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Background Erythropoiesis-stimulating agents (ESAs) are the standard treatment for patients with renal anemia to increase hemoglobin (Hb) levels and reduce the need for blood transfusions. However, treatments targeting high Hb levels require high doses of ESAs administered intravenously, which is associated with an elevated risk of adverse cardiovascular events. Furthermore, there have been some problems such as hemoglobin variability and low achievement of target hemoglobin due to the shorter half-lives of ESAs. Consequently, erythropoietin-promoting medications, such as hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) inhibitors, have been developed. This study aimed to evaluate changes in the Treatment Satisfaction Questionnaire for Medicine version II (TSQM-II) domain scores relative to baseline in each trial, to assess patient satisfaction with molidustat versus darbepoetin alfa. Methods This post-hoc analysis of two clinical trials compared treatment satisfaction with an HIF-PH inhibitor, molidustat, versus a standard ESA, darbepoetin alfa, as part of therapy in patients with non-dialysis chronic kidney disease (CKD) and renal anemia. Results Exploratory outcome data using the TSQM-II showed that both arms in both trials had enhanced treatment satisfaction over the course of the study period, as well as improvements in most TSQM-II domains at week 24 of treatment. Molidustat was associated with convenience domain scores at multiple time points depending on the trial. More patients were highly satisfied with the convenience of molidustat than that of darbepoetin alfa. Patients treated with molidustat had increased global satisfaction domain scores compared with those treated with darbepoetin alfa; however, the differences in global satisfaction domain scores were not significant. Conclusion These patient-reported satisfaction outcomes support the use of molidustat as a patient-centered treatment option for CKD-related anemia. Registration of clinical trials ClinicalTrials.gov Identifier: NCT03350321 (November 22, 2017). ClinicalTrials.gov Identifier: NCT03350347 (November 22, 2017).

We investigate triplet pair dynamics in pentacene dimers that have varying degrees of coplanarity (pentacene-pentacene twist angle). The fine-tuning of the twist angle was achieved by alternating connectivity at the 1-position or 2-positions of pentacene. This mix-and-match connectivity leads to tunable twist angles between the two covalently linked pentacenes. These twisted dimers allow us to investigate the subtle effects that the dihedral angle between the covalently linked pentacenes imparts on singlet fission and triplet pair recombination dynamics. We observe that as the dihedral angle between the two bonded pentacenes is increased, the rates of singlet fission decrease, while the accompanying decrease in triplet recombination rates is stark. Temperature-dependent transient optical studies combined with theoretical calculations show that the triplet pair recombination proceeds primarily through a direct multiexciton internal conversion process. Calculations further show that the significant decrease in recombination rates can be directly attributed to a corresponding decrease in the magnitude of the nonadiabatic coupling between the singlet multiexcitonic state and the ground state. These results highlight the importance of the twist angle in designing systems that exhibit rapid singlet fission, while maintaining long triplet pair lifetimes in pentacene dimers.

Erythropoiesis-stimulating agents (ESAs) are a standard treatment for patients with renal anemia to increase hemoglobin (Hb) levels and reduce their need for blood transfusions. However, treatments targeting high Hb levels require high doses of ESAs by the intravenous injection which are associated with an elevated risk of adverse cardiovascular events. In response to this key limitation other erythropoietin-promoting medications have been developed such as hypoxia-inducible factor-prolyl hydroxylase inhibitors (HIF-PH inhibitor). This post-hoc analysis of two clinical trials evaluates patients’ treatment satisfaction with a HIF-PH inhibitor, molidustat, compared to a standard ESA, darbepoetin alfa, as part of therapy for patients with non-dialysis chronic kidney disease (CKD) and renal anemia. Exploratory outcome data using the Treatment Satisfaction Questionnaire for Medicine version II (TSQM-II) showed that both arms in both trials had increased treatment satisfaction over the course of the study period as well as improvements in most TSQM-II domains at week 24. Molidustat was associated with convenience domain scores at multiple timepoints depending on the trial and more patients were highly satisfied with the convenience of molidustat compared to darbepoetin alfa. Patients treated with molidustat also had increases in global satisfaction domain scores compared to darbepoetin alfa, but the differences s in global satisfaction domain scores were not significant. These patient-reported satisfaction outcomes provide findings supporting the use of molidustat as a patient-centered treatment option for CKD-related anemia.

