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Study Design: This is a single-center retrospective cohort study with a university hospital setting.Purpose: This study aims to evaluate the short-term course of physical function and walking ability after intramedullary spinal cord tumor (ISCT) resection and predict walking independence 1 year after surgery.Overview of Literature: Although several reports have shown the postoperative functional prognosis of spinal intramedullary tumors with long-term follow-up, no reports have identified the predictors associated with the functional outcome at an early stage. Methods: A total of 79 individuals who underwent ISCT resection at our institute between 2014 and 2019 were enrolled in the study, whose preoperative walking state was independent ambulator regardless of cane support with the Functional Independence Measure Locomotor Scale (FIM-L) score of ≥6. The FIM-L, the American Spinal Injury Association (ASIA) motor and sensory scores in the lower extremities, and the Walking Index for Spinal Cord Injury II (WISCI II) were assessed for walking independence, lower-limb function, and walking ability, respectively. These evaluations were performed at 4 time points: preoperatively, 1 week (1W), 2 weeks (2W), and 1 year after surgery.Results: In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93–1.00).Conclusions: The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.

In this paper, we propose a fighting game AI that selects its actions from the perspective of highlight generation using Monte-Carlo tree search with three highlight cues in the evaluation function. The proposed AI is targeted for being used to generate gameplay in live streaming platforms such as Twitch and YouTube where a large number of spectators watch gameplay to entertain themselves. A gameplay analysis and user study are conducted using FightingICE, a fighting game platform in an international fighting game AI competition. Results show that gameplay generated by two AI players of the proposed method has more promising characteristics than not only gameplay generated according to an existing method but also gameplay by the top two AI players in the 2019 competition and that it is more entertaining than the latter gameplay.

Focal segmental glomerulosclerosis (FSGS) is a major renal complication of human mitochondrial disease. However, its pathogenesis has not been fully explained. In this study, we focused on the glomerular injury of mito-miceΔ and investigated the pathogenesis of their renal involvement. We analyzed biochemical data and histology in mito-miceΔ. The proteinuria began to show in some mito-miceΔ with around 80% of mitochondrial DNA deletion, then proteinuria developed dependent with higher mitochondrial DNA deletion, more than 90% deletion. Mito-miceΔ with proteinuria histologically revealed FSGS. Immunohistochemistry demonstrated extensive distal tubular casts due to abundant glomerular proteinuria. Additionally, the loss of podocyte-related protein and podocyte's number were found. Therefore, the podocyte injuries and its depletion had a temporal relationship with the development of proteinuria. This study suggested mitochondrial DNA deletion-dependent podocyte injuries as the pathogenesis of renal involvement in mito-miceΔ. The podocytes are the main target of mitochondrial dysfunction originated from the accumulation of mitochondrial DNA abnormality in the kidney.

A unique design of our ultracompact microcavity wavelength conversion device exploits the simple principle that the wavelength conversion efficiency is proportional to the square of the electric field amplitude of enhanced pump light in the microcavity, and expands the range of suitable device materials to include crystals that do not exhibit birefringence or ferroelectricity. Here, as a first step toward practical applications of all-solid-state ultracompact deep-ultraviolet coherent light sources, we adopted a low-birefringence paraelectric SrB4O7 crystal with great potential for wavelength conversion and high transparency down to 130 nm as our device material, and demonstrated 234 nm deep-ultraviolet coherent light generation, whose wavelength band is expected to be used for on-demand disinfection tools that can irradiate the human body.

Some intraductal papillary mucinous neoplasms (IPMNs) have malignant potential and can become pancreatic cancer. The mechanism behind the malignant progression of IPMN remains unknown. We aimed to identify the risk factors and interactions between backgrounds for IPMN.We retrospectively enrolled 980 patients of pancreatic cancer or suspected IPMN (sIPMN) who underwent endoscopic ultrasound or retrograde cholangiopancreatography. We classified them into pancreatic cancer, high-risk sIPMN, and low-risk sIPMN, and investigated the risk factors for high-risk sIPMN.Smoking habits (odds ratio [OR], 3.74; 95% confidence interval [CI], 2.04-6.85; Plt; 0.001), serum carbohydrate antigen 19-9 ≥37 U/mL (OR, 6.30; 95% CI, 2.88-13.80; Plt; 0.001), and family history of cancers (OR, 2.38; 95% CI, 1.30-4.37; P = 0.005) were independent risk factors for high-risk suspected IPMN. Odds ratios of diabetes and neutrophil-to-lymphocyte ratio of 2.45 or greater were significantly higher in patients with a family history of cancer than those without a family history of cancer (OR, 3.28; 95% CI, 0.52-20.80 vs 1.85; 95% CI, 0.78-4.41; OR, 2.44; 95% CI, 0.81-7.34 vs 1.24; 95% CI, 0.67-2.30, respectively).Understanding the interactions between background factors can effectively prevent IPMNs' malignant transformation.

