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In this study, the CCD response surface methodology was used to model and optimise the performance of Lasienthera africanum leaves extract (LALE) as a corrosion inhibitor on mild steel. The experimental parameters were assessed at different immersion time and inhibitor concentration to determine the optimum conditions for corrosion mitigation. Using experimental results of the corrosion characteristics such as the weight loss, corrosion rate, and inhibition efficiency of LALE, new models were developed, the significance of which was tested using variance analysis. The developed RSM models of WL, CR, and IE were accurate and reliable, and their P-values were 0.0001, which is less than 0.05. Likewise, the R2-statistics (R2, adjusted-R2, and predicted-R2), adequate precision, and diagnostic plots were also used as a means to ascertain the degree of accuracy and adequacy of the WL, CR, and IE models. In addition, optimization of the corrosion inhibition process for LALE revealed that the optimum conditions for maximum IE, minimum WL, and CR were achieved at a concentration of 93.93 ppm and an immersion time of 228 hrs. Under these settings, the inhibition efficiency, weight loss, and corrosion rate were 93.85%, 0.294g and 3.267 mm/y, respectively. Therefore, the models are considered ideal for prediction with a confidence level of 95%, and the optimal combination is suitable for the corrosion inhibition process design. Hence these models can be recommended for applications such as oil well acidizing and pickling pipelines.

Background: The aim of this study was to evaluate the accuracy and added value of specimen tomosynthesis (ST) to specimen ultrasound (SUS) in margin assessment of excised breast specimens in breast-conserving therapy for non-palpable US-visible breast lesions.Materials: Between January 2018 and August 2019, all consecutive patients diagnosed with non-palpable breast cancer visible by ultrasound (US), treated with breast-conserving surgery (BCS) and requiring radiological intraoperative breast specimen assessment, were included in this study. Excised breast specimens were examined with SUS by radiologists blinded to the ST results, and margins smaller than 10 mm were recorded. STs were evaluated retrospectively by experienced radiologists.Results: A total of 120 specimens were included. SUS showed a statistically significant correlation with pathological margin measurements, while ST did not and provided no additional information. The odds ratios (ORs) for SUS to predict a positive margin was 3.429 (confidence interval (CI) = 0.548–21.432) using a 10-mm cut-off point and 14.182 (CI = 2.134–94.254) using a 5-mm cut-off point, while the OR for ST were 2.528 (CI = 0.400–15.994) and 3.188 (CI = 0.318–31.998), respectively.Conclusions: SUS was superior in evaluating intraoperative resection margins of US-visible breast resection specimens when compared to ST. Therefore, ST could be considered redundant in applicable situations.

This study assessed the significance of hands-on-training (HoT) and questionnaire-based surveys on 3D image-guided brachytherapy (3D-IGBT) and a combination of intracavitary and interstitial brachytherapy, the so-called ‘hybrid’ BT (HBT), in uterine cervical cancer. In October 2023, 29 radiation oncologists, nurses, radiologic technologists and medical physicists from 10 Japanese facilities participated in an HoT on 3D-IGBT and HBT. Questionnaires were distributed to each participant before and after the HoT, and feedback was obtained through online channels. The questionnaire response rate was 83% (24/29), with at least one participant responding from each facility. ‘Insertion of applicators and needles’, ‘human resource shortage’ and ‘pain relief and sedation’ were the primary concerns of radiation oncologists. ‘Applicator reconstruction’, ‘ optimization of dwell positions’, ‘ treatment planning’ and ‘ human resource shortages ’ were the primary concerns of radiological technologists and medical physicists. The HoT content was adjusted according to the results of preliminary surveys. The concerns expressed by the participants were addressed during the lectures and practical training. Significant reductions in anxiety were observed toward all items of the 10-point self-assessment after the HoT, regardless of the profession. The average score on satisfaction with the HoT (on a 10-point scale) was 9.52 (minimum of 8 and maximum of 10). In conclusion, HoT tailored in response to a pre-questionnaire-based survey effectively reduced participants’ anxiety regarding the implementation of 3D-IGBT and HBT.

Identifying the mechanisms of action of anticancer drugs is an important step in the development of new drugs. In this study, we established a comprehensive screening platform consisting of 68 oncogenes (MANO panel), encompassing 243 genetic variants, to identify predictive markers for drug efficacy. Validation was performed using drugs that targeted EGFR, BRAF, and MAP2K1, which confirmed the utility of this functional screening panel. Screening of a BRCA2-knockout DLD1 cell line (DLD1-KO) revealed that cells expressing SMOand GLI1were resistant to olaparib. Gene set enrichment analysis identified genes associated with DNA damage repair that were enriched in cells overexpressing SMOand GLI1. The expression of genes associated with homologous recombination repair (HR), such as the FANCfamily and BRCA1/2, was significantly upregulated by GLI1expression, which is indicative of PARP inhibitor resistance. Although not all representative genes of the nucleotide excision repair (NER) pathway were upregulated, NER activity was enhanced by GLI1. The GLI1 inhibitor was effective against DLD1-KO cells overexpressing GLI1both in vitro and in vivo. Furthermore, the combination therapy of olaparib and GLI1 inhibitor exhibited a synergistic effect on DLD1-KO, suggesting the possible clinical application of GLI1 inhibitor targeting cancer with defective DNA damage repair. This platform enables the identification of biomarkers associated with drug sensitivity, and is a useful tool for drug development.

