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Abstract Background Papillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow‐up during AS. Aims This study aimed to determine adherence and loss‐to‐follow‐up rates in low‐risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles. Materials and Methods This cohort study analyzed the 2016 data from a single registered institution of Japan's public National Cancer Registry. Results We identified and retrospectively analyzed the cases of 327 patients diagnosed with low‐risk PTMC; 227 patients chose to undergo AS while the other 100 underwent PTMC surgery. Main outcomes were the adherence rate and loss‐to‐follow‐up rate of each group, factors influencing discontinuation, and safety considerations. The rate of AS adoption was substantial in the complete series of 327 low‐risk PTMC patients (69.4%). There was a significantly higher loss‐to‐follow‐up rate at 5 years in the AS group (28.6%) compared to the Surgery group (17.8%) (HR 1.62, 95% CI: 1.01–2.61; p = 0.046). Both univariate and multivariate analyses confirmed the significantly higher loss‐to‐follow‐up rate in the AS group as well as in older patients. No deaths due to PTMC progression were observed in the cases lost to follow‐up. Conclusion Despite concerns about loss to follow‐up, active surveillance remains a safe option for low‐risk PTMCs. Consistent follow‐up strategies are crucial, and further research is needed to enhance patient counseling and care for the management of patients with PTMC.

Abstract Interpersonal space (IPS) refers to the area surrounding the body in which we engage in social interactions while maintaining our comfort. Numerous previous studies have reported the psychological and physiological changes associated with the proximity of two people engaged in face-to-face interaction. Currently, there is limited knowledge about how the relative position between two socially intimate individuals affects their psychological and physiological states. This research measured the subjective discomfort and electrocardiographic responses of participants when standing static at various relative positions. The highest discomfort, lowest heart rate, and highest heart rate variability (HRV; parasympathetic activity index) were observed when the friend stood in the face-to-face position. Interestingly, heart rate also decreased when the friend stood on the right side, although HRV did not change. We interpreted the results as suggesting that the presence of a familiar person elicits the electrocardiographic responses associated with an increase in parasympathetic activity.

Abstract Background Carbon fibers are high aspect ratio structures with diameters on the submicron scale. Vapor grown carbon fibers are contained within multi-walled carbon tubes, with VGCF™-H commonly applied as a conductive additive in lithium-ion batteries. However, several multi-walled carbon fibers, including MWNT-7, have been reported to induce lung carcinogenicity in rats. This study investigated the carcinogenic potential of VGCF™-H fibers in F344 rats of both sexes with the vapor grown carbon fibers VGCF™-H and MWNT-7 over 2 years. The carbon fibers were administered to rats by intratracheal instillation at doses of 0, 0.016, 0.08, and 0.4 mg/kg (total doses of 0, 0.128, 0.64, and 3.2 mg/kg) once per week for eight weeks and the rats were observed for up to 2 years after the first instillation. Results Histopathological examination showed the induction of malignant mesothelioma on the pleural cavity with dose-dependent increases observed at 0, 0.128, 0.64, and 3.2 mg/kg in rats of both sexes that were exposed to MWNT-7. On the other hand, only two cases of pleural malignant mesothelioma were observed in the VGCF™-H groups; both rats that received 3.2 mg/kg in male. The animals in the MWNT-7 groups either died or became moribund earlier than those in the VGCF™-H groups, which is thought related to the development of malignant mesothelioma. The survival rates were higher in the VGCF™-H group, and more carbon fibers were observed in the pleural lavage fluid (PLF) of the MWNT-7 groups. These results suggest that malignant mesothelioma is related to the transfer of carbon fibers into the pleural cavity. Conclusions The intratracheal instillation of MWNT-7 clearly led to carcinogenicity in both male and female rats at all doses. The equivocal evidence for carcinogenic potential that was observed in male rats exposed to VGCF™-H was not seen in the females. The differences in the carcinogenicities of the two types of carbon fibers are thought due to differences in the number of carbon fibers reaching the pleural cavity. The results indicate that the carcinogenic activity of VGCF™-H is lower than that of MWNT-7.

Abstract Background Tumor-produced high molecular weight insulin-like growth factor-II (big insulin-like growth factor-II) is considered to cause non-islet cell tumor hypoglycemia. This paper presents a case of surgically resected retroperitoneal liposarcoma that produced big insulin-like growth factor-II. Case presentation Here, we report the case of a 62-year-old woman who presented with an abdominal mass and hypoglycemia. Non-islet cell tumor hypoglycemia due to retroperitoneal liposarcoma was suspected. After complete resection of the tumor, the patient’s hypoglycemia improved and big insulin-like growth factor-II disappeared in the molecular weight analysis of serum insulin-like growth factor-II by western blotting. The patient had no tumor recurrence or reappearance of hypoglycemia 16 months after the operation without any adjuvant therapy. Conclusions Although insulin-like growth factor-II-producing tumors are generally large and difficult to operate on, surgical resection is currently the most effective and only treatment; thus, it is essential to attempt resection aggressively.

Neurofeedback training (NFT) refers to a training where the participants voluntarily aim to manipulate their own brain activity using the sensory feedback abstracted from their brain activity. NFT has attracted attention in the field of motor learning due to its potential as an alternative or additional training method for general physical training. In this study, a systematic review of NFT studies for motor performance improvements in healthy adults and a meta-analysis on the effectiveness of NFT were conducted. A computerized search was performed using the databases Web of Science, Scopus, PubMed, JDreamIII, and Ichushi-Web to identify relevant studies published between January 1st, 1990, and August 3rd, 2021. Thirty-three studies were identified for the qualitative synthesis and 16 randomized controlled trials (374 subjects) for the meta-analysis. The meta-analysis, including all trials found in the search, revealed significant effects of NFT for motor performance improvement examined at the timing after the last NFT session (standardized mean difference = 0.85, 95% CI [0.18–1.51]), but with the existence of publication biases and substantial heterogeneity among the trials. Subsequent meta-regression analysis demonstrated the dose-response gradient between NFTs and motor performance improvements; more than 125 min of cumulative training time may benefit for the subsequent motor performance. For each motor performance measure (e.g., speed, accuracy, and hand dexterity), the effectiveness of NFT remains inconclusive, mainly due to its small sample sizes. More empirical NFT studies for motor performance improvement may be needed to show beneficial effects on motor performance and to safely incorporate NFT into real-world scenarios.

