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There is concern that vitamin D deficiency is prevalent among children in Japan as well as worldwide. We conducted a nationwide epidemiologic survey of symptomatic vitamin D deficiency to observe its incidence rate among Japanese children. A questionnaire inquiring the number of new patients with vitamin D deficiency rickets and/or hypocalcemia for 3 years was sent to 855 randomly selected hospitals with a pediatrics department in Japan. In this survey, we found that 250 children were diagnosed with symptomatic vitamin D deficiency. The estimated number of patients with symptomatic vitamin D deficiency per year was 183 (95% confidence interval (CI): 145-222). The overall annual incidence rate among children under 15 years of age was 1.1 per 100,000 population (95% CI: 0.9-1.4). The second survey has provided detailed information on 89 patients with symptomatic vitamin D deficiency under 5 years of age in hospitals in the current research group. The nationwide and second surveys estimated the overall annual incidence rate of symptomatic vitamin D deficiency in children under 5 years of age to be 3.5 (2.7-4.2) per 100,000 population. The second survey revealed 83% had bowed legs, 88% had exclusive breastfeeding, 49% had a restricted and/or unbalanced diet and 31% had insufficient sun exposure among the 89 patients. This is the first nationwide survey on definitive clinical vitamin D deficiency in children in Japan. Elucidating the frequency and characteristics of symptomatic vitamin D deficiency among children is useful to develop preventative public health strategies.

A series of earthquakes struck Kumamoto City area, SW Japan, including a magnitude 7.3 (mainshock) at 01:25 (Japan Standard Time: JST) on April 16 and a foreshock with a magnitude 6.5 at 21:26 JST on April 14, 2016. The earthquakes tremendously damaged the vulnerable structures and left a huge amount of disaster waste. Immediately after the earthquake, the Kumamoto Prefectural Government designated a number of locations for the erection of temporary waste storage facilities essentially in the vicinity of the most affected zones for the purpose of removing of the disaster waste from the damaged areas and their accumulation in the properly managed sites. The facilities provided sufficient ground for the temporary storage, handling, early sorting, and crushing of metallic objects, wood and its derivatives, glass, soil and rock, concrete, and household appliances. Mashiki Machi (town) and Nishihara Village were the nearest settlements to the epicenters of Kumamoto earthquakes that were severely damaged. The estimated amount of the disaster waste generated in Kumamoto Prefecture was about 2.89 million tons, the recycling and disposal of which must be completed within two years from the date of earthquake. Among various waste disposal facilities, the Nishihara Village storage facility was selected as the target for in-depth site investigation and disaster waste estimation. Drone survey was also conducted at different intervals at Nishihara Village facility with emphasis on wood debris. The drone technique employed in this survey demonstrated a reliable method for capturing high-resolution images from the selected site in a remarkably short period of time, and a relatively quick measure for estimating the amount of the disaster waste immediately after the disaster occurred.

This paper investigates energy resilience of countries by quantifying the supplier diversification of both direct and embodied energy import. In particular, we quantify two approaches to diversify a country's supplier portfolio: by lowering the dependency on each supplier (portfolio diversification) and by having embodied energy suppliers that are different from its direct energy suppliers (portfolio differentiation). We examine possibilities for strategic utilization of embodied energy trade to compensate for low diversity of direct energy trade for three types of fossil resources: coal, oil, and gas. We find that the diversity of embodied energy import is much greater than that of direct energy import. Of the three energy resources, coal enables countries to adopt portfolio diversification and portfolio differentiation more than gas and oil. Our results suggest embodied energy can be considered as a transfer of energy resources across national borders that can directly benefit from the diversity of the world energy production by “skipping” the limited diversity of the world energy export.

Background Lymphovascular invasion (LVI) in high-grade clinical T1 bladder cancer is usually considered a poor prognostic factor, but it is often difficult to achieve correct staging of T1 bladder cancer and diagnose the presence of LVI because of the inadequacy of conventional transurethral resection specimens. The aims of this study were to evaluate the prognostic value of LVI in patients with correctly staged high-grade pathological T1 (pT1) bladder cancer who initially underwent transurethral resection in one piece (TURBO). Methods Eighty-six high-grade pT1 bladder cancer patients who underwent TURBO were enrolled. Risk of tumor understaging was avoided by examining the vertical resection margin of the TURBO specimen. Immunohistochemical staining using D2-40 and CD31 was performed to confirm LVI. We examined the association of LVI with other clinicopathological factors and the impact of LVI on progression-free survival and cancer-specific survival. Results The median follow-up period was 49 months (range, 6-142). In all patients, the tumors were accurately staged as pT1 at initial TURBO. LVI was detected in 15 patients (17%) and was significantly associated with tumor growth pattern (P = 0.001). Multivariate analysis identified LVI as the only independent predictor for reduced progression-free survival (HR, 4.48; 95% CI, 1.45-13.90; P = 0.009) and cancer-specific survival (HR, 4.35; 95% CI, 1.17-16.24; P = 0.029). Conclusions The presence of LVI in TURBO specimens independently predicts poor clinical outcomes in patients with high-grade pT1 bladder cancer. This information may help urologists to counsel their patients when deciding whether to choose a bladder-preserving strategy or radical cystectomy.

