Search

In last mile delivery, to manage delivery default risks and ensure delivery completion, reserve personenel are placed. This is due to driver procurement having to be planned and executed about one-month ahead, when delivery demands could only be roughly predicted. Although reserve drivers occasionally work as final defense, it regularly lowers driver utility, and a method to place reserve drivers balancing delivery default risk and driver utility is required. Previous work tackled this problem by stochastic staffing problem approaches, but there existed a limit in feature modelling and result interpretability, which created a gap in algorithms and procurement manager decision making. The proposed method aims to fill this gap, by taking a transdisciplinary approach of traditional scheduling, probability modelling, and explainable AI. In doing so, a flow of first creating a staffing schedule based on fixed staffing number demands, and then determining a fixed number of reserve personnel required for each staffing window, was designed. A probablity distribution of required personnel number per delivery is calculated in doing so, and this distribution is used as a easy to understand decision support tool for delivery managers. Through a case study using delivery demand data of a Japanese EC-logistics company, the proposed method was shown capable of lowering reserve drivers, with having a high potential of no delivery defaults.

Objective: Fibroblast growth factor (FGF)23 suppresses erythropoiesis and is implicated in iron metabolism. It was investigated whether high levels of FGF23 was associated with hepcidin levels of iron metabolism markers in hemodialysis patients. Methods: The serum hepcidin, erythroferrone, and intact-FGF23 or total-FGF23 level as well as iron-related parameters at pre-dialysis in 70 hemodialysis (HD) patients was measured and performed a regression analysis. Results: Each measurement for FGF23, including the intact-/total-FGF23 ratio, correlated strongly with both serum inorganic phosphate and calcium-phosphate product concentrations. Serum hepcidin levels showed a positive correlation with TSAT or serum ferritin concentration. In addition, a negative correlation was found between serum of hepcidin and erythroferrone levels, but no correlation was found between FGF23-related measurements and serum hepcidin levels. Both serum FGF23 levels and erythroferrone levels correlated with erythropoietin-stimulating agent treatment. Conclusion: It was strongly suggested that both serum phosphate concentrations and calcium-phosphate products were associated with FGF23 production in HD patients. As previously reported, the association between hepcidin and iron metabolism markers was reconfirmed, but a simple linear relationship between hepcidin and FGF23 was not observed even after adjusting FGF23. However, a significant negative correlation between erythroferrone and serum hepcidin levels was confirmed in HD patients.

The emergence of multicellularity is a key event in the evolution of life and is an attractive challenge among researchers, including those investigating the artificial design of cellular behavior1. Multicellular organisms are widely distributed on Earth, and retracing the specific conditions conducive for the initial transition from unicellularity to multicellularity is difficult. However, by examining organisms that inhabit unique (e.g., isolated) environmental niches, we may be able to get a glimpse into primitive multicellularity in the context of a given environment. Here we report the discovery of a new bacterium that displayed multicellular-like characteristics and behavior. The bacterium, which was isolated adjacent to an underground stream in a limestone cave, is to be named Jeongeupia sacculi sp. nov. HS-3. On a solid surface, HS-3 self-organizes its filamentous cells to form an appearance similar to the nematic phase of a liquid crystal2. Mature colonies produce and accommodate clusters of coccobacillus progeny, and release them upon contact with water. HS-3 demonstrated novel, spatiotemporally regulated multicellularity that can resolve the so-called ‘competition-dispersal trade-off’ problem3. This study illustrates a hypothetical missing link on the emergence of multicellularity.

Anaerobic digestion is an energy-generating, ecologically friendly waste/wastewater treatment process. However, treatment of anaerobic digestion effluent (ADE) and purification of carbon dioxide in the biogas, commonly called biogas upgrading, are two issues that prevent propagation of this process. Since ADE contains high concentrations of nutrients, it can be utilized for microalgal cultivation if the chemical composition is optimized for the purpose. Microalgal cultivation is at the same time a promising platform to capture and utilize carbon dioxide in biogas. Therefore, simultaneous ADE utilization and biogas upgrading can be possible by coupling microalgal culture. Previous studies using the simultaneous process adopted open pond systems with algal-bacterial consortium. Although these processes were effective in treatment of both ADE and biogas, the volumetric productivity and economic value of the microalgal biomass are low in such systems. Thus, this study aimed to establish a simultaneous algal pure culture and biogas upgrading using centrifuged supernatant of anaerobic digestion effluent from an activated sludge treatment facility. To achieve this goal, the ADE concentration, pH, dissolved inorganic carbon, and metal composition were adjusted by batch optimization tests with Chlorella sorokiniana. The optimized ADE media was then scaled up to 4-L photobioreactor (PBR) coupled with a 1.8-L gas/liquid exchange column for simultaneous processing. Since the current study adopted algal pure culture in a closed PBR, gas/liquid transfer was expected to be different from previous studies, and thus, three liquid circulation flow rates (1, 2 and 4 L d-1) were tested, which resulted in liquid to gas ratio (L/G) of 0.1, 0.3 and 0.5. As a result, the ADE media was optimized to 10% ADE content, pH 8.0, 0.1 mol L-1 bicarbonate addition, and Mg + Mn addition. While the raw ADE did not allow the growth of Chlorella sorokiniana, the maximum algal specific growth rate using the optimized media reached more than 2 d-1, which equals a doubling time of less than 9 hours. The optimized media was then used for the simultaneous microalgae cultivation and biogas upgrading process. The average productivity in the PBR was 206 ±138 mg L-1 d-1. The carbon dioxide recovery rates for L/G 0.1, 0.3, and 0.5 were 90, 94, and 99%, respectively. On the other hand, O2 contents in the upgraded gas were 8.5, 8, and 14%, respectively. The content of carbon dioxide and O2 were in a reverse relationship over various L/G ratios. The current study demonstrated the effectiveness of carbon capture from the biogas, but also suggested further challenge in prevention of oxygen intrusion from algal pure culture. Comparisons with other studies suggest that optimization in gas/PBR volume may enhance the quality of biogas upgrading.

