced cancer-cell immunogenicity, loss of major histocompatibility complex, dysfunctional tumor-intrinsic interferon-γ signaling, and oncogenic signaling leading to immunoediting. Among these, the Wnt/β-catenin pathway is a notable potential mechanism of immune escape and resistance to immune checkpoint inhibitors. In this review, we will summarize findings on these resistance mechanisms in NSCLC and other cancers, focusing on Wnt/β-catenin signaling. First, we will review the molecular biology of Wnt/β-catenin signaling, then discuss how it can induce immunoediting and resistance to immune checkpoint inhibitors. We will also describe other various mechanisms of immune-checkpoint-inhibitor resistance. Finally, we will propose therapeutic approaches to overcome these mechanisms.

Abstract Patients with vertebral artery injury from penetrating neck trauma may not present with signs of vascular injury because of anatomical characteristics and concomitant conditions, such as hypothermia and shock. If patients are hemodynamically stable, imaging tests should be performed to examine the posterior components, including the vertebral artery.

Modern structures of electrical power systems are expected to have more domination of renewable energy sources. However, renewable energy-based generation systems suffer from their lack of or reduced rotating masses, which is the main source of power system inertia. Therefore, the frequency of modern power systems represents an important indicator of their proper and safe operation. In addition, the uncertainties and randomness of the renewable energy sources and the load variations can result in frequency undulation problems. In this context, this paper presents an improved cascaded fractional order-based frequency regulation controller for a two-area interconnected power system. The proposed controller uses the cascade structure of the tilt integral derivative (TID) with the fractional order proportional integral derivative with a filter (FOPIDN or PIλDμN) controller (namely the cascaded TID-FOPIDN or TID-PIλDμN controller). Moreover, an optimized TID control method is presented for the electric vehicles (EVs) to maximize their benefits and contribution to the frequency regulation of power systems. The recent widely employed marine predators optimization algorithm (MPA) is utilized to design the new proposed controllers. The proposed controller and design method are tested and validated at various load and renewable source variations, as is their robustness against parameter uncertainties of power systems. Performance comparisons of the proposed controller with featured frequency regulation controllers in the literature are provided to verify the superiority of the new proposed controller. The obtained results confirm the stable operation and the frequency regulation performance of the new proposed controller with optimized controller parameters and without the need for complex design methods.

Abstract Background This study’s aim is to measure liver-type fatty acid-binding protein (L-FABP) levels in urine using a rapid semiquantitative assay kit in the emergency department and to investigate whether the onset of acute kidney injury (AKI) after hospitalization can be predicted. Methods This was a prospective observation study. Patients transferred to the emergency and critical care center were divided into two groups: urinary L-FABP negative and positive groups. The status and severity of AKI were evaluated for the respective patients based on the Kidney Disease: Improving Global Outcome (KDIGO) classification. We compared the proportion of AKI patients in the two groups. Results In the urine L-FABP-positive group, many patients had a significant onset of AKI (p

Abstract Background Extended sleeve lobectomy is rarely applied to pulmonary surgery for primary lung cancer to avoid a pneumonectomy. As there is a size discrepancy between main bronchus and peripheral bronchus, ingenuity to improve anastomosis is required in the bronchoplasty. We report herein a case in which successful reconstruction of extended sleeve lobectomy with bronchial wall flap. Case presentation We report on a 64-year-old man suffering from hemoptysis, cough, mild fever and dyspnea. His computed tomography (CT) scan showed solid tumor of 40 mm in diameter in left lower bronchus, which obstructed the lower bronchus and caused obstructive pneumonia of left lower lobe and expanded to second carina and pulmonary artery. His bronchoscopy showed that tumor was exposed in the bronchial lumen and infiltrated to left main bronchus and upper bronchus even though the scope could pass through the exposed tumor of upper bronchus. Transbronchial lung biopsy showed squamous cell carcinoma. He had undergone left sleeve lingular segmentectomy and left lower lobectomy. Reconstruction was performed with bronchial wall flap. Pathological findings revealed pT3N0M0 stage IIB according to UICC 8th edition. Postoperative bronchoscopic findings showed no troubles at the anastomotic site. He has been well for eighteen months without recurrence after surgery. Conclusions We experienced a successful case who was reconstructed with bronchial wall flap (wine cup stoma) after extended sleeve lobectomy. This technique might be also useful for other types of extended sleeve lobectomy and lung transplantation to adjust caliber changes of bronchi.

