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The present paper aims to offer a new understanding of the so-called “Zoroastrian Illuminative philosophers in the sixteenth and seventeenth centuries,” namely the Āẕar Kaivān school. In the twentieth century, this school was understood to be a Zoroastrian phenomenon originating from Āẕar Kaivān (1533–1618), who is believed to have been born at Estakhr (Iran) and later to have immigrated to Patna (India). One way to sketch their texts is to notice their contents as the Zoroastrian Illuminative school, as H. Corbin did. But it may be more likely that the first principle for this school is a matter of ancient Persian culture, especially the Āsmānī language. Until recently, we knew little for certain about the origin of this Āsmānī vocabulary, except the inference that it might be the product of Āẕar Kaivān himself. But Sadeghi (2020) shows that the earliest mention of what would become the Āsmānī vocabulary can be confirmed in the Persian dictionary Farhang-e Mo’aiyid al-Fożalāʾ, compiled in India in 1519. The origin of the essential points of the Āẕar Kaivān school is not Āẕar Kaivān himself, but there were probably some pioneers in the Delhi Sultanate in India before him. Adding to this, a closer look at their writings shows that this school is not a monolith, but a complex of various preceding elements. The Illuminative Philosophy is just one of them. As such, it becomes possible to arrive at the conclusion that the Āẕar Kaivān school is not Āẕar Kaivān’s school. He simply put together the various elements that preceded him.

日本原子力研究開発機構では、高温ガス炉による大量かつ安価なカーボンフリー水素製造技術の実用化を目指し、世界最高の原子炉出口冷却材温度950$^{\circ}$Cを記録した高温工学試験研究炉(HTTR)を用いて水素製造を行うHTTR-熱利用試験を計画している。HTTR-熱利用試験では、原子力規制委員会からの設置許可取得を通じて、高温ガス炉と水素製造施設の接続に関し、高い安全性を実現する安全設計を確立することが求められている。しかしながら、これまでに原子炉に水素製造施設を接続した例は世界にまだなく、我が国唯一の高温ガス炉であるHTTRを含め、既存の原子力施設を対象とした安全設計ではこのようなシステムを想定していない。そこで、高温ガス炉研究開発センターの下に設置した「HTTR-熱利用試験専門委員会」では、原子力規制委員会による新規制基準への適合性審査に合格したHTTR安全設計をベースに、施設の変更や水素製造施設の接続に伴い安全設計上新たに考慮すべき事象に対する対策を考慮し、HTTR-熱利用試験施設の安全設計案の検討を行った。本稿は、HTTR-熱利用試験専門委員会の技術報告資料や委員コメントとその回答、議事録を取りまとめた。, Aiming to realize a massive, cost-effective and carbon-free hydrogen production technology utilizing a high temperature gas cooled reactor (HTGR), Japan Atomic Energy Agency (JAEA) is planning a HTTR heat application test producing hydrogen with High Temperature Engineering Test Reactor (HTTR) achieved 950$^{\circ}$C of the highest reactor outlet coolant temperature in the world. In the HTTR heat application test, it is required to establish its safety design realizing highly safe connection of a HTGR and a hydrogen production plant by the Nuclear Regulation Authority to obtain the permission of changes to reactor installation. However, installation of a system connecting the hydrogen production plant and a nuclear reactor, and its safety design has not been conducted so far in conventional nuclear power plant including HTTR in the world. A special committee on the HTTR heat application test, established under the HTGR Research and Development Center, considered a safety design philosophy for the HTTR heat application test based on an authorized safety design of HTTR in terms of conformity to the New Regulatory Requirements taking into account new considerable events as a result of the plant modification and connection of the hydrogen production plant. This report provides materials of the special committee such as technical reports, comments provided from committee members, response from JAEA for the comments and minutes of the committee.

