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We propose colors light detection and ranging (LiDAR) using visible laser diodes (LD) of red, green, and blue (RGB) colors to identify colors as well as obtain position information of surrounding objects. To verify the principle, we performed round-trip time-of-flight (TOF) measurements by irradiating a target of different colors with pulsed light from a LD of RGB colors. It is clarified that accurate distance measurements of up to 12 m can be realized in any RGB LD, and the received signal in each LD has different intensity characteristics depending on the target color. From a judgment table created from reception intensity characteristics for three types of LD and seven types of color target, the color of each target is successfully identified.

Background IgG4-related kidney disease causes renal impairment of unknown pathogenesis that may progress to kidney failure. Although ectopic germinal centers contribute to the pathogenesis of the head and neck lesions of IgG4-related disease, the presence of tertiary lymphoid tissue (TLT) containing germinal centers in IgG4-RKD has rarely been reported. Case presentation We report a 72-year-old Japanese man who had IgG4-related tubulointerstitial nephritis (TIN) with TLT formation incidentally detected in a resected kidney with mass lesion of IgG4-related ureteritis in the ureteropelvic junction. During follow-up for past surgical resection of a bladder tumor, renal dysfunction developed and a ureter mass was found in the right ureteropelvic junction, which was treated by nephroureterectomy after chemotherapy. Pathology revealed no malignancy but abundant IgG4-positive cell infiltration, obliterative phlebitis and storiform fibrosis, confirming the diagnosis of IgG4-related ureteritis. In the resected right kidney, lymphoplasmacytes infiltrated the interstitium with focal distribution in the renal subcapsule and around medium vessels without storiform fibrosis, suggesting the very early stage of IgG4-TIN. Lymphocyte aggregates were also detected at these sites and consisted of B, T, and follicular dendritic cells, indicating TLT formation. IgG4-positive cells infiltrated around TLTs. Conclusions Our case suggests that TLT formation is related with the development of IgG4-TIN and our analysis of distribution of TLT have possibility to elucidate IgG4-TIN pathophysiology.

The delayed local treatment approach (DL) in high-risk neuroblastoma (HR-NB) refers to the process in which tumor resection is performed after the completion of all the courses of chemotherapy, including myeloablative high-dose chemotherapy (HDC). Alternatively, in the conventional local treatment approach (CL), tumor resection is performed during induction chemotherapy. In this study, we compared the surgical outcomes in HR-NB patients treated by CL and DL.Forty-seven patients with abdominal HR-NB underwent primary tumor resection from 2002 to 2018. The timing of surgery was generally determined by following the trials and guidelines available at the time. The outcomes and surgical complications between the two strategies were compared.Operation time, blood loss, and postoperative WBC counts were lower in the DL group (n = 25) when compared to the CL group (n = 22), statistical significance notwithstanding. Major vascular structures were less frequently encased in the DL group tumors, while immediate surgical complications were significantly more frequent in the CL group (P 0.05). Furthermore, the 3-year EFSs were 50.0% and 53.9% in the DL and CL groups, respectively.DL appears to be a feasible and effective treatment option for HR-NB. Nonetheless, further verifications using larger cohorts are warranted.Treatment study, Level III.

Children and adolescents and young adults (AYAs) with cancer are often treated with a multidisciplinary approach. This includes use of radiotherapy, which is important for local control, but may also cause adverse events in the long term, including second cancer. The risks for limited growth and development, endocrine dysfunction, reduced fertility and second cancer in children and AYAs are reduced by proton beam therapy (PBT), which has a dose distribution that decreases irradiation of normal organs while still targeting the tumor. To define the outcomes and characteristics of PBT in cancer treatment in pediatric and AYA patients, this document was developed by the Japanese Society for Radiation Oncology (JASTRO) and the Japanese Society of Pediatric Hematology/Oncology (JSPHO).

PURPOSEWe report here the outcomes and late effects of the Japanese Study Group for Pediatric Liver Tumors (JPLT)-2 protocol, on the basis of cisplatin-tetrahydropyranyl-adriamycin (CITA) with risk stratification according to the pretreatment extent of disease (PRETEXT) classification for hepatoblastoma (HB).PATIENTS AND METHODSFrom 1999 to 2012, 361 patients with untreated HB were enrolled. PRETEXT I/II patients were treated with up-front resection, followed by low-dose CITA (stratum 1) or received low-dose CITA, followed by surgery and postoperative chemotherapy (stratum 2). In the remaining patients, after 2 cycles of CITA, responders received the CITA regimen before resection (stratum 3), and nonresponders were switched to ifosfamide, pirarubicin, etoposide, and carboplatin (ITEC; stratum 4). Intensified chemotherapeutic regimens with autologous hematopoietic stem-cell transplantation (SCT) after resection were an optional treatment for patients with refractory/metastatic disease.RESULTSThe 5-year event-free and overall survival rates of HB patients were 74.2% and 89.9%, respectively, for stratum 1, 84.8% and 90.8%%, respectively, for stratum 2, 71.6% and 85.9%%, respectively, for stratum 3, and 59.1% and 67.3%%, respectively, for stratum 4. The outcomes for CITA responders were significantly better than those for nonresponders, whose outcomes remained poor despite salvage therapy with a second-line ITEC regimen or SCT. The late effects, ototoxicity, cardiotoxicity, and delayed growth, occurred in 61, 18, and 47 patients, respectively. Thirteen secondary malignant neoplasms (SMNs), including 10 leukemia, occurred, correlating with higher exposure to pirarubicin and younger age at diagnosis.CONCLUSIONThe JPLT-2 protocol achieved up-front resectability in PRETEXT I/II patients with no annotation factors, and satisfactory survival in patients who were CITA responders in the remaining patients. However, outcomes for CITA nonresponders were unsatisfactory, despite therapy intensification with ITEC regimens and SCT. JPLT-2 had a relatively low incidence of cardiotoxicity but high rates of SMNs.

