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For $q\in\mathbb{R}$, the $Q$-matrix $Q=Q_q$ of a connected simple graph $G=(V,E)$ is $Q_q=(q^{\partial(x,y)})_{x,y\in V}$, where $\partial$ denotes the path-length distance. Describing the set $\pi(G)$ consisting of those $q\in \mathbb{R}$ for which $Q_q$ is positive semidefinite is fundamental in asymptotic spectral analysis of graphs from the viewpoint of quantum probability theory. Assume that $G$ has at least two vertices. Then $\pi(G)$ is easily seen to be a nonempty closed subset of the interval $[-1,1]$. In this note, we show that $\pi(G)=[-1,1]$ if and only if $G$ is isometrically embeddable into a hypercube (infinite-dimensional if $G$ is infinite) if and only if $G$ is bipartite and does not possess certain five-vertex configurations, an example of which is an induced $K_{2,3}$., Comment: 6 pages

Infected pancreatic necrosis is a postpancreatitis complication that is mainly caused by Enterobacteriaceae and Enterococci. Here, we have reported a very rare case of

To clarify the trends in radical cystectomy and to compare surgical outcomes among surgical approaches focusing on robot-assisted radical cystectomy based on a Japanese nationwide database.The Diagnosis Procedure Combination database was used to extract data on radical cystectomy cases. Trends in open radical cystectomy, laparoscopic radical cystectomy, minimum incision endoscopic radical cystectomy, and robot-assisted radical cystectomy between April 2012 and March 2021 were evaluated. Basic characteristics and peri-operative indicators were compared among the four groups. Propensity score matching was applied to assess the differences between open radical cystectomy and robot-assisted radical cystectomy.During the study period, a decreasing number of open radical cystectomies and an increasing number of minimally invasive radical cystectomies were shown in the total cohort of 28 345 cases. The number of robot-assisted radical cystectomies rapidly increased after government approval in 2018. Minimally invasive radical cystectomies, including robot-assisted radical cystectomies, had a significantly lower complication rate, a shorter length of stay, and a lower blood transfusion rate, but a longer anesthesia time than open radical cystectomies. In the propensity score matching analysis comparing the surgical outcomes of robot-assisted radical cystectomy and open radical cystectomy, similar results were demonstrated, and blood transfusion rates were equivalent.For the past decade, the number of minimally invasive radical cystectomies has steadily increased without compromised surgical outcomes, except for anesthesia time. Robot-assisted radical cystectomies in particular rapidly became widespread in Japan after government approval in 2018 and became a standard surgery within the first 3 years.

To describe oncological outcomes after progressive site-directed therapy (PSDT) in genuine and induced oligometasatic (OM)-castration-resistant prostate cancer (CRPC).Thirty-seven patients with OM-CRPC treated with PSDT were retrospectively analyzed, and oncological outcomes and recurrence patterns on whole-body diffusion-weighted MRI (WB-DWI) were evaluated.Twenty-two (59%) were classified as genuine OM-CRPC and 15 (41%) as induced OM-CRPC. A 50% decline in PSA after PSDT was observed in 21 (95%) genuine OM-CRPCs and 7 (47%) induced OM-CRPCs (p = 0.0005). At a median observation period of 7.3 months, median PSA progression-free survival were 10.9 months in the genuine OM-CRPCs and 4.8 months in the induced OM-CRPCs (p = 0.015). Among the patients who developed PSA progression after PSDT, 11 of 15 in the genuine OM-CRPCs (73%) and 11 of 14 in the induced OM-CRPCs (79%) underwent WB-DWI at PSA progression. The median numbers of newly detected metastases were 2 (range: 1-5) in the genuine OM-CRPCs and 4 (range: 1-40) in the induced OM-CRPCs (p = 0.049). Only one new metastasis appeared in 5 patients from the genuine OM-CRPCs (46%) and 1 from the induced OM-CRPCs (9.1%, p = 0.048). In 7 of 9 patients from the genuine OM-CRPCs (78%) and 7 of 8 patients from the induced OM-CRPCs (88%) who had bone metastases alone, the newly detected metastasis limited to the bone.Genuine OM-CRPC had better oncological outcomes after PSDT than induced OM-CRPC, and the number of lesions detected at recurrence was limited. Induced OM-CRPC might be a disseminated condition with micrometastases at OM diagnosis.

