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The present paper aims to offer a new understanding of the so-called “Zoroastrian Illuminative philosophers in the sixteenth and seventeenth centuries,” namely the Āẕar Kaivān school. In the twentieth century, this school was understood to be a Zoroastrian phenomenon originating from Āẕar Kaivān (1533–1618), who is believed to have been born at Estakhr (Iran) and later to have immigrated to Patna (India). One way to sketch their texts is to notice their contents as the Zoroastrian Illuminative school, as H. Corbin did. But it may be more likely that the first principle for this school is a matter of ancient Persian culture, especially the Āsmānī language. Until recently, we knew little for certain about the origin of this Āsmānī vocabulary, except the inference that it might be the product of Āẕar Kaivān himself. But Sadeghi (2020) shows that the earliest mention of what would become the Āsmānī vocabulary can be confirmed in the Persian dictionary Farhang-e Mo’aiyid al-Fożalāʾ, compiled in India in 1519. The origin of the essential points of the Āẕar Kaivān school is not Āẕar Kaivān himself, but there were probably some pioneers in the Delhi Sultanate in India before him. Adding to this, a closer look at their writings shows that this school is not a monolith, but a complex of various preceding elements. The Illuminative Philosophy is just one of them. As such, it becomes possible to arrive at the conclusion that the Āẕar Kaivān school is not Āẕar Kaivān’s school. He simply put together the various elements that preceded him.

日本原子力研究開発機構では、高温ガス炉による大量かつ安価なカーボンフリー水素製造技術の実用化を目指し、世界最高の原子炉出口冷却材温度950$^{\circ}$Cを記録した高温工学試験研究炉(HTTR)を用いて水素製造を行うHTTR-熱利用試験を計画している。HTTR-熱利用試験では、原子力規制委員会からの設置許可取得を通じて、高温ガス炉と水素製造施設の接続に関し、高い安全性を実現する安全設計を確立することが求められている。しかしながら、これまでに原子炉に水素製造施設を接続した例は世界にまだなく、我が国唯一の高温ガス炉であるHTTRを含め、既存の原子力施設を対象とした安全設計ではこのようなシステムを想定していない。そこで、高温ガス炉研究開発センターの下に設置した「HTTR-熱利用試験専門委員会」では、原子力規制委員会による新規制基準への適合性審査に合格したHTTR安全設計をベースに、施設の変更や水素製造施設の接続に伴い安全設計上新たに考慮すべき事象に対する対策を考慮し、HTTR-熱利用試験施設の安全設計案の検討を行った。本稿は、HTTR-熱利用試験専門委員会の技術報告資料や委員コメントとその回答、議事録を取りまとめた。, Aiming to realize a massive, cost-effective and carbon-free hydrogen production technology utilizing a high temperature gas cooled reactor (HTGR), Japan Atomic Energy Agency (JAEA) is planning a HTTR heat application test producing hydrogen with High Temperature Engineering Test Reactor (HTTR) achieved 950$^{\circ}$C of the highest reactor outlet coolant temperature in the world. In the HTTR heat application test, it is required to establish its safety design realizing highly safe connection of a HTGR and a hydrogen production plant by the Nuclear Regulation Authority to obtain the permission of changes to reactor installation. However, installation of a system connecting the hydrogen production plant and a nuclear reactor, and its safety design has not been conducted so far in conventional nuclear power plant including HTTR in the world. A special committee on the HTTR heat application test, established under the HTGR Research and Development Center, considered a safety design philosophy for the HTTR heat application test based on an authorized safety design of HTTR in terms of conformity to the New Regulatory Requirements taking into account new considerable events as a result of the plant modification and connection of the hydrogen production plant. This report provides materials of the special committee such as technical reports, comments provided from committee members, response from JAEA for the comments and minutes of the committee.

日本原子力研究開発機構では、高温ガス炉による大量かつ安価なカーボンフリー水素製造技術の実用化を目指し、世界最高の原子炉出口冷却材温度950$^{\circ}$Cを達成した高温工学試験研究炉(HTTR)を用いて水素製造を行うHTTR-熱利用試験を計画している。HTTR-熱利用試験では、原子力規制委員会からの設置変更許可取得を通じて、高温ガス炉と水素製造施設の接続に関し、高い安全性を実現する安全設計を確立することが求められている。そこで、HTTR安全設計をベースに、施設の変更や水素製造施設の接続に伴い安全設計上新たに考慮すべき事象に対する対策を考慮し、HTTR-熱利用試験施設の安全設計の考え方を検討した。検討に当たっては、原子炉安全の観点からの十分な安全性を確保することを大前提としつつ、水素製造施設に対して、高圧ガス災害に対する安全確保の多くの実績を有する一般産業法規を適用することを基本方針とした。本報では、水素製造施設への高圧ガス保安法適用に係る合理性や条件、HTTR-熱利用試験施設の安全機能の重要度分類や耐震設計上の重要度分類、重要安全施設の選定、原子炉設置変更許可申請に係る安全設計の考え方に関する検討結果を報告する。, Japan Atomic Energy Agency is planning a High Temperature Engineering Test Reactor (HTTR) heat application test producing hydrogen with the HTTR which achieved the highest reactor outlet coolant temperature of 950$^{\circ}$C in the world to realize a massive, cost-effective and carbon-free hydrogen production technology utilizing a high temperature gas cooled reactor (HTGR). In the HTTR heat application test, it is required to establish its safety design for coupling a hydrogen production plant to HTGR through the licensing by the Nuclear Regulation Authority (NRA). A draft of a safety design philosophy for the HTTR heat application test facility was considered taking into account postulated events due to the plant modification and coupling of the hydrogen production plant based on the HTTR safety design which was authorized through the safety review of the NRA against New Regulatory Requirements. The safety design philosophy was examined to apply proven conventional chemical plant standards to the hydrogen production plant for ensuring public safety against disasters caused by high pressure gases. This report presents a result of a consideration on safety design philosophies regarding the reasonability and condition to apply the High Pressure Gas Safety Act for the hydrogen production plant, safety classifications, seismic design classification, identification of important safety system.

