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Purpose: Clear cell papillary (CCP) renal cell carcinoma (RCC) is a new subtype of RCC that was formally recognized by the International Society of Urological Pathology Vancouver Classification of Renal Neoplasia in 2013. Subsequently, CCP RCC was added to the 2016 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs. In this study, we retrospectively investigated the computed tomography (CT) findings of pathologically diagnosed CCP RCC. Materials and Methods: This study included 12 patients pathologically diagnosed with CCP RCC at our institution between 2015 and 2017. We reviewed the patient's CT data and analyzed the characteristics. Results: Nine solid masses and 3 cystic masses with a mean tumor size of 22.7±9.2mm were included. Solid masses exhibited slight hyper-density on unenhanced CT with a mean value of 34±6 Hounsfield units (HU), good enhancement in the corticomedullary phase with a mean of 195±34HU, and washout in the nephrogenic phase with a mean of 133±29HU. The walls of cystic masses enhanced gradually during the corticomedullary and nephrogenic phases. Solid and cystic masses were preoperatively diagnosed as clear cell RCC and cystic RCC, respectively. Conclusions: The CT imaging characteristics of CCP RCCs could be categorized into either the solid or cystic type. These masses were diagnosed radiologically as clear cell RCC and cystic RCC, respectively.

To assess the safety and feasibility of unilateral double femoral venous access including double sheath insertion via a single-hole method (two-in-one method) for adrenal venous sampling (AVS). Two 5-Fr sheaths were percutaneously inserted into a single femoral vein for AVS in 324 patients. Two needles were inserted sequentially in tandem under ultrasound guidance; furthermore, two sheaths were individually inserted (two-in-two method) if both punctures were successfully achieved. In the presence of a single puncture, two sheaths were inserted through two guidewires and a temporarily inserted sheath (two-in-one method). This protocol was repeated until two sheaths were successfully inserted. Thus, two sheaths were inserted with the two-in-one method in 56 patients (17.3%) and two-in-two method in 268 patients (82.7%). No significant differences in the technical success rates of AVS were observed (p = 0.067–0.647). Minor groin hematoma was observed more frequently in the two-in-one than in the two-in-two method (8.9% vs. 2.6%, p = 0.039). No major groin hematoma, deep venous thrombosis, or pulmonary embolization was observed. The mean number of needle puncture was 2.5 ± 1.3 and duration of inserting two sheaths 5.1 ± 3.9 min. Unilateral double femoral venous access including the two-in-one method is safe and feasible for AVS.

Disease and information spread over social and information networks. Understanding the spread phenomena in networks requires paying attention not only to the degree distribution but also to the degree correlation. However, it is considered difficult to analytically deal with the effect of degree correlation on spread phenomena. Here, we introduce degree correlation using a simple method and present the theoretical formulas of the outbreak threshold and basic reproduction number. We theoretically clarify the effect of the degree correlation., Comment: 5 pages, 3 figures

The usefulness of the oscillometry, known as forced oscillation technique, for predicting exercise tolerance in subjects with COPD is unknown. To test the hypothesis, we investigated whether oscillometry could predict a 6-minute walking distance (6MWD) 1, 61.0%). Modified MRC dyspnea scale (mMRC), COPD Assessment Test (CAT), oscillometry, spirometry, and 6MWT were performed in a stable condition. The participants were classified into subjects with 6MWD ≥350 m or 6MWD 1, IC, 6MWD, lowest SpO2, maximum Borg scale, respiratory resistance (Rrs), and reactance (Xrs). In multivariate regression analysis, a 6MWD 20/L/s. In conclusion, the oscillatory parameter, inspiratory R5, predicted low exercise tolerance in COPD subjects.

Infection can spread easily on networks with heterogeneous degree distribution. Here, we considered targeted immunization on such networks, wherein a fraction of individuals with the highest connectivity are immunized. To quantify the effect of this targeted immunization approach on population immunity, we proposed a method using the type reproduction number. Consequently, we derived a precise and simple formula that can yield the immunization threshold, which, to the best of our knowledge, is the first such result presented in the literature., Comment: 4 pages, 1 fingure