Viscosity is a prominent rheological property of polymer, which is affected by temperature, pressure, shear rate, molecular structure, and other factors. Despite the importance of the pressure effect, there remains a paucity of investigations on the dependence of pressure on viscosity compared with other factors, such as shear rate and temperature. Previous research has established that the correlation between pressure and viscosity is usually expressed by the pressure coefficient. In this paper, different measurement techniques and methods for the pressure coefficient of viscosity of polymer melts are reviewed and evaluated on the basis of published experimental data. The capillary rheometer with a pressurized exit chamber is widely employed because of its accuracy and simple use. Besides, the accuracy and relationship of pressure coefficients determined by different methods are discussed.

Abstract Goal-directed movements often require choosing an option from multiple potential goals under time constraints. However, there are limited studies on how humans change their time spent on decision-making and movement patterns according to time constraints. Here, we examined how sensorimotor strategies are selected under time constraints when the target values are uncertain. In the double-target condition, the values were uncertain until the movement onset and presented immediately afterwards. The behavior in this condition was compared to the single-target condition, in relation to time constraints and target-separation-angles. The results showed that the participants frequently used the choice-reaction even under tight time constraints, and their performance was consistently lower than that in the single-target condition. Additionally, in the double-target condition, differences in the movement trajectory depending on the time constraint and target-separation angle were confirmed. Specifically, the longer the time constraint, the higher the frequency of the intermediate behavior (to initiate movement toward the intermediate direction of two targets) or the change-of-mind behavior (to change the aiming target during movement). Furthermore, the smaller the target-separation angle, the higher the frequency of intermediate behavior, but the frequency of change-of-mind was not affected by the target-separation angle. These results suggest that the participants initiated the movement at an incomplete value judgment stage in some trials. Furthermore, they seemed to select a strategy to utilize the information obtained during the movement, taking into account the time constraints and target-separation angle. Our results show a consistent cognitive bias in choosing a higher value when multiple alternatives have different values. Additionally, we also suggest flexibility and adaptability in the movement patterns in response to time constraints.

Abstract In goal-directed behavior, individuals are often required to plan and execute a movement with multiple competing reach targets simultaneously. The time constraint assigned to the target is an important factor that affect the initial movement planning, but the adjustments made to the starting behavior considering the time constraints specific to each target have not yet been clarified. The current study examined how humans adjusted their motor planning for double potential targets with independent time constraints under a go-before-you-know situation. The results revealed that the initial movements were modulated depending on the time constraints for potential targets. However, under tight time constraints, the performance in the double-target condition was lower than the single-target condition, which was a control condition implemented to estimate performance when one target is ignored. These results indicate that the initial movement for multiple potential targets with independent time constraints can be modified, but the planning is suboptimal.

Dissimilar material joining via friction stir spot welding (FSSW) has been implemented in some automobiles. However, the effectiveness of this method is easily affected by the surface condition of the lower plate. To solve this problem, a method that combines tool contact to the lower plate and material refilling via refill FSSW (RFSSW) was developed. This method was named scrubbing RFSSW (Sc-RFSSW). In Sc-RFSSW, the plunging depth of the shoulder is larger than that in conventional RFSSW. In this study, the relationship between the process parameters and maximum joint load of an Sc-RFSSW joint composed of an aluminum alloy and non-coated mild steel was determined using design of experiments (DoE). The results of DoE showed that the maximum joint load was improved by reduction of the tool plunging depth into the lower plate, such that it was only scrubbing the lower plate interface. In the optimized Sc-RFSSW joining condition, a nugget pull out was stably obtained in both TSS and CTS. In addition, it was demonstrated that, in joining an aluminum alloy and non-coated mild steel, Sc-RFSSW provides a higher maximum joint load than that of conventional FSSW. The unloading test results confirmed that the maximum joint load of Sc-RFSSW was within the welded area, which was equivalent to the tool outer diameter. Moreover, an extremely thin amorphous layer with a thickness of 4–6 nm was observed at the interface of the Sc-RFSSW joint.

Abstract Humans are often required to plan/execute movements in the presence of multiple motor targets simultaneously. Under such situations, it is widely confirmed that humans frequently initiate movements towards the weighted average direction of distinct motor plans toward each potential target. However, in situations where the potential targets change in a step-by-step manner, the strategy to proceed towards the weighted average direction at each time could be sub-optimal in light of the costs of the corrective response. Herein, we tested the sensorimotor strategy followed during a step-by-step reduction of potential goals. To test the hypothesis, we compared the corrective responses when the number of targets went from three to two, and when the number of targets went from three to one at the same time. As the results, weak corrections were confirmed when the number of targets was reduced from three to two. Moreover, the corrective responses when the number of targets went from three to two was smaller than the average behavior estimated from the corrective responses when the number of targets went from three to one at the same time. This pattern of corrective responses reflects the suppression of unnecessary corrections that generate noise and cost to the control system. These results suggest that the corrective responses are flexibly modulated depending on the necessity, and cannot be explained by weighted average behavior.

Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body-specific attention, as a marker of body representation of the paretic limb and revealed a decline in body-specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body-specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body-specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in 25 patients with subacute stroke. Measurements were taken at baseline (TBL), 2 weeks (T2w), 1 month (T1M), 2 months (T2M), and 6 months (T6M) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real-world arm use was measured using accelerometers on both wrists. Body-specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T6M. Longitudinal changes in body-specific attention were most remarkable at T1M. Changes in body-specific attention up to T1M correlated positively with changes in real-world arm use up to T6M, and from T1M to T6M, and the latter more strongly correlated with changes in real-world arm use. Changes in real-world arm use up to T2M correlated positively with changes in FMA up to T2M and T6M. No correlation was found between body-specific attention and FMA scores. Thus, these results suggest that improved body-specific attention to the paretic limb during the early phase contributes to increasing long-term real-world arm use and that increased real-world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real-world arm use after stroke.

