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We study magic angle graphene in the presence of both strain and particle-hole symmetry breaking due to nonlocal interlayer tunneling. We perform a self-consistent Hartree-Fock study that incorporates these effects alongside realistic interaction and substrate potentials and explore a comprehensive set of competing orders including those that break translational symmetry at arbitrary wave vectors. We find that at all nonzero integer fillings very small strains, comparable to those measured in scanning tunneling experiments, stabilize a fundamentally new type of time-reversal-symmetric and spatially nonuniform order. This order, which we dub the “incommensurate Kekulé spiral” (IKS) order, spontaneously breaks both the emergent valley-charge conservation and moiré translation symmetries but preserves a modified translation symmetry T[over ^]^{′}—which simultaneously shifts the spatial coordinates and rotates the U(1) angle which characterizes the spontaneous intervalley coherence. We discuss the phenomenological and microscopic properties of this order. We argue that our findings are consistent with all experimental observations reported so far, suggesting a unified explanation of the global phase diagram in terms of the IKS order.

Hydrogen production by proton exchange membrane water electrolysis requires an anode with low overpotential for oxygen evolution reaction (OER) and robustness in acidic solution. While exploring new electrode materials to improve the performance and durability, optimizing the morphology of typical materials using new methods is a big challenge in materials science. RuO 2 is one of the most active and stable electrocatalysts, but further improvement in its performance and cost reduction must be achieved for practical use. Herein, we present a novel technology, named "metal oxide plating", which can provide maximum performances with minimum amount. A uniform single-crystal RuO 2 film with thickness of ∼2.5 nm was synthesized by a solvothermal-post heating method at an amount ( x ) of only 18 μg cm -2 (ST-RuO 2 (18)//TiO 2 NWA). OER stably proceeds on ST-RuO 2 (18)//TiO 2 NWA with ∼100% efficiency to provide a mass-specific activity (MSA) of 341 A g cat -1 at 1.50 V ( vs. RHE), exceeding the values for most of the state-of-the-art RuO 2 electrodes.

It is unclear how pulmonary veins (PVs) maintain paroxysmal atrial fibrillation (AF). To clarify the PV's arrhythmogenic role, we examined PV activation sequences during paroxysmal AF. Left superior PV (LSPV) endocardial non-contact mapping was performed after a right PV isolation in 13 paroxysmal AF patients. Activation sequences within the LSPV before and during left-sided PVs ablation were analyzed, and those in complex fractionated atrial electrogram (CFAE) areas were compared with those in non-CFAE areas. CFAEs were observed in the LSPV's proximal half (area; 8.8 ± 3.2cm 2 ) occupying 19.9 ± 6.0% of LSPV. The number of pivoting activations, wave breaks, and fusions over CFAE areas were significantly higher than those over non-CFE areas (25.5 ± 9.3 vs. 4.5 ± 4.8 times/s, p < 0.0001; 9.1 ± 5.3 vs. 1.4 ± 1.8 times/s, p < 0.0001; 13.0 ± 4.6 vs. 5.4 ± 4.4 times/s, p < 0.0001). The conduction velocities in CFAE areas were significantly slower than in non-CFAE areas (0.6 ± 0.2 vs. 1.7 ± 0.8 m/s, p < 0.001). After delivery of ablation lesions around the left-sided PVs (13.2 ± 7.4 applications), the PV activation became organized with a loss of CFAE areas, and the frequency of the LSPV's pivoting activation, wave break, and fusion significantly decreased compared to that pre-ablation (7.3 ± 10.9 vs. 30.0 ± 11.6 times/s, p < 0.001; 2.1 ± 5.3 vs. 10.5 ± 6.2 times/s, p < 0.002; 6.0 ± 6.6 vs. 18.4 ± 8.2 times/s, p < 0.001). Subsequently, AF terminated before the left-sided PV isolation in all patients. In conclusion, high-frequency random reentry associated with pivoting activation, wave break, and fusion within the LSPV, observed mostly over CFAE areas, maintained AF. Linear ablation lesions around the PV suppressed random reentry, resulting in the loss of CFAEs and AF termination., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest., (© 2024. Springer Nature Japan KK, part of Springer Nature.)

Purpose: Many workers had flexible work arrangements during the COVID-19 pandemic. This study aimed to identify the association between flextime and remote working and job resignation among Japanese young adult cancer survivors after diagnosis., Methods: This cross-sectional observational study was conducted using an online survey with 401 Japanese young adult cancer survivors diagnosed with adult-onset cancer and aged 20-39 years at the time of the survey in January 2022. A multivariable Cox regression analysis was performed to analyze the impact of flextime and remote working on job resignation., Results: In the sample, 264 participants (65.8%) were female, and 185 (46.1%) had been diagnosed with cancer between 1 and 5 years ago. After adjusting for potential confounders, the multivariable Cox regression analysis revealed that young adult cancer survivors using remote working only (HR 0.44, 95% CI 0.21-0.96, p = 0.04) and both flextime and remote working (HR 0.37, 95% CI 0.21-0.64, p < 0.01) experienced a lower risk of job resignation after cancer diagnosis compared to those who did not use flextime and remote working., Conclusions: Young adult cancer survivors who used remote working only or remote working combined with flextime could reduce their risk of job resignation after a cancer diagnosis., Implications for Cancer Survivors: This study showed that having the option of remote working can be important for young adult cancer survivors' continuing employment. Furthermore, social welfare systems need to promote a workplace culture and climate that allows remote working., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Recent experiments on rhombohedral pentalayer graphene with a substrate-induced moiré potential have identified both Chern insulators and fractional quantum Hall states at zero magnetic field. Surprisingly, these states are observed in strong displacement fields where the effects of the moiré lattice are weak, and seem to be readily accessed without fine-tuning. To address these experimental puzzles, we study a model of interacting electrons in this geometry. Within self-consistent Hartree-Fock (SCHF) calculations, we find an isolated Chern band with small bandwidth and good quantum geometry. Exact diagonalization and density-matrix renormalization group calculations both confirm the band hosts fractional quantum Hall states without a magnetic field. Remarkably, the Chern band is stable at a wide range of angles, at four through six rhombohedral layers, at varying rhombohedral hopping parameters, and-most strikingly-survives in SCHF calculations when the moiré potential vanishes. In this limit, the state spontaneously breaks time-reversal and translation symmetry simultaneously, giving a topological crystalline state that we term the "anomalous Hall crystal." We argue this is a general mechanism to create stable Chern bands in rhombohedral multilayer graphene, opening the door to studying the interplay between electronic topology, fractionalization, and spontaneous translation symmetry breaking.

Background: Particle therapy is effective for the treatment of soft tissue sarcomas. However, the clinical outcomes of definitive particle therapy, particularly for dedifferentiated liposarcoma (DDLS), remain unknown., Purpose: To analyze the treatment outcomes of proton and carbon ion particle therapies for DDLS., Methods: We retrospectively included patients with DDLS who were treated with particle therapy between 2008 and 2022. The local control (LC), progression-free survival (PFS), and overall survival (OS) rates were evaluated., Results: Fifty-seven patients were included in this analysis. The median patient age was 68 years (range, 36-91 years). The most common tumor site was the retroperitoneum (n = 37), with a median gross tumor volume (GTV) of 181 cm 3 . Twenty-nine patients received proton therapy, and 28 patients received carbon ion therapy. The most common fractionation dose was 70.4 Gy (relative biological effectiveness) in 32 fractions (72.7 Gy equivalent dose in 2 Gy fractions [EQD2]). The median follow-up time was 33 months (range, 1-128 months). The 3-year LC, PFS, and OS rates were 73.1 %, 44.6 %, and 70.6 %, respectively. Patients who received a higher prescribed dose (≥72.7 Gy EQD2) showed significantly better LC (p = 0.04) than did those who received a lower prescribed dose. Moreover, those with a larger GTV (≥181 cm 3 ) had significantly worse OS (p = 0.04) than did those with a smaller GTV. Late adverse events occurred in five (9 %) patients., Conclusions: Particle therapy using protons or carbon ions for the treatment of DDLS is safe and provides good OS and LC. However, further studies with longer follow-up periods and larger cohorts are warranted., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.)

