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Surgical management of chondrosarcoma with hemipelvectomy is well described, but there have been no reports on extensive excision involving bilateral pubis and unilateral ischium. This report describes a novel pelvectomy technique for the treatment of chondrosarcoma in a large-breed dog. A 12-year-old Labrador Retriever presented for tenesmus due to a large, intra-pelvic mass which was confirmed on computed tomography (CT). Surgery involved removal of the entire left ischium and both pubic bones with preservation of both hind limbs. Histopathology confirmed the diagnosis of a high-grade chondrosarcoma with tumour-free margins of less than 3 mm. The dog recovered well following surgery and regained ambulation within 9 days. Four months postoperatively, the dog had no ongoing pain or tenesmus and only a mild gait abnormality in the left hind limb. Pelvectomy involving the entire pubis and unilateral ischium was well tolerated in a large-breed dog. This technique may offer a novel surgical option to treat neoplasia previously considered too extensive for complete excision.

The value of a health technology can be measured in terms of cost and benefit on two-dimensional co-ordinates. This study is to quantitatively analyze the correlation and to conduct a regression on the X-Y plane constituted by cost and QALYs (quality-adjusted life years) associated with the first line treatment, the maintenance treatment, and the second line treatment for non-small cell lung cancer (NSCLC).The cost-effectiveness data of the cost and QALYs were extracted, with respect to the three categories of the NSCLC treatment, from the CEA Registry at Tufts Medical Center, regarding the literature published from 2000-2011. As a result, 44 QALY-cost ratios were identified.Based on those extracted data, the correlation and regression analyses were performed by mathematical model using log and square-root functions. The plotted ratios stratified by the three stages for the NSCLC treatment were visually grouped into three clusters. There were statistically significant differences among the correlation coefficients of the cluster. In regression, the log model was found to be better fitted than the square-root model; formulating QALY = -1.12 + 0.16 log(Cost), -1.99 + 0.28 log(Cost), and -0.69 + 0.10 log(Cost) for the first line, the maintenance, and the second line treatment, respectively. Monetary units were standardized to 2008 US dollars.A good methodological potential was confirmed so as to assess the Incremental Cost Effectiveness Ratio (ICER) variations, considering stratification by multiple factors such as disease and treatment categories. This study has certain limitations, such as the small number of included articles and the stratification, not reflecting a factor of new genetic findings.

In this article, we propose a new control method using reinforcement learning (RL) with the concept of sliding mode control (SMC). Some remarkable characteristics of the SMC method are good robustness and stability for deviations from control conditions. On the other hand, RL may be applicable to complex systems that are difficult to model. However, applying reinforcement learning to a real system has a serious problem, i.e., many trials are required for learning. We intend to develop a new control method with good characteristics for both these methods. To realize it, we employ the actor-critic method, a kind of RL, to unite with the SMC. We are able to verify the effectiveness of the proposed control method through a computer simulation of inverted pendulum control without the use of inverted pendulum dynamics. In particular, it is shown that the proposed method enables the RL to learn in fewer trials than the reinforcement learning method.

SUMMARY In Japan, the number of chronic renal failure patients requiring dialysis treatment is increasing by approximately 10,000 patients a year, totalling 229,538 or 1,801.2 patients per one million population at the end of December, 2002 according to the survey conducted by the Japanese Society for Dialysis Therapy (1). The primary disease is diabetic nephropathy (28.1% of patients), and with greater numbers of long-term and elderly patients, the incidence and severity of complications continue to increase. Dialysis units provide more diversified care, but budget cuts in health care make it difficult to secure sufficient personnel, and the workload on nurses has intensified. In this study, a survey of 157 out of 300 randomly selected dialysis facilities in Japan was made regarding nursing systems and nurses' concerns for medical care of dialysis patients.

