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Splenic hilar lymphadenectomy is not recommended for advanced proximal gastric cancer that does not invade the greater curvature according to the results of the previous studies. The efficacy of splenic hilar lymphadenectomy for type II and type III adenocarcinomas of the esophagogastric junction and easy spread to the greater curvature of the stomach remains unclear. This study aimed to investigate the efficacy of splenic hilar lymphadenectomy and identify the risk factors for metastasis to splenic hilar nodes.We examined patients who underwent R0/1 gastrectomy for Siewert types II and III at a single high-volume center in Japan. We analyzed the metastatic incidence, therapeutic value index, and risk factors for splenic hilar lymph node metastasis.We examined 126 patients (74, type II; 52, type III). Splenectomy was performed in 76 patients. Metastatic incidence and the therapeutic value index of splenic hilar lymph nodes in patients with type II and type III tumors were 4.5% and 0, and 21.9% and 9.4, respectively. In the patients who underwent splenectomy, we identified Siewert type III tumors (odds ratio: 6.93, 95% confidence interval: 1.24-38.8, p = 0.027) and tumor location other than the lesser curvature (odds ratio: 7.36, 95% confidence interval: 1.32-41.1, p = 0.023) to be independent risk factors. The metastatic incidence (46.2%) and therapeutic value index (15.4) were high in patients with both risk factors.Splenic hilar lymphadenectomy may contribute to the survival of patients with Siewert type III tumors, especially when the predominant location is not the lesser curvature.

Background Laparoscopy-assisted distal gastrectomy (LADG) is increasingly being used as an alternative to open distal gastrectomy (ODG) for gastric cancer treatment. Retrospective studies have shown equivalent survival with the two procedures, but these studies are limited by selection bias because LADG is more technically difficult than ODG. We aimed to evaluate whether LADG was non-inferior to ODG in terms of long-term survival outcomes. Methods We did an open-label, multicentre, non-inferiority, phase 3 randomised controlled trial at 33 institutions in Japan. Patients aged 20-80 years with histologically confirmed gastric adenocarcinoma (T1N0, T1N1, or T2[MP]N0), clinical stage I, in the middle or lower third of the stomach, Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, with a body-mass index of less than 30 kg/m2, were randomly assigned (1:1) to receive ODG or LADG. Randomisation was done by telephone, fax, or with a web-based system in the Japan Clinical Oncology Group Data Center; a minimisation method with a random component was used to adjust for institution and clinical stage (IA or IB). Only study-accredited surgeons performed ODG and LADG. The primary endpoint was relapse-free survival and was analysed according to the intention-to-treat principle. The non-inferiority margin (LADG vs ODG) was set at a hazard ratio (HR) of 1·54. The trial was registered with the UMIN Clinical Trials Registry, UMIN000003319. Findings Between March 15, 2010, and Nov 29, 2013, 921 patients were enrolled and randomly assigned to receive ODG (n=459) or LADG (n=462). 912 (99%) participants had the assigned surgery. 5-year relapse-free survival was 94·0% (95% CI 91·4-95·9) in the ODG group and 95·1% (92·7-96·8) in the LADG group. LADG was non-inferior to ODG for relapse-free survival (HR 0·84 [90% CI 0·56-1·27]), p=0·0075). The most common grade 3 or 4 adverse event was bowel obstruction, occurring in 11 (2%) of 455 patients in the ODG group and five (1%) of 457 patients in the LADG group. There were no treatment-related deaths. Interpretation This trial supports the non-inferiority of LADG compared with ODG for clinical stage I gastric cancer relapse-free survival, suggesting that LADG should be considered a standard treatment option when performed by experienced surgeons. Funding Japan National Cancer Center, Ministry of Health, Labour and Welfare of Japan, Japan Agency for Medical Research and Development.

