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In this study, clinical and biochemical methods were utilized to predict the final diagnosis of hereditary spherocytosis (HS), correlate the diagnosis with splenectomy, and examine the usefulness of this approach.We biochemically and cytochemically analysed erythrocyte membrane proteins before making a final HS diagnosis based on gene analysis to compare diagnostic approaches. The clinical features of six patients with various subtypes of HS and symptoms were observed by blood analysis using eosin-5'-maleimide staining, biochemical analysis using sodium dodecyl sulphate - polyacrylamide gel electrophoresis with western blotting, and mass spectrometry. Finally, diagnostic membrane gene analysis was performed.Five of the six patients showed mild to moderate or severe anaemia, and the other patient was non-anaemic; all six patients showed faint eosin-5'-maleimide staining. In western blotting of erythrocyte membrane proteins, all six patients (three with β-spectrin, two with ankyrin, and one withWe determined the relationship among clinical features, cytochemical parameters, and gene anomalies in six patients with newly diagnosed HS while referring to previously published cases.These findings reveal a close relationship between clinical features and membrane characteristics in HS, which can facilitate diagnosis and inform treatment.

Importance: An understanding of the potential prognostic factors as they relate to the employment status of people with traumatic brain injury (TBI) is necessary so that occupational therapy practitioners can provide the most effective treatment. Objective: To examine the impact of apathy, disinhibition, and psychiatric conditions on employment status after TBI. Design: An observational study conducted from March 2015 to March 2020. Setting: Cognitive dysfunction clinics associated with two general hospitals in Japan. Participants: Japanese people of working age (N = 110, ages 18–65 yr) with TBI. Outcomes and Measures: As an outcome indicator, each participant’s employment status was rated on a 3-point scale (i.e., 3 = regular employment, 2 = welfare employment [employed as a person with disabilities or undergoing vocational training in the Japanese welfare employment system, for which a worker is paid under either system], 1 = unemployment). Psychiatric, neuropsychological, and physical assessments were measured as explanatory variables. The impact of various factors on employment status was investigated using linear discriminant regression analysis. Results: The level of apathy, disinhibition, and incidence of psychiatric conditions after TBI, as well as age and years postinjury, were related to employment status. Conclusion and Relevance: Although this is a cross-sectional study, interventions for apathy and disinhibition, as well as management of psychiatric conditions, are recommended to help improve employment status among people with TBI. What This Article Adds: The employment status of people with TBI is related more to apathy, disinhibition, and psychiatric conditions than to intelligence, memory function, or executive function.

Background: The randomized controlled trial (RCT) is accepted as the standard clinical trial to decide a standard therapy, but it remains unclear whether or not elderly patients benefit as much as other patients from participation in an RCT. In the RESPECT study (NCT01104935), the relative value of trastuzumab (H) monotherapy as an adjuvant treatment was compared in an RCT with the standard combination treatment with chemotherapy (H+CT) in patients over 70 years old with HER2-positive invasive breast cancer (BC) who received curative surgery. This cohort study was aimed at comparing prognoses between RCT participants (RCT group) and non-participants (Cohort group). Methods: Patients were divided into RCT participants, and those who did not agree to participate in the RCT despite meeting the eligibility criteria and receiving the explanation given by the investigator. In the RCT group patients were randomized to H or H+CT; in the Cohort group treatment was selected for each patient based on the discretion of the treating physician and the patient's wishes without intervention. Treatment categories were divided into three groups: (1) trastuzumab monotherapy group (cH group), (2) trastuzumab plus chemotherapy group (cH+CT group), and (3) those who received either no therapy at all, or any other anticancer therapies without H (cOther group). The primary endpoint was disease-free survival (DFS). Secondary endpoints were overall survival (OS), relapse-free survival, safety, health-related quality of life (HRQOL) and comprehensive geriatric assessment. Results: A total of 275 patients in the RCT group and 123 patients in the Cohort group, in total 398 patients, were enrolled in this study between October 2009 and October 2014. The median age was 74.0 years in the RCT group, 74.5 years in the Cohort group and the median follow-up time was 4.1 years and 3.2 years, respectively. Patients were classified as Stage I: 41.8%, 42.5%; IIA: 41.5 %, 40.8%; IIB: 13.5%, 13.3%; and IIIA: 1.5%. 3.3%, respectively (P = 0.51), there were no significant differences between the two groups. Treatment categories in the Cohort group were: (1) cH group; 43% (n = 52), (2) cH+CT group; 30% (n = 36), cOther group; 27% (n = 32). The planned analysis showed that DFS at 3 years was 91.4% in the RCT group vs 89.3% in the Cohort group (adjusted hazard ratio (HR) = 1.30; 95%CI, 0.72-2.35, P = 0.38). In patients in the cH+CT, cH and cOther group, DFS at 3 years was 92.3%, 89.2% and 82.5%, respectively. DFS in patients in the cH+CT and the cH group was significantly better than that of the cOther group (adjusted HR = 3.79; 95%CI = 1.35-10.64, P = 0.01). DFS in the cH group showed a better tendency compared with cOther (adjusted HR = 2.59; 95%CI, 0.87-7.73, P = 0.08). The incidence of grade 3/4 non-hematological adverse events in the RCT group was relatively higher compared with the Cohort group (18.5% vs 10.8 %, P = 0.05). Conclusion: The prognosis did not vary between the RCT and Cohort groups. H-containing regimens are often chosen for elderly patients with HER2-positive breast cancer. The prognosis of patients who received any H-containing regimen, even H monotherapy, was better than those who were not treated with H. Citation Format: Shinichi Baba, Masataka Sawaki, Yukari Uemura, Tsuyoshi Saito, Kokoro Kobayashi, Hiroaki Kawashima, Michiko Tsuneizumi, Noriko Sagawa, Hiroko Bando, Masato Takahashi, Miki Yamaguchi, Tsutomu Takashima, Takahiro Nakayama, Masahiro Kashiwaba, Toshiro Mizuno, Yutaka Yamamoto, Naruto Taira, Hiroji Iwata, Tatsuya Toyama, Koichiro Tsugawa, Yasuo Ohashi, Hirofumi Mukai. A cohort study to evaluate the efficacy and safety of postoperative adjuvant therapy in HER2-positive elderly breast cancer patients (RESPECT-cohort study) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-14-02.

