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Anthropogenic sources of mercury emissions have a significant impact on global pollution. Therefore, finding uncharacterised sources and assessing the emissions from these sources are important. However, limited data are available worldwide on mercury emissions from crematories. In Japan, 99.9% of dead bodies are cremated, which is the highest percentage in the world, and more than 1600 crematories are in operation. We thus focused on emissions from crematories in Japan. The number of targeted facilities was seven, and we used continuous emission monitoring to measure the mercury concentrations and investigate mercury behaviour. The total mercury concentrations in stack gases were a few μg/Nm³ (normal cubic meters). Considering the time profile of mercury and its species in cremations, the findings confirmed that the mercury in stack gas originated from dental amalgam. The amount of mercury emissions was calculated using the total concentration and gas flow rate. Furthermore, the annual amount of mercury emission from crematories in Japan was estimated by using the total number of corpses. The emission amount was considerably lower than that estimated in the UK. From statistical analyses on population demographics and measurements, future total emissions from crematories were also predicted. As a result, the amount of mercury emitted by crematories will likely increase by 2.6-fold from 2007 to 2037. [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to determine whether the concepts of critical velocity (CV) and anaerobic swimming capacity (ASC) could be used by coaches as a reliable index in order to monitor 1500-m Surface (SF) performances in Finswimming. Thirteen Finswimmers (6 males and 7 females, 24+/-6 years), members of the Japanese national team, were instructed to swim three different swimming distances (400-, 800-, and 1500-m) at maximal effort in a 50m long course swimming pool. CV and the ASC were calculated using 400-m and 800-m swim times. Mean height and body mass were 170.2 cm and 69.7 kg in male and 160.5 and 61.0 kg in female. A highly positive correlation was found between the CV and the mean velocity of 1500-m SF (V1500) (r=0.91, P<0.01), but no correlation was found between the ASC and V1500. (r=0.46, P=0.11). However, a high correlation was found between the ASC and the residual error of V1500, calculated from the relationship between V1500 and the CV (r=0.89, P<0.01). These results suggest that the CV is a useful method for evaluating 1500-m SF performance and an aerobic performance expressed as the CV contributes to 1500-m SF performance. [ABSTRACT FROM AUTHOR]

