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Simple Summary: This single-center, single-arm, phase II trial aimed to propose a safe and effective salvage spine SBRT regimen for patients with spinal metastases. The second SBRT dose consisted of 30 Gy delivered in five fractions with specific dose constraints for the spinal cord and nerve plexuses. Among the enrolled patients, 12 received the second SBRT at the same spinal level, while 8 received it at an adjacent level. No instances of radiation myelopathy or local failure were observed during the follow-up period. However, grade 3 late adverse effects (including lumbosacral plexopathy and vertebral compression fractures) were observed in 25% of patients throughout the entire follow-up period, suggesting that the second SBRT poses a risk of toxicity. Purpose: The optimal method for the second course of stereotactic body radiotherapy (SBRT) for spinal metastases remains poorly established. This single-center, single-arm, phase II trial was conducted to propose a safe and effective salvage spine SBRT. Methods: The patients initially treated with SBRT for spine-targeted protocol treatment, or for areas adjacent to the spine, were enrolled. The second SBRT dose was 30 Gy delivered in five fractions; the spinal cord dose constraint was 15.5 Gy at the maximum point dose. The brachial or lumbosacral plexuses were dose-constrained to <30 Gy if the boundary between the nerves and tumors was detected. The primary endpoint was dose-limiting toxicity (DLT) (grade ≥ 3 severe radiation-related toxicity) within a year after the second SBRT. Results: The second SBRT was administered to the same spinal level in 12 patients and to an adjacent spinal level in 8 patients. SBRT2 was performed for 14 painful lesions, 10 MESCC, and 6 oligometastases, with some lesions having multiple indications. The median interval between SBRT sessions was 21 months (range: 6–51 months). The median follow-up duration was 14 months. No radiation myelopathy or local failure was reported during the follow-up period. DLT was confirmed in two patients (10%) within a year, both of whom developed grade 3 lumbosacral plexopathy. These two patients received SBRT twice to the S1–2 and S1–5 vertebrae, respectively, and both experienced paralysis of the tibialis anterior muscle (L5 level). Grade 3 late adverse effects (including lumbosacral plexopathy and vertebral compression fracture) were observed in 25% of the patients throughout the entire follow-up period. Conclusions: The second spine SBRT achieved good local control without causing myelopathy. However, one-quarter of the patients experienced grade 3 late adverse effects, suggesting that the treatment protocol carries a risk of toxicity. [ABSTRACT FROM AUTHOR]

Topological gels possess structures that are cross‐linked only via physical constraints; ideally, no attractive intermolecular interactions act between their components, which yields interesting physical properties. However, most reported previous topological gels were synthesized based on supramolecular interlocked structures such as polyrotaxane, for which attractive intermolecular interactions are essential. Here, we synthesize a water‐soluble "molecular net" (MN) with a large molecular weight and three‐dimensional network structure using poly(ethylene glycol). When a water‐soluble monomer (N‐isopropylacrylamide) is polymerized in the presence of the MNs, the extending polymer chains penetrates the MNs to form an ideal topological MN gel with no specific attractive interactions between its components. The MN gels show unique physical properties as well a significantly high degree of swelling and high extensibility due to slipping of the physical cross‐linking. We postulate this method to yield a new paradigm in gel science with unprecedented physical properties. [ABSTRACT FROM AUTHOR]

Natural monoclinic zirconia (baddeleyite) was irradiated with 340 MeV Au ions, and the irradiation-induced nanostructures (i.e., ion tracks and nanohillocks) were observed using transmission electron microscopy. The diameter of the nanohillocks was approximately 10 nm, which was similar to the maximum molten region size calculated using the analytical thermal spike model. Ion tracks were imaged as strained regions that maintained their crystalline structure. The cross-sections of most of the ion tracks were imaged as rectangular contrasts as large as 10 nm. These results strongly indicated that the molten region was recrystallized anisotropically, reflecting the lattice structure. Furthermore, low-density track cores were formed in the center of the ion tracks. The formation of low-density track cores can be attributed to the ejection of molten matter toward the surface. A comparison of the ion tracks in the synthetic zirconia nanoparticles and those in larger natural zirconia samples showed that the interface between the strained track contrast and the matrix was less clear in the former than in the latter. These findings suggest that the recrystallization process was affected by the size of the irradiated samples. [ABSTRACT FROM AUTHOR]

