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[Purpose] Adults with cerebral palsy often use a cane as a walking aid because of their decreased gait ability. However, it is unclear whether this affects lower limb muscle activity during walking. The purpose of this study was to clarify the influence of using a cane during walking on the spatio-temporal parameters of walking, lower limb muscle activity, and lower limb muscle coactivation in adults with spastic cerebral palsy. [Participants and Methods] Eleven participants with cerebral palsy were included. The spatio-temporal parameters of walking, lower limb muscle activity, and coactivation of lower limb muscle were measured during a 10 m trial with no cane, one cane, and two canes. [Results] Walking speed was lower and the stride time longer when using two canes than when using no cane. All muscle activities significantly reduced when using two canes. No significant difference was observed between using no cane and one cane, except for walking speed. In addition, there was no significant difference in coactivation between the conditions. [Conclusion] This study revealed that when two canes were used, the walking speed was reduced, and lower limb muscle activity was reduced, reducing the burden. In contrast, the movement pattern was not suggested to have changed.

A periodic array of topological spin textures, such as skyrmions and hedgehogs, is called the multiple-$Q$ spin texture, as it is represented by a superposition of multiple spin density waves. Depending on the way of superposition, not only the magnetic but also the topological properties are modified, leading to a variety of quantum transport and optical phenomena caused by the emergent electromagnetic fields through the Berry phase. Among others, the phase degree of freedom of the superposed waves is potentially important for such modifications, but its effect has not been fully elucidated thus far. Here we perform systematic theoretical analyses of magnetic and topological properties of the multiple-$Q$ spin textures with the phase degree of freedom. By introducing a hyperspace with an additional dimension corresponding to the phase degree of freedom, we establish a generic framework to deal with the phase shift in the multiple-$Q$ spin textures. Applying the framework to the two-dimensional 3$Q$ spin textures, we clarify the complete topological phase diagram while changing the phase and magnetization, which depends on the types of the superposed waves. We also study the three-dimensional 4$Q$ spin textures and clarify even richer topological phase diagrams. In particular, we find novel topological phase transitions associated with the previously unidentified Dirac strings on which the hedgehogs and antihedgehogs cause pair creation and fusion. Moreover, we demonstrate that phase shifts are caused by an external magnetic field in both 3$Q$ and 4$Q$ cases by analyzing the numerical data in the previous studies. Our results illuminate the topological aspects of the skyrmion and hedgehog lattices with the phase degree of freedom, which would be extended to other multiple-$Q$ textures and useful for the exploration of topologically nontrivial magnetic phases and exotic quantum phenomena.

With the help of circular strategies, products can be used longer (i.e., reuse, repair, and refurbish). Products that are difficult to use will be recycled efficiently. The present paper provides actionable guidelines for reducing environmental impact at all stages of a product’s life cycle, including the manufacture and assembly of the materials that make up the product, environmental impacts during use, and environmental impacts at final disposal, as well as specific actions and evaluation mechanisms. The circular economy is a concept that encompasses specific actions and their evaluations. To clarify the contribution of this circular economy to carbon neutrality, the present paper highlights how it is important to recognize the role of carbon as both an energy carrier and a material. CO2 is a waste product from burning and powering carbon. CO2 must be disposed of like any other waste product, but carbon itself is also an energy carrier. Thus, when promoting the carbon cycle, it is important to harmonize carbon’s function as a material with its role as an energy carrier. The further introduction of renewable energy and societal shift towards circular economy would contribute to carbon neutrality and more resource efficient use in a mutually complementary manner.

OBJECTIVES Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high-level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta-analysis technique. METHODS We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model. RESULTS A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0-17.8, P < 0.001), 7.2% (95% CI 4.6-11.0, P < 0.001), and 15.1% (95% CI 9.8-22.5, P < 0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9-15.1, P < 0.001), 10.2% (95% CI 3.8-24.5, P < 0.001), and 6.4% (95% CI 1.8-20.9, P < 0.001), respectively. CONCLUSION Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures. Laryngoscope, 129:1731-1736, 2019.