Summary Background Postoperative adjuvant chemotherapy with S-1 for 1 year (corresponding to eight courses) is standard care for stage II gastric cancer. Whether the duration of S-1 could be shortened to 6 months (corresponding to four courses) without worsening survival is unclear. The aim of this study was to investigate the non-inferiority of four courses of S-1 compared with eight courses of S-1 for patients with stage II gastric cancer. Methods We did a phase 3, open-label, randomised controlled, non-inferiority trial at 59 hospitals in Japan. Patients aged 20–80 years with stage II adenocarcinoma of the stomach were randomly assigned (1:1) to eight courses or four courses of S-1. Randomisation was done by the Japan Clinical Oncology Group Data Center website, using a minimisation method with a random component using institution, stage (IIA vs IIB), age ( vs ≥70 years), and mode of operation (open gastrectomy with bursectomy vs open gastrectomy without bursectomy vs laparoscopic gastrectomy) as adjustment factors. One course was 80 mg/day per m 2 of S-1 administered for 4 weeks followed by a rest for 2 weeks. The primary endpoint was relapse-free survival, analysed by intention to treat, with a non-inferiority margin for the hazard ratio (HR) set at 1·37. This study is registered at UMIN-Clinical Trial Registry, number UMIN000007306. Findings Between Feb 16, 2012, and March 19, 2017, 590 patients were enrolled (295 per group). 528 (89%) patients were analysed at the first planned interim analysis in March, 2017, at which time the point estimate of HR for the four-course group compared with the eight-course group was 2·52 (95% CI 1·11–5·77), which exceeded 1·37 and met the prespecified criteria for early termination. Predictive probability for showing non-inferiority at the final analysis was calculated to be 2·9%. The study was stopped for futility. Updated 3-year relapse-free survival analysed in May, 2017, was 93·1% (95% CI 87·8–96·1) for the eight-course group and 89·8% (84·2–93·5) for the four-course group (HR 1·84, 95% CI 0·93–3·63). The most common grade 3–4 adverse event was neutropenia, observed in 46 (16%) patients in the eight-course group and 51 (17%) patients in the four-course group. Interpretation S-1 for 1 year should remain as standard adjuvant chemotherapy for stage II gastric cancer. Funding Japan Agency for Medical Research and Development; the Ministry of Health, Labour and Welfare of Japan; the National Cancer Center Research and Development Fund, Japan.

The optimum size of Micro Gas Turbine Cogeneration Systems (MGT-CGSs) in a Sewage Treatment Plant (STP) in terms of its economic performance was investigated. A STP operating in a cold region was adopted as a model and was scaled down to obtain different size ratios. It was also assumed to operate in different regions to obtain different heat demand patterns. MGT-CGSs with power output capacity of 30, 65 and 200 kW were simulated to utilize biogas produced by the STP. Instead of multiple units of the same size of MGT-CGSs, combination of different sizes of MGT-CGSs was also investigated. Life Cycle Cost Analysis was carried out to compare the economic performance of MGT-CGSs. It was found that optimum combination of three types of MGTs (MGT-Combined) stated above had the highest power generated and efficiency. However, MGT-Combined also had larger power generation capacity and low usage ratio, thus resulting in higher capital investment. Although all configurations of MGT-CGSs can generate Net Present Value, optimum configuration was obtained when the rated fuel input of MGT-CGS is approximately equal to the biogas production of the STP. However, when heat demand fluctuates throughout the year smaller size of MGT is preferred.

7Li spectra were observed for amorphous and crystalline Li3PS4 to study the structure of lithium ions. Lithium migration was studied using pulsed-gradient spin-echo 7Li NMR between 30 °C and 120 °C. The lithium diffusion behavior depended on the observation time and the pulsed-field gradient strength, and was quite different from the lithium diffusion in liquid electrolytes. Amorphous Li3PS4 showed higher ionic conductivity than crystalline Li3PS4, and similarly, the lithium diffusion rate was faster in amorphous samples. The lithium diffusion behavior in both conductors was not uniform and was distributed widely in time and space.

