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Abstract Background This study aimed to investigate the relationship between low-dose prednisolone (PSL) and the incidence of hypokalaemia at abiraterone acetate (abiraterone) plus PSL combination therapy targeting Japanese patients with metastatic castration-resistant prostate cancer (mCRPC). Methods This retrospective observational study included 153 Japanese patients treated with abiraterone and PSL for mCRPC at Kariya Toyota General Hospital and Gifu General Medical Center between September 2014 and October 2022. The incidence of grade ≥ 2 hypokalaemia as well as serum potassium level variations and the continuous combination therapy duration were compared between the low-dose (5 mg/day of PSL) and the standard-dose (10 mg/day of PSL) groups. Results This study included 153 patient of which 95 were matched to establish the analysis population. The low-dose and the standard-dose groups consisted of 13 and 82 patients, respectively. No significant difference in the incidence of grade ≥ 2 hypokalaemia was observed between the two groups [15.4% (2/13 patients) in the low-dose group and 12.2% (10/82 patients) in the standard-dose group, P = 0.667]. The low-dose group exhibited a decrease in serum potassium levels from 4.63 on day − 7 − 0 to 4.16 mmol/L on day 84 ± 10 (n = 7, P = 0.066), and serum potassium levels from day − 7 − 0 to 84 ± 10 in the low-dose group appeared to be great in the standard-dose group (n = 37, P = 0.475). The Kaplan–Meier curves for continuity of abiraterone and PSL therapy were not significantly different between the low-dose group (n = 13) and standard-dose group (n = 82, P = 0.427). Conclusion Combination therapy with abiraterone and 5 mg/day of PSL in Japanese patients with mCRPC did not change the incidence of grade ≥ 2 hypokalaemia. However, although not significant, 5 mg/day of PSL demonstrated a decreasing trend in serum potassium levels with a larger degree of change than that of 10 mg/day of PSL. Therefore, the combination of abiraterone and 5 mg/day PSL can be administered to Japanese patients with mCRPC. The patients must be monitored for hypokalaemia through measurement of serum potassium levels and observation of subjective symptoms such as muscle weakness, convulsion etc. In addition, the doctor or the pharmacist must explain these symptoms to the patient and instruct them to consult their medical staff immediately in the event of development of such symptoms.

Background Phase angle, which is associated with cellular health, has attracted attention as a noninvasive and objective method for nutritional assessment. However, the association between malnutrition and phase angle in older inpatients with hip fractures has not been reported. Therefore, this study investigated this association in older inpatients (aged ≥65 years) with hip fractures and determined the cutoff phase angle for determining malnutrition. Methods This cross-sectional study retrospectively analyzed the data of 96 inpatients with hip fractures who were hospitalized in rehabilitation units after surgery (male, 29.4%; mean age, 82.4±6.2 years). Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), with malnutrition defined as a GNRI ≥98. Bioelectrical impedance analysis was used to measure phase angles. Results The phase angle was associated with malnutrition (B=−1.173; odds ratio=0.310; 95% confidence interval 0.58–0.83; p=0.015). The area under the receiver operating characteristic curve was 0.71. The cutoff phase angle for malnutrition was 3.96° (sensitivity=0.85, specificity=0.63). Conclusion Phase angle could be an indicator of malnutrition in older inpatients with hip fractures. Our findings will help formulate rehabilitation strategies for these patients.

Abstract INTRODUCTION The use of anti‐epileptic drugs (AEDs) in degenerative dementia (DD) remains uncertain. We aimed to evaluate the association of early AED administration with subsequent DD occurrence. METHODS Using a large nationwide database, we enrolled patients newly diagnosed with epilepsy from 2014 to 2019 (n = 104,225), and using propensity score matching, we divided them into treatment (those prescribed AEDs in 2014) and control groups. The primary outcome was subsequent DD occurrence in 2019. RESULTS Overall, 4489 pairs of patients (2156 women) were matched. The odds ratio (treatment/control) for DD occurrence was 0.533 (95% confidence interval: 0.459–0.617). The DD proportions significantly differed between the treatment (340/4489 = 0.076) and control (577/4489 = 0.129) groups. DISCUSSION Among patients newly diagnosed with epilepsy, compared to non‐use, early AED use was associated with a lower occurrence of subsequent DD. Further investigations into and optimization of early intervention for epilepsy in DD are warranted. Highlights Anti‐epileptic drug (AED) use before epilepsy diagnosis was linked with a lower subsequent degenerative dementia (DD) occurrence. Identifying the epileptic phenotype was crucial for justifying early AED use in DD. AED use with an epilepsy diagnosis did not pose an additional risk of DD. The potential contribution of combination drug therapy to the strategy was noted.

