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ABSTRACT Background Cancer cachexia complicates advanced non‐small cell lung cancer (NSCLC); however, it remains unclear how often cachexia occurs and how it affects the course of chemotherapy in patients receiving first‐line systemic therapy. Methods We conducted a multicentre, prospective observational study and enrolled previously untreated NSCLC patients with Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0–2 and cachexia between September 2020 and September 2021. The primary outcome measure was the trends in the Functional Assessment of Anorexia/Cachexia Treatment and Anorexia/Cachexia Subscale [FAACT (A/CS)] scores by cohort. Secondary outcome measures included the incidence of cachexia before the initiation of first‐line systemic therapy, quality of life (QOL) measures, body weight (BW) changes, and efficacy and safety of first‐line systemic therapy. Results A total of 887 consecutive patients with previously untreated advanced NSCLC and ECOG PS of 0–2 who were initiated on first‐line systemic therapy were evaluated. A total of 281 patients (31.7%) experienced BW loss consistent with the criteria of cachexia, and 186 were evaluated for QOL, BW and outcome measurements. Overall, 180/186 patients received first‐line systemic therapy. Cohort 1 (targeted therapy), cohort 2 [cytotoxic chemotherapy (CTx) ± immune checkpoint inhibitors (ICIs)] and cohort 3 (ICIs) included 42, 98 and 40 patients, respectively. There were significant variations in QOL trends by cohort, with chemotherapy‐associated emesis affecting early appetite‐related QOL. The change in the FAACT (A/CS) score at 1 week from baseline was worse in cohort 2 (the least square mean change ± standard error: −3.0 ± 0.9) than in cohorts 1 (1.6 ± 1.2, p = 0.003) and 3 (1.8 ± 1.0, p = 0.002); meanwhile, the change at 6 weeks was worse in cohort 1 (−1.5 ± 1.2) than in cohorts 2 (3.6 ± 0.9, p = 0.001) and 3 (3.5 ± 1.1, p = 0.004). BW reduction was observed in all cohorts within 6 weeks of therapy initiation. The targeted therapy cohort demonstrated superior progression‐free survival (PFS) and overall survival (OS) to CTx ± ICIs cohort or ICIs cohort (median PFS was 9.7 months, 6.3 months, 3.1 months, in cohort 1, 2, 3, respectively (cohort 1 vs. cohort 2: HR, 0.58, p = 0.018; cohort 1 vs. cohort 3: HR, 0.41, p = 0.001); median OS was not reached, 15.8 months, 9.9 months, respectively (cohort 1 vs. cohort 2: HR, 0.52, p = 0.033; cohort 1 vs. cohort 3: HR, 0.37, p = 0.003). Conclusions Approximately 1/3 patients with previously untreated advanced NSCLC have cachexia. Appetite‐related QOL trends vary based on the type of first‐line systemic therapy in cachectic NSCLC patients, and the PFS and OS of these patients seemed to be shorter.

Abstract The number of dengue cases has increased dramatically in recent years. In Latin America, the number of cases and deaths in 2023 was the highest ever recorded. We report on a patient who had been infected with dengue virus during his stay in Costa Rica in September 2023, and developed the disease after returning to Japan. Plasma obtained from the patient was used for diagnosis and dengue virus serotyping by real-time PCR. The nucleotide sequence of the envelope region of dengue virus was then determined by the direct sequencing method, and this sequence was used for phylogenetic analyses. The patient was found to be infected with dengue virus type 3 genotype III. The sequence from the present case was more homologous with sequences registered in Florida, USA, associated with travel to Cuba in 2022 than with sequences registered in Costa Rica 10 years ago. The Pan American Health Organization reported that only dengue virus type 1 and 2 cases were reported in Costa Rica in 2019–2021, whereas dengue virus type 3 and 4 cases started being reported in 2022. In 2023, the reported numbers of cases with dengue virus types 3 and 4 exceeded those of dengue virus types 1 and 2. In addition, regional differences in endemic strains have been observed in Costa Rica. Our findings suggest that the dengue virus type 3 that infected the patient was more likely an influx of a strain that had been circulating in Caribbean countries such as Cuba in recent years, rather than a re-emergence of an indigenous virus in Costa Rica. The serotypes of dengue virus prevalent in Costa Rica have been changing since 2022. All four serotypes were prevalent in 2023, with a particularly sharp increase in the number of cases of dengue virus types 3 and 4. Future monitoring and surveillance are essential because changes in endemic serotypes can cause antibody-dependent enhancement, which can lead to severe dengue disease presentations.

