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Background The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR. Case presentation A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae. Conclusion Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient’s life.

The diagnosis of insulinoma in perinatal women can be difficult, as hypoglycemic symptoms may be masked by pregnancy‐associated insulin resistance. In addition, when multiple insulinomas are observed, it is necessary to consider the possibility not only of MEN1, but also of insulinomatosis.

Background Lenvatinib has been shown to be noninferior to sorafenib regarding prognosis and recurrence rate in patients with unresectable hepatocellular carcinoma (HCC) who have not received prior systemic chemotherapy. In patients treated with lenvatinib, 40% of cases achieved sufficient tumor reduction to make potential surgery possible. However, the outcomes of such surgery are unknown. We report a successful case of hepatic resection for recurrent HCC after lenvatinib treatment. Case summary A 69-year-old man underwent right anterior sectionectomy for HCC in segment 8 of the liver. Ten months later, he was found to have an intrahepatic HCC recurrence that grew rapidly to 10 cm in diameter with sternal bone metastases. After confirming partial response to lenvatinib administration for 2 mo, a second hepatectomy was performed. Pathological examination showed that 80% of the tumor was necrotic. The patient did not develop any adverse effects under lenvatinib treatment. He was discharged at 25 d after surgery. Radiation therapy for bone metastases continued to be given under lenvatinib, and the patient has remained alive for 1 year after the second hepatectomy. Conclusion The prognosis of patients with recurrent HCC may be improved by liver resection combined with prior lenvatinib therapy.

Few studies have focused on conversion surgery for biliary malignancy; thus, it is not clear if this treatment modality can extend the survival of patients with unresectable biliary malignancy. We conducted a multicenter retrospective cohort study to evaluate the surgical outcomes of conversion surgery in this setting and analyze long-term survival. We collected clinical data retrospectively on patients who underwent conversion surgery for biliary malignancy. Twenty-four patients met our inclusion criteria. Preoperative chemotherapy regimens or chemoradiation therapy regimens were administered based on the institutional criteria, and surgical procedures were chosen based on tumor location. Morbidity occurred in 16 patients (66.7%), and 1 patient died of liver failure after surgery. The overall 5-year survival rate following initial therapy was 43.2%, and the median survival time was 57.4 months. The corresponding values following surgery were 38.2% and 34.3 months, respectively. The 5-year survival rate of the 24 patients who received both chemotherapy and surgery was significantly better than that of 110 patients treated with chemotherapy only (p

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), BACKGROUND Carbon dioxide (CO2) is believed to be the safest gas for laparoscopic surgery, which is a standard procedure. We experienced severe cerebral infarction caused by paradoxical CO2 embolism during laparoscopic liver resection with injury of the hepatic vessels despite the absence of a right-to-left systemic shunt. CASE REPORT A 60-year-old man was diagnosed with hepatocellular carcinoma in the right hepatic lobe secondary to alcoholic liver disease. We planned the laparoscopy-assisted liver resection. During the surgery, the root of the right hepatic vein was injured. A 1.5-cm hole was accidentally made in the right hepatic vein, while mobilizing the right hepatic lobe laparoscopically. End-tidal CO2 dropped from 39 to 15.5 mmHg, and systemic blood pressure dropped from 121 to 45 mmHg, returning to normal with the administration of inotropes. The transesophageal echocardiography revealed numerous bubbles in the left atrium and ventricle. The Bispectral Index monitoring system showed low brain activity, suggesting cerebral infarction due to paradoxical gas embolism. The hepatectomy was completed by conversion to open laparotomy. The patient went into a coma and suffered quadriplegia after surgery, despite the cooling of his head and the administration of Thiamylal. Brain MRI revealed cerebral infarction in the broad area of the cerebral cortex right side predominantly, with poor blood flow confirmed by the brain perfusion single-photon emission CT. Rehabilitation was gradually achieved with Botox injections. CONCLUSIONS Cerebral infarction by paradoxical gas embolism is a rare complication in laparoscopic surgery, but it is important to be aware of the risk and to be prepared to treat it.

Background Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years. Case summary A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient's wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB. Conclusion The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.