Some Parkinson's disease (PD)-causative/risk genes, including the PD-associated kinase leucine-rich repeat kinase 2 (LRRK2), are involved in membrane dynamics. Although LRRK2 and other PD-associated genes are believed to regulate synaptic functions, axonal transport, and endolysosomal activity, it remains unclear whether a common pathological pathway exists. Here, we report that the loss of Lrrk, an ortholog of human LRRK2, leads to the accumulation of the lysosome-related organelle regulator, Arl8 along with dense core vesicles at the most distal boutons of the neuron terminals in

A 40-year-old Japanese woman developed malignant-phase hypertension complicated by thrombotic microangiopathy, progressing to end-stage renal disease. Five years later, she was diagnosed with pulmonary arterial hypertension and interstitial pneumonia. Despite a lack of overt skin sclerosis, nucleolar staining in our indirect immunofluorescence analysis and nailfold capillaroscopy facilitated the diagnosis of anti-PM/Scl antibody-positive systemic sclerosis. We observed the persistent presence of anti-PM/Scl antibodies throughout the clinical course, suggesting that her kidney disease was scleroderma renal crisis. Anti-PM/Scl antibodies can be associated with multiple organ diseases. Careful attention to a patient's antinuclear antibody pattern and dermatological findings may help clarify the etiology of undiagnosed diseases.

This meta-analysis aimed to evaluate the device performance of conventional balloon catheters (POBA), drug-coated balloons (DCB), bare-metal stents (BMS), and drug-eluting stents (DES) in below-the-knee (BTK) ischemic lesions with regard to lesion characteristics. Online searches of PubMed, Web of Science, and Cochrane databases (2010–2019) were conducted for each of the test devices. Primary patency rates (pp) and major amputation rates 1 year after the use of each device were analyzed using a random-effects meta-analysis model. Meta-regression analysis was conducted to test associations between the outcomes and lesion characteristics. The analysis included 18 studies reporting on 24 separate cohorts comprising 2,438 patients. DES demonstrated the best pp among the test devices (83.6%; 95% confidence interval = 78.4–88.8%, studies = 8; I2 = 66%, P = 0.005). A negative coefficient between lesion length and pp (P = 0.002) was obtained. The ratio of critical limb ischemia (CLI) patients impacted the amputation rates (P = 0.031), whereas no statistically significant difference was found between the devices. DES showed favorable pp in BTK lesions; however, as the lesion lengths using DES were short, pp in long lesions still needs to be evaluated. Shorter lesions gained better pp. A higher ratio of CLI patients resulted in increased amputation rates.

The value of the Vesicle Imaging-Reporting and Data System (VI-RADS) in the diagnosis of muscle-invasive bladder cancer (MIBC) for urothelial carcinoma with variant histology (VUC) remains unknown. We retrospectively evaluated 360 consecutive patients with bladder cancer (255 pure urothelial carcinoma [PUC] and 69 VUC) who underwent multiparametric magnetic resonance imaging between 2011 and 2019. VI-RADS scores assigned by four readers were significantly higher for the VUC group than for the PUC group (p0.05). In the cohort of 122 pair-matched patients, there was no significant difference in VI-RADS score distribution between the PUC and VUC groups for all readers (p 0.05). The area under the receiver operating characteristic curve for MIBC diagnosis via overall VI-RADS score was 0.93-0.94 for PUC and 0.89-0.92 for VUC, with no significant difference between the PUC and VUC groups (p = 0.32-0.60). These data suggests that VI-RADS scores achieved high diagnostic performance for detection of muscle invasion in both PUC and VUC. PATIENT SUMMARY: The Vesical Imaging-Reporting and Data System (VI-RADS) is a standardized system for reporting on detection of muscle-invasive bladder cancer via magnetic resonance imaging (MRI) scans. Our study shows that VI-RADS is also highly accurate for diagnosis for different variants of muscle-invasive bladder cancer, with good inter-reader agreement.

The adaptive seamless design combining phases II and III into a single trial has been shown growing interest for improving the efficiency of drug development, becoming the most frequent adaptive design type. It typically consists of two stages, the trial objectives being often different in each stage. The primary objectives are to select optimal experimental treatment group(s) in the first stage and compare the efficacy between the selected treatment and control groups in the second stage. In this article, we focus on a two-stage adaptive seamless design, for which treatment selection is based on the short-term binary endpoint and treatment comparison is based on the long-term binary endpoint. We thus propose an exact conditional test as a final analysis, based on the bivariate binomial distribution and given the selected treatment with the most promising short-term endpoint response rate from an interim analysis. Additionally, the mid

Background: To investigate the cognitive function and its relation to home discharge of patients following subacute stroke.Methods: This retrospective cohort study included 1,229 convalescent patients experiencing first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariate logistic regression analysis to identify factors related to home discharge. Results: Of the 1,229 participants (mean age: 68.7±13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariate logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91–0.96; PConclusions: MMSE at admission may be a useful indicator for predicting home discharge.