In the routine maintenance of piping systems in power plants, maintenance management priorities are determined based on quantitative indicators, such as safety classification guidelines and probabilistic risk assessments, as well as qualitative metrics, such as supply reliability, operating experience, and work safety. In power plants, quantifying the level of maintenance criticality for areas that pose little risk to safety is difficult. Assuming damage to the piping system due to deterioration, the internal fluid flowing to the surrounding area may affect the functions of the peripheral equipment and work safety at the site. If the fluid temperature is high, the risk of burning increases. This study was aimed at quantifying the indicators of human burns that may pose a risk to work safety. Based on indicators related to the severity of human burns, we constructed an evaluation model using the results of fluid experiments and analysis of heat conduction in the skin to estimate the PBI, which in turn can be used to estimate the prognosis of burns. It was found that, especially under the condition for the evaluation of flashing, when a phase change occurs before and after a leak, the fluid diffusion range is large, and the fluid temperature is also high near the leak source. Such flow conditions can induce serious burns over a wide area. Based on the trends of the indicators related to human burns obtained in this study, we will construct a model to evaluate work safety risks in power plants using design information like temperature, pressure, and piping layout of the system.

Abstract Background Selecting pembrolizumab monotherapy (MONO) or pembrolizumab plus platinum‐based chemotherapy (COMB) for patients with nonsmall cell lung cancer (NSCLC) and high programmed death‐ligand 1 (PD‐L1) expression is an important issue in clinical practice. We previously conducted a retrospective multicenter observational study of patients with NSCLC and high PD‐L1 expression who received MONO or COMB as a first‐line treatment. Here, we report updated data and evaluate the long‐term outcomes. Methods We performed a retrospective multicenter study of 298 patients with NSCLC and high PD‐L1 expression who received MONO or COMB as first‐line treatment between December 2018 and January 2020. We reviewed the medical records and assessed the clinical efficacy and toxicity using a prolonged data cutoff. Results In total, 164 (median age: 74 years) and 134 (median age: 68 years) patients received MONO and COMB, respectively; patients who received COMB were younger and had better performance statuses (0–1). At the prolonged data cutoff, the median follow‐up was 20.2 (range: 0.1–41.4) months. The median progression‐free survivals were 7.5 and 13.1 months, and overall survivals (OSs) were 17.2 and 33.7 months for MONO and COMB, respectively. Treatment discontinuation rates were 21.9% and 20.1% for the MONO and COMB, respectively. With prolonged follow‐up, although COMB demonstrated an OS benefit and higher objective response rate than MONO, in the propensity score matching analysis COMB didn't demonstrate a significant benefit compared to the MONO. Conclusions COMB may be effective as a first‐line treatment for NSCLC with high PD‐L1 expression in a selected subset of patients.

Abstract Purpose Immune‐checkpoint inhibitors (ICIs) are effective against advanced non‐small cell lung cancer (NSCLC). However, whether the efficacy and safety of ICI treatment in elderly patients are similar to those in younger patients is unclear. This study was designed to address this question. Methods We enrolled patients who received ICI monotherapy in Japan between December 2015 and December 2017; those ≥75 years of age comprised the elderly group. We compared the efficacy and safety of ICI monotherapy in elderly patients with those in younger patients and explored prognostic factors in elderly patients. Results We enrolled 676 patients; 137 (20.3%) were assigned to the elderly group. The median age of the elderly and younger groups was 78 (range, 75–85) and 66 (range, 34–74) years. The median progression‐free survival (4.8 months vs. 3.3 months, p = 0.1589) and median overall survival (12.3 months vs. 13.0 months, p = 0.5587) were similar between the elderly and younger groups. Multivariate analysis revealed that a significantly better OS in the elderly group was associated with better responses to first‐ or second‐line ICI treatment (p = 0.011) and more immune‐related adverse events (irAEs) (p = 0.02). IrAEs that led to ICI discontinuation occurred in 34 of 137 patients (24.8%) in the elderly group, and their survival was significantly higher than that in those who did not have irAEs. Conclusion ICI is also effective in elderly NSCLC patients, and treatment discontinuation due to irAEs may be a good prognostic marker.

In this work, p-type cuprous oxide (Cu2O) films grown on beta gallium oxide (β-Ga2O3) substrates by magnetron sputtering were reported. The resulting vertical Cu2O/β-Ga2O3 heterojunction p–n diodes demonstrated superior performance compared to devices fabricated with polycrystalline Cu2O thin films. Meanwhile, analysis of the discrepancies between the built-in potential and turn-on voltage revealed diverse carrier transport mechanisms in the fabricated devices. Numerical fitting of the forward J–V characteristics further discerned that distinct carrier transport mechanisms dominated under various bias voltages or temperature conditions. At 300 K, trap-assisted tunneling dominates the regime because of the presence of defects in β-Ga2O3 or Cu2O. While the bias voltage is low, the polycrystalline nature of the films formed at room temperature leads to the prevalence of grain boundaries as the primary source of interface-type defects at the Cu2O/β-Ga2O3 interface. Consequently, the dominant mechanism governing carrier transport is interface recombination. As the temperature increases, however, thermionic emission becomes more important. This study presents an opportunity for further investigation into the epitaxial growth of Cu2O and provides insights into the carrier transport mechanism of β-Ga2O3-based heterojunctions.