Although adjuvant chemotherapy with gemcitabine is standard care for resected pancreatic cancer, S-1 has shown non-inferiority to gemcitabine for advanced disease. We aimed to investigate the non-inferiority of S-1 to gemcitabine as adjuvant chemotherapy for pancreatic cancer in terms of overall survival.We did a randomised, open-label, multicentre, non-inferiority phase 3 trial undertaken at 33 hospitals in Japan. Patients who had histologically proven invasive ductal carcinoma of the pancreas, pathologically documented stage I-III, and no local residual or microscopic residual tumour, and were aged 20 years or older were eligible. Patients with resected pancreatic cancer were randomly assigned (in a 1:1 ratio) to receive gemcitabine (1000 mg/m(2), intravenously administered on days 1, 8, and 15, every 4 weeks [one cycle], for up to six cycles) or S-1 (40 mg, 50 mg, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14 day rest, every 6 weeks [one cycle], for up to four cycles) at the data centre by a modified minimisation method, balancing residual tumour status, nodal status, and institutions. The primary outcome was overall survival in the two treatment groups, assessed in the per-protocol population, excluding ineligible patients and those not receiving the allocated treatment. The protocol prespecified that the superiority of S-1 with respect to overall survival was also to be assessed in the per-protocol population by a log-rank test, if the non-inferiority of S-1 was verified. We estimated overall and relapse-free survival using the Kaplan-Meier methods, and assessed non-inferiority of S-1 to gemcitabine using the Cox proportional hazard model. The expected hazard ratio (HR) for mortality was 0.87 with a non-inferiority margin of 1.25 (power 80%; one-sided type I error 2.5%). This trial is registered at UMIN CTR (UMIN000000655).385 patients were randomly assigned to treatment between April 11, 2007, and June 29, 2010 (193 to the gemcitabine group and 192 to the S-1 group). Of these, three were exlcuded because of ineligibility and five did not receive chemotherapy. The per-protocol population therefore consisted of 190 patients in the gemcitabine group and 187 patients in the S-1 group. On Sept 15, 2012, following the recommendation from the independent data and safety monitoring committee, this study was discontinued because the prespecified criteria for early discontinuation were met at the interim analysis for efficacy, when all the protocol treatments had been finished. Analysis with the follow-up data on Jan 15, 2016, showed HR of mortality was 0.57 (95% CI 0.44-0.72, pnon-inferiority0.0001, p0.0001 for superiority), associated with 5-year overall survival of 24.4% (18.6-30.8) in the gemcitabine group and 44.1% (36.9-51.1) in the S-1 group. Grade 3 or 4 leucopenia, neutropenia, aspartate aminotransferase, and alanine aminotransferase were observed more frequently in the gemcitabine group, whereas stomatitis and diarrhoea were more frequently experienced in the S-1 group.Adjuvant chemotherapy with S-1 can be a new standard care for resected pancreatic cancer in Japanese patients. These results should be assessed in non-Asian patients.Pharma Valley Center, Shizuoka Industrial Foundation, Taiho Pharmaceutical.

This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)., BACKGROUND: The use of grafts from donors after cardiac death (DCD) would greatly contribute to the expansion of the donor organ pool. The objective of this study is to determine the benefits of extracorporeal membrane oxygenation (ECMO) and subnormothermic machine perfusion (MP) with rewarming in a large animal model of DCD liver. METHODS: After cardiac arrest, the abdominal aorta and the inferior vena cava were cannulated and connected to an ECMO circuit. Porcine livers were perfused in situ with ECMO at 22°C for 60 minutes after 60 minutes of cardiac death. Then the livers were perfused for 4 hours by MP as a graft viability test. In group 1, non-in situ ECMO and grafts were preserved hypothermic MP. In group 2, non-in situ ECMO and grafts were preserved subnormothermic rewarming MP. In group 3, we used ECMO and subnormothermic rewarming MP. To assess potential methods and effect, effluent enzymes were measured. Portal vein and hepatic artery pressure during MP were evaluated. RESULTS: Effluent enzyme of AST, alanine aminotransferase and LDH as viability markers were significantly low (aspartate aminotransferase, 2899, 2292, and 972 IU/L; alanine aminotransferase, 134, 140, and 72 IU/L; and lactate dehydrogenase, 4354, 4455, and 1855 IU/L in each group, respectively). Portal vein and hepatic artery pressure during preservation came down smoothly in group 3 compared with group 1. CONCLUSIONS: The combined use of in situ subnormothermic ECMO and machine preservation with rewarming is more essential for the recovery and resuscitating function of DCD liver grafts.