Case report: an 80-year-old woman presented with rapidly progressive glomerulonephritis and was admitted to our hospital. Myeloperoxidase-specific antineutrophil cytoplasmic antibody (MPO-ANCA) was positive. We diagnosed ANCA-associated renal vasculitis (ANCA-RV). Treatment was initiated with intravenous methylprednisolone pulse therapy, followed by prednisolone (PSL) at 30 mg/day. We gradually reduced the PSL dose to 7.5 mg/day over 6 months. At that time, the patient developed disturbances of consciousness which progressed subacutely. MRI revealed regions of patchy white matter with an increased signal on T2-weighted, fluid attenuated inversion recovery (FLAIR) sequences and diffusion-weighted sequences. JC virus DNA was detected in the cerebrospinal fluid (CSF) by polymerase chain reaction (PCR), leading to a diagnosis of progressive multifocal leukoencephalopathy (PML). PML is a rare infectious demyelinating disease of the central nervous system caused by JC virus infection, occurring in highly immunosuppressed individuals such as HIV-infected patients and patients using some biological agents, and having a very poor prognosis. In the present case, PML may have been associated with steroid use, although there are very few case reports of PML in patients taking only steroids. We report progressive multifocal leukoencephalopathy during steroid treatment of ANCA-RV. When patients show progressive disturbance of consciousness during treatment for ANCA-RV, we need to take PML into consideration for differential diagnosis.

Background The Response Evaluation Criteria in Solid Tumors (RECIST) for computed tomography (CT) is preoperatively used to evaluate therapeutic effects. However, it does not reflect the pathological treatment response (PTR) of pancreatic ductal adenocarcinoma (PDAC). The Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) for positron emission tomography (PET)/CT is effective in other cancers. This study aimed to confirm the usefulness of PERCIST and the prognostic utility of PET/CT for PDAC. Methods Forty‐two consecutive patients with PDAC who underwent neoadjuvant therapy (NAT) and pancreatectomy at our institution between 2014 and 2018 were retrospectively analyzed. We evaluated the treatment response and prognostic significance of PET/CT parameters and other clinicopathological factors. Results Twenty‐two patients who underwent PET/CT both before and after NAT with the same protocol were included. RECIST revealed stable disease and partial response in 20 and 2 cases, respectively. PERCIST revealed stable metabolic disease, partial metabolic response, and complete metabolic response in 8, 9, and 5 cases, respectively. The PTR was G3, G2, and G1 in 8, 12, and 2 cases, respectively. For comparing the concordance rates between PTR and each parameter, PERCIST (72.7% [16/22]) was significantly superior to RECIST (36.4% [8/22]) (P = .017). The area under the curve survival values of PET/CT parameters were 0.777 for metabolic tumor volume (MTV), 0.500 for maximum standardized uptake value, 0.554 for peak standardized uptake value corrected for lean body mass, and 0.634 for total lesion glycolysis. A 50% cut‐off value for the MTV reduction rate yielded the largest difference in survival between responders and nonresponders. On multivariate analysis, MTV reduction rates, 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) was more accurate in determining the therapeutic effects of neoadjuvant therapy for pancreatic ductal adenocarcinoma than CT, which detects anatomical changes. The reduction rate of the PET/CT parameter was an independent prognostic factor for pancreatic ductal adenocarcinoma.

OBJECTIVES Total arch replacement (TAR) using an endovascular approach has been initially introduced as the frozen elephant trunk technique (FET). In our institute, TAR using the FET with Frozenix has been used as the first-line treatment for distal aortic arch aneurysms since 2014. This study aimed to evaluate the early and long-term outcomes and demonstrate the efficacy of this procedure. METHODS Between 2014 and 2021, 121 consecutive patients were treated with TAR using the FET with Frozenix for distal aortic arch aneurysms. Early and long-term outcomes were retrospectively analysed. RESULTS The 30-day mortality rate was 2.5% (3/121). Of postoperative complications, paraplegia due to spinal cord injury occurred in 2 (1.7%) patients, stroke in 12 (9.9%) and acute renal failure in 10 (8.3%). At follow-up, 23 secondary aortic interventions were required and 8 (6.6%) patients underwent intended secondary thoracic endovascular aortic repair for residual descending aortic aneurysm. Late and aortic-related deaths occurred in 16 (13.2%) and 4 (3.3%) patients, respectively. The overall long-term survival rates at 1, 3 and 5 years were 87.6%, 83.1% and 65.4%, respectively, while the rates of freedom from aortic-related death at 1, 3 and 5 years were 95.7%, 95.7% and 84.8%, respectively. CONCLUSIONS TAR using the FET with Frozenix for distal aortic arch aneurysms has acceptable early mortality and morbidity. Spinal cord injury and paraplegia occur less frequently than previously reported. The technique has satisfactory long-term survival and freedom from aortic-related death.