The development of three-dimensional printers has facilitated the creation of patient-specific hollow vessel models. Preoperative simulations using these types of models have improved our ability to select appropriate devices and embolic materials before performing complex endovascular procedures. This report describes 2 cases of high-flow renal arteriovenous fistulas (r-AVFs) that were successfully treated via short-segment embolization using the preloading coil-in-plug (p-CIP) technique. To our knowledge, this is the first report of r-AVF being treated using the p-CIP technique. Our findings demonstrate that preoperative simulation has the potential to improve the safety and reliability of complex vascular embolization procedures.

Flow-accelerated corrosion (FAC) is the major pipe wall thinning phenomenon to be managed for its potential of catastrophic pipe rupture. Present management rule for pipe wall thinning in Japanese nuclear power plants is based on pipe wall thickness measurements resulting in large number of measurements in each plant. For future improvement of the plant management in Japan, introduction of prediction method or prediction code for thinning rate and residual lifetime evaluation is expected. To predict the maximum wall thinning rate or minimum wall thickness efficiently for each pipe component, one-dimensionally along the pipelines, relative wall thinning trend of each component type, “geometry factor”, combined with the effect of upstream component, “declining effect”, are essential, which are both derived from hydraulic features. In this study, the geometry factor and the declining effect for pipeline elbows are evaluated considering specific geometric parameters through series of computational fluid dynamics calculations. For the geometry factor, correlation equation is arranged as a function of curvature radius and bending angle of elbows, showing evident effect of each geometric parameter. And for the declining effect, firstly, the effect of plane angle formed by the upstream and downstream elbows is evaluated that the in-plane configuration with the flow streaming forward would be the most conservative condition. Then, based on the in-plane configuration, correlation equation for the declining effect is arranged as a function of the distance between the two elbows. It is found that even when the distance is very short, the remaining portion of the upstream effect on the downstream elbow would be much less than previous knowledge which may improve the overprediction in proximate condition. By implementing these correlations into author’s FAC prediction model, residual wall thickness of plant pipe elbows is shown to be predicted mostly within 20 % from the measured data.

Abstract Many therapeutic antibodies (Abs) and mRNA vaccines, both targeting SARS-CoV-2 spike protein (S-protein), have been developed and approved in order to combat the ongoing COVID-19 pandemic. In consideration of these developments, a common concern has been the potential for Ab-dependent enhancement (ADE) of infection caused by inoculated or induced Abs. Although the preventive and therapeutic effects of these Abs are obvious, little attention has been paid to the influence of the remaining and dwindling anti-S-protein Abs in vivo. Here, we demonstrate that certain monoclonal Abs (mAbs) approved as therapeutic neutralizing anti-S-protein mAbs for human usage have the potential to cause ADE in a narrow range of Ab concentrations. Although sera collected from mRNA-vaccinated individuals exhibited neutralizing activity, some sera gradually exhibited dominance of ADE activity in a time-dependent manner. None of the sera examined exhibited neutralizing activity against infection with the Omicron strain. Rather, some ADE of Omicron infection was observed in some sera. These results suggest the possible emergence of adverse effects caused by these Abs in addition to the therapeutic or preventive effect.

Summary: A 25-year-old patient with a primary immunodeficiency lacking immunoglobulin production experienced a relapse after a 239-day period of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Viral genetic sequencing demonstrated that SARS-CoV-2 had evolved during the infection period, with at least five mutations associated with host cellular immune recognition. Among them, the T32I mutation in ORF3a was found to evade recognition by CD4+ T cells. The virus found after relapse showed an increased proliferative capacity in vitro. SARS-CoV-2 may have evolved to evade recognition by CD4+ T cells and increased in its proliferative capacity during the persistent infection, likely leading to relapse. These mutations may further affect viral clearance in hosts with similar types of human leukocyte antigens. The early elimination of SARS-CoV-2 in immunocompromised patients is therefore important not only to improve the condition of patients but also to prevent the emergence of mutants that threaten public health.

Flow-Accelerated Corrosion (FAC) is a pipe wall thinning phenomenon to be monitored and managed in the power plants with high priority. Its management has been conducted with conservative evaluation of thinning rate and residual lifetime of piping based on wall thickness measurements. However, in the actual plants, noticeable case of the wall thinning occurred in branch and junction piping (T tube). There is a problem to manage the wall thickness of the part covered by reinforcing plate of the T tube, because measurement of this area is difficult to be conducted with ordinary ultrasonic testing devices due to the presence of the reinforcing plate. In this study, numerical flow analysis for the T tube was conducted, and the wall thinning profile due to the FAC was evaluated by calculating the mass transfer coefficient. It was found that a localized wall thinning distribution occurs in the area where the reinforcement plate of the T tube exists. And this tendency is affected by pipe geometry and Reynolds number. In previous studies, a model that functionalized by pipe geometry and Reynolds number was introduced to predict this wall thinning trend. In this paper, the effectiveness of the proposed decay function was confirmed by comparing it with measurements taken in actual plants. It was shown that the maximum wall thinning rate at the T tube junction, including below the reinforcing plate, can be evaluated conservatively within an appropriate range by making corrections to the proposed decay function that take into account the causes of variation in the actual data.