The efficacy of laparoscopic multivisceral resection (Lap-MVR) has been reported by several experienced high-volume centers. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan to improve the skill of laparoscopic surgeons and further develop surgical teams. We examined the safety and feasibility of Lap-MVR in general hospitals, and evaluated the effects of the Japanese ESSQS for this approach. We retrospectively reviewed 131 patients who underwent MVR between April 2016 and December 2019. Patients were divided into the laparoscopic surgery group (LAC group, n = 98) and the open surgery group (OPEN group, n = 33). The clinicopathological and surgical features were compared between the groups. Compared with the OPEN group, BMI was significantly higher (21.9 vs 19.3 kg/m2, p = 0.012) and blood loss was lower (55 vs 380 ml, p

A 61-year-old woman who underwent hemodialysis presented with heart failure. Echocardiography revealed multiple mobile masses in the left atrium. The masses were excised, and histopathologic examination revealed calcified amorphous tumors. Here, we present several echocardiography images, including 3-dimensional transesophageal echocardiography, demonstrating the revolving masses in the left atrium. (Level of Difficulty: Intermediate.), Central Illustration

Purpose Although the safety and comparable long-term outcomes after laparoscopic surgery (LAP) for advanced colon cancer versus open surgery (OP) were previously reported, the indications for highly advanced colon cancer are controversial. We aimed to assess long-term outcomes after LAP versus OP for pathological T4 (pT4) and/or N2 (pN2) colon cancer. Methods We retrospectively reviewed 255 primary tumor resections for pT4 and/or pN2 colon cancer performed from 2015 to 2020 at six hospitals, divided into LAP (n = 204) and OP groups (n = 51). After propensity score matching to minimize selection bias, 42 matched patients per group were assessed. Results Before matching, the rate of males (53.9% vs 37.3%, p = 0.042), left sided colon cancer (53.9% vs 37.3%, p = 0.042), D3 lymph node dissection (90.7% vs 68.6%, p

Background Conflicting results between bacterial mutagenicity tests (the Ames test) and mammalian carcinogenicity tests might be due to species differences in metabolism, genome structure, and DNA repair systems. Mutagenicity assays using human cells are thought to be an advantage as follow-up studies for positive results in Ames tests. In this collaborative study, a thymidine kinase gene mutation study (TK6 assay) using human lymphoblastoid TK6 cells, established in OECD TG490, was used to examine 10 chemicals that have conflicting results in mutagenicity studies (a positive Ames test and a negative result in rodent carcinogenicity studies). Results Two of 10 test substances were negative in the overall judgment (20% effective as a follow-up test). Three of these eight positive substances were negative after the short-term treatment and positive after the 24 h treatment, despite identical treatment conditions without S9. A toxicoproteomic analysis of TK6 cells treated with 4-nitroanthranilic acid was thus used to aid the interpretation of the test results. This analysis using differentially expressed proteins after the 24 h treatment indicated that in vitro specific oxidative stress is involved in false positive response in the TK6 assay. Conclusions The usefulness of the TK6 assay, by current methods that have not been combined with new technologies such as proteomics, was found to be limited as a follow-up test, although it still may help to reduce some false positive results (20%) in Ames tests. Thus, the combination analysis with toxicoproteomics may be useful for interpreting false positive results raised by 24 h specific reactions in the assay, resulting in the more reduction (> 20%) of false positives in Ames test.

