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Abstract Background Although posterior decompression with fusion (PDF) are effective for treating thoracic myelopathy, surgical treatment has a high risk of various complications. There is currently no information available on the perioperative complications in thoracic ossification of the longitudinal ligament (T-OPLL) and thoracic ossification of the ligamentum flavum (T-OLF). We evaluate the perioperative complication rate and cost between T-OPLL and T-OLF for patients underwent PDF. Methods Patients undergoing PDF for T-OPLL and T-OLF from 2012 to 2018 were detected in Japanese nationwide inpatient database. One-to-one propensity score matching between T-OPLL and T-OLF was performed based on patient characteristics and preoperative comorbidities. We examined systemic and local complication rate, reoperation rate, length of hospital stays, costs, discharge destination, and mortality after matching. Results In a total of 2,660 patients, 828 pairs of T-OPLL and T-OLF patients were included after matching. The incidence of systemic complications did not differ significantly between the T-OPLL and OLF groups. However, local complications were more frequently occurred in T-OPLL than in T-OLF groups (11.4% vs. 7.7% P = 0.012). Transfusion rates was also significantly higher in the T-OPLL group (14.1% vs. 9.4%, P = 0.003). T-OPLL group had longer hospital stay (42.2 days vs. 36.2 days, P = 0.004) and higher medical costs (USD 32,805 vs. USD 25,134, P

Abstract Objective Multisystem proteinopathy (MSP) is an inherited disorder in which protein aggregates with TAR DNA‐binding protein of 43 kDa form in multiple organs. Mutations in VCP, HNRNPA2B1, HNRNPA1, SQSTM1, MATR3, and ANXA11 are causative for MSP. This study aimed to conduct a nationwide epidemiological survey based on the diagnostic criteria established by the Japan MSP study group. Methods We conducted a nationwide epidemiological survey by administering primary and secondary questionnaires among 6235 specialists of the Japanese Society of Neurology. Results In the primary survey, 47 patients with MSP were identified. In the secondary survey of 27 patients, inclusion body myopathy was the most common initial symptom (74.1%), followed by motor neuron disease (11.1%), frontotemporal dementia (FTD, 7.4%), and Paget's disease of bone (PDB, 7.4%), with no cases of parkinsonism. Inclusion body myopathy occurred most frequently during the entire course of the disease (81.5%), followed by motor neuron disease (25.9%), PDB (18.5%), FTD (14.8%), and parkinsonism (3.7%). Laboratory findings showed a high frequency of elevated serum creatine kinase levels and abnormalities on needle electromyography, muscle histology, brain magnetic resonance imaging, and perfusion single‐photon emission computed tomography. Interpretation The low frequency of FTD and PDB may suggest that FTD and PDB may be widely underdiagnosed and undertreated in clinical practice.

This paper presents a methodology for optimizing the short-term operation of electric vehicle (EV) charging and discharging while considering the potential curtailment of active power due to volt-var control (VVC) prioritizing reactive power output. The proposed approach involves exchanging information between the EV aggregator and the distribution system operator (DSO). This approach allows the EV aggregator to optimize EV charge/discharge schedules while considering voltage-related constraints in the distribution system (DS). Initially, the aggregator shares the optimized schedule with the DSO to estimate the anticipated active power reduction through power flow analysis. Subsequently, the aggregator revises the constraint on active power output to avoid its expected curtailment and performs a second optimization for EV charging and discharging operation. Numerical simulations conducted on a realistic DS model in Japan validate the effectiveness of the proposed method in enhancing profitability in the day-ahead market while ensuring the quality of DS voltage. The results demonstrate an increase in profit by shifting the time of EV charging and discharging based on shared information from the DSO.

Virtual inertia (VI) control schemes implemented in inverter-based resources (IBRs) present a promising solution for mitigating the absence of inertial response in power systems after the decommissioning of synchronous generators (SGs). The interaction of multiple grid-following (GFL) and grid-forming (GFM) inverters with the power grid demands a thorough understanding, as different control mechanisms can lead to undesired interference that could severely impact the grid’s stability. Power hardware-in-the-loop (PHIL) simulation is a verification technique that effectively bridges the gap between pure simulation and field demonstration. However, the topic of PHIL testing frameworks for multiple inverters equipped with VI control schemes has not been extensively addressed. To address this gap, this study presents a PHIL test framework that enables the verification of the performance and possible interference of multiple hardware inverters. The proposed framework enables the testing of inverters with different rated capacities and control mechanisms under equivalent capacity and control parameter conditions. This framework allows for the testing of various combinations of two inverters, from different manufacturers, to assess their performance and possible interference. The inverter prototypes from different manufacturers will be combined and tested with the proposed PHIL test framework to examine performance and potential interference for all combinations of the two inverters.

ABSTRACT: Background: Treatment for pyogenic spondylitis tends to be prolonged; however, few studies have examined the factors associated with the time required for infection control. Therefore, we analyzed a consecutive cohort of patients to identify factors associated with the time required to control infection in pyogenic spondylitis. This study aimed to clarify the factors linked to the duration necessary for achieving infection control in cases of pyogenic spondylitis, using C-reactive protein (CRP) normalization as an indicator. Methods: In this retrospective observational study, we investigated 108 patients diagnosed with pyogenic spondylitis. We evaluated the number of days from the first visit to CRP normalization; for cases wherein CRP did not normalize, the number of days to the date of final blood sampling was evaluated. In the present study, infection control in pyogenic spondylitis was defined as a CRP falling within the normal range (≤0.14 mg/dL). We performed univariate and multivariate Cox regression analyses to identify various factors associated with the time required for CRP normalization in pyogenic spondylitis. Results: The mean time required for CRP normalization was 148 days. Univariate Cox regression analysis showed that the serum creatinine level, estimated glomerular filtration rate (eGFR), lymphocyte percentage, neutrophil percentage, CRP level, CRP-albumin ratio, and neutrophil-to-lymphocyte ratio were significantly associated with the time required to control infection. Multivariate Cox regression analysis showed that a higher neutrophil percentage, diabetes mellitus, and a lower eGFR were the independent factors associated with a longer infection control time. Conclusions: We found that a higher neutrophil percentage, diabetes mellitus, and a lower eGFR were significantly associated with a longer time for CRP normalization in pyogenic spondylitis. These findings may help identify patients with pyogenic spondylitis who are at a high risk for an extended infection control period.