Abstract Osimertinib is a standard of care therapy for previously untreated epidermal growth factor receptor mutation-positive non-small cell lung cancer. However, limited data exist regarding the efficacy and safety of osimertinib as a first-line therapy for elderly patients aged 75 years or older. To assess the potential clinical benefits of osimertinib in this population, this retrospective multi-institutional observational study included 132 patients with non-small cell lung cancer (age ≥ 75 years), who received osimertinib as first-line treatment. The proportion of patients with 1-year progression-free survival was 65.8% (95% confidence interval 57.1–73.5). The median progression-free survival was 19.4 (95% confidence interval 15.9–23.9) months. The median overall survival was not reached (95% confidence interval 24.6–not reached). The frequency of pneumonitis was 17.4%, with a grade 3 or higher rate of 9.1%. More than two-thirds of treatment discontinuations due to pneumonitis occurred within 3 months of starting osimertinib, and the prognosis of patients with pneumonitis was unsatisfactory. Osimertinib is one of the effective first-line therapeutic options for patients aged 75 years or older; however, special caution should be exercised due to the potential development of pneumonitis.

A 40-year-old female (gravida 3 para 1) presented with menstrual, urinary, and anal pain. Computed tomography revealed type II acquired uterine arteriovenous malformation, a common dilated venous sac with bilateral uterine arteries, and multiple branches of iliac arteries draining to the bilateral ovarian veins. Venous sac transvenous embolization via the left ovarian vein of dominant outflow was planned, since complete arteriovenous malformation occlusion was difficult with super-selective transarterial embolization of multiple feeders. Therefore, transarterial embolization of the minor feeder was performed before completing transvenous embolization using coils and 50% glue under left iliac artery flow control. Immediately thereafter, angiography confirmed the complete disappearance of the uterine arteriovenous malformation, and all pain symptoms remitted. In conclusion, transvenous embolization combined with adjunctive transarterial embolization can be an effective and radical treatment for type II uterine arteriovenous malformations.

If a piping system under high pressure is damaged and steam is ejected into the atmosphere, human safety and safety equipment may be damaged by the impingement of the steam jet. Therefore, it is necessary to evaluate the region affected by the steam jet impinging on the surrounding equipment and people. This study is conducted to identify the problems with the evaluation model of the region affected by the jet specified in the ANSI standard and to reconstruct the evaluation model of the affected region based on the experimental results. From the visualization experiment and CFD analysis results, we found that the ANSI standard can be used to appropriately evaluate the experimental and CFD results for the steam spread angle and asymptotic plane area. On the other hand, the results of asymptotic length were different from the experimental and CFD results owing to the assumption in the ANSI standard that the expanding angle of the steam jet is constant at 45° regardless of any pressure change. A correlation equation for the expansion angle of the steam jet caused by a pressure change was developed referring to the experimental and CFD results, and the improved model was used to evaluate the asymptotic length. By using this improved model, it is possible to evaluate the region affected by the steam jet in the event of pipe failure, under a wide range of pressure and nozzle conditions.

Abstract Background Recent improvements in stone extraction implements and apparatus have lessened the complexity of the endoscopic bile duct stone treatment. However, despite confirmation of complete removal, cases of residual stones have been reported, which can result in recurrent biliary symptoms, cholangitis, and pancreatitis and considerably increase cost given the need for repeat imaging and/or procedures. To date, risk factors for residual bile duct stones following endoscopic retrograde cholangiopancreatography (ERCP) extraction have not been thoroughly evaluated. This study retrospectively investigated the incidence and risk factors of residual bile duct stones following extraction via ERCP. Methods We retrospectively reviewed all ERCP cases that underwent endoscopic bile duct stone extraction between April 2014 and March 2019. A total of 505 patients were enrolled and evaluated for the incidence and risk factors of residual bile duct stones after ERCP. Results The rate of residual stones was 4.8% (24/505). Residual stones were detected by computed tomography (12/24) or magnetic resonance cholangiopancreatography (12/24). In univariate analyses, a large number of stones (P = 0.01), long procedure time (P = 0.005), and performance of the pancreatic duct guidewire placement method (P-GW) for selective bile duct cannulation (P = 0.01) were the factors involved in residual stones. In multiple logistic regression analysis, performing P-GW was retained as the only independent factor of residual stones (adjusted odds ratio, 3.44; 95% CI, 1.19–9.88; P = 0.02). Conclusions When removing bile duct stones with a pancreatic guidewire in place, paying attention to residual stones is necessary.