[Purpose] Failure and recurrence are concerns in nonoperative management (NOM) for acute appendicitis (AA) and interval appendectomy (IA). The goal of the study was to identify predictors of failure and recurrence in patients with AA who underwent NOM. [Methods] A total of 348 adults with appendicitis were treated in our department from April 2016 to October 2021. Among these patients, 337 who did not undergo emergency surgery were divided into those with failed NOM and unplanned surgery (n=28) and successful NOM (n=309). These groups were compared to identify predictive factors for NOM failure. In the NOM-success group, 195 patients were divided into non-recurrence (n=166) and recurrence (n=29) groups to identify predictive factors for recurrence of appendicitis. [Results] In multivariate analysis, post-treatment CRP level (odds ratio (OR)=1.126, 95% confidence interval (CI) 1.076-1.179, P=0.000) and fecal stones with abscess formation (OR=5.530, 95% CI 2.081-14.691, P=0.001) were independently associated with NOM failure. Receiver operating characteristic curve analysis showed an optimum cutoff CRP level of 10.46 mg/dl for failure appendicitis. The initial CRP level was significantly lower and the % CRP decrease was significantly higher in the recurrence group than in the non-recurrence group. [Conclusions] These findings suggest that the post-treatment CRP level and fecal stones with abscess formation are predictors of NOM failure, but that recurrence may not be affected by the severity of previous appendicitis.

Purpose To gauge the effects of treatment practices on prognosis for all older patients with HER2-positive breast cancer, particularly to determine whether adjuvant trastuzumab alone can offer benefit over no adjuvant therapy. This report accompanies the RESPECT study, a randomized-controlled trial (RCT) comparing trastuzumab monotherapy with trastuzumab-plus-chemotherapy for early HER2-positive breast cancer.Patients and methods Patients who declined the RCT were treated based on the physician’s discretion. We studied the (1) trastuzumab-plus-chemotherapy group, (2) trastuzumab-monotherapy group, and (3) non-trastuzumab group (no therapy or anticancer therapy without trastuzumab). The primary endpoint was disease-free survival (DFS), which was compared using the propensity-score method.Results We enrolled 398 eligible patients, aged over 70 years, with HER2-positive invasive breast cancer, of whom 275 (69%) were in the RCT, and 123 (31%) were in this cohort group. The median age was 74.5 years. Among cohort group treatment categories were as follows: (1) trastuzumab-plus-chemotherapy group (n = 36, 30%), (2) trastuzumab-monotherapy group (n = 52, 43%), and (3) non-trastuzumab group (n = 32, 27%). A total of 73% of patients received trastuzumab-containing regimens, with or without chemotherapy. The 3-year DFS was 92.3% in the trastuzumab-plus-chemotherapy group, 89.2% in the trastuzumab-monotherapy group, and 82.5% in the non-trastuzumab group. DFS in the non-trastuzumab group was lower than in the trastuzumab-plus-chemotherapy and trastuzumab-monotherapy groups (propensity-adjusted HR: 3.29; 95% CI: 1.15–9.39; P = 0.026). The relapse-free survival in the non-trastuzumab group was lower than in the trastuzumab-plus-chemotherapy and trastuzumab monotherapy groups (propensity-adjusted HR = 7.80; 95% CI: 2.32–26.2, P < 0.0001). Chemotherapy with trastuzumab or trastuzumab monotherapy did not affect health-related quality of life (HRQoL) at 36 months.Conclusions Trastuzumab-treated patients had better prognoses than patients not treated with trastuzumab without deterioration of HRQoL. Thus, trastuzumab monotherapy can be considered for patients who reject chemotherapy.Trial registration number The protocol was registered on the website of the University Hospital Medical Information Network (UMIN), Japan (protocol ID: UMIN 000028476).

BackgroundAppendicitis is the most common cause of acute abdomen. Although emergency surgery used to be the standard treatment for both simple and complex appendicitis, there are now options for interval surgery, laparoscopic surgery, and even non-surgical treatment. In this study, we aimed to establish better treatment strategies for pediatric acute appendicitis and to find out whether minimally invasive treatment is superior to the traditional open approach. We retrospectively reviewed the cases of acute appendicitis treated in our hospital during the period from 2013 to 2018. The patients who underwent appendectomy were divided into four groups. Group 1 underwent early appendectomy with open approach, group2 underwent interval appendectomy with open approach, group 3 underwent early appendectomy with laparoscopic approach, and group 4 underwent interval appendectomy with laparoscopic approach. In addition to the above groups, the non-surgical treatment group was also studied. Clinical presentation, laboratory findings, imaging results, operative time, morbidity, and length of hospital stay were reviewed.ResultsOne hundred six children’s records were reviewed. Thirty-five of them were selected for non-surgery as they were cases with no fecal stone and first onset appendicitis, and 15 of these 35 patients (42.9%) relapsed after antibiotic treatment. As for the appendix diameter, the relapse group was significantly larger than the non-relapse group (p=0.007). In cases of surgery, group 4 had significantly less intraoperative blood loss than group 1 (pp=0.009), group 4 vs. group 2 (p=0.034)]. The postoperative hospital stay in groups 2 and 4 were significantly shorter than group 1 [group 1 vs. group 2 (p=0.015), group 1 vs. group 4 (pp=0.029), group 1 vs. group 4 (pConclusionInterval laparoscopic appendectomy and non-surgical treatment were safe and effective in children. From the viewpoint of avoiding unnecessary emergency surgery and prolonged hospitalization, we believe that interval laparoscopic appendectomy or non-surgical treatment should be performed after identifying patients who do not require surgery, paying attention to the risk factors for relapse.

