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Highlights • The prognosis of atypical pulmonary carcinoid with liver metastases is poor, and the patients are often treated using non-surgical therapies. • We successfully treated multiple liver metastases from atypical pulmonary carcinoid by using two-stage hepatectomy combined with embolization of portal vein branches. • Two-stage hepatectomy may be a good option for bilobar multiple liver metastases of atypical pulmonary carcinoid., Introduction The prognosis of atypical pulmonary carcinoid with liver metastases is extremely poor, and patients with multiple liver metastases are often treated using non-surgical therapies. We report a case with multiple liver metastases from atypical pulmonary carcinoid that was successfully treated using two-stage hepatectomy combined with embolization of portal vein branches. Presentation of case A 48-year-old man was referred to our department after multiple liver tumors were detected in both liver lobes on computed tomography. He had undergone right upper lobectomy of the lung for atypical pulmonary carcinoid (T2a, N0, M0; Stage IB) 2 years previously. Positron emission tomography-computed tomography showed no extrahepatic tumor manifestations. The tumors were located in segment 2, 3, 5/8 and the right hepatic vein drainage area. We planned complete resection of metastases in a two-stage hepatectomy. The first stage comprised concomitant left lateral segmentectomy, partial hepatectomy of segment 5/8 and portal vein embolization of the posterior segmental branches. The second stage comprised resection of the right hepatic vein drainage area, performed 21 days after the first surgery. Histopathological diagnosis was liver metastases of atypical pulmonary carcinoid. Postoperative bile leak developed, which was treated with endoscopic retrograde biliary drainage and percutaneous bile leak drainage. He has been followed for 24 months postoperatively without tumor recurrence. Discussion Two-stage hepatectomy may represent an option for bilobar multiple liver metastases from atypical pulmonary carcinoid. Conclusion We successfully treated a patient with multiple liver metastases of atypical pulmonary carcinoid using a two-stage hepatectomy combined with portal vein embolization of the posterior segmental branches.

In Japan, breakthroughs to improve the share of renewable energy in the energy mix have become an urgent issue. However, the problem could not be solved by simply adding more power plants for various technical reasons, such as the unsuitability of using renewable energy as baseloads due to its intermittency. Furthermore, establishing the required cooperative systems for regionally distributed power adjustment is also tricky. Based on these backgrounds, this paper constructs an operation plan that minimizes CO2 emissions by correcting the generation and load patterns of the renewable energy of solar power, utilizing power generation from waste as a substitute for baseload power, and estimating the power demand of each facility. The result shows that by adjusting the operation plans, the model can reduce CO2 emission by 20.95 and 8.30% in weeks with high and low solar power generation surpluses, respectively. Furthermore, these results show that it is possible to reduce CO2 emissions in regions that have power sources with low CO2 emission coefficients by forecasting the amount of power generation and power load in the region and appropriately planning the operation in advance.

A 52-year-old man with acute myeloid leukemia underwent allogeneic hematopoietic stem cell transplantation and developed extensive chronic graft-versus-host disease and myasthenia gravis (MG), which became involved with oculobulbar and proximal upper and lower limb weakness in 677 days. In the literature, we identified 24 cases where MG developed after allo-SCT. Graft-versus-host disease development and male recipients of female donors might be prone to the development of posttransplant MG (odds ratio, 3.75). Keywords: Acetylcholine receptor antibody, Allogeneic stem cell transplantation, Chronic GVHD, Myasthenia gravis

Objective To elucidate the mechanisms by which orally administered tacrolimus was not absorbed in a patient following allogeneic hematopoietic stem cell transplantation. Clinical Course A 17-year-old girl with acute myeloid leukemia underwent HLA-haploidentical peripheral blood stem cell transplantation following fludarabine, busulfan, and total-body irradiation. Graft-vs-host disease prophylaxis was post-transplant cyclophosphamide, followed by intravenous tacrolimus and mycophenolate mofetil. When tacrolimus was switched to oral administration, its blood level declined rapidly, resulting in development of acute graft-vs-host disease, which was ameliorated by switching back to intravenous administration. Methods/Results To elucidate if impaired tacrolimus absorption could be related to genetic polymorphism of tacrolimus-metabolizing enzymes, we analyzed gene polymorphisms of cytochrome P450 3A4, cytochrome P450 3A5, and multidrug resistance 1 (MDR1). The patient had wild-type cytochrome P450 3A4 (*1/*1) and variant-type cytochrome P450 3A5 (*3/*3), while MDR1 genes (2677A/G, 3435C/C) were wild-type. Conclusion Wild-type MDR1 gene product P-glycoprotein expressed in the intestine reduces drug absorption from the gastrointestinal tract and may have contributed to low blood levels of tacrolimus in this patient when tacrolimus was orally administered.