Background/purpose The purpose of this study was to clarify the role of pulmonary metastasectomy in hepatoblastomas with lung metastasis at diagnosis. We reviewed cases enrolled in the JPLT-2 study. Methods A total of 360 cases with hepatoblastoma were enrolled. The clinical courses and outcome of 60 cases with pulmonary metastasis at diagnosis were reviewed, focusing on metastasectomy. Results Induction chemotherapy resulted in eradication of nodules in 26, residual nodules in 33, and early treatment-related death in one. Of the 33 cases with residual nodules, 11 underwent complete resection of the lung lesions, and among these, progression was reported in five. Complete resection of the liver tumor was not achieved in two of these. Three underwent incomplete resection of lung nodules, eventually leading to progression. Twelve cases with incomplete or no liver tumor resection progressed regardless of the status of lung lesions. Contrarily, among patients who underwent complete resection of the liver tumor, half were cured without metastasectomy. Conclusions Metastasectomy for residual pulmonary nodules after induction chemotherapy is effective provided that the liver tumor could be completely resected. Type of study Prospective Cohort Study. Level of evidence Level II.

Ce-doped yttrium aluminum garnet (YAG:Ce) has been used as a phosphor emitting white light using a blue-light-emitting diode as a light source. Recently, studies on laser lighting as next-generation lighting have been carried out. However, because a high-power blue laser diode is used as the light source, the decrease in phosphor emission due to temperature increase (thermal quenching) has become a serious issue. Therefore, it is desirable to develop a method to suppress the temperature increase of the YAG:Ce phosphor. To increase the thermal conductivity of the YAG:Ce phosphor and suppress the temperature increase, we fabricated a composite ceramic of AlN (nonoxide), which has a high thermal conductivity, and YAG:Ce (oxide) using a modified vapor transport equilibration technique. The oxynitride was not completely removed, but we succeeded in adding up to 80 wt% AlN to YAG:Ce. The ceramic with 50% added AlN had a thermal conductivity up to 19.2 W m−1K−1 and emitted almost the same intensity as that of the nondoped YAG:Ce. This thermal conductivity exceeds the reported values of 12–13 W m−1K−1 for Al2O3–YAG:Ce composite ceramics. Moreover, the luminous efficacy exhibited by the ceramic with a 20 wt% AlN addition was 266.0 lmW−1, which is larger than the reported values obtained from composite ceramics.

Proton beam therapy (PBT) is a potential new alternative to treatment with photon radiotherapy that may reduce the risk of late toxicity and secondary cancer, especially for pediatric tumors. The goal of this study was to evaluate the long‐term benefits of PBT in cancer survivors. A retrospective observational study of pediatric patients who received PBT was performed at four institutions in Japan. Of 343 patients, 62 were followed up for 5 or more years. These patients included 40 males and 22 females, and had a median age of 10 years (range: 0–19 years) at the time of treatment. The irradiation dose ranged from 10.8 to 81.2 GyE (median: 50.4 GyE). The median follow‐up period was 8.1 years (5.0–31.2 years). The 5‐, 10‐ and 20‐year rates for grade 2 or higher late toxicities were 18%, 35% and 45%, respectively, and those for grade 3 or higher late toxicities were 6%, 17% and 17% respectively. Univariate analysis showed that the irradiated site (head and neck, brain) was significantly associated with late toxicities. No malignant secondary tumors occurred within the irradiated field. The 10‐ and 20‐year cumulative rates for all secondary tumors, malignant secondary tumors, and malignant nonhematologic secondary tumors were 8% and 16%, 5% and 13%, and 3% and 11%, respectively. Our data indicate that PBT has the potential to reduce the risk of late mortality and secondary malignancy. Longer follow‐up is needed to confirm the benefits of PBT for pediatric tumors.

In Japan, epidemiological transition has profoundly influenced the priorities of child healthcare. As pediatric care is shifting from a disease-driven curative approach to an integrated approach, the value of child health care now needs to be redefined with an integrated scope. With the trend to emphasize a rational judgement on the social value in terms of resource allocation and health policy, a value-based approach is necessary for child health care. This study aims to provide an overview and perspective of value-based policy making in child health care, under a context of epidemiological transition, health care system and social changes. The current methodology scheme of CEA and outcome evaluation has limitations, not meeting the urgent need of the application. The outcomes of child health care are no longer limited in clinical and health indicators such as survival rate, cure rate and health related quality of life, but also various aspects other than health, such as education, well-being of children and their primary caregivers, especially when treatment of diseases is no longer the dominant role of health care. Such the evaluation should reflect the impacts of the integrated approach in a long-term scope.

Treatment strategy for trilateral retinoblastoma (TRb: very rare RB with brain tumor) or retinoblastoma with central nervous system (CNS) involvement is not established yet. We retrospectively reviewed our seven cases of these rare almost fatal tumors. Their ages at diagnosis are 0y3m-1y10m (median 1y3m) (Male 4, Female 3). Only one had RB family history. Their affected eyes were bilateral 3, unilateral 3 and no 1. Their CNS involvements were suprasellar tumor 4, pineal tumor 1 and cerebrospinal fluid (CSF) cytology positive 2. Three of the suprasellar tumor patients had spinal metastasis. Four of the seven patients were TRb and one were genetically classified suprasellar retinoblastoma. All of them were treated with chemotherapy and four received high-dose chemotherapy. Three brain tumors of four TRb almost disappeared with chemotherapy. Two of them also received radiotherapy but relapsed. Although one radiation-free long-term TRb survivor developed secondary osteosarcoma, he got remission again and live 5 more years. One CSF positive Rb patient with chiasm invasion died of disease 11 months later. The other patient had no chiasm invasion nor CSF involvement at diagnosis, but his CSF cytology turned to positive after his second cycle of chemotherapy. He got remission with radiotherapy and high-dose chemotherapy, and alive without disease for 4 years. 2-year RFS and 2-year OS of all patients were 40% and 60%. Although our TRb patients responded to chemotherapy, it was difficult to avoid radiotherapy except one. Data accumulation is necessary for better treatment of these cancer-predisposed patients.