Large area inspection using a robot is critical in a disastrous situation; especially when humans are inhabiting the catastrophic environment. Unlike natural environments, such environments lack details. Thus, creating 3D maps and identifying objects has became a challenge. This research suggests a 3D Point Cloud Data (PCD) merging algorithm for the less textured environment, aiming World Robot Summit Standard Disaster Robotics Challenge 2021 (WRS). Spider2020, a robotic system designed by the Robot Engineering Laboratory, University of Aizu, was used in this research. Detecting QR codes in a wall and merging PCD, and generating a wall map are the two main tasks in the competition. The Zxing library was used to detect and decode QR codes, and the results were quite accurate. Since the 3D mapping environment has fewer textures, decoded QR code locations are used as the PCD mapping markers. The position of the PCD file was taken from the location given by the robotic arm in Spider2020. The accuracy of merging PCD was improved by including the position of PCD files in the merging algorithm. The robotic system can be used for Large area Inspections in a disastrous situation.

Standard Disaster Robotics Challenge of World Robot Summit (WRS) aims to test the ability of robots that can be used as disaster response robots. Robot Engineering Lab of the University of Aizu is developing a robotic system to address challenges in the WRS. The competition has five stages, and the teleoperation robotic system had to be developed to satisfy the requirements of each challenge. REL uses a disaster-response robot called Giraffe, which has the capability of traveling in hard terrain. Open Robot Technology Middleware uses to integrate all of the subsystems inside the robot. Each subsystem has different tasks that process video data, RGB depth data, Point Cloud Data, sensor data and, feedback data. The Robotic system includes 6 cameras and NDI Software Developer Kit used to transmit and view video streams remotely. The video stream from each camera can be viewed separately, and it gives wider control over the robot for the operator. The teleoperation robotic system was tested during a robot demonstration held in Fukushima Robot Test Field, and results were analyzed according to the WRS 2018 competition guidelines. The results were at an acceptable level.

Most studies of vertebral compression fractures (VCF) caused by stereotactic body radiotherapy (SBRT) do not discuss the symptoms of this complication. In this paper, we aimed to determine the rate and prognostic factors of painful VCF caused by SBRT for spinal metastases. Spinal segments with VCF in patients treated with spine SBRT between 2013 and 2021 were retrospectively reviewed. The primary endpoint was the rate of painful VCF (grades 2–3). Patient demographic and clinical characteristics were evaluated as prognosticators. In total, 779 spinal segments in 391 patients were analyzed. The median follow-up after SBRT was 18 (range: 1–107) months. Sixty iatrogenic VCFs (7.7%) were identified. The rate of painful VCF was 2.4% (19/779). Eight (1.0%) VCFs required surgery for internal fixation or spinal canal decompression. The painful VCF rate was significantly higher in patients with no posterolateral tumor involvement than in those with bilateral or unilateral involvement (50% vs. 23%; p = 0.042); it was also higher in patients with spine without fixation than in those with fixation (44% vs. 0%; p < 0.001). Painful VCFs were confirmed in only 2.4% of all the irradiated spinal segments. The absence of posterolateral tumor involvement and no fixation was significantly associated with painful VCF. [ABSTRACT FROM AUTHOR]

A lateral overflow integration capacitor (LOFIC) complementary metal oxide semiconductor (CMOS) image sensor can realize high-dynamic-range (HDR) imaging with combination of a low-conversion-gain (LCG) signal for large maximum signal electrons and a high-conversion-gain (HCG) signal for electron-referred noise floor. However, LOFIC-CMOS image sensor requires a two-channel read-out chain for LCG and HCG signals whose polarities are inverted. In order to provide an area-efficient LOFIC-CMOS image sensor, a one-channel read-out chain that can process both HCG and LCG signals is presented in this paper. An up/down double-sampling circuit composed of an inverting amplifier for HCG signals and a non-inverting attenuator for LCG signals can reduce the area of the read-out chain by half compared to the conventional two-channel read-out chain. A test chip is fabricated in a 0.18 μ m CMOS process with a metal–insulator–metal (MIM) capacitor, achieving a readout noise of 130 μ V rms for the HCG signal and 1.19 V for the LCG input window. The performance is equivalent to 103 dB of the dynamic range with our previous LOFIC pixel in which HCG and LCG conversion gains are, respectively, 160 μ V / e − and 10 μ V / e − . [ABSTRACT FROM AUTHOR]