Double portal veins are a duplication of the portal vein and normal portal vein with an accessory portal vein. We report a case of a 63-year-old asymptomatic female with double portal veins. There was fat accumulation observed in the area which was supplied by the first portal vein in normal position, and fatty sparing of the liver was observed in the area which was supplied by the second portal vein in the preduodenal position. The 2 portal veins were equal in size. Furthermore, the patient presented with multiple congenital anomalies, including double inferior vena cava, splenic lobulation, and accessory liver lobe. Therefore, double portal veins in our case were thought to be an incomplete duplication of the portal vein with multiple congenital anomalies.

Grid-forming inverters (GFMs) have emerged as crucial components in modern power systems, facilitating the integration of renewable energy sources and enhancing grid stability. The significance of GFMs lies in their ability to autonomously establish grid voltage and frequency, enabling grids to form and improve system flexibility. Discussing control methods for grid-forming inverters is paramount due to their crucial role in shaping grid dynamics and ensuring reliable power delivery. This paper explores the fundamental and advanced control methods employed by GFMs, explaining their operational principles and performance characteristics. Basic control methods typically involve droop control, voltage and frequency regulation, and power-balancing techniques to maintain grid stability under varying operating conditions. Advanced control strategies encompass predictive control, model predictive control (MPC), and adaptive control, which influence advanced algorithms and real-time data for enhanced system responsiveness and efficiency. A detailed analysis and performance comparison of different control methods for GFM is presented, highlighting their strengths, limitations, and suitability for diverse grid environments. Through comprehensive studies, this research interprets the ability of various control strategies to mitigate grid disturbances, optimize power flow, and enhance overall system stability.

Grid-forming inverters (GFMIs) are promising technologies that can replace some of the capabilities traditionally provided by synchronous generators (SGs), such as inertial response. While there have been many simulation-based studies on GFMIs, performance testing has not been adequately discussed. Power hardware-in-the-loop (PHIL) simulation is an attractive option for testing GFMIs. The interaction between GFMI and power systems can be observed under a variety of conditions, including low-inertia and contingency conditions. Since PHIL testing was primarily used for grid-following inverters (GFLIs), the PHIL configuration needs to be adjusted to test GFMIs, which respond faster to changes in grid voltage than GFLIs. This paper proposes the PHIL setup for testing GFMIs. It utilizes the PHIL interface developed for testing GFLIs and adjusts it for testing GFMIs. The stability and accuracy of the PHIL testing are evaluated in terms of frequency stability in low-inertia power systems by comparing test and simulation results.

Abstract Punctate white matter lesions (PWMLs) in infants may be related to neurodevelopmental outcomes based on the location or number of lesions. This study aimed to assess the automatic detectability of PWMLs in infants on deep learning using composite images created from several cases. To create the initial composite images, magnetic resonance (MR) images of two infants with the most PWMLs were used; their PWMLs were extracted and pasted onto MR images of infants without abnormality, creating many composite PWML images. Deep learning models based on a convolutional neural network, You Only Look Once v3 (YOLOv3), were constructed using the training set of 600, 1200, 2400, and 3600 composite images. As a result, a threshold of detection probability of 20% and 30% for all deep learning model sets yielded a relatively high sensitivity for automatic PWML detection (0.908–0.957). Although relatively high false-positive detections occurred with the lower threshold of detection probability, primarily, in the partial volume of the cerebral cortex (≥ 85.8%), those can be easily distinguished from the white matter lesions. Relatively highly sensitive automatic detection of PWMLs was achieved by creating composite images from two cases using deep learning.

Developing advanced control functions for inverter-based resources (IBRs) to replace the inertial response of retiring synchronous generators (SGs) is progressing rapidly. Although various control mechanisms have been proposed for grid-following (GFL) inverters and grid-forming (GFM) inverters, the comprehensive comparison of their performance in contributing to grid stabilization based on hardware testings has not been studied well. This paper performs power hardware-in-the-loop (PHIL) testing for multiple inverter prototypes from different manufacturers and compares their performance concerning the difference in inverter types, control methods, and IBR penetration conditions in the power system. It also tests the possible interference between islanding detection methods (IDMs) and frequency control capabilities of GFL and GFM inverters.

Due to the increasing burden on the traditional control systems, inverter-based resources (IBR) is required to take part in grid stability efforts. This is the key to increasing the share of IBRs in the power grid and ensuring that issues related to reduced inertia are handled properly. There have been some efforts towards developing frequency control for smart inverters such as frequency–watt​ mode. However, a fully functioning synthetic inertia mode combined with a smart inverter has not been developed yet. In this paper, a novel function is developed for implementing synthetic inertia in smart inverters as a combination of several control modes. Then, the operating curves of these control modes are varied to investigate their impact on the synthetic inertia’s performance and stability. These operations are tested both with lab equipment and controller hardware in the loop (CHIL) testing to study the accuracy of the latter. Once accuracy is established, further CHIL tests have been performed to investigate the interaction between the developed synthetic inertia function and other smart inverter functions such as Volt-Var Control. Results show that there is no negative impact on either of the functions and they can be safely activated simultaneously.

