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A local structure analysis method based on convergent-beam electron diffraction (CBED) has been used for refining isotropic atomic displacement parameters and five low-order structure factors with sin θ/λ ≤ 0.28 Å−1 of potassium tantalate (KTaO3). Comparison between structure factors determined from CBED patterns taken at the zone-axis (ZA) and Bragg-excited conditions is made in order to discuss their precision and sensitivities. Bragg-excited CBED patterns showed higher precision in the refinement of structure factors than ZA patterns. Consistency between higher precision and sensitivity of the Bragg-excited CBED patterns has been found only for structure factors of the outer zeroth-order Laue-zone reflections with larger reciprocal-lattice vectors. Correlation coefficients among the refined structure factors in the refinement of Bragg-excited patterns are smaller than those of the ZA ones. Such smaller correlation coefficients lead to higher precision in the refinement of structure factors.

Influenza vaccination is necessary to reduce severe influenza complications, especially in immunocompromised people such as cancer patients. However, few studies have examined influenza vaccination uptake among adult Japanese patients with cancer; their attitudes toward vaccination, as well as factors related to vaccine hesitancy, are unclear. From September 1 to October 31, 2020, we disseminated a web-based questionnaire to patients with a history of cancer via snowball sampling through e-mails and social media of two Japanese cancer patients associations. A total of 163 surveys were completed. One hundred (61.3%) participants received an influenza vaccination in the 2019/2020 season, and the main reasons for vaccination were as follows: recommendation by medical professionals, positive awareness of vaccination through books or the internet, and provision of vaccination in the workplace. The main reasons for not receiving a vaccination were fear of adverse events, lack of concern about influenza infection, and lack of trust in vaccine effectiveness. In terms of the 2020/2021 season, 120 participants (73.6%) reported their intention to receive an influenza vaccination. Multiple regression analysis showed that significant factors for positive intention were the the treatment without chemotherapy (p = .009), vaccination history in the 2019/2020 season (p

We appreciate the reviewer’s comment to our article on the correlation between the national BCG vaccination policy and coronavirus disease 2019 among Organisation for Economic Co-operation and Development countries as of April 20, 2020. In this letter, we further updated the data up to November 1, 2020, and found that the updated results also arrive at the similar conclusion as the accepted article.

Ariga Tetsutaro (1899–1977) war Professor für das Studium des Christentums an der Universität Kyoto und gehörte dort der zweiten Professoren-generation an. Er legte die Grundlagen der Patristik und der Erforschung des Christentums in Japan. In seinem Hauptwerk “Origenes” hatte er den Historismus in der Theologie erforscht, aber nachdem er seinen Dienst als Professor an der staatlichen Universität aufgenommen hatte, die die Trennung von Staat und Religion hochhielt, suchte er nach Wegen, ein ‘Studium des Christlichen’ zu etablieren, das sich von der Theologie unterschied. Dabei dienten ihm Schleiermachers “Kurze Darstellung des theologischen Studiums” und die Tradition des deutschen liberalen Protestantismus als Anhaltspunkte. Anstatt der Theologie, die den Glauben als methodischen Ausgangspunkt hat, und der Religionswissenschaft, die nur die distanzierte Objektivität als Ausgangspunkt wählt, schlug er als neuen Versuch ein Christliches Studium mit akademischem Standpunkt vor, bei dem der Gelehrte eine Forschungshaltung einnimmt, die durch ein Mindestmaß an vernünftiger Kritik und ‘Ur-Sympathie’ gegenüber der Religion geprägt ist.