Abstract Background After total knee arthroplasty (TKA), patients’ physical activity (PA) levels at 6 months are lower than those of healthy subjects. Few studies have investigated the factors associated with PA at 6 months after TKA by objectively measuring preoperative and postoperative PA intensity using an accelerometer and knee function using a goniometer and dynamometer. The purpose of this study was to determine the factors associated with PA levels at 6 months after TKA based on objective data. Methods Eighty-two patients (mean [SD] age 74.5 [6.4] years) with moderate-to-severe knee osteoarthritis (OA) who were scheduled for TKA at the Nagoya Orthopaedic and Joint Replacement Clinic from July 2018 to July 2019 were enrolled in this longitudinal study. All patients underwent evaluations of knee function, including range-of-motion and knee-extension muscle strength; knee pain; performance in the timed up-and-go test; and accelerometer-measured PA both preoperatively and 6 months postoperatively. Factors associated with PA at 6 months after TKA were assessed using a hierarchical multiple linear regression analysis adjusted for age, sex, body mass index, and presence of diabetes mellitus. Results A higher average daily step count at 6 months after TKA was significantly associated with greater preoperative knee-extension muscle strength on the operated side (β = 0.155, p = 0.028) as well as a higher preoperative average daily step count (β = 0.834, p

In this paper, we propose clustering schemes appropriate for a cell-free massive multi-input multi-output (CF mMIMO) system with centralized hybrid beamforming (BF) in the millimeter wave (mmWave) band, with the aim of reducing computational complexity and achieving scalability at the central processing unit (CPU) while ensuring system performance. Conventional access point (AP)-wise clustering schemes have been proposed for a decentralized architecture that mitigates inter-user interference at each AP through local digital BF and analog BF of each radio frequency (RF) chain to efficiently improve performance. However, in a centralized architecture, in which the digital BF weights is designed at the CPU while considering all RF chains of all APs together. In cases where each AP employs multiple RF chains forming different analog beams, the coupling loss (the sum of the path loss and BF gain of the analog beam) of each RF chain may differ even between the same AP and UE due to differences in the analog BF gain. AP-wise clustering is not well suited because RF chains with a high coupling loss (the sum of the path loss and BF gain of the analog beam) may be included among the APs of the cluster assigned to each UE. In the method proposed in this paper, clusters are formed on a per-RF-chain basis (RF chain-wise clustering). In this way, RF chains with lower coupling loss can be selected for each UE regardless of to which AP an RF chain belongs when forming a cluster for each UE. Moreover, the existing clustering schemes do not account for the amount of inter-cluster interference. Accordingly, we propose a cluster recombination scheme to effectively mitigate inter-cluster interference. Then, by combining RF chain-wise clustering and cluster recombination, a higher received signal power can be achieved while mitigating inter-cluster interference. Through simulation-based evaluations, we show that the proposed RF chain-wise clustering and cluster recombination schemes can achieve superior spectral efficiency while effectively reducing the complexity of centralized digital BF.

Nickel (Ni) -base alloy 82 weld material is widely used for the primary reactor components of boiling water reactor (BWR). Although alloy 82 has shown excellent service performance for BWR application in terms of material reliability, several experiences have recently been reported regarding stress corrosion cracking (SCC) in welds associated with alloy 82. The present study aimed at enhancing the SCC resistance of the weld material by developing and evaluating alloy 82 with increased chromium (Cr) content of 30%, 33% and 36%. Weld joint specimens were prepared by tungsten inert gas (TIG) welding with the prototyped wires of alloy 82 with increased Cr content. The mechanical properties and weldability were investigated using the weld joint specimens. For comparison, conventional alloy 82 and alloy 52M were also tested. The mechanical properties of alloy 82 with increased Cr content were equal to or better than those of the conventional alloy 82. The varestraint test and bending test were carried out to determine the weldability. In the varestraint test, the susceptibility to solidification cracking and ductility-dip cracking was evaluated. The temperature ranges of the ductility-dip cracking of the alloy 82 with increased Cr content was about the same as that of the conventional alloy 82. As a result of these tests, it was confirmed that the alloy 82 with increased Cr content has the same weldability as that of the conventional alloy 82 and was applicable for BWR components.