To evaluate the image quality of early postoperative CT angiography with low contrast material and radiation dose using model-based iterative reconstruction (FIRST) for screening pseudoaneurysms after partial nephrectomy.CT angiography was obtained before surgery using conventional iterative dose reduction reconstruction (AIDR 3D) with 120 kVp and 600 mgI/kg of contrast material and obtained after partial nephrectomy using FIRST with 80-100 kVp and 360 mgI/kg in 35 patients. Contrast-to-noise ratio, visual image quality scores using a 5-point scale, and longest length of the unaffected renal arteries on maximum intensity projection images were retrospectively compared between FIRST and AIDR 3D.No significant differences existed in contrast-to-noise ratio or image quality scores of the renal arteries between FIRST and AIDR 3D (25.8 ± 6.6 vs. 25.4 ± 7.0, p = 0.991 and 4.8 ± 0.4 vs. 4.5 ± 0.9, p = 0.515, respectively). Visualization scores and longest length of the peripheral renal arteries in FIRST were significantly superior to those of AIDR 3D (4.3 ± 0.8 vs. 3.5 ± 1.0, p0.001 and 100.4 ± 14.9 mm vs. 90.2 ± 15.7 mm, p = 0.010, respectively). The dose-length product with FIRST was significantly lower than that with AIDR 3D (566.1 ± 217.4 mGy.cm vs. 829.8 ± 324.9 mGy.cm, p0.001).FIRST can improve visualization of the peripheral renal arteries with contrast material and radiation dose reduced by approximately 30 % compared with AIDR 3D, which enables adequate evaluation of pseudoaneurysms after partial nephrectomy.

Insects are the most diverse organisms on earth consisting of more than 900 thousand species. However, only few of them are considered agricultural pests. Life history traits such as high fecundity, fast population growth, and high dispersal ability have been used to characterize agricultural pest insects. However, many other non-pest insects also share these traits, which indicates that there has not been a decisive condition characterizing agricultural pest insects. Agricultural habitats are risky and ephemeral to pests because of pest control and harvesting. The usual arithmetic mean fitness cannot be used to measure the persistence of these pests, because the maximal mean fitness is achieved only when they exhibit no dispersal, but that leads to immediate extinction. Using a geometric mean fitness model, we propose a quantitative measure of long-term reproductive success for agricultural pest insects. By using this approach, we can evaluate the trade-off between long-distance dispersal and high reproduction correctly and estimate the condition for the long-term persistence of pest insects in agricultural habitats. We discuss some general perspectives of pest control from the proposed characterization.

To review the techniques and technical success rate of adrenal venous sampling (AVS) in patients with inferior vena cava (IVC) or renal vein anomalies. The techniques and success rate of AVS in 15 patients with anomalies [8 with double IVC (dIVC), 3 with left IVC (ltIVC), 2 with retroaortic left renal vein (LRV), and 2 with circumaortic LRV] underwent AVS was retrospectively reviewed. Among 11 patients with IVC anomalies, the success rates for sampling the right and left adrenal veins (RAV and LAV) were 81.8 and 90.9%, respectively. In dIVC, the LAV was selected using the following four methods: approaching through the right IVC from the right femoral vein, flipping the LAV catheter tip in the LRV (n = 4) or the interiliac-communicating vein (n = 1), or through the ltIVC from the right (n = 1) or left (n = 2) femoral vein. Among the four patients with LRV anomalies, the success rate was 100% for each adrenal vein. AVS can be successfully performed in patients with anomalies. The key to technical success is understanding the venous anatomy based on pre-procedural CT images and choosing appropriate methods.

Background: Some patients present clinical features of both asthma and chronic obstructive pulmonary disease (COPD), which has led to the recent proposal of asthma-COPD overlap (ACO) as a diagnosis. Fractional exhaled nitric oxide (FeNO) is a candidate biomarker to diagnose ACO. We assessed the effect of an add-on treatment with budesonide/formoterol (BUD/FM) combination in patients with ACO, which was diagnosed by FeNO. Methods: This was a prospective, single-arm, open-label, before and after comparison study. Subjects included 83 patients with COPD who attended outpatient clinics for routine checkups at Shizuoka General Hospital between June and November 2016. All patients fulfilled the GOLD definition of COPD and were receiving long-acting muscarinic antagonist (LAMA) or LAMA/long-acting β2 agonist (LABA) combinations. After an 8-week run-in period, BUD/FM was added to the patients with FeNO levels of ≥35 ppb, defined as having ACO. For patients receiving LAMA/LABA, BUD/FM was added after the discontinuation of LABA. The modified British Medical Research Council (mMRC) score, COPD assessment test (CAT) score, spirometric indices, forced oscillation parameters, and FeNO were assessed before and after 8 weeks of BUD/ FM add-on treatment. Results: Twenty-four patients (28.9%) had FeNO levels ≥ 35 ppb, and 17 patients completed the study (mean age: 73 years and GOLD I/II/III/IV, 5/10/1/1). The mean CAT scores significantly improved (9.2 to 5.4, p = 0.015) and 10 patients (58.8%) showed ≥2 points improvement, a minimal clinically important difference. The mean FeNO levels significantly decreased from 63.0 to 34.3 ppb (p < 0.006). However, there were no changes in mMRC scores, spirometric indices, or forced oscillation parameters. Conclusions: FeNO-guided treatment with BUD/FM improves symptoms in patients with ACO.