A superposition of spin helices can yield topological spin textures, such as skyrmion and hedgehog lattices. Based on the analogy with the moir\'e in optics, we study the magnetic and topological properties of such superpositions in a comprehensive way by modulating the interference pattern continuously. We find that the control of the angles between the superposed helices and the net magnetization yields successive topological transitions associated with pair annihilation of hedgehogs and antihedgehogs. Accordingly, emergent electromagnetic fields, magnetic monopoles and antimonopoles, and Dirac strings arising from the noncoplanar spin textures show systematic evolution. In addition, we also show how the system undergoes the magnetic transitions with dimensional reduction from the three-dimensional hedgehog lattice to a two-dimensional skyrmion lattice or a one-dimensional conical state. The results indicate that the concept of "spin moir\'{e}" provides an efficient way of engineering the emergent electromagnetism and topological nature in magnets.

We theoretically study skyrmion lattices realized in a Kondo lattice model on a triangular lattice, focusing on the phase, ellipticity, and angle of the constituent multiple-Q waves. Analyzing the numerical data obtained in the previous study [Ozawa R, Hayami S and Motome Y 2017 Phys. Rev. Lett. 118 147205], we extract these parameters for the two types of skyrmion lattices with the skyrmion number of 1 and 2. We show that the topological transition between the two skyrmion lattices driven by an external magnetic field is accompanied by significant modulations of all three parameters.

Posturography (PG) shows various patterns corresponding to a patient's equilibrium condition; however, PG is not useful for the differential diagnosis of peripheral vestibular diseases (PVDs). The aim of this study was to identify parameters of PG that can distinguish between PVDs.The differences in PG parameters between PVDs were evaluated retrospectively. Two hundred and two patients with Ménière's disease (MD), 154 patients with benign paroxysmal positional vertigo (BPPV), 20 patients with sudden sensorineural hearing loss with vertigo (SSNHLwV), and 31 patients with vestibular neuritis (VN) underwent PG during the non-acute phase of vertigo, from January 2010 to March 2017.The velocity of body oscillation of BPPV patients with eyes open and closed were significantly faster than those of MD patients with eyes open (p 0.001) and closed (p = 0.033). The velocity of body oscillation of VN patients with eyes open was significantly faster than that of MD patients with eyes open (p = 0.0083). There were no significant differences among the other PG parameters between PVDs. Although there were significant differences among the velocity with eyes open and closed between males and females (eye open: p = 0.0009, eye close: p 0.0001), there was no significant difference in the ratio of males to females among PVDs (p = 0.1834). Therefore, the ratio did not influence the difference in velocity among PVDs. Patient age correlated with the velocity with eyes open (p 0.001) and with eyes closed (p 0.001). Post-hoc analysis revealed significant differences in patient age, and comparisons of MD and BPPV, MD and SSNHLwV, BPPV and VN, and VN and SSNHLwV. Therefore, we performed multiple regression analysis to determine whether the significant differences in the velocity of body oscillation among PVDs were caused by the difference in age distribution between PVD groups, rather than by differences in the PVDs themselves. There were correlations between age and the velocity of body oscillation with eyes open (p 0.001) and with eyes closed (p 0.001). There also were correlations between MD or VN and the velocity of body oscillation with eyes open (p = 0.0194).There were significant differences in the velocity of body oscillation with eyes open between MD and VN patients. The difference between MD and VN was significant regardless of the age distribution. To distinguish between MD and VN, the velocity of body oscillation with eyes open is a useful PG index.

We develop a theory of designing slit experiments in two-dimensional electron systems with the Rashba spin-orbit interaction. By investigating the spatiotemporal dynamics of electrons passing through a single slit or a double slit both analytically and numerically, we find that the interference fringes of the electron probability density attain specific spin orientations via the precession of spins around effective magnetic fields mediated by the Rashba spin-orbit interaction the directions of which are determined by the propagation path. The spin orientations of the fringes can be controlled by tuning the Rashba spin-orbit parameter, which can be achieved by applying an electric gate voltage. This phenomenon can be exploited to implement electrically tunable transmission of spin information and to generate spin-polarized currents.