IMPORTANCE: Substantial heterogeneity exists in treatment recommendations across molecular tumor boards (MTBs), especially for biomarkers with low evidence levels; therefore, the learning program is essential. OBJECTIVE: To determine whether a learning program sharing treatment recommendations for biomarkers with low evidence levels contributes to the standardization of MTBs and to investigate the efficacy of an artificial intelligence (AI)–based annotation system. DESIGN, SETTING, AND PARTICIPANTS: This prospective quality improvement study used 50 simulated cases to assess concordance of treatment recommendations between a central committee and participants. Forty-seven participants applied from April 7 to May 13, 2021. Fifty simulated cases were randomly divided into prelearning and postlearning evaluation groups to assess similar concordance based on previous investigations. Participants included MTBs at hub hospitals, treating physicians at core hospitals, and AI systems. Each participant made treatment recommendations for each prelearning case from registration to June 30, 2021; participated in the learning program on July 18, 2021; and made treatment recommendations for each postlearning case from August 3 to September 30, 2021. Data were analyzed from September 2 to December 10, 2021. EXPOSURES: The learning program shared the methodology of making appropriate treatment recommendations, especially for biomarkers with low evidence levels. MAIN OUTCOMES AND MEASURES: The primary end point was the proportion of MTBs that met prespecified accreditation criteria for postlearning evaluations (approximately 90% concordance with high evidence levels and approximately 40% with low evidence levels). Key secondary end points were chronological enhancements in the concordance of treatment recommendations on postlearning evaluations from prelearning evaluations. Concordance of treatment recommendations by an AI system was an exploratory end point. RESULTS: Of the 47 participants who applied, 42 were eligible. The accreditation rate of the MTBs was 55.6% (95% CI, 35.3%-74.5%; P < .001). Concordance in MTBs increased from 58.7% (95% CI, 52.8%-64.4%) to 67.9% (95% CI, 61.0%-74.1%) (odds ratio, 1.40 [95% CI, 1.06-1.86]; P = .02). In postlearning evaluations, the concordance of treatment recommendations by the AI system was significantly higher than that of MTBs (88.0% [95% CI, 68.7%-96.1%]; P = .03). CONCLUSIONS AND RELEVANCE: The findings of this quality improvement study suggest that use of a learning program improved the concordance of treatment recommendations provided by MTBs to central ones. Treatment recommendations made by an AI system showed higher concordance than that for MTBs, indicating the potential clinical utility of the AI system.

IMPORTANCE: Non–small cell lung cancer (NSCLC) with uncommon EGFR mutations is a rare subgroup, composing 14% of all EGFR mutations. OBJECTIVE: To determine the usefulness of osimertinib in previously untreated patients with metastatic NSCLC harboring uncommon EGFR mutations, excluding exon 20 insertion mutations. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, open-label, single-group, phase 2 nonrandomized clinical trial enrolled patients from April 10, 2020, to May 31, 2022, with a follow-up of 6 months from the date the last patient was enrolled. The study enrolled 42 patients with uncommon EGFR mutations, of whom 40 were eligible. INTERVENTION: Osimertinib, 80 mg once daily, was administered orally to patients. MAIN OUTCOMES AND MEASURES: The primary end point was the overall response rate (ORR). The secondary end points were disease control rate (DCR), progression-free survival (PFS), time to treatment failure (TTF), overall survival (OS), duration of response (DoR), and safety of osimertinib. Patients were included in the study on an intention-to-treat basis. RESULTS: Of the 40 eligible patients, 22 were men (55.0%) and the median age was 72 years (range, 39.0-88.0 years). The most common mutations were G719X (20 [50.0%]), S768I (10 [25.0%]), and L861Q (8 [20.0%]). The ORR was 55.0% (90% CI, 40.9%-68.5%) and the DCR was 90.0% (95% CI, 76.3%-97.2%). The median PFS was 9.4 months (95% CI, 3.7-15.2 months) after a median follow-up of 12.7 months (range, 2.7-30.7 months). The median TTF was 9.5 months (95% CI, 5.6-30.3 months), median OS was not reached (NR; 95% CI, 19.3 months to NR), and median DoR was 22.7 months (95% CI, 9.5 months to NR). The ORR for patients with solitary or compound uncommon EGFR mutations was 45.5% (90% CI, 26.9%-65.3%) and 66.7% (90% CI, 43.7%-83.7%), respectively. Median PFS for patients with solitary or compound uncommon EGFR mutations was 5.4 months (95% CI, 3.6-22.7 months) and 9.8 months (95% CI, 5.1 months to NR), respectively. Median OS for patients with solitary or compound uncommon EGFR mutations was 23.0 months (95% CI, 12.3 months to NR) and NR, respectively. Median DoR for patients with solitary or compound uncommon EGFR mutations was 22.7 months (95% CI, 3.6-22.7 months) or NR (95% CI, 5.7 months to NR), respectively. Grade 3 or 4 adverse events were reported by 11 patients (27.5%), and 5 patients (12.5%) developed interstitial lung disease. All adverse events were manageable, and there were no treatment-related deaths. CONCLUSIONS AND RELEVANCE: Osimertinib showed clinical activity with manageable toxic effects among previously untreated patients with metastatic NSCLC harboring uncommon EGFR mutations other than exon 20 insertion mutations. The results support the use of osimertinib as a treatment option for this patient population. TRIAL REGISTRATION: Japan Registry of Clinical Trials Identifier: jRCTs071200002