Aim The hepatic microenvironment, which may include chronic inflammation and fibrosis, is considered to contribute to the pathogenesis of liver metastases of colorectal cancer. A similar mechanism is anticipated for pulmonary metastases, although no reports are available. Smoking causes pulmonary inflammation and fibrosis. Thus, we hypothesized that smokers would be especially affected by pulmonary metastases of colorectal cancer. In this study, we attempted to clarify the impact of smoking on pulmonary metastasis of colorectal cancer. Method Between September 2005 and December 2010 we reviewed 567 patients with pathological Stage I, II or III colorectal cancer, whose clinicopathological background included a preoperative smoking history, pack-year history from medical records. Univariate and multivariate analyses using the Cox proportional hazard model were performed to determine the independent prognostic factors for pulmonary metastasis-free survival. Results Pulmonary metastases occurred in 39 (6.9%) patients. The smoking histories revealed 355 never smokers, 119 former smokers and 93 current smokers among the subjects. Multivariate analysis revealed that being a current smoker (hazard ratio = 2.72, 95% CI 1.18–6.25; P = 0.02) was an independent risk factor for pulmonary metastases. Conclusion Smoking may be a risk factor for pulmonary metastasis of colorectal cancer. Cessation of smoking should be recommended to prevent pulmonary metastasis, although further basic and clinical studies are required.

Background Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases. The phenotypes that have clinical features of both asthma and COPD are still incompletely understood. Objective To clarify the best discriminators of the asthma-COPD overlap phenotype from asthma and COPD subgroups using a clustering approach. Methods This study assessed pathophysiological parameters, including mRNA expression levels of T helper cell-related transcription factors, namely, TBX21 (Th1), GATA3 (Th2), RORC (Th17), and FOXP3 (Treg), in peripheral blood mononuclear cells in asthma patients (n = 152) and in COPD patients (n = 50). Clusters were determined using k-means clustering. Exacerbations of asthma and COPD were recorded during the 1-year follow-up period. Results The cluster analysis revealed four biological clusters: cluster 1, predominantly patients with COPD; cluster 2, patients with an asthma-COPD overlap phenotype; cluster 3, patients with non-atopic and late-onset asthma; and cluster 4, patients with early-onset atopic asthma. Hazard ratios for exacerbation were 2.5 (95% confidence interval [CI], 1.1–5.6) in cluster 1 and 2.3 (95% CI, 1.0–5.0) in cluster 2 compared with patients in other clusters. Cluster 2 was discriminated from other clusters by total serum IgE level ≥ 310 IU/mL, blood eosinophil counts ≥ 280 cells/μL, a higher ratio of TBX21/GATA3, FEV1/FVC ratio < 0.67, and smoking ≥ 10 pack-years with an area under the curve of 0.94 (95% CI, 0.90–0.98) in the receiver operating characteristic analysis. Conclusions & Clinical Relevance The asthma-COPD overlap phenotype was characterized by peripheral blood eosinophilia and higher levels of IgE despite the Th2-low endotype. This article is protected by copyright. All rights reserved.

In grassland studies, an intermediate level of grazing often results in the highest species diversity. Although a few hypotheses have been proposed to explain this unimodal response of species diversity to grazing intensity, no convincing explanation has been provided. Here, we build a lattice model of a grassland community comprising multiple species with various levels of grazing. We analyze the relationship between grazing and plant diversity in grasslands under variable intensities of grazing pressure. The highest species diversity is observed at an intermediate grazing intensity. Grazers suppress domination by the most superior species in birth rate, resulting in the coexistence of inferior species. This unimodal grazing effect disappears with the introduction of a small amount of nongrazing natural mortality. Unimodal patterns of species diversity may be limited to the case where grazers are the principal source of natural mortality.

