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Takashi Kojima,1,2 Akeno Tamaoki,2 Kazuo Ichikawa,3 Yuya Satoh,4 Ryota Tomemori,5 Keizo Watanabe,6 Asato Hasegawa,2 Ayako Sawaki,2 Tatsushi Kaga2 1Department of Ophthalmology, Nagoya Eye Clinic, Nagoya, Aichi, Japan; 2Department of Ophthalmology, Japanese Community Healthcare Organization Chukyo Hospital, Nagoya, Aichi, Japan; 3Department of Ophthalmology, Chukyo Eye Clinic, Nagoya, Aichi, Japan; 4Department of Ophthalmology, Satoh Yuya Eye Clinic, Sendai, Miyagi, Japan; 5Department of Ophthalmology, Tomemori Eye Clinic, Hashimoto, Wakayama, Japan; 6Department of Ophthalmology, Minami Osaka Eye Clinic, Sennangun, Osaka, JapanCorrespondence: Takashi Kojima, Email tkojkoj@mac.comPurpose: We evaluated the effect of optimization of the intraocular lens (IOL) power calculation formula SRK/T and Barrett Universal II (BU II) in long eyes (≥ 26 mm: group L) and short eyes (≤ 22 mm: group S) using axial length calculated from segmented refractive indices (SRI).Setting: Multicenter study at five sites in Japan.Design: Retrospective observational study.Methods: This study included 461 eyes of 461 patients (mean age 73.8 ± 8.4 years) who underwent cataract surgery. The predicted refractive error (PRE) was compared between the SRI (ARGOS) and the equivalent refractive index (ERI) biometers (IOLMasterTM 700). The patients were randomly divided into two groups, a learning group and a validation group. The optimization constants were determined in the learning group, and the optimization constants were subsequently applied to the validation group and compared with the ERI biometer results.Results: Using both SRK/T and BU II, the validation group’s PRE using optimization constants for the SRI biometer in group L was significantly smaller than that using the ERI biometer (p< 0.001, p< 0.01). In group L, the arithmetic PRE of Barrett UII formula with SRI showed a significant improvement after optimization compared to before optimization (p< 0.0001). In group S, the arithmetic PRE of SRK/T and Barrett UII formula with SRI showed a significant improvement (p< 0.0001, p< 0.0001).Conclusion: In long and short eyes, the current study revealed that optimization of the SRK/T and Barrett formula constants for the SRI biometer was beneficial to achieve accurate refractive outcomes after cataract surgery.Keywords: segmented refractive index, intraocular lens power calculation, Sanders-Retzlaff-Kraff theoretic, Barrett universal II, optimization

Although the potential of traditional domestic rainwater harvesting systems (RWHSs) is easily determined, objective knowledge is required to determine their sustainability or scientific validity. We aimed to broadly review recent trends and emerging opportunities for research on the potential of RWHSs in the global context. We reviewed three types of representative RWHSs: water cellars, stepwells, and qanats. In total, 16 potential categories were defined. First, to date, 50% of the categories of potential have been demonstrated but are not considered beneficial, have been proven only in limited locations, only in limited sampling sets, or are theoretical. Second, whether the involvement of other disciplines has resulted in an expansion of the research scope or whether a particular potential has not been comprehensively explained remains to be determined by researchers. Third, potential that has emerged in the 21st century is not beyond our imagination such as tourism potential and ecological potential. Therefore, researchers should actively explore and incorporate new innovative technologies with RWHSs to explore new potential. The findings of this study offer a viable research framework for investigating the evolution of the discipline and contribute to the development of critical thinking in the analysis of the potential of RWHSs.

The designation of historic conservation areas (DHCAs) from the cities classified as “National Famous Historical and Cultural City” (NFHC-city) is the key tool for maintaining large-scale historic environments, wherein the boundaries are blurred because of redevelopment. Therefore, exploring potential historic conservation area is fundamentally important. In this study, we examined historic urban areas in 11 old colonial cities (concessions and leased territories) to determine the potential historic conservation areas (P-HCAs). Our results suggest that P-HCAs are characterized by relatively small size, minimal residential use, and irregular morphological boundaries, except in some non-NFHC-cities, where P-HCAs are located adjacent to officially protected public and commercial buildings. The DHCA boundaries and extent of urban development influence the storage of P-HCA. The approach and method proposed in this study not only provide reference for the conservation and replenishment of the historic districts in China, but are also applicable for other countries.