The identification of right ventricular (RV) abnormalities is clinically important in the evaluation of arrhythmogenic substrates in right ventricular-originated ventricular tachycardia (RVT). The purpose of this study was to determine the diagnostic benefit of quantitative analysis in RV single photon emission computed tomography (SPECT) imaging with (99m)Tc-tetrofosmin/sestamibi in patients with RVT. Thirty patients with RVT (15 with idiopathic RVT and 15 with arrhythmogenic right ventricular cardiomyopathy (ARVC)) were compared with 27 control subjects (including 11 with right bundle branch block) with regard to the semiquantitative RV uptake score in each of six segments and the quantitative RV extent score in polar coordinate map displays by SPECT imaging. The RV total score and RV extent score were compared with the RV global function. Perfusion abnormalities were more frequently detected (P = 0.0001) in the ARVC group (59/90, 65.6%) than in the idiopathic RVT group (4/90, 4.4%) or controls (1/162, 0.6%). The RV extent score in the ARVC group (53.0 +/- 24.8) was significantly higher than that in the idiopathic RVT group (8.4 +/- 10.1) or controls (1.2 +/- 4.9). The RV extent score correlated well with the regional RV perfusion score (P < 0.0001) and with the RV ejection fraction (P < 0.0001). Non-invasive RV perfusion mapping using a (99m)Tc-labelled tracer is useful for the quantitative evaluation of RV substrates in patients with ARVC.

Summary In Japan, the number of patients seeking kidney transplants has declined in recent years. To investigate the reasons for this decline, a questionnaire was given to 73 haemodialysis patients treated at the Tokiwa-Tatsumi Clinic. The resulting data showed the percentage of patients seeking transplants declined from 61% in 1992 to 19.2% in 1999. The reasons given for not seeking transplants were the improvements of physical condition and resultant quality of life (QOL) due to progress in dialysis therapy, upgraded social welfare support, uncertainties of transplant medicine, loss of expectations due to limited availability of transplant kidneys and aging of patients. Meanwhile, the number of patients on dialysis continues to increase by approximately 10,000 a year, and the mean age of patients rises. To reduce this number, greater effort must be directed toward preventive medical care as well as educating the public regarding transplant medicine.

Using two-step liquid chromatographic method, the metallofullerene LaC 82 has been isolated for the first time from the carbon soot. The isolated LaC 82 was well identified as a stable molecule classified to a novel family of fullerene cage molecules. Comparison of the IR absorption spectra between LaC 82 and C 82 empty fullerene suggests an endohedral form for LaC 82 with the same cage structure (C 2 symmetry) previously proposed for C 82 . The presence of electronic absorption in the near-infrared region strongly supports the formation of an open-shell electronic structure for LaC 82 .

Magnetic properties of Cs x C60 have been studies by the magnetic susceptibility and ESR. The observation of Pauli and Curie-Weiss susceptibilities implies the existence of a metallic phase Cs1C60 and a paramagnetic phase Cs4C60.

Higher Fullerenes up to C110 were isolated from carbon soot by using HPLC and the presence of magic number was ascertained. By 13C NMR measurement, molecular structures and isomers of C78, C82, and C84 were determined. There are three isomers of C78. The production ratio of C2v′, C2v, D3-C78 is about 5:2:2. The main isomer of C82 have the structure with C2 symmetry and its production yield is about 70% of total C82. There are two main isomers in C84 (D2,D2d-C84). The preliminary investigation indicated that any higher fullerenes up to C90 does not show superconductivity even when alkali-metals doped.

New kinds of fullerenes were separated by HPLC with benzene from carbon soot. At least four fractions were well separated. Mass analysis confirmed the separation of C60, C70, C84 and the mixture of C76 and C78. Absorption spectra of C76, C78, and C84 were measured for the first time.