Patients with dense breasts on mammography have a higher risk of developing breast cancer and missing a tumor mass than those with non-dense breasts. Whether examinees who have dense breasts should be notified is currently under consideration in Japan; however, there is concern about the low level of understanding regarding dense breasts. A questionnaire survey on the degree of comprehension regarding dense breasts was conducted among 409 general women of >20 years of age in Hachinohe city in October 2017 and 2018. The results showed that the degree of comprehension was extremely low, as only 35 people (8.5%) responded with, “I know the meaning”; however, 32 of them (91.5%) stated that they would like to be notified in they had dense breasts. In addition, the degree of comprehension regarding dense breasts was significantly greater among those who had a breast cancer screening history (OR = 6.4; 95% CI = 2.0 - 19.8; P = 0.001) and a self-examination history than among those with no such history (OR = 2.5; 95% CI = 1.1 - 5.8; P = 0.03). However, the degree of comprehension did not differ between participants of years of age or between participants with and without a breast cancer sufferer among their close blood relatives. The present findings to reflect a low understanding of dense breasts on mammography screening and suggest that the degree of comprehension is influenced by the presence or absence of a consultation history and a self-examination history.

Posterior cortical atrophy is a rare degenerative condition with prominent visuospatial dysfunction which commonly occurs between ages 50 and 65. A diagnosis of posterior cortical atrophy during its initial stage is sometimes challenging and can be delayed because there are currently no established neuropsychological examination methods that can easily be used in clinical settings. In this study, we examined whether the tapping span test is a potential diagnostic tool for posterior cortical atrophy and what impairment the tapping span test is indicative of in this condition. Eight patients with initial-stage posterior cortical atrophy were recruited. Age- and severity-matched individuals with amnesic Alzheimer’s disease (n = 9) were also recruited as a control group. The participants were subjected to the tapping span test and several visuospatial working memory tests. The results of the tapping span and visuospatial working memory tests were worse for the posterior cortical atrophy group when compared with the control group. The results from the tapping span tests were strongly correlated with those from the visuospatial working memory tests. The tapping span test is a simple and potentially useful diagnostic tool for patients with initial-stage posterior cortical atrophy, as it reflects visuospatial working memory function.

PURPOSE Adjuvant trastuzumab monotherapy has not been compared with trastuzumab + chemotherapy. We investigated the relative value of trastuzumab monotherapy for older patients with breast cancer. METHODS This study was an open-label, randomized controlled study with a treatment selection design in which a noninferiority criterion was predefined. Patients aged 70-80 years with surgically treated human epidermal growth factor receptor 2–positive invasive breast cancer received trastuzumab monotherapy or trastuzumab + chemotherapy. The primary end point was disease-free survival (DFS) with assessment of prespecified hazard ratio (HR), relapse-free survival (RFS), adverse events (AEs), health-related quality of life (HRQoL), and restricted mean survival time (RMST). RESULTS The study involved 275 patients (mean age, 73.5 years) who were followed up for a mean of 4.1 years (range, 0.3-8.0 years). The percentages of patients by cancer stage were as follows: I (pT > 0.5 cm), 43.6%; IIA, 41.7%; IIB, 13.5%; and IIIA, 1.1%. Three-year DFS was 89.5% with trastuzumab monotherapy versus 93.8% with trastuzumab + chemotherapy (HR, 1.36; 95% CI, 0.72 to 2.58; P = .51). At 3 years, RMST differed by −0.39 months between arms (95% CI, −1.71 to 0.93; P = .56). Three-year RFS was 92.4% with trastuzumab monotherapy versus 95.3% with trastuzumab + chemotherapy (HR, 1.33; 95% CI, 0.63 to 2.79; P = .53). Common AEs were anorexia (7.4% v 44.3%; P < .0001) and alopecia (2.2% v 71.7%; P < .0001), and grade 3/4 nonhematologic AEs occurred in 11.9% versus 29.8% ( P = .0003) for trastuzumab monotherapy versus trastuzumab + chemotherapy, respectively. Clinically meaningful HRQoL deterioration rate showed significant differences at 2 months (31% for trastuzumab monotherapy v 48% for trastuzumab + chemotherapy; P = .016) and at 1 year (19% v 38%; P = .009). CONCLUSION The primary objective of noninferiority for trastuzumab monotherapy was not met. However, the observed loss of survival without chemotherapy was < 1 month at 3 years. Therefore, and in light of the lower toxicity and more favorable HRQoL profile, trastuzumab monotherapy can be considered an adjuvant therapy option for selected older patients.

A 59-year-old man was diagnosed with cholecystolithiasis and cholecystitis and underwent cholecystectomy. The pathological findings were moderately differentiated adenocarcinoma(pT2)in the gallbladder fundus. Sixteen days after surgery, he visited our hospital due to jaundice. Abdominal enhanced CT and EOB-MRI revealed multiple liver metastases and lymph node metastases in the hepatoduodenal ligament that we deemed to be unresectable. A metallic stent was inserted for bile duct obstruction, and he underwent chemotherapy with gemcitabine plus cisplatin(GC). After 12 courses of GC, the metastatic lesions disappeared, and the patient showed complete response. FDG-PET/CT showed FDG uptake in the hepatoduodenal ligament and we subsequently decided to perform surgery. He underwent resection of the extrahepatic bile duct and regional lymphadenectomy. The pathological findings revealed no residual carcinomas in the bile duct or lymph nodes. We are continuing chemotherapy at present, and the patient is alive with no signs of recurrence at 1 year and 3 months following the diagnosis of multiple liver metastases.