Background and Objectives: Opioid analgesics, which are used for cancer-related pain management, cause opioid-induced constipation (OIC). Naldemedine, a peripheral opioid receptor antagonist, is an OIC-modifying agent, but no focused efficacy and safety analysis has been conducted for its use in hepatobiliary pancreatic cancers. We performed a multi-institutional study on the efficacy and safety of naldemedine in patients with hepatobiliary pancreatic cancer using opioids in clinical practice. Materials and Methods: We retrospectively evaluated patients with hepatobiliary pancreatic cancer (including liver, biliary tract, and pancreatic cancers) treated with opioids and naldemedine during hospitalization at ten institutions in Japan from June 2017 to August 2019. We assessed the frequency of bowel movements before and after the initiation of naldemedine therapy. Responders were defined as patients who defecated ≥3 times/week, with an increase from a baseline of ≥1 defecations/week over seven days after the initiation of naldemedine administration. Results: Thirty-four patients were observed for one week before and one week after starting naldemedine. The frequency of bowel movements increased by one over the baseline frequency or to at least thrice per week in 21 patients. The response rate was 61.7% (95% confidence interval: 45.4–78.0%). The median number of weekly bowel movements before and after naldemedine treatment was 2 (range: 0–9) and 6 (range: 1–17), respectively, in the overall population (n = 34); the increase in the number of bowel movements following naldemedine administration was statistically significant (Wilcoxon signed-rank test, p < 0.0001). Diarrhea was the predominant gastrointestinal symptom, and 10 (29.4%) patients experienced grade 1, grade 2, or grade 3 adverse events. The only other adverse event included fatigue in one patient; grade 2–4 adverse events were absent. Conclusions: Naldemedine is effective, and its use may be safe in clinical practice for patients with hepatobiliary pancreatic cancer receiving opioid analgesics.

We demonstrate 128 Gbaud HB-CDM with InP-based modulator having 3D-printed SSCs on chip facet. Optical coupling loss of 1.1 dB and Telcordia compliant reliability promise practical usage of 3D-print technology based on two photon polymerization.

The X-linked human glutamate receptor subunit 3 (GRIA3) gene (MIM *305915, Xq25) encodes ionotropic α amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA)-type glutamate receptor subunit 3, which mediates postsynaptic neurotransmission. Variants in this gene can cause a variety of neurological disorders, primarily reported in male patients. Here, we report a female patient with developmental and epileptic encephalopathy who carries the novel de novo GRIA3 variant NM_007325.5: c.1982T > C: p.Met661Thr.

Kelp forests are a non-negligible blue carbon resource that has gained global attention as an ocean carbon source. In addition to the role of carbon storage, kelp forests have certain economic impact in Japan for a long time. However, the environmental and economic effects of kelp forests are not yet clear. Therefore, this chapter introduces the environmental and economic impacts of kelp forests in Hakodate City, Hokkaido Prefecture, Japan, as a case study. The study suggests promoting cultivation of kelp from both ecological and economic aspects by financial schemes for conservation and restoration of natural kelp.

To evaluate a conceptually simple model to predict new-baseline-glomerular-filtration-rate (NBGFR) after radical nephrectomy (RN) based on split-renal-function (SRF) and renal-functional-compensation (RFC), and to compare its predictive accuracy against a validated non-SRF-based model. RN should only be considered when the tumor has increased oncologic potential and/or when there is concern about perioperative morbidity with PN due to increased tumor complexity. In these circumstances, accurate prediction of NBGFR after RN can be important, with a threshold NBGFR 45 ml/min/1.73m236 RCC patients who underwent RN (2010-2012) with preoperative imaging (CT/MRI) and relevant functional data were included. NBGFR was defined as GFR 3-12 months post-RN. SRF was determined using semi-automated software that provides differential parenchymal-volume-analysis (PVA) from preoperative imaging. Our SRF-based model was: Predicted NBGFR = 1.24 (× Global GFRThe correlation-coefficients (r) were 0.87/0.72 for SRF-based/non-SRF-based models, respectively (p = 0.005). For prediction of NBGFR 45 ml/min/1.73mPrevious non-SRF-based models to predict NBGFR post-RN are complex and omit two important parameters: SRF and RFC. Our proposed model prioritizes these parameters and provides a conceptually simple, accurate, and clinically implementable approach to predict NBGFR post-RN. SRF can be easily obtained using PVA software that is affordable, readily available (FUJIFILM-Medical-Systems), and more accurate than nuclear-renal-scans. The SRF-based model demonstrates greater predictive-accuracy than a non-SRF-based model, including the clinically-important predictive-threshold of NBGFR 45 ml/min/1.73m

Unlike in thermodynamic systems, phase separation can occur without a thermodynamic driving force in active systems. How phase separation of purely hydrodynamic origin proceeds is an intriguing physical question. To this end, we study the phase separation of a binary mixture of oppositely rotating disks in a two-dimensional (2D) viscous fluid at an athermal condition by hydrodynamic simulations, focusing on the inertia effect. At symmetric and off-symmetric compositions, phase separation forms the oppositely flowing bands and a circular rotating droplet in the disordered matrix phase. In both cases, phase separation creates the largest structure directly from a chaotic state without gradual domain coarsening, unlike in the thermodynamic and corresponding dry rotor mixtures. We show that this unusual behaviour results from the nonlinear convective acceleration, i.e., the inverse cascade phenomena characteristic of 2D turbulence. Our finding reveals nontrivial nonlinear hydrodynamic effects on the self-organisation of active/driven particles in a fluid.