In this study, we proposed improvements based on actual measured data of a hybrid heat supply system that uses solar heat and ground heat as the heat sources of a restaurants complex in Honjo city, Saitama, Japan. Our evaluation from the actual monitoring measurements showed that the solar heat collection efficiency was 50–60%. The geothermal Heat Pump’s Coefficient of Performance decreased significantly in the summer. We propose to set the heat insulation and burial depth of the piping from the ground heat collection to the heat pump and recommends five units of 5 units of solar heat collectors as the most ideal scenario.

Graft-versus-host disease (GVHD) and infection are major obstacles to successful allogeneic hematopoietic stem cell transplantation (HSCT). Intestinal goblet cells form the mucus layers, which spatially segregate gut microbiota from host tissues. Although it is well known that goblet cell loss is one of the histologic features of GVHD, effects of their loss in pathophysiology of GVHD remain to be elucidated. In mouse models of allogeneic HSCT, goblet cells in the colon were significantly reduced, resulting in disruption of the inner mucus layer of the colon and increased bacterial translocation into colonic mucosa. Pretransplant administration of interleukin-25 (IL-25), a growth factor for goblet cells, protected goblet cells against GVHD, prevented bacterial translocation, reduced plasma concentrations of interferon-γ (IFN-γ) and IL-6, and ameliorated GVHD. The protective role of IL-25 was dependent on Lypd8, an antimicrobial molecule produced by enterocytes in the colon that suppresses motility of flagellated bacteria. In clinical colon biopsies, low numbers of goblet cells were significantly associated with severe intestinal GVHD, increased transplant-related mortality, and poor survival after HSCT. Goblet cell loss is associated with poor transplant outcome, and administration of IL-25 represents an adjunct therapeutic strategy for GVHD by protecting goblet cells.

Background Immune checkpoint inhibitors can cause various adverse effects. Recently it has been shown that Vogt–Koyanagi–Harada (VKH) disease-like uveitis can occur in patients treated with nivolumab. Case presentation A 69-year-old man developed bilateral panuveitis after nivolumab treatment for recurrent hypopharyngeal cancer. Slit lamp examination revealed bilateral granulomatous keratic precipitates, anterior chamber cells and partial synechiae. Fundus examination revealed bilateral optic disc edema and diffuse serous retinal detachment. His human leukocyte antigen (HLA) typing showed HLA-DRB1*04:05 allele. A lumbar puncture did not demonstrate pleocytosis. Bilateral sub-tenon injections of triamcinolone acetonide were initiated. As his panuveitis did not regress completely, steroid pulse therapy was administered. That therapy led to the resolution of his serous retinal detachment and to rapid improvement in his vision. Following this, we treated him with 50 mg/day of prednisolone for 1 week and then reduced it by 5 mg every week. No bilateral uveitis relapse had occurred by his 3-month follow-up; however, he subsequently died because of his cancer. Conclusion To our knowledge, this is the first report of a patient with NVKH who underwent a lumbar puncture. Unlike VKH, our case did not show meningismus or pleocytosis. NVKH may, therefore, have a different etiology from VKH. In cases of NVKH with posterior uveitis, steroid pulse therapy may be considered as a treatment option, as it is in VKH.

Secret sharing (SS) has been extensively studied as both a means of secure data storage and a fundamental building block for multiparty computation (MPC). For these purposes, code-efficiency and MPC-suitability are required for SS but they are incomparable. Recently, a computational SS and a conversion protocol were proposed. The computational SS is code-efficient and the conversion protocol converts shares of the computational (code-efficient) SS into those of an MPC-suitable SS, and it can be applied to reduce the amount of data storage while maintaining extendibility to MPC. However, this protocol is one-way: one cannot convert the share of MPC output value. In addition, it is only passively secure. The authors propose three protocols and a new computational SS. The first protocol is the inverse of the existing protocol, that is, it converts an MPC-suitable SS to the existing SS. The other two protocols are actively secure conversion protocols that convert shares between the new SS and an MPC-suitable SS. The new computational SS is code-efficient when the number of parties is small, so these two protocols are for converting between the code-efficient SS and an MPC-suitable SS. These two conversion protocols are actively secure in the honest majority.

