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Objectives The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment. (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease Study [AFIRE]; UMIN000016612 , NCT02642419 )

Cholesterol crystals embolise when an aortic atherosclerotic lesion ruptures and cholesterol crystals are scattered and obstruct small peripheral arterioles. Risk factors include both iatrogenic factors such as intravascular catheterisation, and spontaneous factors for atherosclerosis such as aging, hypertension, dyslipidaemia, and smoking. We describe the case of an 83-year-old Japanese man who developed unilateral, superficial necrosis of the tongue as a result of spontaneous embolisation of cholesterol crystals.

We overview of our recent experimental study on the optical second harmonic (SH) response of the rutile TiO_2(110) and (001) faces, and the analysis of these results by phenomenological electromagnetic theory using nonlinear susceptibility tensors and by ab initio theory using the self-consistent full potential linearized augmented plane-wave (FLAPW) method within the local-density approximation. Since bulk rutile TiO_2 has a uniaxial crystal structure of symmetry D^_, nonlinear optical response of its surface and bulk showed remarkable anisotropy. The TiO_2(110) face exhibited stronger reflected SH response when the incident electric field was directed parallel than perpendicular to the [001] axis, while the TiO_2(001) face exhibited relatively isotropic SH response. The anisotropy of the SH intensity patterns depended remarkably on the incident photon energy and the polarization combination. By using a phenomenological electromagnetic theory, we performed a simultaneous analysis of the SH intensity patterns from the (110) and (001) faces as a function of the sample rotation angle around its surface normal. As a result we could separate the contributions from the surface second-order and bulk higher order nonlinear susceptibilities. We also found that the SH intensity spectra as a function of the SH photon energy depended strongly on the sample rotation angle and the polarization combination of the fundamental and SH light. The onset of the SH resonance of the TiO_2(110) face was located at 2ηω～3.4 eV when the induced nonlinear polarization was perpendicular to the surface. It was located at 2ηω～3.2 eV when the induced nonlinear polarization is parallel to the [001] direction in the surface plane. These onset energies were higher than the onset energy of the bulk linear absorption at 3.0 eV. On the other hand, the onset energy of the SH resonance of the (001) face was found at 2ηω～3.0 eV. Discussion was given on the physical meaning of the observed SH intensity spectra. Furthermore, ab initio calculation of the nonlinear optical response from the TiO_2(110) surface using the FLAPW method was performed. The calculated results agreed very well with the experimental SH intensity patterns and spectra. We found both from the phenomenological and ab initio calculation that the main SH response from the TiO_2(110) surface originated from the Ti-O-Ti-O- zigzag chains on the TiO_2(110) surface.

The reactivity of oxidized ZrC(1 0 0) surfaces toward H 2 O and CH 3 OH adsorption has been investigated using X-ray photoelectron spectroscopy and ultraviolet photoelectron spectroscopy. It is found that the reactivity of the ZrC(1 0 0) surface toward H 2 O adsorption is much enhanced when the surface is covered with an ordered suboxide (ZrO) like layer; H 2 O does not adsorb on the ZrC(1 0 0) surface but adsorbs dissociatively forming hydroxyl (OH) and atomic O adsorbates on the surface covered with the ZrO-like layer. When the surface is covered with a disordered ZrO x (1 x 2 O also adsorbs dissociatively forming hydroxyl adsorbates, but the sticking probability up to 1 L is estimated to be ∼45% of that on the ZrO-like surface. CH 3 OH is found to adsorb dissociatively forming methoxy (CH 3 O) adsorbates on both oxidized surfaces while CH 3 OH adsorbs molecularly on the ZrC(1 0 0) surface. Thus, the dissociation of CH 3 OH is facilitated on both oxidized surfaces, however, the sticking probabilities of CH 3 OH on the ZrC(1 0 0) surface and on the oxidized surfaces are found to be comparable.