Precipitation during creep exposure at 550 °C in the fine grain heat-affected zone of a Grade91 steel weld produced by gas tungsten arc welding with no filler and post-weld heat treatment at 760 °C for 30 min. has been investigated. The applied tension load during creep testing was 165 MPa, the creep rupture time was 1138 hrs. (100% creep aging), and the creep exposure times were 911, 569, 341, 223 and 114 hrs. for 80%, 50%, 30%, 20% and 10% creep aging, respectively. Light microscopy and scanning electron microscopy were used to examine the heat-affected zone in the steel weld. Grain size in the fine grain heat-affected zone was measured by a circular intercept method on secondary electron images from scanning electron microscopy. Precipitates were detached from the fine grain heat-affected zone by a carbon-film extraction replica technique and investigated by transmission electron microscopy. During creep, a continual increase in grain size was observed in the fine grain heat-affected zone, starting from about 1.70 µm after post-weld heat treatment to about 2.30 µm at 100% creep aging. Precipitates found during creep were M

Degradation of the crystalline quality of transmission electron microscopy specimens in silicon prepared with different conditions has been examined using convergent-beam electron diffraction (CBED). The specimens are prepared using focused ion beam (FIB) with different accelerating voltages, Ar-ion milling and crushing method. Symmetry breaking of CBED patterns was quantitatively evaluated by symmetry breaking index S, which has been previously reported. The degradation and inhomogeneity of the FIB specimen were suppressed by decreasing the accelerating voltages of the FIB fabrication in the final process.

Ferroaxial materials that exhibit spontaneous ordering of a rotational structural distortion with an axial vector symmetry have gained growing interest, motivated by recent extensive studies on ferroic materials. As in conventional ferroics (e.g., ferroelectrics and ferromagnetics), domain states will be present in the ferroaxial materials. However, the observation of ferroaxial domains is non-trivial due to the nature of the order parameter, which is invariant under both time-reversal and space-inversion operations. Here we propose that NiTiO3 is an order-disorder type ferroaxial material, and spatially resolve its ferroaxial domains by using linear electrogyration effect: optical rotation in proportion to an applied electric field. To detect small signals of electrogyration (order of 10−5 deg V−1), we adopt a recently developed difference image-sensing technique. Furthermore, the ferroaxial domains are confirmed on nano-scale spatial resolution with a combined use of scanning transmission electron microscopy and convergent-beam electron diffraction. Our success of the domain visualization will promote the study of ferroaxial materials as a new ferroic state of matter., The presence of ferroaxial domain states is recently experimentally demonstrated by a nonlinear optical technique, which lacks high spatial resolution to visualize ferroaxial domains. Here, the authors visualize spatial distributions of ferroaxial domains in NiTiO3 showing an order-disorder type ferroaxial transition.

The magnetic susceptibility of the 1/1 approximants to icosahedral quasicrystals in a series of Cd85-xMgxTb15 (x = 5, 10, 15, 20) alloys was investigated in detail. The occurrence of antiferromagnetic to spin-glass-like transition was noticed by increasing Mg. Transmission electron microscopy analysis evidenced a correlation between the magnetic transition and suppression of the monoclinic superlattice ordering with respect to the orientation of the Cd4 tetrahedron at T > 100 K. The possible origins of this phenomenon were discussed in detail. The occurrence of the antiferromagnetic to spin-glass -like magnetic transition is associated with the combination of chemical disorder due to a randomized substitution of Cd with Mg and the orientational disorder of the Cd4 tetrahedra., 9 pages, 9 figures

We compared whether the national BCG vaccination (BCGV) policy influenced coronavirus disease 2019 (COVID-19) in Organisation for Economic Co-operation and Development (OECD) countries. Those currently implementing BCGV have a reduced number of COVID-19 morbidity and mortality cases, compared to those who have never implemented a BCGV policy, suggesting the potential protective effect of BCGV against COVID-19.

The accuracy of electron density distribution analysis using large-angle convergent-beam electron diffraction (LACBED) patterns is evaluated for different convergence angles. An orbital ordered state of FeCr2O4 is used as an example of the analysis. Ideal orbital-ordered and non-ordered states are simulated by using orbital scattering factors. LACBED patterns calculated for the orbital-ordered state were used as hypothetical experimental data sets. Electron density distribution of the Fe 3d orbitals has been successfully reconstructed with a higher accuracy from LACBED patterns with convergence angles larger than 15.2 mrad, which is 4 times as large as that for conventional convergent-beam electron diffraction patterns. Excitation of particular Bloch waves with the aid of LACBED patterns has a key role in the accurate analysis of electron density distributions.