Introduction: The prognosis for mantle cell lymphoma (MCL) has remained poor despite the current use of autologous transplantation and induction chemotherapy that includes high-dose cytarabine. The introduction of rituximab and bendamustine, however, has led to the improvement of prognosis of diffuse large B-Cell lymphoma and indolent lymphoma. For these reasons, we analyzed the effectivity of rituximab maintenance therapy and bendamustine against mantle cell lymphoma at our hospital.Methods: We selected 22 cases of MCL for which treatment was initiated between January 2004 and December 2016 at our hospital. We compared the cases based on the use of rituximab maintenance therapy or bendamustine, simplified Mantle Cell Lymphoma International Prognostic Index (sMIPI), staging, and treatment regimens to analyze the effect of rituximab maintenance therapy and bendamustine on prognosis.Results: Overall five-year survival rate was 67%. Significant difference (P=0.0432) was observed in the 5-year survival rate between the group treated with rituximab maintenance therapy (90.9%) and the group that was not (56.2%). Likewise, significant difference (P=0.0197) was observed in the 5-year survival rate between the group that received bendamustine during the course of treatment (90.9%) and the group that did not (50%). Majority of the cases in the group that received bendamustine, however, had been treated with rituximab maintenance therapy.Conclusion: Our study showed an improvement in prognosis of MCL due to the treatment with rituximab maintenance therapy and bendamustine. Although the analysis was conducted on a limited number of cases, we believe that rituximab maintenance therapy and treatments that include bendamustine are promising therapies for MCL.

This work describes a three-times ($3\times$) improvement to the performance of secure computation of AES over a network of three parties with an honest majority. The throughput that is achieved is even better than that of computing AES in some scenarios of local (non-private) computation. The performance improvement is achieved through an optimization of the generic secure protocol, and, more importantly, through an optimization of the description of the AES function to support more efficient secure computation, and an optimization of the protocol to the underlying architecture. This demonstrates that the development process of efficient secure computation must include adapting the description of the computed function to be tailored to the protocol, and adapting the implementation of the protocol to the architecture. This work focuses on the secure computation of AES since it has been widely investigated as a de-facto standard performance benchmark for secure computation, and is also important by itself for many applications. Furthermore, parts of the improvements are general and not specific to AES, and can be applied to secure computation of arbitrary functions.

The purpose of this study is to study the usefulness of post-remission antiviral therapy in cases of HCV-RNA-positive diffuse large-cell lymphoma. Antiviral therapy against HCV was performed after remission using CHOP or CHOP-like chemotherapy in combination with rituximab in five successive cases of HCV-RNA-positive diffuse large-cell lymphoma. The control groups consisted of a group of HCV-RNA-positive diffuse large-cell lymphoma cases prior to this trial (control 1), and a group of cases that tested negative for HIV, HCV, and HBV (control 2). All the cases were in remission at the time of initial treatment. There were no significant differences between the three groups in terms of age, sex, treatment, stage, or International Prognosis Index (IPI). When HCV antiviral therapy was performed after treatment for diffuse large-cell lymphoma, we observed no recurrence or deaths, and the 2-year overall survival and progression-free survival rates were significantly greater than those in the control 1 group (P = 0.0246). It is possible that a better prognosis can be achieved by performing HCV antiviral therapy after achieving remission in cases of HCV-RNA-positive diffuse large-cell lymphoma through the use of R-CHOP or similar treatments.

Comparable Encryption proposed by Furukawa (ESORICS 2013, CANS 2014) is a variant of order-preserving encryption (OPE) and order-revealing encryption (ORE); we cannot compare a ciphertext of v and another ciphertext of v', but we can compare a ciphertext of v and a token of b and compare a token of $b$ and another token of b'. Comparable encryption allows us to implement range and point queries while keeping the order of v's as secret as possible. Recently, Karras, Malhotra, Bhatt, Nikitin, Antyukhov, and Idreos independently re-define comparable encryption and propose two schemes, a basic one and an "ambiguous" one, based on linear algebra~(SIGMOD 2016). The basic scheme is just comparable encryption. To hide the order revealed by tokens, they also proposed an ambiguous scheme where each ciphertext has two interpretations v and vdummy. In the context of an indexed database, this means that every encryption has two places in the database corresponding to the two interpretations, masking the correct placement in the database unless the dummy value is detectable. They assessed that their basic scheme (and ambiguous scheme upon the basic scheme) is secure against known-plaintext attacks; the adversary will require O(l) plaintext-ciphertext pairs to recover secret key, where l is a security parameter. This paper cryptanalyzes their comparable encryption schemes by using simple linear algebra. We show that a few tokens and a few plaintext-ciphertext pairs instead of O(l) pairs allow us to mount several attacks efficiently. Our attacks are summarized as follows: Attacks against the basic scheme: -A ciphertext-only attack using two tokens orders the ciphertexts correctly. -A known-plaintext attack using two tokens and two plaintexts reveals exact value of v. Attacks against the ambiguous scheme: -A ciphertext-only attack using two tokens orders the ciphertexts with a constant probability. -A known-plaintext attack using three tokens and three plaintexts reveals exact value of v.

