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Objective The objective of this study was to assess the efficacy of a tobacco cessation intervention conducted by different dental specialists directed at a group of patients with tobacco-related oral diseases or undergoing implant treatment. Methods The study design was a multicentre, nonrandomized prospective cohort study to examine the effects of smoking cessation. The target patients were current smokers (aged ≥20 years) with an oral potentially malignant disorder or periodontitis and those seeking dental implants. A total of 74 patients were enrolled in the study. All dental specialists who participated in the trial completed an e-learning Japan Smoking Cessation Training Outreach Project (J-STOP) tobacco cessation education programme. Nicotine dependence was evaluated by the Fagerstrom Test for Nicotine Dependence. Cessation status was verified biochemically by measurement of salivary cotinine or exhaled carbon monoxide. Tobacco cessation intervention was implemented for 8 weeks with or without nicotine replacement therapy with follow-up for 12 months. Results A total of 61 patients agreed to the tobacco cessation intervention. The mean biochemically confirmed tobacco abstinence rate was 37.7% at month 3, 34.4% at month 6, and 32.8% at month 12. The highest rate of biochemically confirmed tobacco abstinence at month 12 was among patients receiving implant treatment (42.9%) followed by patients with oral potentially malignant disorder (37.1%), and those with periodontitis (21.1%). Conclusion This interventional study demonstrates the challenges encountered and the feasibility of tobacco cessation intervention among Japanese patients attending dental specialists who had completed an e-learning course on smoking cessation. Making tobacco cessation an integral part of patient management by dental specialists requires further evaluation.

An organized hematoma is a cystic lesion characterized by superficial fibrotic encapsulation. While an organized hematoma is benign, making a differential diagnosis from a malignant lesion is difficult, as both exhibit invasive behavior and cause bone resorption. The objective of this study was to describe a rare case of organized hematoma in the cheek of a 28-year-old male. The swelling in the cheek developed following the extraction of the right mandibular third molar. The extraction site did not show any signs of inflammation and the patient did not have any systemic risk factors. A preoperative magnetic resonance image revealed characteristic findings associated with organized hematoma. Clarithromycin was administered for 2 months before the lesion was surgically removed. The results of this case suggested that antibiotic administration prior to surgical removal was important, as the cause of the organized hematoma was mild inflammation.

Although concurrent chemoradiotherapy (CRT) followed by consolidation immunotherapy considerably improves the duration of survival in patients with unresectable stage III non-small cell lung cancer (NSCLC), few data are available on the management of local relapse after therapy. We present a patient with initially unresectable NSCLC who underwent a right upper lobectomy with reconstruction of the bronchus and pulmonary artery after definitive CRT, followed by consolidation durvalumab. No postoperative complications occurred, and he was recurrence-free at the 10-month follow-up. Salvage surgery might be a viable option for local relapse of NSCLC treated with definitive CRT and durvalumab.

Paragangliomas in the diaphragm are extremely rare. We report the case of a 27‐year‐old woman with a nonfunctioning paraganglioma protruding superiorly from the right diaphragm. The patient underwent an anterior thoracotomy, and a supradiaphragmatic tumor (70 mm in diameter), which compressed the inferior vena cava and the right hepatic vein, was completely resected by combined partial resection of the right diaphragm and pericardium. To our knowledge, this is the first report of a paraganglioma situated both on the diaphragm and close to the inferior vena cava and hepatic vein. Key points, Herein, we report the case of a 27‐year‐old woman with a nonfunctioning paraganglioma protruding superiorly from the right diaphragm. A supradiaphragmatic tumor, 70 mm in diameter, which was compressing the inferior vena cava and right hepatic vein, was completely resected with combined partial resection of the right diaphragm and pericardium. To our knowledge, this is the first report of a paraganglioma arising from the diaphragm in such close proximity to the inferior vena cava and hepatic vein.