Space-making particle therapy, which consists of surgical placement of a spacer followed by particle therapy, has become a solution to the problem of normal organs being exposed to a high radiation dose. A bioabsorbable spacer is particularly suitable for this purpose, but is not widely used. Surgical placement of a spacer is performed mostly to protect the digestive tract, but can also be used to protect the kidneys. Therefore, we have been interested in the use of space-making particle therapy to preserve renal function. A 14 month-old boy with intermediate-risk retroperitoneal rhabdomyosarcoma underwent surgery with placement of a bioabsorbable spacer following neoadjuvant chemotherapy and then received proton beam therapy of 41.4 Gy (relative biological effectiveness) in 23 fractions. In the 41 months since PBT, he has survived without local recurrence or signs of renal impairment. This report describes the first-ever case of surgical placement of a bioabsorbable spacer with the aim of preserving renal function during proton beam therapy. Space-making particle therapy is an innovative solution for peritoneal tumors adjacent to the kidneys., Competing Interests: Conflict of interestRyohei Sasaki received research funding from Alfresa Pharma Corporation; Takumi Fukumoto received patent licensing fees from Alfresa Pharma Corporation and research funding from Alfresa Pharma Corporation, Kanai Juyo Kogyo Co.,Ltd, and Kureha Corporation., (© The Author(s) under exclusive licence to The Japan Society of Clinical Oncology 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Plasmonic photocatalysts represented by gold nanoparticle (NP)-loaded titanium(IV) oxide (Au/TiO 2 ) can be promising solar-to-fuel converters by virtue of their response to visible-to-near infrared light. Hitherto, Au/rutile (R)-TiO 2 has been recognized as exhibiting photocatalytic activity higher than that of Au/anatase (A)-TiO 2 . Herein, we demonstrate that the high potential of A-TiO 2 as the Au NP support can be brought out through atomic level interface control. Faceting of Au NPs is induced by a heteroepitaxial junction on an A-TiO 2 (001) nanoplate array (Au/A-TiO 2 NPLA). Photoexcitation towards the Au/A-TiO 2 NPLA electrode generates current for the water oxidation reaction at λ < 900 nm with a maximum efficiency of 0.39% at λ = 600 nm, which is much larger than the values reported so far for the usual electrodes. The striking activity of the Au/A-TiO 2 NPLA electrode was rationalized using a potential-dependent Fowler model. This study presented a novel approach for developing solar-driven electrodes for green and sustainable fuel production.

Background/aim: Malignant lymphoma (ML) including Hodgkin's lymphoma and non-Hodgkin's lymphoma is often treated with local radiation therapy (RT) in combination with autologous hematopoietic stem cell transplantation (ASCT) to prevent relapse; however, the efficacy and optimal timing of this approach is unclear. In this study, a national survey conducted by the Japanese Radiation Oncology Study Group reviewed ML cases from 2011 to 2019 to determine whether RT should be added to ASCT, focusing on the use of autologous peripheral blood stem cell transplantation (auto-PBSCT), a predominant form of ASCT., Patients and Methods: The survey encompassed 92 patients from 11 institutes, and assessed histological ML types, treatment regimens, timing of RT relative to auto-PBSCT, and associated adverse events., Results: The results indicated no significant differences in adverse events, including myelosuppression, based on the timing of RT in relation to auto-PBSCT. However, anemia was more prevalent when RT was administered before auto-PBSCT, and there was a higher incidence of neutropenia recovery delay in patients receiving RT after auto-PBSCT., Conclusion: This study provides valuable insights into the variable practices of auto-PBSCT and local RT in ML treatment, emphasizing the need for optimized timing of these therapies to improve patient outcomes and reduce complications., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Purpose: Survival rates of patients with high-risk neuroblastoma are unacceptable. A time-intensified treatment strategy with delayed local treatment to control systemic diseases has been developed in Japan. We conducted a nationwide, prospective, single-arm clinical trial with delayed local treatment. This study evaluated the safety and efficacy of delayed surgery to increase treatment intensity., Patients and Methods: Seventy-five patients with high-risk neuroblastoma were enrolled in this study between May 2011 and September 2015. Delayed local treatment consisted of five courses of induction chemotherapy (cisplatin, pirarubicin, vincristine, and cyclophosphamide) and myeloablative high-dose chemotherapy (melphalan, etoposide, and carboplatin), followed by local tumor extirpation with surgery and irradiation. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS), response rate, adverse events, and surgical complications., Results: Seventy-five patients were enrolled, and 64 were evaluable (stage 3, n = 8; stage 4, n = 56). The estimated 3-year PFS and OS rates (95% confidence interval [CI]) were 44.4% [31.8%-56.3%] and 80.7% [68.5%-88.5%], resspectively. The response rate of INRC after completion of the treatment protocol was 66% (42/64; 95% CI: 53%-77%; 23 CR [complete response], 10 VGPR [very good partial response], and nine PR [partial response]). None of the patients died during the protocol treatment or within 30 days of completion. Grade 4 adverse effects, excluding hematological adverse effects, occurred in 48% of patients [31/64; 95% CI: 36%-61%]. Major Surgical complications were observed in 25% of patients [13/51; 95% CI: 14%-40%]., Conclusion: This study indicates that delayed local treatment is feasible and shows promising efficacy, suggesting that this treatment should be considered further in a comparative study of high-risk neuroblastoma., (© 2024 Wiley Periodicals LLC.)