While eye gaze data contain promising clues for inferring the interests of viewers of digital catalog content, viewers often dynamically switch their focus of attention. As a result, a direct application of conventional behavior analysis techniques, such as topic models, tends to be affected by items or attributes of little or no interest to the viewer. To overcome this limitation, we need to identify “when” the user compares items and to detect “which attribute types/values” reflect the user’s interest. This paper proposes a novel two-step approach to addressing these needs. Specifically, we introduce a likelihood-based short-term analysis method as the first step of the approach to simultaneously determine comparison phases of browsing and detect the attributes on which the viewer focuses, even when the attributes cannot be directly obtained from gaze points. Using probabilistic latent semantic analysis, we show that this short-term analysis step greatly improves the results of the subsequent step. The effectiveness of the framework is demonstrated in terms of the capability to extract combinations of attributes relevant to the viewer’s interest, which we call aspects, and also to estimate the interest described by these aspects.

A 70-year-old woman was brought to our hospital by ambulance because of severe groin pain on the right side. Computed tomography scan revealed a tumor in the ascending colon, intraperitoneal abscess spread to the subcutaneous tissues, and a large amount of pneumoderma. She was diagnosed with necrotizing fasciitis caused by penetration of ascending colon cancer and underwent lavage and drainage, right hemicolectomy, end ileostomy, and debridement of necrotic tissues on emergency. Postoperatively, she underwent debridement and irrigation at the bedside every day, but the necrotizing tissues spread. Debridement under general anesthesia was repeated on postoperative day 8. On postoperative day 20, negative pressure wound therapy(NPWT)was initiated to manage the exudates and wound condition, and healthy granulation tissues formed gradually. After 4 weeks, she underwent split-thickness skin graft implantation. The postoperative course was uneventful, and she was discharged from the hospital. She is currently on chemotherapy and has been alive for 1 year and 3 months after the first operation.

A 69-year-old man was hospitalized for gastric cancer. He underwent total gastrectomy with distal pancreatectomy, splenectomy, and cholecystectomy. Pathological staging was pT3N3aM0 and Stage ⅢB. Adjuvant chemotherapy(S-1)was administered postoperatively. Ten months later, left adrenal metastasis was detected on computed tomography(CT)scans. He was then treated with 4 courses of chemotherapy with SOX therapy and 2 courses of PTX plus RAM therapy for the left adrenal metastasis. However, the tumor size increased. He underwent adrenalectomy with left nephrectomy and partial resection of the transverse colon for the solitary adrenal metastasis. His pathological diagnosis was metastatic carcinoma of the left adrenal gland and lymph nodes, which invaded the left renal vein and originated from gastric carcinoma. Three months after the adrenalectomy, CT scans identified paraaortic, porta hepatis, and left supraclavicular lymph node metastases. The patient was continuously treated with nivolumab, for 20 courses, and is doing well with good PS. Adrenalectomy for solitary adrenal metastasis of gastric cancer very rarely occurs. We report a case of multiple lymph node metastases treated with nivolumab after an adrenalectomy for solitary adrenal metastasis of gastric cancer after a gastrectomy.

This paper analyzes a self-height estimation method from a single-shot image using a convolutional architecture. To estimate the height where the image was captured, the method utilizes object-related scene structure contained in a single image in contrast to SLAM methods, which use geometric calculation on sequential images. Therefore, a variety of application domains from wearable computing (e.g., estimation of wearer’s height) to the analysis of archived images can be considered. This paper shows that (1) fine tuning from a pretrained object-recognition architecture contributes also to self-height estimation and that (2) not only visual features but their location on an image is fundamental to the self-height estimation task. We verify these two points through the comparison of different learning conditions, such as preprocessing and initialization, and also visualization and sensitivity analysis using a dataset obtained in indoor environments.

Ultrathin films of HfO 2 -ZrO 2 system, Hf x Zr 1- x O 2 , were fabricated for generating ferroelectric phase. Polycrystalline Hf x Zr 1- x O 2 films were prepared via chemical solution deposition process, in which precursor films consisting of amorphous phase on platinized silicon wafer were crystallized by post-annealing. Metastable orthorhombic phase, recognized as the “ferroelectric” phase, appeared in the Hf x Zr 1- x O 2 films with chemical composition of x = 0.40–0.70 and with film thickness of approximately 40 nm, together with stable monoclinic and/or cubic phases. The dielectric permittivity, e r , and remanent polarization, P r , varied with the chemical composition, meaning that constituent phases of the resulting Hf x Zr 1- x O 2 films dominate their dielectric and ferroelectric properties. Saturated P – E hysteresis loop with P r of 2.1 μC/cm 2 and coercive field of 580 kV/cm was confirmed for the solid solution film of Hf 0.70 Zr 0.30 O 2 ( x = 0.70) at 80 K, whereas no spontaneous polarization was confirmed for pure HfO 2 film ( x = 1.00). These results imply that the orthorhombic phase stabilized by Zr substitution would contribute to the generation of ferroelectricity in HfO 2 -based material consequently.