In commercial and office buildings, it has recently become popular to install variable refrigerant flow (VRF) compression-type heat pump systems. In particular, VRF systems with multiple indoor units are being installed in large buildings because such systems have large adjustment capacity. On the other hand, because users of VRF systems can freely choose the number of indoor units to install and can turn indoor units on and off independently, operating conditions are not predictable and it is difficult to find adequate control parameters under wide changes in load. With this background, we are developing a new numerical simulation model based on the laws of physics. Because this model can easily add and delete system elements, we believe that it will be useful for VRF system analysis. In this study, we utilize a numerical simulation model to evaluate both steady and unsteady conditions in VRF systems. In this paper, we focus on the connection between manipulated variables (the expansion valve's open pulse and fan rotational speed) and controlled variables (supply air temperature and the degree of superheating at the evaporator outlet). Moreover, we compare the difference between the performance of a single indoor unit and that of multiple indoor units operating simultaneously. As a result, we can evaluate the dynamic characteristics of manipulated variables and the effect of changing the number of active indoor units, each of which has their own VRF characteristics.

Metaplastic thymoma is a rare histologic variant of thymic epithelial tumors and is characterized by a biphasic growth pattern. We herein report the case of 44-year-old woman who underwent surgery for metaplastic thymoma. Computed tomography scan revealed a well-circumscribed mediastinal tumor: 56 mm in diameter with homogenous enhancement. The tumor was suspected to be a non-invasive thymoma, and thymomectomy with resection of the surrounding thymus was performed using thoracoscopy. The resected tumor measured 60 mm and was grossly well-encapsulated. The cut surface was gray to white and homogenous. Microscopically, the epithelial components took the form of an anastomosing nest to broad trabeculae intertwining with the bundle of spindle cells. Mitosis was not found and the Ki-67 index was1%. Cytokeratin 5/6 was strongly positive in the epithelial components composed of polygonal cells. Terminal deoxynucleotidyl transferase positive immature T cells were not observed. Based on these pathologic findings, the tumor was identified as metaplastic thymoma.

This study aimed to assess perioperative morbidity and mortality in elderly patients following colorectal cancer resection and to investigate risk factors for postoperative complications. This study reviewed 697 consecutive patients who underwent elective colorectal cancer resection between 2005 and 2013 at our institution. Patients were divided into 3 groups according to their age: ≤74 (n = 420), 75 to 89 (n = 261), and ≥90 years (n = 16). Clinical findings, morbidity, and mortality were compared among these groups. Univariate and multivariate logistic regression analyses were performed with clinically relevant variables for the complications that increased with aging. Postoperative delirium and pneumonia showed significant increases with aging. There were no significant differences in mortality and morbidity among the 3 groups, except for the 2 aforementioned diseases. Multiple logistic regression analysis showed that dementia and laparoscopic surgery were independent determinants of postoperative delirium and that age and American Society of Anesthesiologists (ASA) score were independent risk factors for postoperative pneumonia. Dementia, high ASA score, and age were the risk factors for higher postoperative morbidity in elderly patients. Our results demonstrated the effectiveness of laparoscopic surgery for the prevention of postoperative delirium after colorectal resection.

The use of endoscopic submucosal dissection (ESD) for duodenal neoplasms has increased in recent years, but delayed perforation and bleeding are also known to frequently occur. We present two cases in which duodenal adenoma was successfully treated with laparoscopic-endoscopic cooperative surgery. ESD was combined with laparoscopic seromuscular sutures. The lesions in both cases were located in the second portion of the duodenum. The patients requested resection of the lesion, and we performed laparoscopic-endoscopic cooperative surgery. After the laparoscopic surgeon mobilized the duodenum, the endoscopic surgeon performed ESD for the duodenal tumor without perforation. The laparoscopic surgeon sutured the duodenal wall in the seromuscular layer to strengthen the ulcer bed after ESD. Histopathological studies confirmed that the surgical margins were tumor-free in both cases. The patients were discharged with no complications. This unique laparoscopic-endoscopic cooperative procedure is a safe and effective method for resecting superficial nonampullary duodenal tumors.