Background: Physical function and knee kinematics recovery after discoid lateral meniscus (DLM) tear surgery are essential for a better prognosis. However, these alterations remain unclear. Therefore, this study aimed to investigate changes in physical function and knee kinematics following saucerization and DLM tear repair., Methods: We enrolled 16 patients who underwent saucerization and DLM tear repair. Postoperative changes in knee kinematics during gait, and physical function, were evaluated at 3, 6, and 12 months., Results: The peak flexion angle of the operated limb during weight acceptance was significantly higher than that of the contralateral limb at 3 (operated limb: 34.6 ± 8.9°, contralateral limb: 23.7 ± 8.3°; P < 0.01) and 6 months (operated limb: 32.1 ± 9.7°, contralateral limb: 24.6 ± 8.2°; P = 0.03) postoperatively, but not at 12 months (operated limb: 27.1 ± 7.1°, contralateral limb: 23.1 ± 9.5°; P = 0.22) postoperatively. The knee extensor strength of the operated limb was significantly lower than that of the contralateral limb at 3 (operated limb: 1.00 ± 0.59 Nm/kg, contralateral limb: 1.37 ± 0.59 Nm/kg; P = 0.01), 6 (operated limb: 1.22 ± 0.55 Nm/kg, contralateral limb: 1.48 ± 0.60 Nm/kg; P < 0.01), and 12 months (operated limb: 1.39 ± 0.57 Nm/kg, contralateral limb: 1.55 ± 0.64 Nm/kg; P = 0.04) postoperatively., Conclusion: Knee extension deficits and extensor weakness persisted at 6 months after saucerization and repair of DLM tears. Postoperative rehabilitation should be focused on knee extension function., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: To investigate the dose stability of craniospinal irradiation based on irradiation method of proton beam therapy (PBT)., Methods and Materials: Twenty-four pediatric and young adult brain tumor patients (age: 1-24 years) were examined. Treatment method was passive-scattered PBT (PSPT) in 8 patients and intensity-modulated PBT (IMPT) in 16 patients. The whole vertebral body (WVB) technique was used in 13 patients whose ages were younger than 10, and vertebral body sparing (VBS) technique was used for the remaining 11 patients aged 10 and above. Dose stability of planning target volume (PTV) against set-up error was investigated., Results: The minimum dose (D min ) of IMPT was higher than that of PSPT (p = 0.01). Inhomogeneity index (INH) of IMPT was lower than that of PSPT (p = 0.004). When the irradiation field of the cervical spinal cord level (C level) was shifted, the maximum dose (D max ) was lower in IMPT, and mean dose (D mean ) was higher than PSPT as movement became greater to the cranial-caudal direction (p = 0.000-0.043). D min was higher and INH was lower in IMPT in all directions (p = 0.000-0.034). When the irradiation field of the lumber spinal cord level (L level) was shifted, D max was lower in IMPT as movement became greater to the cranial direction (p = 0.000-0.028). D min was higher and INH was lower in IMPT in all directions (p = 0.000-0.022)., Conclusions: The PTV doses of IMPT and PSPT are robust and stable in both anterior-posterior and lateral directions at both C level and L level, but IMPT is more robust and stable than PSPT for cranial-caudal movements., Trial Registry: Clinical Trial Registration number: No. 04-03., (© 2023. The Author(s).)

A (2+1)D topologically ordered phase may or may not have a gappable edge, even if its chiral central charge c&#95;{-} is vanishing. Recently, it was discovered that a quantity regarded as a "higher" version of chiral central charge gives a further obstruction beyond c&#95;{-} to gapping out the edge. In this Letter, we show that the higher central charges can be characterized by the expectation value of the partial rotation operator acting on the wave function of the topologically ordered state. This allows us to extract the higher central charge from a single wave function, which can be evaluated on a quantum computer. Our characterization of the higher central charge is analytically derived from the modular properties of edge conformal field theory, as well as the numerical results with the ν=1/2 bosonic Laughlin state and the non-Abelian gapped phase of the Kitaev honeycomb model, which corresponds to U(1)&#95;{2} and Ising topological order, respectively. The Letter establishes a numerical method to obtain a set of obstructions to the gappable edge of (2+1)D bosonic topological order beyond c&#95;{-}, which enables us to completely determine if a (2+1)D bosonic Abelian topological order has a gappable edge or not. We also point out that the expectation values of the partial rotation on a single wave function put a constraint on the low-energy spectrum of the bulk-boundary system of (2+1)D bosonic topological order, reminiscent of the Lieb-Schultz-Mattis-type theorems.

Cancer of the adolescent and young adult (AYA) generation has received increasing attention in recent years, however, there were few reports on radiotherapy for this area. As for pediatric cancer, many cancer of the AYA generation were treated with radiation therapy as the multidisciplinary treatment. In this article, we will review reproductive complications, which are considered to be particularly important complications of radiation therapy for AYA generation, and describe investigation of radiation therapy for cancers of the AYA generations at the Hyogo Cancer Center and the Hyogo Ion Beam Medical Center Kobe Proton Center. Germ cells are highly radiosensitive, and even low doses of radiation can cause infertility. Therefore, patients should be treated with sufficient knowledge to prevent fertility. Proton beam therapy for cancer of the AYA generation was useful therapy as pediatric cancer. However, proton beam therapy used less frequently. Insurance coverage, publicity, and access to facilities were considered issues for future study., (© 2023. The Author(s) under exclusive licence to Japan Radiological Society.)

Slightly acidic electrolyzed water (SAEW) is used as a disinfectant for raw chicken meat. Because its volume for a single immersion exceeds 10 times the weight of meat, a large amount of wastewater is generated. Importantly, a higher frequency of immersion is believed to reduce microbial contamination. The objective of this study was to investigate the effect of SAEW immersion at different frequencies on the disinfection and quality of raw chicken legs, thereby possibly limiting the usage of SAEW. Immersion for 1, 3, and 5 times, with a 7:1 SAEW:meat ratio, and duration of 15 min was tested. Meat quality was evaluated based on total aerobic bacteria, Enterobactericeae , total volatile basic nitrogen, thiobarbituric acid reactive substances, and color. A higher immersion frequency lowered the numbers of total aerobic bacteria and Enterobacteriaceae. Moreover, two immersions with a SAEW:meat ratio of 4:1 and a total immersion time of 6 min reduced the bacterial load as effectively as a single 15-min immersion with a SAEW:meat ratio of 7:1. Higher frequencies of SAEW immersion also resulted in lower total volatile basic nitrogen and lipid oxidation after 0 or 3 days of storage. They did, however, magnify the change in color, resulting in brighter meat. Overall, SAEW treatments with two to five immersions can improve the quality of raw chicken legs and reduce wastewater generation., Competing Interests: Conflicts of Interest: Mareto Hamatani and Takashi Soejima are employees of Morinaga Milk Industry Co., Ltd, which manufactured the purester SAEW generator used in this study. Yutaka Kitamura received a research grant from Morinaga Milk Industry Co., Ltd., (2023 Japan Poultry Science Association.)