Multiple sexually transmitted infections (STIs) have threatened human health for centuries. Most STIs spread not only through sexual (horizontal) transmission but also through mother-to-child (vertical) transmission. In a previous work (Ito et al. 2019), we studied a simple model including heterosexual and mother-to-child transmission and proposed a formulation of the basic reproduction number over generations. In the present study, we improved the model to take into account some factors neglected in the previous work: adult mortality from infection, infant mortality caused by mother-to-child transmission, infertility or stillbirth caused by infection, and recovery with treatment. We showed that the addition of these factors has no essential effect on the theoretical formulation. To study the characteristics of the epidemic threshold, we derived analytical formulas for three type-reproduction numbers for adult men, adult women and juveniles. Our result indicates that if an efficient vaccine exists for a prevalent STI, vaccination of females is more effective for containment of the STI than vaccination of males, because the type-reproduction number for adult men is larger than that for adult women when they are larger than one., Scientific reports, 9(1), art.no.17408; 2019

The importance of cosyntropin stimulation during adrenal vein sampling (AVS) is not fully established, partly due to insufficient AVS data relating the presence and absence of cosyntropin stimulation with postoperative outcome. Therefore, we investigated differences in AVS indices before and after cosyntropin stimulation, and determined whether unstimulated or stimulated AVS indices better correlated with treatment outcome. A retrospective study was conducted in two parts: one with 185 patients who underwent AVS and the other with 81 patients who underwent unilateral adrenalectomy for unilateral aldosterone oversecretion. The selectivity index (SI), lateralized ratio (LR), and contralateral ratio (CR) before and after cosyntropin stimulations were determined, along with blood pressure outcome 1 year after surgery. Primary aldosteronism was diagnosed according to the Japanese Endocrine Society 2009 guidelines. The percentage of AVS patients with successful catheterization, defined as unstimulated SI > 2 before and stimulated SI > 5, increased after cosyntropin stimulation from 52% to 93% and from 74% to 98% for the right and left adrenal veins, respectively. LR decreased after cosyntropin stimulation (P

Background We examined the utility of transient hepatic attenuation differences (THADs) detected in the arterial phase of computed tomography for the diagnosis of acute gangrenous cholecystitis (AGC). Methods We examined 83 consecutive patients who underwent cholecystectomy within 72 h of undergoing three-phase dynamic computed tomography scans for acute cholecystitis between 2009 and 2018 (histopathological examination later confirmed 42 with AGC, 41 without). The THAD volume (cm3 ) was calculated by multiplying the total area of the enhancing lesions (traced on axial images) by the thickness of the scan (0.5-cm slices). We evaluated the sensitivity and specificity of the THAD volume and other computed tomography findings of AGC. Results The THAD volume was significantly larger in the AGC group than in the non-gangrenous acute cholecystitis group (P 78 cm3 to be an independent predictor of AGC. Conclusions Acute gangrenous cholecystitis can be diagnosed using THAD volume, resulting in improved treatment and fewer serious complications.

INTRODUCTION AND OBJECTIVES:Tumor enucleation with partial nephrectomy for treatment of renal tumors yields a specimen that includes a tumor surrounded by the peritumoral pseudocapsule (PC) with mi...

Elucidation of the structure of human sexual networks is not only an interesting topic in the area of social networks but also an important clue for understanding the spreading risk of sexually transmitted infections (STIs). Some previous studies have indicated that sexual networks are scale free, while others have suggested that they are not. We conducted a Web-based survey on sexual contact in Japan to collect data on cumulative (total) heterosexual partners and the number of recent (in the last three or previous three months) heterosexual partners. To determine whether the number of heterosexual contacts in Japan has a power-law tail, we used maximum likelihood fitting methods and Kolmogorov-Smirnov tests. For confirmation, we also used the Akaike information criterion (AIC) and the Bayesian information criterion (BIC). Our results indicate that the distributions of the number of sexual partners in Japan have power-law tails., PLoS ONE, 14(8), art.no.e0221520; 2019