An increasing number of supermarkets and convenience stores has led to a proportionally higher demand for open refrigerated display cabinets (ORDCs). Ease of access to refrigerated products is the main advantage of ORDCs; however, they also exhibit high cumulative energy consumption as well as direct and indirect CO2 emissions. This work aims to formulate, establish, and apply a seasonal performance evaluation method for ORDCs and “walk-in” type refrigerated device driven by CO2 chillers. First, a thermodynamic modeling approach is used and fitted to experimental data. The relative error between the predicted and actual heat load is within ±10%, whereas it is within ±20% for the normalized compressor electric input. Then, an evaluation tool is constructed using the seasonal energy consumption of ORDCs commonly used in Japan and driven by a transcritical CO2-compression chiller within Japanese climatic conditions. This tool can be used to predict the annual energy demand for given ambient conditions as well as the reduced environmental impact of multiple combinations of refrigerated display cabinets compared to conventional HFC/HCFC-based systems. According to the annual temperature distribution in chosen regions, the annual thermal load, annual electricity consumption, and annual coefficient of performance are calculated and analyzed. Simulation results quantitatively evaluate the beneficial effect of Te as being translated to a better COP, and lower energy consumption and CO2 emissions. Considering the geographic location of the store, the quantitative results show how a hotter climatic condition leads to higher energy consumption and CO2 emissions, and lower COP. The proposed evaluation method is generally applicable to any regional setting and any chiller-ORDC combination.

In this paper, dynamic performance identification for a direct expansion (DX) air conditioning (AC) system is proposed using Bayesian artificial neural network (ANN). The input and output datasets are generated by a dedicated AC simulator by varying the compressor speed in various signal amplitudes and including dynamic cooling load and ambient temperature. The exergy destruction, which represents the work potential losses in the system and room temperature indicating the thermal comfort are selected as the output variables. The key parameters of an ANN model, including the number of neurons and tapped delay lines, are optimized to improve the prediction accuracy. The results show that the dynamic response of the exergy destruction and room temperature can be predicted accurately by the optimized ANN model using three neurons, a Bayesian regularization algorithm, five delayed inputs for the compressor speed and room temperature, and six delayed inputs for the cooling load and ambient temperature. The validation of the multi-step-ahead prediction showed satisfying results with respect to the root mean squared errors (RMSEs) and coefficient of variations (CVs) of the room temperature (RMSE: 0.18 °C and CV: 0.85%) and exergy destruction (RMSE: 1.79 W and CV: 0.4%). Accordingly, the identification of the AC system behavior presented in this paper could be further implemented to control the DX AC system operation to achieve a desired thermal comfort with low exergy destruction.

For sentinel lymph node biopsy (SLNB), a combination of dye-guided and γ-probe-guided methods is the most commonly used technique. However, the number of institutes in which the γ-probe-guided method is able to be performed is limited, since special equipment is required for the method. In this study, SLNB with the dye-guided method alone was evaluated, and the clinicopathological characteristics were analyzed to identify any factors that were predictive of whether the follow-up axillary lymph node dissection (ALND) was able to be omitted. A total of 374 patients who underwent SLNB between 1999 and 2009 were studied. The SLN identification rate was analyzed, in addition to the false-positive and false-negative rates and the correlation between the clinicopathological characteristics and axillary lymph node metastases. The SLN was identified in 96.8% of cases, and, out of the patients who had SLN metastasis, 63.0% did not exhibit metastasis elsewhere. The sensitivity was 96.4% and the specificity was 100%. The false-negative rate was 3.6%. Univariate analyses revealed significant differences in the lymph vessel invasion (ly) status, nuclear grade (NG), maximum tumor size and the percentage of the area occupied by the tumor cells in the SLN (SLN occupation ratio) between the patients with and without non-SLN metastasis, indicating that these factors may be predictive of axillary lymph node metastasis. Multivariate analysis revealed that ly status was an independent risk factor for non-SLN metastasis. In conclusion, SLN with the dye-guided method alone provided a high detection rate. The study identified a predictive factor for axillary lymph node metastasis that may improve the patients’ quality of life.

Experimental results of a volumetric display system based on three-dimensional (3D) scanning using an inclined image are reported. An optical real image of an inclined two-dimensional (2D) display device is moved laterally by an optical mirror scanner. Inclined cross-sectional images of a 3D object are projected in accordance with the position of the image plane. A 3D real image is formed as a stack of 2D cross-sectional images as a result of high-speed scanning. This 3D image can satisfy all the criteria for stereoscopic vision. An experimental system using a galvanometer mirror and a digital micromirror device was constructed, and generated three-dimensional images consisting of 1024×768×200 voxels. A multilevel image can be formed by a spatial dithering technique, even though the binary display device was used.

