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Artificial intelligence has shown remarkable performance in perfect information games. However, it is still no match for human players when it comes to most imperfect information games. Information set Monte Carlo tree search (ISMCTS) has been developed to reduce the effects of strategy fusion caused by determinization of the imperfect information and demonstrated advantages over the conventional Monte Carlo tree search (MCTS) that uses determinization. Because ISMCTS has only been used for games with relatively simple structure, it is still unknown whether it works effectively for more complex games. In this study, we take Pok´emon as an example of a complex imperfect information game and implement a simulator to evaluate the effectiveness of ISMCTS. Experimental results show that ISMCTS outperforms the conventional MCTS that uses determinization.

We compared perioperative outcomes and costs between open and laparoscopic radical prostatectomy for prostate cancer. The Japanese Diagnosis Procedure Combination database, including cases from 2007 to 2010, was used by one-to-one propensity-score matching. The following items were compared: complication rate; homologous and autologous transfusion rate; first cystography day and cystography repeat rate; anesthesia time; postoperative length of stay; and costs. Multivariate analyses were carried out by including age, Charlson Comorbidity Index, T stage, hospital volume and hospital academic status as variables. As a result, among 15 616 open and 1997 laparoscopic radical prostatectomies, 1627 propensity-score matched pairs were generated. The laparoscopic approach showed a better overall complication rate (3.4% vs 5.0%), homologous transfusion rate (3.3% vs 9.2%), autologous transfusion rate (44.9% vs 79.3%), first cystography day (mean 6th vs 7th day), mean postoperative length of stay (mean 11 vs 13 days), and cost without surgery and anesthesia (mean $7965 vs $9235; all P

We investigated the effect of extracellular adenosine triphosphate (ATP) on the production of interleukin (IL)-6, whose molecules are capable of stimulating the development of osteoclasts from their hematopoietic precursors as well as are involved in signal transduction systems in human osteoblastic SaM-1 cells. These human osteoblasts constitutively expressed P2X4, P2X5, P2X6, P2Y2, P2Y5, and P2Y6 purinergic receptors. ATP increased gene- and protein-expression of IL-6 in SaM-1 cells. The expression of the IL-6 mRNA was maximal at 1h, and the increase in IL-6 synthesis in response to ATP (10-100 microM) occurred in a concentration-dependent manner. Over the same concentration range of the nucleotide that was effective for IL-6 synthesis, ATP caused an increase in the intracellular Ca(2+) concentration ([Ca(2+)](i)), which increase was inhibited by pretreatment with suramin, a P2Y receptor antagonist, or 2-aminoethoxydiphenyl borate (2-APB), an inositol 1,4,5-trisphosphate receptor blocker, but not by the extracellular Ca(2+)-chelating agent EGTA. The pretreatment of SaM-1 cells with suramin or 2-APB also inhibited the increase in IL-6 synthesis in response to ATP. These findings suggest that extracellular ATP-induced IL-6 synthesis occurs through P2Y receptors and mobilization of Ca(2+) from internal stores in human osteoblastic cells.

OBJECTIVE To investigate survival of hormone-naive prostate cancer patients diagnosed with prostate-specific antigen ≥500 ng/ml, stratified according to the prostate-specific antigen level and type of therapy. METHODS Data of prostate cancer patients with prostate-specific antigen ≥500 ng/ml diagnosed between 2001 and 2003 and receiving primary androgen deprivation therapy were extracted from the Japan Study Group of Prostate Cancer database. Cancer-specific survival and overall survival were assessed according to the prostate-specific antigen level (500-999, 1000-4999 and ≥5000 ng/ml) and type of therapy using Kaplan-Meier analyses and multivariate Cox proportional hazards models including age, Gleason score, oncological stage and comorbidity. RESULTS The median follow-up was 27 months (interquartile range, 13-51) and a total of 1961 patients were included. Five-year cancer-specific and overall mortalities were 39.0 and 33.0%, respectively. There was a significant inverse relationship between overall survival and prostate-specific antigen magnitude among combination therapy patients, but not monotherapy patients (log-rank test, P = 0.034 and 0.558, respectively). The median overall survival in combination therapy patients with low-, intermediate- and high prostate-specific antigen and monotherapy patients with any prostate-specific antigen were 79, 59, 45 and 43 months, respectively. Multivariate analysis showed that combination therapy in patients with low- and intermediate prostate-specific antigen was significantly associated with a favorable overall survival compared with monotherapy (hazard ratios 0.66 and 0.75, respectively, both P < 0.001). Similar results were obtained for cancer-specific survival. CONCLUSIONS There are major survival differences in extremely high prostate-specific antigen cases according to the prostate-specific antigen level and hormone therapy type and those patients would benefit notably from combination androgen blockade.