Self-sacrifice is very rare among organisms. Here, we report a new and astonishing case of adaptive self-sacrifice in a polyembryonic parasitic wasp, Copidosoma floridanum. This wasp is unique in terms of its larval cloning and soldier larvae. Male clone larvae have been found to be killed by female soldier larvae, which suggests intersexual conflict between male and female larvae. However, we show here that mass killing is adaptive to all the killed males as well as the female soldiers that have conducted the killing because the killing increases their indirect fitness by promoting the reproduction of their clone sibs. We construct a simple model that shows that the optimal number of surviving males for both male and female larvae is very small but not zero. We then compare this prediction with the field data. These data agree quite well with the model predictions, showing an optimal killing rate of approximately 94–98% of the males in a mixed brood. The underlying mechanism of this mass kill is almost identical to the local competition for mates that occurs in other wasp species. The maternal control of the sex ratio during oviposition, which is well known in other hymenopterans, is impossible in this polyembryonic wasp. Thus, this mass kill is necessary to maximize the fitness of the female killers and male victims, which can be seen as an analogy of programmed cell death in multicellular organisms.

The construction and discontinuance processes of factories are complicated problems in sociology. We focus on the spatial and temporal changes of factories at Hamamatsu city in Japan. Real data indicate that the clumping degree of factories decreases as the density of factory increases. To represent the spatial and temporal changes of factories, we apply “contact process” which is one of cellular automata. This model roughly explains the dynamics of factory distribution. We also find “historical effect” in spatial distribution. Namely, the recent factories have been dispersed due to the past distribution during the period of economic bubble. This effect may be related to heavy shock in Japanese stock market.

A 56-year-old man was diagnosed with aplastic anemia and paroxysmal nocturnal hemoglobinuria at 43 years of age and treatment with cyclosporin A was started. Liver cirrhosis, ascites, and thrombus in the hepatic veins were found at 56 years of age and Budd-Chiari syndrome (BCS) was diagnosed according to angiography findings. He was treated with diuretics and paracentesis was performed several times, but with limited efficacy. A Denver® peritoneovenous shunt (PVS) was inserted into the right jugular vein; his ascites and renal function improved immediately and his general condition has remained good for 12 months since starting the above treatment regimen. A PVS is a treatment option for ascites due to BCS.

This study investigates the influence of lattice structure in evolutionary games. The snowdrift games is considered in networks with high clustering coefficients, that use four different strategy-updating. Analytical conjectures using pair approximation were compared with the numerical results. Results indicate that general statements asserting that the lattice structure enhances cooperation are misleading., 12 pages, 3 figures

Expiratory flow limitation (EFL) during tidal breathing is common in patients with severe COPD, and a major determinant of dynamic hyperinflation and exercise limitation. The negative expiratory pressure (NEP) technique has been the gold standard to detect EFL, while the forced oscillation technique (FOT) has also been reported to detect it. However, the association of FOT with NEP is not fully understood. We assessed whether broadband frequency FOT would predict the presence of EFL measured by NEP. FOT, NEP, and spirometry were performed in 51 patients with COPD. The extent of emphysema was measured by high-resolution computed tomography and scored. Fifteen patients were classified into the EFL-positive group and 36 into the EFL-negative group. In multivariate logistic regression analysis, EFL was independently predicted by emphysema score, forced vital capacity, and whole-breath respiratory system reactance at 5Hz (X5). The receiver operator characteristic curve analysis revealed that inspiratory X5 best predicted EFL-positivity. X5-related forced oscillatory parameters are useful for detecting EFL in the management of COPD.

Synergy is known to be vital for the group collaboration among non-kin individuals. In order to evaluate the condition of synergy that initiates group living, we build a model of food intake based on three types of functional response. We show that type III functional response is prerequisite for synergy to allow group living.The optimal number of gathering individuals can be also evaluated from Type III functional response curve. Type III functional response consists of terms depending linearly and bilinearly on the number of individuals and the bilinear term represents synergy. For a fixed value of the linear coefficient, there are upper and lower boundaries of the bilinear coefficient for synergistic collaboration. The dilution effect can be incorporated into the model through the functional response of the predator. Thus, the functional response of the predator as well as that of the prey contribute to the group living of the prey. Our model shows that group livings can be categorized into three types, namely those due to (1) synergy effect of the own group, (2) dilution effect against predators, and (3) both effects contributing together. The predator's functional response plays a decisive role in the last two types, where the predator response should be of anti-Type III (i.e., Type II)., Ecological Complexity, 44, art.no.100874; 2020