The increasing share of renewable energy-based resources in the power grid has a detrimental impact on the power system stability. As these resources are inverter-based, they decrease the overall inertia of the grid. To mitigate this problem, recent research focuses on developing novel techniques to provide synthetic inertia with inverters. In this fashion, inverter-based resources (IBR) can also contribute to power system inertia, hence, its stability. Some of the approaches for providing synthetic inertia are discussed in the standards. However, despite its potential, frequency-derivate-based (df/dt) solutions are not studied to adapt grid code in Japan. This paper addresses this need by developing a full df/dt control approach for IBRs. Several intricacies of this design is presented along with operation curves and system designs. Considering the special needs of the Japanese Electrical Grid, and the speed in which inertia support should be provided, a novel rate of change of frequency (RoCoF) measurement approach is also developed and presented. Lab tests are performed with hardware-in-the-loop tests and the results validate the operation and performance of both novel RoCoF measurement and df/dt control model.

Introduction: Although intraoperative spinal neuromonitoring (IONM) is recommended for spine surgeries, there are no guidelines regarding its use in Japan, and its usage is mainly based on the surgeon's preferences. Therefore, this study aimed to provide an overview of the current trends in IONM usage in Japan. Methods: In this web-based survey, expert spine surgeons belonging to the Japanese Society for Spine Surgery and Related Research were asked to respond to a questionnaire regarding IONM management. The questionnaire covered various aspects of IONM usage, including the preferred modality, operation of IONM, details regarding muscle-evoked potential after electrical stimulation of the brain (Br(E)-MsEP), and need for consistent use of IONM in major spine surgeries. Results: Responses were received from 134 of 186 expert spine surgeons (response rate, 72%). Of these, 124 respondents used IONM routinely. Medical staff rarely performed IONM without a medical doctor. Br(E)-MsEP was predominantly used for IONM. One-third of the respondents reported complications, such as bite injuries caused by Br(E)-MsEP. Interestingly, two-thirds of the respondents did not plan responses to alarm points. Intramedullary spinal cord tumor, scoliosis (idiopathic, congenital, or neuromuscular in pediatric), and thoracic ossification of the posterior longitudinal ligament were representative diseases that require IONM. Conclusions: IONM has become an essential tool in Japan, and Br(E)-MsEP is a predominant modality for IONM at present. Although we investigated spine surgeries for which consistent use of IONM is supported, a cost-benefit analysis may be required.

Hydrogen lines from forming planets are crucial for understanding planet formation. However, the number of planetary hydrogen line detections is still limited. Recent JWST/NIRSpec observations have detected Paschen and Brackett hydrogen lines at TWA 27 B (2M1207b). Although classified as a planetary- mass companison (PMC) rather than a planet due to its large mass ratio to the central star, TWA 27 B’s hydrogen line emissions are expected to be same as the planetary one, given its small mass (≈5 M _J ). We aim to constrain the accretion properties and accretion geometry of TWA 27 B, contributing to our understanding of hydrogen-line emission mechanisms common to both PMCs and planets. We conduct spectral fitting of four bright hydrogen lines (Pa- α , Pa- β , Pa- γ , Pa- δ ) with an accretion-shock emission model tailored for forming planets. We estimate the mass accretion rate at $\dot{M}\approx 3\times {10}^{-9}\,{M}_{{\rm{J}}}\,{\mathrm{yr}}^{-1}$ with our fiducial parameters, though this is subject to an uncertainty of up to factor of ten. Our analysis also indicates a dense accretion flow, n ≳ 10 ^13 cm ^−3 just before the shock, implying a small accretion-shock filling factor f _f on the planetary surface ( f _f ≲ 5 × 10 ^−4 ). This finding suggests that magnetospheric accretion is occurring at TWA 27 B. Additionally, we carry out a comparative analysis of hydrogen-line emission color to identify the emission mechanism, but the associated uncertainties proved too large for definitive conclusions. This underscores the need for further high-precision observational studies to elucidate these emission mechanisms fully.

PDS 70 is a protoplanetary system that hosts two actively accreting gas giants, namely, PDS 70b and PDS 70 c. The system has a ∼60–100 au dusty ring that has been resolved by the Atacama Large Millimeter/Submillimeter Array (ALMA), along with circumplanetary disks around the two gas giants. Here, we report the first Karl G. Jansky Very Large Array (JVLA) Q - (40–48 GHz), Ka - (29–37 GHz), K - (18–26 GHz), and X - (8–12 GHz) bands' continuum observations, and the complementary ALMA Bands 3 (∼98 GHz) and 4 (∼145 GHz) observations towards PDS 70. The dusty ring appears azimuthally asymmetric in our ALMA images. We obtained firm detections at Ka and K bands without spatially resolving the source; we obtained a marginal detection at Q band, and no detection at X band. The spectral indices ( α ) are 5 ± 1 at 33–44 GHz and 0.6 ± 0.2 at 22–33 GHz. At 10–22 GHz, the conservative lower limit of α is 1.7. The 33–44 GHz flux density is likely dominated by the optically thin thermal emission of grown dust with ≳1 mm maximum grain sizes, which may be associated with the azimuthally asymmetric substructure induced by planet–disk interaction. Since PDS 70 was not detected at X band, we found it hard to explain the low spectral index at 22–33 GHz only with free–free emission. Hence, we attribute the dominant emission at 22–33 GHz to the emission of spinning nano-meter-sized dust particles, while free–free emission may partly contribute to emission at this frequency range. In some protoplanetary disks, the emission of spinning nano-meter-sized dust particles may resemble the 20–50 GHz excess in the spectra of millimeter-sized dust. The finding of strong continuum emission of spinning nano-meter-sized particles can complicate the procedure of constraining the properties of grown dust. Future high resolution, multifrequency JVLA/Next Generation Very Large Array and Square Kilometer Array observations may shed light on this issue.

