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Optical enhancement cavities enabling laser pulses to be coherently stacked in free space are used in several applications to enhance accessible optical power. In this study, we develop an optical cavity that accumulates harmonically mode-locked laser pulses with a self-resonating mechanism for X-ray sources based on laser-Compton scattering. In particular, a Fabry-Perot cavity composed of 99% reflectance mirrors maintained the optical resonance in a feedback-free fashion for more than half an hour and automatically resumed the accumulation even if the laser oscillation was suspended. In contrast to conventional optical enhancement cavity systems with a dedicated feedback controller, this characteristic is highly beneficial in practical applications, such as for laser-Compton scattering X-ray sources. Lastly, upscaling and adoption of the proposed system might improve the operability and equipment use of laser Compton-scattering X-ray sources.

Objective Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC. Methods Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into 2 groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups. Results Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 versus 182.5 min; P = 0.026), lower blood loss (14 versus 105 mL; P < 0.001), and shorter period to the first flatus passage (2 versus 3 days; P < 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the 2 groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathologic findings revealed that the laparoscopic group had a smaller tumor size (not pathologic T category) and fewer metastatic lymph nodes than the open group, leading to an earlier distribution of the pathologic stage in the laparoscopic group. Conclusions LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.

Gamma–gamma colliders based on backward Compton scattering have been discussed mainly as an option for high energy electron–positron linear colliders, aiming to play a complementary role in energy frontier physics. The flexibility of gamma-ray beam by the Compton scheme, however, allows us to apply them to physics in a wide energy range, from MeV to TeV. In this paper, we review the future prospects of gamma–gamma colliders including recent discussions about Higgs boson factories and mid- and low-energy colliders as well as the option for electron–positron linear colliders.

Deep space exploration by humans has become more realistic, with planned returns to the Moon, travel to Mars, and beyond. Space radiation with a low dose rate would be a constant risk for space travelers. The combined effects of space radiation and partial gravity such as on the Moon and Mars are unknown. The difficulty for such research is that there are no good simulating systems on the ground to investigate these combined effects. To address this knowledge gap, we developed the Simulator of the environments on the Moon and Mars with Neutron irradiation and Gravity change (SwiNG) for in vitro experiments using disposable closed cell culture chambers. The device simulates partial gravity using a centrifuge in a three-dimensional clinostat. Six samples are exposed at once to neutrons at a low dose rate (1 mGy/day) using Californium-252 in the center of the centrifuge. The system is compact including two SwiNG devices in the incubator, one with and one without radiation source, with a cooling function. This simulator is highly convenient for ground-based biological experiments because of limited access to spaceflight experiments. SwiNG can contribute significantly to research on the combined effects of space radiation and partial gravity.

BackgroundComplete gastrectomy for gastric stump cancer can be challenging due to severe adhesions; therefore, advanced techniques are required to perform laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy for the treatment of gastric stump cancer.MethodsPatient records from January 2010 to October 2018 were retrospectively evaluated. The patients were divided into two groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data; survival rates; and prognosis between the groups.ResultsTwenty open and 17 laparoscopic completion total gastrectomies were performed. No significant differences in the distribution of the clinical T and N categories, clinical stage, and reconstruction methods of the initial gastrectomy between the two groups were observed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 vs. 182.5 min; p = 0.026), lower blood loss (14 vs. 105 mL; p = 0.0000179), and shorter period to the first flatus passage (2 vs. 3 days; p = 0.0000401) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the two groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathological findings revealed that the laparoscopic group had a smaller tumor size (not pathological T category) and less metastatic lymph nodes than the open group; this led to an earlier distribution of the pathological stage and better overall or disease-free survivals in the laparoscopic group.ConclusionsLaparoscopic completion total gastrectomy was safely conducted without complications and mortality implicating the oncological validity for the treatment of gastric stump cancer. With sophistication of laparoscopic skills and advanced technologies, laparoscopic completion total gastrectomy may be the best way to perform less invasive surgery in terms of decreased blood loss and earlier recovery of intestinal peristalsis.