This prospective phase I trial aimed to determine the recommended dose of 3‐day total marrow and lymphoid irradiation (TMLI) for a myeloablative conditioning regimen by increasing the dose per fraction. The primary end‐point of this single‐institution dose escalation study was the recommended TMLI dose based on the frequency of dose‐limiting toxicity (DLT) ≤100 days posthematopoietic stem cell transplantation (HSCT); a 3 + 3 design was used to evaluate the safety of TMLI. Three dose levels of TMLI (14/16/18 Gy in six fractions over 3 days) were set. The treatment protocol began at 14 Gy. Dose‐limiting toxicities were defined as grade 3 or 4 nonhematological toxicities. Nine patients, with a median age of 42 years (range, 35–48), eight with acute lymphoblastic leukemia and one with chronic myeloblastic leukemia, received TMLI followed by unrelated bone marrow transplant. The median follow‐up period after HSCT was 575 days (range, 253–1037). Three patients were enrolled for each dose level. No patient showed DLT within 100 days of HSCT. The recommended dose of 3‐day TMLI was 18 Gy in six fractions. All patients achieved neutrophil engraftment at a median of 19 days (range, 14–25). One‐year overall and disease‐free survival rates were 83.3% and 57.1%, respectively. Three patients experienced relapse, and no nonrelapse mortality was documented during the observation period. One patient died due to disease relapse 306 days post‐HSCT. The recommended dose of 3‐day TMLI was 18 Gy in six fractions. The efficacy evaluation of this regimen is currently being planned in a phase II study. [ABSTRACT FROM AUTHOR]

Intensity-modulated radiation therapy (IMRT) helps achieve good radiation dose conformity and precise dose evaluation. We conducted a single-centre prospective study to assess the safety and feasibility of total body irradiation with IMRT (IMRT-TBI) using helical tomotherapy in allogeneic haematopoietic stem cell transplantation (allo-HSCT). Thirty-nine adult patients with haematological malignancy (acute lymphoblastic leukaemia [n = 21], chronic myeloid leukaemia [n = 6], mixed phenotype acute leukaemia [n = 5], acute myeloid leukaemia [n = 4], and malignant lymphoma [n = 3]) who received 12 Gy IMRT-TBI were enrolled with a median follow-up of 934.5 (range, 617–1254) d. At the time of transplantation, 33 patients (85%) achieved complete remission. The conditioning regimen used IMRT-TBI (12 Gy in 6 fractions twice daily, for 3 d) and cyclophosphamide (60 mg/kg/d, for 2 d), seven patients were combined with cytarabine, and five with etoposide. We set dose constraints for the lungs, kidneys and lens as the organs at risk. The mean doses for the lungs and kidneys were 7.50 and 9.11 Gy, respectively. The mean maximum dose for the lens (right/left) was 5.75/5.87 Gy. The 2-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) were 69, 64, 18 and 18%, respectively. Thirty-six patients developed early adverse events (AEs) (including four patients with Grade 3/4 toxicities), most of which were reversible oral mucositis and may partially have been related to IMRT-TBI. However, the incidence of toxicity was comparable to conventional TBI-based conditioning transplantation. None of the patients developed primary graft failure, or Grade III–IV acute graft-versus-host disease (GVHD). In late complications, chronic kidney disease was observed in six patients, a lower incidence compared to conventional TBI-based conditioning transplantation. No radiation pneumonitis or cataracts were observed in any of the patients. IMRT-TBI is safe and feasible for haematological malignancies with acceptable clinical outcomes. IMRT-TBI-helical tomotherapy aids in accurate dose calculation and conformity. It could be used without any considerable increase in the rate of TBI-related AEs. Allo-HSCT with IMRT-TBI may be an alternative to conventional TBI for clinical use. [ABSTRACT FROM AUTHOR]