Purpose: The purpose of this study is to analyze the risk factor for infusion related reaction (IRR) due to the rituximab treatment in patients with B cell non-Hodgkin’s lymphoma. Methods: A retrospective analysis was conducted the newly diagnosed B cell non-Hodgkin’s lymphoma patients who have received rituximab contained chemotherapy. Several factors with cytokines in patients were calculated. A P value

We provide a garbling scheme which creates garbled circuits of a very small constant size four bits per gate for circuits with fan-out one formulas. For arbitrary fan-out, we additionally need only two ciphertexts per additional connection of each gate output wire. We make use of a trapdoor permutation for which we define a generalized notion of correlation robustness. We show that our notion is implied by PRIV-security, a notion for deterministic searchable encryption. We prove our scheme secure in the programmable random oracle model.

The speed of secret sharing (SS)-based multiparty computation (MPC) has recently increased greatly, and several efforts to implement and use it have been put into practice. Authentication of clients is one critical mechanism for implementing SS-based MPC successfully in practice. We propose a password-based authentication protocol for SS-based MPC. Our protocol is secure in the presence of secure channels, and it is optimized for practical use with SS-based MPC in the following ways.

Secret sharing scheme (SSS) has been extensively studied since SSSs are important not only for secure data storage but also as the fundamental building block for many cryptographic protocols such as multiparty computation (MPC). Although both code efficiency and application of MPC are important for SSSs, it is difficult to satisfy both. There have been many studies about MPC on Shamir’s and replicated SSS while their share size is large, and computationally secure SSS and a ramp scheme have a short share size while there have been few studies concerning their MPC. We propose a new computational SSS, and show how to convert shares of our SSS and a ramp SSS to those of multiparty-friendly SSS such as Shamir’s and replicated SSS. This enables one to secretly-share data compactly and extend secretly-shared data to MPC if needed.

Pneumonia is a major cause of death in the elderly. To investigate the role of silent aspiration in community-acquired pneumonia, we examined the occurrence of silent aspiration during sleep in 14 elderly patients with acute episode of pneumonia and 10 age-matched control subjects by a new technique using indium111 chloride. Scanning of the thorax demonstrated that 71% of patients aspirated, whereas aspiration was observed in only 10% of control subjects. The percentage of positive scans was significantly higher in patients with acute episode of pneumonia than in control subjects (p < 0.02). The results may indicate an important role of silent aspiration in the development of community-acquired pneumonia in the elderly.

Pneumonia is a major cause of death in patients with cerebral infarction. We assessed morbidity associated with pneumonia in 276 patients 65 years of age or older who were admitted to a long-term care facility. Furthermore, we studied the swallowing reflex during the day and at night and monitored the occurrence of silent aspiration during sleep.To examine the possible relationship between the location of cerebral hemispheric infarctions and the incidence of pneumonia and to evaluate the role of silent aspiration in the development of pneumonia.The incidence of pneumonia was analyzed in 4 groups of patients who were assigned to a group on the basis of the following computed tomographic findings: no infarct (group A); 1 or more unilateral basal ganglia infarcts (group B); bilateral basal ganglia infarcts (group C); and 1 or more cerebral hemispheric infarcts outside the basal ganglia (group D). Criteria for diagnosis of pneumonia were (1) a new pulmonary infiltrate seen on a chest radiograph and (2) 1 or more of the following features: cough, temperature greater than 37.8 degrees C, or subjective dyspnea. Before the study, the patients with stroke were followed up for more than 1 year after their ictus and were monitored to determine if they sustained affecting cerebral hemispheric structures. The average duration of observation for incidence of pneumonia was 22 months. To study the swallowing reflex and to monitor for the occurrence of silent aspiration during sleep, 15 of the patients who were confined to bed or chair were randomly selected from each of groups A through C. The swallowing reflex was examined at both 1 PM and 1 AM and was evaluated according to latency of response, which was timed from the injection of 1 mL of distilled water into the pharynx through a nasal catheter to the onset of swallowing. The incidence of silent aspiration during sleep was examined using indium-111 chloride as a radioactive tracer attached to the teeth, and scanning of the thorax was performed the next morning.The incidence of pneumonia was 2.12 times higher in the patients of group B (27.4%; P.01) and 3.64 times higher in the patients of group C (47.0%; P.001) than in the patients of group A (12.9%). The latency of response was longer in the patients of groups B (P.05) and C (P.001) than in those of group A at 1 AM. The percentage of positive scans was also higher in the patients of groups B (P.01) and C (P.001) than in those of group A.Basal ganglia strokes might predispose these patients to develop pneumonia owing to frequent aspiration during sleep.