Aim To investigate the cognitive function and its relation to the home discharge of patients following subacute stroke. Methods This retrospective cohort study included 1,229 convalescent patients experiencing their first subacute stroke. We determined discharge destination and demographic and clinical information. We recorded the following measurement scores: Mini-Mental State Examination (MMSE) score, Stroke Impairment Assessment Set score, grip strength, and Functional Independence Measure (FIM). We performed a multivariable logistic regression analysis with the forced-entry method to identify factors related to home discharge. Results Of the 1,229 participants (mean age: 68.7 ± 13.5 years), 501 (40.8%), 735 (59.8%), and 1,011 (82.3%) were female, had cerebral infarction, and were home discharged, respectively. Multivariable logistic regression analysis revealed that age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 – 0.96; P P = 0.003), living situation (OR, 4.40; 95% CI, 2.69 – 7.20; P P = 0.035), FIM motor score at admission (OR, 1.04; 95% CI, 1.01 – 1.06; P = 0.001), and FIM cognitive score at admission (OR, 1.08; 95% CI, 1.04 – 1.13; P Conclusions MMSE at admission is significantly associated with home discharge in patients with subacute stroke.

High-entropy-alloy-type (HEA-type) compound superconductors have been drawing much attention as a new class of exotic superconductors with local structural inhomogeneity. NaCl-type (Ag,In,Sn,Pb,Bi)Te is a typical HEA-type superconductor, but the carrier doping mechanism had been unclear. In this study, we synthesized (Ag,In,Sn,Pb,Bi)Te with various In concentration using high-pressure synthesis: the studied system is (AgSnPbBi)(1-x)/4InxTe (x = 0-0.4). Single-phase samples were obtained for x = 0-0.3. A semiconductor-like temperature dependence of resistivity was observed for x = 0, while superconductivity appeared for the In-doped samples. The highest transition temperature (Tc) was 3.0 K for x = 0.3. The Seebeck coefficient decreases with increase of x, which suggests that In3+ generates electron carriers in (AgSnPbBi)(1-x)/4InxTe. Tuning of carrier concentration and superconducting properties of (Ag,In,Sn,Pb,Bi)Te would be useful for further investigation of exotic superconductivity in the HEA-type compound., Comment: 11 pages, 4 figures, 1 table

Theoretically, the maximum likelihood estimator has the sandwich-type asymptotic variance-covariance matrix under model misspecification. Its empirical estimator, that is called the robust variance estimator, is consistent. Thus, the estimator is asymptotically valid even under model misspecification. In practice, the robust variance estimator is used for computation of standard errors in longitudinal data analysis. Recently, Golden et al. (2019 Econometrics, 7, 1-27) showed that the maximum likelihood estimator retains a sandwich-type asymptotic variance-covariance matrix in the presence of missing data even when the missing-data mechanism is missing not at random. Although they revealed the asymptotic validity of the robust variance estimator in the simultaneous presence of both model misspecification and missing data, its finite-sample performance did not be investigated. In this article, we evaluated the finite-sample performance via simulation studies and clarify its small-sample problems. In addition, we illustrated the robust variance estimator using longitudinal CD4 count data from a randomized double-blind study.

Stroke patients may have a step-to gait pattern during the early stages of gait reacquisition. This gait provides stability, but it is slow and inefficient. Therefore, acquiring step-through gait is desirable for better efficiency as ability improves. This study aimed to examine the relevant factors affecting the acquisition of step-through gait pattern in subacute stroke patients based on assessments of physical function at admission.This was a retrospective cohort study. A total of 91 patients with hemiplegic stroke, Functional Independence Measure (FIM) gait item of 4 or less on admission, and FIM gait item of 5 or greater on discharge were included. Factors necessary for the acquisition of step-through gait pattern were examined based on the motor function assessed by Stroke Impairment Assessment Set (SIAS) at the time of admission. Gait pattern was defined by the gait step length of the Tinetti Performance-Oriented Mobility Assessment at discharge.Knee-joint extension function on the paralyzed side was determined as a factor associated with the acquisition of step-through gait pattern at discharge [odds ratio 2.24, 95% confidence interval (CI) 1.44‒3.50, P0.001]. The area under the receiver operating characteristic curve for predicting the step-through gait pattern at discharge was 0.786 (95% CI 0.676-0.896, P0.001) for the SIAS knee joint score at admission; the optimal cut-off score being 2 or greater (sensitivity 81%, specificity 61%).Knee function on the paralyzed side in subacute stroke patients is an independent predictor for the acquisition of step-through gait pattern.