Size control of the poly (1,4-phenylene-5-hydroxyisophthalamide) hollow spheres was examined by tuning the polymerization condition, focusing on concentration, temperature and solvent. Higher concentration lowered the diameter owing to the higher degree of super-saturation for nucleation. Temperature drop during the polymerization just before the nucleation was so effective to make the diameter smaller. Moreover, the diameter was susceptive to the solubility of oligomers in the solvent, and higher content of liquid paraffin in the aromatic solvent lowered the solubility, resulting in the decrease in the diameter. Based on these results, the combination of the temperature drop and the solvent effect was the most desirable to prepare the smallest hollow spheres, and the diameter of hollow spheres could be controlled from 4.4 to 0.7 μm.

The present research focused on evaluating the role of waste fishbone hydroxyapatite (FB-HAP) in stabilizing heavy metals, particularly Pb and Zn, in incineration fly ash (IFA). Bones were collected from various fish species and processed for batch experiments. A commercial apatite product (Apatite II™) was also obtained for a comparative analysis. The experiments were performed at fishbone/fly ash ratios of 0.0 (control group) and 1:10 (by weight), settling times of 6, 12, 24, and 672 h (28 days), and W/S ratios of 1.0 and 1.5 mL/g. The highest Pb removal efficiency reached 86.39% at 28 days settling periods, when the FB-HAP dose was only 10% at W/S 1.5 mL/g. FB-HAP was found noticeably more effective (approximately 1.5 to 2 times) than Apatite II™, particularly at shorter settling periods. Stabilization of Zn was efficient at longer settling period (28 days) using FB-HAP. The highest stabilization rate of Zn was 62.67% at W/S 1.0 mL/g. The results indicated that settling time and W/S ratio were the most important factors to enhance the stabilization of Pb and Zn in IFA. Utilization of waste fishbone is expected to be a low-cost and eco-friendly technology.

Objective Glycemic control varies based on lifestyle factors and stress coping mechanisms, which are influenced by personality. The psychological factors associated with glycemic control have not yet been established in patients with type 2 diabetes mellitus (T2DM). The relationship between a 5-factor model of personality and glycemic control was evaluated in individuals with T2DM. Methods The subjects were 503 Japanese outpatients with T2DM. Glycated hemoglobin A1c (HbA1c) levels, depressive status, insomnia and personality traits were assessed. Lifestyle factors of the patients, such as habitual alcohol consumption and smoking, were also included in the analyses. Results Because the influence of insulin therapy on HbA1c is so strong, we stratified the patients according to insulin use. Simple regression analysis showed a significant correlation between HbA1c and neuroticism in patients who did not use insulin. After adjustment for confounders, multiple regression analyses revealed that none of the personality factors, including neuroticism, were found to be associated with HbA1c. Conclusion These findings suggest that personality traits do not have a large impact on glycemic control. Further studies are required to confirm the relationships between psychological factors and glycemic control using a longitudinal study design.

Aims/Objectives Glycemic control varies according to stress level and the efficacy of control measures, affecting the outcomes of diabetes. Although detailed coping styles have not been well studied in patients with type 2 diabetes mellitus, problem‐focused coping strategies are believed to be related to better control of blood glucose. Associations between coping profiles/dimensions and blood glucose control were examined in individuals with type 2 diabetes. Materials and Methods The participants included 503 Japanese patients (mean age 63.9 ± 12.6 years) with type 2 diabetes. The average glycated hemoglobin A1c (HbA1c) levels were calculated from HbA1c levels measured more than four times within the 12 months before the assessment. Coping profiles were assessed using the Brief Scale for Coping Profile. Lifestyle factors were also included in the analyses. Results Factors other than age were not associated with HbA1c levels in patients who used insulin. Conversely, habitual alcohol consumption, single status, the adaptive emotion‐focused coping dimension, and changing mood and changing one’s point of view profiles were associated with HbA1c levels. Conclusions These findings suggest that adaptive emotion‐focused coping supports glycemic control in type 2 diabetes patients who do not use insulin. Additional studies using a longitudinal design are required to further examine the relationships between psychological factors and glycemic control., This study investigated coping styles associated with glucose control in people with type 2 diabetes. An adaptive emotion‐focused coping dimension supports glycemic control in people with type 2 diabetes who do not use insulin.

Three pilot-scale lysimeters were operated for 4.5years to quantify the change in the carbon and nitrogen pool in an old landfill under various air injection conditions. The results indicate that air injection at the bottom layer facilitated homogeneous distribution of oxygen in the waste matrix. Substantial total organic carbon (TOC) decomposition and methane generation reduction were achieved. Considerable amount of nitrogen was removed, suggesting that in situ nitrogen removal via the effective simultaneous nitrification and denitrification mechanism is viable. Moreover, material mass change measurements revealed a slight mass reduction of aged MSW (by approximately 4.0%) after 4.5years of aeration. Additionally, experiments revealed that intensive aeration during the final stage of the experiment did not further stimulate the degradation of the aged MSW. Therefore, elimination of the labile fraction of aged MSW should be considered the objective of in situ aeration.

The combination chemotherapy regimen of eribulin (ERI) and trastuzumab (TRA)—the ERI-TRA regimen—has been shown to be highly tolerable for patients with recurrent or metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer. However, no sufficient clinical evidence is available for the long-term safety profile of the regimen. We report on three patients in the Phase I combination study of the regimen, for whom the regimen could be conducted over the long term. Patient #1 was a 68-year-old woman and underwent the regimen until cycle 23. Patient #2 was a 61-year-old woman and underwent the regimen until cycle 27. Patient #3 was a 59-year-old woman and underwent the regimen until cycle 22. All these patients had undergone TRA-based combination therapy before the onset of the regimen. Any new categories of adverse events did not occur in association with the long-term combination chemotherapy. Neutropenia experienced by these patients was reversible and easily manageable by dose adjustment (interruption/delay and reduction). Neither increase in the risk of cardiomyopathy nor the worsening of peripheral neuropathy greater than grade 1 was found. The present regimen was suggested to be a novel chemotherapeutic option for patients with HER2-positive recurrent or metastatic breast cancer. The fact that the long-term ERI-TRA regimen was successfully conducted for these patients can be supplementary clinical information that is beneficial for clinical oncologists.