Virtual inertia emulation could be regarded as an inevitable component of microgrids with renewable energy, enhancing microgrid inertia and damping properties. In applying this control technique, a phase-locked loop (PLL) is necessary to obtain the estimation of the system frequency data. However, the employment of PLL could cause larger frequency oscillation to the microgrid due to its dynamics. This issue would be exacerbated in a low-inertia microgrid driven by high renewable penetration, severely deteriorating the frequency stability. Thus, the effect of PLL with measurement delay is a critical issue in utilizing the virtual inertia control. To overcome such problem, this paper proposes a robust virtual inertia control for a low-inertia microgrid to minimize the undesirable frequency measurement effects, improving the microgrid frequency stability. The robust H∞ control design using a linear fractional transformation (LFT) technique is used to develop the virtual inertia control loop, considering the dynamics of PLL with measurement delay and the uncertainties of system inertia and damping. The efficacy of the proposed H∞ control method is compared to the conventional and optimum proportional-integral (PI)based inertia control. The results show that the H∞-based robust virtual inertia control is superior to both conventional virtual inertia control and optimum PI-based virtual inertia control against a wide range of microgrid operating conditions, disturbances, and parametric uncertainties.

Virtual inertia control is considered as an important part of microgrids with high renewable penetration. Virtual inertia emulation based on the derivative of frequency is one of the effective methods for improving system inertia and maintaining frequency stability. However, in this method, the ability to provide virtual damping is usually neglected in its design, and hence, its performance might be insufficient in the system with low damping. Confronted with this issue, this paper proposes a novel design and analysis of virtual inertia control to imitate damping and inertia properties simultaneously to the microgrid, enhancing frequency performance and stability. The proposed virtual inertia control uses the derivative technique to calculate the derivative of frequency for virtual inertia emulation. Trajectory sensitivities have been performed to analyze the dynamic impacts of the virtual inertia and virtual damping variables over the system performance. Time-domain simulations are also presented to evaluate the efficiency of the virtual damping and virtual inertia in enhancing system frequency stability. Finally, the efficiency and robustness of the proposed control technique are compared with the conventional inertia control under a wide range of system operation, including the decrease in system damping and inertia and high integrations of load variation and renewable energy.

Maintaining frequency stability of low inertia microgrids with high penetration of renewable energy sources (RESs) is a critical challenge. Solving this challenge, the inertia of microgrids would be enhanced by virtual inertia control-based energy storage systems. However, in such systems, the virtual inertia constant is fixed and selection of its value will significantly affect frequency stability of microgrids under different penetration levels of RESs. Higher frequency oscillations may occur due to the fixed virtual inertia constant or unsuitable selection of its value. To overcome such a problem and provide adaptive inertia control, this paper proposes a self-adaptive virtual inertia control system using fuzzy logic for ensuring stable frequency stabilization, which is required for successful microgrid operation in the presence of high RESs penetration. In this concept, the virtual inertia constant is automatically adjusted based on input signals of real power injection of RESs and system frequency deviations, avoiding unsuitable selection and delivering rapid inertia response. To verify the efficiency of the proposed control method, the contrastive simulation results are compared with the conventional method for serious load disturbances and various rates of RESs penetration. The proposed control method shows remarkable performance in transient response improvement and fast damping of oscillations, preserving robustness of operation.

Recent advancements in renewable generation resources and their vast implementation in power sectors have posed serious challenges regarding their operation, protection, and control. Maintaining operating frequency at its nominal value and reducing tie-line power deviations represent crucial factors for these advancements due to continuous reduction of power system inertia. In this paper, a new modified load frequency controller (LFC) method is proposed based on fractional calculus combinations. The tilt fractional-order integral-derivative with fractional-filter (TFOIDFF) is proposed in this paper for LFC applications. The proposed TFOIDFF controller combines the benefits of tilt, FOPID, and fractional filter regulators. Furthermore, a new application is introduced based on the recently presented artificial hummingbird optimizer algorithm (AHA) for simultaneous optimization of the proposed TFOIDFF parameters in the studied two-area power grids. The contribution of electric vehicle (EVs) is considered in the centralized control strategy using the proposed TFOIDFF controller. The performance of the proposed TFOIDFF controller has been compared with the existing tilt with filter, PID with filter, FOPID with filter and hybrid fractional-order with filter LFCs from the literature. Moreover, the AHA optimizer results are compared with the featured LFC optimization algorithms in the literature. The proposed TFOIDFF and AHA optimizer are validated against renewable energy fluctuations, load stepping, generation/loading uncertainty, and power-grid parameter uncertainty. The AHA optimizer is compared with the widely-used optimizers in the literature, including the PSO, ABC, BOA, and AEO optimizers at the IAE, ISE, ITAE, and ITSE objectives. For instance, the proposed AHA method has a minimized IAE after 34 iterations of 0.03178 compared to 0.03896 with PSO, 0.04548 with AEO, 0.04812 with BOA, and 0.05483 with ABC optimizer. Therefore, fast and better minimization of objective functions are achieved using the proposed AHA method.

Circularly polarized luminescence (CPL) spectroscopy measures the difference in luminescence intensity between left- and right-circularly polarized light, and is often used to analyze the structure of chiral molecules in their excited state. Recently, it has found an increasing range of applications in the analysis of molecules that emit circularly polarized light and can be employed in 3D displays. Thus, the number of articles focusing on CPL spectroscopy has increased dramatically. However, since the luminescence dissymmetry factor (glum) for organic compounds is generally