The association between insulin resistance and lipid dysmetabolism after consuming a meal is unclear. We aimed at assessing the effects of ezetimibe on postprandial hyperlipidemia and hyperinsulinemia and to find out whether the medication improves endothelial function in obese metabolic syndrome (MetS) patients with coronary artery disease (CAD). We obtained oral fat loading test results (4 and 6 h after load) and brachial flow-mediated vasodilation (FMD) measurements before and 24 weeks after ezetimibe treatment initiation from 27 MetS patients with CAD and from 68 control patients with CAD alone. Serum triglyceride (TG) and insulin levels (2 h after the loading dose) were significantly higher in MetS patients than in control patients. The incremental areas under the curve (iAUCs) for these levels decreased significantly after ezetimibe treatment in MetS patients but not in control patients. Treatment with ezetimibe resulted in significant FMD changes in MetS patients (from 3.4 to 4.9%, P = 0.002), but not in control patients (from 5.1 to 5.4%, P = 0.216). When MetS patients were divided into two groups based on the median insulin iAUC reduction rate (higher group ≥ 34%, n = 14; lower group

OBJECTIVE This multicenter cooperative study aimed to analyze the adverse events (AEs) associated with tyrosine kinase inhibitors (TKIs) used as initial treatment for chronic-phase chronic myeloid leukemia (CML-CP) and their impact on outcome. METHODS We retrospectively evaluated 450 patients with CML-CP who received TKIs between 2004 and 2014. RESULTS The 5-year overall survival (OS) and event-free survival (EFS) rates were 95.1% and 89.0%, respectively. Patients with comorbidities (46.4%) and aged ≥60 years (50.4%) at diagnosis had significantly inferior OS to those without comorbidities and aged

Highlights • The subvesical bile ducts are important from the potential risk for bile leakage. • It is difficult to identify the subvesical bile ducts intraoperatively. • Fluorescent cholangiography visualized the subvesical bile ducts clearly., Introduction The subvesical bile ducts are located in the peri-hepatic connective tissue of the gallbladder fossa. Injury of the subvesical bile ducts provokes the severe complication of bile leak. Until now, fluorescent cholangiography has been employed during hepatobiliary surgery. Herein, we report the detection of subvesical bile ducts by fluorescent cholangiography during laparoscopic cholecystectomy. Presentation of case A 63-year-old female was admitted to our department for surgery for symptomatic cholelithiasis. The subvesical bile ducts were not observed on drip-infusion cholangiography with computed tomography. Immediately following induction of anesthesia, 2.5 mg of indocyanine green was intravenously injected. Fluorescent cholangiography demonstrated two thin aberrant bile ducts during dissection of Calot’s triangle. We considered them to be subvesical bile ducts. We ligated them with clips, divided them, and then performed laparoscopic cholecystectomy using a standard procedure. The patient had a good post-operative recovery without bile leakage. Postoperative laboratory test results were all within normal limits. Computed tomography revealed no dilatation of the intrahepatic bile duct after laparoscopic cholecystectomy. The patient was discharged on postoperative day 4. Discussion Injury to the subvesical bile ducts is one of the most common causes of bile leakage associated with cholecystectomy. Fluorescent cholangiography enabled real-time identification of the thin subvesical bile ducts, which were undetectable by drip-infusion cholangiography with computed tomography. Conclusion Fluorescent cholangiography during laparoscopic cholecystectomy may be useful for preventing postoperative bile leakage.