ImportanceThe risk of premature infants in neonatal incubators exposed to evaporated alcohol from alcohol-based disinfectants (ABDs) is unknown.ObjectiveTo assess alcohol concentrations in the peripheral blood of premature infants and neonatal incubators.Design, Setting, and ParticipantsA quality improvement study comparing 2 different populations before and after introduction of ABD practice (ABD-PRAC) was conducted in a neonatal intensive care unit of a single tertiary hospital in Japan. Participants included premature infants who were born before 34 weeks of gestational age and received medical care in neonatal incubators. The study consisted of 3 periods: (1) September 1, 2020, to August 1, 2021 (prospective observation of pre–ABD-PRAC, (2) August 2 to August 22, 2021 (introduction of ABD-PRAC to medical staff and parents in the neonatal intensive care unit), and (3) August 23, 2021, to March 31, 2022 (prospective observation of post–ABD-PRAC). No follow-up studies were initiated.InterventionsAn ABD-PRAC that aimed to reduce alcohol evaporation from ABDs inside neonatal incubators was instituted: (1) place alcohol preps in the incubator just before use and remove them from the incubator as soon as possible and (2) withhold placing hands into the incubators until 60 seconds after using ABDs for disinfection (applied only to family members).Main Outcomes and MeasuresBlood alcohol concentration and evaporated alcohol concentrations in neonatal incubators.ResultsDisinfectant practice was assessed among 28 infants during the pre–ABD-PRAC (17 infants [10 girls]; median gestational age at birth, 29.4 [IQR, 26.3-30.3] weeks) and post–ABD-PRAC (11 infants [3 girls]; median gestational age at birth, 30.0 [IQR, 25.3-32.2] weeks) study periods. The median blood alcohol concentration was 7.0 (IQR, 5.4-9.3) mg/dL pre–ABD-PRAC and 4.2 (IQR, 2.5-7.2) mg/dL post–ABD-PRAC. The median evaporated alcohol concentration inside neonatal incubators during pre–ABD-PRAC during the day was 23.6 (IQR, 15.9-36.5) ppm and, at night, was 13.2 (IQR, 8.9-19.4) ppm; during post–ABD-PRAC, the concentration was 9.4 (IQR, 6.0-16.0) ppm during the day and 5.7 (IQR, 3.6-9.7) ppm at night. The introduction of ABD-PRAC at 22 weeks’ corrected gestational age was associated with a lower blood alcohol concentration in premature infants: regression coefficient value, −8.3 (95% CI, −12.0 to −4.7).Conclusions and RelevanceIn this study, alcohol evaporated from ABDs was absorbed by premature infants in neonatal incubators. The findings suggest that introduction of ABD-PRAC was associated with lower alcohol concentrations in neonatal incubators and in the blood of premature infants.

With ageing, normal human tissues experience an expansion of somatic clones that carry cancer mutations1-7. However, whether such clonal expansion exists in the non-neoplastic intestine remains unknown. Here, using whole-exome sequencing data from 76 clonal human colon organoids, we identify a unique pattern of somatic mutagenesis in the inflamed epithelium of patients with ulcerative colitis. The affected epithelium accumulates somatic mutations in multiple genes that are related to IL-17 signalling-including NFKBIZ, ZC3H12A and PIGR, which are genes that are rarely affected in colon cancer. Targeted sequencing validates the pervasive spread of mutations that are related to IL-17 signalling. Unbiased CRISPR-based knockout screening in colon organoids reveals that the mutations confer resistance to the pro-apoptotic response that is induced by IL-17A. Some of these genetic mutations are known to exacerbate experimental colitis in mice8-11, and somatic mutagenesis in human colon epithelium may be causally linked to the inflammatory process. Our findings highlight a genetic landscape that adapts to a hostile microenvironment, and demonstrate its potential contribution to the pathogenesis of ulcerative colitis.

Deep-ultraviolet continuous-wave photoluminescence spectroscopy is performed for nano-polycrystalline diamond (NPD) synthesized by a high pressure high-temperature technique. NPD exhibits clear dee...

Purpose: To assess the impact of the updated Bosniak classification (BC2019) for cystic renal masses (CRMs) on interobserver agreement between radiologists and urologists and the diagnostic value of adding MRI to CT examination (combined CT/MRI).Method: This study included 103 CRMs from 83 consecutive patients assessed using contrast-enhanced CT and MRI between 2010 and 2016. Nine readers in three groups (three radiologists, three radiology residents, and three urologists) reviewed CT alone and the combined CT/MRI using BC2019. Bosniak category was determined by consensus in each group for diagnosing malignancy, with a cut-off category of ?>= III. Interobserver agreement was assessed using Fleiss' kappa values. The effect of CT or combined CT/MRI on the diagnosis of malignancy was assessed using McNemar's test.Results: Interobserver agreement of BC2019 for CT alone was substantial for radiologists and residents, moderate for urologists (0.77, 0.63, and 0.58, respectively). Interobserver agreement of BC2019 for combined CT/MRI was substantial for all three groups (radiologists: 0.78; residents: 0.65; and urologists: 0.61). Among residents, the sensitivity/specificity/accuracy rates of combined CT/MRI vs. CT alone were 82.1/74.7/76.7% vs. 75.0/66.7/68.9%, and specificity and accuracy were significantly higher for combined CT/MRI than that for CT alone (p = 0.03 and 0.008, respectively). Similarly, sensitivity/specificity/accuracy values were significantly higher for combined CT/MRI among urologists (78.6/73.3/74.8% vs. 64.3/64.0/64.1%, p = 0.04/0.04/0.008). However, sensitivity/specificity/accuracy did not significantly differ between the two among radiologists (89.3/74.7/78.6% vs. 85.7/73.3/76.7%, p = 0.32/0.56/0.32).Conclusions: Combined CT/MRI is useful for diagnosing malignancy in patients with CRMs using BC2019, especially for non-expert readers.