We sought to determine whether loss of renal function increases risk of recurrence and metastases in renal cell carcinoma (RCC), and whether this impact was age-related.We performed a retrospective analysis of the International Marker Consortium for Renal Cancer (INMARC) registry. Patients were separated into younger (65 years old) and elder (≥65 years old) age groups, and rates of de novo estimated glomerular filtration rate (eGFR45 mL/min/1.73m2 [eGFR45]) were calculated. Multivariable analysis (MVA) was conducted for predictors of progression-free survival (PFS) and all-cause mortality (ACM). Kaplan-Meier Analysis (KMA) was conducted for PFS and overall survival (OS) in younger and elder age groups stratified by functional status.We analyzed 1805 patients (1113 age65, 692 age≥65). On MVA in patients65, de novo eGFR45 was independently associated with greater risk for worsened progression (HR=1.61, P=.038) and ACM (HR=1.82, P=.018). For patients ≥65, de novo eGFR45 was not independently associated with progression (P=.736), or ACM (P=.286). Comparing patients with de novo eGFR45 vs. eGFR ≥45, KMA demonstrated worsened 5-year PFS and OS in patients65 (PFS: 68% vs. 86%, P.001; OS: 73% vs. 90%, P.001), while in patients ≥65, only 5-year OS was worsened (77% vs. 81%, P.021).Development of de novo eGFR45 was associated with more profound impact on patients65 compared to patients ≥65, being an independent risk factor for PFS and ACM. The mechanisms of this phenomenon are unclear but underscore desirability for nephron preservation when safe and feasible in younger patients.

Fatigue fracture is a unique failure mode of materials induced by repeated loading and is crucial for the long-term stability of materials used in cars and aeroplanes. Fatigue is the progressive and localised structural damage of a material subjected to cyclic loading. The minimum strain amplitude that causes such damage is much less than the material’s yield strain under simple loading. This observation leads to a widespread belief that the threshold strain amplitude for fatigue fracture is much smaller than that for monotonic fracture under continuous loading. Here, we study the physical mechanism of the low-cycle fatigue fracture of amorphous solids by considering the complex coupling between density, deformation (velocity), and stress. Contrary to the common belief, we find that the critical strain amplitude, i.e., the onset of irreversible deformation, is the same for fatigue and monotonic fractures. Experimental verification of this prediction is desirable.

Background/aims To clarify the characteristics of automobile driving performance in patients with brain injury, 26 patients (patient group) and 26 driving instructors (control group) were evaluated via an on-road driving assessment. Methods On-road driving performance was evaluated using an event data recorder, driving analysis software, and a video-based driving assessment scale. The number of unsafe driving events, the score on the driving analysis software, and the score on the driving assessment scale were then compared between the two groups. Results The patient group had 12 unsafe events (7 braking, 4 acceleration, 1 curving), but the instructors only had two sudden braking events, both of which were to avoid a collision when another vehicle forcibly entered from outside the roadway. In the case of the driving analysis software, the patient group showed significantly lower scores for braking (PConclusions These objective video and g-force-generated on-road driving assessments may provide important information regarding driving and advice for patients with brain injury.

ObjectiveTo compare renal function (RF) outcomes after bladder-preserving tetramodal therapy against muscle-invasive bladder cancer (MIBC) to those after radical cystectomy (RC).MethodsThis study included 95 patients treated with tetramodal therapy consisting of transurethral bladder tumour resection, chemoradiotherapy and partial cystectomy (PC) and 300 patients treated with RC. The annual change in the estimated glomerular filtration rate (eGFR) was compared using the linear mixed model. Renal impairment was defined as a >25% decrease from the pretreatment eGFR, and renal impairment-free survival (RIFS) was calculated. The association between treatment type and renal impairment was assessed.ResultsThe number of patients who received neoadjuvant chemotherapy was 8 (8.4%) in the tetramodal therapy group and 75 (25.0%) in the RC group. After the inverse probability of treatment weighting adjustments, the baseline characteristics were balanced between the treatment groups. The mean eGFR before treatment in tetramodal therapy and RC groups was 69.4 and 69.6 mL/min/1.73 m2 and declined with a slope of −0.7 and −1.5 mL/min/1.73 m2/year, respectively. The annual deterioration rate of post-treatment eGFR in the tetramodal therapy group was milder than in the RC group. The 5-year RIFS rate in the tetramodal therapy and the RC groups was 91.2 and 85.2%, respectively. Tetramodal therapy was an independent factor of better RIFS compared with RC.ConclusionsRF was better preserved after tetramodal therapy than after radical therapy; however, even after tetramodal therapy, the eGFR decreased, and a non-negligible proportion of patients developed renal impairment.