Abstract In IDH-mutant astrocytoma, IDH2 mutation is quite rare and biological mechanisms underlying tumor progression in IDH2-mutant astrocytoma remain elusive. Here, we report a unique case of IDH2 mutant astrocytoma, CNS WHO grade 3 that developed tumor progression. We performed a comprehensive genomic and epigenomic analysis for primary and recurrent tumors and found that both tumors harbored recurrent IDH2 R172K and TP53 R248W mutation with CDKN2A/B hemizygous deletion. We also found amplifications of CDK4 and MDM2 with PDGFRA gain in the recurrent tumor and upregulated protein expressions of these genes. We further developed, for the first time, a xenograft mouse model of IDH2 R172K and TP53 R248W mutant astrocytoma from the recurrent tumor, but not from the primary tumor. Consistent with parent recurrent tumor cells, amplifications of CDK4 and MDM2 and PDGFRA gain were found, while CDKN2A/B was identified as homozygous deletion in the xenografts, qualifying for integrated diagnosis of astrocytoma, IDH2-mutant, CNS WHO grade 4. Cell viability assay found that CDK4/6 inhibitor and PDGFR inhibitor potently decreased cell viability in recurrent tumor cells, as compared to primary tumor cells. These findings suggest that gene alterations that activate retinoblastoma (RB) signaling pathways and PDGFR may drive tumor progression and xenograft formation in IDH2-mutant astrocytoma, which is equivalent to progressive IDH1-mutant astrocytoma. Also, our findings suggest that these genomic alterations may represent therapeutic targets in IDH2-mutant astrocytoma.

Background: Currently, cryoballoon (CB) thawing after single stop is generally performed. Previous research had reported that long thawing time using a single stop affects pulmonary veins tissue injury. However, it is uncertain whether CB thawing after single stop affects clinical outcomes. Objective: This study aimed to clarify clinical significance of CB thawing in patients with paroxysmal atrial fibrillation. Methods: Two hundred ten patients with paroxysmal atrial fibrillation who underwent CB from January 2018 to October 2019 were analyzed. We compared the clinical outcomes of patients whose CB applications were completely stopped with only the double stop technique (DS group, n = 99) and patients with single stop (SS group, n = 111). In DS group, we performed double stop technique for all CB application regardless of phrenic nerve injury or the temperature of esophagus. Results: The atrial arrhythmia free-survival rate at 2 years after CB was significantly lower for the DS group than the SS group (76.8% vs 87.4%; p = 0.045). Complications occurred in 2 patients from the DS group and no complications were observed in patients from the SS group (p = 0.13). Mean procedural time was shorter in the DS group than in the SS group (53.1 vs 58.1 min; p = 0.046) Conclusion: DS group had higher recurrence rate than SS group. There was no significant difference regarding safety between both the groups. We found that the thawing process after single stop is very important for CB application.

Abstract Pathogenic variants in the HIBCH gene cause HIBCH deficiency, leading to mitochondrial disorders associated with valine metabolism. Patients typically present with symptoms such as developmental regression/delay, encephalopathy, hypotonia and dystonia. Brain magnetic resonance imaging (MRI) shows bilateral lesions in the basal ganglia with/without brainstem involvement. Here, we report a case of a Japanese patient with Leigh-like syndrome caused by novel HIBCH variants. Long-term follow-up MRI revealed progressive cerebellar atrophy, which expands the phenotypic spectrum of HIBCH deficiency.

Background Cryoballoon ablation, especially Arctic Front Advance Pro (AFA-Pro) (Medtronic, Minneapolis, Minnesota, USA), has been widely recognised as a standard approach to atrial fibrillation (AF). Recently, Boston Scientific has released a novel cryoballoon system (POLARx). Despite comparable acute clinical outcomes of these two cryoballoons, the recent study reported a higher complication rate, especially for phrenic nerve palsy, with POLARx. However, their impact on biological tissue remains unclear.Objective The purpose of our study is to evaluate temperature change of biological tissue during cryoablation of each cryoballoon using a porcine experimental model.Method A tissue-based pulmonary vein model was constructed from porcine myocardial tissue and placed on a stage designed to simulate pulmonary vein anatomy and venous flow. Controlled cryoablations of AFA-Pro and POLARx were performed in this model to evaluate the tissue temperature. A temperature sensor was set behind the muscle and cryoballoon ablation was performed after confirming the occlusion of pulmonary vein with cryoballoon.Results The mean tissue nadir temperature during cryoablation with AFA-Pro was −41.5°C±4.9°C, while the mean tissue nadir temperature during cryoablation with POLARx was −58.4°C±5.9°C (p