The increasing eutrophication of freshwater and brackish habitats globally has led to a corresponding increase in the occurrence of harmful cyanobacterial blooms. Cyanobacteria can produce highly toxic substances such as microcystins (MCs) that affect the health of livestock, wildlife, and humans. The present study broaden the understanding of cyanobacteria ecology and MC dynamics in the field, focusing on the estimation of the production and sedimentation rates of MCs in a natural habitat. The nutrient concentrations of the reservoir water and sediment pore water were monitored at 3-h intervals for 24 h during the summer cyanobacterial bloom. The DIN uptake rate of Microcystis in the Isahaya reservoir was estimated and the large-scale blooms in the reservoir were largely controlled by the interactions between rainfall and nutrient levels in the warm season. By using calculations based on the nitrogen budgets and tracking changes of the MC concentrations in the water column, the total MC production and sedimentation rates were estimated to be 52.2 kg MCs d−1 and 21.5 kg MCs d−1, respectively. Although MCs could be degraded in the environment, the MC sedimentation still comprised 41% of the in-water production.

Freshwater cyanobacteria produce toxic microcystins (MCs), which travel from freshwater areas into the sea. The MCs produced by cyanobacteria in a freshwater reservoir were discharged frequently into the adjacent Isahaya Bay, remained in the surface sediments, and then accumulated in various macrobenthic animals on the seafloor. The MCs were transported further outside of Isahaya Bay (Ariake Bay), and the median values of the MC contents in the sediments were in the same levels in both bays, while their temporal variations were also similar during the study period. Therefore, the fluctuations of the MC contents in the surface sediments were physically controlled by the timing of the discharge from the reservoir. The MC contents in polychaetes and oysters collected in Isahaya Bay increased markedly during winter. The median values of the carbon-based MC contents in the sediments, primary consumers, and secondary consumers in the bay were 87, 160, and 250 ngMC gC-1, respectively. These results demonstrated bio-accumulation at lower trophic levels in benthic marine ecosystems. An understanding of the processes occurring between sediments and macrobenthic animals is important for clarifying MC dynamics in ecosystems.

An efficient method for the direct introduction of alkoxy groups into the β-position of alkene moieties of various α,β-unsaturated carbonyl compounds through the palladium-catalyzed C(sp2)–H monoalkoxylation using alcohols in the presence of sodium nitrite was developed; the corresponding enol ethers were selectively synthesized with minimal generation of acetals.

Aim This study investigated whether the characteristic changes in hippocampal atrophy seen in coronal scans are useful for differentiating Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), and major depressive disorder (MDD). Methods Subjects included 58 patients with AD, 33 with aMCI, 20 with MDD, and 22 normal controls, all aged 60 years or older. For each subject, eight coronal short TI inversion recovery images perpendicular to the hippocampal longitudinal axis were obtained. Images were manually measured using the conventional region of interest method of quantitative analysis. Results The overall trend in the corrected volumes of the hippocampus was AD < aMCI < MDD < normal controls. We found atrophy in all slices in AD, atrophy centred on the hippocampal head in aMCI, and atrophy in the slice of the hippocampal body 12 mm from the amygdala in MDD. Conclusions The present study suggested that our method of comparing hippocampal atrophy by region may be useful in distinguishing AD, aMCI, MDD, and normal controls.

A 64 year-old woman with steroid-dependent immune thrombocytopenia developed anemia. Esophagogastroduodenoscopy revealed the presence of a tumor, which was diagnosed to be diffuse large B-cell lymphoma, in the second portion of the duodenum. 18F-fluorodeoxy glucose positron emission tomography showed an increased uptake mass in the pelvic cavity as well as in the duodenum. Though the duodenal tumor disappeared after 4 cycles of chemotherapy, the pelvic mass did not shrink in size. As a result, laparoscopic resection of the pelvic tumor was performed and the tumor was histologically diagnosed to be a gastrointestinal stromal tumor. Subsequently, the patient was treated with 2 more cycles of the chemotherapy. Eventually, thrombocytopenia completely resolved.