Welded joints sometimes exhibit poor corrosion resistance due to variations in chemical composition at the weld surface, or heat-affected zone (HAZ) caused by induced stress, and microstructural changes. There is need to enhance weld corrosion resistance and the microstructural properties of such joints through post-weld tempering (PWT). In this study, the effect of PWT on the corrosion resistance and microstructure properties of UNS G10400 carbon steel was investigated. The UNS G10400 samples were cut to the desired dimensions, welded by means of an electric metal arc welding process, and subjected to PWT at 550 °C, 650 °C and 700 °C for 1 h, respectively. The samples were immersed in seawater, and their corrosion resistance and microstructure properties were evaluated using gravimetric techniques, Potentiodynamic polarization (PDP), electrochemical impedance spectroscopy (EIS), and scanning electron microscopy (SEM), respectively. The findings show that the post-weld tempered (PWT) samples exhibited higher corrosion resistance compared to the as-welded samples. The corrosion rate values are 0.1351, 0.06331, 0.06271, and 0.01578 mm/year for as-welded, PWT-550 °C, PWT-650 °C, and PWT-700 °C samples, respectively. The SEM images of PWT samples revealed tempered martensite around the grain boundaries. These results are due to re-crystallization and grain growth resulting from post-weld tempering. Therefore, appropriate post-weld tempering for UNS G10400 carbon steel welded joints is recommended for advanced industrial applications.

Corrosion has severe consequences for the integrity of pipelines used in the petroleum industry. Modelling and optimising the parameters of a circulating fluid are two of the numerous methods for combating corrosion. The objective of this study was to develop a multiphase flow simulation model for estimating the corrosion rate of oil and gas pipelines, considering the erosional effect. In addition to carbon dioxide (CO2) and hydrogen sulphide (H2S) corrosion, the present model also takes into account the impacts of chloride concentrations. The current model evaluates and reflects a comprehensive understanding of corrosion in a saline environment, making it readily applicable for estimating corrosion rates for industrial applications. The model's results indicate a prediction accuracy of about 85%. Field data gathered under a broad range of environmental conditions confirms the model's prediction accuracy. The predictions from the present model are in good agreement with the field data. In addition, the present model was found to be more effective than the model created by Dewaard and Milliam. This research is likely to have widespread applications in the oil and gas industry for predicting more accurate corrosion rates.

The uterus is known as one of the moving organs. We evaluated the movement of the uterus during irradiation and the effects of changes in the surrounding organs using a magnetic resonance (MR)-guided radiotherapy system. Seven patients with cervical cancer underwent pre- and posttreatment MR imaging to assess changes in the positioning of the uterus and cervix as well as the alterations in bladder and rectal volume. The study revealed that the movements of the uterus were greater than that of the cervix and showed a tendency to correlate with the bladder rather than the rectum. We also examined whether intrafractional motion could lead to insufficient dose coverage of the clinical target volume (CTV), specifically focusing on the D98%of the CTV in the uterine body and cervix. The impact of intrafractional motion on the D98%varied among patients, with one out of the seven patients experiencing an average dosimetric change of −2.6 Gy in the uterus, although larger planning target volume margins of 1.5 cm were applied, therefore, indicating the need for individualized optimal margins in each case. Online adaptive radiotherapy offers the advantage of modifying the treatment plan when irradiating moving organs, such as the uterus. However, it should be noted that this approach may result in longer overall treatment times compared with the traditional methods. Therefore, we must carefully consider the influence of intrafractional organ motions when opting for such a treatment.

Spindle cell lipoma (SCL) is a benign, slow-growing tumor developing from the subcutaneous tissue of the upper back, the posterior neck, or shoulder region, usually occurring in middle-aged or older men as a solitary nodule. However, the involvement of the oral cavity, particularly the tongue, has seldom been reported. SCL is microscopically characterized by a mixture of mature adipocytes and bland spindle cells against a fibromyxoid background. Here, we describe two rare cases of multiple SCLs involving the bilateral margins of the tongue and a literature review. The patients were 72- and 86-year-old Japanese male patients with multiple painless soft nodules on the bilateral margins of the tongue. Excisional biopsy confirmed the diagnosis of SCL, and the tumors were resected. No recurrence was noted at the 12-month follow-up. SCLs of the tongue should be distinguished from other fat-containing spindle cell neoplasms that can develop at this anatomical site.