CASE A 18-month-old boy presented with approximately 2 months history of progressive left hemiparesis and left exotropia. MRI study showed a 3–4 cm T1-iso, T2-high tumor at right thalamus to midbrain with little contrast enhancement. The patient underwent endoscopic biopsy of the tumor, which showed relatively dense proliferation of small cells with round nuclei, mitosis of the tumor cell, but no necrosis. Immunohistochemical showed positive stain of GFAP and Olig2. Ki-67 was 34%. The histopathological diagnosis was compatible with high grade glioma. Chemotherapy with vincristine, cyclophosphamide, cisplatin and etoposide was initiated. Molecular testing of the tumor revealed H3F3A K27M and BRAF V600E double mutations in DNA from frozen tumor tissue. DISCUSSION The concurrent mutation of H3F3A K27M and BRAF V600E in pediatric glioma is very rare, but there are several cases previously reported in literature. Interestingly those cases are heterogenous in age, location, histopathological subtypes and clinical outcome.

Recent progress in the treatment for pediatric malignancies using a combination of surgery, chemotherapy, and radiotherapy has improved survival. However, late toxicities of radiotherapy are a concern in long‐term survivors. A recent study suggested reduced secondary cancer and other late toxicities after proton beam therapy (PBT) due to dosimetric advantages. In this study, we evaluated the safety and efficacy of PBT for pediatric patients treated in Japan. A retrospective observational study in pediatric patients who received PBT was performed. All patients aged

The purpose of this study is to determine the recommended dose (RD) of proton beam therapy (PBT) for inoperable stage III non-small cell lung cancer (NSCLC). We tested two prescribed doses of PBT: 66 Gy (relative biological effectiveness [RBE]) in 33 fractions and 74 Gy (RBE) in 37 fractions in arms 1 and 2, respectively. The planning target volume (PTV) included the primary tumor and metastatic lymph nodes with adequate margins. Concurrent chemotherapy included intravenous cisplatin (60 mg/m(2) , day 1) and oral S-1 (80, 100 or 120 mg based on body surface area, days 1-14), repeated as four cycles every 4 weeks. Dose-limiting toxicity (DLT) was defined as grade 3 or severe toxicities related to PBT during days 1-90. Each dose level was performed in three patients, and then escalated to the next level if no DLT occurred. When one patient developed a DLT, three additional patients were enrolled. Overall, nine patients (five men, four women; median age, 72 years) were enrolled, including six in arm 1 and three in arm 2. The median follow-up time was 43 months, and the median progression-free survival was 15 months. In arm 1, grade 3 infection occurred in one of six patients, but no other DLT was reported. Similarly, no DLT occurred in arm 2. However, one patient in arm 2 developed grade 3 esophageal fistula at 9 months after the initiation of PBT. Therefore, we determined that 66 Gy (RBE) is the RD from a clinical viewpoints. (Clinical trial registration no. UMIN000005585).

Although the survival rate of intraocular retinoblastoma (RB) is nearly 100%, the outcome of central nervous system (CNS) involvement or Trilateral retinoblastoma (TRb: very rare RB which associated with brain tumor) is dismal. We retrospectively reviewed our six cases of these rare tumors. Their ages at diagnosis are 0y3m-1y10m (median 1y3m) (Male 4, Female 2). Only one had RB family history. Their affected eyes were bilateral 2, unilateral 3 and no 1. Their CNS diseases were suprasellar tumor 3, pineal tumor 1 and cerebrospinal fluid (CSF) cytology positive 2. Two of the suprasellar tumor patients had spinal metastasis. Three of the six patients were TRb. One TRb patient was treated with chemotherapy and high-dose chemotherapy without radiotherapy. Although he suffered with secondary osteosarcoma seven years later, he got complete remission and alive 5 years more without any tumor recurrence. The second TRb patient was treated with chemotherapy and local radiotherapy but relapsed 20 months later. The third TRb patient was chemotherapy resistant. Two CSF positive patients had optic nerve invasion. One patient with chiasm invasion died 11 months later because of treatment resistance. The other patient with optic nerve invasion before optic canal had no CNS tumor nor CSF involvement at diagnosis. Chemotherapy before enucleation was given to avoid dissemination. However, CSF cytology became positive after enucleation and remained even with intensified chemotherapy. Finally, he got remission with radiotherapy and high-dose chemotherapy, and alive without disease for 3.8 years. The last patient had suprasellar genetically classified retinoblastoma tumor and cerebrospinal metastasis. This patient showed good chemotherapy response and is still under treatment. Even with &quotso called° fatal RB cases, some case could survive with intensified therapy. Data accumulation is necessary for better survival of these tumors.

The lateral electron‐photon technique (LEPT) and intensity‐modulated radiation therapy (IMRT) are commonly used for total scalp irradiation. However, the treatment planning and irradiation are laborious and time‐consuming. We herein present the multijaw‐size concave arc technique (MCAT) as a total scalp irradiation method that overcomes these problems. CT datasets for eight patients previously treated for angiosarcoma of the scalp were replanned using MCAT, LEPT, and IMRT. The MCAT was designed with a dynamic conformal arc for the total scalp, with a multileaf collimator to shield the brain. Two additional conformal arcs with a decreased upper‐jaw position of the first dynamic conformal arc were used to reduce the cranial hotspots. The prescribed dose was 40 Gy (2 Gy/fraction) to 95% of the planning target volume (PTV, defined as the total scalp plus a 4 mm margin). MCAT was compared with LEPT and IMRT with respect to the PTV dose homogeneity (D5%–95%), underdosage (V < 90%), overdosage (V > 110%), doses to the brain, and the delivery time and monitor units (MUs) for single irradiation. We were able to formulate treatment plans for all three techniques that could deliver the prescription dose in all patients. MCAT was significantly superior to LEPT with respect to PTV dose homogeneity, overdosage, and underdosage, although MCAT was inferior to IMRT with respect to dose homogeneity and overdosage. The mean brain dose and high‐dosage volume of all three techniques were low, but IMRT provided larger volume to the brain than did the other two techniques in the low dosage region. In MCAT, the mean delivery time could be reduced by approximately half or more, and the mean MUs could be reduced by at least 100 compared to the other two techniques. MCAT can achieve total scalp irradiation with substantially fewer MUs and a shorter delivery time than LEPT and IMRT. PACS number: 87.55.D‐