Background: The long-term impact of a nuclear accident on deployment of physicians remains unclear due to relative lack of such accidents. We examined chronological changes in number of physicians in areas affected by Fukushima Daiichi Nuclear Power Plant accident following Great East Japan Earthquake in 2011. Methods: We examined rate of change in physicians per population ratios in Fukushima from 2010 to 2018, comparing them to those of two neighboring prefectures combined, which were not directly affected by nuclear accident, as a control. We further conducted a descriptive sub-analysis of physicians stratified by characteristics. Findings: Following 2011 disaster, number of physicians per 100,000 people in Fukushima increased by 0.4% from 183.3 in 2010 to 184.1 in 2012. In control number increased by 4.0% from 200.1 to 208.1 in same period. Since 2012, number of physicians per 100,000 population in Fukushima increased, reaching 207.4 in 2018. In terms of specifics, there were some notable differences in Fukushima compared to control. During 2010-2012, number of female physicians in Fukushima fell by 19.0% compared to control, physicians 60 years of age increased noticeably, by 40.9% and 6.1%, respectively. Interpretations: The nuclear accident affected number and distribution of physicians in Fukushima. The number of physicians per capita initially decreased but had increased over original levels seven years later. Funding Statement: The Ministry of the Environment. Declaration of Interests: AH reports personal fees from K. Ambiente co., ltd. TT reports personal fees from Medical Network Systems, MNES Inc., and Bionics co., ltd, outside the submitted work. AO reports personal fees from Medical Network Systems, MNES Inc. MK reports personal fees from Medical Network Systems, MNES Inc., SBI Biotech Co., Ltd., MRSO Inc., and Rectus Co., Ltd. The other authors declare no competing interests. Ethics Approval Statement: Only information in the public domain was used in this study, therefore no ethical approval was required.

In this study, we have investigated the electric-field response of polar nanodomains in the ferroelectric tetragonal phase of BaTiO3. Polar nanodomains were observed by a combination of scanning transmission electron microscopy (STEM) and convergent-beam electron diffraction (CBED). By applying an electric-field, significant changes in the distributions of nanometer-size domains were observed, besides the changes in the configurations of mesoscopic 90° and 180° ferroelectric domains. The obtained CBED patterns are categorized into three. One has higher tetragonal symmetry, and the other two show a deviation from tetragonal symmetry and exhibit a left-right reversal relation with each other. We propose a structural model of the rhombohedral nanodomain redistribution to reproduce the observed CBED patterns. The model consists of a balanced change in volume and size of rhombohedral nanodomains.

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo. We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients’ sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records. Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients’ median age was 3 years (interquartile range, 1–6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 am and 3 pm, respectively. Approximately 20% of weekday visits occurred after 6 pm, when other pediatricians’ offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 pm. The overall median waiting time was 650 seconds (interquartile range, 429–1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%). The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 pm. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.

ObjectivesLittle is known regarding how natural disasters affect patients with cancer in low-income and middle-income countries. The objective of the present study was to assess the impact of the 2015 Nepal earthquake on the admission of patients with cancer at a core medical institution in Kathmandu.Design, setting and participantsWe considered all 3520 cancer patient admissions to Tribhuvan University Teaching Hospital, from 25 April 2013 to 24 April 2017 (2 years before and 2 years after the earthquake).Outcome measuresThe number of cancer patient admissions was calculated for each month. Using a negative binomial model, we estimated the incidence rate ratio (IRR) for admission numbers each month after the earthquake compared with the pre-earthquake baseline and investigated chronological change.ResultsThe total admission number in the first month after the earthquake was decreased compared with that of the predisaster baseline (IRR=0.66, 95% CI 0.43 to 1.00), which largely reflected decreased admissions of patients from outside of the most disaster-affected districts. From the second month, the admission number consistently exceeded the predisaster baseline for the remaining postdisaster period. In contrast to the month of the disaster, the continuation of increased admissions was most prominent among those from outside of the most affected districts.ConclusionsAfter a transient decrease immediately following the 2015 Nepal earthquake, there was a long-term increase in cancer patient admissions in a core hospital in Kathmandu. These changes were seen most prominently in patients from outside the most disaster affected areas.