OBJECTIVE: To compare single-shot turbo spin-echo (TSE) diffusion-weighted whole-body imaging with background suppression (DWIBS) and echo-planar imaging (EPI) DWIBS to determine the feasibility of direct-coronal TSE-DWIBS. METHODS: All measurements were performed using a 3.0 T MRI scanner. In the phantom study, we compared the contrast ratios (CRs) of tumor-mimicking phantom (tumor) to muscle-mimicking phantom (muscle) and water to muscle and the signal-to-noise ratio (SNR) between TSE-DWIBS and EPI-DWIBS. In the volunteer study, 10 healthy volunteers were whole-body scanned with direct-coronal TSE-DWIBS, direct-coronal EPI-DWIBS (corEPI-DWIBS), and transverse EPI-DWIBS (traEPI-DWIBS). Two radiologists assessed the image distortion, uniformity of fat suppression, overall artifacts, and overall image quality in maximum intensity projection (MIP) images from each DWIBS image using a 5-point scale. RESULTS: In the phantom study, the CR of tumor to muscle was found to be lower for TSE-DWIBS (10.57 ± 0.45) than for EPI-DWIBS (15.38 ± 0.27), and the CR of water to muscle was higher for TSE-DWIBS (9.61 ± 0.66) than for EPI-DWIBS (2.52 ± 0.60). The volunteer study revealed good inter observer agreement between TSE-DWIBS and EPI-DWIBS with respect to image distortion, uniformity of fat suppression, overall artifacts, and overall image quality, with weighted Cohen’s κ coefficients of 0.91, 0.74, 0.87, and 0.72, respectively. Qualitative analysis scores for image distortion, uniformity of fat suppression, overall artifacts, and overall image quality were significantly higher for TSE-DWIBS than for corEPI-DWIBS or traEPI-DWIBS (p < 0.05). CONCLUSION: Direct-coronal TSE-DWIBS is robust against magnetic field inhomogeneity. High-quality images without distortion or fat suppression inhomogeneity were obtained. ADVANCES IN KNOWLEDGE: Many studies on DWIBS have been previously reported; however, these studies used EPI read-out. To the best of our knowledge, no studies using TSE read-out have been reported. In this study, we examined the feasibility of TSE-DWIBS with lesser artifacts than EPI-DWIBS.

Background: The usefulness of the forced oscillation technique (FOT) in diagnosing cough variant asthma (CVA) has not been demonstrated. Aims: This retrospective study aimed to evaluate diagnostic accuracy of the changes in respiratory system resistance (Rrs) and reactance (Xrs) as possible predictors of CVA. Methods: Twenty-six patients with CVA and 20 with non-CVA (gastroesophageal reflux disease, rhinosinusitis, and post-infectious cough) were enrolled. FOT (MostGraph-01) and spirometry were performed in airway reversibility testing. Fractional exhaled nitric oxide (FeNO) was also measured before the testing. A diagnosis of CVA was based on an isolated cough lasting for at least 8 weeks without wheezing, which was relieved by β2 agonists. Receiver operator characteristic (ROC) curves were constructed to assess which parameters would predict CVA diagnosis. Results: CVA patients showed a significant improvement in Rrs at 5 Hz (R5), Xrs at 5 Hz (X5), resonant frequency (Fres), and a low-frequency reactance area (AX), but not in spirometric indices. ROC curve analyses revealed that the changes in R5, X5, Fres, and AX were superior to the change in FEV1 or the FeNO value to diagnose CVA. The best area under the curve was 0.72 for AX with the optimal cutoff point of 0.41 cmH2O/L (sensitivity, 0.98; and specificity, 0.62). Conclusion: The FOT is superior to spirometry or FeNO measurements in predicting CVA.