We investigated the relative biological effectiveness (RBE) of therapeutic proton beams at six proton facilities in Japan with respect to cell lethality of HSG cells. The RBE of treatments could be determined from experimental data. For this purpose, we used a cell survival assay to compare the cell-killing efficiency of proton beams. Among the five linear accelerator (LINAC) X-ray machines at 4 or 6 MeV that were used as reference beams, there was only a small variation (coefficient of variation CV = 3.1% at D10) in biological effectiveness. The averaged value of D10 for the proton beams at the middle position of the spread-out Bragg peak (SOBP) was 4.98. These values showed good agreement, with a CV of 4.3% among the facilities. Thus, the average RBE10 (RBE at the D10 level) at the middle position of the SOBP beam for six facilities in Japan was 1.05 with a CV of 2.8%.

Background: The aim of this study is to evaluate the cost-effectiveness of proton beam therapy with cochlear dose reduction compared with conventional X-ray radiotherapy for medulloblastoma in childhood. Methods: We developed a Markov model to describe health states of 6-year-old children with medulloblastoma after treatment with proton or X-ray radiotherapy. The risks of hearing loss were calculated on cochlear dose for each treatment. Three types of health-related quality of life (HRQOL) of EQ-5D, HUI3 and SF-6D were used for estimation of quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for proton beam therapy compared with X-ray radiotherapy was calculated for each HRQOL. Sensitivity analyses were performed to model uncertainty in these parameters. Results: The ICER for EQ-5D, HUI3 and SF-6D were $21 716/QALY, $11 773/QALY, and $20 150/QALY, respectively. One-way sensitivity analyses found that the results were sensitive to discount rate, the risk of hearing loss after proton therapy, and costs of proton irradiation. Cost-effectiveness acceptability curve analysis revealed a 99% probability of proton therapy being cost effective at a societal willingness-to-pay value. Conclusions: Proton beam therapy with cochlear dose reduction improves health outcomes at a cost that is within the acceptable cost-effectiveness range from the payer's standpoint.

Periodic checks for proton machine quality assurance (QA) are significant for machine users safely and accurately to provide proton-beam treatment for cancer. Our aim in this study was to describe a revision to proton machine QA procedures for wobbled-proton-beam therapy at the Shizuoka Cancer Center (SCC) in Japan. The previous daily, monthly, and annual QA procedures were determined by reference to our past operational experience and to QA papers for medical accelerators. The revised QA procedures were initiated in May 2011 after preliminary measurements to decide baselines for the QA procedures. This paper presents the proton machine QA procedures and the results of representative QA measurements. Three action levels were decided on by reference to the American Association of Physicists in Medicine Task Group 142 report. Tolerances of inspection action were decided on based on the provisional operational results and actual fluctuations of the QA measurement for a year, and those of scheduled action and stop-treatment action were determined by reference to the machine QA papers and those of the inspection action. No deviation from the tolerance of the scheduled action has been observed so far. Although a few QA procedures exceeded the tolerance of the inspection action, these excesses were resolved by inspection and improvement of the respective measuring procedure within the designated QA time. Hereafter, the proton machine QA procedures proposed in this study will be performed continuously at the SCC to assure patient safety and accurate operation of proton therapy.

METHODS: Twenty-six patients with diffuse intrinsic pontine glioma (DIPG) were retrospectively analyzed at National Center for Child Health and Development, one of the largest pediatric brain tumor centers in Japan. The following information was collected from the electric medical record: clinical characteristics, surgery / pathology reports, treatments and outcomes. RESULTS: Between June, 2002 and April, 2016, 26 patients were diagnosed as DIPG and treated. Median age was 6 years (2–12). There were 19 boys and 7 girls. Common presenting symptoms included, cranial nerve palsies, ataxia, long-tract signs, vomiting, and altered consciousness. 20 patients (77%) were diagnosed within 40 days from symptom onset. 13 patients (50%) underwent biopsy. Patients who underwent biopsy tend to have atypical imaging and clinical features. Interval from diagnosis to radiation therapy was significantly longer in biopsy group than non-biopsy group (29 days and 8 days respectively, p=0.04). Histopathlogy diagnoses were: glioblastoma 4, anaplastic astrocytoma 5 and other glioma 4. H3 K27M mutations were detected in 5 patients among 8 patients tested (63%). CMV protein was not detected in all 4 patients tested. All but one patient underwent focal radiation therapy (RT) of 54Gy/30 fractions and one patient presented with dissemination underwent craniospinal RT. Fourteen patients (54%) did not receive any chemotherapy as an upfront treatment. Seven patients (27%) received temozolomide (TMZ)-based chemotherapy and the rest (19%) received other chemotherapy regimen. Mean overall survival (OS) of all 26 patients was 313 days. Mean progression-free survival (PFS) was 201 days. Biopsy, TMZ, any chemotherapy or H3 K27M mutation was not associated with survival outcomes. CONCLUSIONS: DIPG continues to be an incurable disease. Biopsy in DIPG is safe and feasible. H3 K27M mutation is a frequent event in DIPG. Chemotherapy is not a standard upfront treatment for DIPG.