A 65-year-old man was hospitalized for gastric cancer. Abdominal computed tomography detected lower gastric cancer and invasion of the liver. Initial laboratory data showed high levels of serum AFP(2,688.6 ng/mL). He underwent distal gastrectomy with left lobectomy of the liver and cholecystectomy. Histology confirmed that the tumor consisted of 2 components: primary gastric choriocarcinoma and AFP-producing carcinoma. The pathological staging was pT4b(liver), N3aM0, Stage ⅢC. After surgery, AFP levels decreased to within the normal limits. Adjuvant chemotherapy(S-1)was administered for 1 year after the operation. Fourteen months later, PET-CT and EOB-MRI detected liver recurrence. He was treated with weekly paclitaxel(PTX)chemotherapy for the liver recurrence. After 12 courses, the tumor had disappeared. The patient was continuously treated with weekly PTX and is doing well without recurrence 24 months after the resection of the liver tumor. Co-existence of primary gastric choriocarcinoma and AFP-producing carcinoma is very rare. We report a case of liver recurrence of choriocarcinoma and AFP-producing carcinoma of the stomach showing a complete histological response after chemotherapy.

With the increase in demand flexibility and the rapid introduction of uncontrollable renewable power sources, effective schemes for managing the power usage of end-users are required. In this line, we propose an energy management framework for coordinating the power usage of communities of networked agents. More specifically, communities (groups of loads) coordinate to minimize their aggregated power imbalance, while taking into account each community's objectives and constraints, as well as the preferred power usage pattern of each end-user. For having a robust coordination that can work under unexpected events, we propose to assign the agents to communities using a measure of the flexibility of sets of agents. The coordination framework builds on the alternating directions method of multipliers (ADMM), algorithm that is used to implement a distributed coordination using a hierarchical architecture. While the distributed coordination allows to manage the power usage of each end-user, the hierarchical architecture enables the integration, in a single framework, of energy management problems that would be otherwise handled independently. We illustrate and analyze the coordination framework using three simulated scenarios.

Background: There are few randomized clinical trials examining adjuvant treatment in elderly breast cancer patients. While obtaining informed consent is essential for participation in clinical studies, there is little information on the frequency of agreement to participate among elderly patients. Furthermore, elderly patients might have specific reasons to decline participation. Patients and Method: The National Surgical Adjuvant Study of Breast Cancer 07 (N-SAS BC 07) is a randomized clinical trial in women over 70 years with HER2-positive primary breast cancer. The primary aim was to investigate the benefit of trastuzumab monotherapy compared with the combination of trastuzumab and chemotherapy. Key inclusion criteria were as follows: women between 70 and 80 years old with HER2-positive breast cancer; underwent curative operation; stage I to IIIA; with sufficient organ function. Patients were randomized to receive either trastuzumab plus chemotherapy or trastuzumab monotherapy. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival, relapse-free survival, safety, health-related quality of life, and cost effectiveness (NCT01104935). It was not possible to predict the number of patients who would agree to participate. In order to comprehensively assess the effect of postoperative adjuvant therapy, we evaluated the reasons why eligible patients declined to participate. The patients were registered in a cohort study to prospectively evaluate the subsequent treatment options and prognosis (07-Cohort). This study examined the obtaining of informed consent for N-SAS BC 07 and the reasons for declining participation, and compared the clinicopathological backgrounds between the N-SAS BC 07 and 07-Cohort groups. Results: 398 eligible patients have been recruited. Informed consent to participate in N-SAS BC 07 has been obtained from 275 patients (69%) and 123 patients (31%) who declined to participate in the RCT have been registered in the 07-Cohort. The common reasons to decline participation in the RCT were "cannot choose the treatment option (55%)", "refused chemotherapy (16%)", "wanted chemotherapy (9%)", "anxious about clinical studies (9%)" and "family opposition (8%)". The mean ages of the patients in N-SAS BC 07 and 07-Cohort were 73.9 and 74.6 years old, respectively. There were no differences in stage, surgical procedure, lymph node metastasis, or co-morbidities between the groups. ER-positive rate was higher in 07-Cohort group compared with N-SAS BC 07 group (53% vs. 37%, p=0.017, χ2 test). Conclusion: While we expected the number of registrants to be small, since N-SAS BC 07 investigated whether elderly patients with HER2-positive breast cancer should undergo chemotherapy, almost 70% of the patients accepted informed consent. The most common reason to decline participation in N-SAS BC 07 was "cannot choose the treatment option" and the majority refused chemotherapy. Furthermore, ER-positivity was higher in the 07-Cohort group, which suggested that ER expression in the patients with HER2-positive breast cancer might influence their decision to participate in the study or to choose the treatment option. Citation Format: Sagara Y, Sawaki M, Taira N, Saito T, Kashiwaba M, Iwata H, Kobayashi K, Nakayama T, Bando H, Mizuno T, Yamamoto Y, Tsuneizumi M, Takahashi M, Yamaguchi M, Kawashima H, Takashima T, Uemura Y, Hozumi Y, Sagawa N, Mukai H, Ohashi Y. A randomized clinical trial of postoperative adjuvant therapy for elderly breast cancer patients: Conditions of obtaining informed consent and reasons for declining participation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-18-01.