TWA 27B (2M1207b) is the first directly imaged planetary-mass ( M _p ≈ 5 M _J ) companion and was observed at 0.9–5.3 μ m with ​​​JWST/NIRSpec. To understand the accretion properties of TWA 27B, we search for continuum-subtracted near-infrared helium and hydrogen emission lines and measure their widths and luminosities. We detect the He i triplet at 4.3 σ and all Paschen-series lines covered by NIRSpec (Pa α , Pa β , Pa γ , Pa δ ) at 4 σ –5 σ . The three brightest Brackett-series lines (Br α , Br β , Br γ ) as well as Pf γ and Pf δ are tentative detections at 2 σ –3 σ . We provide upper limits on the other hydrogen lines, including on H α through Hubble Space Telescope archival data. Three lines can be reliably deconvolved to reveal an intrinsic width Δ v _intrsc = (67 ± 9) km s ^−1 , which is 60% of the surface freefall velocity. The line luminosities seem significantly too high to be due to chromospheric activity. Converting line luminosities to an accretion rate yields $\dot{M}\approx 5\times {10}^{-9}\,{M}_{{\rm{J}}}\,{\mathrm{yr}}^{-1}$ when using scaling relationships for planetary masses, and $\dot{M}\approx 0.1\times {10}^{-9}\,{M}_{{\rm{J}}}\,{\mathrm{yr}}^{-1}$ with extrapolated stellar scalings. Several of these lines represent the first detections at an accretor of such low mass. The weak accretion rate implies that formation is likely over. This analysis shows that JWST can be used to measure low line-emitting mass accretion rates onto planetary-mass objects, motivates deeper searches for the mass reservoir feeding TWA 27B, and hints that other young directly imaged objects might—hitherto unbeknownst—also be accreting.

Recent high-sensitivity observations reveal that accreting giant planets embedded in their parental circumstellar disks can emit H α at their final formation stages. While the origin of this emission is not yet determined, magnetospheric accretion is currently the most plausible hypothesis. In order to test this hypothesis further, we develop a simplified but physics-based model and apply it to our observations taken toward HD 163296 with Subaru/SCExAO+VAMPIRES. We specify under which conditions embedded giant planets can undergo magnetospheric accretion and emit hydrogen lines. We find that when the stellar accretion rates are high, magnetospheric accretion becomes energetic enough to self-regulate the resulting emission. On the other hand, when massive planets are embedded in disks with low accretion rates, earlier formation histories determine whether magnetospheric accretion occurs. We explore two different origins for the hydrogen emission lines (magnetospheric accretion flow heated by accretion-related processes versus planetary surfaces via accretion shock). The corresponding relationships between the accretion and line luminosities dictate that the emission from accretion flow achieves higher line flux than that from accretion shock, and the flux decreases with increasing wavelengths (i.e., from H α to Pa β and up to Br γ ). Our observations do not detect any point-like source emitting H α , and they are used to derive the 5 σ detection limit. The observations are therefore not sensitive enough, and a reliable examination of our model becomes possible when the observational sensitivity is improved by a factor of 10 or more. Multi-band observations increase the possibility of efficiently detecting embedded giant planets and carefully determining the origin of the hydrogen emission lines.

An inner component misaligned from an outer component in a protoplanetary disk can result in the former casting shadows on the latter. We present a new instance of shadowing on the outer disk around a very-low-mass star, ZZ Tau IRS. Through the analysis of near-infrared (NIR) archival data at λ = 1.6 μ m acquired with the Wide Field Camera 3 on the Hubble Space Telescope, we identified brightness asymmetries in the top and bottom halves of the highly inclined outer disk, separated by a dark lane. The brighter sides in the top and bottom halves are on the opposite sides, which we attributed to shadows cast by a misaligned inner disk. Radiative transfer modeling of the system with a misaligned angle of 15 deg between the inner and outer disks well reproduced the observations. Additionally, we found an elevated brightness temperature of ^12 CO (3–2) at r ∼ 30 au on the brighter side in NIR wavelengths in the top half disk, which can be explained by the shadowing effect too. While the origin of the misaligned inner disk remains unclear, future monitoring observations to search for temporal variations in brightness asymmetries will likely provide useful clues.

ABSTRACT: Background: Due to its association with bone metabolic status and muscle strength/mass, vitamin D deficiency has the potential to affect neurological symptom recovery after surgery for degenerative cervical myelopathy (DCM). However, few studies have investigated the effects of vitamin D deficiency (serum 25(OH)D

Microgrids consisting of renewable energy based distributed generators have become popular as a way of energizing off-grid systems. Due to their low-inertia, these distributed generators require a robust frequency control system to maintain it. This problem is amplified by the fact that there is no centralized grid that anchor the system voltage and frequency. For this reason, such off-grid microgrid employs storage systems and diesel generators to provide some flexibility. Flywheel energy storage systems (FESSs) have very quick reaction time and can provide frequency support in case of deviations. To this end, this paper develops and presents a microgrid frequency control system with FESS. The system performance tests are performed with real-equipment where FESS is connected to digital real time simulator. Several frequency events are triggered and the frequency profile is observed to compare microgrid’s performance with and without the developed frequency control. Results show that flywheel energy storage system provides a much smoother frequency profile with less deviations.

Grid-forming (GFM) inverters are promising technologies in future power systems. Although the voltage-source characteristic of the GFM inverter has been validated to enhance the stabilities in low-inertia power systems, modifying protective function mechanisms is needed from grid-following (GFL) inverters with the current-source characteristic. Therefore, the protective functions that coexist with grid stabilization capabilities in GFM inverters and their verification methods should be studied for practical deployment. This paper applies the existing Japanese conformance testing on prototypes of GFL and GFM inverters to reveal issues in the existing conformance testing framework, which was not designed to consider the voltage-source characteristics of GFM inverters. The test results identify the three main issues of GFM inverters in the existing test framework. The discussion based on the results will provide helpful knowledge to design future provisions on the functional requirements of GFM inverters and their verification methods.