We built a Kaleckian dynamic model that can comprehensively analyse the growth, distribution, and employment rate of the government's social infrastructure and debt accumulation. The model allows for not only wage-led growth and profit-led growth regimes but also labour-market-led and goods-market-led distribution regimes. Particular attention is paid to the demand effects of fiscal policy and the productivity growth effect of social infrastructure investment. Our model derives the following results. A combination of alternative growth and distribution regimes is important for stability. When government debt also changes in the long-run, the Domar condition is required for stability. Despite the principally Kaleckian nature, the long-run economic growth rate depends not on demand or fiscal parameters but on supply-side parameters. We conclude that the government can still play an important role in stabilising the economy, improving the quality of social infrastructure, and achieving a resilient economy.

Graphical abstract:

The trigeminocardiac reflex (TCR) in maxillofacial surgical procedures can occasionally lead to sudden bradycardia in response to the manipulation of maxillofacial bony structures. However, asystole induced by TCR during maxillofacial surgery has rarely been reported. Here, we report an extremely rare case of ventricular asystole induced by the TCR in a 56-year-old female patient, which was caused by zygomatic fracture repositioning during the surgical repair of a zygomaticomaxillary complex fracture. Chest compressions that were performed immediately by the oral-maxillofacial surgeons was successful, and an electrocardiogram confirmed the patient’s return to sinus rhythm. The patient’s postoperative clinical course was unremarkable.

Osteochondromas (OCs) are rare benign tumors of the temporomandibular joint (TMJ) area, while synovial chondoromatoses are rare benign tumor-like disease. Few reports on the simultaneous development of an OC and synovial chondromatosis have been published. We describe here an extremely rare case of facial asymmetry caused by an ipsilateral OC and synovial chondromatosis at the TMJ. A patient was referred to our department with a chief complaint of malocclusion. Cephalometric photographs showed facial morphological asymmetry, and computed tomography imaging revealed a left condylar head tumor and multiple calcified lesions in the superior joint space. A dentofacial deformity induced by a tumor at the left condylar head and synovial osteochondromatosis at the left TMJ was diagnosed. He initially underwent condylectomy and tumorectomy. Histopathologically, the mandibular surface was elevated and capped with cartilage that exhibited weak atypia and a low cell density. The bone beneath the cartilage cap was thickened, but no atypia was noted. In the second surgical step, bilateral sagittal split ramus osteotomy was performed to improve the facial appearance and achieve normal occlusion. Finally, three dental implants were inserted to replace missing teeth for oral rehabilitation. Three years have passed since the completion of all treatments, and the patient is progressing well without recurrence of the TMJ tumor or mandibular deviation. Mandibular movement is normal, and the final occlusion and facial appearance remain satisfactory.

This study aimed to investigate whether the immunosenescence-related score is a critical prognostic predictor of anti-programmed cell death protein 1 (PD-1) axis inhibitors in elderly patients with advanced non-small cell lung cancer (NSCLC).

Objective:We aimed to assess seasonal and age-related variations in sleep quality using Fitbit data and offer lifestyle recommendations for enhancing winter sleep quality. Methods:Fitbit sleep and activity data of 51 participants randomly recruited from members of the Association for Research in Supporting System of Chronic Disease, a nonprofit organization in the Yamanashi Prefecture of Japan, were collected and retrospectively analyzed from July to December 2022. Sleep stage targets were set at 10% to 25% for deep sleep, 50% to 60% for shallow sleep, and 20% to 25% for REM sleep. Participants were categorized into improved, unchanged, and worsened groups based on sleep stage unit changes between August and December. Results:The median (interquartile range) age was 71 (68–74) years old. There were eight participants in the improved group, 23 in the unchanged group, and nine in the worsened group. The improved group showed significantly more steps (990 ± 1,102 steps/day, p= .039) in December than in August, while the worsened group showed fewer steps (−507 ± 1,638 steps/day, p= .38). Conclusion:Increasing step count in winter may improve sleep quality, as assessed by sleep stage. Further research considering potential confounders and factors affecting winter sleep is needed to support and extend these findings.