Purpose: The optimal treatment following endocrine therapy (ET) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) has not been established. We aimed to investigate treatment patterns and time to treatment failure (TTF) of subsequent therapy after palbociclib in a Japanese real-world setting. Methds: This retrospective observational study used de-identified data of patients with advanced breast cancer treated with palbociclib, using a nationwide claims database (April 2008 to June 2021). Measures included the type of subsequent therapies after palbociclib (endocrine-based therapy: ET alone, ET + CDK4/6i, and ET + mammalian target of rapamycin inhibitor [mTORi]; chemotherapy; chemotherapy + ET; and others) and their TTFs. The median TTF and 95% confidence interval (CI) were estimated using the Kaplan-Meier method. Results: Of 1170 patients treated with palbociclib, 224 and 235 received subsequent therapies after first- and second-line palbociclib treatment, respectively. Among them, 60.7% and 52.8% were treated with endocrine-based therapies as first subsequent therapy, including ET + CDK4/6i (31.2% and 29.8%, respectively). The median TTF (95% CI) of ET alone, ET + CDK4/6i, and ET + mTORi as first subsequent therapy after first-line palbociclib were 4.4 (2.8–13.7), 10.9 (6.5–15.6), and 6.1 (5.1–7.2) months, respectively. No apparent relationship between the treatment duration of prior ET + palbociclib and subsequent abemaciclib was observed. Conclusion: This real-world study revealed that one-third of the patients received sequential CDK4/6i after ET + palbociclib, and treatment duration of ET + CDK4/6i following ET + palbociclib was the longest among the treatment options. Further data are awaited to determine whether ET + targeted therapy with CDK4/6i and mTORi provides acceptable treatment options following ET + palbociclib.

Abstract Background With advances in breast cancer treatment, the importance of de-escalation therapy to reduce harm during the treatment of elderly patients has attracted attention in recent years. Certain patient populations are expected to have a superior response to anti-HER2 drugs, particularly those with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer. In this report, we describe our experience of dramatic anti-HER2 drug response in a patient who achieved pathological complete response (pCR) with a single dose of trastuzumab. Case presentation An 88-year-old woman presented with a 2-cm palpable mass in the left breast. Vacuum-assisted breast biopsy, ultrasonography, and positron emission tomography–computed tomography revealed estrogen receptor-negative and HER2-positive, T1N0M0, stage I breast cancer. Mastectomy was scheduled within 2 months of the initial visit; however, the patient was anxious about the length of the waiting period and requested medication in the interim. Therefore, prior to surgery, one cycle of trastuzumab monotherapy was administered at the discretion of the attending physician. Postoperative pathology showed no remnant of invasive carcinoma and pCR with only a 0.2-mm ductal carcinoma in situ remnant. The patient refused further medication after surgery because of severe diarrhea after trastuzumab administration. Postoperative treatment was limited to follow-up, and no recurrence was observed at 1 year and 6 months postoperatively. Conclusion This case suggests that trastuzumab monotherapy may be effective in certain patients with HER2-positive breast cancer. In the future, identifying patients who are more likely to respond to trastuzumab, as in this case, will allow for more options regarding de-escalation therapy without chemotherapy, particularly in elderly patients who are concerned about the side effects of chemotherapy.

ABSTRACT Aims/Introduction The discrepancy between HbA1c and glucose exposure may have significant clinical implications; however, the association between the hemoglobin glycation index (HGI) and clinical parameters in type 1 diabetes remains controversial. This study aimed to find the factors associated with HGI (laboratory HbA1c − predicted HbA1c derived from the continuous glucose monitoring [CGM]). Materials and Methods We conducted a cross‐sectional study of adults with type 1 diabetes (n = 211, age 50.9 ± 15.2 years old, female sex = 59.2%, duration of CGM use = 2.1 ± 1.0 years). All subjects wore the CGM for 90 days before HbA1c measurement. Data derived from the FreeStyle Libre sensor were used to calculate the glucose management indicator (GMI) and glycemic variability (GV) parameters. HGI was defined as the difference between the GMI and the laboratory HbA1c levels. The participants were divided into three groups according to the HGI tertile (low, moderate, and high). Multivariate regression analyses were performed. Results The female sex ratio, HbA1c, and % coefficient of variation (%CV) significantly increased over the HGI tertile, while eGFR and Hb decreased over the HGI tertile. In multivariate analysis, the factors associated with HGI were %CV and eGFR, after adjusting for HbA1c level and sex (R2 = 0.44). Conclusions This study demonstrated that HGI is associated with female sex, eGFR, and some glycemic variability indices, independently of HbA1c. Minimizing glycemic fluctuations might reduce HGI. This information provides diabetic health professionals and patients with personalized diabetes management for adults with type 1 diabetes.

Abstract Background The aim of this study was to determine a predictive indicator of gemcitabine (GEM) efficacy in unresectable pancreatic cancer using tissue obtained by endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). Methods mRNAs extracted from 35 pancreatic tubular adenocarcinoma tissues obtained by EUS-FNA before GEM-treatment were studied. mRNAs were amplified and applied to a Focused DNA Array, which was restricted to well-known genes, including GEM sensitivity-related genes, deoxycytidine kinase (dCK), human equilibrative nucleoside transporter 1 (hENT1), hENT2, dCMP deaminase, cytidine deaminase, 5'-nucleotidase, ribonucleotide reductase 1 (RRM1) and RRM2. mRNA levels were classified into high and low expression based on a cut-off value defined as the average expression of 35 samples. These 35 patients were divided into the following two groups. Patients with partial response and those with stable disease whose tumor markers decreased by 50% or more were classified as the effective group. The rest of patients were classified as the non-effective group. The relationship between GEM efficacy and mRNA expression was then examined by chi-squared test. Results Among these GEM sensitivity-related genes, dCK alone showed a significant correlation with GEM efficacy. Eight of 12 patients in the effective group had high dCK expression, whereas 16 of 23 patients in non-effective group had low dCK expressions (P = 0.0398). Conclusion dCK mRNA expression is a candidate indicator for GEM efficacy in unresectable pancreatic cancer. Quantitative mRNA measurements of dCK using EUS-FNA samples are necessary for definitive conclusions.