Abstract Background Vascular abnormalities in neurofibromatosis type 1 (NF1) are rare, but are the second leading cause of death in persons with NF1. In NF1 vasculopathy (NF-V), fatal bleeding due to a spontaneous arterial rupture sometimes occurs. Ruptured extracranial arteries in patients with NF1 often involve thoracic vessels, such as the intercostal and subclavian arteries; very few reports exist regarding the abdominal region. Herein, we present the first case of intraperitoneal bleeding due to spontaneous pancreatic arcade artery (PAA) rupture associated with NF1, successfully treated by transcatheter arterial embolization (TAE) combined with stent-graft placement and partial intra-aortic balloon occlusion (IABO). Case presentation A 40-year-old woman complained of back and abdominal pain. Upon admission, her blood pressure was 85/41 mmHg and heart rate was 129 beats/min. Computed tomography (CT) showed large intraperitoneal bleeding due to PAA rupture. After CT scanning, her systolic blood pressure decreased to 50 mmHg. Therefore, we performed emergency TAE with partial IABO. She was treated by TAE of the anterior superior pancreaticoduodenal artery, anterior inferior pancreaticoduodenal artery, and inferior pancreaticoduodenal artery. However, even after TAE, minor extravasation around the superior mesenteric artery continued, and her vital signs remained unstable. Stent-graft placement was selected to stop the haemorrhage, preserving normal blood flow of the superior mesenteric artery trunk. Excellent patency of the stent graft was confirmed on follow-up CT, and she was discharged on postoperative day 56. Conclusion PAA rupture associated with NF1 can be successfully treated by TAE combined with partial intra-aortic balloon occlusion, and stent-graft placement.

Background Several studies have previously demonstrated the survival benefit of both EGFR‐TKI treatment and chemotherapy in patients with non‐small cell lung cancer (NSCLC) harboring EGFR mutations. The aim of the present study was to clarify the factors influencing the treatment sequence after failure of EGFR‐TKI therapy, focusing on the number of organs with metastasis (hereafter, metastatic organs). Methods Between January 2010 and December 2016, consecutive patients with EGFR‐mutated NSCLC who were started on first‐line EGFR‐TKI were reviewed. The factors influencing withholding systemic chemotherapy and the post‐progression survival (PPS) after failure of EGFR‐TKI were investigated. Results A total of 393 patients were started on first‐line EGFR‐TKI during the study period. After excluding patients maintained on EGFR‐TKI or who received osimertinib targeting secondary EGFR T790M, 297 patients were included in the analysis. Among these, 180 (60.6%) received chemotherapy after failure of EGFR‐TKI (TKI‐Ct group), while the remaining 117 (39.4%) received no chemotherapy (TKI‐only group). Multivariate analysis identified older age (≥75 years: odds ratio [OR] = 0.25, 95% confidence interval [CI]: 0.11–0.43, P

The ocular mucosal tissues are exposed to potentially harmful foreign antigens in the air and tear fluid. The tear duct-associated lymphoid tissue (TALT) may contribute to immune surveillance in the eye region. Follicle-associated epithelium (FAE) of TALTs is classified as stratified squamous epithelium and consists of squamous epithelial cells arranged in layers on the basement membrane. In contrast, most mucosa-associated lymphoid tissue is covered by a monolayer of epithelium containing microfold (M) cells. Therefore, antigen uptake and the presence of M cells in TALT are not fully understood. The present study found that a small population of FAE cells in the TALT expressed intestinal M-cell markers, namely Sox8, Tnfaip2, GP2, and OPG. This cell population was identified as functional M cells because of their uptake capacity of luminal nanoparticles. In addition, RANKL, which is essential for M-cell differentiation, was expressed by stroma-like cells at the subepithelial region and its receptor RANK by the FAE in the TALT. The administration of RANKL markedly increased the number of Sox8+ M cells. In contrast, deficiency in OPG, an endogenous inhibitor of RANKL, increased the number of M cells in the TALT. These data demonstrate that the RANKL-RANK axis is essential for M-cell differentiation in the TALT. Furthermore, immunization via eye drops elicited the production of antigen-specific antibodies in tears, which was enhanced by RANKL administration. Thus, TALT M cells play an important role in the immunosurveillance of the eye region.

Background Although non‐small cell lung cancers (NSCLCs) harboring EGFR mutations initially respond well to EGFR‐tyrosine kinase inhibitors (TKIs), they typically progress after approximately one year. The EGFR T790M mutation is the most common resistance mechanism. NSCLCs with T790M respond well to osimertinib; however, the heterogeneity of NSCLCs may limit the efficacy. Some patients exhibit a mixed response (MR), in which some lesions shrink and others progress, but little is known of the incidence and characteristics of such a response. We sought to determine the frequency and clinical course in MR patients. Methods We retrospectively reviewed the records of patients who had received osimertinib for NSCLC with EGFR T790M. Results Between April and December 2016, 48 patients were administered osimertinib. Seven patients (15%) exhibited one of two MR types: (i) progressive lesions that did not include the re‐biopsy site (5 patients), and (ii) progressive lesions that included the re‐biopsy site (2 patients). The most frequent progressive sites were liver and lung metastases (4 patients). Three patients continued osimertinib following an MR, one of whom had received local therapy for liver metastasis and achieved disease control on osimertinib for an additional four months. Conclusion An MR was detected in 15% of NSCLC patients with T790M. This finding suggests that several different resistance mechanisms are active within a single patient who develops resistance to EGFR‐TKIs. Osimertinib is basically effective for tumors that acquire resistance to EGFR‐TKIs as a result of T790M mutation. Therefore, additional local therapy may be beneficial for patients who develop an MR to osimertinib.