Superpositions of spin helices can yield topological spin textures, such as two-dimensional vortices and skyrmions, and three-dimensional hedgehogs. Their topological nature and spatial dimensionality depend on the number and relative directions of the constituent helices. This allows mutual transformation between the topological spin textures by controlling the spatial anisotropy. Here we theoretically study the effect of anisotropy in the magnetic interactions for an effective spin model for chiral magnetic metals. By variational calculations for both cases with triple and quadruple superpositions, we find that the hedgehog lattices, which are stable in the isotropic case, are deformed by the anisotropy, and eventually changed into other spin textures with reduced dimension, such as helices and vortices. We also clarify the changes of topological properties by tracing the real-space positions of magnetic monopoles and antimonopoles as well as the emergent magnetic field generated by the noncoplanar spin textures. Our results suggest possible control of the topological spin textures, e.g., by uniaxial pressure and chemical substitution in chiral materials.

Assisted reproduction techniques are required to maintain a genetically diverse captive population of bottlenose dolphins. These techniques include semen preservation, and liquid storage has been proposed as a suitable alternative to cryopreservation, but the optimum conditions, in terms of temperature, duration, and media, have yet to be fully established. The aim of this study, therefore, was to determine the optimum temperature for the liquid storage of dolphin semen during a 14-day period and the usefulness of carboxylated poly-L-lysine (CPLL) as an additive to the semen extender used for the liquid storage. The semen was collected from a mature male dolphin housed at the Kagoshima Aquarium, Japan, transferred into a Beltsville (BF5F) extender, and analyzed for motility and characteristics after five-fold dilution. The optimum temperature was determined by evaluating sperm viability after liquid storage at 4, 17, or 36 °C, and the usefulness of CPLL was evaluated at concentrations of 0%, 0.5%, 1.0%, 2.0%, and 3.0% (v/v) at the optimum temperature. Sperm stored at 4 ℃ had a greater motility maintenance compared with samples stored at 17 or 36 ℃. The most efficacious storage regimen at various time points occurred when there was addition of CPLL at 1.0% (v/v) in terms of sperm motility and other relevant determinations, with this storage approach having greater efficacy that samples stored without CPLL. The most efficacious processes for preserving bottlenose dolphin sperm functions is storage at 4 °C and with there being semen extender supplementation of 1% CPLL.

Aim To investigate the functional characteristics of older adults who experienced a fall in the winter season and other seasons. Methods Participants were 403 older adults enrolled in the project "Population-Based and Inspiring Potential Activity for Old-old Inhabitants," and were living in cold, snowy regions in Japan. They were aged ≥75 years, and 41.9% (n = 169) were men. Sociodemographic characteristics, and physical, psycho-cognitive and social factors were surveyed. By experiences of falls, they were divided into three groups: the non-fall group, the fall in non-winter group and the fall in winter group. Each factor was compared with a χ2 -test, Student's t-test and Mann-Whitney U-test. Logistic regression analysis was carried out. spss version 25 was used for the statistical analysis. The level of significance was set at 5%. Results No differences were confirmed between the non-fall and fall in winter groups. In contrast, the maximum walking speed in the fall in non-winter group was significantly slower than the non-fall group, even with adjustment by variables, such as age, sex and self-efficacy. Conclusions When considering intervention methods for health promotion, it is necessary to consider not only the presence or absence of falls, but also the seasons of falls. Geriatr Gerontol Int 2019; 19: 124-129.

Aim The present study aimed to propose a structural model to explain the interaction of physical, cognitive and social domains of health status in the incidence of disability in community-dwelling people aged ≥75 years. Methods We analyzed 185 older adults (mean age 79.4 years, 58.4% female) who participated in a baseline assessment from 2012 to 2013. They were followed for incident certification of care needs in the national long-term care insurance certification system during the 2 years. Baseline assessments included several measurements related to the physical, cognitive and social domains of health status. We compared the model fit index between two hypothesis models - the parallel model and the hierarchical model - using structural equation modeling. Results During the follow-up period, 15 participants (8.1%) were newly certified as requiring personal support from the long-term care insurance system. The structural equation modeling showed that the hierarchical model, indicating that cognitive and social status were indirectly associated with disability through physical status, had a better fit with the data than the parallel model, indicating that physical, cognitive and social status each were directly associated with disability. Conclusions The present results suggest that cognitive and social status might indirectly affect disability incidence through physical aging. Further research is required to examine the temporal relationship between physical, cognitive and social change using data over several time-periods. Geriatr Gerontol Int 2018; 18: 1614-1619.