OBJECTIVE Serum amino-terminal propeptide of C-type natriuretic peptide (NT-proCNP) levels have been proposed as a biomarker of linear growth in healthy children. The usefulness of NT-proCNP in patients with achondroplasia (ACH)/hypochondroplasia (HCH) remains to be elucidated. The objective was to study whether serum NT-proCNP level is a good biomarker for growth in ACH/HCH and other patients of short stature. DESIGN This was a longitudinal cohort study. PATIENTS Sixteen children with ACH (aged 0·4-4·3 years), six children with HCH (2·7-6·3 years), 23 children with idiopathic short stature (ISS) (2·2-9·0 years), eight short children with GH deficiency (GHD) (2·9-6·8 years) and five short children born small for gestational age (SGA) (2·0-6·6 years). Patients with ACH/HCH received GH treatment for 1 year. MEASUREMENTS Serum NT-proCNP levels and height were measured. RESULTS NT-proCNP levels positively correlated with height velocity in these short children (P < 0·05, r = 0·27). NT-proCNP levels inversely correlated with age in children with ISS alone (P < 0·01, r = -0·55). Serum NT-proCNP levels in patients with ACH/HCH were increased 3 months following the initiation of GH treatment (P < 0·05). Height SDS gain during GH treatment for 1 year was positively correlated with the changes in NT-proCNP levels after the initiation of GH (P < 0·01, r = 0·72). CONCLUSION Serum NT-proCNP levels may be a good biomarker to indicate the effect of GH treatment on growth in patients with ACH/HCH at least in the first year and height velocity in short stature patients.

Objective: Type 2 diabetes mellitus (T2DM) is associated with a high prevalence of depression, and depression is influenced by personality traits; however, these psychological factors have not been well studied in individuals with T2DM. The association between the use of a 5-factor model of personality and depressive symptoms was examined in individuals with T2DM. Methods: The subjects were 435 T2DM patients (mean age 63.1±12.6 years). Depressive status and personality traits were assessed using the Center for Epidemiologic Studies Depression Scale and the Ten-Item Personality Inventory, Japanese version, respectively. Lifestyle factors and glycated hemoglobin A1c levels in the patients were also included in the analyses. Results: Among the 435 subjects with T2DM, 130 (29.9%) exhibited possible depression, and 68 (15.6%) exhibited probable depression. After adjustment for confounders, Extraversion, Agreeableness and Neuroticism were found to be significantly associated with the presence of depression. No relationships were found between depression and HbA1c. Conclusion: These findings indicate that Extraversion and Agreeableness are protective factors, and Neuroticism is a risk factor for depression in T2DM patients. Psychological therapy focusing on personality may reduce depressive symptoms. Additional studies are needed to examine the relationships between psychological factors and depressive symptoms using a longitudinal study design.

The onset of type 2 diabetes mellitus(T2DM) is based on the insulin resistance and decreasing of insulin secretion. Residual β-cell function is a key factor in achieving optimal glycemic control in patients with type 2 diabetes. Glucagon induces insulin secretion by direcdtly stimulating β-cells, therefore glucagon stimulaton test(GST) is a reliable marker for β-cell function. Fasting C-peptide(CPR)-index(CPR[ng/ml] to glucose[mg/dl] ratio x100; F-CPRI) is used as a marker of insulin secretion. We evaluated the efficacy of postprandial CPR to glucose ratio(P-CPRI) as a tool for evaluating β-cell function. Japanese T2DM patients with inadequte glycemic control(HbA1c>7.0%) were enrolled in the study(n=333, insulin therapy =217). HbA1c, fasting CPR and glucose were measured, and F-CPRI was calculated. Postprandial(120 min after breakfast) CPR and glucose were measured, and P-CPRI was calculated. For the GST, CPR was determinated before and 6 min after 1mg of glucagon injection. GSTδCPR(CPR[6 min] - CPR[0 min]) was calculated. Factors correlated with GSTδCPR were analyzed using simple and multiple stepwise regression analysis. P value Disclosure Y. Matsuhashi: None. S. Chikazawa: None. H. Nakayama: None. M. Murabayashi: None. S. Mizushiri: None. S. Osonoi: None. K. Takahashi: None. H. Otaka: None. M. Yanagimachi: None. H. Murakami: None. M. Daimon: None.

The Stroke and Cardiovascular Disease Control Act was enacted in Japan in December 2018. This law has become the first ever legislative countermeasure against stroke and cardiovascular disease in Japan. The government shall make a “Basic Plan to Promote Stroke and Cardiovascular Disease Control Programs” with input from a council consisted of stakeholders. In accordance with the government plan, each prefecture shall make a prefectural plan. Both government and prefectural plans will be reviewed at least every six years. A nationwide approach is expected to contribute to reducing the burden of disease and to prolong healthy life expectancy.