Objectives We conducted a subanalysis of data from the multicentre, retrospective observational Nivolumab Japan Real World (CA209-9CR) study to evaluate nivolumab effectiveness and safety in elderly patients (aged ≥75 years) with advanced/metastatic non-small cell lung cancer.Materials and methods Medical record data of patients initiating nivolumab treatment between April 2016 and December 2016 were collected using electronic data capture from 23 cancer hospitals in Japan between March 2017 and August 2018. Nivolumab treatment data were collected to investigate the treatment patterns by age group (

Flow Accelerated Corrosion (FAC) is a pipe wall thinning phenomenon to be monitored and managed in the power plants with high priority. Its management has been conducted with conservative evaluation of the thinning rate and the residual lifetime of the piping based on the wall thickness measurements. However, noticeable case of the wall thinning was occurred in branch and junction piping (tee tube). It is a problem to manage the section beneath the reinforcing plate of the tee tube; the region where measurement is difficult to conduct with ordinary ultrasonic testing device. In this study, numerical analysis for the tee tube was conducted, and the wall thinning profile due to the FAC was evaluated by calculating the mass transfer coefficient. In the case of the union flow, local wall thinning profile was found near the junction where is covered by the reinforcing plate. This profile showed the tendency of increase in association with increasing of the flow amount from the branch pipe. And, the profiles also have smooth decay tendency from the junction to downstream of the main pipe. Therefore, the amount of the wall thinning beneath the reinforcing plate can be predicted from the location where is deviated from the plate.

This paper presents a detailed experimental study on the dispersion behaviour of a horizontal water jet with atomization. The study mainly focuses on flow structure of the water jet such as a spread angle and a flying distance. The experiments were conducted by using a flow visualization method. Dimensionless numbers (Reynolds number and Weber number) were introduced to determine evaluation condition on a map of the jet flow pattern. The experimental results were compared with existing theoretical model. The jet spread angle was increased by the atomization at the interface between the water jet and surrounding air, and its angle were correlated with non-dimensional numbers. It was also found that the experimental data of the jet flying distance agree with the theoretical model under the low velocity condition. However, the experimental data showed shorter flying distance compared with the theoretical model due to the atomization under the high velocity condition.

Steam is widely used as a medium for thermal energy transport in industry, such as in heat supply and drying processes. It is therefore important to evaluate precisely the steam flow rate at the demand end from the viewpoint of energy management. The state of steam in the steam piping of industrial facilities without the superheating process is usually wet steam resulting from causes such as heat loss, heat supply, and work. It is well known that steam wetness often causes measurement error of the steam flow meter. However, there has been no established standard for estimating the measurement error since it is difficult to evaluate the effects of steam wetness quantitatively in plants and factories. A clamp-on ultrasonic steam flow meter is suitable for use in factories since pipe processing is unnecessary. We conducted experiments to clarify characteristics of the measurement error of a clamp-on ultrasonic flow meter owing to steam wetness considering the influence of pipe diameter. The total mass flow rate of the steam through the test section was measured using a calibrated Coriolis flow meter downstream of the condenser to obtain a reference value. The measurement error of the clamp-on ultrasonic flow meter was estimated by comparison with the reference value. The flow rate difference between these two flow meters was found to increase with increasing steam wetness. Moreover, the clamp-on ultrasonic flow meter measurement was almost the same as the flow rate of only the gas phase in the wet steam flow. From the experimental results, we proposed a correction method for measurement using the clamp-on ultrasonic flow meter in a wet steam flow by correcting the density in the flow rate calculation. Moreover, we clarified the applicability of the clamp-on ultrasonic flow meter in piping of various diameters.

Removability is one of the important features of biliary covered self-expandable metal stents (CSEMS). In this study, we evaluated the diagnostic ability of washing cytology of removed CSEMS. For 14 removed CSEMS that had been placed for the biliary strictures (12 malignant, 2 benign), the surface of CSEMS was washed with saline, and pathological examination of the washing liquid as cytology (CSEMS washing cytology) was performed. The specimen sampling rates and sensitivity for malignancy of CSEMS washing cytology were 92.9 % and 41.7 %, respectively. Sensitivity according to the primary disease was 60.0 % for bile duct cancer and 20 % for pancreatic cancer. Sensitivities based on the methods of stent removal were 16.7 % and 66.7 % for removal through the channel of the scope and with the scope, respectively. Therefore, it is possible that sensitivity of CSEMS washing cytology is higher in bile duct cancer and for removal with the scope. In conclusion, CSEMS washing cytology may have potential as a pathological diagnostic method.