Atypical teratoid rhabdoid tumors (AT/RTs) are highly aggressive embryonal CNS tumors. Up to one-third of AT/RTs are reported to have germline mutation and/or deletion of SMARCB1/hSNF5. In accordance with the increased understanding for pediatric cancer predisposition syndrome, the needs for genetic counseling and testing is expanding. And next generation suquencing technique is inevitable for these genotyping. So we start to prepare genetic testing system of AT/RT for future pediatric cancer predisposition program. Proior to the genetic testing, pretest counseling is performed for each patient/family. Informed consent was obtained according to the institutional ethical review board. Genomic DNA was isolated from the patient’s periphera blood, and somatic DNA was extracted from frozen tissues or FFPE samples. Genetic analysis of the SMARCB1 coding sequence was performed by Sanger method. Deletion of SMARCB1 is examined by quantitative analysis of each exon with droplet digital PCR (ddPCR). SNP array analysis is also tried if frozen sample is available. Three AT/RT patients and one rhabdoid tumor patient received genetic testing. None of them had germline mutation. In an infant ATRT, Sanger sequence analysis revealed frameshift mutation (c649-650delAT). Also, ddPCR showed uniparenteral heterodisomy (UPD). In another AT/RTs, copy number decrease and UPD over whole region of SMARCB1, or exon 3 deletion are recognized respectively. Rhabdoid tumor case had nonsense mutation (c610C>T). Although most of AT/RT should have biallelic mutation, false negative could happen due to less tumor cells obtained in those samples. Enlightenment for sampling and accumulation for testing would be important.

The prognosis of diffuse intrinsic pontine glioma (DIPG) remains dismal. The only effective treatment is radiation therapy so far. Nevertheless, the therapeutic effect of radiation therapy doesn’t last for long and almost all the patients experience relapse after several months. Recently, re-irradiation for relapsed DIPG was attempted and showed some benefit for those patients. We retrospective reviewed the efficacy and safety of re-irradiation therapy for five DIPG cases from April 2013 to December 2017. Five patients include three boys and two girls, their mean age was 7.2 years old (4–12). One case only did biopsy for diagnosis, others diagnosed clinically. One case underwent ventricular Ommaya reservoir insertion due to hydrocephalus. Radiation doses were from 19.8Gy to 50.4Gy(1.8–3.0Gy/Fr). The median duration between diagnosis and recurrence was 7.5 months (4–10 months), and the mean survival after the re-irradiation was 6.3 months (two of them still surviving). All five patients completed the treatment without acute toxicity, and four out of five patients demonstrated some improvement of their symptoms which occurred at the recurrence. It has been suggested that re-irradiation might be an effective and safe treatment for selected patients with recurrent DIPG.

To evaluate dose-volume histogram (DVH) parameters as predictors of radiation pneumonitis (RP) in esophageal cancer patients treated with definitive concurrent chemoradiotherapy.Thirty-seven esophageal cancer patients treated with radiotherapy with concomitant chemotherapy consisting of 5-fluorouracil and cisplatin were reviewed. Radiotherapy was delivered at 2 Gy per fraction to a total of 60 Gy. For most of the patients, two weeks of interruption was scheduled after 30 Gy. The percentage of lung volume receiving more than 5-50 Gy in increments of 5 Gy (V5-V50, respectively), and the mean lung dose (MLD) were analyzed.Ten (27%) patients developed RP of grade 2; 2 (5%), grade 3; 0 (0%), grade 4; and 1 (3%), grade 5. By univariate analysis, all DVH parameters (i.e., V5-V50 and MLD) were significantly associated with grade 2 RP (p0.01). The incidences of grade 2 RP were 13%, 33%, and 78% in patients with V20s of 24%, 25-36%, and 37%, respectively. The optimal V20 threshold to predict symptomatic RP was 30.5% according to the receiver operating characteristics curve analysis.DVH parameters were predictors of symptomatic RP and should be considered in the evaluation of treatment planning for esophageal cancer.

Rectal volume variation has a crucial effect on prostate localization during external beam radiotherapy for prostate cancer. This study investigated the effect of rectal volume reduction by a rectum-emptying tube (RET) on prostate immobilization.The study group comprised 21 patients who underwent proton beam treatment for prostate cancer. Sigmoid-shaped flexible plastic RETs were used to drain gases from the rectum. Computed tomography (CT) was performed before and after RET placement at the treatment planning stage and at the beginning of treatment. Prostate displacement and changes in rectal volume were measured on the CT images. The feasibility of RET placement was evaluated during and after the procedure.All 21 patients tolerated the procedure. The rectal volume was significantly lower with a RET than without a RET. The differences in rectal volume between the treatment planning stage and the beginning of treatment were significantly lower with a RET than without. RET placement significantly decreased prostate displacement in the anteroposterior and superoinferior directions but not in the left-right direction.RET placement reduced both rectal volume and variation in rectal volume. The procedure reduced displacement of the prostate. RET placement thus appears to be an effective technique for immobilizing the prostate.

By an IBAD/PLD method, a 500 m-length high-performance GdBa2Cu3Ox (GdBCO) coated conductor with BaZrO3 (BZO) was fabricated. End-to-end Ic of the 503.5 m tape was 349.6 A/cm at 77 K, corresponding Ic times L value of 176,023 Am. New approaches to decrease the thickness of IBAD buffer layers were developed by combination of IBAD-MgO(111) and IBAD-Gd2Zr2O7 (GZO). The maximum Jc of the GdBCO on the buffer layer was 550 A/cm. We also started to investigate IBAD-MgO(OOl) by using a large IBAD system with a 110 cm times 15 cm ion source. A 50 m-length IBAD-MgO tape with DeltaPhi of 13deg was fabricated at a 100 m/h-1 pass. Insulated REBCO wires with Cu or Ni-Cr lamination were developed using 5 mm-wide conductors sliced from 10 mm-wide IBAD/PLD tapes. Practical long insulated wires were supplied for several prototypes of motors, transformers and fault current limiters in fiscal 2007.

Pinning effect induced by a grainlike structure on top of a TbFeCo recording layer with an Al or Ag underlayer is investigated. We confirm that the pinning effect depends on the surface structure of the recording layer as well as the underlayer. The Al-underlayered TbFeCo medium shows higher recording density during thermally assisted magnetic recording and higher coercivity than those of the Ag-underlayered one. We can observe that only the Al-underlayered TbFeCo medium has the grainlike structure on top of the TbFeCo recording layer, which reflects well a grainlike structure on the Al underlayer's surface. It indicates that the surface profile of not only the underlayer but also the TbFeCo recording layer laminated onto the underlayer is necessary for inducing the strong pinning effect in the TbFeCo magnetic recording media.