Acute coronary syndrome (ACS) is associated with a high incidence of unstable plaques beyond the culprit lesion, leading to early recurrence of cardiovascular events. Coronary computed tomography angiography (CCTA) can be used to noninvasively observe plaques throughout the coronary arteries. To evaluate the impact of intensive low-density lipoprotein cholesterol (LDL-C)-lowering therapy on quantitative changes in coronary plaque, assessed using CCTA in a study population with ACS. In total, 81 consecutive patients with ACS who underwent CCTA at discharge and at 1-year follow-up from April 2018 to March 2020 were analyzed. The patients were divided into 2 groups: those who achieved LDL-C <70 mg/100 ml and those who did not. Changes in plaque morphology within and between the 2 groups were compared using CCTA. A total of 198 vessels were analyzed. The calcified plaque volume was significantly increased in the LDL-C <70 group (65.8 ± 80.1 mm 3 to 73.6 ± 83.7 mm 3 , p = 0.007), whereas no significant change was observed in the LDL-C ≥70 group (106.9 ± 161.7 mm 3 to 105.7 ± 137.5 mm 3 , p = 0.552). Percent change in low-attenuation plaque volume in the LDL <70 group was significantly lower than in the LDL-C ≥70 group (17.2 ± 90.9% vs 84.4 ± 162.6%, p = 0.020). Receiver operating characteristic curve analysis demonstrated that the target LDL-C level for low-attenuation plaque volume regression was 64 mg/100 ml. In conclusion, noninvasive CCTA demonstrated that intensive LDL-C lowering in high-risk patients with ACS could potentially lead to plaque stabilization., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The 13-item version of the Patient Activation Measure (PAM-13) is a frequently used measure that gauges the level of self-management in an individual. However, its applicability across Japanese young adult (YA) cancer survivors during and after their treatment remains unclear. This study confirmed the psychometric properties and measurement invariance of the Japanese version of PAM-13 across them during and after treatment. We used cross-sectional observational data collected through an online survey from 500 survivors in January 2022. We determined feasibility, internal consistency, concurrent validity against physical fatigue and depression, and known-groups validity regarding educational level. Structural validity was also found using Rasch analysis for survivors both during and after treatment. Furthermore, measurement invariance of the PAM-13 was examined using multiple-group structural equation modeling. Rasch fit statistics were acceptable for the unidimensional structure of PAM-13. It was found to be internally consistent for survivors during (McDonald's omega: 0.88, item-total correlations: 0.48-0.62) and after treatment (McDonald's omega: 0.90, item-total correlations: 0.32-0.72). The PAM-13 was concurrently valid with physical fatigue (Pearson's product-moment correlation coefficients: -0.25 and -0.18 for survivors during and after treatment, respectively) and depression (Pearson's product-moment correlation coefficients: -0.20 and -0.19 for survivors during and after treatment, respectively). Known-groups validity showed that survivors after treatment with a higher educational level reported a higher patient activation score than those with a lower educational level (p = 0.001); however, there was no difference due to the education level between survivors during treatment. The configural and metric invariance of the PAM-13 were confirmed, but scalar invariance was rejected. It was found that the PAM-13 is applicable for Japanese YA cancer survivors during and after treatment. However, given the lack of scalar invariance in the PAM-13, the scores of particular items between YA cancer survivors during and after treatment should be interpreted with caution., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Soejima, Kitao. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Interactions among electrons create novel many-body quantum phases of matter with wavefunctions that reflect electronic correlation effects, broken symmetries and collective excitations. Many quantum phases have been discovered in magic-angle twisted bilayer graphene (MATBG), including correlated insulating 1 , unconventional superconducting 2-5 and magnetic topological 6-9 phases. The lack of microscopic information 10,11 of possible broken symmetries has hampered our understanding of these phases 12-17 . Here we use high-resolution scanning tunnelling microscopy to study the wavefunctions of the correlated phases in MATBG. The squares of the wavefunctions of gapped phases, including those of the correlated insulating, pseudogap and superconducting phases, show distinct broken-symmetry patterns with a √3 × √3 super-periodicity on the graphene atomic lattice that has a complex spatial dependence on the moiré scale. We introduce a symmetry-based analysis using a set of complex-valued local order parameters, which show intricate textures that distinguish the various correlated phases. We compare the observed quantum textures of the correlated insulators at fillings of ±2 electrons per moiré unit cell to those expected for proposed theoretical ground states. In typical MATBG devices, these textures closely match those of the proposed incommensurate Kekulé spiral order 15 , whereas in ultralow-strain samples, our data have local symmetries like those of a time-reversal symmetric intervalley coherent phase 12 . Moreover, the superconducting state of MATBG shows strong signatures of intervalley coherence, only distinguishable from those of the insulator with our phase-sensitive measurements., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

In recent years, correlated insulating states, unconventional superconductivity, and topologically non-trivial phases have all been observed in several moiré heterostructures. However, understanding of the physical mechanisms behind these phenomena is hampered by the lack of local electronic structure data. Here, we use scanning tunnelling microscopy and spectroscopy to demonstrate how the interplay between correlation, topology, and local atomic structure determines the behaviour of electron-doped twisted monolayer-bilayer graphene. Through gate- and magnetic field-dependent measurements, we observe local spectroscopic signatures indicating a quantum anomalous Hall insulating state with a total Chern number of ±2 at a doping level of three electrons per moiré unit cell. We show that the sign of the Chern number and associated magnetism can be electrostatically switched only over a limited range of twist angle and sample hetero-strain values. This results from a competition between the orbital magnetization of filled bulk bands and chiral edge states, which is sensitive to strain-induced distortions in the moiré superlattice., (© 2023. The Author(s).)

This study aimed to evaluate the efficacy and safety of particle therapy (proton beam therapy and carbon-ion radiotherapy) for esophageal cancer by analyzing prospective nationwide registry data from particle therapy facilities throughout Japan. Patients diagnosed with esophageal cancer who received particle therapy between May 2016 and June 2018 were recruited from the registries of 12 particle therapy centers in Japan. Eventually, we enrolled 174 patients who met the inclusion criteria. Of the 174 patients, 137 (78.7%) were male, with a median age of 69 years (range: 41-88 years). Clinical stages included I (n = 55; 31.6%), II (n = 31; 17.8%), III (n = 82; 47.1%), IV (n = 3; 1.7%) and unknown (n = 3; 1.7%) (Union for International Cancer Control, seventh edition), and the median follow-up period was 908 days (range: 76-1669 days) for all patients. The 3-year overall survival (OS) rate, the 3-year progression-free survival (PFS) rate and the 3-year local control (LC) rates were 60.5, 53.2 and 72.7%, respectively. For each clinical stage, the 3-year OS rates were I, 84.8%; II, 60.3% and III, 42.9%; the 3-year PFS rates were I, 71.9%; II, 58.3% and III, 37.0% and the 3-year LC were I, 78.4%; II, 79.8% and III, 65.2%, respectively. Notably, four patients (2.3%) with ≥Grade 3 cardiopulmonary toxicities were observed (Common Terminology Criteria for Adverse Events, version 5.0). Our study showed that particle therapy for esophageal cancer has lower rates of adverse cardiopulmonary events than X-ray radiotherapy., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

A Japanese version of the short form of the expanded Posttraumatic Growth Inventory (PTGI-X-SF-J) was developed in this study, as the extended version captures broader, more diverse personal growth perspectives, such as existential spiritual growth. We collected cross-sectional data from 408 (first sample) and 284 (second sample) Japanese university students using the expanded version of the Posttraumatic Growth Inventory (PTGI-X-J). Exploratory factor analysis (EFA) was performed with the first sample and confirmatory factor analysis (CFA) with the second; reliability and validity were examined. The short-form version resulting from the EFA and CFA comprised 10 items and five factors. Cronbach's alpha for the PTGI-X-SF-J total and subscale scores ranged from 0.671 to 0.875. The intraclass correlation coefficient for the total and subscale scores between the PTGI-X-J and PTGI-X-SF-J ranged from 0.699 to 0.821. Regarding external validity, no significant correlation was found between posttraumatic growth and posttraumatic stress disorder checklists. Due to its brevity, the PTGI-X-SF-J can help assess diverse spiritual and existential personal growth experiences among clients, patients, and trauma survivors while reducing physical and psychological burdens.

Purpose: This study compared craniospinal irradiation using proton beam therapy (PBT) according to irradiation method and investigated the initial effects., Methods and Materials: Twenty-four pediatric patients (1-24 years old) who received proton craniospinal irradiation were examined. Passive scattered PBT (PSPT) and intensity modulated PBT (IMPT) were used in 8 and 16 patients, respectively. The whole vertebral body technique was used for 13 patients <10 years old, and the vertebral body sparing (VBS) technique was used for the remaining 11 patients aged ≥10 years. The follow-up period was 17 to 44 (median, 27) months. Organ-at-risk and planning target volume (PTV) doses and other clinical data were examined., Results: The maximum lens dose using IMPT was lower than that using PSPT ( P  = .008). The mean thyroid, lung, esophagus, and kidney doses were lower in patients treated using the VBS technique compared with the whole vertebral body technique (all P < .001). The minimum PTV dose of IMPT was higher than that of PSPT ( P  = .01). The inhomogeneity index of IMPT was lower than that of PSPT ( P  = .004)., Conclusions: IMPT is better than PSPT at reducing the dose to the lens. The VBS technique can decrease the doses to neck-chest-abdomen organs. The PTV coverage of IMPT is superior to that of PSPT., (© 2023 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.)