Introduction Neovascular glaucoma is characterized by neovascularization of the iris and anterior angle chamber. Intravitreal anti-vascular endothelial growth factor agents may decrease intraocular pressure (IOP) and improve neovascularization. The VENERA study assessed the efficacy and safety of intravitreal aflibercept (IVT-AFL) in patients with neovascular glaucoma. Methods This was a 5-week, single-arm, nonrandomized, open-label, phase 3 study performed at 7 study sites in Japan that enrolled Japanese patients with anterior segment neovascularization and IOP > 25 mmHg who had not undergone (within 30 days prior), nor were imminently scheduled to undergo (within 8 days following) intraocular surgeries, including panretinal photocoagulation (PRP). Patients received background therapy plus 2 mg IVT-AFL at baseline. Background therapy with systemic IOP-lowering drugs was prohibited for 3 days before day 1 and until IOP evaluation at week 1. The primary endpoint was the change in IOP from baseline to week 1 and the secondary endpoint was the proportion of patients with an improvement of ≥ 1 grade of neovascularization of the angle (NVA) from baseline to week 1. Results Sixteen patients received treatment (full analysis set); the per-protocol set comprised 15 patients. The mean IOP decreased from 34.1 mmHg at baseline to 25.8 mmHg at week 1 (mean change, −8.3 mmHg [95% confidence interval; CI −12.2 to −4.4; P = 0.0004]). At week 1, 81.3% of patients had an improvement in the grade of neovascularization of the iris (NVI) and 50.0% of patients had an improvement in NVA grade. The proportion of patients with controlled IOP (≤ 21 mmHg) was 43.8% (95% CI 19.8–70.1) at week 1, and increased to 56.3% at week 2 and 86.7% at week 5. The most common ocular treatment-emergent adverse event was eye pain, which occurred in 4 patients (25.0%). Conclusions IVT-AFL was associated with statistically significant and clinically meaningful IOP reductions, without concomitant use of systemic IOP-lowering drugs or PRP. The safety profile was consistent with the known safety profile of IVT-AFL. These findings supplement those from the previous VEGA study, and suggest that IVT-AFL may be a potential treatment option for patients with neovascular glaucoma. Trial Registration Clinicaltrials.gov identifier NCT03639675. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01580-y.

We aimed to investigate the impact of the controlling nutritional status (CONUT) score, an immuno-nutritional biomarker, on the prognosis of patients with hepatocellular carcinoma (HCC) treated with lenvatinib (LEN). This retrospective study enrolled 164 patients with HCC and treated with LEN (median age 73 years, Barcelona Clinic Liver Cancer (BCLC) stage B/C 93/71). Factors associated with overall survival (OS) were evaluated using multivariate and decision tree analyses. OS was calculated using the Kaplan&ndash, Meier method and analyzed using the log&ndash, rank test. Independent factors for OS were albumin&ndash, bilirubin grade 1, BCLC stage B, and CONUT score &lt, 5 (hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.58&ndash, 5.31, p &lt, 0.001). The CONUT score was the most important variable for OS, with OS rates of 70.0% and 29.0% in the low and high CONUT groups, respectively. Additionally, the median survival time was longer in the low CONUT group than in the high CONUT group (median survival time not reached vs. 11.3 months, p &lt, 0.001). The CONUT score was the most important prognostic variable, rather than albumin&ndash, bilirubin grade and BCLC stage, in patients with HCC treated with LEN. Accordingly, immuno-nutritional status may be an important factor in the management of patients with HCC treated with LEN.

We introduce a singularity-free golden-rule rate expression for internal conversion (IC), a spin-conserved radiationless relaxation process, expressed as the product of a nonadiabatic coupling term and the time integral of a vibration correlation function. For a set of small polyatomic molecules (acenes and azulene), we show that our calculated rates are in near quantitative agreement with the rates derived from experiments. Interestingly, we find that our rates do not agree with previous golden-rule-based theoretical efforts; detailed analysis shows that while the level of electronic structure theory can play a role, the more significant error is from not fully converging the numerical time integral over the oscillatory vibration correlation function. We then use our singularity-free IC rate expression to compute the rate of recombination of the correlated triplet pair state generated by intramolecular singlet fission in a trio of bipentacenes. We show that the recombination rates are in good agreement with experimentally observed trends-specifically, the rates are robust to temperature changes and decrease rapidly with increasing inter-monomer dihedral angle. Finally, we use a pair-wise breakdown of normal mode contributions to the rate to identify the key vibrational modes that drive recombination in bipentacenes.