We have developed a long Y-123 coated conductors by ion-beam-assisted deposition (IBAD) and pulsed-laser-deposition (PLD) method. Now, we can routinely obtained 100 m class Y-123 tapes with over 100 A at 77 K. For power applications using Y-123 conductors, coiling and cooling techniques are important elements. From 2004, we have developed and demonstrated a solenoid type coil that is the most suitable for practical application because it has advantage such as (1) uniformity of magnetic field (2) no joint. In this paper, we describe the development of conduction-cooled HTS test coil that has 14 turn × 22 layers using 100 m Y-123 conductors. In order to use the conduction cooling system, the Y-123 conductors were stabilized for 0.1 mm thick Cu tapes and spacers between the layers consisted of aluminum nitride in the coils. In the demonstration of this coil at 30 K, 40 K, 50 K, 60 K and 77 K by cryo-cooling system, the good cooling and superconducting performances were observed. The central magnetic fields of over 1 T were successfully obtained with operating currents of over 400 A and under 40 K. Furthermore, this coil was operated on additional magnetic fields of 3 T by combination of LTS magnets. The central magnetic fields of 0.5 T were generated from the cooled HTS coils with operating current of 190 A on additional magnetic fields of 3 T by LTS magnets at 30 K. Total magnetic fields were exceeded 3.5 T at 30 K.

High quality YBa 2 Cu 3 O 7− δ coated conductors with a length of several hundred meters are available now. For practical applications of long tapes, non-destructive and efficient techniques for characterization are necessary. For that purpose, we installed a commercial machine. The measuring principle is that a tape is introduced into a space of an applied magnetic field and the induced current within the superconducting tape is evaluated by measuring the magnetic field distribution just above the tape surface using a Hall sensor array. The advantages of the technique are that the measurement speed is rather high, 15 mm/s at maximum, and tapes are absolutely safe from damages by excessive heating. On the other hand, the estimation of the critical current is not straightforward because the issue of the calibration is not trivial. A 2D computer simulation code was developed to calculate the distribution of the induced current within the tape. In the simulation, it was assumed that the current–voltage relation of the superconductor obeys a power law. It is shown that the critical current deduced from the measurement is strongly dependent on the n -value.

We have succeeded in patterning narrow lines and dots with 100 nm dimensions in a photoresist film by a ‘thermal lithography’ technique using a semiconductor laser with 635 nm wavelength. The demonstrated resolution of the patterns produced is far beyond the diffraction limit of 530 nm given by our optical set-up. We utilized a focused laser spot, which approximately has a Gaussian profile in its light intensity distribution, to produce a spatially confined hot area in a phase change recording layer on a conventional polycarbonate optical disk. This hot area induced a thermal cross-linking reaction in an adjacent photoresist film. By optimizing the sample rotation speed and the laser power, we were able to confine the area where the thermal cross-linking reaction in the photoresist occurred and patterned extremely fine structures.

We attempted to increase the signal intensity of small pits the sizes of which were smaller than the optical diffraction limit in read-only memory (ROM) disks. For this purpose we employed a granular film and a thermochromic film in this study. The reason for using these films was to apply the super-resolution near-field structure (super-RENS) model, which suggests that the signal intensity of very small marks is increased by metal nanoparticles or a small aperture in the disk, to super-ROM. We investigated the effect of adjoining these films to a reflective layer on readout signals. It was found that the signal intensity of very small pits was increased by both of these films, but the mechanisms of increase were different.

Background The significance of definitive radiotherapy for sinonasal mucosal melanoma (SMM) is sill controvertial. This study was to evaluate the role of high-dose proton beam therapy (PBT) in patients with SMM. Methods The cases of 20 patients with SMM localized to the primary site who were treated by PBT between 2006 and 2012 were retrospectively analyzed. The patterns of overall survival and morbidity were assessed. Results The median follow-up time was 35 months (range, 6–77 months). The 5-year overall and disease-free survival rates were 51% and 38%, respectively. Four patients showed local failure, 2 showed regrowth of the primary tumor, and 2 showed new sinonasal tumors beyond the primary site. The 5-year local control rate after PBT was 62%. Nodal and distant failure was seen in 7 patients. Three grade 4 late toxicities were observed in tumor-involved optic nerve. Conclusion Our findings suggested that high-dose PBT is an effective local treatment that is less invasive than surgery but with comparable outcomes.

Primary cancer of the trachea is rare and accounts for only 0.1-0.4% of all newly diagnosed respiratory tract cancers, worldwide. In the present study, a case of primary tracheal malignant melanoma, a particularly rare type of cancer, is reported. A 68-year-old male presented with a cough and bloody sputum. A chest computed tomography scan revealed a 25×20×15-mm tracheal tumor, located immediately above the carina, which reduced the cross-sectional area of the trachea by ~90%. Histopathological analysis of biopsy specimens determined a diagnosis of malignant melanoma. The patient was treated with argon plasma coagulation and chemoradiotherapy, which restored airway patency, however, metastasis was detected in the lungs. The patient refused further treatment and received palliative care. Subsequently, the patient succumbed to the disease within four months. Thus, although primary malignant melanoma of the trachea is extremeley rare, the possibility should be considered during diagnosis.

Super-resolution readout was established by using a non-magnetic readout layer on a magneto-optical disk. The readout layer was composed of AgOx and separated from a recording layer at a near-field coupling distance as well as a super-resolution near-field structure (Super-RENS) disk. A laser-generated Ag cluster works as a scattering center in the readout layer to reproduce a Kerr rotation angle of a recorded mark. As a result, by using the AgOx readout layer, marks of about 200-nm size could be read out beyond the diffraction limit

As a result of applying super-resolution near-field structure to a magneto-optical disk with a non-magnetic mask layer such as a silver oxide light scattering center type mask layer, we could retrieve the signals of below 200-nm mark length. With the improved antimony transparent aperture type mask layer, in this work, we could get the polarized magneto-optical signals as well that we had not been able to obtain by using the previous antimony mask layer. This was well agreed with computer simulation result. Another optimization, such as magnetic layer thickness, dielectric materials and so on, was also investigated for a better magneto-optical disk of super-resolution near-field structure with a silver oxide light scattering center type mask layer.