Fatty acid-binding protein 4 (FABP4) is a critical immune-metabolic modulator, mainly expressed in adipocytes and macrophages, secreted from adipocytes in association with lipolysis, and plays essential pathogenic roles in cardiovascular and metabolic diseases. We previously reported Chlamydia pneumoniae infecting murine 3T3-L1 adipocytes and causing lipolysis and FABP4 secretion in vitro. However, it is still unknown whether C. pneumoniae intranasal lung infection targets white adipose tissues (WATs), induces lipolysis, and causes FABP4 secretion in vivo. In this study, we demonstrate that C. pneumoniae lung infection causes robust lipolysis in WAT. Infection-induced WAT lipolysis was diminished in FABP4-/- mice or FABP4 inhibitor-pretreated wild-type mice. Infection by C. pneumoniae in wild-type but not FABP4-/- mice induces the accumulation of TNF-α- and IL-6-producing M1-like adipose tissue macrophages in WAT. Infection-induced WAT pathology is augmented by endoplasmic reticulum (ER) stress/the unfolded protein response (UPR), which is abrogated by treatment with azoramide, a modulator of the UPR. C. pneumoniae lung infection is suggested to target WAT and induce lipolysis and FABP4 secretion in vivo via ER stress/UPR. FABP4 released from infected adipocytes may be taken up by other neighboring intact adipocytes or adipose tissue macrophages. This process can further induce ER stress activation and trigger lipolysis and inflammation, followed by FABP4 secretion, leading to WAT pathology. A better understanding of the role of FABP4 in C. pneumoniae infection-induced WAT pathology will provide the basis for rational intervention measures directed at C. pneumoniae infection and metabolic syndrome, such as atherosclerosis, for which robust epidemiologic evidence exists., (Copyright © 2023 by The American Association of Immunologists, Inc.)

A simple process has been developed to form single-crystalline β-MnO 2 nanowire arrays (NWAs) with a large surface area of 125 m 2 g -1 on a glass plate working as a highly active three dimensional (3D) photothermal catalyst under the illumination of near infrared light due to the efficient light harvesting and heat confinement near the reaction field in addition to the large surface area.

Purpose: Remimazolam is a new ultra-short-acting benzodiazepine with unknown effects on cerebral circulation. We measured total cerebral hemoglobin concentrations, which reflect cerebral blood volume (CBV), and cerebral oxygen saturation, using time-domain near-infrared spectroscopy, which can measure the absolute values of cerebral hemoglobin concentrations. We also measured cerebral blood flow velocity (CBFV) in the middle cerebral artery using transcranial Doppler as an indicator of cerebral blood flow (CBF). We did so to examine the effect of remimazolam on cerebral circulation in humans, as assessed CBV, CBF, and cerebral oxygen saturation., Methods: This was a prospective, observational study. Fifteen patients without serious complications scheduled for general anesthesia were recruited. We measured total cerebral hemoglobin concentrations, CBFV, and cerebral oxygen saturation throughout the anesthetic induction course with remimazolam., Results: Total cerebral hemoglobin concentrations did not change during the process (p = 0.51). In contrast, the mean CBFV was reduced by 11% (significant, p = 0.04). The drop in mean blood pressure following the induction of anesthesia was 17%; however, it was within the range of cerebrovascular autoregulation. Moreover, cerebral oxygen saturation increased by 4% (statistically significant, p < 0.01)., Conclusions: We found that anesthetic induction with remimazolam did not alter CBV and reduced CBF in uncomplicated patients., (© 2022. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Poorly differentiated chordoma (PDC) is a rare, aggressive subtype of chordoma. A two-year-old girl presented with cervical pain, limb paralysis and respiratory failure. Magnetic resonance imaging and positron emission tomography-computed tomography revealed a tumor compressing the pons at the clivus and osteoblastic metastatic lesions of the left upper arm and right iliac bone. Her tumors shrank substantially after treatment with chemotherapy and proton beam therapy. Our initial diagnosis was an atypical teratoma/rhabdoid tumor, but final diagnosis of PDC was made on the basis of the immunohistochemical expression of brachyury. In addition, the detection of SMARCB1/INI1 mutation confirmed the diagnosis of PDC., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

This study examined whether perceiving an event as a trauma influenced a cognitive processing model explaining posttraumatic growth (PTG). A cross-sectional questionnaire survey was conducted with 311 university students from eight universities in Japan. The participants provided information about the most stressful event they had experienced and completed the expanded version of the PTG Inventory, Core Belief Inventory, Event Related Rumination Inventory, and Cognitive and Emotional Processing from Disclosure Inventory. A multi-group structural equation modeling was conducted by dividing the participants into two groups depending on whether they identified the most stressful event as a trauma. The model with no constraint showed a good fit. The model with partial constraint showed a better fit than the models with no constraint or full constraint. The difference of the model was seen as a covariance between the Event Related Rumination Inventory and the Cognitive and Emotional Processing from Disclosure Inventory. The results demonstrated configural invariance and partial metric invariance. This indicated that PTG would be recognized irrespective of whether the event was perceived as a trauma. This study also indicated that different factors out of the model could be associated with the ruminative process and disclosure process. The importance of focusing on the process of PTG, regardless of an individual's perception of the event, was emphasized, especially for factors related to rumination and disclosure.

A growing body of experimental work suggests that magic angle twisted bilayer graphene exhibits a "cascade" of spontaneous symmetry-breaking transitions, sparking interest in the potential relationship between symmetry breaking and superconductivity. However, it has proven difficult to find experimental probes which can unambiguously identify the nature of the symmetry breaking. Here, we show how atomically resolved scanning tunneling microscopy can be used as a fingerprint of symmetry-breaking order. By analyzing the pattern of sublattice polarization and "Kekulé" distortions in small magnetic fields, order parameters for each of the most competitive symmetry-breaking states can be identified. In particular, we show that the "Kramers intervalley coherent state," which theoretical work predicts to be the ground state at even integer fillings, shows a Kekulé distortion which emerges only in a magnetic field.