Colorectal neuroendocrine carcinoma（NEC）is extremely rare and has a dismal prognosis. However, no standardized treatment strategy has been established for this lesion. For patients with NEC and distant metastasis, disease stabilization is difficult even after treatment with multidisciplinary strategies including chemotherapy. Here we describe a case of rectal NEC that presented as multiple liver metastases; a favorable prognosis was obtained after treatment with a multidisciplinary strategy that included surgery, irradiation, and chemotherapy. A 66-year-old male presented with diarrhea and constipation. Colonoscopy and a computed tomography（CT）scan revealed a rectal mass involving all of the luminal circumference, after which a diagnosis of NEC was confirmed by pathological examination. A CT scan also revealed several liver metastases in S5, S6, and S8. Abdominoperineal resection with total mesenteric excision and lymphadenectomy, including the lateral area, was performed. After resection, we administered radiation for local disease control in the lateral area. We also administered chemotherapy consisting of cisplatin and irinotecan for the liver metastases because only the endocrine cell component constituted this tumor. After chemotherapy, a CT scan was performed to confirm that the liver metastasis in S5 and S6 had disappeared, and it was shown that the other lesion in S8 had shrunk substantially（it eventually disappeared）. Then, 48 months after resection, all metastatic liver tumors were under good control, and no other recurrent lesion was recognized. In conclusion, a multidisciplinary strategy including optimal chemotherapy seems to be important to achieve a favorable prognosis of NEC of the colorectum with distant metastasis.

The fast-track surgery protocol, including perioperative immunonutritional management, is increasingly gaining attention for the prevention of surgical site infections （SSIs）. To analyze the association between the fast-track surgery protocol employed at a single center and outcomes, including SSIs and the length of hospital stays. This retrospective analysis included 217 patients who underwent hepatectomy at the study department between January 2009 and February 2014. Patients were divided into two groups: those managed by a conventional protocol （group C, n＝75） and those managed by the fast-track surgery protocol （group F, n＝142）. There were no significant differences in patient characteristics or factors between the two groups. However, serum albumin and total cholesterol levels before surgery were significantly higher in group F than in group C, and pre-hepatectomy C-reactive protein （CRP） levels were lower in group F than in group C. Moreover, serum albumin and CRP levels at postoperative day 7 were better in group F than in group C. The operations were longer in group F than in group C （312 vs. 286 min） and blood loss volume was less （385 g in group F vs. 428 g in group C）. SSI rates were significantly lower in group F （4.2％, n＝6） than in group C （13.3％, n＝10）, and the length of hospital stay was significantly shorter in group F （16.7 days） than in group C （25.8 days）. The fast-track surgery protocol as a perioperative management strategy may improve preoperative nutritional status and postoperative inflammation, with subsequent reductions in SSI rates and the length of hospital stay in patients undergoing hepatectomy.

Here we review the prognosis of patients with unsuspected gallbladder carcinoma（GBC）, detected after laparoscopic cholecystectomy（LC）in a single institute. We reviewed the medical records of patients diagnosed with gallbladder stones on admission, who underwent LC. Carcinoma involving the gallbladder was found in 22 of 2,770 patients（0.9％）via postoperative pathological examination. This GBC group spanned 58-87 years of age（mean, 75 years; 13 females and 9 males）. The preoperative diagnosis was gallbladder stones with acute/chronic cholecystitis or adenomyomatosis of the gallbladder in all patients. We performed an additional surgery in 6 of 15 patients with pT2 and T3 disease; of these, 3 patients with pT2 disease and 1 with pT3 experienced bile spillage during the LC. The mean survival of patients with unexpected GBC was 21 months, with bile spillage occurring as a complication of LC identified as a potential risk factor for shorter survival（15.3 vs. 32.5 months）. We identified patients with pT2 and pT3 disease after LC, and two patients with pT2 and 1 with pT3 who had bile spillage during LC died of peritoneal dissemination within 28 months, despite additional surgery. Occasional seeding caused by bile spillage during LC should be carefully avoided to minimize the risk of developing unsuspected GBC after LC.