In the mouse intestinal epithelium, Lgr5Transcriptional heterogeneity among colonic epithelial cells was analyzed by means of single-cell RNA sequencing analysis of human and mouse colonic epithelial cells. To trace the fate of human colonic stem or differentiated cells, we generated LGR5-tdTomato, LGR5-iCasase9-tdTomato, LGR5-split-Cre, and KRT20-ERCreER knock-in human colon organoids via genome engineering. p27Single-cell RNA sequencing analysis illuminated the presence of nondividing LGR5Our results highlight the quiescent nature of human LGR5

To elucidate the microscopic origin of the thermal droop, a blue-emitting indium gallium nitride (InGaN) quantum well grown on epitaxially laterally overgrown gallium nitride was investigated using temperature-dependent microphotoluminescence spectroscopy. Below 300 K, the sample exhibited a well-known dislocation-tolerant luminescence behavior. However, as temperature increases from 300 K to 500 K, the near band-edge emission at the wing region (with lower threading dislocation densities) was stronger than that at the seed region (with higher threading dislocation densities), indicating that threading dislocations are the microscopic origin of the thermal droop. Considering the carrier diffusion length, edge-type threading dislocations should play a major role in the thermal droop of heteroepitaxially grown InGaN-based LEDs.

The radiative recombination efficiency (RRE) of AlGaN quantum wells on epitaxially laterally overgrown AlN/sapphire templates was investigated by picosecond-laser–excited photoluminescence (PL) spectroscopy under selective and non-selective excitation conditions. The PL efficiency, which was deduced by excitation-power-dependent PL measurements at low temperature (LT) and room temperature (RT), was unity at LT under both excitation conditions; However, at RT, the PL efficiency under non-selective excitation conditions was lower than that under selective excitation conditions. Time-resolved PL measurements revealed that, under non-selective excitation conditions, additional carriers are provided from the surrounding layers to the quantum-well layers, especially at LT. Therefore, at RT, the PL efficiency does not correspond to the RRE under non-selective excitation conditions. We propose a model to explain carrier dynamics under the two excitation conditions showing that the PL efficiency equals the RRE under selective excitation conditions.

To assess the relationship between spinal reflexes and motor function in sub-acute (SAS) and chronic stroke (CS) patients.Twelve SAS and 16 CS patients underwent electrophysiological assessment of heteronymous facilitation (HF), heteronymous inhibition (HI), disynaptic reciprocal inhibition (DRI), and D1 inhibition (D1). The Fugl-Meyer Assessment Lower Extremity (FMA-LE) and modified Ashworth scale (MAS) were assessed. The relationship between spinal reflexes and motor function was examined in a cross-sectional manner. SAS patients were also longitudinally evaluated before and after intensive rehabilitation for approximately 2 months.SAS patients with triceps surae muscle spasticity (MAS ≥ 1) showed higher HF values (p = 0.03) than those without spasticity. SAS patients with quadriceps muscle spasticity showed higher HF values (p 0.01); patients with hamstring muscle spasticity showed higher DRI value (disinhibition) (p 0.01) than those without spasticity. CS patients showed no significant correlation between spinal reflexes and motor function. The longitudinal study revealed a significant correlation between increase in D1 inhibition and FMA-LE improvement in SAS patients (r = 0.69).The association between impaired spinal reflexes varies with the stage of stroke; HF and DRI may be spasticity indicators in SAS patients.Spinal reflexes as potential biomarkers may facilitate tailor-made rehabilitation of stroke patients.

Denosumab has been shown to be highly effective at suppressing the progression of giant cell tumor of bone (GCTB). However, recent studies have observed a potential increased risk of local recurrence after surgery following the use of denosumab, raising concerns on the use of this agent against GCTB in combination with surgery.We retrospectively reviewed the medical records of 234 patients with GCTB who were surgically treated at multiple institutions from 1990 to 2017. Patient background, tumor characteristics, treatment methods, local recurrence-free survival rate, distant metastasis rate, oncologic outcome, and limb function at final follow-up were analyzed and compared between cases treated with and without denosumab.The 3-year local recurrence-free survival rate was significantly lower in patients who underwent preoperative denosumab therapy (35.3%) compared with those treated without denosumab (79.9%) (P0.001). Among patients who were preoperatively treated with denosumab, those who had a local recurrence all underwent curettage surgery.Preoperative denosumab therapy in combination with curettage surgery was significantly associated with an increased risk of local recurrence in Campanacci grade 3 tumors. Our data suggest that clinicians seeing GCTB patients should be aware to this increased risk when planning preoperative denosumab therapy.