This study investigates the effect of employment of different operation strategies on the economic and environmental performance of a micro gas turbine trigeneration system (MGT-TGS). The MGT-TGS covers power, heating and cooling load of a selected building in a tropical region. The prime movers used were MGTs with electrical output capacity of 30 kW and 65 kW. Four operation strategies; Power-Match, Heat-Match, Mix-Match, and Base-Load were examined. The Net Present Value and Emissions Reduction Index throughout the life cycle of the MGTs were calculated. It was found that MGT-TGS can only generate positive NPV (Net Present Value) at the end of 25 years life time under unsubsidized electricity price. Mix-Match and Power-Match operation strategies can generate positive NPV because the systems can generate more electricity. However, these operation strategies cannot reduce emissions especially CO2 and CO when they were compared to a CCGT (Combined Cycle Gas Turbine). Base-Load is the only operation strategy that can reduce all emissions even when it is compared to a CCGT. When the economic and environmental performance is fairly considered using CPERI (Cost Per Emissions Reduction Index), Mix-Match is the optimum solution because it can generate CPERI of US$16.0–92,407, based on NPV.

Background: Postoperative adjuvant chemotherapy with S-1 for 1 year (corresponding to 8 courses) is a standard care for pathological stage II gastric cancer. It remains unclear whether duration of S-1 for 1 year could be shortened to 6 months (corresponding to 4 courses) without worsening the survival. Methods: We conducted a phase 3, open-label, randomized controlled non-inferiority trial at 59 hospitals in Japan. Patients with pathological stage II adenocarcinoma of the stomach were randomly assigned (1:1) to 4 courses S-1 or 8 courses S-1. 80 mg/m2/day of S-1 was administered for 4 weeks with a rest for 2 weeks as one course. Primary endpoint was relapse-free survival (RFS), analyzed by intension to treat. Total sample size was determined to be 1,000, expecting 3-year RFS of 85% with non-inferiority margin of hazard ratio (HR) of 1·37, one-sided alpha of 5% and 80% power. Findings: Between Feb 2012 and Mar 2017, 590 patients were enrolled (8-courses, 295; 4-courses, 295). Among them, 528 patients were analyzed at the first planned interim analysis in Mar 2017. The point estimate of HR of the 4- courses group compared with the 8-courses group was 2·52 (95% CI: 1·11- 5·77), which was greater than 1·37 and met the prespecified criteria for early termination, associated with predictive probability of 2·9% for showing non-inferiority at the final analysis. Updated 3-year RFS analyzed in May 2017 were 93·1% (95% CI 87·8%-96·1%) for the 8-courses group and 89·8% (95% CI 84·2%-93·5%) for the 4-courses group (HR 1·84, 95% CI 0·93-3·63). Interpretation: Postoperative S-1 adjuvant chemotherapy for p-stage II gastric cancer should be continued for 1 year. Clinical Trial Number: This study is registered at UMIN-CTR, number UMIN000007306. Funding Statement: Japan Agency for Medical Research and Development; the Ministry of Health, Labour and Welfare of Japan; the National Cancer Center Research and Development Fund. Declaration of Interests: TYo had received reports grants from Japan Agency for Medical Research and Development (AMED) during the conduct of the study, lecture fees from Taiho Pharmaceutical, Chugai Pharmaceutical, Ono Pharmaceutical, Bristol, MSD, Daiichi Sankyo, Yakult Honsha, Takeda Pharmaceutical, Nippon Kayaku, Kaken Pharmaceutical, Abbott Japan, Medtronic, Johnson & Johnson, and Olympus, and grant supports from Taiho Pharmaceutical, Chugai Pharmaceutical, and Yakult Honsha outside the submitted work. JM had received grants from Ministry of Health, Labour and Welfare, Japan, grants from Japan Agency for Medical Research andÝevelopment (AMED) during the conduct of the study. KY had received grants, personal fees, and non-financial support from Taiho Pharm. Co. during the conduct of the study, grants, personal fees, and non-financial support from Sanofi, grants, personal fees, and non-financial support from Chugai Pharm. Co., Ltd., grants, personal fees, and non-financial support from Yakult Honsha Co., Ltd., grants, personal fees, and non-financial support from Eli Lilly Japan K.K., grants, personal fees, and non-financial support from Daiichi Sankyo Co., Ltd., grants, personal fees, and non-financial support from Merck Serono Co., Ltd., grants, personal fees, and non-financial support from Novartis Pharma, grants, personal fees, and non-financial support from EA Pharma Co., Ltd., grants, personal fees, and non-financial support from Johnson & Johnson K.K., grants, personal fees, and non-financial support from Covidien Japan, grants, personal fees, and non-financial support from Takeda Pharmaceutical Co., Ltd., grants, personal fees, and non-financial support from Ono Pharm. Co.,Ltd, grants and personal fees from Nippon Kayaku Co.,Ltd., grants and personal fees from Otsuka Pharma Co., Ltd., grants from Sumitomo Dainippon Pharma, grants from Bristol Myers Japan, grants from Tsumura, grants from Kyowa Hakko Kirin, grants from Astellas, grants from Toyama Chemical, grants from KCI, grants from Abbott Japan, grants from Asahi Kasei, personal fees from Olympus, personal fees from Terumo, personal fees from Denka, personal fees from MSD K.K., personal fees from Bayer Yakuhin, Ltd, outside the submitted work. SI had received grants from MSD, grants from Ono Pharmaceutical, personal fees from Chugai Pharmaceutical, personal fees from Otsuka Pharmaceutical Factory outside the submitted work. HK had received grants from Ministry of Health, Labour and Welfare, Japan, grants from Japan Agency for Medical Research and Ýevelopment (AMED) during the conduct of the study and personal fees from Johnson & Johnson outside the submitted work. HF had received grants from Ministry of Health, Labour and Welfare, Japan, grants from National Cancer Center, Japan during the conduct of the study, personal fees from Taiho Pharma, and personal fees from Chugai Pharmaceutical outside the submitted work. NB had received honorarium from Taiho, Ono, Chugai, Shionogi, Yakult, Bristol Myers Squibb, Eli Lilly, Merck Serono, and study grant from Taiho, Ono and Bristol Myers Squibb outside of the submitted work. TS had received personal fees from Taiho Pharma outside the submitted work. MS had received personal fees from Taiho Pharmaceutical during the conduct of the study. Ethics Approval Statement: This study was done in accordance with the international ethical recommendations stated in the Declaration of Helsinki, Japanese Ethical Guidelines for Clinical Research. All patients were required to provide written informed consent prior to enrollment.