Electron count is one of the key factors controlling the formation of complex intermetallic structures. The delocalized nature of bonding in metals, however, has made it difficult to connect these electron counts to the various structural features that make up complex intermetallics. In this article, we illustrate how structural progressions in transition metal-main group intermetallics can in fact be simply understood with the 18-n bonding scheme, using as an example series the four binary phases of the Os–Al system. Our analysis begins with the CsCl-type OsAl phase, whose 11 electrons/Os count is one electron short of that predicted by the 18-n rule. This electron deficiency provides a driving force for Al incorporation to make more Al-rich intermetallic phases. In the structures of Os2Al3 (own type) and OsAl2 (MoSi2 type), each additional Al atom contributes three electrons, two of which go towards cleaving Os–Os isolobal bonds, with the third alleviating the original electron deficiency of OsAl. Across the series, the framework of isolobal Os–Os bonds is reduced from a primitive cubic network (n=6, OsAl) to layers of cubes (n=5, Os2Al3) to individual square nets (n=4, OsAl2). Upon adding more Al to form Os4Al13, the Os–Os contacts are further reduced to dumbbells at the interfaces between fluorite-type columns. At this point, the added Al raises the electron count beyond that needed for filled octadecets on the Os atoms; the excess electrons are accommodated by Al–Al bonds. Throughout this work, we emphasize how the 18-n scheme can be applied from structural inspection alone, with theoretical calculations confirming or refining these conclusions.

Aim: To evaluate the effect of antenatal corticosteroids (ANS) on short- and long-term outcomes in small-for-gestational age (SGA) infants. Methods: A retrospective database analysis was performed. A total of 1,931 single infants (birth weight

To evaluate the short- and long-term outcomes among very low birth weight (VLBW) preterm infants after histologic chorioamnionitis (HCA).We performed a retrospective analysis of 5849 single infants (birth weight1500 g) born at a gestational age between 22 + 0 and 33 + 6 weeks. Clinical data were obtained from the Neonatal Research Network Japan between 2003 and 2007. Multivariable logistic regression analyses were performed to assess the effect of HCA on short- and long-term outcome.According to logistic regression analysis, HCA was associated with lower incidence of respiratory distress syndrome (odds ratio [OR] = 0.54; p 0.001), increased chronic lung disease (OR = 1.68; p 0.001) and sepsis (OR = 1.71; p 0.001) and as a short-term outcomes. There was no significant association with intraventricular hemorrhage (OR = 1.11; p = 0.33), periventricular leukomalacia (OR = 1.07; p = .070) and death before discharge (OR = 0.97; p = 0.084). HCA was associated with increased home oxygen therapy (OR = 3.09; p 0.001), but not with cerebral palsy (CP; OR = 0.91; p = 0.63), develop quotient 70 (OR = 1.27; p = 0.17), visual impairment (OR = 1.08; p = 0.77), severe hearing impairment (OR = 1.28; p = 0.62) and death (OR = 0.98; p = 0.91) before three years of age.In this retrospective population-based study in Japan, HCA was not a risk factor for death, neurodevelopmental impairment and CP in VLBW three-year-old preterm infants.

To clarify the association between amniotic neutrophil elastase levels and the development of bronchopulmonary dysplasia (BPD).The database between July 2001 and December 2012 was reviewed for women with amniocentesis on admission for amniotic fluid neutrophil elastase levels and with singleton deliveries between 22 + 0 and 31 + 6 weeks of gestation. Following deliveries, placentas were examined for histologic chorioamnionitis. The peripheral blood of the neonates was analyzed for acute phase reactants.Among 294 infants, no, mild, moderate or severe BPD was observed in 126, 89, 40 and 39 infants, respectively. The medians of gestational age on admission, at premature rupture of membranes and at delivery were significantly smaller in BPD (+) when compared with BPD (-) (p 0.001). The median level of amniotic neutrophil elastase on admission was significantly greater in BPD (+) than that in BPD (-). Histologic chorioamnionitis and funisitis were both detected more frequently in BPD (+) patients than in BPD (-) patients. In a logistic regression model, the only variable that affected an increased chance of BPD was the gestational age at delivery (odds ratio, 0.58; 95% confidence interval, 0.36-0.92; p = 0.021).The level of amniotic neutrophil elastase cannot be a definitive risk factor for BPD.