We examined the hypothesis that collateral channels were identical within small airways and ducts, therefore both should respond similarly to chemical and mechanical stresses. A double lumen catheter was wedged into a segmental bronchus of the dog and humidified air or 10% CO2 in air (Vs) flowed at a segmental bronchial pressure (Pb) of 2 cm H2O. A small circular area about 1 cm diameter was peeled from the wedged segment and covered with a capsule glued to the surrounding pleura for measuring either a small airway flow (Vsaw) or capsule pressure (Pcap). Collateral resistance (Rcoll) and small airway resistance (Rsaw) were calculated as Rcoll = Pb/(Vs − Vsaw), Rsaw = (Pb-Pcap)/Vsaw, respectively. Hypocapnia (air) resulted in increases in Rcoll and Rsaw, while hypercapnia (10% CO2) generally had the opposite effect. Gcoll and Gsaw both increased linearly with lung volume (V l ). The pattern of the responses of Rsaw closely paralleled those of Rcoll to local hypercapnia and hypocapnia, and to changing V l , implying that the major sites of resistance along collateral channels and along the airways are functionally and structurally similar.

We examined the effect of acute pulmonary vascular congestion on bronchial reactivity in dogs in a standard challenge protocol. Airway responsiveness to histamine whose concentration was varied in a stepwise incremental fashion was assessed from changes in pulmonary resistance (RL) and dynamic compliance (Cdyn) in 10 anesthetized dogs. Brief acute pulmonary congestion was created by inflating a balloon placed in the left atrium to raise left atrial pressure to 20-30 cmH2O for 1 min. Pulmonary congestion did not change RL in the control condition. However, after histamine inhalation, RL was further increased by pulmonary congestion, making the two effects synergistic. This phenomenon could not be observed with vagi cut. Pulmonary congestion decreased Cdyn in all dogs regardless of histamine concentration, with or without vagotomy. We conclude that pulmonary vascular congestion makes the bronchi hyperreactive through vagal reflexes. The reduction in Cdyn caused by pulmonary congestion appears to stem mainly from the narrowing of peripheral airways by adjacent vascular engorgement.

We performed pulmonary function tests after antigen inhalation challenge in 6 patients with hypersensitive pneumonia. 2 patients showed a reduction in maximal expiratory flow at 25% vital capacity (V25) within the first 1-3 h (early reaction) followed by a decrease in vital capacity, forced expiratory volume at 1 s and increased respiratory resistance in the next 4-7 h (late reaction). In the other 4 patients, only V25 decreased within the first 1-3 h. Diffusion capacity did not change significantly. It is suggested that the small airway is the most sensitive site of reaction to an antigen inhalation challenge in hypersensitive pneumonia and that the obstructive change of the small airway could occur as the early reaction.

NAKAMURA, M., SASAKI, H., IKEDA, Y., KIKUCHI, R., OKUBO, T. and TAKISHIMA, T. Bronchial Length Behavior with Respect to Lung Volume Histories in Different Bronchial Sizes in Excised Dog Lungs. Tohoku J. exp. Med., 1981, 133 (2), 233-241-The bronchial length behavior of three differentsized segments in seven excised dog lobes was examined in terms of the transpulmonary pressure (PL)-bronchial length relationship and the absolute lung volume (VL)-bronchial length relationship during lung inflation and deflation. The straight bronchi of the right lower lobes were used and the bronchial lengths were measured directly and continuously with a linear displacement transducer which was connected by a thin rod to a wedged bead in the bronchi. From PL 30 to 0cm H2O, the lengths of proximal, intermediate and distal bronchi from the airway opening decreased by 25.2±4.0%; 36.5±10.4%; and 37.0±11.5% (mean ±S.D.), respectively. Hysteresis of bronchial length existed in the lung volume histories at the same PL, but not at the same VL. With deflation of lung from PL 30 to 0cm H2O, the more proximal bronchi less changed their length disproportionately with lung volume. It is suggested that nonhomogeneous expansion between lung parenchyma and the bronchi would be more intense in the proximal bronchi than the distal bronchi in terms of bronchial length.