This study assessed the characteristics and toxicity of aqueous pyrolytic liquid (APL) derived from digested sewage sludge on anaerobic digestion (AD) and determined its rate-limiting step. Digested sewage sludge was pyrolyzed at multiple temperatures (350-650 °C) and moisture levels (0-40.4 %), resulting in APLs with varying AD toxicities. APL 350 °C-0 % showed the least toxicity, whereas APL 650 °C-40.4 % exhibited the greatest toxicity. Glucose (GL) and sodium acetate (SA) were introduced to elucidate the rate-limiting steps. SA, but not GL, enhanced APL conversion to CH 4 . And volatile fatty acid lack was observed in treatments without SA addition. This suggested that acidification was the primary rate-limiting step. This finding was confirmed using the modified Gompertz model: SA considerably improved the maximum methane production rate, whereas GL did not. Insights gained from this research clarified the feasibility and potential of AD for APL utilization and conversion., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Microplastic (MP) pollution is a growing public and scientific concern. In urban environments, wastewater treatment plants (WWTPs) are major sources of MPs. This study sampled sludge and separated water from each sludge treatment unit in two WWTPs in Osaka, Japan. Analyzing method for MPs in sewage sludge was optimized, ultrasonic pretreatment and double digestion were introduced into the analyzing method of MPs in sewage sludge, recovering test of standard MPs proved its high efficiency. Then MPs larger than 100 μm were extracted and analyzed, their size and type were recorded, the MP concentration was calculated, and the MP flow in the sludge treatment system was estimated. MPs were detected at every step of the sludge treatment process, and 13 types of MPs were identified. The MP concentration in sludge ranged from 81 ± 48 to 6470 ± 1490 particles/kg dry sludge (DS). In the separated water, MP concentrations were much lower, ranging from 0 to 1740 ± 794 particles/kg DS. During the thickening and dewatering processes, nearly all MPs were transferred into thickened or dewatered sludge; only 5-10 % of MPs returned to the primary sedimentation pond with the separated water. The most common types of MPs were PMMA, PE, and PS. No significant differences in MP type distributions were observed among sampling batches; however, significant differences in a few types of MPs were detected between treatment units, which requires further investigation. All detected MPs were smaller than 1000 μm; larger MPs might have been removed in the grit chamber before reaching the primary or secondary sedimentation ponds. Overall, the particle size distribution did not substantially change during sludge treatment., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kazuyuki OSHITA reports financial support was provided by the Environmental Restoration and Conservation Agency, Ministry of Environment, Japan. Masaki TAKAOKA reports financial support was provided by the Environmental Restoration and Conservation Agency, Ministry of Environment, Japan. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background/aim: Sarcopenia is diagnosed based on grip strength and skeletal muscle mass. Although decreased skeletal muscle mass has been reported to be associated with poor outcomes after hepatectomy, a few studies have included data on grip strength in hepatectomy candidates. This multicenter study investigated the clinical factors and postoperative complications associated with sarcopenia by assessing the grip strength and skeletal muscle mass in patients undergoing hepatectomy for hepatocellular carcinoma (HCC)., Patients and Methods: Data from patients who underwent hepatectomy for HCC between January 2020 and March 2022 were retrospectively collected from multi-institutional databases. Sarcopenia was defined as reduced grip strength and skeletal muscle mass. The patients were categorized into the sarcopenia and non-sarcopenia groups, and baseline characteristics and short term outcomes were compared between the two groups., Results: Overall, 253 patients were included, among which 36 (14.2%) had sarcopenia. The sarcopenia group was significantly associated with older age, low body mass index, comorbid heart or chronic pulmonary disease, cerebrovascular accident history, and overall and major postoperative complications compared to the non-sarcopenia group. Among major postoperative complications [Clavien-Dindo classification (CDC) ≥III], the incidence of bile leakage and intra-abdominal abscess were higher in the sarcopenia group than in the non-sarcopenia group. Multivariate analysis revealed that sarcopenia was an independent risk factor for overall and major postoperative complications (CDC ≥III)., Conclusion: Sarcopenia, defined by grip strength and skeletal muscle mass, is a predictor of overall and major complications after hepatectomy for HCC., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background/aim: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare subtype of primary liver carcinoma, characterized by the unequivocal presence of both hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). However, its clinicopathological characteristics have not yet been thoroughly elucidated. In particular, cholangiolocellular carcinoma (CLC) was classified as a subtype of cHCC-CCA according to the 2010 World Health Organization (WHO) classification. However, according to the 2019 WHO classification, tumors displaying histological features consistent with CLC but lacking evidence of hepatocellular differentiation should be regarded as a distinct subtype of iCCA. Nevertheless, there may be notable differences in prognosis between CLC and iCCA, indicating the necessity for refining the classification when devising clinical treatment strategies. This study aimed to determine the clinicopathological features and prognostic factors of cHCC-CCAs following radical resection., Patients and Methods: Between January 2010 and September 2020, based on the 2010 WHO classification, we retrospectively studied the clinicopathological features and prognoses of patients with cHCC-CCAs in relation to the pathological dominant classification. The patients were classified according to the pathological dominant components of cHCC-CCA as HCC-dominant (HCC-D), iCCA-dominant (iCCA-D), or CLC-dominant (CLC-D)., Results: Data of 55 patients who underwent primary radical hepatectomy for cHCC-CCA were analyzed. The prevalences of each dominant classification were HCC-D, 21 (38.2%); iCCA-D, 11 (20.0%); and CLC-D, 23 (41.8%). Multivariate analysis showed that dominant classification was an independent risk factor for recurrence and cancer-specific survival (CSS)., Conclusion: The dominant classification of cHCC-CCA has the potential to predict recurrence and CSS., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Objective: This study investigated whether pulmonary artery catheter placement method with combined transesophageal echocardiography and pressure waveform measurement improve the placement success rate within 5 min and reduce the incidence of arrhythmia during pulmonary artery catheter placement compared to conventional pulmonary artery catheter placement with pressure waveform measurement only., Methods: This single center prospective observational study included 129 patients scheduled for cardiac surgery. Patients were divided into two groups. In the conventional group, the pulmonary artery catheter was placed by monitoring the pressure waveform and the length of placement; in the combination group, not only were the pressure waveform and the length monitored but also the following transesophageal echocardiography images: "mid esophageal bicaval view," " mid esophageal modified bicaval view," a mirror image of "mid esophageal 4 chamber view," "mid esophageal right ventricular inflow-outflow view," and "mid esophageal ascending aortic short axis view.", Results: A 1:1 propensity score matching was used to adjust for confounding factors. The success rates of pulmonary artery catheter placement within 5 min in the conventional and combination groups were 85.5 % vs. 97.8 % (p = 0.032) before matching, and 73.7 % vs. 100 % (p = 0.001) after matching. The incidences of arrhythmias in the conventional and combination groups were 28.9 % vs. 17.4 % (p = 0.20) before matching, and 28.9 % vs. 18.4 % (p = 0.42) after matching., Conclusion: Pulmonary artery catheter placement with transesophageal echocardiography had a significantly higher rate of successful placement within 5 min, but no significant differences were observed in the incidences of arrhythmias., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Several studies have demonstrated a relationship between genetic polymorphisms of interleukin-1 beta (IL-1β) and cancer development; however, their influence on cancer prognosis is unknown. In the present study, we aimed to evaluate the impact of IL-1β single nucleotide polymorphisms on the hematogenous dissemination and prognosis of hepatocellular carcinoma., Methods: We conducted a retrospective cohort study including patients with hepatocellular carcinoma who underwent primary liver resection at our hospital between April 2015 and December 2018. The primary endpoints were overall and recurrence-free survival. Secondary endpoints were microscopic portal vein invasion and number of circulating tumor cells., Results: A total of 148 patients were included, 32 with rs16944 A/A genotype. A/A genotype was associated with microscopic portal vein invasion and number of circulating tumor cells (p = .03 and .04). In multivariate analysis, A/A genotype, alpha-fetoprotein level, and number of circulating tumor cells were associated with microscopic portal vein invasion (p = .01, .01, and <.01). A/A genotype, Child-Pugh B, and intraoperative blood loss were independent predictive factors for overall survival (p = .02, <.01, and <.01)., Conclusions: Our results indicate that the IL-1β rs16944 A/A genotype is involved in number of circulating tumor cells, microscopic portal vein invasion, and prognosis in HCC., (© 2024 The Author(s). Journal of Hepato‐Biliary‐Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)

