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Introduction Intravesical Bacillus Calmette–Guérin immunotherapy is an effective treatment for non‐muscle‐invasive bladder cancer, which is occasionally associated with side effects and complications. The incidence of significant renal complications after intravesical Bacillus Calmette–Guérin immunotherapy is less than 2%. We report a case of renal granuloma after intravesical Bacillus Calmette–Guérin immunotherapy for bladder cancer, which radiologically resembled a papillary renal cell carcinoma. Case presentation A 65‐year‐old man, who had a medical history of urothelial carcinoma and received intravesical Bacillus Calmette–Guérin therapy, was referred to our Urology Department with a right renal tumor. Imaging findings suggested papillary renal cell carcinoma. Robot‐assisted partial nephrectomy was performed, and the histopathological examination revealed epithelioid cell granuloma, which were considered to be Bacillus Calmette–Guérin‐related renal granuloma. Conclusion Bacillus Calmette–Guérin‐related renal granuloma mimicking papillary renal cell carcinoma have been reported. We should consider the possibility of renal granulomas when encountering image abnormalities for patients treated with intravesical Bacillus Calmette–Guérin therapy.

Abstract The carbon to nitrogen (CN) ratio of phytoplankton connects the carbon and nitrogen cycles in the ocean. Any variation in this ratio under climate change will alter the amount of carbon fixed by photosynthesis, and ultimately the amount sequestered in the ocean. However, a consistent mechanistic explanation remains lacking for observed species‐specific variations in phytoplankton CN ratios. We show that acclimation to ambient environmental conditions explains the observed variation of phytoplankton CN ratios by incorporating phytoplankton acclimation theory based on a resource allocation trade‐off between carbon vs. nitrogen acquisition capacity into a three‐dimensional marine ecosystem model. Inter‐specific differences in CN ratio and its sensitivity are caused by inter‐specific differences in Droop's minimum nitrogen cell quota. Our model, constrained by observed phytoplankton parameters, shows that the global mean phytoplankton CN ratio is greater than the canonical Redfield ratio, as suggested previously based on regional in situ observations.

Primary pleural angiosarcoma (PPA) is a rare and clinically fatal pleural tumor originating from vascular endothelial cells. Herein, we presented the case of a 73-year-old man who was referred to our emergency room with complaints of right chest and back pain for a few days. Chest computed tomography revealed massive pleural effusion and a large mass in the right chest cavity. Thoracoscopic examination demonstrated a large hemorrhagic tumor on the parietal pleura whose pathological analysis indicated PPA. The patient received immunotherapy combined with nivolumab and ipilimumab. A cycle of nivolumab and ipilimumab improved his hemorrhagic anemia and reduced the pleural effusion and tumor size. This treatment outcome suggests that nivolumab and ipilimumab comprise a vital treatment option for PPA.

Abstract Bystander cardiopulmonary resuscitation (BCPR), early defibrillation and timely treatment by emergency medical services (EMS) can double the chance of survival from out-of-hospital sudden cardiac arrest (OHCA). We investigated the effect of the COVID-19 pandemic on the pre-hospital chain of survival. We searched five bibliographical databases for articles that compared prehospital OHCA care processes during and before the COVID-19 pandemic. Random effects meta-analyses were conducted, and meta-regression with mixed-effect models and subgroup analyses were conducted where appropriate. The search yielded 966 articles; 20 articles were included in our analysis. OHCA at home was more common during the pandemic (OR 1.38, 95% CI 1.11–1.71, p = 0.0069). BCPR did not differ during and before the COVID-19 pandemic (OR 0.94, 95% CI 0.80–1.11, p = 0.4631), although bystander defibrillation was significantly lower during the COVID-19 pandemic (OR 0.65, 95% CI 0.48–0.88, p = 0.0107). EMS call-to-arrival time was significantly higher during the COVID-19 pandemic (SMD 0.27, 95% CI 0.13–0.40, p = 0.0006). Resuscitation duration did not differ significantly between pandemic and pre-pandemic timeframes. The COVID-19 pandemic significantly affected prehospital processes for OHCA. These findings may inform future interventions, particularly to consider interventions to increase BCPR and improve the pre-hospital chain of survival.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has significantly influenced epidemiology, yet its impact on out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to evaluate the impact of the pandemic on the incidence and case fatality rate (CFR) of OHCA. We also evaluated the impact on intermediate outcomes and clinical characteristics. Methods PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library databases were searched from inception to May 3, 2021. Studies were included if they compared OHCA processes and outcomes between the pandemic and historical control time periods. Meta-analyses were performed for primary outcomes [annual incidence, mortality, and case fatality rate (CFR)], secondary outcomes [field termination of resuscitation (TOR), return of spontaneous circulation (ROSC), survival to hospital admission, and survival to hospital discharge], and clinical characteristics (shockable rhythm and etiologies). This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021253879). Results The COVID-19 pandemic was associated with a 39.5% increase in pooled annual OHCA incidence (p