Ureteric sciatic hernias are extremely rare. Here we report a case of a 78-year-old woman presented with colicky left abdominal pain. Computed tomography revealed a ureteric sciatic hernia, and drip infusion pyelography revealed dilated left ureter with herniation of the ureter into the sciatic foramen. The hernia was successfully repaired laparoscopically. We have described the diagnosis and management of the patient, followed by a review of the literature on sciatic hernias.

The Park & Ride system in many provincial regions has become an important and urgent topic of discussion in regional transportation planning for both reducing the progress of motorization and developing public transportation. The purpose of this paper is to make the Park & Ride user property in the areas clear, and to analyze the cost-time characteristics and necessary conditions of the parking in provincial regions. Based on the survey conducted at seven stations of JR Ryomo Line and the investigation using the data, we showed the possibility of developing the Park & Ride system in regions with progress of motorization.

Idiopathic scrotal calcinosis is a rare, benign condition characterized by progressive calcification of the scrotal skin. A 29-year-old man who had undergone primary surgical excision of idiopathic scrotal calcinosis 7 years previously presented with recurrence that he had first noticed 3 years after surgery. Multiple yellowish nodules were observed in the scrotal skin and were confirmed by computed tomography. He underwent repeat resection without any postoperative complications. Histological examination of the surgical specimens revealed diffusely calcified areas within and beneath the squamous epithelium, some of which were associated with epithelial cysts. Immunopathological stains for antibodies against carcinoembryonic antigen, epithelial membrane antigen, and gross cystic disease fluid protein-15 were negative. This is the first reported case of recurrence of scrotal calcinosis. One possible reason for the relapse is that there were remnant seeds of calcification after the primary surgery. This case demonstrates the importance of careful identification and resection of all calcified areas, and of counseling patients about the possibility of relapse after surgical treatment.

We compared perioperative outcomes and costs between open and laparoscopic radical prostatectomy for prostate cancer. The Japanese Diagnosis Procedure Combination database, including cases from 2007 to 2010, was used by one-to-one propensity-score matching. The following items were compared: complication rate; homologous and autologous transfusion rate; first cystography day and cystography repeat rate; anesthesia time; postoperative length of stay; and costs. Multivariate analyses were carried out by including age, Charlson Comorbidity Index, T stage, hospital volume and hospital academic status as variables. As a result, among 15 616 open and 1997 laparoscopic radical prostatectomies, 1627 propensity-score matched pairs were generated. The laparoscopic approach showed a better overall complication rate (3.4% vs 5.0%), homologous transfusion rate (3.3% vs 9.2%), autologous transfusion rate (44.9% vs 79.3%), first cystography day (mean 6th vs 7th day), mean postoperative length of stay (mean 11 vs 13 days), and cost without surgery and anesthesia (mean $7965 vs $9235; all P 0.001). Anesthesia time was longer (mean 345 vs 285 min) and total cost was higher (mean $14 980 vs $12 356) for the laparoscopic approach (both P 0.001). The secondary cystography rates were comparable between the groups (18.3% vs 15.7%, P = 0.144). The multivariate analyses showed similar trends. In conclusion, these findings confirm several benefits of laparoscopy over open approach for radical prostatectomy.