The sense of body ownership, the feeling that one’s own body belongs to oneself, is generated from the integration of visual, tactile, and proprioceptive information. However, long-term non-use of parts of the body due to physical dysfunction caused by trauma or illness may disturb multisensory integration, resulting in a decreased sense of body ownership. The rubber hand illusion (RHI) is an experimental method of manipulating the sense of ownership (SoO). In this illusion, subjects feel as if the rubber hand in front of them were their own hand. The RHI elicits the disownership phenomenon; not only does the rubber hand feels like one’s own hand, but one’s own hand does not feel like one’s own hand. The decrease of ownership of one’s own body induced by the bodily illusion is accompanied by neurophysiological changes, such as attenuation of somatosensory evoked potential and decreases in skin temperature. If the loss of the SoO is associated with decreased neurophysiological function, the dysfunction of patients complaining of the loss of ownership can be exacerbated; appropriate rehabilitation prescriptions are urgently required. The present study attempted to induce a sense of disownership of subjects’ own hands using the RHI and investigated whether the tactile sensitivity threshold was altered by disownership. Via questionnaire, subjects reported a decrease of ownership after the RHI manipulation; at the same time, tactile sensitivity thresholds were shown to increase in tactile evaluation using the Semmes-Weinstein monofilaments test. The tactile detection rate changes before and after the RHI were negatively correlated with the disownership-score changes. These results show that subjects’ sense of disownership, that their own hands did not belong to them, led to decreases in tactile sensitivity. The study findings also suggest that manipulating of illusory ownership can be a tool for estimating the degree of exacerbation of sensory impairment in patients. Consideration of new interventions that optimize the sense of body ownership may contribute to new rehabilitation strategies for post-stroke sensory impairment.

To execute the intended movement, the brain directs attention, called body-specific attention, to the body to obtain information useful for movement. Body-specific attention to the hands has been examined but not to the feet. We aimed to confirm the existence of body-specific attention to the hands and feet, and examine its relation to motor and sensory functions from a behavioral perspective. The study included two groups of 27 right-handed and right-footed healthy adults, respectively. Visual detection tasks were used to measure body-specific attention. We measured reaction times to visual stimuli on or off the self-body and calculated the index of body-specific attention score to subtract the reaction time on self-body from that off one. Participants were classified into low and high attention groups based on each left and right body-specific attention index. For motor functions, Experiment 1 comprised handgrip strength and ball-rotation tasks for the hands, and Experiment 2 comprised toe grip strength involved in postural control for the feet. For sensory functions, the tactile thresholds of the hands and feet were measured. The results showed that, in both hands, the reaction time to visual stimuli on the hand was significantly lesser than that offhand. In the foot, this facilitation effect was observed in the right foot but not the left, which showed the correlation between body-specific attention and the normalized toe gripping force, suggesting that body-specific attention affected postural control. In the hand, the number of rotations of the ball was higher in the high than in the low attention group, regardless of the elaboration exercise difficulty or the left or right hand. However, this relation was not observed in the handgripping task. Thus, body-specific attention to the hand is an important component of elaborate movements. The tactile threshold was higher in the high than in the low attention group, regardless of the side in hand and foot. The results suggested that more body-specific attention is directed to the limbs with lower tactile abilities, supporting the sensory information reaching the brain. Therefore, we suggested that body-specific attention regulates the sensory information to help motor control.

During goal-directed behaviors, individuals can be required to start a movement before deciding on the final goal. Previous studies have focused on the initial movement direction in situations involving multiple targets in different directions from the starting position and have shown that the movement is initiated in the average direction among the target directions. However, the previous studies only included situations with targets at equivalent distances, and the characteristics of motor planning in situations with multiple movement possibilities over different potential distances are unclear. In such situations, movement velocity is another important control variable. Furthermore, while previous studies examined situations with an uncertain motor target position, uncertainty can also exist in the effector position (e.g., body or tool locations). Therefore, we examined (1) whether the average output is confirmed in the initial movement velocity during execution in situations involving two potential movements with different distances. In addition, we examined (2) whether planning of the movement velocity can differ depending on the presence of uncertainty in the cursor or the target. In the main conditions, the participants were required to start a reaching movement with two potential movement distances; in the two-cursor condition, two cursors were presented before the start of the trial, and in the two-target condition, two targets were presented. As a control condition, a distance condition corresponding to each main condition was also performed. In the control condition, the initial movement velocity varied linearly with distance. Then, we tested whether the initial movement velocity in situations with two potential movement distances would follow the averaging output of the corresponding control condition. The results revealed that while the initial movement velocity in the two-target condition was slower than the averaging output, that in the two-cursor condition approached the averaging output. These results suggest that the velocity profile of the goal-directed movement is not simply averaged in a situation where two potential targets exist, and that there is a difference in the planning policy of the initial movement depending on whether the known uncertainty is for the movement goal or the effector.

As crystallization behavior has a great effect on the injection molding process, the flash differential scanning calorimetry (FSC) method was employed to study the influence of cooling rate on the crystallization behavior of a semi-crystalline polypropylene (PP). As the experimental results show, crystallization temperatures (onset crystallization temperature and maximum crystallization temperature) and crystallinity decrease as the cooling rate increases. In addition, the corresponding mathematical models were established to describe the relationship between the crystallization temperatures/crystallinity and the cooling rate. A revised Tait equation was also carried out based on the mathematical models.