Abstract The left inferior phrenic vein (LIPV) is a major drainage vessel of gastric varices and serves as an important conduit in endovascular treatment for gastric varices. The narrowing of LIPV has been empirically demonstrated and sometimes hinders catheter insertion for the treatment of gastric varices. We herein investigated the morphology of narrowed LIPV in patients with portal hypertension. Venograms of LIPV on 25 patients with gastric varices (15 males; 10 females; age range, 45–79 years with a mean of 67 years) were retrospectively reviewed, the following four parameters were measured: the diameter of LIPV, the diameter of narrowed LIPV, the narrowing rate, and the distance to narrowed LIPV from the left renal vein. On all 25 venograms, a narrowing was detected just above the common trunk with the left adrenal vein. The diameter of LIPV was 9.0 ± 4.2 mm, the diameter of narrowed LIPV was 5.1 ± 2.3 mm, the narrowing rate was 40.6 ± 16.0%, and the distance to narrowed LIPV from the left renal vein was 20.0 ± 7.4 mm. This anatomical information about the narrowing of LIPV may contribute to the safe and efficacious treatment of gastric varices.

Introduction Reports of urothelial carcinoma with testicular metastasis are limited and the etiology and prognosis remain unclear. We report a rare case of testicular metastasis derived from bladder urothelial carcinoma. Case presentation A 68‐year‐old man presented with gross hematuria and urinary frequency. Cystoscopy demonstrated an 8‐cm‐sized tumor in the bladder; transurethral resection and magnetic resonance imaging confirmed invasive urothelial carcinoma. Cystoprostatourethrectomy was performed, and the pathological diagnosis was high‐grade muscle‐invasive urothelial carcinoma. Three years later, the patient noticed a left scrotal mass. Left high orchiectomy was performed, and histopathologic examination of the surgical specimen revealed urothelial carcinoma, confirming testicular metastasis derived from bladder cancer. The patient received chemotherapy with gemcitabine and cisplatin and has survived for 7 years since the initial diagnosis without progression. Conclusion Although rare, secondary lesions should be considered for the differential diagnosis of testicular tumors in patients with a history of urothelial carcinoma.

Abstract Background The V-Akt murine thymoma viral oncogene (AKT) 1 (E17K) is a subfamily of serine/threonine protein kinases that affects the survival, proliferation, and invasion of cancer cells. The clinicopathological features and frequencies in Asian populations with AKT1 mutations in breast and endometrial cancers are unclear. Hence, we aimed to determine the frequencies and relationships between clinicopathological features and AKT1 mutations in Asian women with cancer. Methods We extracted DNA from 311 and 143 samples derived from patients with breast and endometrial cancers to detect the AKT1 point mutation (hotspot), E17K. We examined correlations between clinicopathological features and AKT1 mutation status. Results The frequency of AKT1 mutations in breast cancer was 7.4%, and they were found more frequently in human epidermal growth factor receptor 2 (HER2)-negative breast cancer subtypes, although this was not statistically significant (P = 0.08). The frequency of AKT1 mutations in endometrial cancer was 4.1%, and the mutations were histologically detected only in endometrioid types. However, AKT1 mutations did not correlate with relapse-free or overall survival of patients with breast or endometrial cancer. Conclusions AKT1 mutations are associated with HER2-negative subtype in breast cancer and in endometrial cancer with endometrioid histology. The frequencies of AKT1 mutations in breast and endometrial cancers were similar between Asian and other regional women. The frequency of mutations is too low in both tumor types to talk about predictive significance.

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

We examined the grain size in the dust ring encircling the 0.19 M _☉ T Tauri star CIDA 1 using the Karl G. Jansky Very Large Array at multiple centimeter wavelengths, with a spatial resolution of 0.″2–0.″9. We detected distinct partial-ring structures at these wavelengths around CIDA 1. Based on spatial distributions and spectral indices, we determined that these centimeter emissions originated from dust, rather than free–free or synchrotron emissions. To estimate the maximum grain size ( ${a}_{\max }$ ) within the ring, we compared the observed spectral energy distribution (SED) with SEDs calculated for different ${a}_{\max }$ values using radiative transfer calculations. Our findings indicate an ${a}_{\max }$ value of approximately 2.5 cm in the ring, assuming that the dust opacity can be approximated by the DSHARP models. These results suggest that grain growth took place within the CIDA 1 ring, potentially facilitating more efficient planet formation through pebble accretion scenarios involving centimeter-sized pebbles.

The powerful, high-energy magnetic activities of young stars play important roles in the magnetohydrodynamics in the innermost parts of the protoplanetary disks. In addition, the associated UV and X-ray emission dictates the photochemistry; moreover, the corona activities can affect the atmosphere of a newborn extrasolar planet. How the UV and X-ray photons are generated and how they illuminate the disks are not well understood. Here we report the analyses of the optical and infrared (OIR) photometric monitoring observations and the high angular resolution centimeter-band images of the low-mass (M1-type) pre-main-sequence star DM Tau. We found that the OIR photometric light curves present periodic variations, which suggests that the host young star is rotating in the same direction as the natal disk and is hosting at least one giant cold spot. In addition, we resolved that the ionized gas in the DM Tau disk is localized and its spatial distribution is varying with time. All the present observations can be coherently interpreted, if the giant cold spot is the dominant anisotropic UV and/or X-ray source that illuminates the ambient cone-like region. These results indicate that a detailed theoretical model of the high-energy protostellar emission is essential in understanding the space weather around extrasolar planets and the origin of life.

Crescent-like asymmetric dust structures discovered in protoplanetary disks indicate dust aggregations. Thus, researching these structures helps us understand the planet formation process. Here we analyze ALMA data of the protoplanetary disk around the T-Tauri star SR 21, which has asymmetric structures that were detected in previous submillimeter observations. Imaged at ALMA Band 6 (1.3 mm) with a spatial resolution of about 0.″04, the disk is found to consist of two rings and three asymmetric structures, with two of the asymmetric structures being in the same ring. Compared to the Band 6 image, the Band 3 (2.7 mm) image also shows the three asymmetric structures, but with some clumps. The elongated asymmetric structures in the outer ring could be due to the interactions of a growing planet. Based on fitting the Band 3 and Band 6 dust continuum data, two branches of solutions for the maximum dust size in the disk are suggested: one is larger than 1 mm, and the other is smaller than 300 μ m. High-resolution continuum observations at longer wavelengths as well as polarization observations can help break the degeneracy. We also suggest that the prominent spiral previously identified in VLT/SPHERE observations south of the star at 0.″25 may be the scattered-light counterpart of the inner arc, and the structure is a dust-trapping vortex in nature. The discovered features in SR 21 make it a good target for studying the evolution of asymmetric structures and planet formation.