慢性腎不全による意識消失出現し緊急血液透析が施行されたが, その後シャント手術および血液透析導入を拒否した1症例に対し, 血液透析の受容を促すことができたので報告する.症例は, 45歳, 男性. 1979年から慢性糸球体腎炎のため, 他院に通院していた. 1990年3月, 血液透析導入の必要性を医師から説明されたが, その後自己判断で通院を中止した. 同年6月16日, 尿毒症のため意識消失, 緊急血液透析が施行された. しかし, 5日後一旦承諾したシャント手術および血液透析の継続を拒否した.そのため6月21日から8月31日まで, コンサルテーション・リエゾン活動を応用し, 精神的援助を試みた. 具体的には, (a) 入院管理, (b) 専属看護婦による頻回のカウンセリング, (c) 主治医・心療内科医・看護婦がチームとなった支持的アプローチを行った.本症例は, 対象喪失に対する悲哀の仕事を進行させていた. 現状認識ができなかったため, 腎機能や血夜透析についての指導は, 効果が少なかった. そこで, 患者の訴えをありのままに受けとめ, 患者が自分自身の気持ちを整理できるように努めた. その結果, 血液透析は拒否し続けていたが, スタッフを拒否することはなかった. 上記 (a)-(c) は, 本症例の心の支えとなり, 悲哀の仕事の進行に影響を与えた. そして, 腎性貧血の進行を機に透析療法を受容し, 9月1日血液透析を導入した.今回は, 血液透析の拒否患者を受容に導くことができた. 本症例では, コンサルテーション・リエゾン活動に基づいた支持的アプローチが, 血液透析導入前の看護として有用であった. 今後も, 血液透析導入においては, 個々の患者に適した精神的援助が必要である.

The study on quantitative characterization of flame colors was carried out by using the chromaticity coordinates (x, y) defined by the CIE 1931 standard colorimetric system. Propane/air premixed flames were used in the study. It was found that the coordinates could characterize the colors of flames with various air ratios and contained information about the spectral intensity of CH and C2 radicals in the flames. These results suggest that flame colors, which had previously been considered qualitative because of their dependence on fallible human perception, can be used to evaluate flame behavior quantitatively. There is a good possibility that the measurement of the colors is applicable to combustion control and monitoring systems.

Purpose To determine the influence of pneumoperitoneum on respiratory function during urological laparoscopic surgery. Materials and methods We performed laparoscopic surgery on 82 patients, 45 of these patients were examined in detail of the effect of pneumoperitoneum on the respiratory function. Of these 45 patients, 14 patients received lymphadenectomy and 31 patients received adrenalectomy. For comparative analysis, 4 patients with laparoscopic cholecystectomies were also examined. Under general anesthesia, carbon dioxide tension (PaCO2) was analyzed before, during, and after the pneumoperitoneum. The data were analysed along with 4 factors; the patient's spirographic parameters, alveolar-arterial gas difference (AaDO2), insufflation pressure for the pneumoperitoneum, and operating time. Result After starting the pneumoperitoneum, PaCO2 levels rose significantly. The PaCO2 levels of patients underwent laparoscopic adrenalectomy were higher than that of patients underwent laparoscopic cholecystectomy. The preoperative vital capacity and forced expiratory volume in one second (FEV1.0) did not show a significant difference of increase in the degree of PaCO2 increase. In contrast, the important factors that were closely related to the elevation of PaCO2 were preoperative AaDO2 and intraoperative insufflation pressure. Patients with high preoperative AaDO2 (> 10 torr) showed a significant increase in PaCO2 levels after pneumoperitoneum. When insufflation pressure was high (> = 10 mmHg), there was a significant rise of PaCO2 after pneumoperitoneum. In all patients whose operating time was 300 minutes or more, high levels of PaCO2 continued on the next day after surgery. Conclusion We should still carefully observe the insufflation pressure, operating time, and other ventilation conditions during laparoscopic surgery.

From November 1991 through January 1993, we performed laparoscopic lymphadenectomy on 10 patients. These patients were aged 54 to 77 years. All laparoscopic procedures were performed under general anesthesia. We dissected obturator lymph nodes on bilateral side. Total operation time ranged from 127 to 325 minutes. We could excise 3 to 9 lymph nodes on right side and 0 to 10 lymph nodes on left side. Blood loss was 180 ml in one patient, but minimal in the remaining 9 patients. Ureteral injury occurred during laparoscopic procedure in one patient. This injury could be managed with laparoscopic and cystoscopic procedure. Postoperatively complications were observed in 5 procedures, which consisted of subcutaneous emphysema in 2 procedures, fever (over 38 degrees C) in 2, shoulder and arm pain in 1, ileus in 1. The patient with ileus complained of abdominal fullness but he was able to ingest. All patients resumed their preoperative activity by postoperative day 3 to 5. We believe that this procedure was safe and useful for decision making in the management of our patients. We need further study on indications and techniques for this procedure.