Intelligent reflecting surfaces (IRSs) have been attracting attention as a solution to coverage hole problems in millimeter-wave communication areas and are considered one of the key technologies of next-generation mobile communication systems. To utilize the IRS for mobile networks, the reflection power of the IRS should be evaluated in advance to estimate the coverage enhancement. Because the IRS becomes large, up to several tens or hundreds of wavelengths, a reflection power evaluation method for a large IRS is required. Although the reflection amplitude and phase of the reflecting element are available for the physical optics (PO)-based evaluation method, they depend on the location of the reflecting element because of the mutual coupling between adjacent reflecting elements, and should be measured at each location of the reflecting element. Since the number of reflecting elements in large IRS becomes several tens of thousands, measurement becomes difficult. In addition, although the radar cross section (RCS) is available for reflection power evaluation in the far field, a massive measurement system of several hundreds of meters is required to satisfy the far-field condition of the IRS. For these reasons, the evaluation of large IRS is challenging. To solve this problem, we propose a practical evaluation method for large IRS by synthesizing the RCS patterns of small IRSs (sub-IRSs). Since the influence of the mutual coupling between sub-IRSs depends on the size of the sub-IRSs, we formulated the mutual coupling on the IRS and evaluated the proposed method by changing the size of the sub-IRSs. The measurement results in an anechoic chamber verified that the proposed method can estimate the RCS pattern of a large IRS with a reflection power difference of less than 1dB and the correlation between the estimated RCS pattern and the actual RCS pattern exceeds more than 0.87.

Intelligent reflecting surfaces (IRSs) have been attracting attention as a solution to coverage hole problems in millimeter-wave communication areas. They are considered to be one of the key technologies of next-generation mobile communication systems. Since polarized multiple-input-multiple-output (MIMO) is utilized in millimeter-wave communication systems to deliver high-speed data transmission, an IRS is also required to be applied for polarized MIMO and reflect signals in a wide angle range. To realize an IRS for the polarized MIMO, the IRS is required to reflect the signal of each polarization in the same direction with high isolation. In addition, the IRS is required to control the reflection phase over a wide range. In recent research, many proposals related to the development of IRSs have been proposed. However, since the configuration of a conventional IRS with diodes controls the reflection characteristics by controlling the electric length or shape of the reflecting element, it becomes asymmetrical in the direction of each polarization and it is difficult to apply polarized MIMO. To solve this problem, in this paper, we propose a new design of a dual-polarized liquid-crystal-based IRS for 28 GHz mobile communication systems. Since the proposed IRS controls the reflecting phase by controlling the electric thickness of the substrate, the IRS can control the reflecting phase without changing the shape of the reflecting element. By optimizing the design of the reflecting element, the IRS can achieve a wide reflection phase control of 260 degrees for both vertical and horizontal polarizations. The IRS can also control the reflection direction of each polarization in the range of ±60 degrees with a high isolation of more than 20 dB. The main contributions of this paper are 1) a proposal for the design of a liquid crystal IRS for polarized MIMO; 2) a proposal of a design method for the liquid-crystal IRS using unit cell analysis; 3) verification of the proposed IRS through electromagnetic field analysis; 4) development of the proposed liquid-crystal IRS; 5) experimental verification of the proposed IRS in an anechoic chamber, and 6) derivation of the MIMO channel capacity of the proposed dual-polarized IRS.

A probabilistic fracture mechanics (PFM) analysis code, PASCAL, has been developed by Japan Atomic Energy Agency for failure probability and failure frequency evaluation of reactor pressure vessels (RPVs) considering neutron irradiation embrittlement and thermal transients. To strengthen the applicability of PASCAL, considerable efforts on verifications of the PASCAL code have been made in the past years. As a part of the verification activities, a working group consisted of different organizations from industry, universities and institutes, was established in Japan. In the early phase, the working group focused on verifying the PFM analysis functions for RPVs in pressurized water reactors (PWRs) subjected to pressurized thermal shock (PTS) events. Recently, the PASCAL code has been improved in order to run PFM analyses for both RPVs in PWRs and boiling water reactors (BWRs) subjected to a broad range of transients. Simultaneously, the working group initiated a verification plan for the improved PASCAL through independent PFM analyses by different organizations. Concretely, verification analyses for a PWR-type RPV subjected to PTS transients and a BWR-type RPV subjected to a low-temperature over pressure (LTOP) transient were performed using PASCAL. This paper summarizes those verification activities, including the verification plan, analysis conditions and results. Through the verification studies, it is confirmed that the mathematical models and probabilistic calculation algorithms incorporated in PASCAL work appropriately and the applicability of PASCAL has been improved.

New specific scenarios are expected for 5G systems in various environments, such as stadiums, subway platforms, factories, livestock barns. On the other hand, the applicability of conventional propagation models to new specific environments has not been clarified. In this paper, we report path loss and spatiotemporal characteristics such as delay spread (DS) and azimuth and zenith angular spread of arrival (ASA and ZSA) in the 28 GHz-band in various environments. By comparing the degree of fit to the conventional models, we considered whether the models for conventional scenarios assumed by previous mobile systems can be applied to the propagation characteristics in each specific environment. As a result, we clarify that the following points should be considered when applying the conventional model. The measured path loss characteristics were mostly close to those of the conventional models. However, the path loss in the non-line-of-sight with propagation to another room was larger than the conventional model, assuming there was a hall space environment with some blockers. Regarding the DS, we obtained the results that the characteristics were mainly affected by existence of long-distance delayed wave caused by a long narrow space and materials of the internal walls and ceiling. Larger ASA characteristics were obtained in the subway platform environment and the factory environment because of metallic obstacles and walls. Regarding the ZSA, a larger ZSA was obtained in the stadium due to scattering from spectator seats, and a smaller ZSA was obtained in the subway platform due to the low ceiling height and long propagation distance.