In recent years, lipids reused from urban wastewater materials have come to prominence as possible raw materials for biodiesel production. The present work investigated liquefied dimethyl ether (DME) for the lipid extraction of fat balls from sewage pumping stations. A response surface methodology (RSM) based on a Box-Behnken design (BBD) was utilized to optimize DME extraction parameters (sample size, velocity of liquefied DME, and DME/sample ratio). The maximum lipid yield was 65.2% under optimal DME extraction conditions (sample size 1 mm, velocity of liquefied DME 3.3 m/h, and DME/sample ratio 80 mL/g). Under the optimum conditions, the DME technique exhibited higher lipid recovery than that of mechanical shaking extraction (49.0%) or Soxhlet extraction (62.0%). The extracted lipids were converted into biodiesel, resulting in an approximately 35.2-46.2% biodiesel yield. Furthermore, the fatty acid methyl ester composition of the extracted lipids was characterized. These significant findings highlight the promising potential of fat balls as sustainable biodiesel feedstocks and provide valuable insight that will aid the development of better technology for lipid extraction., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

This report discusses a rare case of delayed migration of a Sapien 3 Ultra Resilia (S3UR) valve following transcatheter aortic valve implantation. An 81-year-old Japanese woman had a borderline aortic annular size of 20-23 mm according to the manufacturer's size chart. We chose to implant a smaller S3UR of 20 mm with an 80/20 depth ratio to allow for a second intervention, ensuring good hemodynamics and minimizing paravalvular leak. The patient initially had a favorable outcome despite an accidental 50/50 depth ratio during implantation. On postoperative day 3, the S3UR migrated into the left ventricular outflow tract. Emergency surgical aortic valve replacement was performed to retrieve the migrated valve. Use of the S3UR has led to a growing preference for smaller valve sizes. However, the risk of migration should be recognized. When an accidental 50/50 depth ratio implantation is encountered, post-dilation or second valve implantation should be performed immediately., Competing Interests: No conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press.)

Introduction: Hypotension is a cardiovascular symptom that appears at the onset of anaphylaxis. It is considered an important factor as it affects the severity of anaphylaxis; however, its details remain to be elucidated. In this study, we investigated the characteristics of hypotension at the onset of anaphylaxis during anesthesia, along with the relationship between hypotension, tryptase and histamine., Materials and Methods: The minimum systolic blood pressures of patients diagnosed with anaphylaxis using the clinical diagnostic criteria of the World Allergy Organization guidelines were extracted from electronic anesthesia records. We analyzed changes in tryptase and histamine that were measured after the onset of anaphylaxis. We analyzed the relationship of tryptase and histamine with the minimum systolic blood pressure and the severity of anaphylaxis., Results: Of 55,996 patients, 25 were diagnosed with anaphylaxis during anesthesia (0.045%). Among these patients, the minimum systolic blood pressure was less than 90 mmHg. Furthermore, the minimum systolic blood pressure was inversely correlated with tryptase levels immediately to 1 hour, and 2 to 4 hours after the onset of anaphylaxis. The minimum systolic blood pressure was inversely correlated with the severity of anaphylaxis. The severity of anaphylaxis was positively correlated with tryptase levels immediately to 1 hour, and 2 to 4 hours after the onset of anaphylaxis., Conclusion: Hypotension tended to reflect the severity of anaphylaxis. Tryptase is an adjunct in the diagnosis of hypotension and may be a useful indicator of the severity of anaphylaxis. A larger-scale study is needed to validate these results.

Background: Having higher muscle mass in early adulthood is an important factor in preventing sarcopenia. However, university students undergo lifestyle changes compared to their high school years, which may lead to changes in body composition, such as an increase in body fat and a decrease in muscle mass. The study aimed to investigate the association between body composition and lifestyle behaviors, including chronotype, among Japanese female university students, due to the prevalence of underweight among young females in the country., Methods: The physical activity level (PAL), daily dietary intake status, morningness-eveningness questionnaire (MEQ) score, and body composition of 230 students were assessed in this cross-sectional study. Body composition was measured using a multifrequency bioelectrical impedance analyzer, and body mass index (BMI), body fat percentage (%BF), and skeletal muscle mass index (SMI) were determined., Results: Individuals who were evening type (ET) had a higher %BF and lower SMI than those who were non-ET, but no differences in body weight or BMI were found. Although ET individuals had lower total energy intake, protein intake, and PALs than non-ETs, the differences were small. However, multiple regression analyses showed that SMI was significantly positively associated with MEQ and PAL, and %BF was significantly negatively associated with MEQ and PAL., Conclusion: These results suggest that female university students with lateness of chronotype and low physical activity have a body composition imbalance resulting in higher body fat and lower muscle mass. Therefore, young females may need to take chronotype-specific measures (especially ET individuals) to help them maintain an appropriate body composition., (© 2024. The Author(s).)

We investigated the potential of waste materials from wastewater treatment plants (WWTPs) to serve as an alternative lipid feedstock for biodiesel production. The average lipid recoveries from fat balls (46.4%) and primary scum (49.5-54.5%) were higher than the lipid recovery of primary sludge (15.8-16.4%). The yield of biodiesel produced from the extracted lipids ranged from 5.7 to 20.1%. There were considerable site- and season-dependent variations in the characteristics of the lipid waste materials. Radiocarbon analysis indicated the presence of fossil-derived carbon (26.0-42.0%) in the biodiesel obtained from wastewater lipids. Finally, we estimated the potential for biodiesel production from WWTP-derived lipids; about 333.0 metric tons of biodiesel per year could be produced from fat balls and primary scum in Japan. The results indicate that lipid-rich materials from WWTPs represent a valuable alternative feedstock for biodiesel production., Competing Interests: The authors declare there is no conflict., (© 2024 The Authors This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying, adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).)