The largest outbreak of dengue fever in Tanzania is ongoing. Dengue virus type 1 was diagnosed in a traveler who returned from Tanzania to Japan. In phylogenetic analysis, the detected strain was close to the Singapore 2015 strain, providing a valuable clue for investigating the dengue outbreak in Tanzania.

Endoscopic transpapillary gallbladder drainage (ETGBD) for acute cholecystitis is challenging. We evaluated the influence of pre-procedural imaging and cystic duct cholangiography on ETGBD. Patients who underwent ETGBD for acute cholecystitis were retrospectively examined. The rate of gallbladder contrast on cholangiography, the accuracy of cystic duct direction and location by computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), and the relationship between pre-procedural imaging and the technical success of ETGBD were investigated. A total of 145 patients were enrolled in this study. Gallbladder contrast on cholangiography was observed in 29 patients. The accuracy of cystic duct direction and location (proximal or distal, right or left, and cranial or caudal) by CT were, respectively, 79%, 60%, and 58% by CT and 68%, 55%, and 58% by MRCP. Patients showing gallbladder contrast on cholangiography underwent ETGBD with a significantly shorter procedure time and a lower rate of cystic duct injury. No other factors affecting procedure time, technical success, and cystic duct injury were identified. Pre-procedural evaluation of cystic duct direction and location by CT or MRCP was difficult in patients with acute cholecystitis. Patients who showed gallbladder contrast on cholangiography showed a shorter procedure time and a lower rate of cystic duct injury.

Background and study aims Biliary plastic stents are generally substituted for gallbladder stents in endoscopic transpapillary gallbladder stenting (EGBS), there is no sufficient evidence about what type of plastic stent is suitable. We examined outcomes of EGBS using standard biliary stents and a novel stent for acute cholecystitis and evaluated the efficacy of the novel stent. Patients and methods Seventy patients with acute cholecystitis in whom EGBS was performed were evaluated retrospectively. We performed EGBS in 23 patients using the novel stent (novel stent group) and 47 patients using standard biliary stents (pigtail: 35, straight: 12) (control group). In the two groups, we examined outcomes of EGBS. Results There were no significant differences in patient backgrounds or rates of technical success, clinical success, or early adverse events (AE) between the novel stent group and the control groups. However, rates of late AEs were 4.3 % in the novel stent group (liver abscess: 1) and 40.4 % in the control group (stent migration: 15, recurrence of cholecystitis: 4), indicating a significantly higher rate in the control group (P = 0.004). The rate of stent migration was significantly higher in the control group (P = 0.006). Multivariate analysis identified a straight type stent as the risk factor for stent migration (odds ratio: 8.81, 95 % confidence interval: 1.66 – 46.83). Conclusions The novel stent had significantly lower rates of late AEs and stent migration. Thus, for long-term stent placement, the novel stent was more effective than traditional biliary stents.

Background/Aims. Endoscopic sphincterotomy (EST) is often performed before fully covered self-expandable metal stent (FCSEMS) placement in order to prevent pancreatitis. However, it is not clear whether EST prevents pancreatitis or affects other adverse events (AEs). This study is conducted to evaluate the necessity of EST before FCSEMS placement for distal malignant biliary strictures due to a pancreatic head tumor. Methods. This study included 68 patients who underwent FCSEMS placement for distal malignant biliary stricture due to a pancreatic head tumor. Treatment outcomes and AEs were retrospectively compared between 32 patients with EST before FCSEMS placement (EST group) and 36 patients without EST (non-EST group). Results. The success rates of drainage for the EST and non-EST groups were 100% and 97.2%, respectively (P=0.95). The incidence of pancreatitis in the EST and non-EST groups was 3.1% and 0%, respectively (P=0.95). The incidence of hyperamylasemia in the EST and non-EST groups was 12.5% and 13.9%, respectively (P=0.85). The incidence of all AEs in the EST and non-EST groups was 15.6% (pancreatitis: 1, cholecystitis: 2, and stent migration: 2) and 13.9% (cholecystitis: 3, stent migration: 2), respectively (P=0.89). Conclusions. EST before FCSEMS placement for distal malignant biliary stricture due to a pancreatic head tumor does not affect the successful drainage and incidence of adverse events. The necessity of EST to prevent pancreatitis before FCSEMS placement was deemed low.