Laryngeal cleft is an anomaly of failed posterior closure of the larynx. Most cases are diagnosed and need treatment early in life due to respiratory and swallowing problems. We report an unusual case of a 66-year-old man with an asymptomatic laryngeal cleft until treatment for hypopharyngeal cancer. During concurrent chemoradiotherapy (CCRT), despite reduced tumor volume, he presented severe dysphagia and dyspnea, followed by severe pneumonia twice. Because CCRT had to be discontinued, a pharyngolaryngectomy was performed for the cancer treatment. The resected specimen showed total removal of the tumor and a total longitudinal cleft of the cricoid cartilage, classified as a type III laryngeal cleft by the Benjamin and Inglis' classification. A review of computed tomography images indicated that the redundant mucosa from bilateral edges closed the separation of the posterior cricoid cartilage and narrowed the laryngeal airway during CCRT. Adult presentations of laryngeal cleft are quite rare with only ten reported cases in English literature; the present case is of the oldest patient. Undiagnosed cases with laryngeal cleft may exist asymptomatically or without severe symptoms. The awareness of this condition may increase its diagnosis as a cause of diseases such as aspiration and recurrent pneumonia even in adult patients.

[Purpose] The purpose of this study was to determine the change of allocation of attention caused by a difference in gait phase and gait speed. We also determined the relationship between attentional demand and gait automaticity change caused by the gait speed alteration. [Subjects and Methods] Ten male participated. Participants were instructed to perform the probe reaction time (RT) task during treadmill walking in four different gait speed conditions (60%, 80%, 100%, and 120% of preferred speed). Walking ratio in each gait speed conditions were calculated, and RTs and walking ratios were compared in each gait speed condition and in the single-support and double-support gait phase. [Results] RTs were significantly delayed with decline of gait speed. Walking ratio was significantly decreased in proportion of decrement of gait speed. There was no difference of gait phase between single-support and double-support phase. [Conclusion] This study showed that relationship between attentional load and deficit of gait automaticity. While gait phase didn't influence attentional demand, and this result showed the characteristics of treadmill gait.

OBJECTIVE External auditory canal squamous cell carcinoma (EACSCC) is a rare disease with no standard treatment supported by high-level evidence. The aim of this study was to investigate EACSCC prognoses according to treatment modality and thus determine the optimal intervention for early-stage disease. DATA SOURCES PubMed, Scopus, and Ichushi-Web searches of the English and Japanese-language literature published between January 1, 2006 and December 31, 2016 were performed using the key words "external auditory canal cancer" and "temporal bone cancer." STUDY SELECTION Articles related to EACSCC that include the 5-year overall survival rate or individual patient data for histological types, follow-up periods, and final outcomes were enrolled. DATA EXTRACTION Sex, age, Moody's modified Pittsburgh stage, type of treatment modality, type of operation, follow-up period, and 5-year survival rates were extracted. DATA SYNTHESIS Twenty articles were used for the aggregate meta-analysis using a random-effects model, and 18 articles that reported 99 patients with early-stage EACSCC were used for the individual patient data meta-analysis. CONCLUSION The 5-year overall survival rate of early-stage EACSCC was 77%. Postoperative radiation therapy (PORT) was performed in 45% of stage I patients and 68% of stage II patients. Survival analysis of all patients showed no differences between the surgery-only and PORT groups; however, PORT exhibited a better prognosis than surgery alone among patients with stage I disease (p = 0.003, log-rank test). This result indicated that PORT can be the standard therapy for stages I and II EACSCC.