Neoadjuvant chemotherapy/neoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p

Retroperitoneal liposarcoma is a rare neoplasm that often involves other organs and major blood vessels. Complete surgical resection with negative margins is the only potential curative treatment. Here, we report the case of a patient with a large retroperitoneum liposarcoma that was removed by resection of the descending abdominal aorta and infrahepatic inferior vena cava, right nephrectomy and pancreatoduodenectomy following creation of an extra anatomical femoro-femoral crossover bypass after left axillo-left femoral bypass. The patient developed leg edema for a few weeks after surgery but this condition was gradually resolved with diuretics. Otherwise, no serious postoperative complication was observed, and the patient was discharged at 37 days after surgery. There has been no evidence of recurrence for 16 months. In conclusion, radical surgical resection is a possible therapeutic option for retroperitoneal liposarcoma involving major vessels or other organs, and may improve survival if negative resection margins can be achieved.

Background Adjuvant chemotherapy with S-1 for resected pancreatic cancer demonstrated survival benefits compared with gemcitabine in the JASPAC 01 trial. We investigated the effect of these agents on health-related quality of life (HRQOL) of patients in the JASPAC 01 trial. Methods Patients with resected pancreatic cancer were randomly assigned to receive gemcitabine (1000 mg/m2 weekly for three of four weeks for up to six cycles) or S-1 (40, 50, or 60 mg twice daily for four of six weeks for up to four cycles). HRQOL was assessed using the EuroQol-5D-3L (EQ-5D) questionnaire at baseline, months three and six, and every 6 months thereafter. HRQOL end-points included change in EQ-5D index from baseline, responses to five items in the EQ-5D, and quality-adjusted life months up to 24 months. Results Of randomised 385 patients, 354 patients were included in HRQOL analysis. Mean change in the EQ-5D index was similar in the S-1 and gemcitabine groups within 6 months from treatment initiation (difference, 0.024; P = 0.112), whereas corresponding mean from 12 to 24 months was better in the S-1 group than in the gemcitabine group (difference, 0.071; P Conclusion Adjuvant chemotherapy with S-1 does not improve HRQOL within 6 months from treatment initiation but does improve HRQOL thereafter and quality-adjusted life months. Clinical trial registration number UMIN000000655 at UMIN CTR.

出版社版 オープンアクセス, AIM: To evaluate the clinical utility of hepatic clearance (HC) measured with technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single-photon emission computed tomography (SPECT) to estimate the degree of liver fibrosis. METHODS: Seventy-eight consecutive patients who underwent initial hepatectomy due to hepatocellular carcinoma were enrolled in this study. Indocyanine green clearance (ICG R15), quantitative indices estimated by (99m)Tc-GSA [the receptor index (LHL15 and HH15) and HC via SPECT analysis], and conventional liver function tests were performed before hepatectomy. Correlations among the quantitative indices for liver functional reserve, conventional liver function tests, and the degree of liver fibrosis were evaluated. RESULTS: The degree of liver fibrosis was correlated with ICG R15, HH15, LHL15, and HC. HC showed the best correlation with conventional liver function tests. According to multivariate analysis, HC and LHL15 were significant independent predictors of severe fibrosis. HC was the most valuable index for predicting severe fibrosis. CONCLUSION: HC measured with (99m)Tc-GSA SPECT is a reliable index for assessing liver fibrosis before hepatectomy.