Angle-resolved photoemission spectroscopy utilizing synchrotron radiation has been used to study the electronic structure of the ZrC(1 0 0) surface covered by a ZrO-like layer. When the ZrC(1 0 0) surface exposed to 50 L O 2 is heated at 950 °C, a ZrO-like layer is formed on the surface and the surface is activated towards gas adsorption. Angle-resolved photoemission measurements show that the O 2p-derived bands show clear dispersion along both the 〈1 0 0〉 ( Γ M ) and 〈0 1 1〉 ( Γ X ) symmetry directions of ZrC(1 0 0). Since the surface gives a sharp (1×1) LEED pattern, it is concluded that a well ordered ZrO layer having a (1×1) periodicity is formed on the ZrC(1 0 0) surface. The O 2p-derived bands show no dispersion along the axis normal to the surface, thus the bands can be viewed as two-dimensional electronic states. In addition to the O 2p-derived bands, partially filled states are found around the Fermi level in the ZrO-like layer. The states are removed by water or oxygen adsorption. The origin of the states is discussed and the states are ascribed to partially filled Zr 4d states.

The adsorption of water on oxidized ZrC(100) surfaces at room temperature has been investigated using X-ray photoelectron spectroscopy (XPS) and ultraviolet photoelectron spectroscopy (UPS). It is found that the reactivity of the ZrC(100) is much enhanced when the surface is covered with an ordered suboxide (ZrO) like layer; the ZrC(100) surface is inert towards H 2 O adsorption, while H 2 O is found to adsorb dissociatively on the ZrC(100) surface covered with the ordered ZrO-like layer forming hydroxyl (OH) species and atomic O species.

This study was aimed at investigating the degree of calcification of coronary arteries in type II diabetes mellitus for the purpose of examining as risk factors for coronary disease as well as parameters of diabetic complications. One hundred and three patients with type II diabetes were studied by the newly developed noninvasive technology of electron beam computed tomography, in which the degree of calcification was expressed as coronary calcification scores. The mean +/- SE value of coronary calcification scores were 247.5 +/- 48.1, which were significantly greater than the control patients without diabetes (148.9 +/- 48.3, p

The phase stabilities of three pseudopolymorphs of DN-9693 were studied by using thermogravimetry and differential thermal analysis. The thermal dehydration of DN-9693·2HCl·H2O proceeds by the mechanism of two-dimensional growth of nuclei. The thermal dehydration of 0.5 mol of H2O per mol of DN-9693·2HCl·2H2O, and that of 2 mol of H2O per mol of DN-9693·2HCl·3H2O, proceed by the mechanisms of three-dimensional diffusion and three-dimensional phase boundary reaction, respectively, but the dehydration followed overlaps with the thermal elimination of HCl. The half-lives for the dehydration at 25°C show that DN-9693·2HCl·H2O is the most stable form.

Nafagrel hydrochloride has two kinds of stable pseudopolymorphs such as hemihydrate and monohydrate. The dehydration of crystal water of these hydrates took place in one step under nitrogen gas atmosphere, whereas the two dehydration steps could be detected for the monohydrate under self-generated atmosphere such as the quasi-sealed and/or the completely sealed systems. These observations indicated that the crystal water of the monohydrate consisted of two different crystal waters.

Recently many researches about transmission of traffic information among vehicles by using inter-vehicle communication without any load side infrastructures have been studied. In order to evaluate performance of such inter-vehicle communication, traffic simulators are widely used. However, in most of existing traffic simulators, distance between two following vehicles is modeled as equals based on statistical flow rates. Such mobility models do not reflect real performance of inter-vehicle communication, In this paper, we extract particular characteristics of real vehicular mobility from several traces of vehicular movement, formulate them formally, implement the formulated realistic vehicular mobility on an existing traffic simulator and obtain more real performance of inter-vehicle communication. In the extracted vehicular mobility, each vehicle runs at a different speed, with different distance from the vehicle ahead, and with different vehicular density/distribution while the bottleneck capacity and saturation flow rate of the target roads are preserved as the same as those on the original one. We have shown that performance of inter-vehicle communication is rather different between the proposed mobility and original mobility by evaluating the reachable hop counts of multi-hop communication and performance of the DSR protocol.