Background: An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services. Methods: The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study. Results: After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P < 0.05) increased (eg, from 4 to 5 correctly identified symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009). Conclusions: Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance.

Energy is a critical component of achieving sustainable development. In addition to the three aspects of promoting access, renewables, and efficiency, the dimension of resilience in energy systems should also considered. The implementation of resilient energy systems requires a quantitative understanding of the socio-economic practices underlying such systems. Specifically, in line with the increasing globalization of trade, there remains a critical knowledge gap on the link between embodied energy in the production and consumption of traded goods. To bridge this knowledge gap, we investigate the resilience of global energy systems through an examination of a diversity measure of global embodied electricity trade based on multi-regional input-output (MRIO) networks. The significance of this research lies in its ability to utilize high resolution MRIO data sets in assessing the resilience of national energy systems. This research indicates that secure and responsible consumption requires the diversification of not only energy generation but also energy imports. This research will lay the ground for further research in the governance of resilience in global energy networks.

Hollow spheres of poly(1,4-phenylene-5-hydroxyisophthalamide) had been obtained by the reaction-induced phase separation during polymerization of 5-hydroxyisophthalic acid and 1,4-phenylene diamine in an aromatic solvent. In this study, formation mechanism of the hollow spheres was considered from the view points of eliminated small molecules, polymer structure, and cross-linking reaction. With respect to the eliminated small molecules, water was the most desirable to form gas-bubbles in droplets compared with methanol and acetic acid, due to the insolubility into the polymerization system. Rigid polymer structure was also needed to prepare hollow spheres owing to the rapid solidification of droplets. Further, phenolic hydroxyl group in 5-hydroxy-1,3-phenylene moiety caused the ester-amide exchange reaction to form cross-linked skin layer in the droplets. The efficient formation of the skin layer was important to encapsulate gas-bubbles in the droplets, resulting in the formation of hollow structure. © 2015 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2015, 53, 1966–1974

As one of the Nitrous Oxide (N 2 O) production pathways, denitrification plays an important role in regulating the emission of N 2 O into the atmosphere. In this study, the influences of different substrate concentrations and transient conditions on the denitrification rate and N 2 O-reducing activities were investigated. Results revealed that N 2 O production rates (i.e. denitrification rates) were stimulated by increased total organic carbon (TOC) concentration, while it was restrained under high oxygen concentrations. Moreover, the impact of nitrate concentrations on N 2 O production rates depended on the TOC/NO 3 − –N ratios. All the N 2 O production rate data fitted well to a multiplicative Monod equation, with terms describing the influence of TOC and nitrate concentrations, and an Arrhenius-type equation. Furthermore, results demonstrated that high temperatures minimized the N 2 O-reducing activities in aged municipal solid waste, resulting in an accumulation of N 2 O. On the other hand, a transient condition caused by changing O 2 concentrations may strongly influence the N 2 O production rates and N 2 O-reducing activities in solid waste. Finally, based on the results, we believe that a landfill aeration strategy properly designed to prevent rising temperatures and to cycle air injection is the key to reducing emissions of N 2 O during remediation of old landfills by means of in situ aeration.

Background Renal cell carcinoma is well-known for its propensity to metastasize to unusual sites. However, metastasis to the gallbladder has been rarely reported in the literature. Case presentation A 75-year-old Japanese (Asian) woman presented for further evaluation of a gallbladder polyp, 15 years after right radical nephrectomy for renal cell carcinoma. Computed tomography revealed a 12 mm enhancing pedunculated tumor in the gallbladder fundus. Open simple cholecystectomy was performed and the tumor was histologically confirmed as a metastasis of renal cell carcinoma to the gallbladder. Our patient is alive and has been disease-free for 3 years after cholecystectomy. Conclusions Although metastasis of renal cell carcinoma is a rare differential diagnosis of gallbladder tumors, simple cholecystectomy is likely to offer a chance of long-term survival for patients with gallbladder metastases of renal cell carcinoma.

Cystic lymphangiomas of the mesocolon are very rare in adults. They are usually asymptomatic, but can present with an acute abdomen. We report an adult patient with cystic lymphangioma of the mesocolon that manifested with peritonitis. A 33-year-old man presented with fever and severe pain with muscle guarding in the left abdomen. Laboratory data indicated high-grade inflammation. Enhanced computed tomography (CT) showed multiple low-density masses with peripherally enhancing rims, strongly suspicious for cysts, in the left abdomen. Based on a diagnosis of peritonitis, emergency surgery was performed and revealed many cysts in the descending mesocolon. Histopathological examination findings indicated a cystic lymphangioma. The post-operative course was uneventful, and 1-year follow-up CT showed no recurrence. This case demonstrates that cystic lymphangiomas of the mesocolon in adults can present with acute peritonitis, although this is extremely rare. Complete resection is required for accurate diagnosis and for preventing recurrence.

This article proposes to analyze the quantitative effects of a gradual physical and "social" exhaustion of a landfill site on an equilibrium waste management service. A gradual social exhaustion of a landfill is defined here as an upward shift of a "subjective factor" associated with the amount of waste, based on the plausible hypothesis that an individual will not accept excessive presence of landfilled waste. Physical exhaustion occurs when the absolute capacity of a landfill site decreases. The paper shows some numerical examples using specific functions and parameters, and proposes appropriate directions for three policy objectives: to decrease the equilibrium waste disposal, to increase the economic surplus of the individual and/or the waste management firm, and to lower the equilibrium collection fee.