Abstract Humans are often required to make decisions under time constraints and to adjust speed-accuracy tradeoff (SAT) based on time constraints. Previous studies have investigated how humans adjust SAT depending on the time discount rate of expected gain. Although the expected gain of actions can be determined by both gain and probability, only situations where gain decreases over time have been tested. Considering the effect of risk on decision-making, the difference in time discount factors may modulate the response strategies for SAT, since temporal changes in variance of possible outcomes differ when gain or probability decreases over time. Here, we investigated the response strategies for SAT under different time discount factors. Participants were required to select one of the two options with different initial values in situations where the expected gain of options declined over time by a linear decrease in gain or probability. Comparison of response strategies between conditions revealed that response times in the gain condition were longer than those in the probability condition, possibly due to risk-aversion. These findings indicate the existence of common rules underpinning sensorimotor and economic decision-making.

Introduction Little is known about the risk of hypertension in patients with the early stage of type 2 diabetes. We investigated the risk of hypertension in participants with newly diagnosed type 2 diabetes and prediabetes.Research design and methods This is a retrospective cohort study consisting of 2136 middle-aged participants (1022 with normal fasting glucose/normal glucose tolerance (NFG/NGT), 418 with impaired fasting glucose (IFG), 466 with impaired glucose tolerance (IGT) and 230 with diabetes) and 3426 elderly participants (1762 with NFG/NGT, 599 with IFG, 781 with IGT, and 284 with diabetes). All participants underwent 75 g oral glucose tolerance tests at baseline.Results Over a median 59-month follow-up period, 459 middle-aged and 1170 elderly participants developed hypertension. In middle-aged participants, the odds of incident hypertension were significantly higher in those with IFG (OR 1.40; p=0.019), IGT (OR 1.49; p=0.004), and diabetes (OR 1.55; p=0.013) than those with NFG/NGT, which was no longer significant after adjustment for body mass index. Subgroup analysis showed that the risk of hypertension was significantly higher in diabetes than NFG/NGT only in participants without obesity. Conversely, obesity was a risk factor of hypertension only in those with IFG and NFG/NGT. In elderly participants, there was no difference in the risk of hypertension among the NFG/NGT, IFG, IGT and diabetes groups.Conclusions The risk of hypertension is modest in participants with newly diagnosed type 2 diabetes and prediabetes. Our findings suggest that the early stages of type 2 diabetes and prediabetes may be a key period for reducing hypertension, given the pronounced risk of hypertension in patients with diabetes reported in previous studies. In terms of reducing the risk for hypertension, obesity treatment might be advantageous in the early stages rather than the advanced stages of impaired glucose metabolism.

Background The interrelationships among the different stages of impaired glucose metabolism, insulin resistance, and hypertension are not fully understood. Methods and Results We investigated the impact of insulin resistance, plasma glucose, and serum immunoreactive insulin levels on hypertension in 19 166 participants with different stages of impaired glucose metabolism (7114 normal fasting glucose/normal glucose tolerance, 3543 isolated impaired fasting glucose [IFG], 2089 isolated impaired glucose tolerance, 2922 IFG plus impaired glucose tolerance, and 3498 diabetes mellitus]) determined by 75‐g oral glucose tolerance tests. Participants were recruited from examinees who finished a general health checkup for atomic bomb survivors between 1982 and 2017. The profiles of plasma glucose and immunoreactive insulin during oral glucose tolerance tests were assessed using the total area under the curve. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance. The rate of hypertension increased from 36.3% in participants with normal fasting glucose/normal glucose tolerance to 50.1%, 50.8%, 58.3%, and 63.8% in participants with isolated IFG, isolated impaired glucose tolerance, IFG plus impaired glucose tolerance, and diabetes mellitus, respectively. Homeostasis model assessment of insulin resistance was associated with hypertension regardless of the presence and the degree of impaired glucose metabolism. Furthermore, fasting plasma glucose and serum immunoreactive insulin levels and areas under the curve for plasma glucose and immunoreactive insulin during oral glucose tolerance tests were associated with hypertension in normal fasting glucose/normal glucose tolerance and isolated IFG, but such a relationship was diminished in other types of prediabetes and diabetes mellitus. Conclusions The prevalence of hypertension increases with worsening stages of impaired glucose metabolism; however, hyperglycemia and hyperinsulinemia are significant contributors to the presence of hypertension only in the early stages of impaired insulin metabolism.

This study proposes a method to measure ground force outside the laboratory using motion sensors. The authors estimated ground reaction force (GRF) from the measurements obtained by a motion sensor at an athletics track with no force plates installed. First, experimental data were measured in the laboratory using motion sensors and a 3D motion analysis system and by motion sensors and force plates. Data were compared using three types of prosthetic foot parts with different shapes and rigidities and were evaluated using a root mean square error method. As a result, the estimation accuracy of the displacement of the prosthetic foot and GRFs were high, and the laboratory experiment demonstrates the accuracy of the proposed method. In the second measurement, the authors measured a 60 m run at a stadium comparing two subjects with different competition levels. The GRF of subject A showed values of 2.8 to 3.5 times the body weight whereas subject B showed a value of 1.8 to 2.5 times the body weight. As a result of comparing trunk momentum and prosthesis side, in the stance phase of subject B, the trunk went up, and only the movement on the prosthesis side was used to obtain propulsive force. This may be due to the timing of the trunk and lower limb being unsynchronized. Furthermore, the trunk momentum of both subjects was compared using wavelet analysis. In Subject B, a larger value also appeared at high frequencies other than the main component. This is considered to be due to a difference in the movement of the lower limb during the swing phase. Based on these findings, this analysis method could be useful, and the GRF measured with this analysis method may be an important index in the evaluation of running motion, parts selection, setting of prostheses, and coaching.