Background: Difficulties are often encountered while controlling atrial fibrillation (AF), especially in hemodialysis (HD) patients. Previous data revealed that cryoballoon ablation (CBA) for treating paroxysmal atrial fibrillation (PAF) was not inferior to radiofrequency ablation (RFA); however, HD patients were excluded in this prior trial. Thus, the efficacy of CBA for HD patients is still unknown. Methods: This retrospective study analyzed HD patients who underwent catheter ablation (CA) for AF from August 2011 to June 2019. Patients who received CBA (CBA group) and those who received RFA (RFA group) were compared. The primary endpoint was defined as freedom from a composite outcome (a documented recurrence of any atrial tachyarrhythmia or a prescription of antiarrhythmic drugs) at one year after CA. Results: The RFA and CBA groups were composed of 21 and 23 patients, respectively. Freedom from a composite outcome was 58.4% in the RFA group and 68.2% in the CBA group (Log-rank: p = 0.571). Conclusion: Our results suggest that patients on HD with AF who were treated with CBA tended to have better outcomes than patients treated with RFA. Therefore, CBA could be a suitable ablation method for HD patients.

Abstract We present a case of a 14-year old boy with tumor-associated refractory epilepsy. Positron emission tomography imaging demonstrated a region with heterogeneous high 11C-methionine uptake and a region with homogenous low 18F-fluorodeoxyglucose uptake within the tumor. Histopathological and genomic analyses confirmed the tumor as BRAF V600E-mutated polymorphous low-grade neuroepithelial tumor of the young (PLNTY). Within the high-methionine-uptake region, we observed increased protein levels of L-type amino acid transporter 1 (LAT1), a major transporter of methionine; c-Myc; and constituents of the mitogen-activated protein kinase (MAPK) pathway. We also found that LAT1 expression was linked to the BRAF V600E mutation and subsequent activation of MAPK signaling and c-Myc. Pharmacological and genetic inhibition of the MAPK pathway suppressed c-Myc and LAT1 expression in BRAF V600E-mutated PLNTY and glioblastoma cells. The BRAF inhibitor dabrafenib moderately suppressed cell viability in PLNTY. Collectively, our results indicate that BRAF V600E mutation-activated MAPK signaling and downstream c-Myc induces specific metabolic alterations in PLNTY, and may represent an attractive target in the treatment of the disease.

Abstract Background Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) are used for the treatment of various cancer types. However, immune-related adverse events (irAEs) occur in patients treated with ICIs. Several small-scale studies have reported the onset of irAEs and therapeutic effects of ICIs. Here we report a large-scale retrospective study covering a wide range of cancers. We evaluated irAEs and the therapeutic effects of ICIs and determined whether irAEs could be predicted. Methods This study included patients treated with the anti-PD-1 antibodies nivolumab or pembrolizumab at Fujita Health University Hospital between December 2015 and March 2019. We retrospectively reviewed the electronic medical records for age, cancer type, pre-treatment blood test data, presence or absence of irAE onset, type and severity of irAEs, outcome of irAE treatment, response rate, progression-free survival and overall survival. Results Two hundred-eighty patients received ICIs. The overall incidence of irAEs was 41.1% (115 patients), and the incidence of severe irAEs of grade 3 and higher was 2.8% (eight patients). The most common irAEs were skin disorders, thyroid disorders and interstitial pneumonitis. Patients with irAEs were significantly older than those without irAEs (69.7 versus 66.0 years, P = 0.02). The objective response rate (ORR) in patients with irAEs was 30.4%, which was significantly higher than in patients without irAEs (12.7%; P