A large amount of municipal and industrial flood waste was generated during a 2011 monsoon in Thailand. This paper examines the generation and disposal of flood waste related to Thailand floods using data obtained through field surveys and interviews with involved organizations. As a result, problems with flood waste treatment were found. These included a shortage of waste collection capacity such as vehicles and boats under emergency conditions, a lack of appropriately designed temporary waste storage at waste transfer stations, a lack of recycling systems for the wood waste that dominated waste from flooding, and the possibility thatmixed disposal ofmunicipal and industrial waste introduced contamination. To improve flood waste treatment, some proposals were provided for the predisaster, disaster and post-disaster stages.

A 66-year-old woman presented with a 2-year history of asthma has progression of dyspnea within a week, and a computed tomography (CT) revealed an endotracheal tumor at level of aortic arch. The resected tumor, measured by 18 × 12 × 10 mm, has histologically malignant features including frank invasion with desmoplastic stroma and foci of necrosis. Presence of glycogen and mucin was confirmed by periodic acid-Schiff (PAS) and diastase PAS staining. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin (CK) 7 and AE1/3, focally positive for CK5/6 and CK14, but negative for CK20. Thyroid transcription factor-1 (TTF-1), Napsin A, and SP-A, indicating lung parenchymal origin were all negative. Other muscular markers, neuroendocrine markers, renal cell carcinoma markers, and markers related to perivascular epithelioid cell tumors were all negative. Postoperative systemic examination suggests no primary tumor outside the lung. The follow up was excellent being recurrence free for 14 months in spite of the positive surgical margin by the tumor cells. This is a first report of rare neoplasm, clear cell carcinoma of salivary gland type, presenting as an endotracheal mass.

Background: It is important that the general population be aware of the early symptoms, since it has been shown that early arrival to hospitals leads better prognosis of stroke patients. However, the general population is not well informed about the early symptoms of stroke. This study was conducted to clarify which stroke symptoms are less well known and which information sources are related to awareness of stroke symptoms. Methods: A multiple-choice, mail-in survey involving 5,540 randomly selected residents, aged 40-74 years, of 3 cities in Japan was conducted. Their knowledge about stroke symptoms and their information sources were surveyed; information sources were classified as mass media (television/newspaper/radio) and personal communication sources (posters/leaflets/internet/health professionals/family and/or friends). ‘Awareness' was defined as selecting all 5 of the correct stroke symptoms from among 10 listed symptoms with decoy choices. The estimated fraction of the possible impact due to each source on the whole population was also calculated by odds ratios (ORs) and the proportion of respondents who selected each source (Pe). The combined effects of mass media and personal communication sources on awareness were also assessed. Results: Of the 5,540 residents, only 23% selected all 5 correct symptoms. Visual disturbance was the least known of the 5 symptoms (35%). All sources were positively related to awareness, with ORs (Pe) of: television, 1.58 (72.5%); newspaper, 1.79 (48.0%); radio, 1.74 (13.3%); posters, 1.73 (7.6%); leaflets, 1.50 (24.7%); Internet, 1.66 (5.6%); health professionals, 1.33 (34.8%), and family/friends, 1.21 (44.6%). The estimated fraction of the possible impact due to each source was higher for mass media (television, 0.31 and newspaper, 0.28) than personal communication sources (Internet, 0.04 and leaflets, 0.12). Mass media only and mass media/personal communication sources were significantly associated (ORs: 1.66, 2.75, respectively). Conclusions: As a single method of public education, television could be the most effective strategy. Moreover, the combined approach involving mass media and personal communication sources might have a synergistic effect. Less well-known symptoms, such as visual disturbances, should be noted in public education campaigns.

Methane from landfills contributes to global warming and can pose an explosion hazard. To minimize these effects emissions must be monitored. This study proposed application of portable gas detector (PGD) in point and scanning measurements to estimate spatial distribution of methane emissions in landfills. The aims of this study were to discover the advantages and disadvantages of point and scanning methods in measuring methane concentrations, discover spatial distribution of methane emissions, cognize the correlation between ambient methane concentration and methane flux, and estimate methane flux and emissions in landfills. This study was carried out in Tamangapa landfill, Makassar city-Indonesia. Measurement areas were divided into basic and expanded area. In the point method, PGD was held one meter above the landfill surface, whereas scanning method used a PGD with a data logger mounted on a wire drawn between two poles. Point method was efficient in time, only needed one person and eight minutes in measuring 400 m2 areas, whereas scanning method could capture a lot of hot spots location and needed 20 min. The results from basic area showed that ambient methane concentration and flux had a significant (p < 0.01) positive correlation with R2 = 0.7109 and y = 0.1544 x. This correlation equation was used to describe spatial distribution of methane emissions in the expanded area by using Kriging method. The average of estimated flux from scanning method was 71.2 g m−2 d−1 higher than 38.3 g m−2 d−1 from point method. Further, scanning method could capture the lower and higher value, which could be useful to evaluate and estimate the possible effects of the uncontrolled emissions in landfill.