Aim The aim of this study was to clarify the association between fetal heart rate (FHR) tracing interpretation levels in the second stage of labor and poor fetal acid-base balance. Material and Methods The database at one tertiary hospital in Nagoya, Japan, was retrospectively reviewed for women with singleton fetuses in cephalic presentation and vaginal labor at ≥37 + 0 gestational weeks between 1 June 2011 and 30 April 2012. Continuous FHR tracings in the second stage of labor were subdivided into 15-min intervals, each of which we called a window, from the beginning of labor through delivery, and were assessed according to the five-tier classification proposed by the Japan Society of Obstetrics and Gynecology, in which level 1 is normal, level 2 is subnormal, and levels 3–5 are abnormal patterns. Results In total, 777 parturient women were eligible for the study protocol. The numbers of women with maximal levels of 1, 2, 3, 4, and 5 were 3, 77, 341, 349, and 7, respectively. No cases of severe fetal acidosis (pH

To evaluate the effectiveness of antenatal corticosteroids (AC) therapy on outcomes of very low birthweight infants with histologic chorioamnionitis. We performed a retrospective analysis of 10,935 single infants born at a gestational age between 22 + 0 and 33 + 6 weeks and birth weight

Objective To assess the neonatal and maternal outcomes of pregnancy complicated by previable preterm premature rupture of membranes (PPROM). Design Retrospective study. Setting Tertiary referral hospital. Sample. Forty-five women having aggressive intervention with antibiotics, amnioinfusion, cerclage and tocolysis. Methods The hospital database between July 2001 and December 2009 was reviewed for women with singleton fetuses and PPROM before 23(+0) weeks of gestation. We analysed maternal and neonatal characteristics. Main outcome measures Neonatal survival without major morbidity. Results Thirty-eight infants were delivered alive and seven were stillborn. Ten infants died in the neonatal intensive care unit and one in the labor ward. Twenty-seven live-born infants survived to discharge from hospital. The survival rate of pregnancies with aggressive management was 60% (27 of 45); that of live-born infants was 71.1% (27 of 38). The median gestational age at PPROM and at delivery were significantly lower in the non-surviving group than the surviving group. Thirty-seven women (82.2%) had an amniotic neutrophil elastase level >0.15 μg/mL. Only four women (8.9%) developed clinical chorioamnionitis. Overall, 90.7% of the women showed histological evidence of chorioamnionitis. Eighty-three per cent of the surviving children had bronchopulmonary dysplasia. Nine infants had serious sequelae at a corrected age of one and a half years. Maternal complications were uncommon. Conclusions An aggressive treatment protocol for women with previable PPROM resulted in a high neonatal survival rate. Neonatal survival was associated with higher gestational age at delivery and with more frequent use of antenatal corticosteroids. The prognosis is still bad in PPROM before 22(+0) weeks of gestation.

Aim: To validate a previously developed prediction model for vaginal birth after cesarean (VBAC) using a Japanese cohort. Methods: We performed a cohort study of all term pregnant women with a vertex position, singleton gestation, and one prior low transverse cesarean delivery attempting a trial of labor between April 1985 and March 2010. Variables necessary for the prediction of successful VBAC were maternal age, pre-pregnancy body mass index, ethnicity, prior vaginal delivery, prior VBAC, and indication for prior cesarean delivery. They were extracted from medical records and put into the formula that calculates an individual woman's predicted VBAC success rate. The predicted rates were then partitioned into deciles and compared with the actual VBAC rates. The predictive ability of the model was assessed with a receiver operating characteristic and the area under the curve (AUC) was determined. Results: Seven hundred and twenty-five women who met the inclusion criteria had complete data available, of which 664 (91.6%) had VBAC. The predicted probability of VBAC, as calculated by the regression equation, was significantly higher in those who had a successful trial of labor (median 80.1%, interquartile range 71.5-88.7) than those who did not (median 69.4%, interquartile range 59.9-78.9, P

A novel method to form Ag nano-dot pattern on Ag"2S surface has been demonstrated using electron beam (EB) irradiation. When we irradiated EB in raster-scanning mode on Ag"2S surface, we observed nano-protrusions growth on the surface. We consider that the protrusion must be made of Ag. For point EB irradiation, a nano-dot having a minimum diameter of 13nm was obtained. We also demonstrated the writing of the nano-letters, ''GUNMA UNIV.'' with each character having a width of less than 600nm, and the forming of a nano-dot array pattern with a dot-size of about 25nm and dot-pitch of 30nm, which corresponds to about 600Gb/in^2 for storage applications.