Hydrodynamic interactions (HIs) play a critical role in the self-organization of colloidal suspensions and biological solutions. However, their roles have remained elusive particularly for charged soft matter systems. Here we consider the role of HIs in the self-assembly of oppositely charged colloidal particles, which is a promising candidate for electrical tunable soft materials. We employ the fluid particle dynamics method to consider many-body HIs and the coupling between the colloid, ion, and fluid motions. We find that, under a constant electric field, oppositely charged colloidal particles form clusters and percolate into a gel network, unlike bundlelike aggregates aligned in the field direction observed by Brownian dynamics simulations neglecting HIs. We reveal that the cluster-forming tendency originates from the incompressibility-induced "inverse squeezing flow" effect that dramatically slows down the disaggregation of attached colloids. Our findings indicate that the HI selects a unique kinetic pathway to the nonequilibrium colloidal self-assembly.

Accurately predicting of progression is important for patients with non-muscle-invasive bladder cancer (NMIBC). We previously reported that bladder neck involvement (BNI) was significantly associated with progression of NMIBC. In this study, we evaluated the prognostic significance of the detailed BNI location in NMIBC patients.We retrospectively reviewed 651 patients diagnosed with primary NMIBC at a single center between 2000 and 2018. Using the detailed BNI location, patients were divided into the following three groups: dorsal BNI (BNId; 4 to 8 o'clock position), ventral BNI (BNIv; 8 to 4 o'clock but not 4 to 8 o'clock position), and non-BNI group. Both time to progression to muscle-invasive disease and distant metastasis was compared among the three groups. A prognostic model was developed and its discriminative ability was evaluated.Dorsal bladder neck involvement and BNIv were observed in 43 (6.6%) and 36 (5.5%) patients, respectively. During a median follow-up of 61 months, 35 (5.4%) patients progressed. The cumulative incidence at 5 years was 12%, 0%, and 5.0% in BNId, BNIv, and non-BNI groups, respectively. On multivariate analysis, BNId was a significant and independent risk factor for progression, tumor stage pT1, and histologic grade G3. One point was assigned to each factor, and patients were classified into four well-stratified prognostic groups based on the total score.Dorsal bladder neck involvement was an independent and significant risk factor for progression in primary NMIBC. Our simple and practical prognostic model including BNId is easy to use and may help selecting the optimal treatment and its timing.

To evaluate effects of worsening surgically induced chronic kidney disease (CKD-S) on oncological and non-oncological survival outcomes in renal cell carcinoma (RCC).We performed a retrospective analysis of patients who underwent partial (PN) or radical nephrectomy (RN) and were free of preoperative CKD (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 mWe analysed 3239 patients. The mean preoperative and last-follow-up eGFRs were 87.4 and 69.5 mL/min/1.73 mDevelopment of CKD-S Stage 3b and 4, but not 3a, was associated with worsened ACM and NCM. The decision to proceed with nephron preservation via PN should be individualised based on oncological risk and risk of functional decline to CKD-S 3b or 4, and not CKD-S 3a.

BackgroundSeveral markers of inflammation have been associated with oncologic outcomes. Prognostic markers are not well-defined for renal cell carcinoma (RCC). We sought to investigate the association of preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and De Ritis ratio with mortality in RCC.MethodsMulti-center retrospective analysis of patients undergoing surgery for RCC. Primary outcome of interest was all-cause mortality (ACM). Secondary outcomes were non-cancer mortality (NCM) and cancer-specific mortality (CSM). Elevated NLR was defined as ≥2.27, elevated PLR as ≥165, and elevated De Ritis ratio as ≥ 2.72. Multivariable cox regression analysis (MVA) was conducted to elucidate risk factors for primary and secondary outcomes, and Kaplan-Meier analysis (KMA) was used to evaluate survival outcomes comparing elevated and non-elevated NLR, PLR, and De Ritis ratio.Results2656 patients were analyzed (874 patients had elevated NLR; 480 patients had elevated PLR and 932 patients had elevated De Ritis). Elevated NLR was a significant predictor of ACM (HR 1.32, 95% CI: 1.07-1.64, p=0.003) and NCM (HR 1.79, 95% CI: 1.30-2.46, pConclusionsElevated NLR was independently associated with worse ACM and NCM, while elevated De Ritis was predictive for CSM in addition to ACM and NCM. These differences may be useful in refining risk stratification with respect to cancer-related and non-cancer mortality in RCC patients and deserve further investigation.