To examine the ability of comorbidity indices to predict the prognosis of laryngopharyngeal cancer and their association with treatment modalities.This retrospective study included 198 patients with laryngeal, hypopharyngeal, and oropharyngeal cancers. The effect of comorbidity indices on overall survival between surgery and (chemo)-radiation therapy ((C)RT) groups was analyzed. The cumulative incidence rates for cancer mortality and other mortalities according to the age-adjusted Charlson Comorbidity Index (ACCI) and Charlson Comorbidity Index (CCI) were compared.Univariate survival analyses showed a significant association between the ACCI and overall survival in the (C)RT group, but not in the surgery group. The association between the CCI and overall survival was not significant in either group. In multivariate analyses, a high ACCI score was an independent prognostic factor in the (C)RT group (HR 2.89, 95% confidence interval (CI) 1.28-6.49), but not in the surgery group (HR 1.39, 95%CI 0.27-5.43). The higher ACCI group had increased mortality from other causes compared with the lower ACCI group (5-year cumulative incidence, 8.5% and 17.8%, respectively, p = .003).The ACCI was a better prognostic factor than the CCI. Surgery may be more beneficial than radiation for patients with a high ACCI.

Objective: Individuals maintain a spatial margin or ‘personal space' between themselves and others. The form of this space and strategies for avoiding obstacles can be influenced by participant characteristics such as age. In this study, we investigated the characteristics of personal space and obstacle avoidance strategies in young and older adults. We also examined differences in perceptual personal space and walking trajectory during obstacle avoidance using a three-dimensional motion capture system. Methods Ten young adults and ten older adults participated in this study. We calculated actual obstacle avoidance trajectory and obstacle avoidance data such as the lateral spatial margin and body rotation angle during walking in a task that included obstacle avoidance. We also measured the perceptual personal space created by approaching a confederate. In order to calculate each personal space and obstacle avoidance data, we used a three-dimensional motion capture system. Two factors (two groups and personal space) of repeated analysis of variance were used in statistical analysis. Results We found no age-related differences in personal space or obstacle avoidance strategy in this study (F = 0.52, p = 0.48). However, we found significant differences in the form of perceptual personal space and personal space formed during obstacle avoidance (F = 11.86, p = 0.0030). Conclusion This study indicates that perceptual personal space did not reflect the walking trajectory created by actual obstacle avoidance. In addition, age did not influence the obstacle avoidance strategy. These results suggest that the perceptual personal space and aging have little effect in the situation of avoiding a single standing pedestrian.

Epistaxis, especially posterior epistaxis, is occasionally refractory to treatment. In these cases, sphenopalatine artery surgeries, including cauterization and ligation, are required. Previous reports have demonstrated treatment results for these procedures but failed to provide high-level evidence. The aim of this study was to quantify the rates of failure and perioperative complications of these procedures by using a meta-analysis technique.We systematically searched electronic databases and identified articles regarding epistaxis, sphenopalatine artery ligation, or cauterization. Pooled rebleeding and complication rates were calculated by using a random effects model.A total of 896 cases of sphenopalatine ligation or cauterization for epistaxis were analyzed. Pooled rebleeding rates for the entire cohort, cauterization group, and ligation group were 13.4% (95% confidence interval [CI] 10.0-17.8, P0.001), 7.2% (95% CI 4.6-11.0, P0.001), and 15.1% (95% CI 9.8-22.5, P0.001), respectively. Pooled perioperative complication rates for the entire cohort, cauterization group, and ligation group were 8.7% (95% CI 4.9-15.1, P0.001), 10.2% (95% CI 3.8-24.5, P0.001), and 6.4% (95% CI 1.8-20.9, P0.001), respectively.Overall, sphenopalatine surgery for refractory epistaxis is an effective method because of its low rates of failure and complications. Cauterization is more effective than ligation, whereas complications are comparable between the two procedures. Laryngoscope, 129:1731-1736, 2019.