The cusp overlap technique allows greater visual separation between the basal annular plane and the conduction system and decreases the permanent pacemaker implantation rate. We assessed the impact of the cusp overlap technique on conduction disturbance and paravalvular leakage after transcatheter aortic valve replacement. A total of 97 patients underwent transfemoral transcatheter aortic valve replacement with self-expandable valves at our institution from November 2018 to January 2023. The mean age of the patients was 85 years, and 23% were male. The patients were divided into two groups: the cusp overlap technique group and the non-cusp overlap technique group. We compared the clinical results between the two groups. The 30-day permanent pacemaker implantation rate was similar between the two groups (cusp overlap technique: 6.3% vs. non-cusp overlap technique: 10.2%, p = 0.48). The rate of new-onset conduction disturbance was slightly lower in the cusp overlap than non-cusp overlap technique group (18.8% vs. 34.7%, respectively; p = 0.08). The implanted valve function was similar between the two groups, but the rate of trivial or less paravalvular leakage (PVL) was significantly higher in the cusp overlap technique group on echocardiography (69% vs. 45%, p = 0.02). On multidetector computed tomography, the implantation depth at the membranous septum was significantly shorter in the cusp overlap technique group (2.0 ± 2.3 vs. 2.9 ± 1.5 mm, p = 0.02). The degree of canting was slightly smaller in the cusp overlap technique group (1.0 ± 2.2 vs. 1.7 ± 1.9 mm, p = 0.07). The relative risk of PVL equal to or greater than mild was 1.76 times higher for valve implantation without the cusp overlap technique (adjusted odds ratio, 3.74; 95% confidence interval, 1.45-9.69; p < 0.01). Transcatheter aortic valve replacement using the cusp overlap technique is associated with an optimized implantation depth, leading to fewer conduction disturbances. Optimal deployment may also maximize the radial force of self-expanding valves to reduce paravalvular leakage., (© 2023. Springer Nature Japan KK, part of Springer Nature.)

Background: In patients with chronic liver diseases such as cirrhosis, massive ascites after hepatic resection is the cause of prolonged hospitalization and worsening prognosis. Recently, the efficacy of tolvaptan in refractory ascites has been reported; however, there are no reports on the efficacy or safety of tolvaptan for refractory ascites after hepatic resection. This study aims to evaluate the efficacy of early administration of tolvaptan in patients with refractory ascites after hepatic resection., Materials and Methods: This is an open-label, single-arm phase I/II study. This study subject will comprise patients scheduled for hepatic resection of a liver tumor. Patients with refractory ascites after hepatic resection (drainage volume on postoperative day 1 ≥5 ml/body weight 1 kg/day) will be treated with tolvaptan. The primary endpoint will include the maximum change in body weight after hepatic resection relative to the preoperative baseline. The secondary endpoints will include drainage volume, abdominal circumference, urine output, postoperative complication rate (heart failure and respiratory failure), number of days required for postoperative weight gain because of ascites to decrease to preoperative weight, change in improvement of postoperative pleural effusion, total amount of albumin or fresh frozen plasma transfusion, type and amount of diuretics used, and postoperative hospitalization days., Conclusion: This trial will evaluate the efficacy and safety of tolvaptan prophylaxis for refractory ascites after hepatic resection. As there are no reports demonstrating the efficacy of tolvaptan prophylaxis for refractory ascites after hepatic resection, the authors expect that these findings will lead to future phase III trials and provide valuable indications for the selection of treatments for refractory postoperative ascites., Competing Interests: The authors declare that they have no competing interests in this study., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: This study evaluated the safety and feasibility of a technique of liver resection named dual-wield parenchymal transection technique (DWT), using cavitron ultrasonic surgical aspirator (CUSA) and water-jet scalpel simultaneously., Methods: This multicenter, prospective, open-label, and single-arm phase I trial included patients aged 20 years or older with hepatic tumors indicated for surgical resection and scheduled for open radical resection. This study was conducted at two institutions affiliated with the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO). The primary endpoint was the proportion of massive intraoperative blood loss (≥ 1000 mL). The secondary endpoints were the amount of blood loss, operative time, parenchymal transection speed, postoperative complications, and mortality. The safety endpoints were device failure and adverse events associated with devices., Results: From June 2022 to May 2023, 20 patients were enrolled; one was excluded and 19 were included in the full analysis set (FAS). In the FAS, segmentectomy was performed in nine cases, sectionectomy in four cases, and hemihepatectomy in six cases. Radical resection was achieved in all patients. Intraoperative blood loss greater than 1000 mL was observed in five patients (26.3%). The median amount of blood loss was 545 mL (range, 180-4413), and blood transfusions were performed on two patients (10.5%). The median operative time was 346 minutes (range, 238-543) and the median parenchymal transection speed was 1.2 cm 2 /minute (range, 0.5-5.1). Postoperative complications of Clavien-Dindo classification ≥ Grade 3 occurred in four patients (21.1%). No mortalities occurred in this study. In the safety analysis, there were no device failures or adverse events associated with devices., Conclusions: This study demonstrated the safety and feasibility of DWT for liver resection. The efficacy of the DWT will be evaluated in future clinical trials., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Oshita et al.)