日本原子力研究開発機構では、高温ガス炉による大量かつ安価なカーボンフリー水素製造技術の実用化を目指し、世界最高の原子炉出口冷却材温度950$^{\circ}$Cを達成した高温工学試験研究炉(HTTR)を用いて水素製造を行うHTTR-熱利用試験を計画している。HTTR-熱利用試験では、原子力規制委員会からの設置変更許可取得を通じて、高温ガス炉と水素製造施設の接続に関し、高い安全性を実現する安全設計を確立することが求められている。そこで、HTTR安全設計をベースに、施設の変更や水素製造施設の接続に伴い安全設計上新たに考慮すべき事象に対する対策を考慮し、HTTR-熱利用試験施設の安全設計の考え方を検討した。検討に当たっては、原子炉安全の観点からの十分な安全性を確保することを大前提としつつ、水素製造施設に対して、高圧ガス災害に対する安全確保の多くの実績を有する一般産業法規を適用することを基本方針とした。本報では、水素製造施設への高圧ガス保安法適用に係る合理性や条件、HTTR-熱利用試験施設の安全機能の重要度分類や耐震設計上の重要度分類、重要安全施設の選定、原子炉設置変更許可申請に係る安全設計の考え方に関する検討結果を報告する。, Japan Atomic Energy Agency is planning a High Temperature Engineering Test Reactor (HTTR) heat application test producing hydrogen with the HTTR which achieved the highest reactor outlet coolant temperature of 950$^{\circ}$C in the world to realize a massive, cost-effective and carbon-free hydrogen production technology utilizing a high temperature gas cooled reactor (HTGR). In the HTTR heat application test, it is required to establish its safety design for coupling a hydrogen production plant to HTGR through the licensing by the Nuclear Regulation Authority (NRA). A draft of a safety design philosophy for the HTTR heat application test facility was considered taking into account postulated events due to the plant modification and coupling of the hydrogen production plant based on the HTTR safety design which was authorized through the safety review of the NRA against New Regulatory Requirements. The safety design philosophy was examined to apply proven conventional chemical plant standards to the hydrogen production plant for ensuring public safety against disasters caused by high pressure gases. This report presents a result of a consideration on safety design philosophies regarding the reasonability and condition to apply the High Pressure Gas Safety Act for the hydrogen production plant, safety classifications, seismic design classification, identification of important safety system.

Colorectal neuroendocrine carcinoma（NEC）is extremely rare and has a dismal prognosis. However, no standardized treatment strategy has been established for this lesion. For patients with NEC and distant metastasis, disease stabilization is difficult even after treatment with multidisciplinary strategies including chemotherapy. Here we describe a case of rectal NEC that presented as multiple liver metastases; a favorable prognosis was obtained after treatment with a multidisciplinary strategy that included surgery, irradiation, and chemotherapy. A 66-year-old male presented with diarrhea and constipation. Colonoscopy and a computed tomography（CT）scan revealed a rectal mass involving all of the luminal circumference, after which a diagnosis of NEC was confirmed by pathological examination. A CT scan also revealed several liver metastases in S5, S6, and S8. Abdominoperineal resection with total mesenteric excision and lymphadenectomy, including the lateral area, was performed. After resection, we administered radiation for local disease control in the lateral area. We also administered chemotherapy consisting of cisplatin and irinotecan for the liver metastases because only the endocrine cell component constituted this tumor. After chemotherapy, a CT scan was performed to confirm that the liver metastasis in S5 and S6 had disappeared, and it was shown that the other lesion in S8 had shrunk substantially（it eventually disappeared）. Then, 48 months after resection, all metastatic liver tumors were under good control, and no other recurrent lesion was recognized. In conclusion, a multidisciplinary strategy including optimal chemotherapy seems to be important to achieve a favorable prognosis of NEC of the colorectum with distant metastasis.

The fast-track surgery protocol, including perioperative immunonutritional management, is increasingly gaining attention for the prevention of surgical site infections （SSIs）. To analyze the association between the fast-track surgery protocol employed at a single center and outcomes, including SSIs and the length of hospital stays. This retrospective analysis included 217 patients who underwent hepatectomy at the study department between January 2009 and February 2014. Patients were divided into two groups: those managed by a conventional protocol （group C, n＝75） and those managed by the fast-track surgery protocol （group F, n＝142）. There were no significant differences in patient characteristics or factors between the two groups. However, serum albumin and total cholesterol levels before surgery were significantly higher in group F than in group C, and pre-hepatectomy C-reactive protein （CRP） levels were lower in group F than in group C. Moreover, serum albumin and CRP levels at postoperative day 7 were better in group F than in group C. The operations were longer in group F than in group C （312 vs. 286 min） and blood loss volume was less （385 g in group F vs. 428 g in group C）. SSI rates were significantly lower in group F （4.2％, n＝6） than in group C （13.3％, n＝10）, and the length of hospital stay was significantly shorter in group F （16.7 days） than in group C （25.8 days）. The fast-track surgery protocol as a perioperative management strategy may improve preoperative nutritional status and postoperative inflammation, with subsequent reductions in SSI rates and the length of hospital stay in patients undergoing hepatectomy.

