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This article covers the salient and updated themes of the Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGL) 2020 published by the Japanese Society of Pediatric Allergy and Clinical Immunology. In the 2020 guidelines, five new clinical questions (CQs) have been added to address the 12 CQs regarding the treatment of childhood asthma. "Infant and preschool asthma" is diagnosed when young children (6 years of age) have three or more episodes of clear expiratory wheezing, which continue for more than 24 h, and symptom improvement can be observed after beta-2 agonist inhalation. In children without clear improvement, diagnostic therapeutic trial for the duration of 1 month with controller treatment can be used. Since long-term management is initiated, the treatment level is adjusted based on the current control status and the management of risk factors, with the provision for holistic care. This underscores the smooth transition of pediatric patients into adult services. There are several differences between the JPGL and the guidelines of other countries. Further evidence is obtained as the utility of the newly proposed management plans should be evaluated in the Japanese population.

Cardiac or aortic surgeries requiring cardiopulmonary bypass in combination with patent ductus arteriosus in adults present a special problem that requires a tailored approach. We report a case of ruptured type A acute aortic dissection in a 73-year-old woman with patent ductus arteriosus. In this case, we highlight that transpulmonary direct ductus arteriosus closure and subsequent frozen elephant deployment with total arch replacement are reasonable and reliable treatments for type A acute aortic dissection in a patient with patent ductus arteriosus.

To investigate the optimal stent length and distal positioning of frozen elephant trunks (FETs) in patients with type A acute aortic dissection (TAAD).Between October 2014 and April 2021, 191 patients (FET-150 group: 37 patients; stent length, 150 mm; 66.3 ± 12.6 years and FET-non-150 group: 154 patients; 60, 90, or 120 mm; 64.1 ± 12.5 years) underwent total arch repair with FETs for TAAD using the "zone 0 arch repair" strategy. In the FET-150 group, the proximal stent end was positioned at the innominate artery origin of the arch. In the FET-non-150 group, the distal stent end was to be positioned just proximal to the aortic valve level using transesophageal echocardiography. The proximal end of the non-stented FET part was sutured to an arch graft together with the aortic wall at 1 to 2 cm proximal to the innominate artery origin.Distal stent ends were positioned at the thoracic vertebrae (Th) 4-5, 6-7, 8-9, and 10 levels in 0 (0%), 12 (32.4%), 25 (67.6%), and 0 (0%) patients, respectively, in the FET-150 group, and in 6 (3.9%), 98 (63.6%), 49 (31.8%), and 1 (0.7%), respectively, in the FET-non-150 group. No between-group difference in postoperative mortality was noted. The incidence of postoperative residual distal malperfusion and new-onset spinal cord ischemia in the FET-150 versus FET-non-150 groups were 2.7% versus 6.5% (P = .62) and 0% versus 1.9% (P = 1.00), respectively.FET positioning with the distal stent end at around Th 8 can reduce residual distal malperfusion when a FET with a 150-mm stent is deployed from the aortic zone 0 in patients with TAAD undergoing total arch repair.

The Japanese Guideline for Childhood Asthma (JGCA) 2020 is a translation of the Japanese Pediatric Guideline for the Treatment and Management of Asthma (JPGL) 2017 into English, which was published by the Japanese Society of Pediatric Allergy and Clinical Immunology. It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. These guidelines will be of interest to non-specialist physicians involved in the care of children with asthma. In JPGL, JPGL2017 is the first evidence-based guidelines updated according to the GRADE system and Minds approach, and it addresses eight clinical questions about the treatment of childhood asthma. In children aged ≤5 years, infant and preschool asthma is diagnosed according to the response to short acting beta2 agonists or the effect of a therapeutic trial during 1 month with controller treatment and worsening after treatment cessation. Long-term management both promotes pharmacological therapy and measures against risk factors that induce exacerbation, better patient education and a partnership with trinity. In addition, long-term management should not be carried out without review but rather be based on a cycle of evaluation, adjustment and treatment. In JPGL2017, the transdermal patch and oral beta2 agonists are positioned as drugs within the concept of "short-term additional treatment" to be used until the symptoms are stabilized when the control state transiently deteriorates.

A 61-year-old male was referred to our hospital to receive catheter ablation of paroxysmal atrial fibrillation. Since no anatomical abnormalities were detected by preoperative computed tomography of left atrium and pulmonary veins (PVs), he underwent a cryoballoon ablation for a PV isolation. We performed single, 3-min freeze applications to all four PVs while monitoring the esophageal temperature. Immediately after the procedure, he complained of nausea, followed by a body weight loss of 9 kg over 2 months. Since no structural abnormalities were detected even through careful evaluation, he was diagnosed with hypoperistalsis caused by the cryoballoon ablation. Although his symptoms partially improved, they persisted over a year. The cryoballoon procedure is believed to be relatively safe, but even just a simple 3-min freeze application caused severe hypoperistalsis in the present case. Operators should recognize the risk of such complications.