Reactions of Et2NSiPh2B(pin) with [Pd(PCy3)2] and [Pt(PCy3)2] produce dinuclear Pd(0) and Pt(0) complexes bearing a bridging diphenylsilylene ligand, [{M1(PCy3)}{M2(PCy3)2}(μ-SiPh2)] (1-Pd2, M1= M2= Pd; 1-PdPt, M1= Pd, M2= Pt; 1-Pt2, M1= M2= Pt), and a trinuclear Pd complex, [{Pd(PCy3)}3(μ-SiPh2)(μ3-SiPh2)] (2), depending on the conditions used. X-ray crystallographic studies of 1-Pd2, 1-PdPt, and 1-Pt2show that the molecules contain an almost linear P–M–M–P arrangement with P–M–M angles in the range of 157–168°. The distance between two metal centers decreased in the order of 1-Pd2> 1-PdPt> 1-Pt2. Complex 2is composed of a bent Pd3backbone with a Pd–Pd–Pd angle of 110°. All Pd atoms are bridged by a SiPh2ligand, while two of them are bridged by another SiPh2ligand. Complex 1-Pd2catalyzes the 1:2 cycloaddition of Et2NSiPh2B(pin) with HC≡CPh to form 2,4- and 3,4-disubstituted siloles. A similar reaction with HC≡CtBu afforded a mixture of the corresponding siloles and alkynyl(alkenyl)diphenylsilane, (tBuC≡C)(tBuCH═CH)SiPh2(5c). The yields and selectivities of the products are lower than those obtained in the previously reported reactions catalyzed by the Pd–PPh3catalytic system. The stoichiometric reactions of HC≡CtBu and HC≡CSiMe3with 1-Pt2trigger a C–H(sp) bond activation process to occur to form complexes with the alkynyl ligand, [{PtH(PCy3)}{Pt(PCy3)}(μ-SiPh2)(μ-η1,η2-C≡CR)] (6b, R =tBu; 6c, R = SiMe3) at room temperature. Complex 6creacts with alkynes at 70 °C to form complexes bearing the bridging alkenylsilyl ligand, [{Pt(PCy3)}2{μ-η1,η2-SiPh2C(SiMe3)═CH2}(μ-η1,η2-C≡CR)] (7b, R =tBu; 7c, R = SiMe3). Complex 7cundergoes reductive elimination of alkynyl(alkenyl)diphenylsilane upon the addition of a diphosphine ligand. The reaction of dimethyl acetylenedicarboxylate with 1-Pt2gives a diplatinum complex with a silaplatinacyclohexadiene structure, [{(Cy3P)Pt(CZ═CZSiPh2CZ═CZ)Pt(PCy3)}(μ-η1,η2-CZ≡CZ)] (8, Z =CO2Me). The mechanisms of the stoichiometric and catalytic reactions are discussed based on our experimental results.

Liquid biopsy can identify gene alterations that are associated with resistance to fusion gene-targeted treatments. In this study, we present three cases of advanced non-small cell lung cancer (NSCLC) harboring gene fusions; cell-free DNA (cfDNA) was used to assess the resistance mutations. A patient with METamplification underwent RET-fusion NSCLC treatment with selpercatinib. A patient with ROS1G2032R underwent ROS1-fusion NSCLC treatment with crizotinib. A patient who underwent ROS1-fusion NSCLC treatment with crizotinib harbored no somatic mutations. This case series shows that cfDNA analysis can identify potentially actionable genomic alterations, after disease progression, in targeted therapy for fusion genes.

Administration of 400 mg pembrolizumab every 6 weeks (400 mg Q6W) has been approved on the basis of the results of simulated pharmacokinetic modeling and exposure–response analyses. Nevertheless, the safety of switching dosage from 200 mg every 3 weeks (Q3W) to 400 mg Q6W during treatment remains unclear.

Background: We previously reported that supplementation with multivitamins (vitamin B complex, vitamin C, and vitamin E) at multiples of the Recommended Dietary Allowance (RDA) significantly decreased the risk of adverse pregnancy outcomes among HIV-infected women. The minimum dosage of multivitamins necessary for optimal benefits is unknown. Objective: We investigated the efficacy of multivitamin supplements at single compared with multiple RDAs on decreasing the risk of adverse pregnancy outcomes among HIV-infected women. Design: We conducted a double-blind, randomized controlled trial among 1129 HIV-infected pregnant women in Tanzania. Eligible women between 12 and 27 gestational weeks were randomly assigned to receive daily oral supplements of either single or multiple RDA multivitamins from enrollment until 6 wk after delivery. Results: Multivitamins at multiple and single doses of the RDA had similar effects on the risk of low birth weight (11.6% and 10.2%, respectively; P = 0.75). We found no difference between the 2 groups in the risk of preterm birth (19.3% and 18.4%, respectively; P = 0.73) or small-for-gestational-age (14.8% and 12.0%, respectively; P = 0.18). The mean birth weights were similar in the multiple RDA (3045 [+ or -] 549 g) and single RDA multivitamins group (3052 [+ or -] 534 g; P = 0.83). There were no significant differences between the 2 groups in the risk of fetal death (P = 0.99) or early infant death (P = 0.19). Conclusion: Multivitamin supplements at a single dose of the RDA may be as efficacious as multiple doses of the RDA in decreasing the risk of adverse pregnancy outcomes among HIV-infected women. This trial was registered at clinicaltrials.gov as NCT00197678. Am J Clin Nutr 2010;91:391-7. doi: 10.3945/ajcn.2009.28483.

