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Introduction: Meningiomas and schwannomas are common intradural-extramedullary spinal tumors. Because of their different origins, they necessitate different surgical procedures, which makes preoperative diagnosis important. Methods: In this study, clinical and imaging data for 62 patients diagnosed with either meningioma or schwannoma across multiple institutions were analyzed. Results: The average age of patients was older (67.6 vs. 58.9 years), and the frequency of females was higher (72% vs. 46%) for meningioma than for schwannoma. Meningiomas were mostly found in the thoracic region (84%), whereas schwannomas were commonly located in the lumbar region (54%). For each tumor type, specific radiological findings were identified. For meningiomas, findings included the ginkgo leaf sign (GLS) (sensitivity 58%, specificity 100%), oval shape (sensitivity 84%, specificity 63%), dural tail sign (DTS) (sensitivity 75%, specificity 100%), and intertumoral calcification (sensitivity 39%, specificity 100%). Combining GLS and DTS greatly improved sensitivity to 89% (specificity 100%). For schwannomas, specific findings included a lobule shape (sensitivity 25%, specificity 95%), dumbbell shape (sensitivity 54%, specificity 100%), and cystic changes (sensitivity 54%, specificity 97%). Conclusions: GLS may be a specific radiological feature for meningiomas and can aid in diagnosis when combined with DTS. Understanding these distinct radiological characteristics is valuable for preoperative differential diagnosis of intradural-extramedullary spinal tumors.

The present paper applies the concept of extended delayed feedback control, a commonly used method for controlling chaos, to a quenching phenomenon (i.e., amplitude death) in time-delay coupled oscillator networks. We show that a simple characteristic function governs the stability of amplitude death. The simple function enables us to explicitly obtain the stability ranges of the delay time. These ranges depend on the number of oscillators and the network topology. Thus, for situations where the number of oscillators and/or network topology are unknown, one cannot determine the delay time that induces amplitude death. We propose a simple procedure for designing a delay time for which amplitude death is locally stable for any number of oscillators and any network topology. The theoretical results are confirmed by numerical examples. In addition, it is found that the stability ranges of the delay time are much wider than those for conventional delay-coupled oscillator networks.

Abstract Light manipulation and control are essential in various contemporary technologies, and as these technologies evolve, the demand for miniaturized optical components increases. Planar-lens technologies, such as metasurfaces and diffractive optical elements, have gained attention in recent years for their potential to dramatically reduce the thickness of traditional refractive optical systems. However, their fabrication, particularly for visible wavelengths, involves complex and costly processes, such as high-resolution lithography and dry-etching, which has limited their availability. In this study, we present a simplified method for fabricating visible Fresnel zone plate (FZP) planar lenses, a type of diffractive optical element, using an i-line stepper and a special photoresist (color resist) that only necessitates coating, exposure, and development, eliminating the need for etching or other post-processing steps. We fabricated visible FZP lens patterns using conventional photolithography equipment on 8-inch silica glass wafers, and demonstrated focusing of 550 nm light to a diameter of 1.1 μm with a focusing efficiency of 7.2%. Numerical simulations showed excellent agreement with experimental results, confirming the high precision and designability of our method. Our lenses were also able to image objects with features down to 1.1 μm, showcasing their potential for practical applications in imaging. Our method is a cost-effective, simple, and scalable solution for mass production of planar lenses and other optical components operating in the visible region. It enables the development of advanced, miniaturized optical systems to meet modern technology demand, making it a valuable contribution to optical component manufacturing.

Abstract Background Identifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large‐scale studies to evaluate risk factors for LR are limited. Methods Data from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine–Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors. Results Across the entire cohort, the 5‐year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7–14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment‐related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m2, distance from anal verge ≤4.0 cm, non‐well/moderately differentiated adenocarcinoma). The 5‐year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND. Conclusion This large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.