A three-dimensional (3D) model of the human airway tree is proposed based on a deterministic algorithm that can generate a branching duct system in an organ. The algorithm based on two principles: (1) the amount of fluid delivery through a branch is proportional to the volume of the region supplied by the branch; and (2) the terminal branches are arranged homogeneously within the organ. These principles define the basic process of branching: the generation of the dimensions and directionality of the two daughter branches is governed by the properties of the parent branch and the region the parent supplies. The algorithm is composed of nine basic rules and four complementary rules. When the contour of an organ and the position of the trunk are specified, branches are successively generated by the algorithm. Applied to the human lung, the algorithm generates a 3D airway tree which consists of about 54,000 branches. The tree is a fractal structure and its morphometric characteristics of the model are in good agreement with those reported in the literature. The algorithm and the 3D airway model are useful for studying structure function relationship in the lung such as airway-parenchymal interaction and simulated CT imaging.

Anisotropy in the electron energy distribution function (EEDF) in an electron cyclotron resonance plasma with magnetized electrons and weakly magnetized ions is experimentally investigated using a directional Langmuir probe. Under an assumption of independent EEDFs in the directions parallel and perpendicular to the magnetic field, the directional variation of the EEDF is evaluated. In the measured EEDFs, a significantly large population density of electrons with energies larger than 30 eV is found in one of the cross-field directions depending on the magnetic field direction. With the aid of an electron trajectory calculation, it is suggested that the observed anisotropic electrons originate from the EEDF anisotropy and the cross-field electron drift.

Atrial fibrillation (Af) is an important prognostic indicator for clinical deterioration in patients with hypertrophic cardiomyopathy (HCM), particularly in elderly patients, but its significance may vary from unselected to selected populations. This study investigated the risk of Af as a prognostic factor in long-term mortality and morbidity in Japanese patients with HCM at our institution.All fatal and non-fatal cardiovascular events were estimated in 91 patients with HCM (mean age 51 +/- 14 years, 62 men) and follow up continued for 6.7 +/- 4.8 years.Either chronic or paroxysmal Af documented by standard electrocardiography (ECG) or ambulatory ECG monitoring at diagnosis and during follow-up were included with other clinical features in the survival analysis. Af was documented in 22 patients (24%). They were older than those without Af (57 +/- 10 vs 48 +/- 14 years, p0.005) and had larger left atrial dimensions (43 +/- 6 vs 36 +/- 5 mm, p0.01). Cardiovascular events occurred in 12 patients with Af (embolic events in five, heart failure in four, and sudden death in three), and in four patients without Af (embolic event in one, and sudden death in three). Death occurred in 10 patients (seven with Af and three without Af); sudden death in six patients (three with Af and three without Af) and four patients died of cerebrovascular embolism (four with Af and none without Af). Cox's regression analysis showed the occurrence of Af was the most useful predictor of cardiovascular death in patients with HCM. The event-free rate was significantly worse in patients with Af than in those without Af (p0.0001).Af is an important prognostic feature in patients with HCM, which occurs in older patients and in those with left atrial dilation.