We evaluated data from 10,088 participants without cardiovascular disease (CVD) who underwent 75 g oral glucose tolerance tests and had more than four visits during the first 5 years following the test to investigate the association between impaired glucose metabolism and visit-to-visit blood pressure (BP) variability. Participants were classified into groups of normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and diabetes. Visit-to-visit BP variability was estimated for each individual using standard deviation (SD) and coefficients of variation (CV, defined as SD/mean). SDs and CVs of systolic BP (SBP) values were divided into quartiles. The samples falling in the highest quartile were considered as having high SD/CV. The adjusted odds ratio (OR) for high SD of SBP in the IFG (OR, 1.39; P

A high-reliability design method for a MEMS accelerometer using a stretchable beam structure was proposed to prevent sensor property variations due to stresses from device fabrication and packaging. To achieve a compact piezoresistive three-axis accelerometer using a low-cost resin-mold packaging, beam buckling due to compression forces originating from residual stresses of thin films and shrinkage of mold resin must be overcome. The proposed stretchable beam structure, which gives axial flexibility by adding a ring-shape part at the center of the beam, has advantages in which it is effective against not only packaging stress but also inner stress such as thin film stress, and it does not sacrifice compactness. Formulations with a simple accelerometer model revealed that large and nonlinear variations in sensitivity occur due to beam compression. Such large variations have to be avoided to stabilize sensor performances. Besides, it is expected to enhance sensitivity up to about 1.5 times while maintaining linearity by arranging an appropriate compression force using the stretchable beam. The effects of the stretchable beam were verified using simulations and experiments on test samples. The designed stretchable beam, which has two rings connected serially, has five times the axial flexibility compared with a conventional straight beam without significant change in bending stiffness. A preferable increase of about 1.4 times and small deviations in measured sensitivity were achieved with the developed stretchable beam, compared with the straight beam with an unstable increase of about seven times and extremely large deviations. These large deviations seem to come from shape variation due to non-uniformity of dry etching technologies commonly used for MEMS devices. Thus, the effects of the proposed stretchable beam to the MEMS accelerometer design were confirmed to prevent large variations and deviations in sensor properties and to enhance sensitivity.

Purpose: Decision making regarding the urethra before and after radical cystectomy due to urothelial carcinoma has always been controversial. To determine whether anterior urethra sparing cystoprostatectomy for bladder cancer is an oncologically-safe procedure, we evaluated the long-term oncologic clinical outcome., Patients and Methods: A total of 51 male patients with cTa-4N0-2M0 bladder cancer were treated with anterior urethra sparing cystoprostatectomy and simultaneous urinary diversion between 2000 and 2013, and underwent follow up for 4 months or more. We assessed differences in the perioperative outcomes, oncologic outcomes and recurrence rates according to the urinary diversion., Results: The median patient age and follow-up period were 66 years and 35 months, respectively. The 5- and 10-year recurrence free survival (RFS) rates in ileal conduit (IC) group vs. orthotopic neobladder reconstruction (NB) group were 45.0 and 20.3% vs. 39.3 and 19.6%, respectively. Likewise, the 5- and 10-year disease specific survival (DSS) were 52.7 and 32.1% vs. 39.3 and 29.5%, respectively. Multivariate analysis revealed two independent prognostic factors for RFS and DSS, including age at surgery and lymph node status. Local recurrence in the remnant anterior urethra occurred in only 1 patient (2.0%) at 57 months after surgery., Conclusions: Our long-term data show that anterior urethra sparing cystoprostatectomy is an oncologically-safe procedure regardless of the type of urinary diversion in a subset of carefully selected patients with bladder cancer without evidence of urothelial carcinoma in the urethra/bladder neck and urethral surgical margin.

Background: The sarcomatoid variant of metastatic renal cell carcinoma (RCC) has often an aggressive course and a poor prognosis, particularly when accompanied with brain metastasis., Case Report: We describe the case of a patient with sarcomatoid variant RCC in whom brain metastasis was observed as a new lesion during treatment with temsirolimus, despite other extracerebral metastatic lesions being well-controlled and progression-free., Results: This discrepancy between the effectiveness of temsirolimus for extracerebral metastases and the simultaneous progression of brain metastases of RCC raises a concern that while vascular endothelial growth factor (VEGF)-targeted therapy may have clinical efficacy, it may also carry a risk for new brain metastases due to weakening of the structure of the blood brain barrier., Conclusion: This case indicates that computed tomography monitoring of the brain should be regularly performed during VEGF-targeted therapy in patients with sarcomatoid variant RCC, even if brain metastases are absent and extracerebral metastatic lesions are well controlled.

A 34-year-old female with left flank pain persisting for 3 months consulted us on 19 Feb, 2001. Ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI) and renal angiography revealed a cystic renal tumor in the upper pole of the left kidney invading the spleen, and paraaortic lymph node swelling. Left radical nephrectomy combined with splenectomy and partial diaphragmectomy was performed under a tentative diagnosis of renal cell carcinoma. However, histopathological findings revealed xanthogranulomatous pyelonephritis (XGP). XGP is a rare, severe, chronic inflammatory disease characterized by accumulation of lipid laden macrophages. XGP is classified as diffuse or focal type. Preoperative diagnosis of focal XGP is difficult because of radiological similarities to renal cell carcinoma. Our case was more difficult to diagnose because she showed few signs of inflammation and had no history of urinary tract infection or stones.

Background: Partial nephrectomy (PNx) has been performed with temporary renal arterial occlusion and in situ renal hypothermia (conventional PNx). However, the impact of temporary renal arterial occlusion on residual renal function has not been well assessed. To address this question, we performed renal scintigraphy with (99m)technetium-dimercaptosuccinic acid (DMSA) for the quantitative measurement of postoperative residual renal function after conventional PNx and partial nephrectomy without arterial occlusion (non-clamping PNx)., Methods: Thirty-four patients underwent postoperative DMSA scintigraphy after PNx for renal cell carcinoma. No obvious difference in preoperative renal function between the diseased kidney and the contralateral kidney was found in any of the patients. Of these patients, 24 underwent conventional PNx, and 10 underwent non-clamping PNx. Residual renal function was evaluated using the relative DMSA uptake of the operated kidney., Results: The relative DMSA uptake of the operated kidney was 39.9 +/- 7.3% (25.1-58.8) after conventional PNx compared to 34.8 +/- 8.9% (13.5-45.5) after non-clamping PNx. This difference was not statistically significant (P = 0.15). Total ischemic time during conventional PNx had no adverse influence on the residual renal function. In the analysis of the other determinant factors influencing residual renal function, tumor size was the only significant factor that inversely correlated with the relative DMSA uptake., Conclusion: Our results showed that arterial clamping during PNx has no negative impact on the functional residual capacity as long as insitu renal hypothermia is adequately performed.