Hollow spheres of aromatic polyamide are obtained by the reaction-induced phase separation during polymerization of 5-hydroxyisophthalic acid and 1,4-phenylene diamine in an aromatic solvent at a concentration of 1–2% at 320 °C without stirring. The hollow sphere has a dimple hole and the diameters of the hollow spheres are 3–4 μm. The droplets are initially generated via liquid–liquid phase separation and then rigid cross-linked network structure formed the rigid skin layer on the surface of the droplets. The solidification of the droplets occurred owing to the further polymerization in them with maintaining the morphology to form the hollow spheres. The hollow spheres exhibit outstanding thermal stability. © 2012 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2013

Three pilot-scale simulators with different aeration systems were constructed to explore the effects of aeration position on the reduction of pollutants. The simulator with a bottom aeration system successfully distributed oxygen and efficiently inhibited methane production. A close relationship was found between the oxygen distribution and the removal of pollutants, especially that of nitrogen. The transition between nitrification and denitrification in the longitude direction of the simulator with a bottom aeration system contributed to nitrogen removal in aerobic conditions. This process can be defined as a new path for nitrogen removal in addition to simultaneous nitrification and denitrification. The concentration of [Formula: see text]-N, total nitrogen and total organic carbon dropped to 3, 78 and 204 mg L−1, respectively, after 312 days of bottom aeration and to 514, 659 and 828 mg L−1, respectively, after 312 days of top aeration. These results indicate that the bottom aeration system was more efficient for reducing pollutants than the top aeration system.

S-1 plus cisplatin is the standard chemotherapy for recurrent gastric cancer. While depression and delirium are frequent in cancer patients, hypomania during chemotherapy is rare. We describe a rare case of hypomania during S-1 plus cisplatin treatment for recurrent gastric cancer. A 66-year-old woman, with no previous psychiatric disorder, received S-1 plus cisplatin for recurrent gastric cancer. She showed peculiar behavior. Physical examination, urine, blood and imaging findings were normal. There was no gastric cancer progression. During psychiatric consultation, she behaved inappropriately. However, she behaved normally while performing daily activities. She manifested a persistently elevated, expansive or irritable mood, clearly different from her usual non-depressed state, meeting hypomania diagnostic criteria. Her condition did not require chemotherapy discontinuation or additional medication. During the second and subsequent S-1 plus cisplatin cycles, symptoms were stable. Cancer patients often have adjustment disorders, depression and delirium, but rarely hypomania. Our patient showed no significant changes in blood biochemistry and brain and whole body imaging. While S-1 plus cisplatin-induced hypomania cannot be excluded, hypomanic symptoms did not improve during the chemotherapy rest period, nor was there deterioration during subsequent cycles, suggesting drug-induced mania to be unlikely. Possible onset mechanisms include manic defense phenomena, common with stressful life events. There are no reports of recurrent gastric cancer patients experiencing hypomania during S-1 or S-1 plus cisplatin therapy, i.e. our patient represents a rare course. Clinicians should recognize psychosis or mood disorders during gastric cancer treatment. Further accumulation of such rare cases might elucidate pathological mechanisms underlying hypomania in cancer patients.

This study estimates the overall cost savings that have been realized due to disposal of inert wastes in Japan because this material has been deposited in inert waste landfills (IWLs) that are designed exclusively for this purpose, instead of being co-dipsosed with organic wastes in more costly in sanitary landfills (SLs). The total realized cost savings were based on the disposed volume of inert waste and the actual disposal fees for IWLs and SLs for the period 1977–2006. The estimated reduction in expense is 4748 billion JPY for the period. On the other hand, if organic wastes had been deposited in IWLs along with inert wastes, costs would be incurred to clean up the sites because the surrounding environment may be polluted by the decomposition of the non-inert wastes and considerable efforts probably would be required to restore the polluted environment to its normal condition (this is because IWLs typically do not have a barrier system.) The potential cleanup cost was estimated to be 616 to 1226 billion JPY. These estimated costs were compared and it was found that the net reduction in expense was 3522 billion to 4122 billion JPY. Although the expense was reduced substantially, it was noted that a considerable cleanup cost would be generated. In particular, it was found that the increase in cleanup costs becomes most significant after the late 1990s

Hayashi T, Sentani K, Oue N, Anami K, Sakamoto N, Ohara S, Teishima J, Noguchi T, Nakayama H, Taniyama K, Matsubara A & Yasui W (2011) Histopathology59, 710–721 Desmocollin 2 is a new immunohistochemical marker indicative of squamous differentiation in urothelial carcinoma Aims: Urothelial carcinoma (UC) with squamous differentiation tends to present at higher stages than pure UC. To distinguish UC with squamous differentiation from pure UC, a sensitive and specific marker is needed. Desmocollin 2 (DSC2) is a protein localized in desmosomal junctions of stratified epithelium, but little is known about its biological significance in bladder cancer. We examined the utility of DSC2 as a diagnostic marker. Methods and results: We analysed the immunohistochemical characteristics of DSC2, and studied the relationship of DSC2 expression with the expression of the known markers uroplakin III (UPIII), cytokeratin (CK)7, CK20, epidermal growth factor receptor (EGFR), and p53. DSC2 staining was detected in 24 of 25 (96%) cases of UC with squamous differentiation, but in none of 85 (0%) cases of pure UC. DSC2 staining was detected only in areas of squamous differentiation. DSC2 expression was mutually exclusive of UPIII expression, and was correlated with EGFR expression. Furthermore, DSC2 expression was correlated with higher stage (P = 0.0314) and poor prognosis (P = 0.0477). Conclusions: DSC2 staining offers high sensitivity (96%) and high specificity (100%) for the detection of squamous differentiation in UC. DSC2 is a useful immunohistochemical marker for separation of UC with squamous differentiation from pure UC.