Simple Summary: As the superiority of stereotactic body radiotherapy (SBRT) over conventional external beam radiotherapy (cEBRT) for painful non-spine bone metastases remains controversial, we conducted propensity score-matched analysis. Our results showed that the 3-month pain response rate after SBRT was significantly higher than that after cEBRT. Therefore, these findings suggest that large-scale randomized controlled trials are warranted to compare SBRT with cEBRT for painful bone metastases not involving the spine. (1) Background: The superiority of stereotactic body radiotherapy (SBRT) over conventional external beam radiotherapy (cEBRT) in terms of pain palliation for bone metastases remains controversial. (2) Methods: This propensity score-matched study compared the overall pain response (OR) 3 months after radiotherapy among patients with painful (≥2 points on a 0-to-10 scale) non-spine bone metastases. Patients with lesions that were treated with SBRT or cEBRT and whose pain scores were evaluated 3 months after radiotherapy were included in this study. Pain response was evaluated according to the International Consensus Criteria. (3) Results: A total of 234 lesions (SBRT, n = 129; cEBRT, n = 105) were identified in our institutional database. To reduce the confounding effects, 162 patients were selected using a propensity score-matched analysis (n = 81 for each treatment). The OR rate at 3 months after SBRT was significantly higher than that after cEBRT (76.5% vs. 56.8%; p = 0.012). A noteworthy finding of our study is that the same trend was observed even after 6 months (75.9% vs. 50.0%; p = 0.011). The 1-year local failure rates after SBRT and cEBRT were 10.2% and 33.3% (p < 0.001), respectively. (4) Conclusions: Our findings suggest that SBRT is superior to cEBRT for pain palliation in patients with non-spine bone metastases. [ABSTRACT FROM AUTHOR]

Background: Airborne personal protective equipment is required for healthcare workers when performing aerosol-generating procedures on patients with infectious diseases. Chest compressions, one of the main components of cardiopulmonary resuscitation, require intense and dynamic movements of the upper body. We aimed to investigate the protective effect of tight-fitting powered air-purifying respirators (PAPRs) during chest compressions.Methods: This single-center simulation study was performed from February 2021 to March 2021. The simulated workplace protection factor (SWPF) is the concentration ratio of ambient particles and particles inside the PAPR mask; this value indicates the level of protection provided by a respirator when subjected to a simulated work environment. Participants performed continuous chest compressions three times for 2 min each time, with a 4-min break between each session. We measured the SWPF of the tight-fitting PAPR during chest compression in real-time mode. The primary outcome was the ratio of any failure of protection (SWPF <500) during the chest compression sessions.Results: Fifty-four participants completed the simulation. Overall, 78% (n = 42) of the participants failed (the measured SWPF value was less than 500) at least one of the three sessions of chest compressions. The median value and interquartile range of the SWPF was 4304 (685-16,191). There were no reports of slipping down of the respirator or mechanical failure during chest compressions.Conclusions: Although the median SWPF value was high during chest compressions, the tight-fitting PAPR did not provide adequate protection. [ABSTRACT FROM AUTHOR]

A recent article in Angewandte Chemie International Edition discusses a new method developed by Yuichi Ohya et al. for synthesizing hydrogels with a topologically cross-linked structure. These gels have physical constraints rather than specific attractive interactions between their components. The researchers synthesized a water-soluble "molecular net" with a large molecular weight and three-dimensional network structure. When a water-soluble monomer was polymerized in the presence of these molecular nets, the polymer chains penetrated the nets to form an ideal topological gel. [Extracted from the article]

A recent article in Angewandte Chemie discusses a new method developed by Yuichi Ohya et al. for obtaining hydrogel with a topologically cross-linked structure. Topological gels have structures that are cross-linked only through physical constraints. The researchers synthesized a water-soluble "molecular net" with a large molecular weight and three-dimensional network structure. When a water-soluble monomer was polymerized in the presence of the molecular nets, the extending polymer chains penetrated the nets to form an ideal topological gel with no specific attractive interactions between its components. [Extracted from the article]