A retrospective cohort study OBJECTIVE: To establish a logarithmic model to predict functional independence after spinal cord injury.The National Hospital Organization, Murayama Medical Center, Japan.Thirty-one adults with a traumatic spinal cord injury (SCI) were enrolled. The Spinal Cord Independence Measure (SCIM) III scores obtained at month 1 and 3 after admission were used to construct a simple logarithmic model to predict SCIM III scores. The validity of the predicted scores was evaluated using a linear mixed model, and agreement between the predicted and measured scores were assessed using the Bland-Altman analysis.In the linear mixed model, the fixed effect slope [95% CI] and the intercept [95% CI] were 1.18 [0.78, 1.58] and -1.75 [-10.3, 6.83], respectively. The scatter plot showed non-linear correlation between the predicted and actual SCIM III scores. This non-linearity became inconspicuous when Sphincter Management scores were omitted. The fixed effect slope and the intercept were 1.12 [0.89, 1.36] and -1.64 [-4.95, 1.68], respectively. A significant fixed or proportional bias was not identified on the Bland-Altman analysis of the total SCIM III score, with most scores lying between an upper limit of +15.3 and a lower limit of -19.3.The logarithmic model provided an accurate prediction of the functional independence score of individuals with SCI in our cohort which included various neurological levels and severity of the injury. Along with its simplicity, our prediction model could be useful in daily practice.

Polyuria in post-kidney transplant (KT) patients is a common condition generally attributed to delayed tubular function, fluid administration, and solute diuresis. Since excessive water intake post-KT physiologically suppresses arginine vasopressin (AVP) secretion, central diabetes insipidus (CDI) caused by deficient primary AVP release can be overlooked. Although DDAVP (desmopressin) - a selective AVP V2 receptor agonist - has been used to treat massive polyuria, CDI rarely progresses to kidney injury due to the preservation of fluid balance by thirst-dependent osmoregulation. Administration of DDAVP in post-KT recipients with mild polyuria and subclinical CDI is difficult to assess, and whether long-term use of DDAVP is beneficial for the transplanted kidney has not been established. We present the case of a 36-year-old Japanese female who was diagnosed with subclinical/partial CDI post KT. CDI was caused by a sequela of suprasellar germinoma. Graft function gradually declined without evidence of hypovolemia or hypernatremia, and a kidney biopsy revealed advanced ischemic kidney injury. Although daily oral DDAVP administration did not increase extracellular fluid volume, treatment resulted in a gradual improvement of graft function, and a follow-up transplanted kidney biopsy indicated substantial recovery.

Photoluminescence spectroscopy using a scanning near-field optical microscope (SNOM) is a powerful technique to study luminescence properties of III-Nitride semiconductors. To date, we have developed a SNOM with an excitation and a detection wavelength of 210 nm and >220 nm, respectively.[1] The deep-ultraviolet (DUV) SNOM has the shortest operation wavelength ever reported and visualizes the localized emission nature of Al-rich AlGaN quantum wells with a spatial resolution exceeding 150 nm. In the presentation, recent progresses of our study using the DUV-SNOM are given. [1] Ishii et al., APL Photonics 4, 070801 (2019).

Cancer relapse after chemotherapy remains a main cause of cancer-related death. Although the relapse is thought to result from the propagation of resident cancer stem cells

Background and Purpose: Limited research has been conducted with the aim of understanding which upper extremity movements are difficult for persons with severe chronic stroke. The purpose of this study was to test the structure of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) using Rasch analysis in persons with chronic stroke with moderate to severe deficits and to determine the item difficulty hierarchy. Methods: This was a secondary analysis of data from previous randomized, controlled trials, or clinical trials. The participants were 101 persons with chronic stroke with moderate to severe hemiparesis (time after onset of stroke, 1375.3 ± 1157.9 days; the 33-item FMA-UE, 31.1 ± 12.8). Principal component analysis and infit statistics were used to evaluate dimensionality. Rasch analysis using a rating scale model was performed, and item difficulty was determined. Results: Six misfit items were removed. The results showed that the 27-item FMA-UE was unidimensional. Rasch analysis showed that the movements performed within synergies were among the easiest items. Shoulder and elbow movements were among the easiest items, whereas forearm and wrist movements were among the moderately to most difficult items. Hand items spanned various difficulty levels. Discussion and Conclusions: The FMA-UE is a valid assessment tool of upper extremity motor function in persons with chronic stroke with moderate to severe deficits. The results showed that item difficulty was consistent with the stepwise recovery course proposed by Fugl-Meyer. The movements that are difficult for patients with moderate to severe chronic paresis were determined, which would enable comparison of each movement using a measure of motion difficulty in future studies.