High-spatial-resolution observations of CO isotopologue line emission in protoplanetary disks at mid-inclinations (≈30°–75°) allow us to characterize the gas structure in detail, including radial and vertical substructures, emission surface heights and their dependencies on source characteristics, and disk temperature profiles. By combining observations of a suite of CO isotopologues, we can map the two-dimensional ( r , z ) disk structure from the disk upper atmosphere, as traced by CO, to near the midplane, as probed by less abundant isotopologues. Here, we present high-angular-resolution (≲0.″1 to ≈0.″2; ≈15–30 au) observations of CO, ^13 CO, and C ^18 O in either or both J = 2–1 and J = 3–2 lines in the transition disks around DM Tau, Sz 91, LkCa 15, and HD 34282. We derived line emission surfaces in CO for all disks and in ^13 CO for the DM Tau and LkCa 15 disks. With these observations, we do not resolve the vertical structure of C ^18 O in any disk, which is instead consistent with C ^18 O emission originating from the midplane. Both the J = 2–1 and J = 3–2 lines show similar heights. Using the derived emission surfaces, we computed radial and vertical gas temperature distributions for each disk, including empirical temperature models for the DM Tau and LkCa 15 disks. After combining our sample with literature sources, we find that ^13 CO line emitting heights are also tentatively linked with source characteristics, e.g., stellar host mass, gas temperature, disk size, and show steeper trends than seen in CO emission surfaces.

The purpose of this study is to correlate quantitative T1, T2, and proton density (PD) values with breast cancer subtypes. Twenty-eight breast cancer patients underwent MRI of the breast including synthetic MRI. T1, T2, and PD values were correlated with Ki-67 and were compared between ER-positive and ER-negative cancers, and between Luminal A and Luminal B cancers. The effectiveness of T1, T2, and PD in differentiating the ER-negative from the ER-positive group and Luminal A from Luminal B cancers was evaluated using receiver operating characteristic analysis. Mean T2 relaxation of ER-negative cancers was significantly higher than that of ER-positive cancers (p < 0.05). The T1, T2, and PD values exhibited a strong positive correlation with Ki-67 (Pearson’s r = 0.75, 0.69, and 0.60 respectively; p < 0.001). Among ER-positive cancers, T1, T2, and PD values of Luminal A cancers were significantly lower than those of Luminal B cancers (p < 0.05). The area under the curve (AUC) of T2 for discriminating ER-negative from ER-positive cancers was 0.87 (95% CI: 0.69–0.97). The AUC of T1 for discriminating Luminal A from Luminal B cancers was 0.83 (95% CI: 0.61–0.95). In conclusion, quantitative values derived from synthetic MRI show potential for subtyping of invasive breast cancers.

The increase in inverter-based resources associated with the increased installation of PV sources is a concern because it reduces the inertia of the power system during peak PV generation periods. As a countermeasure to reduce grid inertia, the addition of pseudo-inertia using virtual synchronous machines can be selected, and PV generation can cooperatively contribute to the stable operation of the power system by using the suppressed output as reserve power. However, few studies have analyzed VSMs that do not use batteries and use PV as a resource (PV-VSM) in simulations, including grid interconnection and solar radiation fluctuations, and it is necessary to clarify the issues and discuss countermeasures. In this study, electromagnetic transient response analysis was applied to a VSM connected to a two-generator system, simulations were performed, and the following findings were reported and countermeasure methods for the problem were proposed. When the PV capacity is insufficient for the output required by the VSM inverter, the PV-VSM control system may become unstable. This is caused by a drop in the capacitor voltage of the DC/DC converter due to insufficient PV output. The limiter control system is designed to address this problem by combining the headroom estimation system with the current limiting algorithm. The proposed limiter control system is validated on solar radiation ramp fluctuations as a test case and found that the system was effective in supressing PV-VSM instability. In our simulation case, the PV-VSM with our limiter control can continue to operate stably even if the PV available power is 0.03 [p.u.] short of the inverter’s reference power by the solar power ramp fluctuation, as long as the inverter installation rate is less than 50%.

Background: The purpose of this study was to clarify the clinical features of ossification of the posterior longitudinal ligament (OPLL) and extreme ossification at multiple sites. Methods: This prospective study involved patients with a diagnosis of cervical OPLL at 16 institutions in Japan. Patient-reported outcome measures, including responses on the Japanese Orthopaedic Association (JOA) Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ), JOA Back Pain Evaluation Questionnaire (JOA-BPEQ), and visual analog scale pain score, were collected to investigate clinical status. In each patient, the sum of the levels at which OPLL was located (OP index) was evaluated on whole-spine computed tomography, along with ossification of other spinal ligaments including the anterior longitudinal ligament (OALL), ligament flavum (OLF), supra- and intraspinous ligaments (SSL), and diffuse idiopathic skeletal hyperostosis (DISH). The distribution of OP index values in the study population was investigated, and the clinical and radiologic characteristics of patients in the top 10% were assessed. Results: In total, 236 patients (163 male, 73 female; mean age 63.5 years) were enrolled. Twenty-five patients with OP index ≥ 17 were categorized into a high OP index group and the remainder into a moderate/low OP index group. There were significantly more women in the high OP index group. Patients in the high OP index group also had significantly poorer scores for lower extremity function and quality of life on the JOA-CMEQ and in each domain but not for body pain on the JOA-BPEQ compared with those in the moderate/low OP index group. Patients in the high OP index group had more OALL in the cervical spine and more OLF and SSL in the thoracic spine. The prevalence of DISH was also significantly higher in the high OP index group. In the high OP index group, interestingly, OPLL was likely to be present adjacent to DISH in the cervicothoracic and thoracolumbar spine, especially in men, and often coexisted with DISH in the thoracic spine in women. Conclusion: This prospective cohort registry study is the first to demonstrate the clinical and radiologic features of patients with OPLL and a high OP index. In this study, patients with a high OP index had poorer physical function in the lumbar spine and lower extremities and were also predisposed to extreme ossification of spinal ligaments other than the OPLL.