High breakdown voltage (BV) AlGaAs/GaAs/AlGaAs diodes with a pair of hole and electron channels were studied taking account of the residual carbon impurity. The residual acceptor that would affect the charge balance was evaluated by separate growth. Utilizing the residual concentration, the acceptor concentrations (NA) were examined with a fixed donor concentration of 1.1 × 1012 cm−2. For NA of 0.9 × 1012 cm−2, the diode with 113 μm drift region length derived the highest BV of 1800 V. Temperature-dependent I–V measurements revealed the breakdown due to an avalanche multiplication. This implies a uniform electric field across the channels. Then, depletion of both channels was characterized by C–V measurements for obtaining capacitance shut-off voltages of the diodes. The lowest shut-off voltage was obtained for the 0.9 × 1012 cm−2NA diode. This would be due to the simultaneous depletion of hole and electron channels, i.e. the identical net concentration for acceptor and donor. [ABSTRACT FROM AUTHOR]

We treated two patients with COVID-19 pneumonia requiring mechanical ventilation. Case 1 was a 73-year-old Japanese man. Computed tomography (CT) revealed ground-glass opacities in both lungs. He had severe respiratory failure with a partial pressure of oxygen in arterial blood/fraction of inspiratory oxygen ratio (P/F ratio) of 203. Electrocardiogram showed a heart rate (HR) of 56 beats/min, slight ST depression in leads II, III, and aVF, and mild saddle-back type ST elevation in leads V1 and V2. High-sensitivity cardiac troponin T (cTnT) level was slightly elevated. Despite a high fever and hypoxemia, his HR remained within 50–70 beats/min. Case 2 was a 52-year-old Japanese woman. CT revealed ground-glass opacities in the lower left lung. Electrocardiogram showed a HR of only 81 beats/min, despite a body temperature of 39.2 °C, slight ST depression in leads V4, V5, V6, and a prominent U wave in multiple leads. She had an elevated cTnT and a P/F ratio of 165. Despite a high fever and hypoxemia, her HR remained within 50–70 beats/min. Both patients had a poor compensatory increase in their HR, despite their critical status. Relative bradycardia could be a cardiovascular complication and is an important clinical finding in patients with COVID-19. < Learning objective: We report two Japanese cases of COVID-19 pneumonia with relative bradycardia as a condition and no significant compensatory increase in heart rate despite high fever and severe hypoxemia. Relative bradycardia in COVID-19 might be associated with myocardial injury due to not only direct viral involvement but also systemic inflammation. We should carefully observe the occurrence of relative bradycardia because it could potentially be a clinical sign of COVID-19.> [ABSTRACT FROM AUTHOR]

Total body irradiation using intensity-modulated radiation therapy total body irradiation (IMRT-TBI) by helical tomotherapy in allogeneic hematopoietic stem cell transplantation (allo-HSCT) allows for precise evaluation and adjustment of radiation dosage. We conducted a single-center pilot study to evaluate the safety of IMRT-TBI for allo-HSCT recipients. Patients with hematological malignancies in remission who were scheduled for allo-HSCT with TBI-based myeloablative conditioning were eligible. The primary endpoint was the incidence of adverse events (AEs). Secondary endpoints were engraftment rate, overall survival, relapse rate, non-relapse mortality, and the incidence of acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively). Between July 2018 and November 2018, ten patients were recruited with a median observation duration of 571 days after allo-HSCT (range, 496–614). D80% for planning target volume (PTV) in all patients was 12.01 Gy. Average D80% values for lungs, kidneys and lenses (right/left) were 7.50, 9.03 and 4.41/4.03 Gy, respectively. Any early AEs (within 100 days of allo-HSCT) were reported in all patients. Eight patients experienced oral mucositis and gastrointestinal symptoms. One patient experienced Bearman criteria grade 3 regimen-related toxicity (kidney and liver). All cases achieved neutrophil engraftment. There was no grade III–IV aGVHD or late AE. One patient died of sinusoidal obstruction syndrome 67 days after allo-HSCT. The remaining nine patients were alive and disease-free at final follow-up. Thus, IMRT-TBI was well tolerated in terms of early AEs in adult patients who underwent allo-HSCT; this warrants further study with longer observation times to monitor late AEs and efficacy. [ABSTRACT FROM AUTHOR]