Background: In Japan, allogeneic hematopoietic stem cell transplantation is widely performed for recurrent neuroblastomas. This retrospective study aimed to investigate the prognosis of recurrent neuroblastoma in Japan and explore the effectiveness of allogeneic hematopoietic stem cell transplantation., Methods: Clinical characteristics and data on the treatment of patients with high-risk neuroblastoma who experienced first progression between 2003 and 2010 after attaining complete remission or partial remission were collected from hospitals participating in the Japanese Neuroblastoma Research Group., Results: Data from 61 patients who fulfilled these criteria were collected. The median interval from disease onset to first progression was 19 months (range, 7-65 months), whereas the median observation time of the surviving patients was 18 months (range, 1-69 months). All patients were treated with chemotherapy, where 22 and 3 patients received allogeneic and autologous hematopoietic stem cell transplantation, respectively. Seven patients were alive in second complete remission, and 39 died, including two in complete remission. The 3-year progression-free survival and overall survival rates were 15.3% (SE: 6.1%) and 16.9% (SE: 6.5%), respectively. For patients with allogeneic hematopoietic stem cell transplantation, the 3-year progression-free survival and overall survival were 28.3% (standard error, 12.0%) and 24.3% (standard error, 11.5%), respectively, and for patients without allogeneic hematopoietic stem cell transplantation, the 3-year progression-free survival and overall survival were 6.0% (standard error 5.5%) and 12.0% (standard error 7.6%), respectively. The duration of initial remission (≥ 18 months) and implementation of allogeneic hematopoietic stem cell transplantation were independently predictive of progression-free survival (P = 0.002 and P = 0.017), whereas for overall survival, only allogeneic hematopoietic stem cell transplantation was predictive (P = 0.012)., Conclusion: Although allogeneic hematopoietic stem cell transplantation contributed to some improvement in prognosis, it was insufficient., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The purpose of this study is to improve the placement of a hydrogel spacer in patients with prostate cancer receiving radiation therapy., Methods and Materials: A total of 160 patients with prostate cancer were classified into 3 groups: No spacer (group 1; n = 30), spacer placed using conventional technique (group 2; n = 100), and spacer placed using new technique (group 3; n = 30). When placing the spacer, the tip of the needle is placed at the middle of the prostate gland (group 2), or at a level corresponding to a cranial:caudal ratio of 6:4 and as close to the prostate gland as possible (group 3). The separation effect was examined and compared among the groups., Results: The separation in group 2 was larger than that in group 1 from the base to the apex level of the prostate (4 mm), but the separation in group 3 was larger than that in group 2 from the middle to the apex level of the prostate (4 mm). The separation values for the middle to the apex, the spacer thickness from the apex level to the apex (10 mm), the rectal exclusion from the middle to the apex, and the laterality were correlated with the 50 and 60 Gy relative biologic effectiveness (Gy[RBE]) rectal dose (P = 4.1 × 10 -9 - .046). The separation vales were strongly correlated with the spacer thickness at the apex (10 mm) and the apex (4 mm; P = 1.1 × 10 -18 - 1.8 × 10 -17 ). The rectal volumes at 10 to 60 Gy(RBE) differed among the groups (P = 5.1 × 10 -19 - 5.4 × 10 -3 ). The rectal volumes in group 2 were smaller than those in group 1 at all dose levels, but those in group 3 were smaller than those in group 2 at dose levels of 30 to 50 Gy(RBE)., Conclusions: The separation, spacer thickness, and rectal exclusion from the middle to the apex of the prostate and the laterality of the hydrogel spacer affected the reduction in the rectal dose. The rectal dose can be further reduced by implanting a spacer on the caudal and prostate side., (Copyright © 2021. Published by Elsevier Inc.)

Background: The efficacy of catheter ablation from the noncoronary aortic cusp (NCC) of verapamil-sensitive atrial tachycardia arising near the atrioventricular node (AVN-AT) has yet to be fully clarified., Objective: We elucidated the determinant of an effective AVN-AT ablation from the NCC., Methods: After identifying the earliest atrial activation site (EAAS) during tachycardia, the direction of the slow conduction zone (SCZ) of the reentry circuit was identified by demonstrating manifest entrainment in 26 patients with AVN-AT. Catheter ablation was initially performed from the NCC irrespective of the local activation time. If NCC ablation was ineffective, catheter ablation was performed targeting the SCZ entrance. Then the anatomical relationship between the SCZ and the successful ablation site was elucidated., Results: NCC catheter ablation terminated AVN-AT in 14 patients (NCC group) but not in 12 (non-NCC group). Catheter ablation targeting the SCZ entrance terminated all non-NCC group ATs. The local activation time at the NCC relative to the EAAS did not differ between the NCC and non-NCC groups (10.1 ± 6.5 ms vs 11.2 ± 4.8 ms; P = .6333). The direction of the SCZ was posterior to the EAAS in all NCC group patients; however, it was posterolateral (n = 5) and lateral (n = 7) to the EAAS in the non-NCC group, suggesting that the SCZ existed in the direction of the NCC in the NCC group but was away from the NCC in the non-NCC group., Conclusion: A close proximity between the NCC and the SCZ of the reentry circuit, but not the local activation time at the NCC, determined the efficacy of NCC catheter ablation in AVN-ATs., (Copyright © 2021 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Primary CNS germ cell tumors (GCTs) are rare neoplasms predominantly observed in the pediatric and young adult populations. In line with the hypothesis that the primordial germ cell is the cell-of-origin, histopathological examinations for this pathology involve a diverse range of components mirroring the embryogenic developmental dimensions. Chemotherapy and radiotherapy are the mainstays of treatment, with surgery having a limited role for diagnosis and debulking of residual tissue after treatment. While better management has been achieved over recent decades by modifying radiation coverage and selecting appropriate chemotherapy, standardization of treatment remains challenging, partly due to the low volume of cases encountered in each institution. As the incidence is higher in East Asia, including Japan, the Japan Society for Neuro-Oncology established a multidisciplinary task force to create an evidence-based guideline for CNS GCTs. This guideline provides recommendations for multiple dimensions of clinical management for CNS GCTs, with particular focus on diagnostic measures including serum markers, treatment algorithms including surgery, radiotherapy, and chemotherapy, and under-investigated but important areas such as treatment for recurrent cases, long-term follow-up protocols, and long-term sequelae. This guideline serves the purpose of helping healthcare professionals keep up to date with current knowledge and standards of management for patients with this rare disease in daily clinical practice, as well as driving future translational and clinical research by recognizing unmet needs concerning this tumor., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: This study aimed to evaluate acute toxicities associated with irradiation between the X-CSI (photon beam craniospinal irradiation) and P-CSI (proton beam craniospinal irradiation) groups in children with brain tumors., Methods: Sixty-two consecutive patients who received initial craniospinal irradiation (CSI) for brain tumors in our center between January 1, 2011 and May 31, 2021, were included in the study. Acute toxicities were retrospectively evaluated during CSI using Common Terminology Criteria for Adverse Events version 5.0. Maximum grades of fatigue, headache, insomnia, nausea, vomiting, dermatitis, constipation, abdominal pain, oropharyngeal mucositis, and hematological toxicities were evaluated., Results: Thirty-six patients received X-CSI, and 26 patients received P-CSI. The median dose of CSI was 18.0 Gy in the X-CSI group and 23.4 Gy (relative biological effectiveness) in the P-CSI group (p < 0.001). The P-CSI group had a lower incidence of more than grade 2 nausea (11.5% vs. 69.4%, p = 0.008) and vomiting (7.7% vs. 38.8%, p < 0.001), compared with the X-CSI group. Multivariate logistic regression analysis with adjustments for potential confounding factors of doses of CSI showed that proton radiation therapy was associated with a marked reduced risk of more than grade 2 nausea and vomiting during CSI (adjusted odds ratio, 0.050; 95% confidential interval, 0.011-0.24; p < 0.001)., Conclusion: The present study suggests that P-CSI reduces the acute gastrointestinal toxicities associated with irradiation., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Purpose: Inflammation after stent graft surgery is known as postimplantation syndrome (PIS) and it causes leukocytosis. However, we have experienced leukopenia in the very early postoperative phase of endovascular surgery at our institution. We investigated leukopenia, an under-recognized phenomenon that occurred after transcatheter aortic valve implantation (TAVI), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR)., Methods: Records of patients who underwent TAVI, EVAR, and TEVAR between March 2018 and February 2019 were retrospectively reviewed. Primary outcomes were the decline rate of white blood cell count (DR-WBC) in the immediate postoperative period and its differences among surgical procedures. The secondary endpoint was the relationship between DR-WBC and infectious complications. Furthermore, the incidence of PIS and its differences among the procedures and associations with DR-WBC were evaluated., Results: A total of 108 patients (TAVI 41, EVAR 37, TEVAR 30) were included. DR-WBC immediately after surgery was higher in the TAVI group when compared with other groups (TAVI, 43.1 ± 22.6%; EVAR, 27.6 ± 17.3%; TEVAR, 25.4 ± 27.4%; P < 0.01). DR-WBC was not significantly different regardless of postoperative infection (P = 0.45) or PIS (P = 0.62). The incidence rate of PIS was higher in the EVAR group compared with the TAVI group, and was not associated with DR-WBC., Conclusions: Leukopenia was a common phenomenon immediately after endovascular surgery, especially TAVI. It resolved a day after surgery and was not associated with PIS or infectious complications. Therefore, it seems to be a transient abnormal hematological finding and a self-limiting condition., (© 2021. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