Background Some authors have suggested that the immunological response to postoperative infectious complications (ICs) enhances the viability of undetectable residual tumor cells after surgery, thereby inducing disease recurrence. We hypothesize that recurrence might not occur if neoadjuvant chemotherapy (NAC) treatment of micrometastases can prevent residual cancer cell growth. We evaluated whether or not NAC exerted prophylactic effects against the negative prognostic impact induced by postoperative ICs and assessed its interaction among subgroups of histological response. Methods We retrospectively examined 111 patients who received NAC followed by radical esophagectomy between January 2011 and September 2015. Risk factors for the recurrence-free survival (RFS) were examined by Cox proportional hazard analyses. Pathological responders to NAC were defined as those with a tumor disappearance of more than one-third of the initial tumor. Postoperative ICs were defined using the Clavien–Dindo classification. Results A pathological response to NAC was observed in 54 (48.6 %) patients. Forty-five patients (40.5%) developed postoperative ICs. The 3-year RFS were 68.8% in the patients who developed ICs and 38.6% in the patients who did not developed ICs (p = 0.001). The multivariate analysis demonstrated that postoperative ICs were a significant independent risk factor for the RFS (hazard ratio [HR], 2.368; 95% confidence interval [CI], 1.256-4.465, p = 0.008). In the subset analysis, in responders, the 3-year RFS were 63.2% in the patients who developed ICs and 71.5% in the patients who did not developed ICs (p = 0.524). In non-responders, the 3-year RFS were 29.3% in the patients who developed ICs and 65.4% in the patients who did not developed ICs (p = 0.006). The multivariate analysis demonstrated that postoperative ICs were a significant independent risk factor for RFS in the non-responders (HR, 2.632; 95% CI, 1.072-6.467, p = 0.035) but not in the responders (HR, 1.480; 95% CI, 0.469-4.667, p = 0.503). Conclusions These results suggested that response to NAC can eliminate the poor prognosis induced by postoperative ICs in esophageal cancer patients. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