Objectives To determine the usefulness of hsa-miR-346, a potential biomarker enhancing the activity of non-tuberculous mycobacterial diseases, as a biomarker of tuberculosis activity. Methods We investigated whether hsa-miR-346 is secreted by human macrophages infected with Mycobacterium tuberculosis (M. tuberculosis) in an in vitro study. In addition, a cross-sectional study was conducted first to evaluate whether serum hsa-miR-346 is elevated in patients with tuberculosis compared with that in healthy individuals. Second, we conducted a retrospective study to evaluate whether anti-tuberculosis treatment reduces serum hsa-miR-346 levels. Results Log hsa-miR-346 levels were significantly elevated in the supernatant of human macrophages infected with M. tuberculosis in a dose-dependent manner. The mean serum log hsa-miR-346 levels were −15.48 (−15.76 to −15.21) in patients with tuberculosis and −16.12 (−16.29 to −15.95) in healthy volunteers, which significantly differed. In addition, hsa-miR-346 significantly decreased at 2 months from starting an anti-tuberculosis treatment. Conclusions We consider hsa-miR-346 as a potential biomarker enhancing the tuberculosis activity.

Background: Somatosensory impairment is common in patients who have had a stroke and can affect their motor function and activities of daily living (ADL). Therefore, detecting and treating somatosensory impairments properly is considered to be very important, and various examinations have been developed. However, the reliability and validity of few of them have been verified due to differences in the procedure of each examiner or poor quantification by the examination itself.Objective: We hypothesized that, with fixed procedures two convenient clinical examinations, the Semmes-Weinstein Monofilament Test (SWMT) and the Thumb Localizing Test (TLT), could provide reliable assessments of light touch sensation and proprioception. The purpose of this study was to verify the reliability and validity of these two examinations as indices of somatosensory impairment of the upper extremity (UE) in patients with chronic post-stroke hemiparesis.Methods: Fifty patients with chronic stroke (median time after onset of stroke, 848 [474–1708] days, mean age 57 [standard deviation 14] years) were enrolled at Keio University Hospital from 2017 to 2018. Examiners learned the original method of the SWMT and the TLT rigorously and shared it with each other. The TLT procedure was partially modified by dividing the location of the patient's thumb into four spaces. Two examiners evaluated the SWMT and the TLT for 2 days, and intra-rater and inter-rater reliabilities were calculated using weighted kappa statistics. In addition to this, the evaluator size score of the SWMT was assessed with Bland-Altman analysis to evaluate systematic bias. The Stroke Impairment Assessment Set (SIAS) sensory items were used to assess validity, and Spearman's rank correlation coefficients were calculated.Results: Intra/inter-rater agreements of the SWMT grade score were 0.89 (thumb, 95%CI: 0.83–0.95)/ 0.75 (0.60–0.91) and 0.80 (index finger, 0.67–0.93)/0.79 (0.66–0.92), and of the TLT they were 0.83 (navel level proximal space, 0.71–0.95)/ 0.83 (0.73–0.92), 0.90 (navel level distal space, 0.85–0.96)/ 0.80 (0.69–0.90), 0.80 (shoulder level proximal space, 0.68–0.92)/ 0.77 (0.65–0.89), and 0.87 (shoulder level distal space, 0.80–0.93)/ 0.80 (0.68–0.92) (P < 0.001, each item). All of them showed substantial agreement, but the MDC of the SWMT evaluator size was 1.28 to 1.79 in the inter-rater test and 1.94–2.06 in the intra-rater test. The SWMT grade score showed a strong correlation with the SIAS light touch sensation item (r = 0.65, p < 0.001), as did the TLT with the SIAS position sense item (r = −0.70–0.62, p < 0.001 each space).Conclusions: The reliability and validity of the SWMT and the TLT were verified. These tests can be used as reliable sensory examinations of the UE in patients with chronic stroke, and especially for the SWMT, it is more reliable for screening.

To resolve the discrepancies in the exciton fine structure of aluminum nitride (AlN), polarization- and angle-resolved photoluminescence (PL) spectroscopies are performed. The excitonic PL spectra strongly depend on the optical polarization and detection angle. We propose that both the long-range and short-range electron-hole exchange interaction should be used to interpret the luminescence spectra. The theoretical framework fully explains the present and previous experimental results. The large longitudinal-transverse splitting energy obtained in this study suggests that AlN has strong light-matter coupling without quantum-confined structures.

Adenovirus (AdV) infection is a common complication in bone marrow/hematopoietic stem cell transplant and solid organ transplant recipients. AdV infection usually presents as hemorrhagic cystitis, but sometimes it can progress to acute kidney injury showing AdV nephritis (AdVN). We present the case of a 52-year-old Japanese female who had received a living kidney transplantation (KT) from her husband. At 21 months post-KT, the patient presented with a fever, but no renal dysfunction and no abnormal urine findings. A contrast-enhanced computed tomography (CT) scan revealed a few mass lesions with hypoperfusion in the transplanted kidney. An enhanced CT-guided biopsy targeting one of these lesions revealed a necrotizing tubulointerstitial nephritis suggesting AdVN. The polymerase chain reaction tests for ADV were negative in a urine sample but positive in the sera and the frozen kidney biopsy samples. AdVN can manifest as an unusual pattern of acute lobar nephritis/acute focal bacterial nephritis-like localization without symptoms of acute kidney injury or urinary tract infection. Enhanced CT can provide clues for clinical diagnosis.