A case of massive bilateral angiomyolipomas (AML) associated with tuberous sclerosis in a 33-year-old woman is reported. She was hospitalized because she had been experiencing abdominal fullness and epigastralgia. Several imaging studies revealed massive bilateral renal tumors and she was diagnosed as having renal AML associated with tuberous sclerosis. Left nephrectomy was carried out after renal arterial embolization for intratumor hemorrhage. Two years after left nephrectomy, nephron-sparing surgery (tumorectomy) for right AML was done because of an increase in the size of the right renal AML and she hoped for a future pregnancy. The left kidney with AML weighed 5700 g and the right AML weighed 1700 g. Postoperative serous creatinine did not differ from that before operation and an increase in the size of the residual tumor was not observed 8 months after operation. We consider that tumorectomy is an effective therapy in patients with a very large tumor involving a solitary kidney.

Purpose: We investigated electrovaporization of flat bladder tumors with a rollerball electrode 3 mm in diameter as a substitute for conventional transurethral resection with a cutting loop., Materials and Methods: A basic study of the action of electrovaporization was performed in dogs. The bladder was exposed under general anesthesia in three mongrel dogs. The rollerball electrode was attached to the resectoscope and inserted into the bladder via a cystostomy. Then electrovaporization was performed with a low or high pressure on the electrode tip and a speed of about 1 cm/sec using a Force 40 generator. The cutting mode power was set at 100 W or 200 W. The effects of the rollerball and cutting loop electrodes were also examined in the coagulation mode (45 W) as a control., Results: A deeper vaporization zone was obtained by using a power of 200 W in the cutting mode than with a power of 100 W, and a desiccation zone was found below the vaporization zone (VZ). The VZ was thicker with a high contact pressure than with a low contact pressure. This VZ was deeper than the tissue defect and heat-affected zone obtained using a rollerball electrode or cutting loop electrode in the 45 W coagulation mode., Conclusion: Although caution is required because the VZ can become too deep with excessive pressure, the rollerball electrode seems to be safer and more useful than the cutting loop electrode for resection of flat or small papillary bladder tumors.

Background: Cytokines play a pivotal role in growth, differentiation, and apoptosis. In this study, we measured cytokine content in the renal cyst fluid of patients with acquired cystic disease of the kidney (ACDK) in order to elucidate the possibility that cytokines are related to the development of ACDK., Patients and Methods: All or some of 15 cytokines, IL-1a, -1b, -2, -4, -5, -6, -8, -10, IFN-alpha, -gamma, G-, M-, GM-CSF, TNF-alpha, and vascular endothelial growth factor (VEGF) were analyzed in cyst fluid and serum of 12 patients on hemodialysis (HD) including 8 with ACDK and 8 with normally functioning kidneys by sandwich enzyme-linked immunosorbent assay., Results: Out of these cytokines, only IL-6, -8, M-CSF, and VEGF were detected in the cyst fluid of patients with ACDK. Moreover, IL-6, -8, and VEGF showed significantly higher concentrations in the cyst fluid than in the blood (194.9 +/- 90.9 vs. 0.0 +/- 0.0 pg/ml, 2,377. 5 +/- 602.9 vs. 0.0 +/- 0.0 pg/ml, 5,167.8 +/- 1,316.9 vs. 41.1 +/- 14.7 pg/ml, respectively), while M-CSF showed comparable concentrations in the cyst fluid with those in the blood (3,519.4 +/- 730.0 vs. 3,250.3 +/- 319.1 pg/ml, p = 0.69). Additionally, IL-6, -8, and VEGF accumulated more abundantly in the cyst fluid of patients with ACDK than in that of patients with other cystic nephropathies including ADPKD patients on HD (194.9 +/- 90.0 vs. 4.6 +/- 3.2 pg/ml, 2,377.5 +/- 602.9 vs. 76.8 +/- 46.5 pg/ml, 5,167.8 +/- 1,316.9 vs. 131.1 +/- 63.1 pg/ml, respectively). However, there was no significant correlation between the intracystic concentrations of these cytokines and the corresponding cyst diameters., Conclusion: These results showed that in ACDK patients a local environment exists in which production or accumulation of certain cytokines is selectively enhanced compared with patients with other cystic nephropathies. They imply that these cytokines are closely related to pathogenesis particular to ACDK., (Copyright 2000 S. Karger AG, Basel)

We present a case of spontaneous rupture of renal angiomyolipoma with a tumor thrombus extending from the right renal vein and inferior vena cava to the right atrium. A 41-year-old woman, previously in good health, was referred to our hospital with right flank pain. Computed tomography showed fat densities in both tumor and thrombus. Other imaging examinations also demonstrated a large right renal mass (18 cm in diameter), a long tumor thrombus (13 cm in length) and a small left renal tumor (1.5 cm in diameter). Right nephrectomy and en-bloc removal of the intra caval and intracardiac tumor thrombus were performed on cardiopulmonary bypass. It was pathologically diagnosed as an angiomyolipoma without tuberous sclerosis. At present, three years after surgery the patient is doing well, showing neither metastasis nor increase of the left renal angiomyolipoma. To our knowledge, our case seems to be the 3rd case report of renal angiomyolipoma with a tumor thrombus extending to the right atrium. We conclude that renal angiomyolipoma even with an intra cardiac tumor thrombus can be resected safely and successfully.