To decrease the age at first calving in Holsteins, the effects of average daily body weight gain (ADG) and crude protein (CP) level until first insemination on growth performance and milk production were examined. The MM group had a target ADG of 0.75 kg and received a diet with a CP level of 14%. The HM and HH groups had a target ADG of 1 kg; both these groups received a diet with CP levels 14% and 16%, respectively. The ADG in the HM and HH groups was 1.1 kg, whereas in the MM group it was 0.97 kg (P < 0.01). The HM and HH groups showed no differences in withers height at body weight 350 kg. The ages at first calving in MM, HM and HH groups were 23.1, 21.0 and 21.8 months, respectively. The HM and HH groups had lower milk yield at day 305 than the MM group (P < 0.01). These results suggest that growth performance until first insemination should be maintained at an ADG of 0.97 kg or less with a CP level of approximately 14%, to shorten time until first insemination and prevent the decrease of milk yield.

We investigated the effect of cellooligosaccharide (CE) or a combination of dextran and Lactobacillus casei ssp. casei strain JCM1134T (synbiotic; SB) feeding on growth performance, fecal condition and hormone concentrations in Holstein calves. Fifty-two female Holstein calves were randomly assigned to three treatment groups: CE feeding group (n = 16), SB feeding group (n = 18), and control group (n = 18). Body weight at 90 days of age, as well as daily body weight gain (DG) and feed efficiency after weaning to 90 days of age were greater (P

An investigation was carried out to elucidate landfill gas (LFG) and the vegetation characteristics in closed landfill. The results indicate that the stabilization process of the landfill is an important factor influencing the components of landfill gases. The coverage, height and species of vegetation increase with the closed time of landfill. Fourteen species were observed in the investigated cells, dominated by Phragmites australis, an invasive perennial plant. The concentrations of methane and carbon dioxide from vegetated cover soil were lower than those from non-vegetated cover soil.

【目的】頭痛のみ発症した非出血性解離性椎骨動脈瘤に注目し，自験例より検討した．【方法】平成19年11月から平成21年10月までに当院で頭痛のみで診断された非出血性解離性椎骨動脈瘤うち，経過観察が可能であった13例について検討した．【結果】初回の画像検査では，pearl and string signは2例，dilatationは8例，string signは3例であった．画像上改善を認めたのは11例で，残り2例では解離性椎骨動脈瘤の増大がみられたために手術を施行した．9例で初回の画像検査時に解離腔や壁内血腫を認め診断が可能であったが，残りの4例では経時的な血管形態変化で解離性と判断した．頭痛は全例で後頭部痛であった．中には激しくない頭痛も存在していた．【結論】激しくない後頭部痛でも解離性椎骨動脈瘤を考慮する必要がある．そして，経時的な画像検査は診断や外科的治療の検討に重要と考えられた．

Objectives: To demonstrate the usefulness of transurethral resection in one piece (TURBO) as an accurate pathological staging tool for bladder tumor. Methods: Ninety-seven patients with newly diagnosed bladder cancer underwent TURBO that was performed either in an en bloc or in a divisional manner. The histological quality of the resection specimens was evaluated and the pathological stage was assigned on the basis of the depth of invasion, which was histologically determined. Results: Specimens obtained by TURBO were well oriented and their 3-D architecture was maintained. This allowed a histological assessment of the entire specimen. Portions of muscularis propria were identified beneath the tumor base in the specimens of 80 (82%) patients. In only seven (7%) patients, the tumors had a deep resection margin positive for carcinoma and were ambiguously staged as “pT1 or higher” or “pT2 or higher”. Thus, definite pathological staging of TURBO specimens was possible in 90 (93%) patients (pTa, 30; pT1, 58; pT2, 2). Conclusions: An accurate pathological stage can be assigned to the TURBO specimen in most bladder cancer patients.

To elucidate the influence of landfill gas (LFG) emission on environmental factors, an ecological investigation that was primarily concerned with the characteristics of vegetation, cover soil, and solid waste in the landfill was carried out. Temporal and spatial variations in vegetation diversity and coverage and their effects on reducing the emission of methane in the landfill were investigated. The results showed that both vegetation coverage and diversity increased with elapsed landfill closure time. The transition trend of the vegetation species was from perennial plant (Phragmites australis) to annual plants. Perennial vegetation was the dominant type of vegetation during the early closure period, and annual vegetation coverage increased with closure time. Vegetation preferentially appeared in areas of comparatively high depth of cover soil, which was characterized by high moisture retentiveness that enabled vegetation growth. The concentrations of methane and carbon dioxide in the cover soil significantly decreased with increasing closure time. The concentrations of methane and carbon dioxide from bare cover soil were higher than those from vegetated cover soil whereas the CO(2) flux of bare cover soil was less than that of vegetated cover soil.