Selected-area electron diffraction and convergent-beam electron diffraction (CBED) techniques are used to reveal the Ba doping effect on the crystal structure of (${\mathrm{Sr}}_{1\ensuremath{-}x}{\mathrm{Ba}}_{x}{)}_{2}{\mathrm{Nb}}_{2}{\mathrm{O}}_{7}$ [SBN(x)] in the temperature range from 293 to 693 K. Ba doping of ${\mathrm{Sr}}_{2}{\mathrm{Nb}}_{2}{\mathrm{O}}_{7}$ (SN) causes weakening of the incommensurate modulation and deviation from the C-centered lattice. On the other hand, symmetries of fundamental reflections in CBED patterns of SBN(x) are seen to be the same as those of SN, showing a small structural deviation from Cmc${2}_{1}$. Crystal symmetries above and below the temperature of a relaxorlike dielectric anomaly in SBN ($x=0.32$) at 465 K remain unchanged. CBED experiments with a nanometer-sized electron probe do not show any indication of the presence of a nanodomain around this temperature. However, the presence of a few-micron-sized polar-inversion domains is found at around 573 K in SBN ($x=0.32$). The origin of the reported relaxorlike dielectric anomaly in SBN ($x=0.32$) is discussed on the basis of the experimental results of CBED.

The local crystal symmetry and crystal structure at CaTiO3 twin boundaries were examined using convergent-beam electron diffraction (CBED). CBED patterns obtained right at the twin boundaries exhibited one mirror symmetry not observed in the bulk form. Two types of crystal structures were identified at the boundaries on different boundary widths and symmetry breaking. Quantitative analysis using CBED patterns revealed atomic shifts of Ti and Ca. A distortion of oxygen octahedra was also produced, which was smaller than the corresponding distortion obtained in the bulk form. The refined crystal structure conforms to the polar structure expected only at CaTiO3 twin boundaries.

A sensational newspaper article concerning a possible adverse reaction to the human papillomavirus (HPV) vaccine was published in March 2013 in Japan. In June 2013, the Japanese government suspended their proactive recommendation for vaccination, despite the lack of proof for a causal relationship. We searched Nikkei Telecom 21, the largest newspaper database in Japan, for articles published from January 2011 to December 2015 to evaluate the characteristics of newspaper publications about human papillomavirus vaccination. We identified 1138 HPV vaccine-related articles. Compared with those published before March 2013, articles concerning human papillomavirus vaccination after March 2013 were more likely to include adverse reaction-related and authority-related keywords; articles that included efficacy-related keywords decreased significantly. Negative-negative and negative-neutral articles became more frequent, and positive-positive and positive-neutral articles were less frequent. A sensational case report shaped the tone of negative media coverage as a catalyst, regardless of scientific statements from health authorities.

Objective Adherence to rehabilitation exercise is much lower in patients with hematologic malignancies (22.5-45.8%) than in patients with solid tumors (60-85%) due to the administration of more intensive chemotherapeutic regimens in the former. Virtual reality exercise can be performed even in a biological clean room and it may improve the adherence rates in elderly patients with hematologic malignancies. Thus, in this pilot study, we aimed to investigate the feasibility and safety of virtual reality exercise intervention using Nintendo Wii Fit in patients with hematologic malignancies receiving chemotherapy. Methods In this feasibility study, 16 hospitalized patients with hematologic malignancies aged ≥60 years performed virtual reality exercise for 20 minutes using the Nintendo Wii Fit once a day, five times a week, from the start of chemotherapy until hospital discharge. The adherence rate, safety, and physical and psychological performances were assessed. Results The adherence rate for all 16 patients was 66.5%. Nine patients completed the virtual reality exercise intervention with 88 sessions, and the adherence rate was 62.0%. No intervention-related adverse effects >Grade 2, according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0, were observed. We noted maintenance of the physical performance (e.g., Barthel index, handgrip strength, knee extension strength, one-leg standing time, and the scores of timed up and go test and Instrumental Activities of Daily Living) and psychosocial performance (e.g., score of hospital anxiety and depression scale). Conclusion Virtual reality exercise using the Wii Fit may be feasible, safe and efficacious, as demonstrated in our preliminary results, for patients with hematologic malignancies receiving chemotherapy.