To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA). We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22 + 0 and 33 + 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurodevelopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis. In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded without data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32–0.86)], [odds ratio (95 % confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41–1.99)], development quotient

Septic shock during pregnancy is very rare but has high mortality. We report a case of septic shock in a pregnant woman with ileus, showing that severe ileus in a pregnant woman could be attributed to life-threatening septic shock and that we should give special attention to a nosocomial infection.

The aim of this study was to clarify the association between fetal heart rate (FHR) tracing interpretation levels in the second stage of labor and poor fetal acid-base balance.The database at one tertiary hospital in Nagoya, Japan, was retrospectively reviewed for women with singleton fetuses in cephalic presentation and vaginal labor at ≥37 + 0 gestational weeks between 1 June 2011 and 30 April 2012. Continuous FHR tracings in the second stage of labor were subdivided into 15-min intervals, each of which we called a window, from the beginning of labor through delivery, and were assessed according to the five-tier classification proposed by the Japan Society of Obstetrics and Gynecology, in which level 1 is normal, level 2 is subnormal, and levels 3-5 are abnormal patterns.In total, 777 parturient women were eligible for the study protocol. The numbers of women with maximal levels of 1, 2, 3, 4, and 5 were 3, 77, 341, 349, and 7, respectively. No cases of severe fetal acidosis (pH7.0 or base excess-12 mmol/L) were recorded when the maximal levels were below 3. Both the pH and base excess of the umbilical artery decreased with higher levels of FHR tracings interpretation (P0.001). Both the summations of level-4 windows and level-3 and level-4 windows were significantly higher in women with severe fetal acidosis than in women without (P0.001), indicating that the duration of abnormal levels is associated with severe fetal acidosis.Both the degree and duration of FHR tracing abnormalities correlate with severe fetal acidosis.

The best treatment for recurrent granulosa cell tumor(GCT)is considered to be surgical resection, because the effects of chemotherapy or radiation on GCT are obscure. The common site of recurrence is the pelvic cavity, including the surface of the liver and intestine as tumor-dissemination-patterns. Between June 1988 and June 2011, we treated 15 patients with GCT at our hospital. The median follow-up time was 56(22-286)months. Ten patients were stage I, 3 were stage II, and 2 were stage III. No patients had residual lesions at the primary surgery area. Six patients have recurred, and the median disease free survival(DFS)was 85(15-128)months. Six patients had relapses in the pelvic cavity, 2 in the retroperitneal lymph nodes, and 1 in the upper abdomen. Two patients relapsed more than twice; however, the rapid detection of recurrence and surgical resection have kept all patients alive. Thirteen patients have no evidence of disease(NED), 2 are alive with disease(AWD), and no one has died of the disease(DOD). We suggest that maximal debulking surgery to achieve complete cytoreduction of recurrent GCT is the most important treatment for prolonging survival.

我々がC. H. S. で治療した大腿骨頸部外側骨折50例のうち不良例は4例だった. うち3例を症例報告しその原因について検討をくわえた.いずれの症例でも, 内後方の骨皮質の連続性が保たれておらず荷重に対する支持性が十分でなく, ラグスクリューは安定した内固定が得られる位置へ挿入されていなかった.大腿骨頸部外側骨折をC. H. S. をもちいて治療する場合, 正確な整復のもとに安定した内固定が得られる位置ヘラグスクリューを挿入することが重要とおもわれる.

To assess the neonatal and maternal outcomes of pregnancy complicated by previable preterm premature rupture of membranes (PPROM).Retrospective study.Tertiary referral hospital. Sample. Forty-five women having aggressive intervention with antibiotics, amnioinfusion, cerclage and tocolysis.The hospital database between July 2001 and December 2009 was reviewed for women with singleton fetuses and PPROM before 23(+0) weeks of gestation. We analysed maternal and neonatal characteristics.Neonatal survival without major morbidity.Thirty-eight infants were delivered alive and seven were stillborn. Ten infants died in the neonatal intensive care unit and one in the labor ward. Twenty-seven live-born infants survived to discharge from hospital. The survival rate of pregnancies with aggressive management was 60% (27 of 45); that of live-born infants was 71.1% (27 of 38). The median gestational age at PPROM and at delivery were significantly lower in the non-surviving group than the surviving group. Thirty-seven women (82.2%) had an amniotic neutrophil elastase level0.15 μg/mL. Only four women (8.9%) developed clinical chorioamnionitis. Overall, 90.7% of the women showed histological evidence of chorioamnionitis. Eighty-three per cent of the surviving children had bronchopulmonary dysplasia. Nine infants had serious sequelae at a corrected age of one and a half years. Maternal complications were uncommon.An aggressive treatment protocol for women with previable PPROM resulted in a high neonatal survival rate. Neonatal survival was associated with higher gestational age at delivery and with more frequent use of antenatal corticosteroids. The prognosis is still bad in PPROM before 22(+0) weeks of gestation.