Pancreatic cancer is associated with the poorest prognosis of any digestive cancer due to the high incidence of liver metastasis. This study evaluated the possibility that osteopontin (OPN) RNA interference (RNAi) and anti-OPN antibody (Ab) could have antimetastatic effects. The differential gene expression was measured in a parental cell line, HPC-3, and an established highly liver metastatic cell line, HPC-3H4. This study investigated the effect of OPN RNAi and anti-OPN Ab on the metastatic ability of HPC-3H4 to the liver. An OPN RNAi-expressing vector was introduced into HPC-3H4 cells (HPC-3H4/miOPN), in which OPN production was reduced to the level of the parental HPC-3 cells. Finally, the ability of anti-OPN Ab to suppress liver metastasis was investigated. Osteopontin was upregulated 11.1-fold in HPC-3H4 in comparison to HPC-3. The metastatic rate of HPC-3H4/miOPN was significantly reduced to 25% in comparison to the 100% metastatic rate of HPC-3H4 and control HPC-3H4/miNeg cells (P < 0.01). The metastatic rate of the group given anti-OPN Ab was 50%. OPN RNAi and anti-OPN Ab had remarkable inhibitory effects against liver metastasis by the pancreatic cancer cell line.

We investigated a prognosis in the presence or absence of preoperative marker abnormality for 371 cases with primary breast cancer that we experienced in our department this time. 60 (16%) of 371 cases showed the abnormality of the tumor marker and 25 (41.7%) of 60 patients had a recurrence. The positive rate of the marker was 8.1% in CA 15 3, 6.7% in CEA, 4.1% in NCC ST 439, and each rate of recurrence was 56.7%, 48.0%, 33.3%. Rate of recurrence in the negative cases was 12.7%, 13.9, 15.0% respectively and recognized a significant difference statistically (p

The use of endoscopic submucosal dissection (ESD) for duodenal neoplasms has increased in recent years, but delayed perforation and bleeding are also known to frequently occur. We present two cases in which duodenal adenoma was successfully treated with laparoscopic-endoscopic cooperative surgery. ESD was combined with laparoscopic seromuscular sutures. The lesions in both cases were located in the second portion of the duodenum. The patients requested resection of the lesion, and we performed laparoscopic-endoscopic cooperative surgery. After the laparoscopic surgeon mobilized the duodenum, the endoscopic surgeon performed ESD for the duodenal tumor without perforation. The laparoscopic surgeon sutured the duodenal wall in the seromuscular layer to strengthen the ulcer bed after ESD. Histopathological studies confirmed that the surgical margins were tumor-free in both cases. The patients were discharged with no complications. This unique laparoscopic-endoscopic cooperative procedure is a safe and effective method for resecting superficial nonampullary duodenal tumors.

Introduction With the aim of identifying metastases-related genes in gastric cancer, we performed a broad analysis of differential gene expression between low-metastatic parental cell lines and established highly metastatic sublines. Materials and methods We established novel cell lines, AZ-H5c, NUGC-3H5, and TMK-1H7, with a high potential of liver metastasis, and AZ-P7a, NUGC-3P4T, and TMK-1P4a, with a high potential of peritoneal metastasis. These cell lines were derived from low-metastatic parental AZ-521, NUGC-3, and TMK-1 cell lines, respectively. Furthermore, to investigate different levels of gene expression implicated in metastatic potentials in gastric cancer, we investigated approximately 2000 expressed genes in each cell line using a DNA microarray. Results Varieties of genes were up-regulated or down-regulated in highly metastatic liver and peritoneal cell lines. Fifty-eight genes, including the transferrin receptor, ras-related rho, and osteopontin, and 22 genes, including apolipoprotein E and inhibin A-submit, were up-regulated and down-regulated in two or three liver metastatic sublines. On the other hand, 19 genes, the transferrin receptor, c-fos, and RANTES, and 26 genes, including MAC25, PISSLRE, and RNA polymerase, were up-regulated and down-regulated in two or three peritoneal metastatic sublines. Conclusion How gene expression is implicated in gastric cancer metastasis has never been thoroughly explained, and further studies are necessary to understand the involvement of genes in cancer metastasis more thoroughly. We hope that our highly metastatic liver and peritoneal experimental models are helpful for further study and gene therapy of human gastric cancer.