The current study focused on the tea plant (Camellia sinensis) as a target for artificial cultivation because of the variation in its components in response to light conditions. We analyzed its sensory quality by multi-marker profiling using multicomponent data based on metabolomics to optimize the conditions of light and the environment during cultivation. From the analysis of high-quality tea samples ranked in a tea contest, the ranking predictive model was created by the partial least squares (PLS) regression analysis to examine the correlation between the amino-acid content (X variables) and the ranking in the tea contest (Y variables). The predictive model revealed that glutamine, arginine, and theanine were the predominant amino acids present in high-ranking teas. Based on this result, we established a cover-culture condition (i.e., a low-light intensity condition) during the later stage of the culture process and obtained artificially cultured tea samples, which were predicted to be high-quality teas. The aim of the current study was to optimize the light conditions for the cultivation of tea plants by performing data analysis of their sensory qualities through multi-marker profiling in order to facilitate the development of high-quality teas by plant factories.

A technique for reducing cross-recording on data storage media with high track density is described. In order to detect cross-recording sensitively, an inverted mark pattern was first recorded on adjacent tracks and then synchronized with a normal recorded mark pattern on the central track. These patterns were repeatedly recorded as the recording power was increased. Readout signals of the recorded mark pattern were evaluated on the central track in each condition, and an optimum recording power was precisely determined from the maximum amplitude of the signals. When this new technique was applied to a magneto-optical disk, the bit error rate was reduced to less than 10/sup -4/. This is the first technique to reduce cross-recording by laser power only.

For practical applications of high-temperature superconductor tape, the high production rate of tapes is needed to reduce its cost. Recently, the long-length coated conductor with high performance has been fabricated by an ion beam assisted deposition/pulsed laser deposition (IBAD/PLD) method in Fujikura. In IBAD process, we adopted IBAD–Gd2Zr2O7 (GZO) film. The process speed of IBAD–GZO film was increased up to 5 m/h using a polished metal substrate tape. To fabricate biaxially-textured buffer layers at a higher rate, we have started to develop another structures such as (a) IBAD–GZO/IBAD–MgO (3-fold symmetry) and (b) IBAD–MgO (4-fold symmetry). In the case (a), we fabricated GdBCO/CeO2/IBAD–GZO/IBAD–MgO tape and the critical current was Ic = 550 A/cm (2.46 MA/cm2) and throughput of IBAD processes were 20 m/h. In the case (b), IBAD–MgO short samples with ΔΦ of 9°–11° were obtained at 500 m/h. The 500 m/h (10 mm width) is extremely high rate in IBAD process in the world. As long-length IBAD layer 10 m, 50 m and 100 m IBAD–MgO films were fabricated at the speed of 100 m/h. After CeO2 deposition, in-plane textures of these samples were ΔΦ of 3.7°–3.7°, 4.1°–4.9° and 4.2°–4.8°. Using some of these buffer layers, we have obtained GdBCO film with Ic = 400 A/cm (2 MA/cm2, 10 m) and Ic = 550 A/cm (2.7 MA/cm2, short sample).

Although tumor clearance is a common criterion in assessing the impact of radiotherapy (RT), it is not always reliable. Patterns of tumor clearance were determined using 91 metastatic lymph nodes (LNs) from 51 patients with head and neck tumors treated by definitive RT (61-80 Gy) or preoperative RT (43-65 Gy). Clearance rate (CR) was estimated as a daily volume decrement expressed as a ratio to the pre-RT LN volume. CR was greater for the so-called radioresponsive nasopharyngeal subgroups and more poorly differentiated than those of oral cavity and well-differentiated, respectively. Histologically, LNs that were removed following RT consisted mainly of fibrous tissues, necrotic tissues, and few cancer cells. There was no difference in CR between the cancer-cell-positive group (n = 21) and the cancer-cell-negative group (n = 31). Although the CR may reflect inherent radiosensitivity of tumor cells, tumor persistence predicts the amount of oncologically inactive materials rather than that of remaining cancer cells.

We have obtained the good superconducting performance in Y-123 tapes made by Ion-Beam-Assisted Deposition (IBAD) and Pulsed Laser Deposition (PLD) method. In this paper, we describe recent progresses of long Y-123 conductor by IBAD/PLD process using reel to reel systems. Ic of 88 A was obtained in end to end of a 217 m long one. Furthermore, we developed the conduction cooled HTS test solenoid coil using 100 m-Y123 conductors. The results of coil operating tests are described.

Patterns of radiologic response of 10 thymomas treated by preoperative radiotherapy (RT) (18-20 Gy/2 weeks) were determined in conjunction with histologic response. Changes in tumor volume were evaluated with CT scans obtained 5 to 36 days before and 14 to 24 days after the initiation of RT and before surgery. The extent of tumor volume reduction (TR) varied widely (40-78%), while the mean daily volume decrement expressed as a percentage of the pre-RT tumor volume correlated significantly with the pre-RT tumor volume. Histologically, the tumors, all of which were resected 17 to 33 days after RT initiation, generally consisted of predominant fibrous tissues, rare necrotic foci, and few epithelial cells. The TR did not correlate with pre-RT tumor volume, observation period, histologic subtype, or quantity of remaining epithelial cells. The TR of thymomas does not predict RT impact on tumor cells but does reflect the quantity of inherent tumor stroma.