Background: Remimazolam is a novel, ultrashort-acting benzodiazepine that can be antagonized by flumazenil. This study aimed to determine whether remimazolam-based anesthesia with flumazenil provides a more rapid emergence than propofol-based anesthesia in older patients undergoing spinal surgery., Methods: This was a prospective, single-blind, randomized controlled trial. Forty-four patients > 75 years old who had undergone spinal surgery were enrolled in this study. They were randomly assigned to the remimazolam or propofol group (1:1) using a computer randomization system stratified by age and body weight. For anesthesia induction and maintenance, remifentanil was administered at a defined dose in both groups, and remimazolam or propofol was adjusted to maintain the bispectral index or state entropy monitoring within 40-60. All anesthetics were discontinued simultaneously after the postoperative X-ray and 0.5 mg flumazenil was administered to the remimazolam group. The primary outcome was extubation time after discontinuing anesthesia, and the secondary outcomes were time to eye opening, obeying commands, and achieving a white fast-track score (WFTS) of 12., Results: Thirty-nine patients were finally analyzed: remimazolam group (n = 20), propofol group (n = 19). There were no significant differences in intraoperative variables, such as operative time, anesthesia time, and patient background, between the 2 groups. Extubation times were significantly shorter in the remimazolam group than in the propofol group (4 vs 8 minutes, P < .001). The time to eye opening, obeying commands, and achieving a WFTS of 12 were significantly shorter in the remimazolam group (P < .001, for all comparisons)., Conclusion: Remimazolam-based anesthesia with flumazenil resulted in a faster emergence than propofol-based anesthesia in older patients undergoing spinal surgery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Oral mucositis significantly affects the quality of life in hematologic cancer patients undergoing hematopoietic stem cell transplantation. Despite global evidence supporting the efficacy of low-level laser therapy (LLLT) for mucositis prevention, its clinical adoption in Japan is limited. This study aimed to fill this gap by evaluating the safety and efficacy of LLLT in a Japanese patient population. In a single-group, non-blinded, exploratory trial, we compared 21 LLLT-treated patients against a historical control of 96 patients. The primary endpoint was the incidence of Grade ≥ 2 mucositis, based on NCI-CTCAE ver. 4.0. The LLLT group showed a significantly lower incidence of Grade ≥ 2 mucositis (23.8%) compared to the control group (64.6%) ( p = 0.0006). Furthermore, Grade ≥ 2 mucositis correlated with increased oral dryness and longer hospital stays. Our study confirms the efficacy of LLLT in reducing the onset of severe oral mucositis among Japanese hematologic cancer patients, advocating for its clinical introduction as a preventive measure in Japan.

Background/aim: This study aimed to evaluate the outcomes of patients who underwent resection for oligometastasis from hepatocellular carcinoma (HCC) and identify the prognostic factors associated with poor survival., Patients and Methods: Patients who underwent resection for oligometastasis from HCC between January 2000 and April 2021 were retrospectively investigated. Oligometastasis was defined as 1-5 single organ metastases that were detected preoperatively in this study. Clinical characteristics and treatment outcomes were analyzed, and independent risk factors for poor prognosis were identified using cox proportional hazards model., Results: A total of 33 patients were included in this study. Eleven oligometastases were located in the intraabdominal lymph node, 8 in the adrenal gland, 5 in the lung, 4 in the peritoneum, 3 in the pleura, and 1 each in the supraclavicular lymph node and abdominal wall. No re-operation or operative death occurred in this study. The median OS was 44.6 months (range=5.1-150.6 months), and the median survival after primary HCC diagnosis was 116.5 months (range=7.1-253.6 months). The median cumulative incidence of recurrent HCC was 7.2 months (range=0.3-94.7 months). The multivariate analysis showed that an alpha-fetoprotein level ≥20 ng/ml and multiple primary HCC tumors were independent poor prognostic factors., Conclusion: Clinical characteristics and treatment outcomes of patients who underwent resection for oligometastasis from HCC were demonstrated. A high alpha-fetoprotein level and multiple primary HCC tumors were independent poor prognostic factors. Surgical resection can be one of the treatment options for oligometastasis from HCC., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Introduction: Small liver tumours are difficult to identify during hepatectomy, which prevents curative tumour excision. Preoperative marking is a standard practice for small, deep-seated tumours in other solid organs; however, its effectiveness for liver tumours has not been validated. The objective of this study is to evaluate the effectiveness of preoperative markings for curative resection of small liver tumours., Methods and Analysis: This is an open-label, single-arm, single-centre, phase II study. Patients with liver tumours of ≤15 mm requiring hepatectomy will be enrolled and will undergo preoperative marking by placing a microcoil near the tumour using either the percutaneous or transvascular approach. The tumours, including the indwelling markers, will be excised. The primary endpoint will be the successful resection rate of liver tumours, defined as achieving a surgical margin of ≥5 mm and ≤15 mm. Secondary endpoints will include the results of preoperative marking and hepatectomy., Ethics and Dissemination: Ethical approval for this trial was obtained from the Ethical Committee for Clinical Research of Hiroshima University, Japan. The results will be published at an academic conference or by submitting a paper to a peer-reviewed journal., Trial Registration Number: jRCTs062220088., Competing Interests: Competing interests: This study will be conducted with the provision of research targeting medical equipment from Piolax Medical Devices, Yokohama, Japan. Piolax Medical Devices provides information on research equipment but does not intervene in research data management, statistical analysis and auditing., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The feasibility and efficacy of surgical resection following systemic therapy for intermediate-stage hepatocellular carcinoma (HCC) beyond the Up-to-7 criteria is unclear. The combination of lenvatinib (LEN) and transcatheter arterial chemoembolisation (TACE), termed LEN-TACE sequential therapy, has shown a high response rate and survival benefit in patients with intermediate-stage HCC. This trial aims to evaluate the efficacy and safety of LEN-TACE sequential therapy and the feasibility of surgical resection for intermediate-stage HCC beyond the Up-to-7 criteria., Methods and Analysis: This is a multicentre, single-arm, prospective clinical trial. Thirty patients with intermediate-stage HCC beyond the Up-to-7 criteria will be enrolled. Patients eligible for this study will undergo LEN-TACE sequential therapy in which LEN is administered for 4 weeks, followed by TACE, and then further LEN for another 4 weeks. Patients will be assessed for efficacy of LEN-TACE sequential therapy and resectability, and surgical resection will be performed if the HCC is considered radically resectable. The primary outcome of this study is the resection rate after LEN-TACE sequential therapy. The secondary outcomes are the objective response rate of LEN-TACE sequential therapy, safety, curative resection rate, overall survival and recurrence-free survival., Ethics and Dissemination: This trial was approved by the Institutional Review Board of Hiroshima University, Japan (approval no. CRB210003), and has been registered with the Japan Registry of Clinical Trials (jRCTs061220007). The results of this study will be submitted for publication in a peer-reviewed journal and shared with the scientific community at international conferences., Trial Registration Number: jRCTs061220007 (https://jrct.niph.go.jp/latest-detail/jRCTs061220007)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Japan has entered a period of depopulation and aging ahead of any other country. One concern in an aging population is increases in the generation of used disposable diapers. The use of disposable diapers, which are largely composed of plastic, can be an important issue as we work towards building a carbon-free society and break away from using fossil-derived plastics. This study aimed to develop a model to project the future generation of used disposable diapers in each municipality in Japan through 2045 and to identify the effects on municipal solid waste (MSW) management. We revealed the per capita generation of used disposable diapers, distinguishing disposable diaper products, urine and faeces in an online survey of 2000 respondents. The generation of used disposable diapers was estimated to increase in general, but the amount was projected to decrease in rural areas where the population of elderly people would decline. The proportion of used disposable diapers in combustible waste was projected to increase by 2045 in almost all municipalities of Mie Prefecture. Based on the scenario in which disposable diaper products would become lighter in the future because of technical improvements, we concluded that the impact of the decrease in the lower heating value (LHV) of used disposable diapers on the incineration process cannot be ignored in the future.