Although adjuvant chemotherapy (AC) using fluoro-pyrimidine and oxaliplatin (FU + oxaliplatin) is recommended after curative resection for locally advanced colon cancer patients, several randomized controlled trials have shown no additional effect of oxaliplatin in patients aged ≥ 70 years. Here, we examined the effectiveness of FU + oxaliplatin on the long-term outcome of old patients with a high risk of recurrence.This multicenter, retrospective study included 346 colon cancer patients diagnosed with pathological T4 and/or N2 disease from 2016 to 2020. They were divided into an old group (≥ 70 years, n = 197) and a young group ( 70 years, n = 167). Propensity score matching was used to minimize selection bias, and 126 patients per group were matched.Before matching, the rates of poor performance status (p 0.001) and the presence of comorbidities (76.1% vs. 47.9%, p 0.001) were higher in the old group. Although all baseline factors were similar between groups, after matching, the AC rate was lower in the old group (45.2% vs. 65.1%, p = 0.002). In the old group, relapse-free (82.2% vs. 55.6% and 69.6%, p 0.05) and overall survival (83.1% vs. 80.0% and 44.4%, p 0.05) rates were significantly higher in the AC patients with FU + oxaliplatin than in the AC patients with only FU and the non-AC patients.The selected old colon cancer patients with a high risk of recurrence gained an additional benefit with respect to prognosis from FU + oxaliplatin as AC.

This study highlights the severity of the low snow water equivalent (SWE) and remarkably high temperatures in 2020 in Japan, where reductions in SWE have significant impacts on society due to its importance for water resources. A continuous 60-year land surface simulation forced by reanalysis data revealed that the low SWE in many river basins in the southern snowy region of mainland Japan are the most severe on record. The impact of the remarkably high temperatures in 2020 on the low SWE was investigated by considering the relationships among SWE, temperature, and precipitation. The main difference between the 2020 case and prior periods of low SWE is the record-breaking high temperatures. Despite the fact that SWE was the lowest in 2020, precipitation was much higher than that in 2019, which was one of the lowest SWE on record pre-2020. The results indicate the possibility that even more serious low-SWE periods will be caused if lower precipitation and higher temperatures occur simultaneously.

Since 2000, Federation Dentaire Internationale has advocated for “minimal intervention” dental treatments. The dental field has demanded less-invasive caries treatment methods. However, recent caries treatments using a microsecond-pulsed free-running Er:YAG laser with a pulse duration of 200–300 μs have issues with non-selectivity for caries due to the thermal effect caused by the laser. To improve the selectivity by reducing the thermal effect, the ablation characteristics of a nanosecond-pulsed Er:YAG laser are investigated. A Q-switched Er:YAG laser with a rotating mirror Q-switching system attached to a flash lamp-pumped Er:YAG laser and a free-running Er:YAG laser were used. The pulse duration of the Q-switched Er:YAG laser was 80–130 ns, while that of the free-running Er:YAG laser was around 200 μs. The pulse repetition rate of the free-running Er:YAG laser was constant at 10 Hz, but that of the Q-switched Er:YAG laser fluctuated between 10 and 23 Hz. The fluence was 6, 10, or 14 J/cm2. The samples were bovine sound dentin slices and caries models. Caries models were prepared by immersing sound dentin slice samples into a 0.1-M lactic acid solution for 24 h at 37 °C. The samples were irradiated with the two lasers horizontally without water spray for 1, 2, or 4 s. Laser irradiation experiments indicate that the selectivity towards caries occurs at the fluence of 6 J/cm2 without water spray. The ablation depth of a demineralized dentin slice by the Q-switched Er:YAG laser is about three times that by the free-running Er:YAG laser at the fluence of 10 J/cm2. In addition, the Q-switched Er:YAG laser suppresses the thermal effect reducing the range of the thermal melting area. Caries dentin may be selectively removed without water spray using the Q-switched Er:YAG laser with suppressing dental pulp necrosis because the temperature increase is below 5 °C. The ablation depths by the Q-switched Er:YAG are about three times larger than those using the free-running Er:YAG laser.

Climate change currently affects the resilience and aquatic ecosystem. Climate change alters rainfall patterns which have a great impact on river flow. Annual flooding is an important hydrological characteristic of the Mekong River Basin (MRB) and it drives the high productivity of the ecosystem and biodiversity in the Tonle Sap floodplain and the Mekong Delta. This study aims to assess the impacts of climate change on river flow in the MRB and flood inundation in the Lower Mekong Basin (LMB). The changing impacts were assessed by a two-dimensional rainfall-runoff and inundation model (RRI model). The present climate (1979–2003) and future projected climate (2075–2099) datasets from MRI-AGCM3.2H and MRI-AGCM3.2S models were applied with a linear scaling bias correction method before input into the RRI model. The results of climate change suggested that flood magnitude in the LMB will be severer than the present climate by the end of the twenty-first century. The increment of precipitation between 6.6 and 14.2% could lead to increase extreme flow (Q5) 13–30%, peak inundation area 19–43%, and peak inundation volume 24–55% in the LMB for ranging of Representative Concentration Pathways (RCP) and sea surface temperature (SST) scenarios while there is no significant change on peak flood timing.