The clinical benefit of cholesterol-lowering treatment is unknown in the Japanese elderly in whom the prevalence of morbidity and mortality related to coronary artery disease are known to be low. To evaluate the efficacy of cholesterol-lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor in Japanese elderly patients with documented coronary artery disease, 121 patients with serum cholesterolor = 150 mg/dl prospectively received HMG-CoA reductase inhibitor, and 271 patients undergoing cholesterol-lowering treatment based on dietary therapy alone served as historical controls. The 143 elderly patients ageor = 65 years in the 2 groups had similar baseline serum total cholesterol level (201 +/- 30 vs 202 +/- 31 mg/dl), age (71 +/- 4 vs 70 +/- 4 years), proportion of men (37/53 vs 64/90), number of diseased vessels (1.7 +/- 0.9 vs 1.5 +/- 1.0), and incidences of other classical coronary risk factors, including hypertension, diabetes mellitus, smoking, obesity and family history of coronary artery disease. In all 392 patients, similar trends were observed, including serum total cholesterol level (208 +/- 33 vs 201 +/- 34 mg/dl). With HMG-CoA reductase inhibitors, serum total cholesterol level was reduced by 14% in the elderly subjects and by 13% in all patients. During the follow-up of approximately 3 years, cardiac events occurred in 5 patients (one elderly) in the treatment group and 38 patients (12 elderly) in the control group. Kaplan-Meier survival estimates revealed a higher event-free survival rate with HMG-CoA reductase inhibitors in the elderly subjects (98% vs 85%, p0.05) and in all patients (94% vs 86%, p0.05). Cox proportional hazard modeling also demonstrated a significant reduction in risk for cardiac events with drug therapy (relative risk 0.32, p0.05), in addition to the number of diseased vessels (relative risk 1.8, p0.01). In contrast, no additional risk was observed with advancing age. Cholesterol-lowering treatment with HMG-CoA reductase inhibitors is effective to improve the prognosis of Japanese elderly patients, including those with normal serum cholesterol level.

On the basis of elasticity dynamics, we constructed mathematical models of bronchial displacements caused by well-differentiated adenocarcinoma and inflammatory pulmonary nodules. We simulated bronchial displacement with a three-dimensional model of the airway tree that we constructed. One-hundred sixty simulations of cancerous and inflammatory displacements were performed, where 20 nodule centers were placed in the right upper lobe in the three-dimensional bronchial model and four different sizes (30 mm, 37.5 mm, 45 mm, and 60 mm) of original lesions were assumed which contracted to nodules of 15 mm in diameter. The three-dimensional simulation images were highly similar to the cancerous or inflammatory nodules in the clinical images. Angles and distances in simulated structures between respective branches and the nodule center were measured. The mean value of angles of branches whose distance from the nodule center was within a range of 6 mm to 12 mm was in good accordance with the value obtained theoretically. Discrimination between cancer and inflammation was successfully carried out by examining the distance dependency of the angles. We concluded that the measurement of angles of linear structures surrounding a pulmonary nodule would be useful for its differential diagnosis.

Although the aVL lead in exercise electrocardiography is reported to be helpful in identifying a significant narrowing of the left anterior descending coronary artery (LAD), its role in exercise testing has not been fully evaluated. Accordingly, 821 patients who underwent both standard exercise testing and coronary angiography were evaluated. In patients with aVL lead ST elevation, the incidence of a significant narrowing of the LAD (124/165 vs 348/656; p0.001) was higher than in those without. Multiple logistic regression analysis revealed that the 2 most important variables that correlated with aVL lead ST elevation were a greater number of leads with ST depression in the inferior leads and a smaller amplitude of R wave in the aVL lead. In contrast, variables correlating with aVL lead ST depression in the majority of cases were a greater number of leads with ST depression in all leads and the presence of inferior lead ST elevation. The results of this study indicate that although aVL lead ST elevation could be a marker for LAD narrowing, more important factors such as inferior lead ST-segment depression and the R-wave amplitude of the aVL lead should be taken into consideration. In contrast, ST depression in the aVL lead mostly represents exercise-induced myocardial ischemia of greater extent and severity.

A 32-year-old woman presented with a rare case of tricuspid valve endocarditis causing inflammatory reopening of the spontaneously closed ventricular septal defect (VSD), associated with aortic valve malformation. She was admitted to our hospital because of fever lasting 4 weeks. Severe aortic regurgitation was revealed by color Doppler echocardiography. Blood culture identified Microccus faecalis. Antibiotics were administered over 3 weeks, but serial echocardiography showed a developing vegetation in the right ventricle and left-to-right shunt flow. The diagnosis was infective endocarditis complicated by aortic ring abscess and interventricular septal fistula. Surgery performed on the 22nd hospitalized day found a vegetation of the tricuspid valve, a membranous type of VSD, and aortic valve malformation. Aortic valve replacement, patch closure of VSD, and tricuspid valvuloplasty achieved a successful outcome.