Here we review the prognosis of patients with unsuspected gallbladder carcinoma（GBC）, detected after laparoscopic cholecystectomy（LC）in a single institute. We reviewed the medical records of patients diagnosed with gallbladder stones on admission, who underwent LC. Carcinoma involving the gallbladder was found in 22 of 2,770 patients（0.9％）via postoperative pathological examination. This GBC group spanned 58-87 years of age（mean, 75 years; 13 females and 9 males）. The preoperative diagnosis was gallbladder stones with acute/chronic cholecystitis or adenomyomatosis of the gallbladder in all patients. We performed an additional surgery in 6 of 15 patients with pT2 and T3 disease; of these, 3 patients with pT2 disease and 1 with pT3 experienced bile spillage during the LC. The mean survival of patients with unexpected GBC was 21 months, with bile spillage occurring as a complication of LC identified as a potential risk factor for shorter survival（15.3 vs. 32.5 months）. We identified patients with pT2 and pT3 disease after LC, and two patients with pT2 and 1 with pT3 who had bile spillage during LC died of peritoneal dissemination within 28 months, despite additional surgery. Occasional seeding caused by bile spillage during LC should be carefully avoided to minimize the risk of developing unsuspected GBC after LC.

The most common site of distant metastasis from colorectal cancer is the liver, and hepatectomy presents the best curative treatment for recurrence of colorectal liver metastasis （CRLM）. This study aimed to identify factors of prognostic value for repeat hepatectomy for CRLM and to determine whether a third such procedure could similarly produce favourable outcomes for CRLM. We analyzed data for 161 patients in our department with colorectal metastasis. Of these, 22 patients underwent repeat hepatectomy for recurrent metastasis, with 16 undergoing a second hepatectomy and 6 a third hepatectomy. We analyzed patient characteristics, tumor status, operation-related variables, and short- and long-term outcomes. Univariate analysis for repeat hepatectomy identified the following five prognostic risk factors: T factor （＞SE） of the primary cancer, number of tumors involved in the initial hepatectomy （＞5）, interval from first to second hepatectomy （＜1year）, number of tumors involved in second hepatectomy （＞3）, and post-operation time （＞30days）. By multivariate analysis, T factor （＞SE） of the primary cancer, number of tumors in the initial hepatectomy （＞5）, and number of tumors in the second hepatectomy （＞3） were independently associated with a worse survival after surgery for CRLM. Although surgical outcomes of the third hepatectomy were not compared with those of the first and second hepatectomy, there were no obvious differences, nor did the 1-, 3-, and 5-year survival rates differ significantly among the three groups. Repeat hepatectomy for CRLM could improve long-term survival. In addition, patients undergoing a third hepatectomy showed a similar survival benefit to those having one or two resections.

The impacts of chemical stability of inert-matrix-fuel (IMF) on the material attractiveness for states and non-state actors were evaluated in an open transuranic fuel cycle employing high temperature gas cooled reactors. The methodology for material attractiveness evaluation was developed to assess material attractiveness for states and treat IMF which is chemically inert for nitric acid solution. The material attractiveness was relatively assessed with physical properties of material in each of three discrete phases in the development of a nuclear explosive device. The material attractiveness assessment for non-state actors revealed that the non-irradiated TRISO fuel particle and IMF kernel for high temperature gas cooled reactors and the non-irradiated mixed oxide fuel (MOX) powder for MOX light water reactors were the most vulnerable targets in each fuel cycles. The TRISO fuel particle and IMF kernel would have less material attractiveness than the MOX powder because of their greater processing time and complexity. The material attractiveness assessment for states aiming concealed diversion revealed that the TRISO fuel particle and IMF kernel have less material attractiveness than the MOX powder, and are regarded as irradiated uranium fuel grade in the material attractiveness.

Additional file 1: Fig. S1. ROC curve for the NLR and tumor size in well-differentiated PanNENs. The ROC curve illustrated that NLR has an AUC of 0.664 (95% CI 0.464–0.864) and tumor size has an AUC of 0.801 (95% CI 0.675–0.945). Arrows indicate optimal cut-off values. Fig. S2. Recurrence-free-survival and overall survival for PanNENs stratified by the 2017 WHO classification. Recurrence-free-survival and overall survival of neuroendocrine carcinoma (NEC) were significantly shorter than those of well-differentiated PanNENs (NET G1-3). Fig. S3. Distribution of NLR in PanNENs stratified by the 2017 WHO classification. The value of NLR in patients with NEC was significantly higher than that in patients with well-differentiated PanNEN.