To investigate the functional characteristics of older adults who experienced a fall in the winter season and other seasons.Participants were 403 older adults enrolled in the project "Population-Based and Inspiring Potential Activity for Old-old Inhabitants," and were living in cold, snowy regions in Japan. They were aged ≥75 years, and 41.9% (n = 169) were men. Sociodemographic characteristics, and physical, psycho-cognitive and social factors were surveyed. By experiences of falls, they were divided into three groups: the non-fall group, the fall in non-winter group and the fall in winter group. Each factor was compared with a χNo differences were confirmed between the non-fall and fall in winter groups. In contrast, the maximum walking speed in the fall in non-winter group was significantly slower than the non-fall group, even with adjustment by variables, such as age, sex and self-efficacy.When considering intervention methods for health promotion, it is necessary to consider not only the presence or absence of falls, but also the seasons of falls. Geriatr Gerontol Int 2019; 19: 124-129.

Background Thrombocytosis is associated with the prognosis of various types of cancer. The purpose of this study was to quantify the prognostic impact of platelet count and platelet-lymphocyte ratio (PLR) in head and neck squamous cell carcinoma (HNSCC). Methods We systematically searched electronic databases and identified articles reporting an association between platelet count or PLR and HNSCC prognosis. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) were extracted, and the pooled HRs were estimated using random effect models. Results Eight studies that enrolled 4096 patients and 9 studies that enrolled 2327 patients were included in the platelet count and PLR analyses, respectively. A platelet count greater than the cutoff value was associated with poor OS (HR 1.81; 95% CI 1.16-2.82) and any PLR greater than the cutoff value was associated with poor OS (HR 1.64; 95% CI 1.13-2.37). Conclusion Elevated platelet count and PLR are associated with poor prognosis in patients with HNSCC.

[Purpose] The purpose of this study was to examine the associations between the settings of exercise habits and health-related outcomes in community-dwelling older adults. [Subjects] A total of 304 Japanese community-dwelling older adults (70.3 ± 4.1 years; 113 males and 191 females) participated in this study. [Methods] Demographic characteristics, medical conditions, exercise habits, and health-related outcomes were assessed by face-to-face interviews and self-reported questionnaires. Older adults who had exercise habits were classified into two groups: individual- and group-based exercise habits groups, and the health-related outcomes were compared between groups. [Results] The scores for the Geriatric Depression Scale, exercise self-efficacy, and dietary variety of older adults who had group-based exercise habits were better than those of older adults who had individual-based exercise habits. In addition, the exercise settings (individual- and group-based) were significantly associated with scores for the Geriatric Depression Scale (odds ratio = 0.76) and exercise self-efficacy (odds ratio = 1.26), even after adjusting for age and gender. [Conclusion] These results implied that habitual exercise in group settings may have an effective role in promoting exercise self-efficacy and mental health.

Due to habitual drinking and smoking and advanced age at diagnosis, patients with head and neck squamous cell carcinoma (HNSCC) frequently present with comorbidities. Several comorbidity indices have been developed and validated for HNSCC. However, none have become the standard method. In this study, we developed a new comorbidity index for Japanese patients with HNSCC, which was validated against an independent data set. A Cox proportional hazards analysis of 698 patients identified dementia, connective tissue diseases, and second primary malignancies in the oesophagus, head and neck, lungs, and stomach as prognostic comorbidities for overall survival. The Osaka head and neck comorbidity index (OHNCI) was generated from the weighted points of these comorbidities. In the independent data set, the 5-year overall survival rates for the low, moderate, and high scoring OHNCI groups were 62.1%, 64.3%, and 37.7%, respectively. In the multivariate analysis, the high scoring OHNCI group was an independent prognostic factor for overall survival (hazard ratio: 1.81, 95% confidence interval: 1.05–3.13; P = 0.031). The model including the OHNCI exhibited a higher prognostic capability compared to those including other commonly used comorbidity indices. The OHNCI could become the primary choice for comorbidity assessment in patients with HNSCC in Japan.