The prognostic importance of age among well-known prognostic factors such as extent of coronary artery lesions, cardiac function, and myocardial ischemia was evaluated in 147 elderly patients with coronary artery disease aged 65 years or older who underwent dipyridamole perfusion scintigraphy and coronary angiography. After excluding 32 patients who initially underwent percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG), 115 patients who were initially treated medically were analysed by the Cox model for cardiac events during a mean follow-up period of 29 +/- 22 months. Among the 114 patients who were available for follow-up, nine patients (7.9%) had cardiac events, including five cardiac deaths and four non-fatal cardiac events (requiring PTCA or CABG). When the 114 patients were divided into three age-groups; 53 patients aged 65-69 years, 42 aged 70-74 years and 19 aged 75 years or older, the incidence of cardiac death was highest in those aged 75 years or older. Univariate analysis showed that age of 70 years or older (hazards ratio 15.15, p = 0.004), scintigraphic diffuse slow washout (hazards ratio 8.77, p = 0.002), and triple-vessel or left main trunk disease (hazards ratio 6.36, p = 0.05) were important prognostic factors. Multivariate analysis showed that scintigraphic diffuse slow washout (hazards ratio 6.33, p = 0.05), and triple-vessel or left main trunk disease (hazards ratio 11.94, p = 0.05) were statistically significant as independent prognostic factors. However, when age of 70 years or older was included in the analysis, it showed higher hazards ratio (21.21, p = 0.03) than that of scintigraphic diffuse slow washout (7.36) or triple-vessel or left main trunk disease (5.30). Age of 70 years or older may be a significant prognostic factor in elderly patients with coronary artery disease which has an equivalent importance to the extent of coronary lesions.

A 73-year-old man was admitted because of progressive dyspnea. Echocardiography revealed a markedly dilated right sinus of Valsalva and severe aortic regurgitation. Coaptation loss of the aortic valve leaflets was thought to be the cause of regurgitation and congestive heart failure, a rare complication of the unruptured sinus of Valsalva aneurysm. Surgical treatment should be considered to prevent life-threatening heart failure and rupture of the aneurysm even in patients without overt heart failure.

It has been long agreed that the lung contained, at the end of the pseudoglandular stage, mostly the future conductive airway tree and that the intra-acinar structures developed during the subsequent canalicular stage. Recent immunocytochemical investigations have disclosed that the epithelial cells lining the distal airways in the pseudoglandular stage have the characteristics of alveolar epithelial cells. The purpose of this study was to quantitatively evaluate the progress of fetal airway branching.The numerical density of endtips of the airway tree was estimated in three human fetal right lungs after 3D reconstruction of airways from serial histologic sections. The CRLs of the three fetuses were 103 mm, 132 mm, and 145 mm. The former two corresponded to the late pseudoglandular stage and the last to the early canalicular stage. Three-dimensional reconstructions were performed on two portions of the upper and lower lobes in each lung. The numbers of endtips of the airway tree contained in the reconstructed portions were counted an the numerical densities calculated.The numerical densities in the parenchyma of the three right lungs were 1.2 x 10(3)/mm3, 1.7 x 10(3)/mm3, and 2.4 x 10(3)/mm3, respectively. The estimated total numbers of endtips in the whole right lung were 0.85 x 10(6), 2.25 x 10(6), and 5.17 x 10(6), which were equal to 2(19.8), 2(21.2), and 2(22.3), respectively.Since this suggests that 20 generations of branching were completed, we concluded that the airway branching has already reached the level of the future alveolar ducts in the late pseudoglandular stage.