This study investigates the economic and environmental performance of a photovoltaic (PV) and microgas turbine trigeneration system (MGT-TGS) based hybrid energy system with various operation strategies. The hybrid system covers power, heating and cooling load of a selected building under a tropical region. A case of MGT-TGS without PV was also studied for comparison. Each system had an MGT with electrical output capacity of 30 kW or 65 kW as the core prime mover. Economic performance was analyzed using life cycle cost analysis and environmental performance was analyzed based on the actual emissions of MGT reported in literatures. It was found that all operation strategies can only generate Net Profit when subsidy for electricity was eliminated. Combination of photovoltaic and MGT-TGS with power-match operation strategy had the highest Net Profit and was the simplest hybrid system. This was mainly because this system did not require battery that has high cost. However, this system had low environmental performance especially when they are compared to a combined cycle gas turbine (CCGT) because larger MGTs in this system operated frequently under partial load. Operation strategy that had smaller MGT that operated under full load can still generate Net Profit but at lower degree because it needs larger PV and battery. However, it was the only operation strategy that can reduce all emissions even when compared to a CCGT. Thus, this is the best operation strategy when economic and environmental performance are fairly considered.

An all-solid-state lithium-ion battery (ASSB) using non-flammable solid electrolytes is a candidate for a next-generation battery. Although the excellent cycle performance and its high energy density are suggested in the literature, a practical size battery has not been appeared yet. In this paper, we have adopted a sulfide based electrolyte, Li2S–P2S5 (80:20 mol%) to a rocking chair type lithium ion battery. The electrochemical cell consists of a Li2O–ZrO2 coated LiNi0.8Co0.15Al0.05O2 (NCA) cathode, an artificial graphite anode and the sulfide based electrolyte without any organic and inorganic liquids. The cathode charge transfer resistance is significantly reduced by the Li2O–ZrO2 coating. The total cell resistance of the Li2O–ZrO2 (LZO) coated NCA adopted cell is approximately one quarter of non-treated one. A standard type single cell with the nominal capacity of 100 mAh at 25 °C is fabricated by wet printing process, and its capacity retention is approximately 80% at 100 cycles. Also, a 1 Ah class battery was constructed by stacking the single cells, and demonstrated.

Background Long noncoding RNAs (lncRNAs) have recently been known to play various important roles in maintaining molecular regulations. Significant amounts of lncRNAs HOTTIP, PVT1 and H19 are well known to be expressed in pancreatic cancer cells, however their association with efficacy of adjuvant chemotherapy for pancreatic cancer have not been fully investigated. The aim of this study was to evaluate expression of HOTTIP, PVT1 and H19 in the pancreatic cancer cells, and to clarify the predictive roles of those lncRNAs in pancreatic cancer patients who received adjuvant chemotherapy by S-1, an oral fluoropyrimidine or gemcitabine (GEM) after curative resection. Methods Pancreatic cancer patients who underwent curative resection followed by adjuvant chemotherapy by S-1 or GEM since 2005 to 2017 at Kanagawa Cancer Centre were enrolled in this study. In situ hybridization (RNA scope®) to detect each three lncRNAs was performed using tissue microarrays prepared from formalin-fixed and paraffin-embedded tissues of resected specimens. The relations between the expression of HOTTIP, PVT1 and H19 and clinicopathological characteristics were statistically analyzed. Results We analyzed 204 eligible pancreatic cancer patients. 114 patients received adjuvant chemotherapy by S-1, and 90 patients by GEM. The patients with higher expression of H19 were significantly associated with shorter relapse free survival (RFS) regardless of adjuvant chemotherapy regimens (p Conclusions The expression levels of PVT1 and HOTTIP in pancreatic cancer cells were associated with the efficacy of adjuvant chemotherapy for pancreatic cancer in the present study. The higher expression of H19 may serve as a significant predictive/prognostic marker for patients who received adjuvant chemotherapy by S-1 or GEM after curative resection. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