The study evaluated a recently postponed national test policy on the use of external agencies' English tests measuring four skills for Japanese university admission purposes. Using Kunnan's principles of fairness and justice, we generated and evaluated three claims regarding the test policy: vocabulary coverage of the tests, the justifiability of the Common European Framework of References for Languages (CEFR)-based concordance table, and tests' impact on teaching and learning productive skills. Scrutinizing the backing and rebuttal evidence from the test agencies' voices to the key literature, we arrived at a partial acceptance of all three claims with the need for further research, calling into question a optimistic outlook underlying the test policy.

The purpose of the present study is to examine whether performance on the "TOEFL iBT"® Reading practice test is affected by 3 different levels of feedback provided to learners upon completion of reading exercises: (a) correctness of learner response (the knowledge of correct results [KCR] feedback), (b) KCR feedback and rationales for correct/incorrect answers, and (c) KCR feedback and the rationales along with on-demand video lectures. Japanese learners of English completed 18 reading exercises and reviewed the results by using the type of feedback provided to the group to which each learner had been assigned. They also completed 2 TOEFL iBT Reading test forms: 1 as a pretest and 1 as a posttest. A multilevel modeling analysis of data from 193 participants who completed the study showed that despite a gain of over 3 scaled score points on the TOEFL iBT Reading test from the pretest to the posttest, the level of feedback was not found to affect the test score. A learner background variable, previous knowledge about the TOEFL iBT test, was identified as a predictor positively related to the test score. Moreover, a series of ANOVAs conducted on learner survey data suggested that the level of feedback affected the degree to which study participants perceived the usefulness of the study materials in understanding different item types that appear on the TOEFL iBT Reading section and in developing strategies for understanding the gist of the text within a short time.

Abstract Background Stroke remains a major public health concern in the United States and a leading cause of long-term disability in adults. Dynamic body weight support (DBWS) systems are popular technology available for use in clinical settings such inpatient rehabilitation. However, there remains limited studies in such inpatient settings that compare DBWS to standard of care (SOC) using real world outcome measures. For survivors of acute ischemic stroke, we determine if incorporating a dynamic body weight support (DBWS) system into inpatient therapy offers greater improvement than standard of care (SOC). Methods A retrospective chart review included 52 individuals with an acute ischemic stroke admitted to an inpatient rehabilitation facility. Functional Independence Measure (FIM) data, specifically changes in FIM at discharge, served as the primary outcome measure. Patient cohorts received either therapies per SOC or therapies incorporating DBWS. Regardless of cohort group, all patients underwent therapies for 3 h per day for 5 days a week. Results For both groups, a statistically and clinically significant increase in total FIM (P

Purpose: To gauge the effects of treatment practices on prognosis for older patients with HER2-positive early breast cancer, particularly to determine whether adjuvant trastuzumab alone can offer benefit over no adjuvant therapy. This is a prospective cohort study which accompanies the RESPECT that is a randomized-controlled trial (RCT). Methods: Patients who declined the RCT were treated based on the physician's discretion. We studied the 1) trastuzumab-plus-chemotherapy group, 2) trastuzumab-monotherapy group, and 3) non-trastuzumab group (no therapy or anticancer therapy without trastuzumab). The primary endpoint was disease-free survival (DFS), which was compared using the propensity-score method. Relapse-free survival (RFS) and health-related quality of life (HRQoL) were assessed. Results: We enrolled 123 patients aged over 70 years (median: 74.5). Treatment categories were: trastuzumab-plus-chemotherapy group (n = 36, 30%), trastuzumab-monotherapy group (n = 52, 43%), and non-trastuzumab group (n = 32, 27%). The 3-year DFS was 96.7% in trastuzumab-plus-chemotherapy group, 89.2% in trastuzumab-monotherapy group, and 82.5% in non-trastuzumab group. DFS in non-trastuzumab group was lower than in trastuzumab-plus-chemotherapy and trastuzumab-monotherapy groups (propensity-adjusted hazard ratio; HR: 3.29; 95% CI: 1.15–9.39; P = 0.026). The RFS in non-trastuzumab group was lower than in trastuzumab-plus-chemotherapy and trastuzumab-monotherapy groups (propensity-adjusted HR = 7.80; 95% CI: 2.32–26.2, P