Abstract Acute kidney injury (AKI) has been reported to occur in 30–70% of asphyxiated neonates. Hydrogen (H2) gas became a major research focus in neonatal medicine after the identification of its robust antioxidative properties. However, the ability of H2 gas to ameliorate AKI is unknown. We examined histopathological injuries in the piglet renal cortex on day 5 after a hypoxic-ischemic (HI) insult and if H2 gas can alleviate kidney injuries. Twenty piglets were divided into three groups: no insult (Control, n = 6), HI insult alone (HI, n = 8), and HI insult with H2 gas ventilation (HI-H2, 2.1–2.7% for 24 h, n = 6). The total glomerular cell count was significantly higher in the HI group than in the other groups, with no difference between the HI-H2 and control groups. Proximal tubular lumen narrowing was significantly increased in the HI group versus control, but not in the HI-H2 group. In this piglet model, glomerular enlargement with an increase in glomerular cell number due to tubular lumen narrowing was observed on day 5 after HI insult. H2 gas effectively suppressed this glomerular cell increase and tubular lumen narrowing.

ABSTRACT Background The Asian Working Group for Cachexia (AWGC) proposed a new definition of cachexia; however, its impact on cachexia prevalence and overlaps with other conditions, such as sarcopenia and malnutrition, are unclear. We investigated these aspects and the prognostic value of cachexia based on the AWGC on mortality in older patients with heart failure (HF). Methods This study was a secondary analysis of a prospective multicentre cohort, namely, the FRAGILE‐HF cohort study. Older (≥ 65 years) patients who had been hospitalized due to decompensated HF were enrolled. We assessed the presence/absence of cachexia based on the AWGC and Evans' criteria. Sarcopenia and malnutrition based on the Asian Working Group for Sarcopenia 2014 and the Global Leadership Initiative on Malnutrition criteria were also assessed to compare their prevalence and the overlaps between them. Patients were stratified in relation to the presence/absence of cachexia based on the AWGC criteria, and their mortality rates were compared. Results Of the 861 enrolled patients (median [interquartile range] age, 80 years [73–85 years]; male, 58.9%), cachexia, as evaluated based on the AWGC and Evans' criteria, sarcopenia and malnutrition, was present in 74.1%, 36.2%, 20.6% and 55.2% of patients, respectively. AWGC‐defined cachexia was most common in the four conditions. All‐cause death events occurred in 153 (18.1%) patients in 2 years. AWGC‐defined cachexia (adjusted hazard ratio [aHRs], 1.442; 95% confidence interval [95% CI], 0.931–2.233; p = 0.101) was not associated with all‐cause mortality in older patients with HF after adjusting for other HF prognosis factors, such as the B‐type natriuretic peptide and the Meta‐Analysis Global Group in Chronic risk score, whereas cachexia evaluated based on Evans's criteria (aHRs, 1.547; 95% CI, 1.118–2.141; p = 0.009), sarcopenia (aHRs, 1.737; 95% CI, 1.214–2.485; p = 0.003), and malnutrition (aHRs, 1.581; 95% CI, 1.094–2.284; p = 0.015) was associated with all‐cause mortality. Conclusions Three‐quarters of older patients with HF had cachexia as evaluated by the AWGC criteria, and this was not associated with a worse prognosis. As the new AWGC cachexia criteria will result in a significantly larger proportion of patients being diagnosed with cachexia, the implementation of the criteria in clinical practice requires further consideration. Trial Registration: UMIN‐CTR unique identifier: UMIN000023929