The significance of silent myocardial ischemia detected by dipyridamole perfusion scintigraphy was evaluated in 80 patients with stable angina and reversible defects (RD) but no infarction. The patients were divided into two groups: 26 patients with silent RD (62 +/- 7 years) and 54 patients with painful RD (65 +/- 7 years). Coronary risk factors, extent of coronary lesions, localization and degree of RD, and prognosis were compared. There was no significant difference in the incidence of coronary risk factors between these two groups, except for hyperlipidemia which was less frequently observed in patients with silent RD than in those with painful RD (8% vs 41%, p0.01). Coronary angiography revealed a higher prevalence of insignificant lesions or single vessel disease in patients with silent RD than in those with painful RD (73% vs 39%, p0.05). Dipyridamole perfusion scintigraphy revealed a lower degree of RD in patients with silent RD than in those with painful RD (4.4 +/- 3.3 vs 9.0 +/- 4.1 segments, p0.05), though there was no significant difference in the localization of RD between these two groups. Treadmill stress testing revealed a lower incidence of chest pain in patients with silent RD than in those with painful RD (26% vs 65%, p0.05), despite the mean exercise-duration being significantly longer in the former than in the latter (5.5 +/- 1.7 vs 3.9 +/- 1.7 min, p0.05). There was no significant correlation between the late peak serum ML-1 level and LV volume, and the size and motion of infarcted areas in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum troponin T, a myocardial contractile protein, has been reported to be a sensitive marker for the diagnosis of acute myocardial infarction. However, there have been few reports on its ability to detect coronary reperfusion and to predict left ventricular function in the chronic stage. Twenty two patients (20 males and 2 females, 61 +/- 10 y.o.) with acute myocardial infarction were enrolled in this study. They were divided into 2 groups, one with successful reperfusion (group A: n = 13) and one without reperfusion (Group B: n = 9) and the serial changes of their serum troponin T levels were evaluated. Serum myosin light chain was measured in another group of patients with acute myocardial infarction without history of old myocardial infarction (group C: n = 8). The slope of the logarithm of serum troponin T on a time-value curve was calculated from the time of admission to the first peak within 24 hours of the onset of acute myocardial infarction. The correlation coefficient between the late peak of serum troponin T and the left ventricular ejection fraction in 11 patients with first Q wave acute myocardial infarction was compared with that between the serum myosin light chain peak and the left ventricular ejection fraction in group C. 1) The slope of the logarithm of serum troponin T on the time-value curve in group A was greater than that in group B (0.57 +/- 0.45 vs. 0.22 +/- 0.16) (p0.05). 2) There was a good correlation between the late peak level of serum troponin T (78 +/- 10 hours after the onset) and the left ventricular ejection fraction in 11 patients with first Q wave acute myocardial infarction (r = -0.84, p0.01), which was similar to that of the serum myosin light chain peak and the left ventricular ejection fraction (r = -0.72, p0.05). On the other hand, there was no correlation between the peak level of serum creatine phosphokinase and the left ventricular ejection fraction (r = -0.55, NS). The serum troponin T levels 24, 36, 48 and 60 hours after the onset also correlated well with the left ventricular ejection fraction (r = -0.65, -0.7, -0.65 and -0.89, respectively). We conclude that the serial measurement of serum troponin T in patients with acute myocardial infarction is useful in the evaluation of left ventricular function in the chronic stage and that it is a potential non-invasive predictor of coronary reperfusion.

In order to examine clinical usefulness of three-dimensional (3D) imaging of solitary pulmonary nodules froms serial thin-section CT images, 3D reconstruction of a small peripheral lung adenocarcinoma was performed using the inflated fixed lung specimen resected surgically. The left upper lobe was fixed and air-dried by Heitzman's method, and was scanned contiguously 20 times at a section thickness of 2 mm and a section interval of 2 mm. Bronchi, pulmonary vessels and the tumor presented on the CT images were input to a 3D reconstruction personal computer system, and then 3D images were obtained. The reconstructed 3D images included various tomographic images of bronchi and pulmonary vessels. It is expected that this method would be one of the most useful imaging techniques for the differential diagnosis of solitary pulmonary nodules.