A stoma prolapse is one of the late complications and often occurs when the stoma is made in an emergency situation. This complication is not lethal, but causes irritable stoma, skin trouble, and difficulty in stoma care. We herein report the case of a 48-year-old female with an end colostomy that was created as an emergency operation 4 months before. On admission, her colostomy protruded approximately 20 cm from the skin with marked redness, swelling, and erosion; it was impossible to treat manually. We repaired the prolapse successfully in a simple procedure with a Proximate Linear Cutter 100. Briefly, under mild sedation, the instrument was diagonally inserted into the prolapsed stoma and applied twice on both sides. Then, the base of each divided tissue was stapled and cut with the same device. Finally, the prolapse was completely repaired without major bleeding and severe pain. We have applied this novel technique successfully in 5 further cases, and there have been no complications or recurrences. This technique can be performed without spinal or general anesthesia and seems to be a very useful procedure for patients with prolapse of a stoma.

上皮内pagetoid spreadを伴った直腸肛門部の悪性黒色腫の1例を経験したので報告する. 症例は65歳女性で, 平成13年4月, 内視鏡で直腸病変を認められ当科に紹介入院となった. 手術は腹会陰式直腸切断術を行った. 病変は30×17mmで病理組織は悪性黒色腫, sm3,ow (-) , aw (-), ew (-), ly1, v1, n1,腫瘍細胞はメラニン顆粒を持ち, 腫瘍辺縁の肛門管重層扁平上皮内にpagetoid spreadを伴っていたが, 切除断端は陰性であった. 本例の腫瘍細胞は, 免疫染色でHMB-45 (+), S100(+)と悪性黒色腫に特異的な所見を示した. 黒色腫はまれにpagetoid spreadを伴う例があるので, 切除範囲は慎重に決定すべきである.

術後胆管良性狭窄による閉塞性黄疸に対しexpandable metallic stent (EMS) 留置術を施行した1例を経験したので報告する. 症例は53歳,女性.胆石症の診断にて他院にて腹腔鏡下胆嚢摘出術施行.高度の胆嚢炎による癒着を背景としていたとのことで術中総胆管を損傷し,開腹へ移行し胆嚢摘出,総胆管の端々吻合を行った.術後23病日に退院したが,黄疸を生じたため退院後9日目に加療目的に当院へ転科入院となった. 経皮経肝的胆道ドレナージ (PTCD) 術を行い,その後5回にわたるバルーン拡張術を施行した.なお胆管造影にて乳頭括約筋の機能に異常はないと判断した.バルーンによる胆管拡張術のみでは狭窄部位の開存程度が不十分と判断されたためEMS留置を施行した.留置後CT内視鏡にてステントに,再狭窄など異常所見のないことを確認し退院となった. 現在,症状なく外来にて経過観察中である.

A 64-year-old woman was introduced to our hospital with liver tumors. Our examination revealed that she had advanced colon carcinoma with multiple liver metastasis. Without symptoms from the primary cancer, she underwent chemotherapy of avastin FOLFOX. After 2 courses of chemotherapy, she suffered ileus and underwent operation. The resected specimen showed marked tumor necrosis and fibrosis, but few tumor cells remained in the primary lesion. We think this was a rare case of suffered ileus because of marked response of chemotherapy in primary colon carcinoma.

A new experimental volumetric display system based on inclined-image scanning is reported. A volumetric image is formed as a stack of about one hundred cross-sectional images. A high-speed video interface apparatus for controlling a digital micromirror device, which displays the cross-sectional images, is introduced to achieve real-time updating of volumetric images. The cross-sectional images of a three-dimensional (3D) object are generated from a depth map of the 3D polygon surface model within a video frame rate. In addition, to increase the viewing angle, the numerical aperture of an optical system is in-creased by use of a larger scanner mirror.