The most common site of distant metastasis from colorectal cancer is the liver, and hepatectomy presents the best curative treatment for recurrence of colorectal liver metastasis （CRLM）. This study aimed to identify factors of prognostic value for repeat hepatectomy for CRLM and to determine whether a third such procedure could similarly produce favourable outcomes for CRLM. We analyzed data for 161 patients in our department with colorectal metastasis. Of these, 22 patients underwent repeat hepatectomy for recurrent metastasis, with 16 undergoing a second hepatectomy and 6 a third hepatectomy. We analyzed patient characteristics, tumor status, operation-related variables, and short- and long-term outcomes. Univariate analysis for repeat hepatectomy identified the following five prognostic risk factors: T factor （＞SE） of the primary cancer, number of tumors involved in the initial hepatectomy （＞5）, interval from first to second hepatectomy （＜1year）, number of tumors involved in second hepatectomy （＞3）, and post-operation time （＞30days）. By multivariate analysis, T factor （＞SE） of the primary cancer, number of tumors in the initial hepatectomy （＞5）, and number of tumors in the second hepatectomy （＞3） were independently associated with a worse survival after surgery for CRLM. Although surgical outcomes of the third hepatectomy were not compared with those of the first and second hepatectomy, there were no obvious differences, nor did the 1-, 3-, and 5-year survival rates differ significantly among the three groups. Repeat hepatectomy for CRLM could improve long-term survival. In addition, patients undergoing a third hepatectomy showed a similar survival benefit to those having one or two resections.

The impacts of chemical stability of inert-matrix-fuel (IMF) on the material attractiveness for states and non-state actors were evaluated in an open transuranic fuel cycle employing high temperature gas cooled reactors. The methodology for material attractiveness evaluation was developed to assess material attractiveness for states and treat IMF which is chemically inert for nitric acid solution. The material attractiveness was relatively assessed with physical properties of material in each of three discrete phases in the development of a nuclear explosive device. The material attractiveness assessment for non-state actors revealed that the non-irradiated TRISO fuel particle and IMF kernel for high temperature gas cooled reactors and the non-irradiated mixed oxide fuel (MOX) powder for MOX light water reactors were the most vulnerable targets in each fuel cycles. The TRISO fuel particle and IMF kernel would have less material attractiveness than the MOX powder because of their greater processing time and complexity. The material attractiveness assessment for states aiming concealed diversion revealed that the TRISO fuel particle and IMF kernel have less material attractiveness than the MOX powder, and are regarded as irradiated uranium fuel grade in the material attractiveness.

BACKGROUND The main aim of this survey was to analyze how liver surgeons perform liver resections and to define their conception of anatomic procedures within the incorporation of minimally invasive liver surgery (MILS). METHODS The survey was distributed among liver surgeons. It mainly focused on personal experience on open and MILS, methods and landmarks, and experience on anatomic resections and Glissonean approach. RESULTS A total of 445 valid answers from 54 countries was obtained. Surgeons performing MILS mainly have below 10 years of experience (81.8% of responders) and one third has never done complex MILS. New techniques, including indocyanine green demarcation are marginally used (

Additional file 1: Fig. S1. ROC curve for the NLR and tumor size in well-differentiated PanNENs. The ROC curve illustrated that NLR has an AUC of 0.664 (95% CI 0.464–0.864) and tumor size has an AUC of 0.801 (95% CI 0.675–0.945). Arrows indicate optimal cut-off values. Fig. S2. Recurrence-free-survival and overall survival for PanNENs stratified by the 2017 WHO classification. Recurrence-free-survival and overall survival of neuroendocrine carcinoma (NEC) were significantly shorter than those of well-differentiated PanNENs (NET G1-3). Fig. S3. Distribution of NLR in PanNENs stratified by the 2017 WHO classification. The value of NLR in patients with NEC was significantly higher than that in patients with well-differentiated PanNEN.

Data centers (DCs) are becoming increasingly important in recent years, and highly efficient and reliable operation and management of DCs is now required. The generated heat density of the rack and information and communication technology (ICT) equipment is predicted to get higher in the future, so it is crucial to maintain the appropriate temperature environment in the server room where high heat is generated in order to ensure continuous service. It is especially important to predict changes of rack intake temperature in the server room when the computer room air conditioner (CRAC) is shut down, which can cause a rapid rise in temperature. However, it is quite difficult to predict the rack temperature accurately, which in turn makes it difficult to determine the impact on service in advance. In this research, we propose a model that predicts the rack intake temperature after the CRAC is shut down. Specifically, we use machine learning to construct a gradient boosting decision tree model with data from the CRAC, ICT equipment, and rack intake temperature. Experimental results demonstrate that the proposed method has a very high prediction accuracy: the coefficient of determination was 0.90 and the root mean square error (RMSE) was 0.54. Our model makes it possible to evaluate the impact on service and determine if action to maintain the temperature environment is required. We also clarify the effect of explanatory variables and training data of the machine learning on the model accuracy.