Surgical fusion may be indicated to stabilize deformed or painful hindfoot joints. Although more commonly performed in children or adolescents, it is the salvage procedure available for adults. Twenty-six patients (30 feet; 20 women, six men) followed for an average of 44.1 months after hindfoot arthrodesis were investigated in a prospective study. Most (20 patients, 24 feet) had inflammatory arthritis, usually rheumatoid, two had previous fractures, and four patients had other diagnoses. All had fusions done using a dowel graft technique. Twenty-four patients (92%) were completely satisfied with the operation, one had mild reservations, and the one dissatisfied patient was a technical failure. All joints were fused utilizing clinical and roentgenographic evaluation. A detailed roentgenographic assessment indicated that the talometatarsal angle was the most effective measurement to assess the clinical deformity. Anteroposterior weight-bearing roentgenograms of the ankle were also important in evaluating these patients preoperatively and postoperatively. Postoperatively, only nine ankles appeared normal roentgenographically, while the others worsened, and four required ankle arthrodesis.

The mixing mechanisms of solid particles by paddle-type impellers were studied for two pairs of dry powders, having the same particle size distribution, viz., sand-sodium chloride (3242 mesh) and sodium carbonate-polyvinyl chloride (100200 mesh). The degree of mixing was defined anew by Eq. (8) and the relations between the degree of mixing and the operating variables, such as impeller size, rotational speed etc. were determined as given by Eqs. (20) and (21).By analogy with the process of diffusion, the apparent diffusivities from the concentration distribution of the two kinds of particles were evaluated. The relations between the apparent diffusivities and the operating variables were obtained by means of Eq. (22). Furthermore, the theoretical degree of mixing was given in terms of apparent diffusivities as in Eq. (18).Introducing the obtained values of apparent diffusivities into Eq. (18) and comparing the theoretical degree of mixing with observed one, the authors found good agreement between both the values and concluded that in the case of mixing solid particles by paddle-type impellers, the diffusive mixing was quite conspicuous.

In order to investigate the hormone dependency of gastric cancer, the presence of estrogen receptor (E.R.) in surgically resected carcinomatous tissues was studied. E.R. assay was performed by dextran coated charcoal method. We have found 10% E.R. positive cases in gastric cancer (4/40). These 4 patients were all female, and showed Borrmann 3 or 4 type macroscopically. The histological types of these cases were signet-ring cell carcinoma or poorly differentiated adenocarcinoma. Furthermore, experimental studies suggest that the growth of signet-ring cell carcinoma transplanted on nude mice depends on sex hormone. Based on these observations, the clinical trial of chemo-endocrine therapy after gastrectomy for female patients with diffuse carcinoma of the stomach has been performed in our hospital since 1980. The therapy consists of Mitomycin-C plus subsequent Tegafur, with or without Tamoxifen 20 mg/day given orally, twice a day starting 2 weeks after surgery. The results are as follows: The cumulative 3-year survival rate in 21 cases receiving chemo-endocrine therapy (TAM+) after gastrectomy revealed higher (43.3%) than that (5.6%) in 23 cases receiving chemotherapy alone (TAM-). Furthermore, 2 and 3 years survival rates of TAM + in curatively resected cases (8 cases) were both 100% including 2 recurrent cases. In TAM- 10 cases, 2 and 3 years survival rate showed 68.4% and 16.3% respectively with statistically significance (p less than 0.01). Chemo-endocrine therapy for non-curatively resected and recurrent cases were also effective. This result suggests that the chemo-endocrine therapy after gastrectomy may be a new hopeful adjuvant in female patients with diffuse carcinoma of the stomach.

A monoclonal antibody reactive with gastric carcinomas of the stomach was established. This antibody reacted with 88% (15/17) of the scirrhous carcinomas, and 75% (6/8) of the well differentiated adenocarcinomas of the stomach tested, but did not react with normal gastric mucosa or various other normal tissues, with the exception of the mucosa of the large intestine.