Rotational isomerism of 4 amide moieties of the threaded macrocyclic component of [2]rotaxanes featuring mono- and bis-ammonium moieties in dumbbell-shaped axle components was investigated in response to base, and the rotational isomerization of both rotaxanes could be controlled reversibly through the addition of appropriate amounts of base and acids.Graphical AbstractRotational isomerism of 4 amide moieties of the threaded macrocyclic component of [2]rotaxanes featuring mono- and bis-ammonium moieties in the dumbbell-shaped axle components was investigated in response to base, and the rotational isomerism of both rotaxanes could be controlled reversibly through the addition of appropriate amounts of base and acids.

Robert Boyer, a leader in régulationtheory, characterizes the crisis provoked by the COVID-19 pandemic in his latest book. His analysis centers on the political process in which different groups of entities with heterogeneous interests compete against each other and make compromises, and on the interaction of different processes affecting public health, the economy, finance, and freedom. In this book review, we carefully introduce the main argument in the book (which has been published in French) in English to help readers understand its message, and we consider several points to apply the theoretical conjecture proposed in the book to actual issues, especially in Japan. In particular, we investigate the following issues: the actual diversity of national economies from the perspective of the “trilemma,” the current situation of Japan as an embryo of the anthropogenetic development mode, and the issue of ecology to scrutinize the future of capitalism.

High body mass index (BMI) has been reported to be associated with the efficacy of immune checkpoint inhibitors in patients with advanced non-small cell lung cancer (NSCLC), but the association between BMI and efficacy of anti-PD-1 inhibitors remains controversial. The present study investigated this association in patients with advanced NSCLC.

Byline: Yoichi Tabira, Toshitada Okuma, Keiichiro Kondo, Nobuo Kitamura Abstract: Objective: The aim of this study was to evaluate the indication for 3-field lymphadenectomy (3-field dissection) followed by esophagectomy for locally advanced carcinoma of the thoracic esophagus in the presence of lymph node metastasis. Methods: From January 1983 to December 1995, 86 patients with thoracic esophageal carcinoma invading muscularis propria or adventitia underwent radical subtotal esophagectomy after preoperative chemotherapy. Forty-six of the 86 patients underwent a 2-field dissection (mediastinal and abdominal nodes, group A), and 40 patients underwent a 3-field dissection (bilateral cervical, mediastinal, and abdominal nodes, group B). Survival curves were compared between the 2 groups after stratification according to the degree of lymph node involvement (number of positive nodes and involvement of intrathoracic or intrathoracic recurrent nerve chain nodes). Potential prognostic factors of these 86 patients were evaluated by means of Cox regression analysis. Results: There were no significant differences in age, sex ratio, depth of tumor invasion, pTNM classification, or number of positive nodes between the 2 groups. Among patients with positive intrathoracic nodes, the 5-year survival of group B (42%) was significantly longer than that of group A (13%, generalized Wilcoxon test P = .02). Among patients with 1 to 4 positive nodes, the 5-year survival of group B (54%) was significantly higher than that of group A (22%, P = .01). Multivariate analysis revealed the number of positive nodes, age, and pT4 stage to be significant predictors of survival in patients with thoracic esophageal carcinoma. Conclusions: Three-field dissection for advanced carcinoma of the thoracic esophagus is effective in patients with 1 to 4 positive nodes. (J Thorac Cardiovasc Surg 1999;117:239-45) Author Affiliation: From the First Department of Surgery, Kumamoto University, School of Medicine,.sup.a Kumamoto, and Izumi City Hospital,.sup.b Izumi City, Kagoshima, Japan Article History: Received 10 November 1997; Revised 22 January 1998; Revised 9 July 1998; Accepted 16 September 1998 Article Note: (footnote) [star] Address for reprints: Yoichi Tabira, MD, First Department of Surgery, Kumamoto University School of Medicine, 1-1-1, Honjo Kumamoto City, Kumamoto 860 -0811, Japan., [star][star] 12/1/94637

Mycosis fungoides (MF) is a common, low-grade non-Hodgkin’s lymphoma of skin-homing T lymphocytes that can be treated via skin-directed radiotherapy. Our institution has implemented total skin electron therapy (TSET) with a 4.3 m source-to-surface distance (SSD) and 6 MeV electron beams with a beam spoiler. A 35-year-old male undergoing TSET desired to avoid radiotherapy-induced hair loss and temporary infertility; therefore, leakage dose to scalp and testicles was reduced with a special radiation shield composed of stacked lead sheets. The shields for the scalp and scrotal were of 3 mm and 6 mm, respectively. To assess leakage doses, a radiophotoluminescence glass dosimeter (RPLD) was placed at every fraction. The difference dose between the measured and prescribed dose at the calibration point was 2%. The top of the head and scrotal surface exhibited 18 cGy and 10 cGy, respectively. Thus, the dose to the scrotal surface was not beyond the testicular tolerance dose of 20 cGy. Results of semen analysis two months postradiotherapy were normal. There was no hair loss during or after radiation therapy. Therefore, the RPLD is a useful in vivodosimeter that provides technical information on radiation shielding to allow for completion of TSET without hair loss or temporary infertility.