Purpose This study was designed to retrospectively analyze the safety and efficacy of chemoradiation therapy with nedaplatin and 5-fluorouracil in elderly patients with esophageal squamous cell carcinoma. Methods and materials Eligible patients were aged 76 years or older, had a histopathologic diagnosis of esophageal squamous cell carcinoma, and were treated at the Kitasato University Hospital between January 2010 and March 2016. Chemotherapy consisted of nedaplatin in an intravenous dose of 90 mg/m2 on day 1 and 5-fluorouracil in an intravenous dose of 800 mg/m2 on days 1 to 5, repeated every 4 weeks for 2 cycles. Radiation therapy consisted of 50.4 Gy in 28 fractions for thoracic tumors and 61.2 Gy for cervical tumors. Results Twenty-five patients were studied. Patient characteristics were as follows: median age 79 years (range, 76-85 years), clinical stage I/II/III/IV (7/8/8/2, respectively), and surgically resectable/unresectable (17/8, respectively). The completion rates of radiation therapy and chemoradiation therapy were 100% and 84%, respectively. Grade ≥3 acute toxicities included neutropenia (76%), leukopenia (72%), thrombocytopenia (32%), anemia (28%), anorexia (32%), oral mucositis (20%), febrile neutropenia (12%), and esophagitis (8%). Grade ≥3 late toxicities included esophageal stenosis (12%) and pleural effusion (4%). The complete response rate was 64%. In the median follow-up period of 18.9 months, the 1-year overall survival rate was 68%. Conclusions Definitive chemoradiation therapy with nedaplatin and 5-fluorouracil may be a feasible treatment option for elderly patients with esophageal squamous cell carcinoma.

The feature of reusability of a gel dosimeter is of particular interest for application to three-dimensional dosimetry in clinical settings. As one of the reusable materials, the radiochromic gel formula composed of polyvinyl alcohol (PVA), glutaraldehyde (GTA), and iodide (I), abbreviated as “PVA-GTA-I gel dosimeter”, is investigated in the present study. The annealing properties of the PVA-GTA-I gel were examined for energetic X-rays from a medical linear accelerator, while its reusability was confirmed for 137Cs-source γ-rays. The radiation-induced colorings of the PVA-GTA-I gel irradiated with few Gy were erased within several hours, while the reactions induced by higher dose (∼20 Gy) were more persistent and required longer time up to 24 h to be completely reversed. The linear dose response of the PVA-GTA-I dosimeter was well reproduced after repetition of annealing.

In this study, we report a case of a 45-year-old man with dysphagia aortica secondary to chronic traumatic aortic pseudoaneurysm of the aortic isthmus. He had been involved in a motor vehicle accident 27 years earlier. Computed tomography demonstrated a severely calcified aortic pseudoaneurysm of the aortic isthmus that compressed the esophagus extrinsically. An invasive surgical procedure involving a graft replacement and removal of the calcified aortic wall released the esophageal compression and completely improved the patient's symptoms. To the best of our knowledge, a case of dysphagia aortica caused by calcified pseudoaneurysm has never been reported.

Aortic and arterial calcification is a complication of advanced atherosclerosis and is a critical intraoperative issue that can reduce the ability to achieve safe and adequate access for stent graft introduction. Different vascular access sites are used to deliver stent grafts when a standard transfemoral or iliac access is not feasible. We report a challenging case of a direct transabdominal aortic thoracic endovascular aortic repair for a thoracic aortic aneurysm complicated with severe aortic and arterial calcification, in which the noncalcified area of the infrarenal abdominal aorta was extremely limited. This may be a reasonable access site, especially for patients with severe aortic and arterial calcification.

The preparation of graphene with large area, few layers, and without oxidation is required. Thus far, we have determined that by synthesizing graphite intercalation compounds (GICs) and adding water to them, it was possible to prepare few-layer graphene without oxidation; however, its area was small. Therefore, we investigated the addition of aldehyde (with different alkyl chain lengths containing electron-withdrawing groups, which allowed the use of an electrophilic addition reaction on carbon hexagonal layers) to GICs to prepare few-layer graphene with a large area and without oxidation. In this study, stage-1 ternary graphite intercalation compounds (K-THF-GICs) were synthesized using the solution method. Aldehyde solvents with different alkyl chain lengths were then added to K-THF-GICs, and the mixtures were stirred for 72 h. An attempt was made to prepare few-layer, small-area graphene with little oxidation. Results indicated that the addition of aldehyde containing an electron-withdrawing group to GICs promoted exfoliation with the electrophilic addition reaction on the carbon hexagonal layer, producing few-layer graphene. UV–vis (Ultraviolet･Visible Absorption Spectroscopy) results showed that solvents with long alkyl chains were more suitable for preparing few-layer graphene than solvents with short alkyl chains. According to Raman spectroscopy, X-ray photoelectron spectroscopy, and transmission electron microscopy, graphene exfoliated by decanal or octadecanal as three and two layers, respectively, was minimally oxidized and showed an area of several tens of μm2. Comparative analysis of the heat treatment of few-layer graphene demonstrated that it was possible to graft few-layer graphene exfoliated using decanal or octadecanal. Such grafting may be involved in exfoliation. Few-layer graphene was then prepared by adding an aldehyde solvent containing long alkyl chains to K-THF-GICs. Using octadecanal containing the longest alkyl chain among the solvents tested in this study, few-layer graphene with a thickness of 1.8 nm and an average area of 84 µm2 was obtained with little oxidation.