Magnetic resonance imaging (MRI) is the most sensitive imaging modality for breast cancer detection. This systematic review investigated the role of quantitative MRI features in classifying molecular subtypes of breast cancer. We performed a literature search of articles published on the application of quantitative MRI features in invasive breast cancer molecular subtype classification in PubMed from 1 January 2002 to 30 September 2021. Of the 1275 studies identified, 106 studies with a total of 12,989 patients fulfilled the inclusion criteria. Bias was assessed based using the Quality Assessment of Diagnostic Studies. All studies were case-controlled and research-based. Most studies assessed quantitative MRI features using dynamic contrast-enhanced (DCE) kinetic features and apparent diffusion coefficient (ADC) values. We present a summary of the quantitative MRI features and their correlations with breast cancer subtypes. In DCE studies, conflicting results have been reported; therefore, we performed a meta-analysis. Significant differences in the time intensity curve patterns were observed between receptor statuses. In 10 studies, including a total of 1276 lesions, the pooled difference in proportions of type Ⅲ curves (wash-out) between oestrogen receptor-positive and -negative cancers was not significant (95% confidence interval (CI): [−0.10, 0.03]). In nine studies, including a total of 1070 lesions, the pooled difference in proportions of type 3 curves between human epidermal growth factor receptor 2-positive and -negative cancers was significant (95% CI: [0.01, 0.14]). In six studies including a total of 622 lesions, the pooled difference in proportions of type 3 curves between the high and low Ki-67 groups was significant (95% CI: [0.17, 0.44]). However, the type 3 curve itself is a nonspecific finding in breast cancer. Many studies have examined the relationship between mean ADC and breast cancer subtypes; however, the ADC values overlapped significantly between subtypes. The heterogeneity of ADC using kurtosis or difference, diffusion tensor imaging parameters, and relaxation time was reported recently with promising results; however, current evidence is limited, and further studies are required to explore these potential applications.

Virtual inertia control is a methodology to make inverter-based resources (IBR) behave like a synchronous machine. However, an IBR cannot fully emulate the response of synchronous machine because of its low-current capacity. When the inertial response of an IBR is affected by the current limitation, the synchronization of the synchronous machine simulated virtually inside the IBR controller with the other synchronous generators in the grid is affected, which may cause step-out of the simulated generator. We propose a methodology which can keep the synchronization by modifying internal induced voltage of the simulated generator to follow the system voltage change. The proposal is validated by the simulation using a nine-bus transmission system model including two synchronous generators and a large-scale IBR. The result of the generator trip simulation shows that the proposed method suppresses the phase angle variation while the current is limited, and avoids the instability regarding the synchronism. Furthermore, the impact of the current limitation on frequency stability is also evaluated through the simulation study and it is found that as the amount of output suppression increases, the frequency nadir falls, but the rate-of-change of frequency is hardly affected.

Various studies have found a high incidence of early graft dislodgement after multilevel corpectomy. Although a hybrid fusion technique was developed to resolve implant failure, the hybrid and conventional techniques have not been clearly compared in terms of perioperative complications in patients with severe ossification of the posterior longitudinal ligament (OPLL) involving three or more levels. The purpose of this study was to compare clinical and radiologic outcomes between anterior cervical corpectomy with fusion (ACCF) and anterior hybrid fusion for the treatment of multilevel cervical OPLL. We therefore retrospectively reviewed the clinical and radiologic data of 53 consecutive patients who underwent anterior fusion to treat cervical OPLL: 30 underwent ACCF and 23 underwent anterior hybrid fusion. All patients completed 2 years of follow-ups. Implant migration was defined as subsidence > 3 mm. There were no significant differences in demographics or clinical characteristics between the ACCF and hybrid groups. Early implant failure occurred significantly more frequently in the ACCF group (5 cases, 16.7%) compared with the hybrid group (0 cases, 0%). The fusion rate was 80% in the ACCF group and 100% in the hybrid group. Although both procedures can achieve satisfactory neurologic outcomes for multilevel OPLL patients, hybrid fusion likely provides better biomechanical stability than the conventional ACCF technique.

Background: Although diffuse idiopathic skeletal hyperostosis (DISH) is known to coexist with the ossification of spinal ligaments (OSLs), details of the radiographic relationship remain unclear. Methods: We prospectively collected data of 239 patients with symptomatic cervical ossification of the posterior longitudinal ligament (OPLL) and analyzed the DISH severity on whole-spine computed tomography images, using the following grades: grade 0, no DISH; grade 1, DISH at T3–T10; grade 2, DISH at both T3–T10 and C6–T2 and/or T11–L2; and grade 3, DISH beyond C5 and/or L3. Ossification indices were calculated as the sum of vertebral and intervertebral levels with OSL for each patient. Results: DISH was found in 107 patients (44.8%), 65 (60.7%) of whom had grade 2 DISH. We found significant associations of DISH grade with the indices for cervical OPLL (r = 0.45, p < 0.0001), thoracic ossification of the ligamentum flavum (OLF; r = 0.41, p < 0.0001) and thoracic ossification of the supra/interspinous ligaments (OSIL; r = 0.53, p < 0.0001). DISH grade was also correlated with the index for each OSL in the whole spine (OPLL: r = 0.29, p < 0.0001; OLF: r = 0.40, p < 0.0001; OSIL: r = 0.50, p < 0.0001). Conclusion: The DISH grade correlated with the indices of OSL at each high-prevalence level as well as the whole spine.