Supplemental material, Shinzato_T_Suppl_mat_v04 for Uric acid distribution volume calculated by kinetic modeling and extracellular volume predicted by bioimpedance method by Toru Shinzato, Shigeru Nakai, Takahito Ito, Kazuhiko Shibata, Teppei Matsuoka, Shinya Kato, Takeshi Aoki, Ikuto Masakane, Hiroki Hayashi, Naotake Tsuboi, Midori Hasegawa, Daijo Inaguma, Yukio Yuzawa and Susumu Ookawara in The International Journal of Artificial Organs

Solid pseudopapillary neoplasm (SPN) of the pancreas has generally been regarded as a low-grade malignant tumour that preferentially develops in young women and can have a good prognosis with surgery. Among the few patients who have died from metastatic SPN are mostly those whose tumours harbour an undifferentiated component characterized by diffuse sheets of cells with increased nuclear atypia and proliferative index. We herein report a case of an aggressive, fatal, solid pseudopapillary neoplasm (SPN) of the pancreas in a 63-year-old woman complaining of epigastric pain. Despite having undergone surgical resection for a 10 cm pancreatic mass and multiple liver metastases, the patient later died due to uncontrollable metastases 36 months after the initial surgery. Histological examination showed that the tumour displayed unusual high-grade malignant features, showing diffuse sheets of cells with increased nuclear atypia and proliferative activity, along with conventional low-grade malignant features. The tumour was subsequently recognized as an SPN with foci of high-grade malignant transformation according to the 2010 World Health Organization classification. Immunohistochemical studies revealed that p16-RB pathway alterations contributed to the high-grade malignant transformation. The present case report suggests the necessity for developing diagnostic and treatment methods targeting p16 and RB for high-grade variants of SPN.

Various methods, devices, and techniques have been developed to improve safety during laparoscopic hepatectomy procedures. Among these, the Pringle maneuver （PM） is widely used to minimize blood loss during liver transections; however, the risk of ischemic injury associated with this technique is increased by poor hepatic reserve and regeneration dysfunction secondary to liver cirrhosis. This retrospective study evaluated the short-term outcomes and feasibility of precoagulation for endoscopic hepatectomy without PM in patients with liver cirrhosis. Eleven patients with liver cirrhosis who also underwent endoscopic hepatectomy for hepatocellular carcinoma were recruited to undergo either microwave tissue coagulation or radiofrequency ablation for precoagulation before liver transection. A wedge resection without the PM was performed in all patients, with seven patients selected for bipolar radiofrequency ablation and four patients for microwave coagulation therapy. The procedures included video-assisted thoracoscopic hepatectomy in two patients and laparoscopic hepatectomy in nine patients. One patient who underwent radiofrequency ablation developed postoperative bleeding （Clavien-Dindo grade Ⅲ）. In conclusion, precoagulation can help to minimize intraoperative blood loss without the PM, contributing to effective resection of liver tumors. We propose that precoagulation could serve as a standard technique for endoscopic hepatectomy in patients with cirrhosis.

In Japan, amebiasis is typically found in men who have sex with men and in individuals with recent travel to endemic areas. We experienced a patient with fulminant necrotizing amebic colitis and enterocolitis who presented with a severe disorder of the liver and renal function. The patient was a 71-year-old man who had lived in Yokohama City, Japan for 30 years. His stool sample showed no amebic dysentery protozoa and cultured negatively for human immunodeficiency virus. Despite being treated with meropenem, pyrexia of 39-40°C continued for 4 days. On hospital day 8, a colonic abscess and perforation of the transverse colon were detected by computed tomography（CT）. His fever did not improve, suggesting progression of infectious disease. Subsequent emergency laparotomy revealed a perforation in the middle of the transverse colon. Peritoneal lavage and right hemicolectomy were performed; however, a CT scan on hospital day 16 （postoperative day 8） showed re-perforation of the colon and an abscess around the site of anastomosis, prompting emergency intestinal and left hemicolectomy resection. Amebae observed pathologically during the second emergency operation led to a diagnosis of amebic colitis. Endotoxin adsorption therapy was performed, and metronidazole was administered. Despite prompt diagnosis and treatments, the patient’s general conditions became fulminant, and multiple organ failure developed. On hospital day 18 （postoperative day 10）, his C-reactive protein level was 20mg/dl. He was clinically diagnosed as having sepsis and multiple organ failure. The patient died on hospital day 23. Acute colitis is commonly encountered in daily practice, but it is difficult to differentiate between amebic and non-amebic colitis preoperatively and thus, the possibility of amebic colitis should be considered in such clinical presentations.

Herein we report on an extremely rare case of ulcerative colitis （UC） with onset after chemotherapy and colorectal resection, and discuss three previously reported cases. A 61-year-old man presented with fecal occult blood and no subjective symptoms. The diagnosis was rectal cancer with multiple liver metastases. Following chemotherapy, the patient underwent laparoscopy-assisted super-low anterior resection, liver resection. On Day 35 following closure of the ileostomy, the patient was referred to Totsuka Kyoritsu Dai-1 Hospital because of diarrhea, bloody stools. Colonoscopy and pathological examination revealed UC. To the best of our knowledge, only three cases of UC following colorectal cancer resection have been described previously. In conclusion, when encountering intractable diarrhea after chemotherapy or surgery, UC should be one of the bowel diseases considered, with prompt systemic examination recommended.