This study shows performance of micro gas turbine (MGT) based cogeneration system (CGS) and trigeneration system (TGS) in residential buildings located in the area with a tropical climate. Energy, economic and environmental performance of MGT-CGS and MGT-TGS were studied. MGT-CGS consists of an MGT and an exhaust heat exchanger (EHE), whereas MGT-TGS consists of an MGT, an EHE, an absorption heat pump and a heat storage. Heat storage was essential for storing heat generated during daytime to be utilized during night-time in which heat demand was higher. MGT-TGS was a better configuration compared to MGT-CGS because it can utilize more exhaust heat and had Energy Recovery Utilized Efficiency (ηER,utilized) of 0.37 and 0.80 during daytime and night-time, respectively. Furthermore, the payback period for the MGT-TGS was also shorter than MGT-CGS, 13.8 years under highly subsidized electricity tariff. The MGT-TGS also had a higher Fuel Energy Saving Index FESI when compared to a gas turbine, but had a lower FESI when compared to a combined cycle gas turbine. MGT-CGS and MGT-TGS can also reduce pollutants especially NOx emissions compared to conventional systems.

The suitable size (electricity output capacity) of micro gas turbine cogeneration systems (MGT-CGSs) depending on scale of the sewage treatment plant was investigated. Since heat demand of the plant is affected by ambient temperature, performance under three typical ambient temperature conditions was investigated. Considering operation of the MGT-CGS under various loads and efficiency of the MGT-CGS under a partial load condition, the optimal combination of MGT-CGSs (MGT-Combination) with different sizes, 30 kW, 65 kW and 200 kW, was also proposed. An actual middle-scale plant was adopted as the analysis model, and it was scaled down to 0.50 and 0.25 in cases of smaller scale. Excluding MGT-Combination, it was found that the MGT that has approximately the same fuel energy input under full load as the biogas energy produced in the plant has the highest efficiency. However, in the case of heat demand of the plant varying throughout the year such as the operation in a cold region, partial load operation will be frequent and efficiency will decrease. Furthermore, MGT-Combination has the highest efficiency but its efficiency will be the same as that of the other MGT-CGSs when only comparatively constant operation is required throughout the year such as operation in a tropical region.

A historical district is a comprehensive form of historical attractions, and has diverse features that visitors can gaze on. This study proposes the application of the caption evaluation method, participatory research involving photographing by subjects, to a study of visitors’ evaluation of a historical district as a tourism destination. Thirty Japanese undergraduates who majored in commerce and 27 Japanese adults with an interest in architecture and/or town planning photographed settings of their choice in a Japanese historical district and stated how they perceived the captured settings in an open-ended form. Their statements were subjected to analysis using a software package as well as manual analysis. The results indicate relationships between various elements in the district and the subjects’ feelings and desires. Particularly, favourable evaluations of old objects and unfavourable perceptions of modern objects were implied. The results also suggest the types of activities visitors may wish to participate in.

A small-scale prime mover especially micro gas turbine is a key factor in order to widespread the utilization of biogas. It is well known that a performance of large-scale gas turbine is greatly affected by its inlet air temperature. However, the effect of the inlet air temperature on the performance of small-scale gas turbine (micro gas turbine) is not widely reported. The purpose of the present study is to investigate the effect of the inlet air temperature on the performance of a micro gas turbine (MGT) with cogeneration system (CGS) arrangement. An analysis model of the MGT-CGS was set up on the basis of experimental results obtained in a previous study and a manufacturer standard data, and it was analysed under a various ambient temperature condition in a cold region. The results show that when ambient temperature increased, electrical efficiency η_ of the MGT decreased but exhaust heat recovery η_ increased. It was also found that when ambient temperature increased, exhaust heat to mass flow rate Q_/m_e and exhaust heat recovery to mass flow rate Q_/m_e increased, with maximum ratios of 259 kJ/kg and 200 kJ/kg, respectively were found in summer peak. Furthermore, it was also found that the exhaust heat to power ratio Q_/P_e had a similar characteristic with exhaust heat recovery to power ratio Q_/P_e. Q_/P_e and Q_/P_e increased with the increase of ambient temperature. Moreover, although different values of total energy efficiency, fuel energy saving and CO_2 reduction for every temperature condition were found comparing with a two conventional system that were considered, the MGT-CGS could annually reduce 30,000-80,000 m^3/y of fuel consumption and 35?94 t-CO_2/y of CO_2 emissions.