Lateral lumbar interbody fusion (LLIF) is increasingly performed as corrective surgery for patients with adult spinal deformity (ASD). This paper compares the surgical results of LLIF and conventional posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) in ASD using a propensity score matching analysis. We retrospectively reviewed patients with ASD who received LLIF and PLIF/TLIF, and investigated patients’ backgrounds, radiographic parameters, and complications. The propensity scores were calculated from patients’ characteristics, including radiographic parameters and preoperative comorbidities, and one–to-one matching was performed. Propensity score matching produced 21 matched pairs of patients who underwent LLIF and PLIF/TLIF. All radiographic parameters significantly improved in both groups at the final follow-up compared with those of the preoperative period. The comparison between both groups demonstrated no significant difference in terms of postoperative pelvic tilt, lumbar lordosis (LL), or pelvic incidence–LL at the final follow-up. However, the sagittal vertical axis tended to be smaller in the LLIF at the final follow-up. Overall, perioperative and late complications were comparable in both procedures. However, LLIF procedures demonstrated significantly less intraoperative blood loss and a smaller incidence of postoperative epidural hematoma compared with PLIF/TLIF procedures in patients with ASD.

Background: This study investigated how diffuse idiopathic skeletal hyperostosis (DISH) influences clinical characteristics in patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although DISH is considered unlikely to promote neurologic dysfunction, this relationship remains unclear. Methods: Patient data were prospectively collected from 16 Japanese institutions. In total, 239 patients with cervical OPLL were enrolled who had whole-spine computed tomography images available. The primary outcomes were visual analog scale pain scores and the results of other self-reported clinical questionnaires. Correlations were sought between clinical symptoms and DISH using the following grading system: 1, DISH at T3-T10; 2, DISH at both T3–10 and C6–T2 and/or T11–L2; and 3, DISH beyond the C5 and/or L3 levels. Results: DISH was absent in 132 cases, grade 1 in 23, grade 2 in 65, and grade 3 in 19. There were no significant correlations between DISH grade and clinical scores. However, there was a significant difference in the prevalence of neck pain (but not in back pain or low back pain) among the three grades. Interestingly, DISH localized in the thoracic spine (grade 1) may create overload at the cervical spine and lead to neck pain in patients with cervical OPLL. Conclusion: This study is the first prospective multicenter cross-sectional comparison of subjective outcomes in patients with cervical OPLL according to the presence or absence of DISH. The severity of DISH was partially associated with the prevalence of neck pain.

Case: Three cases of inflammatory joint diseases (systemic lupus erythematosus and ongoing juvenile idiopathic arthritis) with painful flexible progressive collapsing foot deformity (PCFD) underwent flatfoot surgery. All cases maintained sufficient radiological correction and achieved good clinical condition at final follow-up. Conclusion: Although the prospect for recurrence of the deformity is not clear, even in inflammatory joint diseases, flat foot surgery such as flexor digitorum longs transfer, spring ligament reconstruction, and lateral column lengthening could have a possibility to be indicated against PCFD, as long as disease activity could be well suppressed by drug therapy, subsequently subtalar and talonavicular joints could be preserved. [ABSTRACT FROM AUTHOR]

To assese of potential benefint of photon-counting detector CT (PCD-CT) over conventional single-energy CT (CSE-CT) on accurate diagnosis of incidental findings with high clinical significance (IFHCS). Materials and methods: This retrospective study included 365 patients who initially underwent abdominopelvic contrast-enhanced CT (AP-CECT) without non-enhancement (PCD-CT: 187 and CSE-CT: 178). We selected IFHCS and evaluated their diagnosability using CE-CT alone. IFHCSs that could not be diagnosed with only CE-CT were evaluated using additional PCD-CT postprocessing techniques, including virtual non-contrast image, low keV image, and iodine map. A PCD-CT scanner (NAEOTOM Alpha, Siemens Healthineer, Erlangen, Germany) was used. Results: Thirty-nine IFHCSs (PCD-CT: 22 and CSE-CT: 17) were determined in this study. Seven IFHCSs in each group were able to diagnose with only CE-CT. Fifteen IFHCSs were able to diagnose using the additional PCD-CT postprocessing technique, which was useful for detecting and accurately diagnosing 68.2% (15/22) of lesions and 65% (13/20) of patients. All IFHCSs were accurately diagonosed with PCD-CT. Conclusion: PCD-CT was useful for characterizing IFHCSs that are indeterminate at CSE-CT. PCD-CT offered potential benefit of PCD-CT over conventional single-energy CT on evaluation of IFHCS on only abdominopelvic CT. [ABSTRACT FROM AUTHOR]

The isolated absence of the azygos vein was incidentally found on computed tomography (CT) examination in a 60-year-old female. The exact anomaly can be evaluated on high-resolution images of 0.4-mm slice thickness with low keV using photon-counting detector CT. The azygos vein, including the azygos arch, was absent, and a mildly dilated hemiazygos vein flowed to the left brachiocephalic vein through the left superior intercostal vein. A hemiazygos vein connected the left renal vein at the level of the first lumbar vertebra. This patient was the second patient to undergo evaluation using volume rendering images. High-resolution maximum-intensity projection images were useful for assessing the anatomy. Radiation dose was decreased compared with that in conventional CT. [ABSTRACT FROM AUTHOR]

This article explores the use of reverse V-shaped osteotomy as a treatment for ankylosing rocker-bottom foot deformity in patients with rheumatoid arthritis (RA). The study examined three cases where patients with RA and foot deformities underwent the procedure, which successfully corrected the deformities and improved their clinical scores. The authors suggest that reverse V-shaped osteotomy could be a valuable and definitive procedure for this type of foot deformity in RA patients. The study acknowledges the need for additional research and highlights some limitations. [Extracted from the article]