Controlling Nutritional Status (CONUT) is an efficient tool for early detection of malnutrition, measured using two biochemical parameters (serum albumin and total cholesterol) and one immune indicator (total lymphocyte count). The aim of this study was to define the efficacy of CONUT for predicting postoperative complications in very elderly patients with colorectal cancer. This study enrolled 52 patients aged 85 years or older with colorectal cancer for whom we were able to measure CONUT before surgery, conducted at the Department of Gastroenterological and General Surgery of Showa University Hospital in Japan between January 2010 and December 2014. The patients were subdivided into those with complications (Group C, n=9) and those with no complications (Group NC, n=43), and then were retrospectively compared for clinical characteristics, CONUT, and surgical outcomes. Multivariate analysis was finally performed to identify the risk factors of complications. The percentage of patients with a CONUT score of 5 or more in Group C was significantly greater than that in Group NC (7 vs. 12 patients, 77.8% vs. 27.9%, P=0.0079). No other significant difference was observed in the clinical characteristics between Group C and Group NC. Multivariate analysis identified CONUT score as the only significant predictor of complications in this patient cohort (odds ratio=1.374; 95% confidence interval, 1.019-1.949; P=0.0366). Our study suggests that CONUT score is predictive of postoperative complications in very elderly patients with colorectal cancer.

As data centers have become increasingly important in recent years their operational management must attain higher efficiency and reliability. Moreover, the power consumption of a data center is extremely large, and it is anticipated that it will continue to increase, so energy saving has become an urgent issue concerning data centers. In the meantime, the environment of the server rooms in data centers has become complicated owing to the introduction of virtualization technology, the installation of high-heat density information and communication technology (ICT) equipment and racks, and the diversification of cooling methods. It is very difficult to manage a server room in the case of such a complicated environment. When energy-saving measures are implemented in a server room with such a complicated environment, it is important to evaluate “temperature risks” in advance and calculate the energy-saving effect after the measures are taken. Under those circumstances, in this study, two prediction models are proposed: a model that predicts the rack intake temperature (so that the temperature risk can be evaluated in support of energy-saving measures implemented in the server room) and a model that evaluates the energy-saving effect (in relation to a baseline). Specifically, the models were constructed by using machine learning. The first constructed model evaluates the temperature risk in a verification room in advance, and it was confirmed that the model can evaluate the risk beforehand with high accuracy. The second constructed model—“baseline model” hereafter—supports energy-saving measures, and it was confirmed that the model can calculate the baseline (energy consumption) with high accuracy as well. Moreover, the effect of proposal process of energy-saving measures in the verification room was verified by using the two proposed models. In particular, the effectiveness of the model for evaluating temperature risk in advance and that of a technology for visualizing the energy-saving effect were confirmed.

Glutathione S-transferase (GST) is a major phase II drug-metabolizing enzyme. Several isoforms of human GST as well as different GST genetic polymorphisms are known, but limited data exists concerning the relationship between GST polymorphisms and GST activity using 1-chloro-2,4-dinitrobenzene in human liver. To resolve this query, we analyzed the genetic polymorphisms of four main GST isoforms [GST mu 1 (GSTM1), GST theta 1 (GSTT1), GST alpha 1 (GSTA1), GST pi 1 (GSTP1)] and measured hepatic GST activity isolated from the same patients. We found that GSTM1 null individuals have significantly lower (P=0.0082) GST activity compared with GSTM1 positive individuals. No significant changes in GST activity were observed in individuals with GSTT1, GSTA1, and GSTP1 genotypes. Interestingly, the levels of GST activity exhibited were similar when compared with GSTA1*A/*A and GSTA1*A/*B, and GSTP1*A/*A and GSTP1*A/*B, respectively, if the genotype was GSTM1 null. Therefore, the genotypes of GSTA1*A/*B and GSTP1*A/*B individuals do not significantly affect the level of hepatic GST activity. An examination of the correlation between GST mRNA expression and GST activity subsequently revealed a significant correlation between GSTM1 mRNA levels and GST activity (r=0.626, P=0.007). These data are expected to facilitate research on the prediction of efficacy and safety of GSTM1 null-mediated drug metabolism and may establish whether genetic polymorphisms of the GST gene, specifically GSTM1, can act as a biomarker.

Compared with the conventional open surgery, thoracoscopic esophagectomy results in decreased thorax destruction, fewer postoperative complications, and shorter hospitalisation. However, preoperative fasting causes hyperglycemia, prompting attempts to improve postoperative hyperglycemia by preoperatively administering carbohydrate orally or intravenously. Herein, we examined the effect of preoperative carbohydrate and amino acid infusion on counter-regulatory hormone levels in patients undergoing elective thoracoscopic esophagectomy. The glucose and amino acid (GA) group (n=12) were infused with a low concentration of sugar accelerant and amino acid, and the control (GAF) group (n=12) was infused with a sugar-free extracellular fluid, until entering the operating room. We evaluated plasma catecholamine 3 fractions, cortisol, and glucose, as well as 3-methylhistidine in the urine. Adrenaline levels were significantly higher in the GAF group (263.0±201.8µIU/ml) than in the GA group (114.7±127.0µIU/ml) at the end of the surgery (P=0.042), and at postoperative day (POD) 1 (200.8±137.4 vs. 80.5±64.3µIU/ml; P=0.013). The noradrenalin level was also significantly higher in the GAF group (517.9±523.6µIU/ml) than in the GA group (254.3±205.4µIU/ml) at POD1 (P=0.028), as was the cortisol level (20.0±10.6µIU/ml vs. 10.2±8.0µIU/ml; P=0.015). No significant differences were observed between the two groups in levels of blood glucose or 3-methylhistidine in the urine. Preoperative glucose-amino acid administration improved catabolism suppression in this study.