Evaluating the importance of input (predictor) variables is of interest in many applications of statistical models. However, nonlinearity and correlation among variables make it difficult to measure variable importance accurately. In this work, a novel variable importance measure, called regression and independence based variable importance (RIVI), is proposed. RIVI is designed by integrating Gaussian process regression (GPR) and Hilbert-Schmidt independence criterion (HSIC) so that it is applicable to nonlinear systems. The results of two numerical examples demonstrate that RIVI is superior to several conventional measures including the Pearson correlation coefficient, PLS-β, PLS-VIP, Lasso, HSIC, and permutation importance with random forest in the variable identification accuracy.

In order to investigate the fatigue limit micro-mechanism of a precipitation-hardened Al–Mg–Si alloy (6061-T6), the alloy was subjected to very-high-cycle fatigue (VHCF) of over 109 cycles by an ultrasonic fatigue method. Two kinds of specimens, one with smooth surface and the other with a small artificial hole on the surface, were compared. The smooth specimens showed no distinct fatigue limit. Conversely, the holed specimens showed clear fatigue limit which had been generally deemed to be absent in non-ferrous alloys. In addition to the conventional fatigue crack growth (FCG) observation by replica technique, metallographically critical analyses by electron backscattered diffraction (EBSD) and cross-sectional focused ion beam (FIB) were conducted to reveal the micro-plasticity associated with FCG. It was found that the fatigue life of smooth specimens at low stress amplitude was controlled by an unstoppable FCG mechanism mediated by persistent slip bands (PSBs). On the other hand, the emergence of distinct fatigue limit in holed specimens was attributed to a non-propagating crack having mode I characteristics in essence. No coaxing effect was, however, confirmed for such non-propagating cracks. The above results, which were somewhat different from previous ones obtained by rotating bending under normal frequency, were discussed in terms of both metallurgical and mechanical points of view.

Background A triple chemotherapeutic regimen including docetaxel, oxaliplatin, and S-1 (DOS) for a neoadjuvant setting has a promising efficacy for locally advanced adenocarcinoma of the esophagogastric junction (AEG). However, the optimal dose of each drug in Japanese population remained to be clarified. The aim of this phase I study is to determine a recommended dose for a triweekly combination neoadjuvant DOS chemotherapy for patients with locally advanced AEG. Methods Patients with cT3 or more advanced AEG without distant metastasis were eligible for this study. The planned dosages of docetaxel (mg/m2, day 1), oxaliplatin (mg/m2, day 1), and S-1 (mg/day, days 1–14) were 50/100/80–120 at level 1, and 60/100/80–120 at level 2. The treatment cycle was repeated every 3 weeks, and patients were assessed for response to the treatment after 2 and 3 cycles. This study was registered with UMIN Clinical Trial Registry (UMIN 000022210). Results Twelve patients with locally advanced AEG were enrolled in this study. At dose level 1, one of six patients experienced dose-limiting toxicity (DLT) of grade 3 febrile neutropenia. At dose level 2, two of the next six patients experienced the same DLT of need for withdrawal of chemotherapy due to serious adverse events. Based on these results, level 2 was considered the recommended dose for this regimen. Total or proximal gastrectomy plus lower esophagectomy, or subtotal esophagectomy was performed in all the 12 patients with the R0 resection rate of 92% (11/12). Histological response evaluation based on the classification defined by Japanese Gastric Cancer Association revealed four patients with grade 1a, two with grade 1b, three with grade 2, and three with Grade 3. Conclusions Recommended doses for a neoadjuvant DOS chemotherapy regimen for locally advanced AEG were determined as Docetaxel: 60 mg/m2, Oxaliplatin: 100 mg/m2 on day 1, S-1: 1.5m2, 120 mg twice a day on days 1–14. DOS chemotherapy showed good preliminary efficacy with acceptable toxicity in this study warranting a further phase II trial to investigate the efficacy of the DOS regimen. Clinical trial identification UMIN 000022210. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Chemical absorption method is a major separation technique employed in CCS (Carbon dioxide Capture and Storage). In recent years, a novel process named a membrane flash process for regeneration of the absorbent was developed to realize an energy-saving technology. In this study, the effects of pore size and thickness of microporous hollow fiber membrane on the CO2 desorption rate in the membrane flash process were examined. CO2 desorption experiments were performed using the three purchased microfiltration (MF) membranes with different pore sizes, 0.2, 0.5 and 1.0 μm, and the two microporous hollow fiber membranes made from alumina particles with different thicknesses. A 30 wt%-monoethanolamine (MEA) aqueous solution was used as the chemical absorbent. The MEA solution which absorbed CO2 in advance was fed into the tube side of the hollow fiber and was forced to permeate through the membrane by reducing the pressure on the shell side to 40 – 1 kPa. The results indicated the CO2 desorption rate increased with decreasing pore size. Also, the thicker membrane showed the greater CO2 desorption rate. The results and observation implied that CO2 desorption occurred not only on the surface of the rich solution falling down along the outer surface of the hollow fiber after permeating through the membrane but inside the pores of the membrane wall. Also, the experimental results supported that the contact of the rich solution with the membrane played an important role in CO2 desorption.