We report on two elderly patients with cognitive impairments, for whom chronic carbon monoxide (CO) exposure was suspected based on elevated carboxyhaemoglobin levels in their serum. On their initial visits, cognitive impairment and brain magnetic resonance imaging findings in both patients were compatible with the diagnosis of Alzheimer's-type dementia. However, after discontinuation of the use of a kotatsu, a charcoal-based heater, their serum carboxyhaemoglobin levels normalized and their physical symptoms resolved. Their cognitive function also slightly improved. The causal relationship between physical symptoms and cognitive impairment after chronic CO poisoning is uncertain; however, it is possible that chronic exposure to low CO levels exacerbated the clinical manifestation in our patients.

Both postprandial hyperlipidemia and hyperinsulinemia have been thought to play an important role in the development of atherosclerosis, and to be a potent risk factor for cardiovascular event. To examine effects of glycemic state on postprandial hyperlipidemia and hyperinsulinemia in patients with coronary artery disease (CAD), a total of 112 consecutive male pati ents with angiographically confirmed CAD were loaded with a high-fat and high-glucose test meal. CAD patients were divided into three groups as “non-diabetic”, “prediabetic”, and “diabetic” CAD groups. The serum triglyceride (TG) and remnant-like particle cholesterol (RLP-C) levels at the 6th hour in diabetic CAD group showed significantly higher than non-diabetic CAD group, and the incremental area under the curves (iAUCs) of these levels in diabetic CAD group were significantly greater than non-diabetic CAD group (TG, P = 0.0194; RLP-C, P = 0.0219). There were no significant differences in the iAUCs of TG or RLP-C between prediabetic and non-diabetic CAD group. The AUCs of plasma insulin levels or insulin resistance index (IRI): (AUCs of insulin) × (AUCs of glucose) as the insulin resistance marker were greater in diabetic CAD group than non-diabetic CAD group (insulin, P = 0.0373; IRI, P = 0.0228). The AUCs of serum TG or RLP-C levels showed a correlation with the AUCs of plasma insulin (AUC-TG, r = 0.5437, P

A robust and quantitative gaseous hydrogen generation method has been developed in an effort to achieve efficient H2 generation derived from H2O. The present reaction could be achieved by a simple ball friction (milling) reaction of H2O using a planetary ball mill machine with a stainless-steel vessel and balls. It was mediated by metals as an element of stainless steel of the ball mill and also promoted by mechanochemical processing.

Freshwater cyanobacteria produce highly toxic substances such as microcystins (MCs), and water containing MCs is often discharged to downstream and coastal areas. We conducted field monitoring in Isahaya Bay to clarify the short-term dynamics of MCs discharged from a reservoir following a cyanobacteria bloom in the warm season. MCs were detected in the seawater of the bay (max. 0.10 μg L−1), and were deposited on the sea floor, with the MC content of the surface sediment increasing by approximately five times (0.11 ± 0.077–0.53 ± 0.15 μg kgww−1, mean ± SD) at the four stations near the reservoir drainage gate before and after the discharge. The MCs was then transported from the mouth of the bay by tidal currents during the period of the study. Therefore, the MCs were moved away from the closed water area where the cyanobacteria blooms, and spread throughout the coastal area.

In the inner part of Ariake Bay, located on the west coast of Kyushu, in western Japan, red tides have occurred with more frequency since the second half of the 1990s. Hypoxic waters have occurred during the summer months since the 2000s, despite the fact that nutrient loading from the land to the bay has not increased over the last five decades. We monitored water conditions at nine stations in the inner part of the bay, conducted benthic environmental surveys, and quantitative samplings of macro-benthic communities at the innermost four stations between 2002 and 2008. Each summer, the water was well-stratified due to the development of a halocline and a thermocline. The DO of the water below the pycnocline fell to hypoxic conditions. At the innermost three stations in the bay, the mud content and organic matter content of the sediment increased significantly, and the carbon stable isotope ratios of the organic matter contained in the sediment ranged between −21.3±0.5‰ and −20.7±0.5‰ of δ13C. These facts indicated that the organic matter was derived photosynthetically from marine phytoplankton. The increase in the mud content of the sediment indicates a deceleration in the tidal current. This may be a key event that induces a series of environmental changes and disturbances, including the stratification of the water, the more frequent occurrence of red tides, the progress of the organic enrichment of the sediment, and the occurrence of hypoxic water during the summer.