The purpose of this study was to describe the cyst infection of intraductal papillary mucinous neoplasm in 2 patients. The patients were 62- and 74-year-old men. The initial symptom was acute febrile abdominal pain. Laboratory tests revealed severe infection (C-reactive protein concentrations were 23.3 µg/mL in patient 1 and 22.3 µg/mL in patient 2) and multilocular cystic masses (the diameters were 70 mm in patient 1 and 50 mm in patient 2) at the pancreatic head that involved peripancreatic vessels were demonstrated by computed tomography. Laboratory and radiographic findings were markedly improved by endoscopic transpapillary drainage. The enteric bacteria were detected in the drainage specimens. Curative resection was achieved, and histological findings indicated a carcinoma in situ in patient 1 and an invasive carcinoma in patient 2. Neither hyperamylasemia nor histological fat necrosis, frequently observed in acute pancreatitis, was evident. Both patients were free from recurrence after surgery (17 months in patient 1, and 18 months in patient 2). Cyst infection is an unknown complication of intraductal papillary mucinous neoplasm. Transpapillary drainage is highly recommended as an initial intervention. It is difficult to distinguish between cyst infection and unresectable invasive carcinoma with imaging modalities; however, surgical intervention after drainage may contribute to long-term survival.

This paper presents the reduction method of torque ripple in position sensorless control at standstill/low-speed region of the wound-field synchronous motor with double three-phase wound stator for Integrated Starter Generator(ISG). High-frequency signal injection method which is commonly used for PMSMs is selected for the test motor's position sensorless control. Due to the injected signal, a large torque ripple is generated on the output torque. As our target machine, Wound-field Synchronous Motor with Double Three-phase Wound Stator, has two sets of three-phase windings, we proposed a method by injecting signal to the set of windings in the opposite sign to reduce the torque ripple. The proposed method can realize position sensorless control but also reduce the torque ripple significantly. The effectiveness of the proposed sensorless control method is shown by actual experiment.

This paper shows that EV range-extender (RXT) with a trailer will provide better mileage than the plug-in hybrid (PHEV) when an appropriate system is used. A weekly driving pattern is assumed to be: 30 km (6 days a week), 100 km (1 day a week). The RXT system made for this evaluation is composed of a pure BEV and a trailer with an electric generator. Japan 10-15 mode is used for the calculation. The result shows that 35.4 kWh/weeks is obtained for RXT, while 36.5 kWh/week for PHEV. This would be the first evaluation of RXT based on the fuel economy.

症例は50歳,男性.平成15年1月24日大腸内視鏡検査にて横行結腸にIIa様病変を認め後日内視鏡的切除予定とし,マーキングクリップにて標識され帰宅.夕食摂取後腹痛出現したため翌1月25日当院再診し腸閉塞の診断で入院.イレウス管による保存的治療にて改善なく1月30日手術施行.開腹すると,横行結腸のマーキングクリップが結腸壁を貫いて回腸を把持しており,ここにさらに口側の回腸がはまり込み絞扼されていた.横行結腸はクリップを含め楔状切除,回腸は漿膜筋層縫合にて修復した.内視鏡的クリップ法は各種用途に有用であり多用されているが,頻度は低いものの偶発症も報告されている.大腸内視鏡による稀な偶発症を経験したので報告する.

出版社版 オープンアクセス, AIM: To present our experiences in studying the clinicopathological features of small nonfunctioning pancreatic neuroendocrine tumors (NF-pNETs). METHODS: The subjects included 9 patients with NF-pNETs who underwent pancreatectomy between April 1996 and September 2012. The surgical procedure, histopathological findings, and prognosis were assessed. RESULTS: All tumors were incidentally detected by computed tomography. The median diameter was 10 mm (5-32 mm). One patient was diagnosed with von Hippel-Lindau disease, and the others were sporadic cases. For the histopathological findings, 7 patients were G1; 1 patient was G2; and 1 patient, whose tumor was 22 mm, had neuroendocrine carcinoma (NEC). One patient who had a tumor that was 32 mm had direct invasion to a regional lymph node and 1 patient with NEC, had regional lymph node metastases. Six of the 7 patients with sporadic NF-pNETs, excluding the patient with NEC, had tumors that were smaller than 10 mm. Tumors smaller than 10 mm showed no malignancy and lacked lymph node metastasis. CONCLUSION: Sporadic NF-pNETs smaller than 10 mm tend to have less malignant potential. These findings suggest that lymphadenectomy may be omitted for small NF-pNETs after further investigation.