EGMAIN-GX is the computerized physician order entry system used in Japan. The automatic rounding-off of the calculated dose of chemotherapeutic drugs is an update in version 4, compared to version 2. We conducted a comparative study between EGMAIN-GX versions 2 and 4 to estimate the effect of the automatic rounding-off function on ordering time and dose dispersion.Twelve hematologists ordered 5 predefined chemotherapeutic regimens most commonly used in treating hematologic malignancies, twice for each regimen.EGMAIN-GX version 4 significantly reduced ordering times compared to version 2 (635s vs. 259s, p0.01). EGMAIN-GX version 4 also yielded a significantly higher ratio of actual to ideal doses of chemotherapeutic drugs than did version 2 (1.0097 and 0.9997, respectively; p0.01) and a lower standard deviation (0.0275 and 0.0290, respectively).The automatic rounding-off function could decrease the ordering time and dose dispersion of chemotherapeutic drugs.

BACKGROUND Japan faces increase of elderly people without children living in single households with the progress of low birthrate and aging population. The elderly without spouse and/or children result in lack of caregivers because most care for the elderly are not provided by private agencies but by family members in Japan. However, family caregivers are not only helpers of daily living but are key participants in the treatment decision-making. Effect of family absence on treatment decision-making has not been elucidated although more and more elderly people will not have family members who make surrogate decisions on behalf of incapacitated themselves. OBJECTIVE To understand the influence of family absence on treatment decision-making, we conducted a randomized, cross-sectional online survey with three hypothetical vignettes of patients. METHODS We conducted a randomised cross-sectional online survey among Japanese physicians using three hypothetical vignettes. The first vignette was about a 65-year-old man with alcoholic liver cirrhosis and the second about a 78-year-old woman with dementia, both of whom developed pneumonia with consciousness disturbance. The third vignette was about a 70-year-old woman with necrosis of her lower limb. Participants were randomly assigned either of the two versions of questionnaires—with family or without family—but otherwise identical. Participants chose yes or no responses to questions about whether they would perform the presented medical procedures. RESULTS Among 1112 physicians, 454 (40.8%) completed the survey and there were no significant differences in the baseline characteristics between groups. Significantly fewer physicians had a willingness to perform dialysis (odds ratio [OR], 0.55; P=0.002) and artificial ventilation (OR, 0.51; P CONCLUSIONS Elderly patients may sometimes be submitted to treatments withheld due to the absence of family, highlighting the potential importance of the advance care planning in the era of aging society with declining birthrate. CLINICALTRIAL None