Abstract Background Although hepatectomy for metastatic colorectal cancer (mCRC) prolongs survival in up to 40% of people, recurrence rates approach 70%. We used a multidisciplinary approach to treat recurrent liver metastases, including chemotherapy, surgery, and palliative care. On the other hand, development of chemotherapeutic agents is remarkable and improves long-term survival. However, whether chemotherapy and repeat hepatectomy combination therapy improve survival or not is still unclear. The aim of this study was to analyze the outcomes of repeat hepatectomy with systemic chemotherapy for mCRC. Methods Following Institutional Review Board approval, we reviewed the records of all patients who underwent hepatectomy for mCRC between 1974 and 2015 at Fujita Health University Hospital. We used the Kaplan–Meier method to estimate overall survival from the first and last hepatectomy in multi hepatectomy cases after 2005 and compared outcomes between groups using the log-rank test. Results A total of 426 liver resections were performed for mCRC; of these, 236 cases were performed after 2005 (late group). In 118 (50%) cases, the site of recurrence was the liver, 59 (50%) underwent repeat hepatectomy, and 14 cases had ≥ 2 repeat hepatectomies. Overall survival (OS) before and after 2005 was 42.2 and 64.1 months, respectively, with the late group having better OS compared to the early (1974–2004) group. OS for single hepatectomy cases was 83.2 months, for two hepatectomies was 42.9 months, and for three hepatectomies was 35.3 months. In total, 59 patients did not undergo surgery after recurrence with an OS of 28.7 months. Mortality of the second and third repeat hepatectomy was 1.7% and 15.3%, respectively. Conclusion Repeat hepatectomy with systemic chemotherapy for mCRC is feasible and might achieve improved survival in carefully selected patients.

Although large bowel obstruction is a common surgical emergency, its occurrence due to bladder distension is rarely reported in the literature. We report a case of large bowel obstruction caused by bladder distention secondary to benign prostate hyperplasia in a 67-year-old man. This case demonstrates a grossly distended urinary bladder compressing the rectosigmoid colon against the sacrum, presenting as a complete large bowel obstruction. Management consisted of transurethral urinary catheter insertion, which resulted in complete resolution of the bowel obstruction with drainage of a large amount of urine. Early recognition of the underlying etiology resulted in the expeditious treatment of large bowel obstruction. Keywords: Large bowel obstruction, Urinary retention, Bladder distention, Benign prostate hyperplasia

Carbon fiber (CF) reinforced polyether ether ketone (PEEK) laminates are applied to the members of transportation structures exposed to severe conditions, because carbon fibers and PEEK have excellent heat-resistant and chemical stability. Therefore, it is important to ensure the long-term reliability of CF/PEEK laminates and evaluate the propagation of transverse cracks, which are generally the initial damage incurred by multidirectional laminates under fatigue loading. This study evaluated the detailed mechanism of transverse crack propagation toward the thickness direction in CF/PEEK quasi-isotropic laminates under fatigue loading. The transverse crack growth was observed using the replica method, and the energy release rate associated with the transverse crack propagation toward the thickness direction was calculated using a three-dimensional virtual crack closure-integral method. Thus, it was found that the transverse crack propagated in a stable manner until it passed through the 90° layer toward the thickness direction. Additionally, it was found that the crack growth rate increased in the range wherein the crack length was short, and maintained an approximately constant growth rate in the middle stage of propagation. According to Paris’ law, when the crack depth was relatively shallow, the experimental results are approximately consistent with the analytical evaluation results for the energy release rate associated with the transverse crack propagation toward the thickness direction. Finally, it is also concluded that the high ductility of the PEEK resin and good fiber/matrix interfacial property of the CF/PEEK laminates are important influencing factors for the stable and characteristic crack propagation observed in the experiment.

Objectives: Zinc, vitamin B12 (VB12) and folate have important roles in haematopoiesis. We assessed deficiencies in zinc, VB12 and folate levels in patients with primary haematological malignancy before the administration of cancer chemotherapy. Methods: We retrospectively reviewed serum levels of zinc, VB12 and folate in 37 patients with haematological malignancy. Results: Of the 37 study patients, 27 had been diagnosed with malignant lymphoma, 8 with leukaemia and 2 with multiple myeloma. The percentages of patients with sufficient, low and deficient levels of zinc were 18.9%, 59.5% and 21.6%, respectively. VB12 levels were sufficient for more than 80.0% of patients. The percentages of patients with sufficient, low and deficient levels of folate were 51.4%, 43.2% and 5.4%, respectively. Conclusions: Zinc and folate levels tended to be deficient in patients with haematological malignancy.