We have developed a unique induction motor that has free rotating magnets inside its rotor. In experimental results for a prototype motor, we have obtained superior performance over existing motors in terms of the power factor, efficiency, and output torque. The experimental details are as follows. The power factor of the test motor is significantly improved in comparison with that of a conventional induction motor. The power factor can be held to be unity, leading or lagging by changing the line frequency and/or source voltage. This is a quite unique feature, because the power factor of the usual induction motors always lags. The improvement of the power factor is effective not only in decreasing current loss, but also in decreasing voltage drop in the line and increasing installation capacity. The efficiency of the motor is remarkably higher than that of similar-sized conventional induction motors over a wide output power range. Actually, in ordinary induction motors, the efficiency is reduced as the power and/or the source voltage are decreased. However, the proposed motor is driven at high efficiency by lower source voltages in lower power ranges. The efficiency is improved by reducing the secondary current and the magnetizing current. © 1998 Scripta Technica, Electr Eng Jpn, 125(3): 59–66, 1998

In this paper, we propose a human-safety-oriented design method to realize a safe robot system for human-robot coexistence. We conduct some simulations to identify problems in human-robot collision situations, and point out, based on the human pain tolerance limit which we have clarified, that a robot working next to a human should be covered with a soft material and be equipped with prompt stopping capability. First, we construct a fail-safe robot system with contact sensing and subsequent emergency stop control capabilities using a simple disturbance observer which plays an important role in checking the normal operation of a two-link DD-motor-driven manipulator. Second, we design a soft covering made of a viscoetastic material which achieves both effective impact force attenuation and high contact sensitivity, keeping impact force within the human pain tolerance limit. Finally, we demonstrate actual human-robot collision experiments to show that the contact force generated at collisions was suppressed below the human pain tolerance limit.

We have developed a unique induction motor that has free rotating magnets inside its rotor. In the experimental results of a prototype motor, we have obtained superior performance over existing motors in terms of the power factor, efficiency and output torque. The experimental details are as follows. The power factor of the test motor is significantly improved as compared with that of conventional induction motor. The power factor can be controlled to be unity, leading or lagging by changing the line frequency and/or source voltage. It is quite a unique feature, because the power factor of usual induction motor is always lagging. The improvement of the power factor becomes effective not only against the decrease of the current loss but against the decrease of voltage drop in line and the increase of installation capacity. The efficiency of the motor, over a wide output power range, is remarkably higher than that of the same size conventional induction motor. Actually, in ordinary induction motor, the efficiency is reduced as the power and/or the source voltage is decreased. However, the proposed motor is driven in the high efficiency by lower source voltage at lower range of power. The efficiency is improved by reducing the secondary current and the magnetizing current.

オープンアクセス誌, The symptoms of gallbladder cancer (GBC) are vague and non-specific. Therefore, GBC is often detected at an advanced or metastatic stage. The most effective treatment for GBC is surgical resection, however the majority of GBC cases are unresectable at the time of diagnosis. Therefore, numerous GBC patients undergo chemotherapy. This study reports the case of a 60-year-old female with GBC who underwent successful surgical curative resection following a single dose of the chemotherapeutic agent, S-1, twice daily for 4 weeks followed by a 14-day rest period for 36 months. S-1 is a novel orally administered drug composed of a combination of the 5-fluorouracil (5-FU) prodrug, tegafur, 5-chloro-2,4-dihydroxypyridine (CDHP) and oteracil potassium in a 1:0.4:1 molar concentration ratio. The focus of the present study was the candidate factors that affect the therapeutic efficacy of S-1-based chemotherapy. In particular, the gene expression involved in the S-1 metabolic pathway was investigated by assessing the intratumoral dihydropyrimidine dehydrogenase (DPD), thymidylate synthase (TS) and orotate phosphoribosyltransferase gene expression. The surgical specimen exhibited high intratumoral DPD gene expression levels compared with those observed in previously reported non S-1 responsive cases of biliary tract cancer. Due to the results obtained in the current study, we hypothesize that CDHP enhanced the antitumor efficacy of 5-FU by inhibiting the excess DPD protein produced by the tumor.