Renal osteodystrophy (ROD) with secondary hyperparathyroidism (2°HPT) is a serious complication in patients who have received long term maintenance hemodialysis. In patients whose bone pain, bone fracture and bone deformity are resistant to medical treatment with aluminium hydrochloride, 1α-OH D3, etc, and whose serum parathyroid hormone (c-PTH) is elevated, parathyroidectomy is generally performed.We report herein two patients who underwent total parathyroidectomy and autoplantation of the parathyroid graft in the left forearm, and subsequently showed amelioration of clinical signs and laboratory data..Case 1 is 29-year-old man. He was diagnosed as chronic proliferative glomerulonephritis with nephrotic syndrome in 1972 and received some medications, but his renal function gradually deteriorated. Hemodialysis was started in 1975. In May 1982, facial change and pain in the lumbar region and the chest were noted. He received 1α-OH D3, but without any effects. Therefore he was admitted to the hospital in December 1982. On laboratory examination, serum alkali-phosphatase (Al-ptase) and c-PTH were found to be elevated to 97.5 K.A.units, and 25.5ng/ml, respectivdly. He received total parathyroidectomy and autoplantation of the parathyroid graft in the left forearm.Three days after the operation, his bone pain disappeared, and he remained free from pain until 1985.Case 2 is 33-year-old woman.She was diagnosed as chronic proliferative glomerulonephritis in 1971, and hemodialysis was started in 1979. In March 1982, she complainted pain in the bilateral knee joints and heels. In November 1983, laboratory examination revealed that serum Al-ptase and c-PTC were elvated to 69 K.A. units and 34.2ng/ml, respectively. She was diagnosed as ROD with 2°HPT and underwent total parathyroidectomy and heterotopic autoplantation. Two days after the operation, her complaint disappeared.

アンギオテンシンI変換酵素阻害剤であるcaptopril治療中の血液透析患者に顕著な味覚障害が出現した.その味覚低下はcaptopril投与中止と硫酸亜鉛投与で改善した.症例は33歳, 男性の血液透析患者, 1日量37.5mgのcaptoprilを投与されていた.投与開始7週後より高度味覚障害が出現した.電気味覚計検査では, 右大錐体神経領域, 舌咽神経領域, 鼓索神経領域, 左大錐体神経領域のすべてに反応は消失し, 左舌咽神経領域の味覚閾値は26dBで左鼓索神経領域では30dBだった. すべての領域で基本の4つの味覚, 酸味, 甘味, 辛味, 苦味が障害されていた.血清亜鉛濃度は65μ9/dlでcaptoprilを中止した. 発中止7日目, 味覚は自覚的および電気味覚計検査で軽度改善した. captopril中止65日目の全血亜鉛濃度は361μg/dlで, 硫酸亜鉛1日量150mg経口投与した. 投与6日目の電気味覚計検査ではさらに改善がみられ, 自覚的改善は顕著だった.亜鉛投与33日目の電気味覚計検査では, 味覚脱失部位はなくなった.この症例においては, captopril治療で惹起された亜鉛欠乏が味覚障害の原因と考えられた.

Copper (II) catalyzes the coupling reaction of 3-methyl-2-benzothiazolinone hydrazone (MBTH) with N,N-dimethylaniline (DMA) to form an intensely colored dye (λmax=590 nm) in the presence of hydrogen peroxide and ammonia as an activator. On the basis of this reaction, a highly sensitive and selective catalytic method for Cu(II) has been developed. As little as 10−9M Cu(II) can be determined by measuring the absorbance of the reaction product at a fixed time (20 min at 40°C). Sandell's sensitivity calculated from the working curve is 1.3×10−3 ng cm−2. The method was applied to water analysis and some comments on the analysis of copper in river water were added.

From a view point of safety measure against the fire hazard involved with aircraft crash or ditch and singular hydrodynamical fluid motions in space flight and refueling with liquid rocket tankage, feasibility of gelled hydrocarbon fuels and propellants is discussed. It is concluded that O/W (oil-in-water) type gelled hydrocarbons are most promising as the safety fuels, resulting from a comparison in the rheological and combustion properties with the other gelled fuels; slurry, scaffold and thickened (highly viscous) ones. Physical properties and flammability of very high internal phase ratio gelled JP-4 and kerosene, ranged 96 to 99 vol% fuel content, and of N2H4/JP-4 gelled propellant developed by ISAS, Univ. of Tokyo and Mitsubishi Oil Company are described.