Background Neutrophils play substantial roles in cancer progression. Previous reports demonstrated the prognostic impact of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in various types of solid cancers. The purpose of this study was to quantify the prognostic impact of NLR on head and neck squamous cell carcinoma (HNSCC). Methods We systematically searched electronic databases, identified articles regarding NLR and HNSCC mortality, and extracted hazard ratios (HRs) and 95% confidence intervals (CIs). Pooled HRs for overall survival (OS) and disease-specific survival (DSS) were estimated using random effect models. Results Nineteen studies enrolling 3770 patients were included in the analyses. Overall, NLR greater than the cutoff value was associated with poorer OS and DSS (HR 1.69; 95% CI 1.47-1.93; P < .001 and HR 1.88; 95% CI 1.20-2.95; P = .006, respectively). Conclusion Elevated NLR predicts worse outcomes in patients with HNSCC.

Conclusions This study demonstrated a high incidence of competing mortality in patients with head and neck cancer (HNC). It identified age to be an independent prognostic factor for non-cancer mortality. These findings contribute to the appropriate treatment selection in clinical settings and study design in clinical trials. Objectives To investigate the incidences of second primary cancer (SPC) and non-cancer mortalities among patients with HNC and reveal the determinant factors for these mortalities. Methods This study reviewed the records of 334 patients with HNC between 2006-2012. The cumulative incidences of HNC, non-cancer, and SPC mortalities were estimated. A Fine and Gray regression model was used to investigate factors associated with cancer and non-cancer mortalities. Results The 5-year cumulative incidences of HNC, SPC, and non-cancer mortalities were 28.0%, 2.5%, and 6.5%, respectively. In univariate analysis, the factors associated with SPC mortality were tumor site and comorbidity, whereas those associated with non-cancer mortality were age, gender, and comorbidity. In multivariate analysis, age (sub-distribution hazard ratio = 2.59) was the independent risk factor for non-cancer mortality.

Healthcare systems vary among countries, and in many countries, insurance and economic statuses significantly impact the mortality associated with head and neck squamous cell carcinoma (HNSCC). Japan prides itself on its unique healthcare and health insurance system, which provides equal coverage and healthcare access with low individual payments to most citizens. Additionally, citizens in poverty are covered by insurance for the poor (public assistance) and receive medical and other types of assistance. Hence, they have no barriers to healthcare services. This study aimed to determine the impact of health insurance status on mortality in Japanese patients with HNSCC. We reviewed 409 patients with HNSCC, using the Kaplan–Meier method to estimate overall survival. The association between insurance status and disease stage at diagnosis was analyzed via logistic regression. Cox and Fine–Gray proportional hazard models were employed to investigate the impact of insurance status on survival. The public assistance and other insurances groups did not significantly differ in clinical stage distribution. The 5-year overall survival, cumulative incidence of HNSCC death, and cumulative incidence of other death rates were 63.3 and 59.1 %, 27.0 and 31.8 %, and 10.3 and 9.7 % for the public assistance and other insurances groups, respectively. The adjusted subdistribution hazard ratio for the association between public assistance and HNSCC death was 0.73 (95 % confidence interval 0.44–1.21). The demonstrated non-inferiority of public assistance regarding HNSCC-specific mortality indicates the equality of healthcare in Japan, irrespective of the insurance status, and the superiority of the Japanese healthcare system.

We report a 42-year-old man with hereditary medullary thyroid cancer (multiple endocrine neoplasia, MEN2A/familial medullary thyroid carcinoma, FMTC), which was diagnosed at the time of tumor recurrence. He had a past history of a left thyroidectomy with neck dissection 7 years previously. A RET gene analysis revealed a point mutation (codon 618), and we diagnosed him as having hereditary medullary thyroid cancer. We resected the recurrent tumor in the right thyroid lobe together with performing a right lateral and central neck dissection. A RET gene analysis should be performed for patients with medullary thyroid cancer. When a RET gene mutation is present, a total thyroidectomy must be performed for the medullary thyroid cancer.

We report a 64-year-old male patient with pure transient global amnesia (TGA) who exhibited global cerebral hypoperfusion during an amnesia attack. Initial single photon emission computed tomography (SPECT) performed 3 hours after the onset of the amnesic attack revealed diffuse hypoperfusion in the cerebrum, whereas a second SPECT study, 1 month later, revealed improvement of cerebral blood flow. This case suggests that SPECT study is useful in revealing the pathophysiological mechanism of TGA and that TGA attacks are associated with global cerebral blood flow change.