Pancreatic hamartoma is a rare tumor, and its characteristic histopathologic features have not yet been fully evaluated. In this study, we collected 9 cases of pancreatic hamartoma to elucidate distinctive histopathologic features that can serve to establish this tumor as a clear disease entity and thus formulate useful histopathologic criteria for this tumor. The cases comprised 4 men and 5 women with a mean age of 62.7 years. The average tumor diameter was 3.3 cm. All patients underwent surgical treatment, and none showed any recurrence postoperatively. Macroscopically, pancreatic hamartomas were well-demarcated tumors with a solid or solid and cystic appearance. Microscopically, these tumors comprised mature acini and small-sized to medium-sized ducts showing a distorted architecture with various amounts of fibrous stroma. Strikingly, the tumors consistently lacked concentric elastic fibers in their duct walls, peripheral nerves, and well-formed islets of Langerhans, all of which exist in both the normal and atrophic pancreas. Immunohistochemically, scattered chromogranin A-positive neuroendocrine cells were observed in the acinar and ductal components. Ductal components were positive for S-100 protein. Spindle-shaped stromal cells expressed CD34 and/or c-kit. These histopathologic features were distinct from those of 5 cases of pancreatic ductal adenocarcinoma, 3 cases of type 1 autoimmune pancreatitis (lymphoplasmacytic sclerosing pancreatitis), 3 cases of alcoholic chronic pancreatitis, and 5 cases of normal pancreas. In conclusion, pancreatic hamartomas share some distinctive histopathologic features and clinical outcomes (neither recurrence nor metastasis) that allow them to be interpreted as malformative lesions. The term "hamartoma" is appropriate for these unique lesions.

In this paper, we discuss a method to achieve a failure-to-safety robot system. First, we point out that there has been little study on human detection through contact sensing and we establish the human pain tolerance for human-oriented design of a safe robot. Secondly, for reliability purposes, we provide a method of sensing contact force by monitoring the direct drive motor current and speed of the robot, without any external sensors. Thirdly, we propose a design method of covering a robot with a viscoelastic material to achieve both impact force attenuation and contact sensitivity, keeping within the human pain tolerance limit. Finally, we covered a two-link arm manipulator with an accordingly designed soft covering material, and demonstrated that the developed manipulator system gives no pain to humans.

This paper describes a new type high torque induction motor which has the rotating magnets in the rotor. The motor basically consists of a usual stator, cylindrical rotor, and inner cylinder of which the surface is covered by a set of magnets. The rotor turns at somewhat less than synchronous speed. The inner cylinder with magnets can revolve freely against a rotor shaft. The magnets revolve synchronized by the rotating magnetic field induced by the stator current. The magnets make the flux in the rotor. Then we can expect torque increase by the increase of the flux. The results of magnetic field analysis indicate the flux is increased. In the experimental results of a test motor which is a 400 W prototype machine, we have obtained the torque increase by approximately 20 percent as anticipated in the magnetic field analysis. Moreover, test results show improvements of efficiency and power factor in the motor operations. The efficiency of the test motor is obtained as high as 10 percent at the rated output over those of a same size conventional induction motor. Although power factor of conventional induction motors is lagging at all times, the test motor can be operated with near unity, leading or lagging by adjusting the ac supplied source voltage.

It is very effective for developing a high torque motor to keep air gap as small as possible between a rotor and a stator. By polishing the surfaces of cylindrical rotor and stators impregnated with epoxi resin, we developed a high torque motor of a hyblid type with extremely small air gaps which has no usual bearings. The rotor and stators with smooth surface play the role as a bearing.All stator poles of VR motors are not simultaneously excited, since reversal torque is generated when rotor teeth leaves stator teeth. As only attraction force is employed, halves of stator poles don't generate torque.We investigated a uniqe hyblid type motor with rare-earth bar magnets in rotor slots, in which all stator poles generate torque by employing not only atrraction force but also repulsion force. Analizing magnetic field of the hyblid motor with MAGNA/FIM, magnetic field analising software, optimum air gap geometry were aquired. We could develop a greatly higher torque motor than a VR type motor with the same size which was developed before [7].