Background: Health-related quality of life (HRQoL) is one of the important outcomes in cancer control trials and has increasingly become the one of the primary foci. Obtaining informed consent from participants is essential for participation in randomized controlled trials (RCTs), but the participation in these RCTs may directly influence HRQoL, because treatment options are determined according to the allocation schedule. To date, only a few studies have compared HRQoL between clinical trial participants and decliners. Patients and Method: The National Surgical Adjuvant Study of Breast Cancer 07 (N-SAS BC 07) is a randomized controlled trial in women with HER2-positive primary breast cancer who are over 70 years of age. The primary aim was to investigate the benefit of trastuzumab monotherapy compared with combination therapy using trastuzumab and chemotherapy. The study concept and design were published in concept paper (Sawaki M. et al., Jpn J Clin Oncol. 2011). In this study, patients were randomized to receive either trastuzumab plus chemotherapy or trastuzumab monotherapy. The primary endpoint was disease-free survival, and the secondary endpoints were overall survival, relapse-free survival, safety, HRQoL, comprehensive geriatric assessment (CGA) and cost effectiveness (protocol ID; NCT01104935). HRQoL and CGA were assessed at registration (baseline), 2 month, 1 year, and 3 years after the start of protocol treatments using the Functional Assessment of Cancer Therapy-General (FACT-G), Hospital Anxiety and Depression Scale (HADS), EuroQol 5 Dimension (EQ-5D), Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, and the Philadelphia Geriatric Center (PGC) Morale Scale. The patients who declined to participate in N-SAS BC 07 were registered in a cohort study to prospectively evaluate the subsequent treatment options and prognosis (07-Cohort). The same questionnaire that was used in N-SAS BC 07 was used in 07-Cohort to evaluate HRQoL and CGA at entry. Results: Patients were enrolled from October 2012 to October 2016. During this period, 275 and 123 patients were registered in N-SAS BC 07 and 07-Cohort, respectively. The mean age at entry of the patients in the N-SAS BC 07 and 07-Cohort groups was 73.9 and 74.6 years, respectively. The questionnaire response rates at baseline in the patients in N-SAS BC 07 and 07-Cohort groups were 89% and 82%, respectively. There were no significant differences in FACT-G, HADS, EQ-5D, or TMIG index of competence at baseline between the groups, but the mean (standard deviation) scores of PGC Morale Scale in N-SAS BC 07 and 07-Cohort groups were 10.8 (3.3) and 9.9 (3.7), respectively, with the scores being significantly greater in the N-SAS BC 07 group (p=0.020, t-test). Conclusion: The PGC Morale Scale provides a multidimensional approach to assess the psychological state of older people. This study indicated that participation in the RCT did not affect the baseline QoL of elderly patients but suggested that the baseline QoL of the RCT participants was better than decliners. Citation Format: Saito T, Sawaki M, Hozumi Y, Sagawa N, Iwata H, Kashiwaba M, Kawashima H, Kobayashi K, Taira N, Takashima T, Takahashi M, Tsuneizumi M, Nakayama T, Baba S, Bando H, Mizuno T, Yamaguchi M, Yamamoto Y, Uemura Y, Ohashi Y, Mukai H. A randomized controlled trial of postoperative adjuvant therapy for elderly breast cancer patients: Comparison of health-related quality of life between clinical trial participants and decliners. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-09.

In order to investigate the pathophysiology of erythrocyte membrane proteins, 10 patients (6 pre- and 4 post-splenectomy) with hereditary spherocytosis (HS) and other patients with haemolytic anaemia were examined.The membrane proteins were analysed by biochemical and mass spectrometry.Reductions in the extracellular membrane of band 3 protein by eosin-5'-maleimide (EMA) binding test were greater in patients with pre-splenectomy HS than in patients with post-splenectomy HS, other types of haemolytic anaemia, and controls. Compared to patients with haemolytic anaemia and healthy controls, the band 3 protein of patients with HS pre- or post-splenectomy was more easily decomposed with N-glycosidase F and by mass spectrometry interactions with degraded low-molecular-weight spectrin and ankyrin. The resulting fragments were observed more frequently in pre-splenectomy than post-splenectomy HS. Haemoglobin-derived peptides were present in patients with haemoglobinopathy (Hb Evans, Hb Sabine) but not in those with haemolytic anaemia and healthy controls.Haemolysis in patients with HS occurred because the fragile proteins in erythrocytes (band 3, spectrin, and ankyrin) collapsed due to compression during blood circulation in the spleen. Further, haemolysis in patients with haemoglobinopathy occurred owing to membrane damage due to combined spectrin, band 3 with denatured haemoglobin in the vessel during blood circulation.

Studies on gaze analysis have revealed some of the relationships between viewers' gaze and their internal states (e.g., interests and intentions). However, understanding content browsing behavior in uncontrolled environments is still challenging because human gaze can be very complex; it is affected not only by viewers' states but also by the spatio-semantic structures of visual content. This study proposes a novel gaze analysis framework which introduces the content creators' point of view to understand the meaning of browsing behavior. Visual content such as web pages, digital articles and catalogs are comprised of structures intentionally designed by content creators, which we refer to as designed structure. This paper focuses on two design factors of designed structure: spatial structure of content elements (content layout), and their relationships such as “being in the same group”. The framework was evaluated with an experiment involving 12 participants, wherein the participant's state was estimated from their gaze behavior. The results from the experiment show that the use of design structure improved estimation accuracies of user states compared to other baseline methods.

In this paper, we explore the relationship between dual decomposition and the consensus-based method for distributed optimisation. The relationship is developed by examining the similarities between the two approaches and their relationship to gradient-based constrained optimisation. By formulating each algorithm in continuous-time, it is seen that both approaches use a gradient method for optimisation with one using a proportional control term and the other using an integral control term to drive the system to the constraint set. Therefore, a significant contribution of this paper is to combine these methods to develop a continuous-time proportional-integral distributed optimisation method. Furthermore, we establish convergence using Lyapunov stability techniques and utilising properties from the network structure of the multi-agent system.