Dynamic behaviour of plasma-wall interactions has been investigated by using triple probe and H α line emission of disruptive plasma in small tokamak HYBTOK-II. As the features of the disruption discharge of HYTOK-II, it was found that the waveform of plasma current quench has two phases of the first slow and the subsequent fast decays. The interaction between plasma and wall was found to be largest during fast decay phase in the course of whole discharge. The increase of plasma-wall interactions is thought to be caused by both of convective pump-out of the plasma particles in the core region and the rapid movement of plasma to the inner wall at the start time of two decay phases.

INTRODUCTIONChylorrhea is a form of lymphorrhea involving digested lipid products absorbed in the small intestine. Here we report a rare case of chylorrhea after laparoscopy-assisted distal gastrectomy (LADG) with D1+ dissection that resolved following administration of a low-fat diet.PRESENTATION OF CASEA 35-year-old woman with early gastric cancer underwent LADG with D1+ dissection, and on postoperative day 4, the drain output increased and the fluid with a high triglyceride level (740mg/dL) changed from clear to milky. On postoperative day 6, oral intake of a low-fat diet was initiated after a 2-day fast, and the daily drain output decreased from postoperative day 9. The drain tube was withdrawn on postoperative day 15, and the patient was discharged on postoperative day 17.DISCUSSIOND1+ dissection does not typically cause injury to the lymphatic trunks, cisterna chyli, or thoracic duct. The maximum output of chylous ascites was minimal, and thus, we assumed that chylorrhea occurred from slightly injured lymphatics with anatomical variation.CONCLUSIONChylorrhea after LADG with D1+ dissection is very rare. The fasting of our case followed by a low-fat diet without TPN would be an effective therapy. As a result, our case recovered favorably without further therapy.

The oxidation behavior of U 0.90 Zr 0.10 alloy (two-phase mixture of α-U and δ-UZr 2 below 890 K, two-phase mixture of s-U and γ-(U, Zr) at 953 K and single solid solution at 1028 K) was studied by thermogravimetry in the temperature range from 432 to 1028 K in air. During oxidation in the low temperature region (432–515 K), the sample kept its initial shape (a rectangular rod) and the surface of the sample was covered by a black thin adherent UO 2+x oxide layer. On the other hand, by oxidation in the middle temperature region, the sample broke to several pieces of thin plates and fine powder at 728 K and entirely to fine powder at 953 K, all of which were analyzed to be the mixture of U 3 O 8 and ZrO 2 . By oxidation at 1028 K the sample broke to fine powder, which consisted of U 3 O 8 and ZrO 2 . Based on the oxidation behavior of U 0.90 Zr 0.10 regarding the sample shape, the oxide phase identified after oxidation and the slope value of the bilogarithmic plots of the weight gain against time, the oxidation kinetics was analyzed with a paralinear equation in the low temperature region below 515 K and a linear equation in the middle and high temperature regions above 728 K. The oxidation behavior of U 0.80 Zr 0.20 alloy was also investigated at 723 K in argon gas to clarify the effect of oxygen partial pressure.