Abstract Aims In heart failure (HF), inflammation is linked to malnutrition and impaired physical function. In this study, we aimed to assess how novel nutritional–inflammatory markers and lymphocyte‐to‐C‐reactive protein ratio (LCR) and score (LCS) are associated with the nutritional status, physical function, and prognosis of patients with HF. Methods and results This study was a secondary analysis of the FRAGILE‐HF study, a prospective observational study conducted across 15 hospitals in Japan. We included 1212 patients (mean age, 80.2 ± 7.8 years; 513 women) hospitalized with HF, who were classified into three groups according to their LCS score: 0 (n = 498), 1 (n = 533), and 2 (n = 181). Baseline data on physical examination, echocardiography, blood test results (including lymphocyte counts and CRP levels), and oral medication usage were collected in a clinically compensated state before discharge. Nutritional status and physical function were evaluated using several indices and tests. The primary outcome of this study was all‐cause death within 2 years. Univariate and multivariate linear regression analyses were performed to evaluate the associations among the nutritional status, physical function, and LCR/LCS. Patients with an LCS score of 2 were older and had a lower body mass index than those in the other two groups. Multivariate linear regression analysis revealed that lower LCR and higher LCS were independently associated with worse nutritional status, lower handgrip strength, shorter physical performance battery score, and shorter 6‐min walk distance. At 2 years, all‐cause death occurred in 254 patients: 86 (17.6%), 113 (21.5%), and 55 (30.9%) with LCS scores of 0, 1, and 2, respectively (P = 0.001). Cox proportional hazards analysis revealed that LCR and LCS were significantly associated with 2‐year mortality even after adjusting for the conventional risk model (LCS score, 0 vs. 2: hazard ratio, 1.64; 95% confidence interval [CI]; 1.14–2.35; P = 0.007; log‐transformed LCR: hazard ratio, 0.88; 95% CI, 0.81–0.95; P = 0.002). LCR yielded additional prognostic predictability compared with the conventional risk model (continuous net reclassification improvement, 0.153; 95% CI, 0.007–0.299; P = 0.041). Conclusions LCR and LCS emerge as potential predictors of nutritional status, physical function, and prognosis in older patients with HF.

Abstract Patients with epilepsy often require long‐term treatment with antiseizure medications, and their impact on daily activities, particularly driving, is of significant concern. The recently published “Guideline for Evaluating Effects of Psychotropic Drugs on the Performance to Drive a Motor Vehicle” in Japan provides a framework that can be referred to for not only the evaluation of new drugs but also the reevaluation of approved drugs. This study conducted a literature review regarding the effects of carbamazepine, valproate, lamotrigine, lacosamide, and levetiracetam, which are frequently prescribed for epilepsy, on driving performance following the guideline's tiered evaluation approach. Analyses of pharmacological, pharmacodynamic, and adverse events suggested that these drugs primarily affect arousal function. Driving studies showed that acute administration of carbamazepine, but not chronic monotherapy with carbamazepine, valproate, lamotrigine, and levetiracetam, significantly impairs driving performance. Epidemiological studies have not identified a definitive association between these drugs and traffic accidents. Initial administration of these five antiseizure medications may affect driving performance, warranting special attention, but the influence appears to diminish with continued use. Nevertheless, while long‐term administration of these five drugs may not have a clinically meaningful effect on driving performance, safe driving is not guaranteed for each individual patient, and appropriate individualized guidance is important in clinical practice.

Author(s): Yukari Nagayasu [1]; Shoki Inui (corresponding author) [1]; Yoshihiro Ueda [1]; Akira Masaoka [1]; Masahide Tominaga [2]; Masayoshi Miyazaki [3]; Koji Konishi [1] INTRODUCTION Recently, high-precision radiation therapies, such [...], Aims: This study aimed to evaluate the geometrical accuracy of atlas-based auto-segmentation (ABAS), deformable image registration (DIR), and deep learning auto-segmentation (DLAS) in adaptive radiotherapy (ART) for head-and-neck cancer (HNC). Subjects and Methods: Seventeen patients who underwent replanning for ART were retrospectively studied, and delineated contours on their replanning computed tomography (CT2) images were delineated. For DIR, the planning CT image (CT1) of the evaluated patients was utilized. In contrast, ABAS was performed using an atlas dataset comprising 30 patients who were not part of the evaluated group. DLAS was trained with 143 patients from different patients from the evaluated patients. The ABAS model was improved, and a modified ABAS (mABAS) was created by adding the evaluated patients' own CT1 to the atlas datasets of ABAS (number of patients of the atlas dataset, 31). The geometrical accuracy of DIR, DLAS, ABAS, and mABAS was evaluated. Results: The Dice similarity coefficient in DIR was the highest, at >0.8 at all organs at risk. The mABAS was delineated slightly more accurately than the standard ABAS. There was no significant difference between ABAS and DLAS in delineation accuracy. DIR had the lowest Hausdorff distance (HD) value (within 10 mm). The HD values in ABAS, mABAS, and DLAS were within 16 mm. Conclusions: DIR delineation is the most geometrically accurate ART for HNC. Keywords: Adaptive radiotherapy, atlas-based auto-segmentation, automatic segmentation, deep learning auto-segmentation, deformable image registration, head and neck