Esophagectomy for esophageal cancer is one of the most invasive gastrointestinal surgeries. In 1996, we introduced video-assisted thoracic surgery for esophageal cancer (VATS-E) to reduce surgical stress. In 2010, we started employing artificial pneumothorax (AP) using carbon dioxide gas in VATS-E to further reduce surgical stress. In this study, we evaluated interleukin-6 (IL-6) levels in pleural cavity lavage fluid (PLF) of patients undergoing VATS-E with or without AP, and examined the effect of AP on VATS-E-induced stress. This non-randomized study included patients who underwent VATS-E with or without AP at Showa University Hospital between 2009 and 2013 and from whom PLF could be collected. IL-6 concentrations in PLF were examined before and after the thoracic part of the operation. We compared IL-6 variation, defined as the difference between IL-6 concentrations in PLF before and after the thoracic part of the operation, between patients for whom AP was used and those for whom it was not used. A total of 52 patients were included in the study; 26 underwent VATS-E with AP (group AP), and 26 underwent VATS-E without AP (group NP). IL-6 concentrations in PLF were significantly elevated immediately after the thoracic part of the operation in both groups. IL-6 variation in PLF correlated with both thoracic operative time and blood loss, which were considered practical parameters of surgical stress, and was significantly lower in group AP than in group NP. In conclusion, IL-6 variation in PLF is a useful and sensitive maker of surgical stress during VATS-E. VATS-E with AP is less invasive than VATS-E without AP because AP lowers the perioperative systemic inflammatory response to thoracic surgery.

Maintaining a long transnasal ileus tube for a long period can be quite painful for patients such as in those with refractory intestinal obstruction and peritonitis carcinomatosa and it can markedly decrease quality of life (QOL) due to unexpected respiratory complications associated with the tube placement. To mitigate such complications, we undertook a trial insertion of a long ileus tube by gastrostomy in five patients with refractory intestinal obstruction (four cases of peritonitis carcinomatosa and one case of chronic intestinal pseudo-obstruction). We inserted the transgastric ileus tube using a percutaneous gastrostomy catheter kit after puncture with a plastic skin (PS) needle covered with a protective sheath, and then endoscopically placed the tube beyond the ligament of Treitz. Subsequently, we removed the long transnasal ileus tube, and comparable decompression was achieved. In all cases, the entire procedure was easily performed with no complications. Moreover, patients experienced reduced pain and stress and they were able to regain some freedom during activity.

To evaluate prognostic factors for recurrence after tegafur-uracil plus leucovorin (UFT/LV) adjuvant chemotherapy in patients with colorectal cancer (CRC). Consecutive patients with CRC who received UFT/LV as adjuvant chemotherapy at Showa University Hospital between June 2005 and December 2008 were included in the study, 5-year disease-free survival (DFS) and overall survival (OS) rates were estimated, and prognostic factors for recurrence were analyzed using the Cox proportional hazards model for multivariate analysis. Of 92 patients included in the study, 17 (18.5%) had disease recurrence. The 5-year DFS and OS rates were 82.2% and 91.9%, respectively. In the multivariate analysis, preoperative CA19-9 level＞37U/ml, emergency operation, and T4 lesions were independent significant prognostic factors after treatment with UFT/LV adjuvant chemotherapy. The three independent prognostic factors —T4 lesions, emergency operation, and high preoperative CA19-9 levels— may be useful for decision-making regarding whether patients should receive 5-fluouracil-based or L-oxaliplatin-based adjuvant chemotherapy. As this was a single-institution study with a small number of patients, our findings need to be confirmed in larger multicenter studies.

IRSA 2017 : Tagungsband, Proceedings : 1st International Railway Symposium Aachen, Aachen, Germany, 28-30 November 2017 / Herausgeber Univ.-Prof. Dr. ir. Dr. h. c. De Doncker, Rik W. (Institut für Stromrichtertechnik und elektrische Antriebe (ISEA), Aachen), Univ.-Prof. Dr.-Ing. Nießen, Nils (Verkehrswissenschaftliches Institut (VIA), Aachen), Univ.-Prof. Dr.-Ing. Schindler, Christian (Institut für Schienenfahrzeuge und Transportsysteme (IFS)/Institute of Rail Vehicles and Transport Systems 1st International Railway Symposium Aachen, IRSA 2017, Aachen, Germany, 28 Nov 2017 - 30 Nov 2017; Aachen : [RWTH Aachen] 116-131 (2018)., Published by [RWTH Aachen], Aachen

Data Centers (DCs) are becoming increasingly important in recent years and require efficient operation and management. Thus, a topic of focus has been DC Infrastructure Management (DCIM) that can manage ICT equipment, power equipment, HVAC systems, etc. In this study, we developed a method to design the ICT equipment layout in the server room by using DCIM and Computer Fluid Dynamics (CFD). The method's effectiveness was evaluated and its ability to achieve efficient data center operation and management was validated.