This paper describes a new type high torque induction motor which has the rotating magnets in the rotor. The motor basically consists of a usual stator, cylindrical rotor, and inner cylinder of which surface is covered by a set of magnets. The rotor turns at somewhat less than synchronous speed. The inner cylinder with magnets can revolve freely against a rotor shaft. The magnets revolve synchronized the rotating magnetic field induced by the stator current. The magnets make the flux in the rotor. Then we can expect torque increase by the increase of the flux. The results of magnetic field analysis indicate the flux is increased.In the experimental results of a test motor which is 400W prototype machine, we have obtained the torque increase by approximately 20% as anticipated in the magnetic field analysis. Moreover, test results show improvements of efficiency and power factor in the motor operations. The efficiency of the test motor is obtained as high as 10% at the rated output than those of a same size conventional induction motor. Although power factor of conventional induction motor is lagging at all times, the test motor can be operated with near unity, leading or lagging by adjusting the AC supplied source voltage.

New level 2 products v2.0 of JEM/SMILES are scheduled to be released in Sep., 2011. This will be the first publicreleased version. In pre-released product v1.3, positive bias of retrieved temperature in the stratosphere was the largest issue since temperature is basic parameter which characterizes the atmospheric structure. The new product use latest L1B 007 which includes gain nonlinearity effect of receivers, bias of temperature in upper stratosphere is suppressed. In addition, we stopped temperature retrieval above 40km and refer MLS temperature product with applying migrating tidal model. HCl profiles in mesosphere become constant, which supports this temperature processing.

The Superconducting Submillimeter-Wave Limb-Emission Sounder (SMILES) observes O3 and other minor chemical species in the stratosphere and mesosphere. Limb observation of SMILES is sensitive to the quality of the tangent altitude retrieval. To obtain better retrieval result, knowledge of initial tangent height and antenna pattern should be as precise and accurate as possible. It was concluded that initial tangent height is calculated by using ISS attitude and mirror pointing angle, and ISS position. Antenna pattern assuming 6 points moving average was applied to the retrieval and showed reasonable results.

This paper describes the development of a parallel-fingered hand with multiple sensing functions for grasping objects with varying hardness, surface roughness, and weight. The multiple sensing functions are: grasping force sensing, static friction coefficient sensing, and weight sensing. Hardware and algorithms are described for measuring the above parameters and for controlling the hand's grasping force by integrating those parameters into a unified control law. We present experimental results that verify the proposed hand system's capabilities of lifting and holding target objects, given only predetermined maximum force settings or limit displacements for the initial grasp. Further studies demonstrate adaptive grasping force control in response to changes in an external force applied to the object, using the static friction coefficient detected by our sensor as a priori information on the object surface roughness.

It is very effective for a high torque motor to make air gap as small as possible between a rotor and a stator. By polishing the surfaces of silindrical rotor and stator impregnated with epoxi resin, we developed a high torque motor of a VR type with extremely small air gaps which has no usual bearings. The rotor and stator with smooth surface play the role as a bearing.Analising the geometry of air gaps by MAGNAFIM, magnetic field analising softwere, we were be able to develop a motor with higher output torque density than that on the market.

This paper shows that EV range-extender (RXT) will provide better mileage than the plug-in hybrid (PHEV) when a model usage of vehicle is applied. The model is assumed to be: 30 km (6 days a week), 100 km (1 day a week). A RXT system was made for this evaluation using a pure EV and an electric generator on a trail. Japan 10-15 mode is used for the calculation. The result shows that 35.4 kWh/weeks is obtained for RXT, while 36.5 kWh/week for PHEV. This would be the first evaluation of RXT based on the fuel economy.