The Japan Society of Clinical Oncology (JSCO) published the "JSCO Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients" in 2017. This was the first guideline in cancer reproductive medicine in Japan. In the field of cancer reproductive medicine, close cooperation between an oncologist and a physician for reproductive medicine is important from before treatment initiation until long after treatment. The guideline takes into consideration disease specificity and provides opinions from the perspective of oncologists and specialists in reproductive medicine that are in line with the current state of the Japanese medical system. It is intended to serve as a reference for medical staff in both fields regarding the availability of fertility preservation therapy before the start of cancer treatment. Appropriate use of this guideline makes it easier to determine whether fertility preservation therapy is feasible and, ultimately, to improve survivorship in childhood, adolescent, and young adult cancer patients. In this article (Part 2), we describe details by organ/system and also for pediatric cancer., (© 2021. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.)

In 2017, the Japan Society of Clinical Oncology (JSCO) published the JSCO Clinical Practice Guidelines 2017 for Fertility Preservation in Childhood, Adolescent, and Young Adult Cancer Patients. These were the first Japanese guidelines to address issues of oncofertility. In this field of medicine, sustained close cooperation between oncologists and reproductive specialists is essential from the diagnosis of cancer until many years after completion of cancer treatment. These JSCO guidelines were intended to guide multidisciplinary medical staff in considering the availability of fertility preservation options and to help them decide whether to provide fertility preservation to childhood, adolescent, and young adult cancer patients before treatment starts, with the ultimate goal of improving patient survivorship. The guidelines are presented as Parts 1 and 2. This article (Part 1) summarizes the goals of the guidelines and the methods used to develop them and provides an overview of fertility preservation across all oncology areas. It includes general remarks on the basic concepts surrounding fertility preservation and explanations of the impacts of cancer treatment on gonadal function by sex and treatment modality and of the options for protecting/preserving gonadal function and makes recommendations based on 4 clinical questions. Part 2 of these guidelines provides specific recommendations on fertility preservation in 8 types of cancer (gynecologic, breast, urologic, pediatric, hematologic, bone and soft tissue, brain, and digestive)., (© 2021. The Author(s).)

Background: PedsQL Infant Scales (PedsQL-I) are used to assess parent-reported health-related quality of life for children younger than 2 years. We determined the feasibility, reliability, and validity of the Japanese version of the PedsQL-I., Methods: A total of 183 participants (parents) with infants aged 1-30 months were recruited from 8 day care centers and one pediatric clinic. Participants completed the PedsQL-I (infants aged 1-18 months), the PedsQL-I and the PedsQL-Toddler version (infants aged 19-30 months), and the Kessler-6 psychological distress scale (all participants). We determined feasibility, internal consistency, test-retest reliability, concurrent validity, convergent and discriminant validity, known-groups validity with regard to acute and chronic illness, and relative and transitional validity with PedsQL-Toddler for the use in infants aged 25-30 months., Results: All subscales were internally consistent (Cronbach's alpha for 1-12 months: 0.88-0.98 and for 13-24 months: 0.85-0.97); test-retest reliability was acceptable (intra-class correlation coefficients > 0.40); and all scales were concurrently valid with the PedsQL-Toddler version (Pearson's product-moment correlation coefficient for the total score = 0.74). The scales' convergent and discriminant validity were acceptable (scaling success rate > 80%). Validation for known-groups showed that the Physical Health Summary score was sensitive to acute and chronic disease, the Psychosocial Health Summary score was sensitive to neither acute nor chronic disease, and the total score was sensitive to acute disease. Relative validity showed a ratio of 1.74 for the squared t values for the total score., Conclusions: The PedsQL-I is suitable for assessing health-related quality of life in infants aged 1-24 months in prospective studies., (© 2022. The Author(s).)

The aim of the present study was to investigate the effects on the dose distribution and beam delivery time in spot scanning proton beam therapy (PBT) incorporating the spot deletion technique. A spot scanning plan was created for 30 patients with prostate cancer. The plan was then modified via two processes: Spots with lower weighting depositions were deleted (process A) and spots that were distant from the clinical target volume (CTV) were deleted (process B). The dose distribution to the organs at risk (OAR), the expanded CTV (exCTV), which was defined by a uniform expansion of the CTV by a radius of 5 mm, and the beam delivery time were compared among initial and modified plans. The V 50 Gy [relative biological effectiveness (RBE)] to the rectum and bladder, and V 60 Gy(RBE) to the urethral bulb, inhomogeneity index (INH) of the exCTV showed a difference (P=1.1x10 -14 , P=6.4x10 -14 , P=2.7x10 -7 , P=3.2x10 -17 ), although only changes by process B were significant. Modified plan by process B showed the V 50 Gy(RBE) to the rectum and bladder decreased by -2.4±1.6 and -2.3±1.4%, and the V 60 Gy (RBE) to the urethral bulb decreased by -15.9±19.4%. The INH of the exCTV increased by 0.05±0.03%. On the other hand, modification of the initial plan by process A did not affect the dose of the OAR, exCTV or beam delivery time. In spot scanning PBT, modification of the initial radiotherapy plan by systemic deletion of spots distant from the CTV could result in a dose reduction to the OAR., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Fukumitsu et al.)

Aim: Anxiety and its correlates in parents of patients with breast cancer have rarely been studied. We explored anxiety among parents of postoperative patients with breast cancer and its relationship with parents' social support and care needs and patients' anxiety., Methods: A cross-sectional survey using self-report questionnaires and medical records was conducted among patients with breast cancer after surgery and their parents at four designated cancer care hospitals between September 2015 and June 2016. Anxiety was measured using the Hospital Anxiety and Depression Scale (HADS). Parents provided information about social support and care needs. Multilevel analysis was performed on patient-parent paired data controlling for patient-level variation., Results: Participants included 107 patients, 83 mothers, and 51 fathers. The mean HADS anxiety scores reported by mothers and fathers were 7.2 and 6.5, respectively, which were higher than patients' HADS anxiety scores. Fulfillment of important care needs was related to lower anxiety among mothers and fathers (estimate = -1.38, p = .01). Lower family support and higher patient anxiety were associated with higher anxiety in mothers, but not fathers., Conclusions: Parents of patients with breast cancer had high anxiety. Communication, providing cancer-related information, and fulfilling care needs can alleviate anxiety in parents of patients with breast cancer after surgery. Furthermore, increasing family support and decreasing patients' anxiety are essential to alleviating mothers' anxiety., (© 2021 Japan Academy of Nursing Science.)