Chronic subdural hematoma (CSDH) with cerebrospinal fluid hypovolemia syndrome (CHS) remains refractory to standard treatment with hematoma drainage by burr hole and irrigation and/or epidural blood patch. Previously, we reported the utility of middle meningeal artery (MMA) embolization for intractable CSDH. In this study, we present the usefulness of MMA embolization as a treatment for CSDHs with CHSs.

ObjectiveTo understand the progression in parameters of functional electrical stimulation (FES) cycling dosage (including duration, velocity, stimulation amplitudes, power output), and the resulting changes in muscle mass early after acute spinal cord injury (SCI).MethodsThree participants, 24–38 years old, with neurological injury level C4–T4, severity AIS (American Spinal Injury Association Impairment Scale) A–C, started FES cycling 16–20 days post injury while admitted at a level-1 trauma center in Canada, and continued for 8–13 weeks in a rehabilitation hospital. They performed three sessions/week of 15–45 min FES cycling, supine or sitting. FES parameters, cycling performance, and muscle cross-sectional area (CSA) in thighs and calves were measured every 2 weeks.ResultsProgression in power output, but not in session duration, was limited in two participants who experienced stimulation-associated referred pain or apprehension, requiring limitation of stimulation amplitudes for up to 65 days after the start of FES cycling. Participants started with 15 min cycling at 20 RPM with no resistance (0 W), and progressed to 30–45 min at 30 RPM producing 8.8–19.0 W average power/session after 2–3 months. Initially, muscle CSA decreased in all 3 participants (up to 16% after 6 weeks), and recovered later after a variable period of FES cycling (up to 16% at 13.3 weeks).ConclusionProgression of FES cycling in the first 3 months after injury required a highly individualized approach, guided by participant response, rather than standardized increments in stimulation intensity or duration. Changes in muscle CSA did not always correspond with the dose of FES cycling.

Marginal mandibulectomy is the treatment of choice when seeking to preserve mandibular continuity. In some cases, the remaining height of the mandibular body is inadequate to sustain the functional load; mandibular reinforcement with a reconstructive plate is necessary. Treatment planning prior to marginal mandibulectomy is sometimes challenging for the novice surgeon; the risk of complications, including iatrogenic fracture, is high. Additionally, intra- or pre-operative bending of the reconstructive plate on a three-dimensional (3D) model is associated with an unavoidable risk of inaccuracy. Recently, virtual planning using surgical guides and patient-specific implants has become popular. Using image manipulation and 3D design software, the surgeon can now precisely translate the preoperative plan to the operation theater. The reconstruction plate meets the patient’s needs and the surgeon’s desires. Although some limitations remain, surgeons can now work more accurately and efficiently. The patient described in the present report had recurrent ameloblastoma of the right mandibular body; marginal resection and reinforcement with a reconstruction plate were required. We present the workflow from virtual surgical planning to actual surgery. Postoperative computed tomography findings reflected concordance between the treatment plan and the surgical results.

The Japanese printing industry needs to find new ways to remain competitive in today's rapidly-changing and highly-competitive business environment. Although some decline has been noted, the printing sector and its related industries are enjoying a measure of prosperity. This is primarily due to the efforts of industry organizations which have sought to unify and put more coherence in the printing business.

Background. From January 1990 to June 1991, the authors tested in vitro chemosensitivity before surgery with endoscopic biopsy specimens from 23 patients with intrathoracic esophageal cancer. Methods. The authors tested eight anticancer agents using the dye exclusion method, and all 23 patients received chemotherapy with the most sensitive three drugs according to the results of the chemosensitivity test. Results. Ten patients (43.5%) had a tumor reduction of more than 50% on radiologic studies, and 4 patients (17.4%) had a good histologic effect. Conclusions. The chemosensitivity test is useful in selecting preoperative chemotherapeutic agents for patients with esophageal cancer. Cancer 1993; 71:661-6.

In 1986, narrow plasma proton nuclear magnetic resonance (NMR) methyl and methylene line widths were reported to be associated with malignant disease, but more recent studies have not confirmed this relationship. The authors analyzed 106 plasma samples from healthy control subjects and patients with cirrhosis, hepatocellular carcinoma, metastatic liver tumors, other untreated cancers, and hyperlipidemia. NMR spectroscopy was performed using a proton NMR spectrometer operating at 399.65 MHz. A significant difference was found between the mean line widths of the plasma methyl resonances in control subjects and those in patients with cancer or hyperlipidemia. However, no significant difference was found between the mean plasma methylene line widths in control subjects and patients with cancer. Plasma samples from patients with liver disease or hyperlipidemia showed a characteristic methylene spectral pattern. The methylene pattern could be separated into three types: type A had a small peak on the right shoulder of the main peak; type B was a sharp single peak; and type C was a broad single peak. All control subjects had type A pattern; patients with liver disease had type C pattern; and patients who had hyperlipidemia had type B pattern, and hyperlipidemia may affect methyl and methylene line widths in NMR spectra. Because the methyl and methylene levels and their average line widths correlated inversely with triglyceride levels, considering the spectral patterns that indicate hyperlipidemia should decrease false-positive results and make the methyl line width useful for cancer screening.