The northeastern coast of Japan suffered a massive tsunami in 2011, a natural disaster which ‘reset’ the coastal ecosystem when it destroyed much of the original sealife and scoured the seabed. This has presented an opportunity to learn more about the load on coastal ecosystems exerted by human exploitation such as aquaculture rafts and areas of anchored and float-suspended ropes. We surveyed the coastal environment in Matsushima Bay for approximately four years following the year after the occurrence of the 2011 tsunami. Phytoplankton abundance increased with increasing water temperature. Nutrient concentrations were high at the exit of a small branch of the Ofuna-iri Canal (entering the southwestern inner part of the bay at Shiogama) but no significant differences in nutrient concentrations were observed at other stations, so it is considered that the aquaculture installations in Matsushima Bay currently have no significant effect on observed nutrient concentrations. The composition of eukaryotes in the surface seawater varied with the year and the season, but there were no clear differences between sampling stations. The lack of any differences in nutrient concentrations or eukaryote assemblages between areas with or without aquaculture installations is considered to be a result of efficient seawater exchange, despite the presence of many small islets separating Matsushima Bay from the open ocean. In addition, the aquaculture installations at present number less than half of the maximum number before the tsunami, so the bay is by no means overexploited by aquaculture. It is concluded that the current aquaculture installations have no major negative impact on the environment in Matsushima Bay.

Mucoepidermoid carcinoma (MEC) of the lung is an extremely rare tumor, and a standard chemotherapy has not been established. Furthermore, little work has been conducted on the genetic characteristics of MEC. We herein report the case of a 42-year-old nonsmoking male patient who was referred to our hospital due to cough. Chest computed tomography demonstrated infiltration and atelectasis in the right lower lobe. He was eventually diagnosed with non-small cell lung cancer (NSCLC) with MEC differentiation corresponding to clinical stage IVA (cT4N2M1a[PLE]). Genetic testing for EGFR mutations was negative, but positive for anaplastic lymphoma kinase (ALK) fusion gene. After 2 weeks of first-line treatment with alectinib, the tumor decreased in size and his symptoms improved. Advanced MEC is a rare tumor, and reports on the treatment of ALK-positive NSCLC with MEC differentiation are rare.

Objectives: Postoperative atrial fibrillation (POAF) is a common problem of cardiac surgery. Beta-blockers are recognized as effective prophylactic agents available for POAF management. To better understand its effect on isolated atrial fibrillation after cardiac surgery, a meta-analysis was conducted. Methods: Randomized controlled trials (RCTs) were searched and filtered by comparing the efficacy of beta-blockers and control users in isolated POAF for cardiac surgery. Seventeen RCTs were identified and analyzed by typical meta-analysis methods. The search was performed from inception to May 31, 2020. Subgroup analyses were conducted for type of surgery and beta-blocker, starting time and route of administration of beta-blocker, and dosage of intravenous landiolol hydrochloride. Results: Beta-blockers were effective in reducing isolated POAF risk (risk ratio [RR], 0.52 [0.41, 0.66], P = .31, I2 = 12%). In subgroup analyses, beta-blocker administration during postoperative period (RR, 0.43 [0.29, 0.62], P = .84, I2 = 0%) and on-pump coronary artery bypass graft (RR, 0.34 [0.04, 3.15], P = .56, I2 = 0%) had lowest risk of isolated POAF incidence. Intravenous landiolol hydrochloride at 2 μg/kg/min also had low risk of isolated POAF occurrence. Conclusions: Beta-blocker treatment helps to reduce isolated atrial fibrillation incidence after cardiac surgery. Our subgroup analyses also reveal postoperative beta-blocker administration after on-pump coronary artery bypass graft surgery is most effective in reducing isolated POAF risk. Intravenous landiolol hydrochloride at a dosage of 2 μg/kg/min has also displayed favorable results. Further trials may be required to explore these factors.

A 58-year-old woman with cough and dyspnea who was suspected of having idiopathic interstitial pneumonia had been treated with corticosteroids and cyclosporine, but the symptoms had worsened. There were no findings to suspect pulmonary alveolar proteinosis (PAP) in the bronchoalveolar lavage fluid, 17 months after the start of treatment. The transbronchial lung biopsy specimens showed eosinophilic bodies that strongly stained with periodic acid-Schiff staining. Anti-granulocyte macrophage colony-stimulating factor (anti-GM-CSF) antibodies were detected in her serum. We diagnosed the patient with autoimmune PAP. Thus, we present a rare case of PAP presenting atypical radiological images and bronchoalveolar lavage fluid findings.