The governing equations of motion of the walking phenomena of the unanchored flat-bottom cylindrical shell tanks are examined. This paper considers that the walking phenomena is followed by the rocking motion of the tanks, since the rocking motion induces the reduction of self-weight and consequently reduces friction force between the tank and the foundation. The equations of motion are derived through variational approach. The physical quantities related to the walking phenomena are the mass of tank itself, tank content, the effective mass of liquid for bulging motion, for rocking motion and for rocking-bulging interaction motion, and friction force including self-weight reduction effects. The roles of every physical quantity related to the walking motion are clearly identified. The time history of the walking motion of the model tank induced by the initial enforced uplift angle and then gently released is well computed by the proposed procedure.Copyright © 2005 by ASME

e15247 Background: To select the candidates for resection for pancreas cancer (PC) via radiographic appearances, response to chemotherapy or biomarker provide favorable outcome due to their aggress...

4008 Background: Adjuvant chemotherapy with gemcitabine (G) has been standard treatment for resected pancreatic cancer (PC). In the GEST study, S-1 (S) had shown non-inferiority to G in overall survival (OS) for unresectable PC. The aim of this phase III study is to investigate non-inferiority of S to G on OS as adjuvant chemotherapy for resected PC. Methods: Patients (pts) after macroscopically curative resection of PC with an ECOG PS of 0-1 and adequate organ functions were randomly assigned to G (1000 mg/m2, iv, d1, 8 and 15, q4w, for 6 courses) or S (80/100/120 mg/day based on BSA, po, d1-28, q6w, for 4 courses) with balancing by surgical margins (R), nodal status (N) and institution. Primary endpoint was OS. With 180 pts per arm, the study had 80% power to prove non-inferiority with a margin of hazard ratio (HR) 1.25 on the basis of expected HR 0.87, with 0.05 two-sided alpha. Secondary endpoints were relapse-free survival (RFS), safety, and quality of life (EQ-5D). One interim analysis was planned after 180 deaths. Results: From 4/2007 to 6/2010, 385 pts were enrolled from 33 hospitals in Japan. 378 pts (G/S: 191/187) were included in the full analysis set. Pts characteristics (G/S) were well balanced (PS0: 67%/70%, R0: 86%/88%, N0: 38%/36%). Based on the interim analysis with 205 OS events, IDMC recommended to publish the results. OS at 2-years were 53% for G and 70% for S. HR for S to G was 0.56 (95% CI, 0.42-0.74, p

145 Background: Gemcitabine (GEM) has been a standard treatment of adjuvant chemotherapy for resected pancreatic cancer (PC). S-1 is an oral fluoropyrimidine, and shown to be non-inferior to GEM on overall survival (OS) for unresectable PC. The aim of this study is to determine non-inferiority of S-1 to GEM on OS as an adjuvant chemotherapy for resected PC. Methods: Patients (pts), who met the following criteria; histologically confirmed ductal adenocarcinoma of the pancreas, R0 or R1 resection, pathological stage I, II, or III with resection of the celiac axis, age >20, no prior chemotherapy or radiotherapy within 3 years, and adequate organ functions, were randomly assigned to GEM (1000 mg/m2, div on days 1, 8 and 15, repeated every 4 weeks, for 6 courses) or S-1 (40-60 mg according to the body surface, twice a day, for 4 weeks, repeated every 6 weeks, for 4 courses). Primary endpoint was OS. With 180 pts in each, the study had 80% power to prove non-inferiority with a non-inferiority margin of hazard ratio (HR) 1.25 on the basis of expected HR 0.87, at 0.05 two-sided alpha. An interim analysis was planned after 180 deaths. Results: From 4/2007 to 6/2010, 385 pts were enrolled (GEM: 193, S-1: 192) from 33 hospitals in Japan. In 378 pts (GEM: 191, S-1:187) of the full analysis set, background factors were well balanced between groups. Based on the interim analysis on survival data obtained by 7/2012, the independent data monitoring committee recommended to publish the results soon. The HR for S-1 to GEM was 0.56 (95% CI, 0.42-0.74, p

This paper presents a unique active filter system which operates with direct digital control (DDC). The system synthesizes the almost identical current with the total harmonic currents generated from the load. The current is injected to the a. c. source line by inverse phase. Although the control is based on simple digital calculations, it is proved that the a. c. source line current can be nearly sinusoidal current on a computer simulations as well as a bench mark test in a single phase circuit with nonlinear load.