Purpose: We evaluate the efficacy of a new technique of minimally invasive treatment for benign prostatic hyperplasia involving direct injection of dehydrated ethanol., Materials and Methods: Dehydrated ethanol was injected transurethrally with lumbar or sacral and urethral anesthesia in 10 patients with prostatic hyperplasia. Endoscopic injection was performed at 4 to 8 sites in the prostate and 3.5 to 12.0 ml. ethanol were used., Results: There were no intraoperative complications but postoperative urinary retention occurred transiently in all patients which required catheterization for a mean of 8.8 days. Mean symptom score plus or minus standard deviation was 12.2+/-5.8 at 3 months postoperatively, which was significantly improved from 23.1+/-7.0 preoperatively (p<0.01). Mean quality of life score also improved significantly from 5.1+/-0.6 preoperatively to 3.2+/-1.5 at 3 months postoperatively (p<0.01), mean peak urinary flow rate increased from 8.0+/-2.2 (9 patients) to 13.1+/-3.6 ml. per second (p<0.05) and mean residual urine volume decreased from 129.1+/-55.3 (9 patients) to 49.3+/-34.7 ml. (p<0.05). There was no significant change in prostate volume. Acute epididymitis and chronic prostatitis occurred in 1 patient each., Conclusions: This technique can be performed as an outpatient procedure and appears to be safe and cost-effective. Retrograde ejaculation can be avoided.

Purpose: The aims of the present study were to examine the effects of intravesical instillation of epirubicin on tumor recurrence and to identify tumors that are at a high risk of recurrence., Methods: Forty-five patients with primary superficial bladder cancer were treated with prophylactic intravesical epirubicin following transurethral resection of the bladder tumor (TUR-BT). Epirubicin (20 mg) was administered intravesically every second week for 4 months and then once a month or every 2 weeks for next 8 months. Patients were analyzed with respect to prognostic factors related to tumor recurrence., Results: The overall recurrence-free rate, calculated using the Kaplan-Meier method, was 76.1 and 52.3% at 2 and 5 years after operation, respectively. These results were better than those reported for patients treated with TUR-BT alone. A univariate analysis demonstrated that high-grade, T1, sessile, large (> or = 2 cm) and multiple tumors were a significantly high risk for recurrence. A multivariate analysis performed by using the Cox proportional hazard model with stepwise selection showed that morphologic features (pedunculated or sessile) were the most prognostic factors for recurrence. This was followed by age and tumor size. The remaining four factors were not found to contribute significantly to recurrence., Conclusions: Epirubicin appears to be effective in preventing the recurrence of superficial bladder cancer. Morphologic features, patient age and size of the tumor were considered independent risk factors. The risk of recurrence for each tumor should be taken into consideration when the intravesical adjuvant therapy protocol is being selected.

We report a 42-year-old renal-transplanted man with renal cell carcinoma (RCC) in the native kidney. He was admitted with gross hematuria and general fatigue as the chief complaint. Ultrasonography, computed tomography, magnetic resonance imaging and angiography, revealed a right RCC with intracaval tumor thrombus extending to the level of hepatic veins. Since selective renal angiography demonstrated a hypervascular tumor, angio-embolization was performed preoperatively. However, he died suddenly the next morning despite aggressive resuscitative measures. Autopsy revealed bilateral pulmonary arteries obstructed by the tumor thrombus. Renal arterial embolization is useful for advanced RCC, and side effects are mostly transient and well tolerated by the patients. However, indications for angio-embolization should be selected carefully with such a fatal case as this patient kept in mind.

Background: A possible role for intercellular adhesion molecules in tumor progression and metastasis has been strongly suggested. To investigate the effect of soluble intercellular adhesion molecule-1 (sICAM-1) on bladder cancer, sICAM-1 serum and urinary concentrations were measured in patients with superficial or invasive bladder cancer and in patients with prostatic hypertrophy., Methods: Serum and urine samples were obtained from 26 patients with transitional cell carcinoma of the bladder (mean age, 66.8 years) and 14 patients with benign prostatic hypertrophy (BPH; mean age, 70.5 years). Fifteen healthy volunteers served as control patients. Samples were collected before surgery and 5 days after surgery. The serum and urinary slCAM-1 levels were measured by an ELISA., Results: The preoperative serum concentration of sICAM-1 was significantly higher in patients with invasive bladder cancer (351.8+/-158.0 ng/mL) than in the healthy controls (233.1+/-96.1 ng/mL; P< 0.05) or BPH patients (224.7+/-80.5 ng/mL; P< 0.05). In addition, serum sICAM-1 levels were significantly higher in patients with tumors greater than 3 cm in size (412.7+/-147.6 ng/mL) than in patients with smaller tumors (246.6+/-101.2 ng/mL; P<0.05). Urinary sICAM-1 levels in patients with invasive bladder cancer were also significantly higher than in the patients with superficial cancer prior to surgery., Conclusion: Our results suggested that sICAM-1 may play an important role in the progression of bladder cancer, and that elevated serum sICAM-1 levels may be related to tumor size.

We examined the preoperative and postoperative, urinary levels of the cytokines, interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in 14 patients with renal cell carcinoma (RCC), and 9 patients who underwent nephrectomy as donors (controls). Although urinary IL-1 beta was measurable in every subject, both IL-6 and TNF-alpha were undetectable in 12 of the 14 patients. None of the urinary cytokines showed levels significantly different from the controls preoperatively. Urinary levels of IL-1 beta showed no correlation with clinical stage or histological grade. Only urinary IL-1 beta was significantly elevated after nephrectomy, when compared with the controls (P < 0.05). However, urinary IL-1 beta showed no correlation with operative blood loss or postoperative infection. These findings suggest that measurement of urinary cytokines is not useful for diagnosis or monitoring of therapy in RCC patients.

A 57-year-old male patient was admitted to our hospital for left flank pain and a slight increase in serum creatinine. He had left hydronephrosis and extrinsic stenosis of left lower ureter shown by intravenous and retrograde pyelography. Computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated a mass along the bilateral lower ureters, the left side of which was larger (5 x 3 x 4 cm). After surgical exploration and biopsy of the tumor the patient was diagnosed as having xanthogranulomatous inflammatory pseudotumor. No malignant findings were observed. Tumor size spontaneously decreased to 20% of the original size at 2 weeks after laparotomy. The patient underwent ureterolysis because of prolonged left hydronephrosis. Approximately 3 years after development of disease, hydronephrosis has improved and the pelvic tumor has almost diminished.