Microstructures of as-cast 28 wt.%Cr–2.6 wt.%C irons containing (0–10)wt.%W with the Cr/C ratio about 10 were studied and related to their hardness. The experimental irons were cast into dry sand molds. Microstructural investigation was performed by light microscopy, X-ray diffractometry, scanning electron microscopy, transmission electron microscopy and energy-dispersive X-ray spectrometry. It was found that the irons with 1 to 10 wt.%W addition was hypereutectic containing large primary M{sub 7}C{sub 3}, whereas the reference iron without W addition was hypoeutectic. The matrix in all irons was austenite, partly transformed to martensite during cooling. The volume fractions of primary M{sub 7}C{sub 3} and the total carbides increased, but that of eutectic carbides decreased with increasing the W content of the irons. W addition promoted the formation of W-rich M{sub 7}C{sub 3}, M{sub 6}C and M{sub 23}C{sub 6}. At about 4 wt.%W, two eutectic carbides including M{sub 7}C{sub 3} and M{sub 6}C were observed together with primary M{sub 7}C{sub 3}. At 10 wt.%W, multiple carbides including primary M{sub 7}C{sub 3}, fish-bone M{sub 23}C{sub 6}, and M{sub 6}C were observed. M{sub x}C where x = 3 or less has not been found due possibly to the high M/C ratio in the studied irons. Wmore » distribution to all carbides has been determined increasing from ca. 0.3 to 0.8 in mass fraction as the W content in the irons was increased. W addition led to an increase in Vickers macro-hardness of the irons up to 671 kgf/(mm){sup 2} (HV30/15) obtained from the iron with 10 wt.%W. The formation of primary M{sub 7}C{sub 3} and aggregates of M{sub 6}C and M{sub 23}C{sub 6} were the main reasons for hardness increase, indicating potentially improved wear performance of the as-cast irons with W addition. - Highlights: • W addition at 1 up to 10 wt.%W to Fe–28Cr–2.6C produced “hypereutectic” structure. • W addition promoted the formation of W-rich M{sub 7}C{sub 3}, M{sub 6}C and M{sub 23}C{sub 6}. • M{sub 23}C{sub 6} has higher Fe/Cr and W/Cr atm% ratios than those in M{sub 7}C{sub 3}. • Si content and high W content over about 11 atm% are characteristics of M{sub 6}C. • Primary M{sub 7}C{sub 3} and aggregates of M{sub 6}C and M{sub 23}C{sub 6} increased the alloy macro-hardness.« less

Letter to the Editor Patients with incurable diseases often crave for various unproven cell therapies worldwide.1 In Japan, after induced pluripotent stem cells were awarded the Nobel Prize in 2012, the government has vigorously supported the development of potential clinical application of cell therapies, resulting larger-than-life hype and hope among the public. Aside from legitimate clinical trials, many for-profit clinics offer unproven cell-based procedures, with more than half of indication for advanced cancer.2 They often advertise online to draw patients' attention, promising effectiveness that have little …

Microstructures of as-cast 28 wt.% Cr–2.6 wt.% C irons containing (0–10) wt.% Mo with the Cr/C ratio of about 10 were studied and related to hardness. The experimental irons were cast into dry sand molds. Microstructural investigation was performed by light microscopy, X-ray diffractometry, scanning electron microscopy, transmission electron microscopy and energy-dispersive X-ray spectrometry. It was found that the iron with about 10 wt.% Mo was eutectic/peritectic, whereas the others with less Mo content were hypoeutectic. The matrix in all irons was austenite, partly transformed to martensite during cooling. Mo addition promoted the formation of M 23 C 6 and M 6 C. At 1 wt.% Mo, multiple eutectic carbides including M 7 C 3 , M 23 C 6 and M 6 C were observed. M 23 C 6 existed as a transition zone between eutectic M 7 C 3 and M 6 C, indicating a carbide transition as M 7 C 3 (M 2.3 C) → M 23 C 6 (M 3.8 C) → M 6 C. At 6 wt.% Mo, multiple eutectic carbides including M 7 C 3 and M 23 C 6 were observed together with fine cellular/lamellar M 6 C aggregates. In the iron with 10 wt.% Mo, only eutectic/peritectic M 23 C 6 and M 6 C were found without M 7 C 3 . Mo distribution to all carbides has been determined to be increased from ca. 0.4 to 0.7 in mass fraction as the Mo content in the irons was increased. On the other hand, Cr distribution to all carbides is quite constant as ca. 0.6 in mass fraction. Mo addition increased Vickers macro-hardness of the irons from 495 up to 674 HV 30 . High Mo content as solid-solution in the matrix and the formation of M 6 C or M 23 C 6 aggregates were the main reasons for hardness increase, indicating potentially improved wear performance of the irons with Mo addition.