FOLLOWING the development of a method for bulk synthesis of C60 and other fullerenes1, the isolation of higher fullerenes ranging from C76 to C96 has been achieved using chromatographic techniques2–5. Whereas C60 and C70 have unique, high-symmetry structures6, theoretical calculations for fullerenes larger than C76 have suggested that each may exist in at least two isomeric forms7. For C84, 24 isomers have been postulated7, and for C96calculations have yielded 196 distinct isomers8. Diederich et al.9 have used liquid chromatography and 13C NMR to identify two isomers of C78, but previous experimental studies of other higher fullerenes2 have produced ambiguous results. Here we use 13C NMR to determine the structures of some principal isomers of C78, C82 and C84. We find a third isomer of C78, which was not reported in ref. 9. Characterization of the structures of these larger fullerenes should provide new understanding of the factors determining the stability of hollow carbon clusters.

A preparative high-performance liquid chromatography was examined for the isolation of higher fullerenes from CS 2 extracts of the carbon soot produced by arc heating of graphite in inert atmosphere. At least eight all-carbon compounds C 60 , C 70 , C 76 , C 78 , C 82 , C 84 , C 90 and C 96 were confirmed as a “stable fullerene”. C 82 and C 96 are new members of fullerene family which have not been reported so far. The presence of stable C 82 seems to be closely related with the recent su macroscopic quantities of production of LaC 82 reported by Smalley's group.

New kinds of fullerenes were separated by HPLC with benzene from carbon soot. At least four fractions were well separated. Mass analysis confirmed the separation of C60, C70, C84 and the mixture of C76 and C78. Absorption spectra of C76, C78, and C84 were measured for the first time.

Titania (titan dioxide) particles were produced by a sol-gel reaction of titan isopropoxide (TIP) with a variety of properties. Amorphous titania was obtained under the reaction conditions of the molar ratios of ultrapure water/TIP (in isopropanol) below stoichiometric ratios. A yellow solution was produced from the amorphous titania reacted with hydrogen peroxide, followed by conversion to a transparent yellow gel, from which thin films were obtainable. The gel was soluble in aqueous nitric acid to form a stable solution. The solution can be utilized to coatings. Some spectroscopic techniques, such as UV-VIS diffuse reflectance spectroscopy (DRS), IR DRS and Laser-Raman spectroscopy, were utilized to measure the surface properties of the particles and the thin films mentioned above. As a result, the reactivity was found to be related to the surface acidity of the amorphous particles, which was correlated to the optical gap value of the particles estimated from the leading edge of absorption in UV-VIS spectra. The solubility of titania thin films in aqueous nitric acid was also related to the optical gap value of the amorphous titania particles. The dissolution did not occur for rutile and anatase.

Ultraviolet photoelectron spectroscopy (UPS) has been applied to the investigation of the electronic structure of oligothiophenes with 4-8 thiophene ring. In a series of α-linked oligomers (αn, with the number of rings n = 4-8), a systematic evolution of the π band forming levels are observed in the region of 0.7-3eV below the Fermi level (EF) and the bandwidth becomes broader with n. The non-bonding π band is observed at 3.5eV below EF and its energy is almost independent of n. UPS spectra of α7 and α8 are fairly similar to the spectra of polythiophene, showing that these oligomers are good model compounds of the polymer. The effect of irregularity on the π-electron system was also studied by using oligomers which contain a β linkage or a vinylene group in the middle of the molecule. The UPS spectra showed that the β linkages significantly affect the electronic structure of polythiophene, but vinylene does not. In order to analyze the UPS spectra and to investigate the electronic structures of oligomers, the orbital energies and the geometry of these oligomers are calculated by the semi-empirical modified neglect of diatomic overlap self-consistent field molecular orbital (MNDO-SCF-MO) method. The calculated spectra using the obtained orbital energies agree well with the observed ones, particularly in the π region. It is shown from the optimized geometry that (1) αn's have planar structures and π electrons can be delocalized, (2) the oligomer with β-linkages have nonplanar structure leading to limited delocalization of π-electrons, and (3) the oligomers with a vinylene group are almost planar and the disturbance by the vinylene group on the delocalization is small.