In order to infer the late Late Permian to early Early Triassic environmental changes in a pelagic realm of the Panthalassic Ocean, the stratigraphic variations of TOC (wt.%) and δ13Corg (‰) of the PTB siliceous rock section (~ 3.5 m in thickness) were examined. The study section crops out in the Mino terrane, central Japan, and consists of the upper Upper Permian chert (Changhsingian) and lower Lower Triassic (Induan) black claystone intermittently with thin chert beds. The succession is reconstructed as sediments on the lower slope of a mid-Panthalassic seamount. The major extinction event of Permian radiolarians (MEE) occurs at the top of the Changhsingian chert. Our analysis shows that the TOC content is markedly higher in the Induan black claystone than the Changhsingian chert. TOC values rapidly increase across the PTB. The onset of the increase in TOC values corresponds to MEE. The rapid and profound increase in TOC values implies the sudden onset of oceanic anoxia as well as the rapid increase in primary production at the PTB. δ13Corg values are generally higher in the Changhsingian chert than the Induan claystone and chert. The stepwise drop of δ13Corg values characterizes their excursion of the study section. The largest-scale drop occurs prior to MEE. The minimum δ13Corg value is recorded at the base of the Induan claystone. The flux of δ13C-depleted gasses related to the Siberian Traps could have significantly contributed to the marked drop of δ13Corg values. Due to the weakened ocean circulation under the predominant condition of global warming, oceanic anoxia suddenly took place at the end of the Permian. The anoxic condition in the surface layer was the most likely kill-mechanism for Permian radiolarians. The anoxic condition persisted into the Induan, but was intermittently weakened. The episodic relaxation of the anoxic condition in the Induan resulted in intermittent and transient blooming of radiolarians and deposition of radiolarian chert with lowered TOC values. These biotic and depositional records of the study section imply the mid-Panthalassic Ocean was under the more hospitable conditions favored by the earlier recovery of radiolarians, relative to the Tethys Ocean and Pangean marginal seas.

The formation of new acceptor-type graphite intercalation compounds (GICs) by traditional methods require a high oxidation potential, rendering the methods unsuitable for a number of compounds. Thus, we have synthesized novel acceptor-type GICs through an electrochemical method. Sodium dimethyldithiocarbamate (NaMDC) and sodium diethyldithiocarbamate (NaEDC) were selected as electrolytes for electrochemical processing in this study. Constant current electrolysis was applied for the synthesis of these acceptor-GICs. An exfoliated graphite sheet was used as the working electrode and a platinum plate in a three electrode cell was used as the counter electrode. Compounds synthesized in this way were identified using X-ray diffraction, enabling crystal structure determination. It appears that the intercalated graphite sheets exhibit a classical stacking in two layers such that there are regularly alternating electropositive and electronegative planes along the c-axis. It is shown that MDC and EDC–GICs were successfully synthesized through this electrochemical method.

Few-layer graphene was prepared from the potassium–graphite intercalation compound (KC 8 ) by hydroxylation. In an oxidative atmosphere, KC 8 decomposes from its initial structural stage to a second or third stage. However, when KC 8 was hydroxylated by dropping a small amount of water onto it in a nonoxidative atmosphere, the KC 8 exfoliated with a disruption of the stage structure and agglomerated graphene was obtained. Sonication of this agglomerated graphene in water yielded few-layer graphene. It was found that dropping small quantities of water onto KC 8 is effective for achieving graphene with just a few layers. [TANSO 2014 (No. 262), 59–62.]