Background: To avoid lateral misplacement of midcervical pedicle screws, we developed a method for Minimally Invasive Cervical Pedicle Screw (MICEPS) fixation via a posterolateral approach. This intramuscular approach allows for horizontal pedicle screw insertion and reduced intraoperative bleeding. We reviewed our initial experience with MICEPS fixation for patients with cervical metastases. Methods: This study included 18 consecutive patients who received cervical spinal surgery for metastatic tumor. We treated 12 patients with conventional cervical pedicle screw fixation, and 6 patients with the MICEPS fixation technique. Average follow-up was 14 months (range 3 to 34). We inserted 117 pedicle screws using the navigation system. Average fusion area was 4.9 vertebrae (range 3 to 8). Alpha-angles between a line perpendicular to the posterior cortex of the vertebral body and the screw trajectory in the transverse plane were also measured. Results: The average surgical time was 250 min (range 151 to 420 min) with the conventional pedicle screw fixation and 234 min (range 154 to 300 min) with the MICEPS fixation. The average total blood loss was 780 mL (range, 180-1430 mL) in the conventional pedicle screw fixation group and 180 mL (range, 70-400 mL) in the MICEPS fixation group. At the level of midcervical (C3-5), average alpha-angles was 52 degrees (range 43 to 62) in MICEPS fixation group, and 39 degrees (range 19 to 55) in conventional cervical pedicle screw group. Conclusions: The MICEPS fixation technique uses an intramuscular approach, which is minimally invasive and reduces intraoperative bleeding. Intramuscular approach allows for horizontal pedicle screw insertion, and reduced critical screw deviation.

Objectives. This study investigated the relationship between the timing of ventricular tachycardia or ventricular fibrillation (VT or VF) and prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Background. It is unknown whether the timing of VT/VF occurrence affects the prognosis of patients with AMI. Methods. From January 2004 to December 2014, 1004 patients with AMI underwent primary PCI. Of these patients, 888 did not have VT/VF (non-VT/VF group) and 116 had sustained VT/VF during prehospitalization or hospitalization. Patients with VT/VF were divided into two groups: early VT/VF (VT/VF occurrence before and within 2 days of admission, 92 patients) and late VT/VF (VT/VF occurrence >2 days after admission; 24 patients) groups. Results. The frequency of VT/VF occurrence was high between the day of admission and the 2nd day and between days 6 and 10 of hospitalization. The late VT/VF group had a significantly longer onset-to-balloon time, lower ejection fraction, poorer renal function, and higher creatine phosphokinase (CK)-MB level on admission (p< 0.001). They also had a lower 30-day cardiac survival rate than the early VT/VF and non-VT/VF groups (42% vs. 76% vs. 96%, p < 0.001). Moreover, independent predictors of in-hospital cardiac mortality among patients with AMI who had sustained VT/VF were higher peak CK-MB [Odds ratio (OR: 1.001, 95%confidence interval (CI): 1.000-1.002, p= 0.03)], higher Killip class (OR: 1.484, 95%CI 1.017-2.165, p= 0.04), and late VT/VF (OR: 3.436, 95%CI 1.115-10.59, p= 0.03). Conclusions. The timing of VT/VF occurrences had a bimodal peak. Although late VT/VF occurrence after primary PCI was less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis.

Object extraction has a crucial role in various visual semantic scenarios. In this paper, we propose a system for object extraction which can deal with an object partly occluded by other objects. In order to estimate the hidden part of the occluded object, the system combines different types of contour completion methods such as curve completion and symmetry completion. The system is composed of two modules: contour discrimination and contour completion. The contour discrimination module separates the contour of the occluded object from the contours of the occluding objects. To the contour of the occluded object, the contour completion module applies different types of contour completion algorithms to generate various completion patterns. Based on the perceptual model of figural goodness, the system computes the figural goodness scores of the generated patterns, where the simplicity and symmetricity are evaluated. Finally, the system outputs the pattern having the highest score as a result of the object extraction. From the experimental results, we have confirmed that the figural goodness model works effectively for extracting partly occluded objects.

While many interfaces for gaze writing (text entry by eye gaze) are available today, these interfaces are just a replacement of a keyboard. For more efficient gaze writing, this paper proposes a novel gaze writing system which has two kinds of gaze writing interfaces: (1) an interface for text entry and (2) an interface for text copy and paste. The interface for text entry was selected from conventional interfaces based on experiments of workload evaluation of beginner users. The interface for text copy and paste, which is newly developed in our study, enables a user to specify a text range and paste the text to a desired position with only gaze interaction. To overcome the lack of accuracy of gaze pointing, the proposed system adopts the model of two step cursor control, which processes initial cursor setting and adjustment in turn. The experimental results have shown that the proposed interface makes gaze writing more efficiently.

This study extended a bar-wave calibration method for acoustic emission (AE) sensors. It combined laser interferometer displacement measurements and the wave propagation medium of a long bar, excited at its end with an ultrasonic transducer driven by a pulser. Receiving bar-wave sensitivities of 16 types of AE sensors were measured and compared to their receiving sensitivities to normally incident waves. The two types of the receiving sensitivity always differed for a given AE sensor. The bar-wave sensitivities of R6a sensors resembled their surface-wave sensitivities, indicating that the bar-wave sensitivities can represent the surface-wave sensitivities in typical AE applications. Some bar-wave modes were identified by comparing peaks found on observed Choi-Williams transform spectrograms with the positions on the dispersion curves for bar waves, calculated with the SAFE procedure. However, numerous bar-wave modes prevented exact identification, especially above 500 kHz. Aperture effects contributed to the sensitivity reduction at higher frequencies and to more fluctuating bar-wave receiving sensitivities even for sensors with smooth or flat receiving sensitivities to normally incident waves. Spectral dips observed in bar-wave results can be accounted for by aperture effect predictions reasonably well. For the selection of AE sensors, one needs to use the appropriate type of sensitivities considering waves to be detected.