A case of xanthogranuloma of the urinary bladder is reported. A 68-year-old man was referred to our hospital for the evaluation of microscopic hematuria. At that time, he did not have an abdominal tumor and ultrasonography showed no abnormality of the kidneys and the bladder wall. Two months later, he was admitted with the chief complaints of perineal discomfort and non tender fist size mass was palpable in the lower abdomen. Ultrasonography, computed tomographic scan and magnetic resonance imaging MRI demonstrated a supravesical mass which was strongly suspected as urachal tumor. Total cystectomy with urachal resection was performed. The histological diagnosis was xanthogranuloma. The patient has been in good health without recurrence, 4 years after surgery. We discuss xanthogranuloma of the urinary bladder in the literature.

A 60-year-old woman with urethral carcinoma treated by bladder sparing surgery is reported. A tumor of Grabstald's clinical stage C2 arose from the anterior urethra infiltrated into the distal wall of vagina with invasion of vaginal mucosa. Pathological findings revealed poorly differentiated squamous cell carcinoma. She underwent a wide local excision of the urethra and the anterior vaginal wall with preserving the bladder. An appendicovesicostomy (Mitrofanoff procedure was selected for the urinary diversion. This technique provided a small stoma, appropriate continence, normal bladder sensation and preseving renal function. Bladder-sparing urethrectomy could be an alternative treatment for female urethral tumors.

The efficacy of prostate specific antigen density (PSAD) in diagnosing prostate cancer was assessed in 98 patients with serum prostate specific antigen (PSA) levels between 2 and 10 ng/ml who had a pathological diagnosis made by prostate biopsy or transurethral resection of the prostate. Of the 98 patients, 22 (22%) had prostate cancer. The PSA (based on a cut-off value of 4.5 ng/ml) had a sensitivity and positive predictive value (PPV) of 82% and 38%, respectively, for diagnosing prostate cancer, while the results for PSAD (based on a cut-off value of 0.13) were 91% and 61%. The PSAD was more efficient than the PSA levels and was also superior to digital rectal examination (DRE) combined with transrectal ultrasonography (TRUS), for which the sensitivity and PPV were 73% and 39%, respectively. Six (11%) out of 57 patients who were normal on DRE and TRUS had prostate cancer. In these 57 patients, the PSA (cut-off value: 4.5 ng/ml) had a sensitivity of 50% and PPV while the values for PSAD (cut-off value: 0.13) were 83% and 36% respectively. The PSAD could effectively detect even impalpable prostate cancer not visible on TRUS.

To examine the indication of nephron sparing operations, we searched 31 nephrectomized kidneys with renal cell carcinoma for small associated lesions in the normal-appearing portion of these kidneys. The diameter of the predominant tumors was between 15 and 50 mm. The kidneys were serially sectioned at 5-mm intervals, and all sections were examined microscopically. Two of the 31 kidneys had a small renal cell carcinoma, and four had a small adenoma in the normal-appearing portion. We recommend that the nephron-sparing operation should be is performed limitedly and that radical nephrectomy is yet a standard operation in the presence of a normal contralateral kidney.

DNA ploidy was investigated using flow cytometry on fresh surgical specimens from 116 cases with renal cell carcinoma. DNA diploid tumor was observed in 39 cases (33.6%) and aneuploid in 77 cases (66.4%). DNA aneuploid group was further classified into 3 subgroups by DNA index (D.I.); near-diploid group (D.I.: 0.8-1.2, 21.6%), near-tetraploid group (D.I.: 1.8-2.2, 12.9%) and other aneuploid group (31.9%). DNA ploidy pattern correlated with clinical stages and histological grading, indicating significantly a higher incidence of DNA diploid in cases in stage I and grade 1. DNA clonal heterogeneity was observed in 48.1%, and homogeneously diploid was in 28.6% of 77 cases who were analyzed more than 2 specimens. Incidences of DNA heterogeneity and homogeneous diploid correlated with the number of analyzed specimens and our results showed that more than 4 specimens were necessary to diagnose the DNA ploidy patterns. The near-tetraploid group was shown to have an extremely poor prognosis compared with the diploid group and the other aneuploid group. There were no significant difference between the diploid group and the aneuploid group in terms of the early prognosis, however, the incidence of disease recurrence was significantly higher in the aneuploid group. Our results demonstrated that DNA ploidy was an useful prognostic factor in the evaluation of patients with renal cell carcinoma.

Intravesical instillation of epirubicin was carried out to investigate the efficacy of this treatment in preventing postoperative recurrence of superficial bladder cancer. The subjects were 100 patients who had been treated with transurethral resection (TUR) for superficial transitional-cell carcinoma of the bladder (classified as primary or recurrent superficial bladder cancer of pathological stage Tis, Ta, or T1 and histological grade G1, G2, or G3) at Tokyo Women's Medical College Hospital and its affiliated hospitals during the 2-year period ranging from April of 1990 through March of 1992. A solution of epirubicin was prepared by dissolving 20 mg in 30 ml physiological saline, and this was instilled into the bladder a total of 17 times during 1 year: once immediately after TUR, once every 2 weeks for the next 4 months, and then once per month for the following 8 months. Thereafter, the course of each patient was followed by performing urinary cytodiagnosis once each month and cystoscopy once every 3 months. Of the 100 patients, 83 were evaluable. The mean duration of follow-up was 461 +/- 222 days, and the recurrence rate was 30.1% (25/83 cases). The recurrence rate determined for primary cases was 19.7%, whereas that recorded for recurrent cases was 61.9%. Adverse effects occurred in 9.3% (9/97) of the patients, but these side effects were mild in severity and the instillation regimen did not have to be discontinued in any of the patients. Analysis of the risk factors for recurrence revealed significantly higher recurrence in the recurrent-patient group and the multiple-tumor group. On the basis of these findings, the authors surmised that when given in an intravesical instillation regimen, epirubicin causes few adverse effects, and its efficacy in the prophylaxis of recurrence of superficial bladder cancer is equivalent to that thus for reported for other drugs. At present, the authors are carrying out a controlled clinical study on epirubicin that takes into account the risk factors for recurrence of superficial bladder cancer.