Background This study aimed to determine associations among short- and long-acting erythropoiesis stimulating agents (ESAs), changes in serum fibroblast growth factor 23 (FGF23) and biomarkers of iron metabolism. Methods Among 108 patients on hemodialysis (HD), 44 received every 2 weeks or monthly doses of continuous erythropoiesis receptor activator (CERA), 31 received weekly doses of darbepoetin-α, 24 received three doses per week of epoetin-β and 9 were not treated with an ESA. Intact and C-terminal FGF23 and transferrin saturation (TSAT), ferritin, erythroferrone and hepcidin 25 were measured in blood samples collected before the HD session at the end of the dialysis week (baseline, Day 0) and on Days 3, 5, 7 and 14 thereafter. Results Levels of ferritin, hepcidin 25 and erythroferrone as well as TSAT were significantly decreased or elevated in patients treated with CERA compared with other types of ESAs. Levels of C-terminal FGF23 increased in all groups during the observation period. Levels of intact FGF23 and ratios of intact FGF23 to C-terminal FGF23 gradually decreased between Days 3 and 7 in the CERA but not in the other groups. Multivariate models associated changes in hepcidin 25 and phosphate with those of intact FGF23. Conclusion The long-acting ESA CERA might influence levels of intact FGF23 by increasing FGF23 cleavage in patients on HD in association with prolonged hepcidin 25 suppression.

The C-reactive protein to albumin ratio (CAR) is a simple and useful score for predicting the outcomes of patients with various cancers. The aim of this study was to evaluate the CAR and short-term outcomes in oldest-old patients with colorectal cancer. A total of 126 patients aged 85 years and older with colorectal cancer who underwent resection for primary colon cancer from April 2015 to December 2018 were included. The preoperative cutoff value of the CAR for predicting postoperative complications was 0.19 on receiver operating characteristic curve analysis. Clinical characteristics and inflammation-based scores were compared between patients with a high CAR (CAR ≥ 0.19, n = 44) and a low CAR (CAR

Background: Because dementia is an emerging problem in the world, biochemical markers of cerebrospinal fluid (CSF) and radio-isotopic analyses are helpful for diagnosing Alzheimer’s disease (AD). Although blood sample is more feasible and plausible than CSF or radiological biomarkers for screening potential AD, measurements of serum amyloid- β (Aβ), plasma tau, and serum antibodies for Aβ1 - 42 are not yet well established. Objective: We aimed to identify a new serum biomarker to detect mild cognitive impairment (MCI) and AD in comparison to cognitively healthy control by a new peptidome technology. Methods: With only 1.5μl of serum, we examined a new target plate “BLOTCHIP®” plus a matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF/MS) to discriminate control (n = 100), MCI (n = 60), and AD (n = 99). In some subjects, cognitive Mini-Mental State Examination (MMSE) were compared to positron emission tomography (PET) with Pittsburgh compound B (PiB) and the serum probability of dementia (SPD). The mother proteins of candidate serum peptides were examined in autopsied AD brains. Results: Apart from Aβ or tau, the present study discovered a new diagnostic 4-peptides-set biomarker for discriminating control, MCI, and AD with 87% of sensitivity and 65% of specificity between control and AD (***p Conclusion: The present serum biomarker set provides a new, rapid, non-invasive, highly quantitative and low-cost clinical application for dementia screening, and also suggests an alternative pathomechanism of AD for neuroinflammation and neurovascular unit damage.

Training experiences where residents provide Spanish-language concordant care (SLCC) have not been widely described despite their increasing need and prevalence in graduate medical education. In this qualitative study, we enrolled nonnative Spanish-speaking residents (n = 21) within SLCC training clinics from 3 geographically unique programs. Participants completed semistructured interviews focused on their overall SLCC training experience. Major themes identified included (1) high levels of satisfaction in their SLCC experience, (2) concern about ongoing language barriers, (3) demonstration of high levels of cultural humility in caring for patients with limited English proficiency, and (4) identification of several valuable programmatic and clinical resources. Based on these findings, we conclude that SLCC training experiences are of significant value to trainees in becoming pediatricians able to promote health equity. Themes identified could help inform how graduate medical education programs utilize SLCC to grow health-equity based efforts to deliver more effective and compassionate care to our linguistically diverse populations.

A chip-sized passively Q-switched laser is demonstrated, in which a solid-state gain medium is intra-cavity pumped and vertically integrated with a semiconductor laser. A laser chip volume of 1 mm3 and peak power of 50 kW are achieved simultaneously.