We report a case of sylvian hematoma enlarging 3 days after neck clipping for a ruptured anterior communicating artery aneurysm, in the contralateral sylvian fissure to the operative approach. This 65-year-old man was admitted with sudden loss of consciousness by ambulance. Angiography revealed a saccular aneurysm at the anterior communicating artery complex, measuring 2.3×2.4 mm and pointing inferiorly. The aneurysmal neck was successfully clipped by using the right pterional approach. To minimize predictable vasospasm, the hematoma in the left sylvian stem was removed. Postoperative CT scan showed a considerable decrease in hematoma in the basal cistern, but a slight decrease in the vertical portion of the left sylvian fissure. The patient’s consciousness gradually recovered, but deteriorated again 3 days after the operation. CT scan showed a large high-density area in the sylvian fissure suggesting unexpected enlargement of sylvian hematoma. A left fronto-temporal craniotomy was performed. When the subpial hematoma around the sylvial fissure was removed, a large amount of bloody cerebrospinal fluid (CSF) flowed out. The cavity containing bloody fluid was located in the temporal lobe. Postoperative course was uneventful. He recovered well, but moderate sensory aphasia remained. Sylvian hematoma is rarely associated with ruptured anterior communicating artery aneurysms. Furthermore, there has been no report describing delayed onset sylvian hematoma as far as we are aware. The following mechanism was considered to explain this very rare condition. Removal of subarachnoid hematoma in the left sylvian fissure made a recovery of CSF flow up to the limen insulae, but CSF appeared to be blocked from entering the distal sylvian fissure by the thick subpial sylvian hematoma. Instead of normal CSF flow route, CSF may enter into the weakened subpial space to allow accumulation of bloody CSF in the temporal lobe. Subpial hematoma may act as a one-way valve.

A 61-year-old woman was referred to our hospital with epigastralgia and appetite loss. Barium examination and upper gastrointestinal endoscopy revealed uneven erythematous mucosa with multiple elevated lesions from the gastric fornix to the upper corpus. Abdominal computed tomography showed thickening of the wall of the fornix and swelling of perigastric lymph nodes, but whole-body gallium scintigraphy and bone marrow examination did not indicate further involvement. Biopsy specimens showed diffuse infiltration of large atypical lymphoid cells in which Epstein-Barr virus (EBV) was detected by in situ hybridization. Diffuse large B-cell lymphoma (DLBCL), stage II1, was diagnosed. Combination chemotherapy [cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP)], was given, and this was followed by radiotherapy. Partial remission was achieved by chemotherapy, but the disease progressed rapidly during radiotherapy. Because the reported prognosis of EBV-positive DLBCL is unfavorable, the therapeutic strategy for EBV-positive gastric DLBCL should be considered carefully.

Toward Sustainable Development in East Asia.- Air, Soil, and Water Pollution in East Asia.- Energy, Resource, and Waste Management in East Asia.- Environmental problems and preventive measures in East Asian Countries.- Environmental Ethics & Politics .- Measurement Technique for Quality of Atmosphere, Water and Soil.- Techniques for Improving Air Environments.- Recycling of Municipal Solid Waste Itineration Residue and Stabilization of Organic Solid Waste in Landfill.- Water Quality Improvement.- River Improvement.- Ecological Conservation Engineering.- Environmental Evaluation Method Using GIS.- Environmental Problems and Systems Analysis.- Material/Energy Flow Analysis and Mathematic Model.- Economic Modelling and Policy Combination.- Economic Analysis on Environment.- Environmental Valuation.- Evaluation of Environmental Burden and Input-Output Analyses of Environmental and Economic Repercussion.- Environmental Project Management.- International Environmental Cooperation and Project Evaluation.- Strategic Analysis on Environmental Policy.- Trade and Environment, Environmental Management, and Factor Analysis of Pollution Emissions.

In this chapter, we explain the basic concepts of the environment and environmental systems analysis. In Sect. 10.1, the concepts of environmental problems are explained using the environmental capacity relationship between the nature and scale of human activities. In Sect. 10.2, the basic concepts necessary for environmental protection are explained. Finally, in Sect. 10.3, the procedures and methods of environmental systems analysis are detailed in a systematic analysis of environmental problems focusing on the relationship between the natural environment and human activities.

Nitrous oxide (N(2)O) has gained considerable attention as a contributor to global warming and depilation of stratospheric ozone layer. Landfill is one of the high emitters of greenhouse gas such as methane and N(2)O during the biodegradation of solid waste. Landfill aeration has been attracted increasing attention worldwide for fast, controlled and sustainable conversion of landfills into a biological stabilized condition, however landfill aeration impel N(2)O emission with ammonia removal. N(2)O originates from the biodegradation, or the combustion of nitrogen-containing solid waste during the microbial process of nitrification and denitrification. During these two processes, formation of N(2)O as a by-product from nitrification, or as an intermediate product of denitrification. In this study, air was injected into a closed landfill site and investigated the major N(2)O production factors and correlations established between them. The in-situ aeration experiment was carried out by three sets of gas collection pipes along with temperature probes were installed at three different distances of one, two and three meter away from the aeration point; named points A-C, respectively. Each set of pipes consisted of three different pipes at three different depths of 0.0, 0.75 and 1.5 m from the bottom of the cover soil. Landfill gases composition was monitored weekly and gas samples were collected for analysis of nitrous oxide concentrations. It was evaluated that temperatures within the range of 30-40°C with high oxygen content led to higher generation of nitrous oxide with high aeration rate. Lower O(2) content can infuse N(2)O production during nitrification and high O(2) inhibit denitrification which would affect N(2)O production. The findings provide insights concerning the production potentials of N(2)O in an aerated landfill that may help to minimize with appropriate control of the operational parameters and biological reactions of N turnover.Investigation of nitrous oxide production potential during in situ aeration in an old landfill site revealed that increased temperatures and oxygen content inside the landfill site are potential factors for nitrous oxide production. Temperatures within the range of optimum nitrification process (30-40°C) induce nitrous oxide formation with high oxygen concentration as a by-product of nitrogen turnover. Decrease of oxygen content during nitrification leads increase of nitrous oxide production, while temperatures above 40°C with moderate and/or low oxygen content inhibit nitrous oxide generation.