The reproduction and early growth of fish are essential elements that affect recruitment and provide breakthrough points for understanding population fluctuations. In this study, larval and juvenile Japanese anchovy (Engraulis japonicus) were collected from five coastal waters off the Pacific coast of Japan in 2020 and 2021 to gain more insight into life history traits such as reproduction and early growth of this species on the basis of otolith microstructure analysis. The spawning period appeared to be related to temperature and chlorophyll-a concentrations, showing latitudinal gradient variation among fishing areas. We detected a significant positive allometric growth pattern between standard length and body weight. The Gompertz model best fits the growth of standard length, showing an initial stage of growth that was quick and accelerating. The mean daily growth rate for standard length was 0.64 ± 0.09 mm per day. A series of mixed-effect models was constructed to investigate the sources of differences in the mean growth rates among individuals. The results revealed regional variability in fish growth, with individuals in the central Pacific stock growing faster. Individuals that grew slower were heavier than those of the same length, indicating a trade-off between length growth and weight growth. The mean growth of individual fish was positively influenced by environmental factors (surface water temperature and chlorophyll-a concentration), and individuals within the same school of fish displayed a striking homogeneity of growth. Our research demonstrates the significance of including both physiological characteristics and environmental influences in early growth studies on fish.

Objective: The aim of this study was to evaluate the effectiveness of a rash team management intervention designed by certified nurses, medical physicians, and certified pharmacists. The quality of life (QOL) of patients administered epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) was assessed using the dermatology life quality index (DLQI) and Skindex-29 QOL questionnaires. Methods: A total of 51 patients with nonsmall cell lung cancer who were treated using EGFR-TKIs were examined between November 1, 2014, and October 31, 2015, at the Institute of Biomedical Research and Innovation in Kobe city, Japan. All the patients were treated daily with erlotinib, gefitinib, or afatinib. The common terminology criteria for adverse events (version 4.0) system were used to grade treatment-induced toxicity events. The multimodality rash management team included nurses, pharmacists, and physicians. The team intervened before the initiation of treatment with EGFR-TKIs and at every visit. Patient QOL characteristics were evaluated using the DLQI and Skindex-29 assessment tools. Results: The number of patients with high-grade toxicity decreased when the multimodal approach was used. No grade 3 skin toxicities were recorded in the postintervention cohort. QOL scores for symptoms and feelings (emotions) were impaired in patients who were treated with EGFR-TKIs. Conclusions: The rash team management approach may be useful for patients treated with EGFR-TKIs. Specific QOL evaluation tools for the assessment of the effects of a team approach for rash management should be developed.

The double-diffusive convection in a porous medium due to the opposing heat and mass fluxes on the vertical walls is solved analytically. In the former analysis, we investigated only when ω < π, the parameter arising from a combination among the density stratification and the buoyancy effects. However, it is shown in the present research that a solution is also possible when ω > π. The Sherwood number Sh is shown to decrease monotonically with an increase in the buoyancy ratio N when ω > π, and Sh approaches 1 when N is 1. We define Nmin as the minimum value of N when Ω is imaginary and ω = π. Nmin increases with an increase in Rc. However, Nmin approaches a constant as Le increases. Furthermore, although the convection pattern is mainly temperature-driven, concentration-driven convection cells also exist under certain.

We report and discuss an experiment and numerical simulation of heat transfer by natural convection inside an autoclave for the solvothermal growth of bulk crystalline GaN. The inner diameter and height of the autoclave were φ 20 and 335 mm, respectively. When the bottom heater of the autoclave is removed and the space between the top and bottom heaters is increased, the crystal growth rate increases. The axisymmetric numerical simulation showed that a rising flow from the center hole in the baffle allows a fast growth rate because the rising fluid is GaN-rich and it reaches the GaN seed crystal quickly. The direction of natural convection can be controlled by changing the vertical position of the heater or baffle.

Numerical simulation of the hydrothermal process for growing two-inch bulk single crystals of ZnO has been done. The autoclave is assumed to be axisymmetric. The heat transfer by natural convection is discussed for flat and funnel-shaped baffles. The funnel-shaped baffle leads to a significant increase in the flow rate between the raw material zone and the crystal growth zone. However, the temperature difference between the two zones does not become very small. Therefore, the funnel-shaped baffle is effective in the hydrothermal crystal growth process from the viewpoint of transport phenomena. The calculations show that the optimum baffle angle about 20°. Similar results are obtained when the raw material is considered as a porous medium.