We have performed scanning tunneling microscopy/spectroscopy (STM/STS) of a high-Jc superconductor, heavily Pb-doped Pb0.6Bi1.4Sr2CaCu2Oy, at low temperatures below Tc. The obtained STM images showed a lamella-type phase separation into Pb-poor and Pb-rich regions. At 4.3 K, values of energy gap Δ, deduced from STS spectra, showed considerable inhomogeneity in the range of 20–80 meV, while Δ variations across the phase boundaries were less significant. At 63 K, in contrast, we found that Δ altered sharply at the boundaries particularly in the annealed samples, resulting from the suppression of electronic inhomogeneity in each phase. This suggests that the phase boundaries act as strong pinning centers at higher temperatures.

Lactate (LA)-polymerizing enzyme (LPE) is a newly established class of polyhydroxyalkanoate (PHA) synthase, which can incorporate LA units into a polymer chain. We previously synthesized P(LA-co-3-hydroxybutyrate)s [P(LA-co-3HB)s] in recombinant Escherichia coli using the first LPE, which is the Ser325Thr/Glu481Lys mutant of PHA synthase from Pseudomonas sp. 61-3 [PhaC1(Ps)ST/QK]. In this study, we finely regulated LA fraction in the copolymer by saturated mutations at position 392 (F392X), which corresponds to the activity-enhancing mutations at position 420 of PHA synthase from Ralstonia eutropha. Among the 19 saturated mutants of LPE at position 392, 17 mutants produced P(LA-co-3HB)s with various LA fractions (16-45 mol %), whereas PhaC1(Ps)ST/QK produced P(LA-co-3HB) with 26 mol % LA under the same culture condition. In particular, the F392S mutation exhibited the highest LA fraction of 45 mol %, and also increased polymer content (62 wt %) compared with PhaC1(Ps)ST/QK (44 wt %). Combination of the F392S mutant and anaerobic culture conditions, which promote LA production, led to a further increase in LA fraction up to 62 mol %. The P(LA-co-3HB)s with various LA fractions exhibited altered melting temperatures and melting enthalpy depending on their monomer composition. Accordingly, the mutations at position 392 in LPE greatly contributed to fine-tuning of the LA fraction in the copolymers that is useful for regulating LA fraction-dependent thermal properties.

Cleaved $\mathrm{ab}$ surfaces of heavily Pb-doped ${\mathrm{Bi}}_{2}{\mathrm{Sr}}_{2}{\mathrm{CaCu}}_{2}{\mathrm{O}}_{y}$ single crystals, including phase separation into Pb-poor $\ensuremath{\alpha}$ and Pb-rich $\ensuremath{\beta}$ phases, were probed by cryogenic scanning tunneling microscopy/spectroscopy at 4.3 K. We could resolve individual Pb atoms substituted into Bi sites, which tend to be concentrated on the crest of modulation in the $\ensuremath{\alpha}$ phase, but are almost randomly dispersed throughout the $\ensuremath{\beta}$ phase. The scanning tunneling spectroscopy results revealed a considerably wide range of gap values $\ensuremath{\Delta},$ originating from the presence of both superconducting and pseudogap regions on a nanometer scale. Furthermore, we found that oxygen annealing substantially increases gap inhomogeneity. This strongly suggests that disorder of excess oxygen, possibly coupled with structural deformation of ${\mathrm{CuO}}_{2}$ sheets, destroys superconducting coherence, resulting in the appearance of a pseudogap.

Cryogenic STM/STS experiments of heavily Pb‐doped Bi2Sr2Ca2CuOy (Bi2212) superconductors were performed at 4.3 K. We succeeded in observing various kinds of atomic impurities as well as nano‐scale inhomogeneity of energy gap widely seen in Bi‐based superconductors. Furthermore, we found that the distribution patterns of impurities are not correlated with the spatial map of gap values derived from STS spectra, implying that the electronic inhomogeneity is not a consequence of the randomly distributed impurity atoms. These results strongly suggest that the inhomogeneity originates from atomic‐scale disorder of excess oxygen which is invisible by STM.