Aim: Monitoring of tumor biology provides pivotal information for suitable therapy. Circulating tumor cells (CTCs) released into the blood stream from primary tumor and metastases may reflect current tumor status. The ClearCell FX system (Clearbridge Biomedics, Singapore), which uses a label-free inertial microfluidics approach based on biomechanical properties, is able to capture CTCs independent of EpCAM expression. We investigated the tumor biology by performing genomic profiling of CTCs using next-generation sequencing (NGS). Methods: Patients with advanced gastric and colorectal cancer were enrolled in this study. We collected 10mL of blood from each patient. CTCs were extracted by using the Clearcell FX system. DNA was prepared immediately after isolation, after a week's culture with RepCellTM (CellSeed) which was a temperature-responsive cell cultureware. Whole genome amplification (WGA) was performed by using REPLI-g Single Cell Kit (Qiagen), and NGS was performed by using Ion Ampliseq (LifeTechnology). Cells were enumerated using cytokeratin staining and immunocytochemical analysis. At the same time, we prepared DNA not only from peripheral blood mononuclear cells but also from plasma (cell-free DNA). Results: 8 patients were enrolled; 6 had colorectal cancer and 2 had gastric cancer. Median of CTC count was 6/mL (ranges 3 to 14). On the other hand, the number of CTCs collected by CellSearch ranged from 0 to 1/7.5mL. In these 8 cases, either right after isolation or after 1 week of culture, DNA derived from CTCs was successfully prepared by WGA. NGS was successfully performed with WGA treated DNA from CTCs and related materials. Conclusions: By using ClearCell FX System's label-free technology, we were able to capture a larger number of CTCs from patients with gastric and colorectal cancer than with using the CellSearch system. NGS from CTCs and related materials can be performed successfully. Disclosure: A. Kakimoto: I am a employee of SRL Inc.; T. Sakuma: I am a employee of Mitsui Knowledge Industry Co and Ltd.; S. Fang: I am a employee of Clearbridge Accelarator; A. Wu: I am a employee of Clearbridge Bio Medics; C.T. Lim: I have stock of Clearbridge Biomedics Pte Ltd. All other authors have declared no conflicts of interest.

Background Preoperative chemoradiotherapy (PCRT) was one of the standard care for resectable esophageal cancer. Because there is tendency of high morbidity at surgery after PCRT, risk benefit balance for PCRT should be considered.Predictive marker which can select the patients who have more benefit for PCRT is needed. Methods To identify a biomarker to predict efficacy of preoperative PCRT for esophageal cancer, expression profiles of serum proteins were determined. The expression levels of 84 serum proteins in 37 patients (7 responders to PCRT and 30 poor-responders) weremeasured. Responders were defined as the patients whom two third or more cancer was pathologically degenerated at the time of operation. The usefulness of biomarkers was validated with two independent retrospective cohorts (PCRT and preoperative chemotherapy (PCT) by cisplatin and 5-FU) and two phase II clinical cohorts (PCRT and PCT with docetaxel, cisplatin and 5-FU) (n = 187). Results In a discovery cohort, the expression levels of six proteins [macrophage inflammatory protein beta 1 (MIP1B), soluble interleukin 6 receptor (sIL6R), macrophage inflammatory protein alpha1 (MIP1A), insulin, interferon alpha 2 (IFNA2) and matrix metalloproteinase 3 (MMP3)] were significantly different between responders and poor-responders to PCRT. The most predictive factor for survival was soluble interleukin 6 receptor (sIL6R) (p = 0.008, log-rank test); sIL6R in poor-responders was higher than in responders (p = 0.005, Student's t-test). The increases of sIL6R in poor-responder who underwent PCRT were confirmed in a etrospective cohort (n = 38), and a phase II clinical trial (n = 26). However, sIL6R levels of patients who underwent PCT only in a retrospective cohort (cisplatin and 5FU n = 100) and a phase II clinical trial (docetaxel, cisplatin and 5FU, n = 23) were not significantly different. Conclusion Serum sIL6R have a potential to be a predictive biomarker for PCRT in esophageal cancer patients, not for preoperative chemotherapy. Disclosure All authors have declared no conflicts of interest.

A new type of neutron shutter for a cyclotron facility is presented. To obtain high reliability, the movement of only horizontal rotation is applied to the massive portion.