To evaluate the five-tier classification of fetal heart rate (FHR) tracings recently proposed by Japan Society of Obstetricians and Gynecologists (JSOG).The database between January and June 2009 was reviewed for women in active labor at ?36 + 0 gestational weeks, with singleton fetuses in cephalic presentation and with umbilical artery blood gas analyses. Continuous FHR tracings were assessed according to the five-tier classification proposed by JSOG, where level 1 is normal, level 2 is subnormal and levels 3?5 are abnormal patterns.A total of 341 parturient women were eligible for this study protocol. The median (range) of the levels in the first and the second stage of labor were 1 (1-4) and 2 (1-4), respectively (p0.001). Both pH and base excess of umbilical artery decreased with higher levels of FHR tracings interpretation (p0.01). Interventions resulting in delivery were more necessary in the first stage of labor than in the second stage of labor in cases of levels 3 and more.Five-tier system for FHR tracing interpretation proposed by JSOG intercorrelates with the fetal acid-base balance well. Categorization of FHR tracings by uniform diagnostic criteria will be useful to standardize therapeutic strategy by sharing common perception among obstetrical staff.

We investigated the results of cervical cytology, pathology of colposcopic biopsy and surgical specimen among 765 women suspected to have cervical intraepithelial neoplasia (CIN). Significantly more patients with cervical cytology class III b than class III a were diagnosed in CIN grade 3 on colposcopic biopsy. The concordance rate of colposcopic biopsy and surgical specimen was 79.8%, but we preoperatively diagnosed CIN grade 3 or more at 96.1% with colposcopic biopsy. In time course observation, CIN regressed in 26.3% of all patients, progressed in 19.3% and did not change in 54.4%. Many patients of CIN grade 2 progressed to grade 3 in two years. Significantly more patients of CIN grade 1 or 2 with cervical cytology class III b progressed than with class III a (p0.05).

Although paraaortic lymphadenectomy is one of the standard treatments for gynecological cancer in Japan, it is very invasive so one must examine its safety for patients. Paraaortic lymphadenectomy was performed in 215. Two hundred and fifteen gynecologic cancer patients at our hospital between January 1991 and August 2005. We evaluated operation time, estimated blood loss and the incidence of operative injury, wound complication, and postoperative ileus. It was revealed that the mean operation time was 364 minutes and the estimated blood loss was increased at the operation around the vena cava or renal vein. After we adopted Kocher's technique, the mean blood loss was decreased. The incidence of postoperative ileus was 13.3%, but almost all of the patients were cured within seven days without surgical treatment. The incidence of wound complication was within 10%.

To test the hypothesis that counting heart rate is dispensable and other components of the Apgar score are satisfactory to evaluate the physical condition of infants shortly after birth in routine deliveries.The database of the Japanese Red Cross Nagoya First Hospital was reviewed for newborn infants whose Apgar scores were marked by trained neonatologists attending delivery.The scores of respiratory effort, muscle tone, and reflex irritability increased parallel to Apgar scores. Heart rate gained higher marks even in lower Apgar scores, whereas color demonstrated lower marks even in higher Apgar scores. Correlation coefficients were higher among respiratory effort, muscle tone, and reflex irritability. In contrast, both heart rate and color exhibited lower correlation coefficients against other components and total Apgar scores. High correlation coefficients were shown between the sum of the four components other than heart rate and the total score.Heart rate and color play more independent roles in the Apgar score. Heart rate seems to be dispensable and the other components of the Apgar score are satisfactory to evaluate the physical condition of infants shortly after birth, and hence, counting heart rate may be omitted in routine deliveries when a newborn infant is apparently well.