This paper introduces the notion of manipulability to mobile, multi-agent networks as a tool to analyze the instantaneous effectiveness of injecting control inputs at certain, so-called leader nodes in the network. Effectiveness is interpreted to characterize how the movements of the leader nodes translate into responses among the remaining follower nodes. This notion of effectiveness is a function of the interaction topologies, the agent configurations, and the particular choice of inputs used to influence the network. In fact, classic manipulability is an index used in robotics to analyze the singularity and efficiency of configurations of robot-arm manipulators. To define similar notions for leader-follower networks, we use a rigid-link approximation of the follower dynamics and, under this assumption, we prove that the instantaneous follower velocities can be uniquely determined from that of the leaders', which allows us to define a meaningful and computable manipulability index for the leader-follower networks. This paper examines the property of the proposed index in simulation and with real mobile robots, and demonstrates how the index can be used to find effective interaction topologies.

Eye movements are an important cue to understand consumer decision processes. Findings from existing studies suggest that the consumer decision process consists of a few different browsing states such as screening and evaluation. This study proposes a hidden Markov-based gaze model to reveal the characteristics and temporal changes of browsing states in catalog browsing situations. Unlike previous models that employ a heuristic rule-based approach, our model learns the browsing states in a bottom-up manner. Our model employs information about how often a decision maker looks at a selected item (the item finally selected by a decision maker) to identify the browsing states. We evaluated our model using eye tracking data in digital catalog browsing and confirmed our model can split decision process into meaningful browsing states. Finally, we propose an estimation method of browsing states that does not require the information of the selected item for applications such as an interactive decision support.

Generation of natural human motion is one of key techniques for multimodal dialogue systems with a human-like avatar. In particular, natural and expressive lip motion synthesis is necessary to make conversation between a user and an avatar richer. However, such expressive lip motion is often difficult to be generated automatically because it can be changed depending on phonemic context and prosody. To address this difficulty, we introduce a novel motion generation method on the basis of the modulation of a set of dynamic models learned from neutral motion data. As a suitable model for lip motion generation, we adopt a hybrid dynamical system, which consists of linear dynamical systems for each motion unit and a symbolic automaton for switching between these units. We show that, from the viewpoint of control theory, it is possible to modulate linear dynamical systems for various types of motion. Early results demonstrate the applicability of the proposed method using lip motion synthesis for simple phoneme sequences.

To design interactive systems that proactively assist users' decision making, the users' gaze information is an important cue for the system to estimate users' selection criteria. Users sometimes change selection criteria while browsing content. Therefore, temporal changes of those criteria need to be traced from gaze data in short time scales. In this paper, we propose an approach to detecting users' distinctive browsing periods with its appropriate time-scale by leveraging multiscale exact tests so that the system can trace temporal changes of selection criteria. We demonstrate the applicability of the proposed method through a toy example and experiments.

The spatio-temporal correlation analysis between visual saliency and eye movements is presented for the estimation of the mental focus toward videos. We extract spatio-temporal dynamics patterns of saliency areas from the videos, which we refer to as saliency-dynamics patterns, and evaluate eye movements based on their correlation with the saliency-dynamics patterns in view. Experimental results using TV commercials demonstrate the effectiveness of the proposed method for the mental-focus estimation.

510Background: The relative value of trastuzumab (H) monotherapy as an adjuvant treatment compared to the standard combination treatment with chemotherapy (CT) is not clear for elderly breast cance...

People are being inundated under enormous volumes of information and they often dither about making the right choices from these. Interactive user support by information service system such as concierge services will effectively assist such people. However, human-machine interaction still lacks naturalness and thoughtfulness despite the widespread utilization of intelligent systems. The system needs to estimate user's interest to improve the interaction and support the choices. We propose a novel approach to estimating the interest, which is based on the relationship between the dynamics of user's eye movements, i.e., the endogenous control mode of saccades, and machine's proactive presentations of visual contents. Under a specially-designed presentation phase to make the user express the endogenous saccades, we analyzed the timing structures between the saccades and the presentation events. We defined resistance as a novel time-delay feature representing the duration a user's gaze remains fixed on the previously presented content regardless of the next event. In experimental results obtained from 10 subjects, we confirmed that resistance is a good indicator for estimating the interest of most subjects (75% success in 28 experiments on 7 subjects). This demonstrated a higher accuracy than conventional estimates of interest based on gaze duration or frequency.

This paper describes a distinctive phonetic feature (DPF) extraction method for use in a phoneme recognition system; our method has a low computation cost. This method comprises three stages. The first stage uses two multilayer neural networks (MLNs): MLNLF-DPF, which maps continuous acoustic features, or local features (LFs), onto discrete DPF features, and MLNDyn, which constrains the DPF context at the phoneme boundaries. The second stage incorporates inhibition/enhancement (In/En) functionalities to discriminate whether the DPF dynamic patterns of trajectories are convex or concave, where convex patterns are enhanced and concave patterns are inhibited. The third stage decorrelates the DPF vectors using the Gram-Schmidt orthogonalization procedure before feeding them into a hidden Markov model (HMM)-based classifier. In an experiment on Japanese Newspaper Article Sentences (JNAS) utterances, the proposed feature extractor, which incorporates two MLNs and an In/En network, was found to provide a higher phoneme correct rate with fewer mixture components in the HMMs.

The Rice Annotation Project Database (RAP-DB) was created to provide the genome sequence assembly of the International Rice Genome Sequencing Project (IRGSP), manually curated annotation of the sequence, and other genomics information that could be useful for comprehensive understanding of the rice biology. Since the last publication of the RAP-DB, the IRGSP genome has been revised and reassembled. In addition, a large number of rice-expressed sequence tags have been released, and functional genomics resources have been produced worldwide. Thus, we have thoroughly updated our genome annotation by manual curation of all the functional descriptions of rice genes. The latest version of the RAP-DB contains a variety of annotation data as follows: clone positions, structures and functions of 31 439 genes validated by cDNAs, RNA genes detected by massively parallel signature sequencing (MPSS) technology and sequence similarity, flanking sequences of mutant lines, transposable elements, etc. Other annotation data such as Gnomon can be displayed along with those of RAP for comparison. We have also developed a new keyword search system to allow the user to access useful information. The RAP-DB is available at: http://rapdb.dna.affrc.go.jp/ and http://rapdb.lab.nig.ac.jp/.