Background/Aims. In early endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis due to choledocholithiasis, it is unclear that single-session stone removal can be safely performed. We examined the efficacy and safety of early single-session stone removal for mild-to-moderate acute cholangitis associated with choledocholithiasis. Methods. Among patients with mild-to-moderate acute cholangitis associated with choledocholithiasis who underwent early ERCP (n = 167), we retrospectively compared the removal group (patients who underwent single-session stone removal; n = 78) with the drainage group (patients who underwent biliary drainage alone; n = 89) and examined the effectiveness and safety of single-session stone removal by early ERCP. Results. The patients in the removal group had significantly fewer and smaller stones compared with those in the drainage group. The single-session complete stone removal rate was 85.9% in the removal group. The complication rate in early ERCP was 11.5% in the removal group and 10.1% in the drainage group, with no significant difference (P = 0.963). On comparing patients who underwent early endoscopic sphincterotomy (EST) with those who underwent elective EST after cholangitis had improved, the post-EST bleeding rates were 6.8% and 2.7%, respectively, with no significant difference (P = 0.600). The mean duration of hospitalization was 11.9 days for the removal group and 19.9 days for the drainage group, indicating a shorter stay for the removal group (P < 0.001). In multiple linear regression analysis, stone removal in early ERCP, number of stones, and C-reactive protein level were significant predictors of hospitalization period. Conclusions. Single-session stone removal for mild-to-moderate acute cholangitis can be safely performed. It is useful from the perspective of shorter hospital stay.

A series of study is presented to develop a prediction method for pipe wall thinning in power plants in order to improve the maintenance management for piping system. In the first report, experiments for flow-accelerated corrosion (FAC) of carbon steel specimens were conducted and basic data of FAC rate were obtained by setting temperature from 50 to 150 ℃ and pH from 7.0 to 9.8 as main parameters. As this second report, the experimental data of FAC rate were compared with the prediction method. Effective mass transfer coefficient correlation was proposed and implemented into the prediction method considering combining effect of local average and turbulent velocity in the near-wall region calculated by computational fluid dynamics (CFD) simulation code. Fairly good agreement was confirmed between experimental and predicted FAC rate profile, quantitatively. Continuously, prediction method was applied to actual power plant piping systems, and some elbow components were chosen for evaluation in detail. Comparison of measured and predicted FAC rate also showed good agreement with data mostly evaluated conservatively in sense of maintenance management. As a whole, presented FAC prediction method including effective mass transfer coefficient was confirmed to predict measured FAC rate data of power plant pipe component with fairly good accuracy and reasonable conservatism, at least for the subjected temperature and pH conditions.

In industrial fields, as the steam is commonly utilized for heat supply, drying process and so on, it is important to be aware of the steam flow rate in the view point of energy management. However, the steam utilized in the factory is usually wet steam condition. Though it is well known that the wetness affects the flowmeter reading, it is difficult to clarify the effects of the wetness in the steam flow quantitatively in actual plants and factories, and thus far, there has been no established method for estimating the error caused by the wetness of steam flow. In this paper, the difference of ultrasonic flowmeter reading due to wetness of the wet steam flow was clarified experimentally. Ultrasonic flowmeter reading in the wet steam flow was compared with Coriolis flow meter installed after heat exchanger in the steam apparatus. As a result, we clarified the flow rate difference of those two flowmeters was increased with increasing wetness, and the ultrasonic flowmeter reading was almost the same as the value of steam phase flow rate in the wet steam flow. We also proposed the correction method of the ultrasonic flowmeter reading by using density correction in the flow rate formula of the ultrasonic flowmeter. And finally, we clarified the uncertainty of the measured flowrates and their differences were less than 1.0%.

We have studied a relationship between magnetic hysteresis and microstructures on high-tensile AISI 4340 steels after impact loading with a strain rate up to 2100 s−1 We find that coercivity, and minor-loop coefficient which is deduced from a power-law scaling between minor-loop parameters increase with strain rate, show a maximum at around a strain rate of 1400 s−1, followed by a decrease at a higher strain rate, associated with magnetic anisotropy with respect to impact direction. These observations are explained from the viewpoints of heat generation and heterogeneous microstructures characteristic to steels subjected to high strain rate deformation.

A series of study is presented to develop a prediction method for pipe wall thinning in power plants in order to improve the maintenance management for piping system. As the first report, experiments for flow-accelerated corrosion (FAC) of carbon steel specimens were conducted and basic data were obtained, focusing on relatively low temperature condition. FAC rate is seen to decrease by lowering temperature and the trend curve tends to remains to keep considerable level in lower temperature around 50 °C. Obtained data would mean that FAC susceptibility of pipeline in condensate demineralizer downstream and deaerator upstream in PWR plants is comparable. In terms of pH, a large drop in FAC rate is seen around pH 9.0 as in previous studies, and its ratio of pH 9.2 to pH 7.0 is approximately 1/10. This ratio fairly agrees with iron solubility in each pH condition at 150 °C while it is smaller in lower temperature condition, which may require additional effect related to pH and temperature to be considered to evaluate the FAC rate. The effect of iron contents on FAC rate is confirmed by referring to saturation solubility of iron. It is suggested that FAC may occur even when the iron concentration in the bulk water is in saturation level, which should be considered in the modelling process for FAC prediction.