Although the international study on MRI-guided brachytherapy in cervical cancer (EMBRACE-I) demonstrated excellent local control regardless of the T stage, up to 14.6% of grade 3–5 late radiation-related toxicities were observed, which is unacceptable. While the efficacy of hydrogel spacers has been established in prostate radiotherapy, its implementation speed in cervical cancer brachytherapy is relatively slow, despite the fact that several articles have reported its efficacy in cervical cancer brachytherapy. The authors believe that using a spacer in cervical cancer brachytherapy and brachytherapy for other gynecologic malignancies will reduce late radiation-related toxicity and improve patients’ quality of life; therefore, its rapid implementation is required.

Genetic studies have indicated possible involvement of the upregulated calcium-nuclear factor of activated T cells pathway in the pathogenesis of Kawasaki disease. We aimed to assess safety and efficacy of ciclosporin, an immunosuppressant targeting this pathway, for protection of patients with Kawasaki disease against coronary artery abnormalities.

Although systemic therapy is the standard treatment for metastatic prostate cancer, a randomized controlled trial showed radiotherapy to the prostate improved overall survival of metastatic prostate cancer patients with the low metastatic burden. Additionally, a randomized phase II trial showed that metastasis-directed therapy for oligo-recurrent prostate cancer improved androgen-deprivation therapy (ADT)-free survival. Therefore, administering radiotherapy to both prostate and metastatic regions might result in better outcomes. Thus, we report the treatment results of radiotherapy to both prostate and metastatic regions. Our institutional database was searched for patients who received radiotherapy to the prostate and metastatic regions. We summarized patient characteristics and treatment efficacy and performed statistical analysis to find possible prognostic factors. A total of 35 patients were included in this study. The median age was 66 years, and the median initial prostate-specific antigen (PSA) level was 32 ng/ml. The Gleason score was 7 in 10 patients, 8 in 13 patients, and 9 in 12 patients. The median radiotherapy dose was 72 Gy to the prostate and 50 Gy to the metastatic bone region. The 8-year overall survival, cause-specific survival, progression-free survival, and freedom from biochemical failure rate were 81, 85, 53, and 57%. Among the 35 patients, 12 were disease-free even after ADT was discontinued. In selected patients with metastatic prostate cancer, ADT and radiotherapy to the prostate and metastatic sites were effective. Patients with good response to ADT may benefit from radiotherapy to both prostate and metastatic regions.

28 SPRING 2021 A VS I E D To honor 100 years of excellence, NHS has partnered with UNICEF USA to bring education to vulnerable populations across the world BY ERI OKUMA CHANGING THE WORLD STUDENT LEADERS WITH UNICEF USA SPRING 2021 29 A VS I E D In celebration of NHS' 100th anniversary in 2021, NHS has partnered with UNICEF USA to empower chapters to raise money to build classrooms in West Africa's Côte d'Ivoire using recycled plastic bricks. UNICEF USA advances the global mission of UNICEF by rallying the American public to support the world's most vulnerable children. ABOUT UNICEF Over eight decades, the United Nations Children's Fund (UNICEF) has built an unprecedented global support system for the world's children. [Extracted from the article]

ABSTRACTSelenium (Se) causes oxidative damage to plants. Proline is accumulated as a compatible solute in plants under stress conditions and mitigates stresses. Selenate at 250 µM increased cell death and inhibited the growth of tobacco BY-2 cells while exogenous proline at 10 mM did not mitigate the inhibition by selenate. Selenate increased accumulation of Se and ROS and activities of antioxidant enzymes but not lipid peroxidation in the BY-2 cells. Proline increased Se accumulation and antioxidant enzyme activities but not either ROS accumulation or lipid peroxidation in the selenate-stressed cells. Glutathione (GSH) rather than ascorbic acid (AsA) mitigated the growth inhibition although both reduced the accumulation of ROS induced by selenate. These results indicate that proline increases both antioxidant enzyme activities and Se accumulation, which overall fails to ameliorate the growth inhibition by selenate and that the growth inhibition is not accounted for only by ROS accumulation.Abbreviations:APX: ascorbate peroxidase; AsA: ascorbic acid; BY-2: Bright Yellow-2; CAT: catalase; DAI: days after inoculation; DW: dry weight; FW: fresh weight; GSH: glutathione; ROS: reactive oxygen species