We report a rare case of fetal intraventricular bleeding possibly due to maternal vitamin K deficiency. A 20-year-old woman was admitted to our hospital due to impending premature delivery and loss of dietary intake at 28 weeks of gestation. Her blood examination showed metabolic alkalosis, prolonged prothrombin time, and extremely high level of plasma des-gamma-carboxyprothrombin (protein induced by vitamin K absence, PIVKA-II). Intraventricular hemorrhage was demonstrated by ultrasonography 6 days after admission. She delivered a 2,288-gram girl infant at 40 weeks of gestation. Cranial computerized tomography and magnetic resonance images obtained postnatally demonstrated a reduced cerebral parenchyma adjacent to the interior side of the right lateral ventricle and the deficit of left cerebellum. The infant’s head control was insufficient and central impaired hearing was noted at 6 months of life.

Chorioamnionitis is considered to be one of the main causes of preterm labor and has been associated with an adverse perinatal outcome in preterm infants. The controversy about the benefits/risks of delaying labor is a critical issue concerning the management of chorioamnionitis.The database between July 2001 and March 2006 was reviewed for women with singleton pregnancies between 22 and 28 weeks of gestation and with chorioamnionitis diagnosed on admission by amniotic fluid neutrophil elastase level. Women were classified according to the severity of chorioamnionitis (group A, amniotic fluid neutrophil elastase level of 0.15-1 microg/ml; B, 1-10 microg/ml; and C,or = 10 microg/ml). During expectant management, serum C-reactive protein levels monitored the remission and aggravation of chorioamnionitis. Following deliveries, placentas were examined for histologic chorioamnionitis.One hundred women were enrolled (group A, 38; B, 34; C, 28). The latency period until delivery was significantly longer in group A than in groups B and C. C-reactive protein levels just before delivery were higher than those on admission in 61% of the overall cases. Histologic chorioamnionitis and funisitis were manifested in 90.4% and 65.5%, respectively. Intrauterine fetal demise (4 cases) and neonatal and postneonatal deaths during admission (10 cases) were observed. Bronchopulmonary dysplasia was the most common major morbidity noted in groups B and C.Chorioamnionitis could be controlled but is hard to cure. Higher levels of amniotic fluid neutrophil elastase are associated with a shorter interval from admission to delivery in women with subclinical chorioamnionitis.

Neoadjuvant chemotherapy (NAC) with intra-arterial infusion was performed in the treatment for 53 patients with advanced cervical squamous cell carcinoma. After NAC with intra-arterial infusion of the anticancer agents including cisplatin via internal iliac artery or uterine artery, 42 patients received radical hysterectomy. The response to therapy was observed in 45 of all patients (84.9%) clinically, and 36 of 42 patients (85.7%) pathologically. Cancer cells disappeared in 11.9% of patients with cervical invasion, 69.2% with vaginal wall invasion and 39.4% with parametrium invasion after NAG. Five-year survival rates were 100% in stage I, 71.5% in stage II, 52.2% in stage II and 0% in stage IV. The group of patients without cancer in the parametrium after NAC showed a significantly better 5-year survival rate than the group with residual cancer in the parametrium. According to the results, the elimination of cancer invasion to the parametrium by NAC is thought to be important for improvement of the prognosis in advanced cervical cancer.

D8-15 modulation, which is a RLL(2,10) modulation, is extended to enable to store an extra information. The extra information is multiplexed to main data with no capacity loss by the modulation of k constraint value. Since a coding table is applied no change by this operation, the same decoder can be used to decode the main data. It means the extra information is invisible from the main channel decoder. The extended code indicates similar DC control performance as the original one.

Thermophillic enzymes tend to be less active at low temperatures than are their natural mesophillic or psychrophillic counterparts, which in turn are less thermostable (Fig. 1). Enzymes that are both highly thermostable and highly active at low temperature are not observed in nature. Our study addresses the following question: Are such enzymes physically possible?

An optical disk system using a blue laser diode and a single objective lens that has a numerical aperture of 0.7, is proposed. A sufficiently low jitter value was obtained with a read-only disk having 17-Gbyte capacity. The paper also includes discussion on the influence of the laser noise and RF modulation method on the playback signal.

A new modulation code and new signal reproduction processes for a high-density optical disk system are proposed. With these new techniques, the capacity of the optical disk system can be 30% higher than the present digital versatile disk (DVD) system. An evaluation in terms of the bit error rate by both simulation and hardware experiments is also shown.