Purpose : To determine the capacity of biological clearance in tumor regression following radiotherapy by using metastatic brain tumors as a clinical model in which mechanical clearance is negligible. Methods and Materials : Thirty-eight tumors (19 nonsmall cell lung cancer, 11 small cell lung cancer, and 8 nonlung cancer) in 23 patients were followed with computed tomography (CT) scans over 3 months or more following initiation of radiotherapy, with doses ranging between 34 and 66 Gy. The tumor regression rate (RR ; mm 3 /day), which represented the capacity of biological clearance, was calculated for each CT observation period. The complete response (CR) rate was calculated. The relationship between RR and tumor diameter was determined with regression analysis in conjunction with the pattern of contrast enhancement and the type of primary disease. The change of the RR also was examined. Results : The CR rate was 60.5% for the total group ; it was lower for ring-enhanced tumors (41.7%) than diffusely enhanced tumors (69.2%), which included mostly small cell lung cancer metastases. The RR correlated significantly with the tumor diameter (D), with a regression curve of exponential function (RR = 0.035 *D 2.5 ). The RR varied widely and was rather large until 40 days following initiation of radiotherapy, especially for the subgroups of diffusely enhanced tumors and the small cell lung cancer tumors, and became rather constant thereafter. Conclusion : A tumor diameter exponent in the regression curve of smaller than 3.0 indicates that the larger the tumor volume is, the smaller the capacity of biological clearance. The capacity of biological clearance also is dependent on vascularity and cellularity of the tumor components expressed by the pattern of contrast enhancement.

Chronic necrotizing pulmonary aspergillosis (CNPA), also called semi-invasive pulmonary aspergillosis, was first described in the early 1980s as a distinct type of pulmonary aspergillosis. CNPA was an indolent, cavitary, infectious process of the lung parenchyma secondary to local invasion by Aspergillus species. Diagnosis is confirmed by pathological evidence of lung tissue invasion by the fungus. Clinical diagnosis by combined clinical, radiological and laboratory findings is needed because histopathological confirmation cannot always be obtained in the clinical setting. CNPA is recognized as a clinical syndrome in Japan, and has been poorly defined histologically. We report three autopsy cases of CNPA evaluated histopathologically. Subjects were middle-aged to older men with a medical history of pulmonary mycobacterial infection who presented with pulmonary or systemic symptoms. Radiologically, progressive upper lobe cavitary infiltrates were seen with mycetomas and infiltration in lower lung fields. Clinically, CNPA was diagnosed based on 2007 Japanese guidelines for the diagnosis and treatment of deep fungal infection. Subjects died of respiratory failure within one month to three years of diagnosis despite antifungal therapy including micafungin, voriconazole, or itraconazole combined with broad spectrum antibiotics. Autopsy findings showed cavities containing the fungus but no fungal invasion of viable lung tissue. The area of progressive infiltration revealed bacterial pneumonia, organizing pneumonia or organizing diffuse alveolar damage without Aspergillus. In conclusion, CNPA is a chronic progressive clinical form of pulmonary aspergillosis with significant morbidity and mortality.

The authors have developed the disc format for land/groove recording on a magneto-optical disc in which only a single side of the groove is wobbled. The format is suited for a rewritable digital video disc system. >

Bit-by-bit detection at a recording density of 0.11 µm pits is achieved on a super-resolution near-field structure (super-RENS) disk with a platinum oxide layer. Pits and spaces are arranged as a recording pattern for pit position recording. The pattern is recorded on the disk with using a 635-nm-wavelength laser and an objective lens with a 0.6 numerical aperture. After recording using laser pulses with pre- and post-heating, the pattern is correctly reproduced despite a size that is smaller than the resolution limit. Furthermore, the readout durability is more improved than that of the previous silver oxide disk. The pattern is clearly digitized by a read channel circuit for bit-by-bit detection.

We explored the general feasibility of proton beam therapy for chordoma and chondrosarcoma of the skull base. Clinical records and treatment-planning data of patients with the pathological diagnosis of chordoma or chondrosarcoma were examined. Proton beam therapy was administered for gross tumor mass as well as microscopic residual disease after surgery. The prescribed dose was determined to maximize the coverage of the target and to not exceed predefined constraints for the organs at risk. Eight cases of chordoma and eight cases of chondrosarcoma were enrolled. The median tumor volume was 40 cm(3) (range, 7 to 546 cm(3)). The prescribed dose ranged from 50 to 70 Gy (relative biological effectiveness [RBE]), with a median of 63 Gy RBE. The median follow-up duration was 42 months (range 9 to 80 months). The overall survival rate was 100%, and the local control rate at 3 years of chordoma and chondrosarcoma were 100% and 86%. None of the patients developed radiation-induced optic neuropathy, brain stem injury, or other severe toxicity. Proton beam therapy is generally feasible for both chordoma and chondrosarcoma of the skull base, with excellent local control and survival rates.

Intensity-modulated proton therapy (IMPT) is expected to improve treatment results with fewer side effects than other proton therapies. The purpose of this study was to evaluate the tumor sites for which IMPT was effective under the same beam calculation conditions by planning IMPT for typical cases treated with passive scattering proton therapy (PSPT). We selected 16 cases of nasal cavity, lung, liver or prostate cancers as typical tumor sites receiving PSPT. The dose distributions and dose volume histograms optimized by the IMPT were compared with those optimized by the PSPT. We took particular note of the doses to the skin and organs at risk (OAR) when PSPT was replaced by IMPT. Furthermore, an improvement of the beam angles was also performed to obtain better dose distributions in the IMPT. The IMPT with the same beam angles resulted in near-maximum doses to the skin of average 78%, 64%, 84% and 99% of the PSPT doses for nasal cavity, lung, liver, and prostate cancers, respectively. However, it was difficult to improve the dose homogeneity of the target volume. The change of the IMPT beam angles could reduce the doses to OARs and skin in the case of the nasal cavity, while it had limited effect in the other cases. We concluded that IMPT was effective for reducing the doses to some OARs when treating nasal cavity, lung, liver and prostate cancers. The selection of beam angles was important in the IMPT optimization, especially for nasal cavity cancers.

A proposal for a photonic transistor is made and some basic proving experiments are described. These experiments show that by focusing two laser beams (405 and 635 nm) in one small spot on a high-speed rotating optical disk, a large signal enhancement is observed. It was found that a plasmon interaction generated between a silver light-scattering center and recorded small marks in the optical disk with a super-resolution near-field structure produced the large signal amplification in the spot (