Introduction: Although some studies have reported on the relationship between appendiceal stump closure methods and postoperative complications, there is no fixed method for this procedure. This study aimed to compare treatment outcomes of the existing procedures., Methods: We retrospectively analyzed the records of 200 patients who underwent urgent laparoscopic surgeries and investigated whether the difference in the appendiceal stump closure method was a risk factor for surgical site infection. The patients were divided into the Endoloop and endostapler groups, and 45 propensity score-matched patients were included. The treatment outcomes of the two groups were compared., Results: The patients with high body temperature showed significantly developed surgical site infection in multivariate analysis (P = .036). There was no significant difference in the appendix stump methods (Endoloop vs endostapler). Regarding postoperative complications, superficial and deep incisional surgical site infection, organ/space surgical site infection, ileus, and complications of Clavien-Dindo grade IIIa or higher; there was no significant difference between the endoloop and endostapler groups after propensity score matching (P = .725, 1.000, .645 and .557, respectively)., Conclusion: By properly using the Endoloop and endostapler according to the severity of inflammation, the Endoloop can be safely performed in many cases. Inexpensive Endoloop as an option for stump closure methods should positively impact medical costs., (© 2022 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Purpose: Harvesting at least 12 lymph nodes (LNs) is recommended for adequate tumor staging in colon surgery. Although preoperative endoscopic tattooing has been used for primary localization of tumors, its impact on LN retrieval in colorectal surgery remains controversial. We aimed to investigate the relationship between preoperative tattooing and LN retrieval after laparoscopic rectal resection., Methods: We reviewed the records of 92 patients with rectal cancer who underwent laparoscopic resection from January 1, 2018 to December 31, 2019. Patients were categorized into 2 groups according to whether preoperative endoscopic tattooing was performed. The rate of adequate LN retrieval (≥12) was compared., Results: The tattooed and non-tattooed groups comprised 49 and 43 patients, respectively. In the tattooed and non-tattooed groups, the rates of adequate LN retrieval were 75.5% and 55.8%, respectively (P=0.046). Univariate analysis revealed that female sex, tattooing, LN metastasis status, pathological pathological stage (p-stage), and LN dissection were predictive factors for adequate LN retrieval. In the multivariate analysis, female sex (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.15-9.73; P=0.027), tattooing (OR, 2.87; 95% CI, 1.03-7.94; P=0.043), and p-stage (OR, 3.34; 95% CI, 1.04-10.75; P=0.043) were independent predictive factors for adequate LN retrieval after surgery., Conclusion: This study revealed that preoperative endoscopic tattooing was statistically significantly associated with adequate LN retrieval in patients with rectal cancer who underwent laparoscopic rectal resection. Preoperative endoscopic tattooing should be considered to improve disease assessment and avoid stage migration.

Background: Methamphetamine abuse is a serious public health concern and causes various life-threatening disorders including pulmonary arterial hypertension (PAH). Herein, we present the first case report describing the anesthetic management of a patient with methamphetamine-associated PAH (M-A PAH) undergoing laparoscopic cholecystectomy., Case Presentation: A 34-year-old female with M-A PAH suffered from deterioration of right ventricular (RV) heart failure due to recurrent cholecystitis and was scheduled for laparoscopic cholecystectomy. Preoperative assessment of PA pressure showed 82/32 (mean, 50) mmHg, and transthoracic echocardiology revealed a slight reduction of RV function. General anesthesia was induced and maintained by thiopental, remifentanil, sevoflurane, and rocuronium. PA pressure gradually increased after peritoneal insufflation; therefore, we administered dobutamine and nitroglycerin to decrease pulmonary vascular resistance (PVR). The patient emerged from anesthesia smoothly., Conclusions: Avoiding increased PVR by appropriate anesthesia and medical hemodynamic support is an important consideration for patients with M-A PAH., (© 2023. The Author(s).)