Introduction: There are few published reports regarding the clinical benefits of pneumococcal vaccination for the prevention of pneumococcal pneumonia among elderly outpatients with chronic respiratory diseases. Objectives: To evaluate the effectiveness of a 23-valent pneumococcal polysaccharide vaccine (PPSV23) and a 13-valent pneumococcal conjugate vaccine (PCV13) among elderly outpatients. Methods: This report describes a case-control study including 4124 outpatients aged ≥65 years with chronic respiratory diseases, treated from 2015 to 2017 in our department. Study outcomes were pneumococcal pneumonia incidence rates in the PPSV23 group, the PCV13 group and the non-vaccination group. The effect of each vaccination within 5 years was evaluated as an odds ratio (OR) adjusted by a propensity score, which was predicted using age, gender, comorbidities, and steroid use. ORs and 95% confidence intervals (CIs) of vaccination were calculated using a logistic regression model. Results: There were 377 vaccinated patients (PPSV23, 327 and PCV13, 50), and 143 were diagnosed with pneumococcal pneumonia (Table). Conclusions: There were no significant differences between the vaccination group and the non-vaccination group, possibly because of the differences in background factors and physicians’ recmmendations.

Classical Lotka-Volterra (LV) competition equation has shown that coexistence of competitive species is only possible when intraspecific competition is stronger than interspecific competition, i.e., the species inhibit their own growth more than the growth of the other species. Note that density effect is assumed to be linear in a classical LV equation. In contrast, in wild populations we can observed that mortality rate often increases when population density is very high, known as crowding effects. Under this perspective, the aggregation models of competitive species have been developed, adding the additional reduction in growth rates at high population densities. This study shows that the coexistence of a few species is promoted. However, an unsolved question is the coexistence of many competitive species often observed in natural communities. Here, we build an LV competition equation with a nonlinear crowding effect. Our results show that under a weak crowding effect, stable coexistence of many species becomes plausible, unlike the previous aggregation model. An analysis indicates that increased mortality rate under high density works as elevated intraspecific competition leading to the coexistence. This may be another mechanism for the coexistence of many competitive species leading high species diversity in nature.

To evaluate the frequency of visualization of the right adrenal vein (RAV) on dual adrenal venous phase multi-detector computed tomography (MDCT) in patients with primary aldosteronism. Images of contrast-enhanced dual adrenal venous phase MDCT (45- and 55-second delays) in 90 patients with primary aldosteronism who underwent adrenal venous sampling were retrospectively evaluated. The degree of RAV visualization on each phase image was evaluated by two radiologists using a five-point scale and RAV visualization rates were estimated. The RAV visualization rates on the first- and second-phase images were 89 % and 91 % by radiologist A, and 93 % and 90 % by radiologist B, respectively. No significant differences in the score of RAV visualization were observed between the first- and second-phase images by the two readers (P = 0.164 and P = 0.06). The kappa values for inter-observer agreement of RAV visualization on the first- and second-phase images were 0.57 and 0.46, respectively. The consensual RAV visualization rates on the first- and second-phase images were 91 % and 92 %, respectively. The overall RAV visualization rate by using both phase images was 98 %. Dual adrenal venous phase MDCT can visualize the RAV in almost all patients with primary aldosteronism. • Dual adrenal venous phase MDCT images can visualize the right adrenal veins. • The adrenal venous phase lies between the arterial and portal phases. • Anatomical information will contribute to the technical success of adrenal venous sampling.

Purpose To evaluate retrospectively whether prophylactic embolization of pseudoaneurysms detected on early postoperative screening with computed tomography (CT) after partial nephrectomy can prevent delayed hemorrhage. Materials and Methods Between January 2012 and May 2014, early postoperative contrast-enhanced CT was performed 3–5 days after partial nephrectomy in 312 patients (group A); CT was not performed in 65 patients (group B) because of renal insufficiency or contrast medium allergy. If pseudoaneurysms were detected on CT in group A, prophylactic embolization was performed. The frequency of delayed hemorrhage occurring more than 3 days after surgery in group A was compared with group B and with 212 patients (group C) who underwent partial nephrectomy between January 2010 and December 2011 without early postoperative CT. Changes in estimated glomerular filtration rate at discharge were compared among the groups. Results Prophylactic embolization of pseudoaneurysms was performed in 26 patients (8%) in group A. Frequency of delayed hemorrhage in group A (0.6%) was significantly lower than in groups B (4.6%; P = .038) and C (4.7%; P = .005). No major complications attributable to prophylactic embolization were observed. The decrease in estimated glomerular filtration rate in group A (−2% ± 13%) was smaller than that in group B (−8% ± 13%; P P = .108). Conclusions Prophylactic embolization of pseudoaneurysms detected on early postoperative CT can prevent delayed hemorrhage after partial nephrectomy, without major complications.