Molting of shore crabs (Hemigrapsus sanguineus) parasitized by rhizocephalans (Sacculina senta) was observed in the laboratory, and the growth of the molted crabs was compared with that of unparasitized animals. Molting of the host was obstructed by the infestation, but was still possible. After the release of several broods of larvae, the externa (the external reproductive system of the parasite) detached from the host. Subsequent molting occurred within 40 days in about 80% of the animals, but in the remainder, it was delayed for at most 4 months. Soon after molting, a new externa protruded from the abdomen of every crab. Thus, the life-span of the externa and the molting of the host would seem to be closely connected. In the female, the molt frequency was reduced, but the molt increment of the parasitized crabs was not different from that in the unparasitized ones. In the male, however, both the molt frequency and the molt increment were reduced. Thus, the annual growth of parasitized males and females was about half that of unparasitized crabs.

Since it was recently reported that an antibody for proprotein convertase subtilisin/kexin type 9 (PCSK9) reduces the risk of cardiovascular events in a clinical context, PCSK9 inhibition is thought to be an attractive therapy for dyslipidemia. In the present study, we created a novel small biologic alternative to PCSK9 antibodies called DS-9001a, comprising an albumin binding domain fused to an artificial lipocalin mutein (ABD-fused Anticalin protein), which can be produced by a microbial production system. DS-9001a strongly interfered with PCSK9 binding to low-density-lipoprotein receptor (LDL-R) and PCSK9-mediated degradation of LDL-R. In cynomolgus monkeys, single DS-9001a administration significantly reduced the serum LDL-C level up to 21 days (62.4% reduction at the maximum). Moreover, DS-9001a reduced plasma non-high-density-lipoprotein cholesterol and oxidized LDL levels, and their further reductions were observed when atorvastatin and DS-9001a were administered in combination in human cholesteryl ester transfer protein/ApoB double transgenic mice. Additionally, their reductions on the combination of atorvastatin and DS-9001a were more pronounced than those on the combination of atorvastatin and anacetrapib. Besides its favorable pharmacologic profile, DS-9001a has a lower molecular weight (about 22 kDa), yielding a high stoichiometric drug concentration that might result in a smaller administration volume than that in existing antibody therapy. Since bacterial production systems are viewed as more suited to mass production at low cost, DS-9001a may provide a new therapeutic option to treat patients with dyslipidemia. In addition, considering the growing demand for antibody-like drugs, ABD-fused Anticalin proteins could represent a promising new class of small biologic molecules.

We herein report a case of a retroperitoneal tumor of unknown origin that was diagnosed as a seminoma after tumor biopsy and was successfully treated with chemotherapy containing bleomycin, etoposide, and cisplatin(BEP). A 47-year old man visited our hospital with left abdominal pain. An endoscopic examination revealed an ulcer lesion on the third part of the duodenum. Abdominal CT scan revealed a retroperitoneal tumor invading the abdominal aorta with the tumor thrombus in the inferior vena cava(IVC). An endoscopic biopsy could not identify the tumor's origin because of the negative staining of various surface markers on immunohistochemistry. Surgical biopsy of the unresectable retroperitoneal tumor that was finally diagnosed as a seminoma was performed. The patient was treated with BEP according to the International Germ Cell Consensus Classification(IGCCC)for risks, and orchiectomy was performed. He has been alive for 7 months with progressive shrinkage of the retroperitoneal tumor, in which 18F-fluorodeoxyglucose(FDG)positron emission tomography(PET)has shown a dramatic reduction of the maximum standardized uptake value(SUV)during chemotherapy.