Atherosclerotic lesions preferentially develop at bifurcations, characterized by non-uniform shear stress (SS). The aim of this study was to investigate SS-induced endothelial activation, focusing on stress-regulated mitogen-activated protein kinases (MAPK) and downstream signaling, and its relation to gap junction proteins, Connexins (Cxs). Human umbilical vein endothelial cells were exposed to flow ("mechanical stimulation") and stimulated with TNF-α ("inflammatory stimulation"). Phosphorylated levels of MAPKs (c-Jun N-terminal kinase (JNK1/2), extracellular signal-regulated kinase (ERK), and p38 kinase (p38K)) were quantified by flow cytometry, showing the activation of JNK1/2 and ERK. THP-1 cell adhesion under non-uniform SS was suppressed by the inhibition of JNK1/2, not of ERK. Immunofluorescence staining and quantitative real-time PCR demonstrated an induction of c-Jun and c-Fos and of Cx43 in endothelial cells by non-uniform SS, and the latter was abolished by JNK1/2 inhibition. Furthermore, plaque inflammation was analyzed in human carotid plaques ( n = 40) using immunohistochemistry and quanti-gene RNA-assays, revealing elevated Cx43 + cell counts in vulnerable compared to stable plaques. Cx43 + cell burden in the plaque shoulder correlated with intraplaque neovascularization and lipid core size, while an inverse correlation was observed with fibrous cap thickness. Our results constitute the first report that JNK1/2 mediates Cx43 mechanoinduction in endothelial cells by atheroprone shear stress and that Cx43 is expressed in human carotid plaques. The correlation of Cx43 + cell counts with markers of plaque vulnerability implies its contribution to plaque progression.

This study investigated the change in the joint angles of the lower limb during gait by heating the tip of the insole to make a conscious push-off with the warm part. Fifteen healthy males performed treadmill walking under three different conditions: CONTROL walked as usual, INST was instructed to extend the stride with a push-off from the ball of foot to the toe, and HEAT was asked to walk while attempting to push off the warm area, which was attached to the disposable warmer to the area from the ball of foot to the toe of the insole. A 3D-motion capture system with infrared cameras was used to analyze the gait. The hip joint angle increased significantly under the INST and HEAT. Although the ankle dorsi-flexion at heel strike did not differ significantly for these conditions, ankle plantar-flexion significantly increased at toe-off under the INST and HEAT. Especially, effect size ( d ) in increased plantar-flexion was large in HEAT (=1.50), whereas it was moderate in INST (=0.68). These results suggest that a heated stimulus during gait enhanced the consciousness of push-off and increased leg swing and ankle plantar-flexion during the terminal stance phase, which may increase the stride length.

This study investigated the relationship between normal weight obesity (NW-O) and skeletal muscle mass index (SMI) in 120 female university students who participated in sporting activities during junior and senior high school. The current physical activity level (PAL) was estimated by a factorial method using 24-h physical activity recall. The body mass index (BMI) of the participants ranged from 18.5 to 24.9 kg/m2; their body fat (BF) was classified as NW-O if above the 75th percentile (28.9% BF), normal weight and lean (NW-L) if below the 25th percentile value (21.0%BF), and all others were normal weight (NW). PAL was significantly lower in NW-O than in NW-L. SMI was significantly lower in NW-O than in NW and NW-L, and 60% of NW-O had Low-SMI (<6.3 kg/m2). Although lower limb muscle mass was significantly lower in NW-O than in NW and NW-L, no significant differences were found in the upper limbs. These results suggest that the current PAL is associated with NW-O, and NW-O is associated with a lower SMI, even in young females with past exercise habits. Therefore, the prevention of NW-O in young females is important for the prevention of not only lifestyle-related diseases, but also future sarcopenia.

The effects of sewage sludge phosphorus (P) content on heavy metal behavior during co-incineration of sewage sludge and municipal solid waste (MSW) were evaluated. Thermogravimetric differential thermal analysis revealed that MSW incineration was mainly caused by organic matter and fixed carbon, while sewage sludge incineration was caused by volatile matter. During co-incineration, the peak weight loss at 460 °C shifted to slightly higher temperatures and the sludge ratio increased, indicating that interaction effects during co-incineration delayed pyrolysis and polymer/fixed carbon incineration. The residual heavy metal ratios after mono-incineration of sewage sludge were higher than those after MSW mono-incineration. The Cl content of MSW (0.757%) was much higher than that of sewage sludge (0.068%), which resulted in the conversion of heavy metals into metal chlorides and then volatilized during MSW mono-incineration. A synergistic effect of co-incineration was evident for Cu, but not for lead (Pb) or cadmium (Cd). X-ray absorption fine structure (XAFS) measurement revealed that Cu in MSW ash was in the form of CuO(s), but was Cu 3 (PO 4 ) 2 in sewage sludge and co-incineration ashes. CuO(s) is relatively unstable and may be transformed to CuO(g) or CuCl(s) before volatilizing at high temperature or in the presence of Cl. Phosphorus has the effect of stabilizing Cu in sewage sludge during co-incineration., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Myofascial pain syndrome is one of the causes of prolonged postoperative pain after abdominal surgery. However, diagnosis and treatment of myofascial pain syndrome, especially its myofascial trigger point (MTrP), have not been well established., Case Presentation: A 55-year-old man experienced severe subacute abdominal pain after laparoscopic hepatectomy despite aggressive postoperative pain management. He had a positive Carnett's sign, indicating abdominal wall pain, 2 weeks after the surgery. Ultrasonography showed a hyperechoic spot surrounded by a hypoechoic area in the inner abdominal oblique muscle under the palpable spot that fulfills the criteria of MTrP. The echogenic MTrP disappeared after repetitive ultrasound-guided trigger point injections (USG TPIs) with pain relief., Conclusions: Our present case indicates that diagnosing myofascial pain by visualizing the echogenic MTrPs in the abdominal muscles, and subsequent USG TPIs, might provide an accurate maneuver for diagnosis and treatment of subacute myofascial pain after abdominal surgery., (© 2022. The Author(s).)