The use of ultrasonically activated devices (USADs) in hepatic resections may be associated with an increased rate of complications, such as postoperative bile leaks. Nonetheless, the safety of USADs for sealing bile ducts during liver surgery has not yet been established. The purpose of this study was to assess the efficacy of a USAD for sealing bile ducts. In animal experiments, the common bile duct of ten anesthetized dogs was individually occluded using a USAD. Additionally, using the prospective liver surgery database from a single institution, we identified 45 consecutive patients who underwent hepatic resection using a USAD (USAD group) and 45 similar patients who underwent hepatic resection without the use of a USAD (NUSAD group). In the occluded and harvested canine bile ducts, the mean burst pressure was 280mmHg, and the lumen of the bile duct was completely sealed morphologically. In the clinical study, there was no significant difference in postoperative mortality or complications between the two groups, and biliary leakage was observed in only one patient (0.7%) in the USAD group. These data demonstrate that the USAD is a safe, efficient, and practical instrument for use during liver surgery to achieve complete hemobiliary stasis.

There is an increasing number of patients with severe liver disease that requires whole organ transplantation or living-related split liver transplantation. This has resulted in a shortage of donor organs, which is particularly problematic and still awaits resolution. Bioartificial liver (BAL) support systems have been developed with the aim of supporting patients with life-threatening liver disease until their liver recovers. Here, we describe a high performance three-dimensional rat hepatocyte culture system using a radial-flow bioreactor (RFB) with a polyvinyl alcohol (PVA) membrane as a small-scale BAL support system. Hepatocytes from male Sprague-Dawley rat livers were isolated and divided into two groups as follows. Group A: isolated hepatocytes were maintained in culture medium as controls; and group B: isolated hepatocytes were injected into the medium chamber of the RFB-PVA culture system. Sampling was carried out every 48 h to analyze the concentrations of ammonia and albumin in the medium. Light and electron microscopic examination of hepatocytes explanted from the PVA membrane was also performed. Albumin production and urea synthesis by cells in group B were both significantly higher than in group A. Hematoxylin-Eosin staining of the cells in group B showed that three-dimensional cell masses were attached to the PVA membrane. It also showed that the cells were stably proliferating in the porous spaces of the PVA. Scanning electron microscopic images of group B also showed clusters of hepatocytes attached to the PVA membrane. Hepatocyte clusters growing in the RFB-PVA culture system retained their biological function and were stable in the porous spaces of the PVA membrane. This cell culture system may be useful for the development of new BAL support systems.

An aneurysm of the abdominal internal organs is relatively rare. Recently, segmental arterial mediolysis (SAM) and median arcuate ligament syndrome (MALS) were identified as specific causes for aneurysms of the pancreaticoduodenal artery arcade. Herein, we report a ruptured anterior superior pancreaticoduodenal artery (ASPDA) aneurysm due to SAM that was misdiagnosed as acute pancreatitis. The patient was a 59-year-old male with acute, severe, and sharp pain in the upper abdomen. He was clinically diagnosed with acute pancreatitis based on abdominal computed tomography (CT). However, a follow-up CT scan revealed an aneurysm of the ASPDA. We therefore diagnosed this case as retroperitoneal hemorrhage due to aneurysm rupture, and we performed an angiogram and transcatheter arterial embolization to prevent aneurysm re-rupture. Based on a subsequent review of all the findings for this patient, we retrospectively determined the cause of the ASPDA aneurysm to be SAM. Such case reports are rare, and further accumulation of similar cases is necessary in the near future to establish proper diagnostic criteria and appropriate treatment protocols.

It is important to predict the outcome of tissue plasminogen activator (tPA)-treated patients early after the treatment for considering the post-tPA treatment option. We assessed cerebral blood flow (CBF) of tPA-treated patients with single-photon emission computed tomography (SPECT) 1 hour after tPA infusion to predict the patient outcome. Technetium-99m-hexamethylpropyleneamine oxime SPECT was performed in 35 consecutive tPA-treated patients. Asymmetry index, a contralateral-to-ipsilateral ratio of CBF, was calculated to analyze CBF quantitatively. Hypoperfusion or hyperperfusion was defined as a decrease of 25% or more or a increase of 25% or more in asymmetry index, respectively. Of all 35 patients, 23 had only hypoperfusion, 8 had both hypoperfusion and hyperperfusion, 2 had only hyperperfusion, and 2 had no perfusion abnormality. When evaluating the association between hypoperfusion and outcome, hypoperfusion volumes were significantly correlated with the modified Rankin Scale at 3 months (r = .634, P < .001). Hyperperfusion was observed in 10 patients (28.6%) and they showed a marked National Institutes of Health Stroke Scale score improvement in the first 24-hour period, which were significantly greater than those of 25 patients without hyperperfusion (P = .033). Eight patients (22.9%) with intracerebral hemorrhage (ICH) were all asymptomatic. Most ICHs were located in hypoperfusion areas, and no ICH was related to hyperperfusion. The results of the present study demonstrated that hypoperfusion volume was associated with poor outcome, whereas the presence of hyperperfusion seemed to be predictive of symptom improvement but not of development of ICH. Taken together, early post-treatment SPECT imaging seems to be a useful biomarker of outcome in tPA-treated patients.