Background The clinical role of sputum Gram stain (SGS) in community-acquired pneumonia (CAP) diagnosis remains controversial. A 1996 meta-analysis of the diagnostic accuracy of SGS reported heterogeneous results. To update the available evidence, we performed a systematic review and a Bayesian standard and latent-class model meta-analysis. Methods We searched Medline, Embase, and Cochrane Central by 23 August 2018 to identify studies reporting on the diagnostic accuracy, yield (percentage of patients with any pathogen[s] correctly identified by SGS), and clinical outcomes of SGS in adult patients with CAP. Two reviewers extracted the data. We quantitatively synthesized the diagnostic accuracy and yield, and descriptively analyzed other outcomes. Results Twenty-four studies with 4533 patients were included. The methodological and reporting quality of the included studies was limited. When good-quality sputum specimens were selected, SGS had a summary sensitivity of 0.69 (95% credible interval [CrI],.56–.80) and specificity of 0.91 (CrI,.83–.96) for detecting Streptococcus pneumoniae , and a sensitivity of 0.76 (CrI,.60–.87) and specificity of 0.97 (CrI,.91–.99) for Haemophilus influenzae. Adjusted analyses accounting for imperfect reference standards provided higher-specificity estimates than the unadjusted analyses. Bacterial pathogens were identified in 73% (CrI, 26%–96%) of good-quality specimens, and 36% (CrI, 22%–53%) of all specimens regardless of quality. Evidence on other bacteria was sparse. Conclusions SGS was highly specific to diagnose S. pneumoniae and H. influenzae infections in patients with CAP. With good-quality specimens, SGS can provide clinically actionable information for pathogen-directed antibiotic therapies. [ABSTRACT FROM AUTHOR]

Background: The role and impact of radiation therapy (RT) on the development of herpes zoster (HZ) has not been well studied. The objective of this study was to investigate the association between RT and HZ.Methods: A propensity score-matched, retrospective cohort study was conducted using institutional cancer registry data and medical records from 2011 to 2015. The risk of developing HZ in the RT and non-RT groups was compared using a Cox proportional hazards model. Associations also were explored between the RT field and the anatomic location of HZ in patients who developed HZ after RT. The expected number of HZ events within the radiation field was calculated according to the RT received by each patient; then, this number was compared with the observed number of in-field events.Results: Of 17,655 patients, propensity score matching yielded 4350 pairs; of these, 3891 pairs were eligible for comparison. The cumulative incidence of HZ in the RT group (vs the non-RT group) during the first 5 years after the index date was 2.1% (vs 0.7%) at 1 year, 3.0% (vs 1.0%) at 2 years, 3.4% (vs 1.3%) at 3 years, 4.1% vs 1.7% at 4 years, and 4.4% vs 1.8% at 5 years. The RT group showed a significantly higher risk of HZ than the non-RT group (hazard ratio, 2.59, 95% CI, 1.84-3.66). In the 120 patients who developed HZ after RT, HZ events were observed significantly more frequently within the RT field than expected (74 vs 43.8 events; P < .001).Conclusions: Patients with cancer who received RT showed a significantly higher risk of HZ, which was commonly observed within the radiation field. [ABSTRACT FROM AUTHOR]

Byline: Weimin Xie, Qunhui Wang, Hongzhi Ma, Hiroaki Ogawa The development and manufacture of an adsorbent to remove phosphate for the prevention of eutrophication in lakes is very important. The use of aluminium oxide (alumina) as an organic adsorbent to remove phosphate from wastewater has been investigated. The characteristics of this absorption process were investigated to determine the important parameters, such as the pH and the aluminium ion concentration. Moreover, chemical treatment methods to enhance the adsorption capacity of alumina were tested. Dynamic studies and equilibrium adsorption isotherm studies were conducted to determine the adsorption capacity and efficiency. The experimental results indicate that it is necessary to increase the temperature above 500uC in order to obtain a high-capacity adsorbent, and alumina treated with acid or calcium or magnesium has a larger adsorption capacity for phosphate than untreated adsorbent. Moreover, the adsorption of phosphate was enhanced at a lower pH and a higher aluminium ion concentration, and a simple Freundlich isotherm could express the equilibrium adsorption isotherm, and the intragranular diffusion controlling model was used to test the dynamic studies. These findings have important implications for the application and development of aluminium oxide as a prospective adsorbent.