Apoptosis is originally defined by unique morphological changes of dying cells, and the biochemical hallmark associated with apoptosis is internucleosomal DNA fragmentation. However, few report has shown the precise time course of the apoptotic events. The present study was designed to try to clarify apoptotic processes using a video-enhanced contrast-differential interference contrast (VEC-DIC) microscopy. The morphological changes of murine fibroblast Ltk-cells treated with TNF-alpha were divided into four stages: (i) pre-apoptotic, (ii) cytoplasmic shrinkage, (iii) membrane blebbing, and (iv) ballooning. Almost of the cells underwent cytoplasmic shrinkage and membrane blebbing within 6 hours after TNF-alpha exposure, and at about 9 hours, they were in the ballooning stage. Based on these data, we investigated the relationship between morphological changes and other biochemical features. The earliest event was exposure of phosphatidyl-serine at the cytoplasmic membrane, which was already observed in the pre-apoptotic stage. Loss of mitochondrial membrane potential was observed in the cytoplasmic shrinkage stage. Caspase-8/-3 activities already started increasing in the pre-apoptotic stage, and reached their peak at 6 hours after TNF-alpha exposure. DNA fragmentation occurred in the late phase of the membrane blebbing.

Left ventricular Doppler index (LVDI) is believed to be a useful echocardiographic index of systolic and diastolic ventricular function. However, the usefulness of right ventricular Doppler index (RVDI) remains uncertain, especially in dilated cardiomyopathy. The predictive value of RVDI for estimating long-term cardiac events, including cardiac death, was investigated.Fifty-nine consecutive patients with dilated cardiomyopathy (41 males and 18 females, mean age 52 +/- 15 years) were enrolled in this follow-up study. RVDI and LVDI were calculated as follows: DI = (isovolumic contraction time + isovolumic relaxation time)/ejection time.During a follow-up period of 3.7 +/- 3.0 years, 27 (46%) of the patients exhibited cardiac events, including cardiac death (n = 9), heart failure (n = 16) and tachyarrhythmias (n = 2) requiring in-hospital treatment. Patients with these cardiac events had higher LVDI and RVDI at the initial follow-up examination, and RVDI had a significant linear correlation with LVDI (LVDI = 0.550 + 0.452 x RVDI, r = 0.530, p = 0.0001). The 6-year survival rate was significantly lower in patients with both LVDIor = 0.78 and RVDIor = 0.49 than in other patients (50% vs 75%, respectively, p = 0.009). Cox proportional hazards model analysis showed that RVDIor = 0.49 was the independent predictor of cardiac events (p = 0.0153) and cardiac death (p = 0.0003).RVDI is clinically useful for estimating the outcome of patients with dilated cardiomyopathy.

The mortality and morbidity associated with residual intracardiac floating thrombi in patients with acute pulmonary thromboembolism remain uncertain. Thirteen patients (2 men and 11 women, mean age 56 +/- 15 years) with pulmonary thromboembolism underwent echocardiography within 24 hours from onset of symptoms. Four patients (31%) had floating intracardiac thrombi in the right heart: 3 in the right atrium and one in the inferior vena cava. The time to evaluation by echocardiography was shorter than in the patients without thrombi. The thrombi disappeared shortly (3.2 +/- 2.4 hr) after thrombolysis without adverse effects in these patients. After thrombolysis, clinical symptoms improved and pressure gradient between the right ventricle and right atrium decreased significantly (p0.01) from baseline 47 +/- 6 to 26 +/- 5 mmHg. Major bleeding complications occurred in 3 (43%) of the patients who underwent thrombolysis. Right-side intracardiac floating thrombus was easily detectable by early echocardiography. Thrombolytic agents are likely to be effective in patients with intracardiac floating thrombi.

The number of kidney grafts in Japan is remarkably small compared to that in Europe and America. We conducted a questionnaire survey to donor families in order to examine problems surrounding kidney grafts, from their viewpoints. Thirty one families of post-mortem kidney donors responded and the majority perceived the donation positively. The survey also revealed that in most cases, donation was decided by the family without knowing the patient's wishes, families who made organ donations were apprehensive about Japanese society being critical of organ donations, and some families later regretted their decision of organ donation. In Japanese society, organ donation continues to face some resistance. It is important that medical professionals concerned with organ grafts understand with compassion the feelings of donor families, and make a greater effort in developing public understanding and support for organ grafts.