Transthoracic subtotal esophagectomy for esophageal cancer is a highly invasive procedure, associated with high mortality and morbidity rates. We examined the use of video-assisted thoracoscopic and laparoscopic surgery for esophagectomy (VATS-E). Further, incentive spirometry (IS) is commonly used in perioperative rehabilitation for esophagectomy. We investigated whether pulmonary complications after VATS-E are related to changes in the perioperative IS volumes and whether such changes could be predictive of these complications. This study included 63 patients who underwent VATS-E from June 2008 to December 2009. IS volumes before and after surgery were recorded for all patients. The perioperative IS volumes and clinicopathological factors were correlated with the incidence of postoperative pneumonia and atelectasis. Nine patients (14.5%) had postoperative pneumonia, and thirteen (22.2%) had atelectasis. Univariate analysis showed an increased risk of atelectasis in patients with diabetes and an increased risk of pneumonia in patients with a long operating time and for whom the lung was adhered to the thoracic wall. The vital capacity (VC) correlation coefficient was 0.674. Further, the risk of pneumonia was high in patients with 13% less than the minimum IS volume/preoperative VC ratio and 22% with less than the average IS volume/preoperative VC ratio. Multivariate regression models for pneumonia showed the same results regarding the IS volume/VC ratio. The results indicated that IS volumes could be used to predict the incidence of complications after VATS-E, and thereby facilitate early application of interventions to prevent pulmonary complications.

International audience; Ticagrelor may be a more effective antiplatelet therapy than aspirin for the prevention of recurrent stroke and cardiovascular events in patients with acute cerebral ischemia.; We conducted an international double-blind, controlled trial in 674 centers in 33 countries, in which 13,199 patients with a nonsevere ischemic stroke or high-risk transient ischemic attack who had not received intravenous or intraarterial thrombolysis and were not considered to have had a cardioembolic stroke were randomly assigned within 24 hours after symptom onset, in a 1:1 ratio, to receive either ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2 through 90) or aspirin (300 mg on day 1 followed by 100 mg daily for days 2 through 90). The primary end point was the time to the occurrence of stroke, myocardial infarction, or death within 90 days.; During the 90 days of treatment, a primary end-point event occurred in 442 of the 6589 patients (6.7%) treated with ticagrelor, versus 497 of the 6610 patients (7.5%) treated with aspirin (hazard ratio, 0.89; 95% confidence interval [CI], 0.78 to 1.01; P=0.07). Ischemic stroke occurred in 385 patients (5.8%) treated with ticagrelor and in 441 patients (6.7%) treated with aspirin (hazard ratio, 0.87; 95% CI, 0.76 to 1.00). Major bleeding occurred in 0.5% of patients treated with ticagrelor and in 0.6% of patients treated with aspirin, intracranial hemorrhage in 0.2% and 0.3%, respectively, and fatal bleeding in 0.1% and 0.1%.; In our trial involving patients with acute ischemic stroke or transient ischemic attack, ticagrelor was not found to be superior to aspirin in reducing the rate of stroke, myocardial infarction, or death at 90 days. (Funded by AstraZeneca; ClinicalTrials.gov number, NCT01994720.).

This study compared results from Gd-EOB-DTPA on two different phases of 3T MRI with those from Tc-99m-GSA hepatic scintigraphy and hepatic function tests. Twenty-four patients with liver tumor were included in this study. All patients underwent Gd-EOB-DTPA-enhanced-MRI and Tc-99m-GSA hepatic scintigraphy. Clearance index (HH15) and receptor index (LHL15) were calculated for the Tc-99m-GSA, while signal intensities (SI) of liver at pre-injection and at 4/20min post-injection, and of spleen at 4 min/20min were measured (SIpre, SI4min, SI20min, SIsp4min, SIsp20min, respectively) for the Gd-EOB-DTPA-MRI. Liver activity at 15min by Tc-99m-GSA scintigraphy or biochemical liver function values were compared with liver spleen contrast at 4min (LSC4min = SI4min/SIsp4min) or 20min post-injection (LSC20min = SI4min/SIsp20min), and the increase in ratio at 4min (IR4min=SI4min/SIsp4min) or 20min (IR20min= SI20min/SIpre). Total bilirubin levels (T-bil), serum albumin levels (Alb), prothrombin activity, and the indocyanine green clearance test (ICG) results were also analyzed. There were statistically significant correlations in all comparisons between Gd-EOB-DTPA and Tc-99m-GSA. The highest coefficient of correlation was obtained in IR4min (LHL15: r = 0.795, P

This paper introduces the curriculum for creativity education that has been conducted at the Department of Mechano-Aerospace Engineering, Tokyo Institute of Technology, for 20 years, for the purpose of systematization of education using robots. In particular, we describe the significance of the lecture and operational know-how of contests for street performance robots, which we have continuously held in the course called “machine creation.” The results of a questionnaire survey of students indicate that this course is a valuable experience for students.

A predictive control strategy aiming to reduce the impact generated on a personal vehicle during obstacle negotiation is proposed. Similarly to the motion executed by a cyclist when he/she is about to negotiate a step, the motion strategy uses a dynamic effect to temporarily reduce the load on the wheel of the vehicle that must negotiate the obstacle, thus reducing the impact force as well. Such motion control strategy was developed for the three-wheeled personal vehicle Falcon-III. The vehicle behavior using the predictive control strategy was first investigated for basic cases, such as when only one of the wheels had to negotiate an obstacle; later, the strategy was generalized by combining the motion derived for the basic cases. Robustness is achieved by the use of fuzzy logic to infer the displacement of the ZMP required to negotiate different obstacles. The predictive motion control strategy was compared with a conventional feedback attitude control strategy, and was shown to produce smaller impacts than simply using the feedback strategy.