Biological in-situ biogas upgrading is a promising approach for sustainable energy-powered technologies. This method increases the CH 4 content in biogas via hydrogenotrophic methanogenesis with an external H 2 supply. In this study, an anaerobic membrane bioreactor (AnMBR) was employed for in-situ biogas upgrading. The AnMBR was operated in semi-batch mode using waste activated sludge as the substrate. Pulsed H 2 addition into the reactor and biogas recirculation effectively increased the CH 4 content in the biogas. The addition of 4 equivalents of H 2 relative to CO 2 did not lead to appreciable biogas upgrading, although the acetate concentration increased significantly. When 11 equivalents of H 2 were introduced, the biogas was successfully upgraded, and the CH 4 content increased to 92%. The CH 4 yield and CH 4 production rate were 0.31 L/g-VS input and 0.086 L/L/d, respectively. In this phase of the process, H 2 addition increased the acetate concentration and the pH because of CO 2 depletion. Compared with a continuously-stirred tank reactor, the AnMBR system attained higher CH 4 content, even without the addition of H 2 . The longer solid retention time (100 d) in the AnMBR led to greater degradation of volatile solids. Severe membrane fouling was not observed, and the transmembrane pressure remained stable under 10 kPa for 117 d of continuous filtration without cleaning of the membrane. The AnMBR could be a promising reactor configuration to achieve in-situ biogas upgrading during sludge digestion., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: CLOCK 3111T/C has been shown to be closely associated with morningness-eveningness, such as sleep-wake rhythms in healthy humans. However, previous studies examined the physical activity (PA) in a single day, and no study has investigated the relationships between CLOCK 3111T/C polymorphism and PA for an entire week. It was hypothesized that the CLOCK 3111T/C polymorphism might be associated with diurnal PA patterns, especially on the weekends., Methods: Eighty-one university students (male, n = 14; female, n = 67; age, 20.4 ± 2.9 years) wore a digital accelerometer for 7 successive days, including the weekend, to collect hour-by-hour objectively-measured PA. CLOCK 3111T/C polymorphism was assessed using the oral mucosa. During the study, participants recorded their wake time and bedtime each day. Furthermore, lifestyle-related variables (i.e. morningness-eveningness, habitual meal and sleep timings) were collected using questionnaires. Linear mixed-effects models assessed the association of polymorphism (TT carriers vs. TC+CC carriers) with wake time and bedtime as well as daily PA throughout the week (time)., Results: TT carriers had an earlier wake time (weekly mean: 44 min [95% CI, -82 to -5 min], time interaction: p = 0.026) and bedtime (weekly mean: 30 min [95% CI, -61 min to - 15 s], time interaction: p = 0.048) than TC+CC carriers. Furthermore, TT carriers' wake time and bedtime on Saturday were significantly later than on other days (gene interaction: all p < 0.05). On Saturday, the hour-by-hour PA in TT carriers was significantly greater than that in TC+CC carriers (hourly mean 1.7 min [95% CI, 0.2 to 3.4 min], time: p < 0.001, group: p = 0.028, interaction: p = 0.155)., Conclusions: CLOCK 3111T/C polymorphism may be associated with objectively measured hour-by-hour PA only on Saturday. Academic/social obligations may mask the genetically determined biological rhythm of PA on weekdays., (Copyright © 2022. Published by Elsevier Inc.)

We evaluated mercury (Hg) behavior in a full-scale sewage sludge torrefaction plant with a capacity of 150 wet tons/day, which operates under a nitrogen atmosphere at a temperature range of 250-350 °C. Thermodynamic calculations and monitoring results show that elemental Hg (Hg 0 ) was the dominant species in both the pyrolysis gas during the torrefaction stage and in the flue gas from downstream air pollution control devices. A wet scrubber (WS) effectively removed oxidized Hg from the flue gas and moved Hg to wastewater, and an electrostatic precipitator (ESP) removed significant particulate-bound Hg but showed a limited capacity for overall Hg removal. Hg bound to total suspended solids had a much higher concentration than that of dissolved Hg in wastewater. Total suspended solid removal from wastewater is therefore recommended to reduce Hg discharge. Existing air pollution control devices, which consist of a cyclone, WS, and ESP, are not sufficient for Hg removal due to the poor Hg 0 removal performance of the WS and ESP; a further Hg 0 removal unit is necessary. A commercial packed tower with sorbent polymer catalyst composite material was effective in removing Hg (83.3%) during sludge torrefaction., (Copyright © 2021. Published by Elsevier B.V.)