Cefepime is an antibiotic that is widely used in patients with haematological malignancies (HM). Although its use has been reported to be associated with encephalopathy, only case reports or small case series have been reported so far.We conducted a retrospective cohort study of 243 patients with HM treated with cefepime at our hospital between August 2011 and May 2013. We also investigated the clinical features of patients with cefepime-induced encephalopathy (CIE).Among 243 HM patients treated with cefepime, 10 were diagnosed with CIE, indicating a cumulative incidence of approximately 4.1%. The median creatinine level on commencement of treatment was 2.13 mg/dl (range 0.60-19.85) and the median initial dose of cefepime was 4.0 g/day (range 1.0-6.0). The median time between commencement of treatment and symptoms was 4.0 days (range 2-5). The most common clinical manifestations were decreased level of consciousness and myoclonus. Symptoms resolved fully in all patients. Univariate analyses showed that impaired renal function (creatinine clearance (CLCr)30 ml/min, acute renal failure, and chronic dialysis) was significantly associated with the development of CIE (univariate p0.0001, p = 0.020, and p = 0.0025, respectively). Receiver operating characteristic (ROC) analysis demonstrated that the threshold levels of creatinine, CLCr, and estimated glomerular filtration rate for CIE were 1.22 mg/dl, 22.96 ml/min, and 43.9 ml/min/1.73 m(2), respectively.This study indicated that the development of CIE is associated with severely impaired renal function in patients with HM.

Metals cannot exhibit ferroelectricity because static internal electric fields are screened by conduction electrons, but in 1965, Anderson and Blount predicted the possibility of a ferroelectric metal, in which a ferroelectric-like structural transition occurs in the metallic state. Up to now, no clear example of such a material has been identified. Here we report on a centrosymmetric (R-3c) to non-centrosymmetric (R3c) transition in metallic LiOsO3 that is structurally equivalent to the ferroelectric transition of LiNbO3. The transition involves a continuous shift in the mean position of Li+ ions on cooling below 140K. Its discovery realizes the scenario described by Anderson and Blount, and establishes a new class of materials whose properties may differ from those of normal metals., Manuscript of published version, including Supplementary Information. See also News & Views article by V. Keppens, Nature Materials 12, 952 (2013)

To clarify the impact of serum free light chain (sFLC) ratio normalization in patients with multiple myeloma (MM) treated with novel agents.Treatment response in 126 consecutive patients over 7 years was assessed by IMWG criteria and sFLC assay.Thirty-four patients (27%) showed complete response (CR), 37 (29%) very good partial response (VGPR), 39 (31%) partial response (PR), and 16 (13%) stable disease (SD) or less at a median follow-up of 28 months. Fifty-two patients (41%) with sFLC ratio normalization showed superior progression-free survival (PFS) and overall survival (OS) compared to those who did not (3-yr OS, 94% vs. 48%; P0.001). This favorable effect of sFLC ratio normalization occurred irrespective of high (1000 mg/dL) or low (100 mg/dL) baseline sFLC. Rates of normal sFLC ratio were as follows: CR, 69%; VGPR, 64%; PR, 16%; and SD or less, 0%. OS was significantly superior in patients with than without normal sFCL ratio in respective response groups. Although various factors (advanced age70, high LDH, ISS stage 3) showed negative prognostic impacts on PFS and OS on univariate analysis, normal sFLC ratio and achievement of CR emerged as the strongest prognostic predictors for longer OS in MM patients on multivariate analysis.This study demonstrated the significance of obtaining normal sFLC ratio independent of other clinical variables. Analysis of sFLC ratio could identify the favorable group of patients as well as immunofixation test and support the inclusion of sFLC ratio as part of the response criteria for MM.

An accurate crystal structure analysis method has been developed using energy-filtering convergent-beam electron diffraction. Characteristic features of the method, the analysis procedure, some applications are described, together with future prospects.