Recently, e-learning systems for self-learning with various types of retrieval functions have been developed. This paper describes a method for keyword extraction using retrieval information stored from many students through the retrieval functions. Firstly, we show that (1) teachers tend to consider technical terms as important, while students unfamiliar with the technical terms tend to retrieve the terms, therefore (2) there is a clear correlation between keywords extracted by the teachers and the retrieval words by the students. Secondly, we propse a method utilizing retrieval information from the students for keyword extraction, and show that the mehod can achieve quite better performance than a method extracting keywords using only lecture information.

In order to develop forging process of magnesium alloys without lubrication, frictional behavior of magnesium alloy AZ31B (Mg-3%Al-1%Zn) is evaluated by a tapered plug penetration test under dry condition. The cemented tungsten carbide (WC) plugs polished to be a mirror-like surface are coated with diamond-like carbon (DLC) and TiAlN by physical vapor deposition (PVD). The cylindrical hollow billets of AZ31B are penetrated by the tapered plugs at a temperature of 200°C. The surface roughness of the hole of the billet, the adhesion length of AZ31B on the plug surface and the penetration load are measured. Compared with WC and TiAlN coating, it is found that DLC coating is effective in preventing AZ31B from adhering to the tool surface and reducing the penetration load.

The POEMS reportedan effect of goserelin for fertility preservation. The Clinical Practice Guideline for Breast Cancer by The Japanese Breast Cancer Society indicates that the use of the LHRH agonist (LHRHa) for preventing chemotherapy-induced early menopause is a grade C-1 recommendation, and its use for fertility preservation is a grade C-2 recommendation. Results from previous studies on the effects of LHRHa for fertility preservation have varied owing to differences in chemotherapy regimens, definitions of ovarian failure, and dosages of tamoxifen. In the POEMS, the primary endpoint of ovarian failure at 2 years was significantly lower, and the secondary endpoint of pregnancy outcomes was better in the combination group; however, precise interpretation is difficult because many cases were excluded. Currently, it is not necessary to revise The Clinical Practice Guideline; however, desirable results from future studies may allow the recommendation of a specific dosage of LHRHa for fertility preservation.

Transcriptome Auto-annotation Conducting Tool (TACT) is a newly developed web-based automated tool for conducting functional annotation of transcripts by the integration of sequence similarity searches and functional motif predictions. We developed the TACT system by integrating two kinds of similarity searches, FASTY and BLASTX, against protein sequence databases, UniProtKB (Swiss-Prot/TrEMBL) and RefSeq, and a unified motif prediction program, InterProScan, into the ORF-prediction pipeline originally designed for the ‘H-Invitational’ human transcriptome annotation project. This system successively applies these constituent programs to an mRNA sequence in order to predict the most plausible ORF and the function of the protein encoded. In this study, we applied the TACT system to 19 574 non-redundant human transcripts registered in H-InvDB and evaluated its predictive power by the degree of agreement with human-curated functional annotation in H-InvDB. As a result, the TACT system could assign functional description to 12 559 transcripts (64.2%), the remainder being hypothetical proteins. Furthermore, the overall agreement of functional annotation with H-InvDB, including those transcripts annotated as hypothetical proteins, was 83.9% (16 432/19 574). These results show that the TACT system is useful for functional annotation and that the prediction of ORFs and protein functions is highly accurate and close to the results of human curation. TACT is freely available at http://www.jbirc.aist.go.jp/tact/.

The coordination and control of the agents in electrical networks is expected to have an important positive impact in future smart-grids. In the present paper we propose a distributed hierarchical coordination framework for power balancing, and the algorithms required to build such coordination architecture. This architecture is built such that a group of agents (a subtree of the hierarchy) can respond and adjust to deviations from a day-ahead plan for that group, without the need to coordinate with its upper levels of the hierarchy at every time step. The agents are arranged in groups by taking into account a measure of the flexibility of each group, thus allowing a partial de-coupling of the groups during the coordination, which reduces the required work of the central coordinator and gives robustness to the system. The assignment of agents to groups is formulated as a welfare maximization problem, a NP-hard problem for which an approximate solution can be obtained efficiently by using the sub-modularity and monotonicity of the involved functions. An electric vehicle charging coordination scenario is presented to exemplify the proposed architecture and methods.

This paper proposes a system architecture for event recognition that dynamically integrates information from multiple sources (e.g., multimodal data from visual and auditory sensors). The proposed system consists of multiple event classifiers called Continuous State Machines (CSMs). Each CSM has a state transition rule in a continuous state space and classifies time-varying patterns from a different single source. Since the rule is defined as an extension of Kalman filters (i.e., the next state is deduced from the trade-off scheme between the input data and the model's prediction), CSMs support dynamic time warping and robustness against noise. We then introduce an interaction method among CSMs to classify events from multiple sources. A continuous state space (i.e., vector space) allows us to design interaction as minimization of an energy function. This interaction enables the system to dynamically suppress unreliable classifiers and improves system reliability and the accuracy of classifying events in dynamically changing situations (e.g., the object is temporary occluded from one of multiple cameras in a gesture recognition task). Experimental results on gesture recognition by two cameras show the effectiveness of our proposed system. © 2003 Wiley Periodicals, Inc. Syst Comp Jpn, 34(14): 1–12, 2003; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/scj.10507