Seven patients with sacral insufficiency fractures and seven patients with sacral metastasis were studied with MR imaging. The diagnoses were confirmed with other imaging modalities and clinical follow-up. The insufficiency fractures appeared as bands of abnormal signal: low signal intensity on T1-weighted images and slightly low to iso signal intensity on T2-weighted images. The lesions were delineated better on T1-weighted images than on T2-weighted images. The sacral alae were involved in all patients; five patients had bilateral lesions. The lesions that run across the sacral body were seen in three cases. Inclined coronal images were useful in demonstrating the pattern of distribution of the sacral insufficiency fractures. In three patients with follow-up MR studies, the lesions were markedly reduced or disappeared. The sacral metastatic tumors were of low signal in density on T1-weighted images and iso to high signal in density on T2-weighted images. The extent and distribution patterns of the lesions were various. It is possible to differentiate sacral insufficiency fractures from sacral metastases based on their distribution patterns on MRI. However, if the diagnosis is uncertain or if the symptoms persist or become worse, follow-up MR studies may be necessary.

At ISPOR's Third Annual European Conference, we presented a new formula that can naturally extend the traditional formula for sample-size calculation of a clinical trial, considering the cost-effectiveness ratios for two regimens A and B. OBJECTIVE: According to the formula, to explore applicability and validity of such a theoretical framework in real clinical trials, and then show the benefit which the new formula brings in terms of designing a prospective cost-effectiveness trial. METHODS: We searched and reviewed the published Japanese articles these ten years that reported socioeconomic evaluation of pharmaceuticals based on a clinical trial for two regimens: a new treatment and an old one. Subsequently we assessed the applicability and the validity of our formula in the context of such reviewed articles, and then if the formula could be applied, we calculated two sample sizes: considering effect only vs. cost-effectiveness. RESULTS: We reviewed eighteen Japanese articles which conducted cost-effectiveness analysis using modeling or retrospective cost evaluation after clinical trials except one prospective study. Of these eight were selected as applicable for our formula. In all of them we found that the sample size for one regimen, considering effect only vs. cost-effectiveness, can be reduced such as 1534 to 5 at the best, and 632 to 319 at the worst ratio. CONCLUSION: In the eight published Japanese studies, the sample size of each clinical trial considering effect only could actually be reduced if such studies are to be designed in advance as a prospective cost-effectiveness trial considering the difference of the cost-effectiveness ratios of two regimens.

Pb 1−x Eu x Te multiple quantum well and double heterostructure lasers were prepared by hot wall epitaxy. Pulsed laser operations were observed for the multiple quantum well laser up to 230K (3.8 μm), and 205K (3.4 μm) for the double heterostrucsture laser. Pb 1−x Eu x S films and superlattices were also prepared. Step-like absorptions corresponding to interband electron transitions between valence and conduction subbands were observed in the optical transmission spectra of the superlattices. Electrical properties of doped Pb 1−x Eu x S films were also measured. High carrier concentration n-type films were obtained by doping bismuth, but films doped by acceptor impurities had always small carrier concentration, owing to the deep donor levels due to europium.

It is pointed out that, in supersymmetry at finite temperature, the usual condition of the spontaneous breakdown of symmetry (i.e. the non-vanishing thermal average of a certain field in a multiplet) does not necessarily lead to the existence of a massless fermion. The particle-thermal hole pair of opposite statistics can replace the long range correlation of the Goldstone mode.

A case of SIADH after head injury was encountered and treated successfully with furosemide and hypertonic saline. 250 mg of furosemide was given twice at two hours' interval. The dose of 2.5% saline for the infusion was calculated according to the excretion of sodium in the urine collected during this period. The level of serum sodium quickly rose from 113 mEq/l to 137 mEq/l in 33 hours. The consciousness of the patient returned to normal. The problems of quick correction of hyponatremia including the central pontine neurolysis were discussed.