Data centers (DCs) are becoming increasingly important in recent years, and highly efficient and reliable operation and management of DCs is now required. The generated heat density of the rack and information and communication technology (ICT) equipment is predicted to get higher in the future, so it is crucial to maintain the appropriate temperature environment in the server room where high heat is generated in order to ensure continuous service. It is especially important to predict changes of rack intake temperature in the server room when the computer room air conditioner (CRAC) is shut down, which can cause a rapid rise in temperature. However, it is quite difficult to predict the rack temperature accurately, which in turn makes it difficult to determine the impact on service in advance. In this research, we propose a model that predicts the rack intake temperature after the CRAC is shut down. Specifically, we use machine learning to construct a gradient boosting decision tree model with data from the CRAC, ICT equipment, and rack intake temperature. Experimental results demonstrate that the proposed method has a very high prediction accuracy: the coefficient of determination was 0.90 and the root mean square error (RMSE) was 0.54. Our model makes it possible to evaluate the impact on service and determine if action to maintain the temperature environment is required. We also clarify the effect of explanatory variables and training data of the machine learning on the model accuracy.

Solid pseudopapillary neoplasm (SPN) of the pancreas has generally been regarded as a low-grade malignant tumour that preferentially develops in young women and can have a good prognosis with surgery. Among the few patients who have died from metastatic SPN are mostly those whose tumours harbour an undifferentiated component characterized by diffuse sheets of cells with increased nuclear atypia and proliferative index. We herein report a case of an aggressive, fatal, solid pseudopapillary neoplasm (SPN) of the pancreas in a 63-year-old woman complaining of epigastric pain. Despite having undergone surgical resection for a 10 cm pancreatic mass and multiple liver metastases, the patient later died due to uncontrollable metastases 36 months after the initial surgery. Histological examination showed that the tumour displayed unusual high-grade malignant features, showing diffuse sheets of cells with increased nuclear atypia and proliferative activity, along with conventional low-grade malignant features. The tumour was subsequently recognized as an SPN with foci of high-grade malignant transformation according to the 2010 World Health Organization classification. Immunohistochemical studies revealed that p16-RB pathway alterations contributed to the high-grade malignant transformation. The present case report suggests the necessity for developing diagnostic and treatment methods targeting p16 and RB for high-grade variants of SPN.

Various methods, devices, and techniques have been developed to improve safety during laparoscopic hepatectomy procedures. Among these, the Pringle maneuver （PM） is widely used to minimize blood loss during liver transections; however, the risk of ischemic injury associated with this technique is increased by poor hepatic reserve and regeneration dysfunction secondary to liver cirrhosis. This retrospective study evaluated the short-term outcomes and feasibility of precoagulation for endoscopic hepatectomy without PM in patients with liver cirrhosis. Eleven patients with liver cirrhosis who also underwent endoscopic hepatectomy for hepatocellular carcinoma were recruited to undergo either microwave tissue coagulation or radiofrequency ablation for precoagulation before liver transection. A wedge resection without the PM was performed in all patients, with seven patients selected for bipolar radiofrequency ablation and four patients for microwave coagulation therapy. The procedures included video-assisted thoracoscopic hepatectomy in two patients and laparoscopic hepatectomy in nine patients. One patient who underwent radiofrequency ablation developed postoperative bleeding （Clavien-Dindo grade Ⅲ）. In conclusion, precoagulation can help to minimize intraoperative blood loss without the PM, contributing to effective resection of liver tumors. We propose that precoagulation could serve as a standard technique for endoscopic hepatectomy in patients with cirrhosis.

In Japan, amebiasis is typically found in men who have sex with men and in individuals with recent travel to endemic areas. We experienced a patient with fulminant necrotizing amebic colitis and enterocolitis who presented with a severe disorder of the liver and renal function. The patient was a 71-year-old man who had lived in Yokohama City, Japan for 30 years. His stool sample showed no amebic dysentery protozoa and cultured negatively for human immunodeficiency virus. Despite being treated with meropenem, pyrexia of 39-40°C continued for 4 days. On hospital day 8, a colonic abscess and perforation of the transverse colon were detected by computed tomography（CT）. His fever did not improve, suggesting progression of infectious disease. Subsequent emergency laparotomy revealed a perforation in the middle of the transverse colon. Peritoneal lavage and right hemicolectomy were performed; however, a CT scan on hospital day 16 （postoperative day 8） showed re-perforation of the colon and an abscess around the site of anastomosis, prompting emergency intestinal and left hemicolectomy resection. Amebae observed pathologically during the second emergency operation led to a diagnosis of amebic colitis. Endotoxin adsorption therapy was performed, and metronidazole was administered. Despite prompt diagnosis and treatments, the patient’s general conditions became fulminant, and multiple organ failure developed. On hospital day 18 （postoperative day 10）, his C-reactive protein level was 20mg/dl. He was clinically diagnosed as having sepsis and multiple organ failure. The patient died on hospital day 23. Acute colitis is commonly encountered in daily practice, but it is difficult to differentiate between amebic and non-amebic colitis preoperatively and thus, the possibility of amebic colitis should be considered in such clinical presentations.