Fraction flow reserve (FFR) derived from computed tomography (FFR CT ) has been proposed to be an effective gatekeeper for invasive angiographic referral. The purpose of the present study is to examine the real-world diagnostic performance of FFR CT and myocardial perfusion imaging as well as to assess the utility of FFR CT as a gatekeeper for invasive coronary angiography in patients suspected of having obstructive coronary artery disease. Total of 146 consecutive patients underwent both single-photon emission computed tomography (SPECT) and invasive FFR were evaluated. An FFR CT value 1 to 2 cm distal to a stenosis ≤0.80 was defined as positive for ischemia and a summed stress score ≥2 or transient ischemic dilatation ≥1.2 were positive for ischemia with the invasive FFR value of <0.80 serving as the gold standard. The patient-based sensitivity of FFR CT was significantly higher than SPECT (91 vs 52%, p <0.001) and exhibited similar positive predictive value (82 vs 82%, p = 0.91). These trends were observed even in patients with multivessel and left main trunk disease and those with severe coronary calcification. In conclusion, our data suggest that FFR CT has higher diagnostic performance characteristics than SPECT and details the superior FFR CT analysis in detecting patients with hemodynamically significant coronary artery disease. Our results support the clinical utility of FFR CT analysis as a gatekeeper for invasive coronary angiography in clinical practice., Competing Interests: Disclosures All authors have no conflict of interest to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The optimal site for measuring computed tomography (CT)-derived fractional flow reserve (FFR CT ) to detect significant coronary artery disease (CAD) remains unknown. We investigated how diagnostic performance changes with FFR CT measurement site. Methods and Results: The diagnostic performance of FFR CT , measured 1-2 cm distal to the stenosis vs. a far-distal site, in detecting significant CAD with invasive fractional flow reserve ≤0.8 was evaluated in 254 diseased vessels from 146 patients with stable or suspected CAD diagnosed by coronary CT angiography. Receiver operating characteristic curve analysis revealed a significantly larger area under the curve for FFR CT measured 1-2 cm distal to the stenosis than at a far-distal site (0.829 vs. 0.791, respectively; P=0.0305). The rate of reclassification of positive FFR CT was 19% for measurements made 1-2 cm distal to the stenosis, and diagnostic accuracy for FFR CT 0.71-0.80 improved from 36% to 58% (P=0.0052). Vessel-based diagnostic accuracy of FFR CT 1-2 cm distal to the stenosis and at a far-distal site was 75% and 65%, respectively (P<0.0001), with corresponding sensitivity of 87% and 94% (P=0.0039), specificity of 60% and 29% (P<0.0001), a positive predictive value of 73% and 62% (P=0.028), and a negative predictive value of 78% and 79% (P=0.958). Conclusions: Our data suggest measuring FFR CT 1-2 cm distal to the stenosis has better diagnostic performance for detecting physiologically significant CAD., Competing Interests: All authors have no conflicts of interest to disclose., (Copyright © 2021, THE JAPANESE CIRCULATION SOCIETY.)

We attempted to re-evaluate the efficacy of prophylactic cranial irradiation (PCI) in limited-stage small cell lung cancer (LS-SCLC) with more recent data. A total of 179 patients with LS-SCLC received radical thoracic radiotherapy and chemotherapy at our institution between 1998 and 2018. One hundred twenty-eight patients who achieved complete response (CR), good partial response (PR), and PR without progression for at least for one year after initial therapy were enrolled in this study. These patients were divided into a PCI group (group A, n = 43), and a non-PCI group (group B, n = 85). Survival outcomes were retrospectively evaluated. Because several background factors differed significantly between groups A and B, propensity score (PS) matching was performed as 1:1 match of the two groups. Finally, we analyzed 64 patients (group A/B = 32/32). Median follow-up periods were 53 and 31 months in groups A and B, respectively. There were no significant differences between the groups' backgrounds. Two-year overall survival (OS) rates were 77% in group A and 62% in group B (p = 0.224). Two-year brain metastasis free survival (BMFS) rates were 85% in group A and 57% in group B (p = 0.008). The number of patients who underwent a brain imaging test for confirmation of no brain metastasis (BM) after radical thoracic radiotherapy and chemotherapy (before PCI) was 84 (group A/B = 32/52). A PS matched analysis for cases of pre-PCI brain imaging group, two-year OS rates for group A/B were 73/59% (p = 0.446). Two-year BMFS rates for group A/B were 91/52% (p = 0.021). Retrospectively, PS matched analysis revealed that adding PCI to LS-SCLC patients who achieved good thoracic control significantly improved BMFS, but OS did not improve., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

The present study simulated the effect of spot-scanning proton beam therapy (PBT) performed using a device equipped with a multi-leaf collimator (MLC) to calculate the dose distribution. Simulation studies using 18 pediatric patients with brain tumors in the posterior fossa were performed. Treatment plans were created for the MLC at different stages: Fully open (initial plan), fully closed to allow an irradiated area extending to 15 mm from the clinical target volume (CTV) (15-mm plan), or closing only the leaves where an organ at risk (OAR) overlapped with a border at 10 or 5 mm from the CTV (10- and 5-mm plans, respectively). The mean dose values for the brainstem, cervical cord, brain and cochlea in all MLC closure plans decreased as the MLC was closed (P=9.9×10 -10 , P=1.3×10 -17 , P=2.1×10 -16 and P=2.0×10 -5 , respectively). The maximum dose (D max ) values of the cervical cord and cochlea in all MLC closure plans were also decreased as the MLC was closed (P=3.0×10 -4 and P=1.1×10 -5 , respectively). The dose to the CTV was almost unchanged. In 10 patients, the D max of the brain in all MLC-closure plans was higher than that of the initial plan, but the maximum increase was only 0.8 gray relative biological effectiveness [Gy(RBE)]. In conclusion, the existing MLC installed in the treatment device can be used to decrease the OAR dose significantly using spot-scanning PBT without a large capital investment. The dose from the scattered particles was small., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Fukumitsu et al.)

Verapamil-sensitive atrial tachycardia originating from the atrioventricular node vicinity (AVN-AT) can be eliminated with radiofrequency energy (RF) deliveries targeting either the entrance or exit of its reentry circuit. However, the outcome of these different approaches has not been clarified well. Thus, we compared the catheter ablation outcome targeting the entrance of reentry circuit, identified by the entrainment method (Ent-Group; 21 patients) with that targeting the earliest atrial activation site (EAAS) during AT (Exit-Group; 16 patients). There was no significant difference in the tachycardia cycle length (441.4 ± 87.4 vs. 392.8 ± 64.8 ms, p = 0.0704) or distance from the His bundle (HB) site to the EAAS (6.5 ± 2.0 vs. 7.6 ± 1.8 mm, p = 0.0822) between the Ent- and Exit-Groups. However, distance from the successful ablation site to the HB site in the Ent-Group was significantly longer than that in the Exit-Group (13.4 ± 3.1 vs. 7.6 ± 1.8 mm, p < 0.0001), resulting in more frequent transient atrioventricular block episodes in the Exit-Group than Ent-Group (31.3 vs. 0%, p < 0.01). Initial ATs (AT1s) were terminated in all patients in both Groups. However, ATs accompanied by shifting in the EAAS (AT2) were induced more frequently in the Exit-Group than Ent-Group (50.0 vs. 14.3%, p < 0.02) after eliminating AT1. RF deliveries to the EAAS eliminated all AT2s. The number of RF deliveries was greater in the Exit-Group than Ent-Group (6.9 ± 3.3 vs. 3.9 ± 1.6, p < 0.001). In conclusion, RF ablation targeting the entrance sites can avoid AVN injury and is superior in reducing the number of RF deliveries and occurrence of different ATs than targeting the exit sites in the AVN-AT.