Induced pluripotent stem (iPS) cells are a type of undifferentiated cell that can be obtained from differentiated cells and have the pluripotent potential to differentiate into the musculoskeletal system, the myocardium, vascular endothelial cells, neurons, and hepatocytes. We therefore cultured mouse iPS cells in a DMEM containing 15% FBS, 10 −7 M dexamethasone, 10 mM β-glycerophosphate, and 50 μg/ml ascorbic acid for 3 weeks, in order to induce bone differentiation, and studied the expression of the bone differentiation markers Runx2 and osteocalcin using RT-PCR in a time-dependent manner. Osteocalcin, a bone differentiation marker in bone formation, exhibited the highest expression in the third week. In addition, the deposition of calcium nodules was observed using Alizarin red S staining. iPS cells cultured for bone differentiation were transplanted into severe combined immunodeficiency (SCID) mice, and the osteogenic potential exhibited after 4 weeks was studied. When bone differentiation-induced iPS cells were transplanted into SCID mice, bone formation was confirmed in soft X-ray images and tissue specimens. However, teratoma formation was confirmed in 20% of the transplanted models. When mouse iPS cells were treated with irradiation of 2 Gray (Gy) prior to transplantation, teratoma formation was inhibited. When mouse iPS cells treated in a likewise manner were xenotransplanted into rats, bone formation was confirmed but teratoma formation was not observed. It is believed that irradiation before transplantation is an effective way to inhibit teratoma formation.

Worldwide, colorectal cancer is the third most common type of cancer affecting both sexes. It has been proposed that a small subset of cancer cells (cancer stem cells) within each tumor is able to initiate tumor growth. In 2007, two research groups simultaneously identified a colon cancer stem cell population in human tumors by the use of CD133 expression. In the present study, we used a human colon cancer cell line, SW620, to analyze the cancer stem cell-like characteristics of CD133 + cells in vitro and in vivo. In vitro, CD133 + SW620 cells had a higher proliferative capacity, were more irradiation- and chemotherapy-resistant, and had a higher expression of β-catenin compared with CD133 - cells. Injections of either CD133 + or CD133 - cells into the skin or rectal mucosa of NOD/SCID mice led to tumors; however, injection of CD133 + cells resulted in the formation of larger tumors. Tumors derived from injections of CD133 - cells did not contain any CD133 + cells, whereas tumors derived from injections of CD133 + cells did contain CD133 + cells, suggesting self-renewing capability. However, the proportion of CD133 + cells in the newly formed tumors in vivo was lower than the proportion of CD133 + cells in vitro. In conclusion, the human colon cancer cell line, SW620, contains both CD133 + and CD133 - phenotypes, and the CD133 + phenotype has characteristics consistent with those of cancer stem cells.

It has been proposed in human colorectal cancers (CRC) a minority subset of cancer cells within tumors able to initiate tumor growth, defined as cancer stem cells (CSC). Solid human primary colonic and its ovarian metastatic cancer tissues were collected from fresh surgical samples and subsequent xenografts were established in nonobese diabetic/severe combined immunodeficient (NOD/SCID) mice. The resulting tumors were disaggregated into single-cell suspensions and a CD133 - cell line (NANK) was newly established and analyzed by flow cytometry. Surface markers of progenitor cells were immunophenotypically analyzed, and expression of stem cell and cancer-related genes was characterized. Secreted angiogenesis-associated molecules were investigated by proteomic array technology. Finally, different numbers of NANK were implanted and their tumor-initiating properties were investigated in NOD/SCID mice. Intraperitoneal injection of NANK in NOD/SCID mice induced tumors with developing progressive peritoneal dissemination and ascites. NANK cells maintained a differentiated phenotype and reproduced the full morphologic and phenotypic heterogeneity of their parental lesions. Noticeably, NANK lacked the expression of conventional CSC markers CD133 and CD44, self-renewal genes Oct-4 and Nanog, but showed the expression of an important gastrointestinal development marker CDX-2 and BMI-1 that is essential in regulating the proliferative activity of normal and leukemic stem cells. In addition, NANK secreted high amounts of important angiogeneic cytokines. These results provide a novel and extensive model in human CSC for studying the generation and maintenance of phenotypic heterogeneity in CRC.