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In 2023, the manufacturing of all the ITER TF coils has been completed 15 years after the sign of procurement arrangements in 2008. This paper has been jointly submitted by F4E and QST to recollect the lessons learnt in the production of the two parties along the last 15 years.

Background: Purpose of the present systematic review is to investigate preclinical evidence in favor of the working hypothesis of efficacy of cannabinoids in ocular pain treatment. Methods: Literature search includes the most relevant repositories for medical scientific literature from inception until November, 24 2021. Data collection and selection of retrieved records adhere to PRISMA criteria. Results: In agreement with a priori established protocol the search retrieved 2471 records leaving 479 results after duplicates removal. Eleven records result from title and abstract screening to meet the inclusion criteria; only 4 results are eligible for inclusion in the qualitative synthesis impeding meta-analysis. The qualitative analysis highlights the antinociceptive and anti-inflammatory efficacy of Δ8-tetrahydrocannabinol, cannabidiol and its derivative HU-308 and of new racemic CB1 allosteric ligand GAT211 and its enantiomers GAT228 and GAT229. Moreover, CB2R agonists RO6871304 and RO6871085 and CB2R ligand HU910 provide evidence of anti-inflammatory efficacy. CB2 agonist HU308 reduces of 241% uveitis-induced leukocyte adhesion and changes lipidome profile. Methodological and design issues raise concern of risk of bias and the amount of studies is too small for generalization. Furthermore, the ocular pain model used can resemble only inflammatory but not neuropathic pain. Conclusions: The role of the endocannabinoid system in ocular pain is underinvestigated, since only two studies assessing the effects of cannabinoid receptors modulators on pain behavior and other two on pain-related inflammatory processes are found. Preclinical studies investigating the efficacy of cannabinoids in ocular inflammatory and neuropathic pain models are needed to pave the way for clinical translation.

Abstract Background Aging‐related degeneration of elastic fibres causes skin wrinkles and loss of elasticity. A correlation has been reported between dermal elastic fibre degradation and wrinkles. However, the mechanism of wrinkle formation is complex and unclear. To establish methods for treating wrinkles, it is necessary to understand the aging‐related morphological alterations underlying elastin fibre degradation or disappearance. Objectives To image and analyse aging‐related three‐dimensional (3D) morphological alterations of elastic fibres in the eyelid and abdominal skin. Methods Excised human eyelid and abdominal skin tissues were examined. The structure of elastic fibres in the skin tissues was examined via nuclear, tropoelastin and fibrillin‐1 immunostaining. Then, 3D imaging was performed using a confocal laser microscope and tissue decolourization technology. Images were analysed using a computational method. Results The decolourization technology made it possible to image elastin fibres in 3D, and we devised a method for analyzing the elastin fibre structure using computational methods. It was quantitatively shown that the eyelid skin has a more complex fibrous structure than the abdomen, and the fibres became curved, shortened and thickened with age. Conclusions We provide a novel 3D analysis method for elastin fibres and report age‐related alterations in elastin fibre structure in the human eyelid and abdominal skin. This method contributes to the understanding of elastin fibre degeneration in more detail than conventional methods. Applying this 3D analysis method to skin tissues will contribute to a better understanding of age‐related changes in fibres and to the development of novel wrinkle treatments.

Ice core derived marine biogenic sulphate does not agree with marine sediment records. Here based on new ice core records spanning the past 720,000 years obtained from Dome Fuji the authors propose that dust contributed a higher percentage of sulphate aerosols than previously thought.

Theoretical studies of quantum magnetism typically assume idealised lattices with freely tunable parameters, which are difficult to realise experimentally. Zvyagin et al. perform challenging measurements at high pressures to tune and to accurately monitor the exchange parameters of a triangular lattice antiferromagnet.

Feedback-controlled electromigration (FCE) has been employed to control atomic junctions with quantized conductance. An FCE scheme is controlled by many parameters, such as the threshold differential conductance GTH, feedback voltage VFB, and voltage step VSTEP. It is considered possible to achieve a precise and stable control of the quantized conductance by automatically optimizing the FCE parameters. This motivated us to develop an approach based on machine learning (ML) to tune the feedback parameters of FCE. The ML system is composed of three kinds of engines, namely, learning, evaluation, and inference. The learning engine performs the FCE procedure with random parameters, collects various experimental data, and updates the database. Subsequently, four variables and a cost function are defined to evaluate the controllability of the quantized conductance. The evaluation engine scores the experimental data by using the defined cost function. Then, the control quality is evaluated in real time during the FCE procedure. The inference engine selects the new FCE parameter according to the evaluated data. These engines determine the optimal parameters without human intervention and according to the situation. Finally, we actually applied this system to the FCE procedure. The parameter is selected from sample data in the database according to the variation in controllability. As a result, the controllability gradually improves during the FCE procedure that uses the ML system. The results indicate that the proposed ML system can evaluate the controllability of the FCE procedure and change the VFB parameter in real time according to the situation.

Small-cell lung cancer (SCLC) is a subgroup of lung cancer with a high frequency of liver metastasis, which is a predictor of poor prognosis. Diffuse liver metastases of SCLC with no visible nodular lesions in the liver when examined using computed tomography (CT) are relatively rare; however, a few cases with rapid progression to acute liver failure that were diagnosed after death have been reported. In this paper, we report a 63-year-old man with diffuse liver metastases of SCLC that were histologically diagnosed using a transjugular liver biopsy while the patient was alive, even though no lesions were visible during a contrast-enhanced CT examination.

The spatial distribution of the source-receptor relationship (SRR) of sulfur over Northeast Asia was examined using a chemical transport model (RAQM) off-line coupled with a meteorological model (MM5). The simulation was conducted for the entire year of 2002. The results were evaluated using monitoring data for six remote stations of the Acid Deposition Monitoring Network in East Asia (EANET). The modeled SO2 and O3 concentrations agreed well with the observations quantitatively. The modeled aerosol and wet deposition fluxes of SO42− were underestimated by 30 % and 50 %, respectively. The domain was divided into 5 source-receptor regions: (I) North China; (II) Central China; (III) South China; (IV) South Korea; and (V) Japan. The sulfur deposition in each receptor region amounted to about 50–75 % of the emissions from the same region. The largest contribution to the deposition in each region was originated from the same region, accounting for 53–84 %. The second largest contribution was due to Region II, supplying 14–43 %. The spatial distributions of the SRRs revealed that subregional values varied by about two times more than regional averages due to nonuniformity across the deposition fields. Examining the spatial distributions of the deposition fields was important for identifying subregional areas where the deposition was highest within a receptor region. The horizontal distribution changed substantially according to season.

The magnetic field and plasma structures during two successive crossings of the subsolar magnetospheric boundary layers (i.e. MagnetoPause Current Layer (MPCL) and Low-Latitude Boundary Layer (LLBL)) under the southward-dawnward IMF are examined on the basis of the data obtained by the GEOTAIL spacecraft. A significant and interesting feature is found, that is, Flux Transfer Events (FTEs) occur in association with the formation of the tilted X-line. During the first inbound MPCL/LLBL crossing, the ion velocity enhancement (in particular, the Vl component negatively increases) can be observed in association with simultaneous typical bipolar signature (positive followed by negative) in the Bn component. In addition, a clear D-shaped ion distribution whose origin is the magnetosheath can also be found in the dawnward direction. A few minutes later, the satellite experiences outbound MPCL crossing. The negative enhancement of the Vm component can be found as well as the positive enhancement of the Vl component. Simultaneously, a typical bipolar signature with the polarity (negative followed by positive) opposite that observed in the first encounter can also be observed. The ions from the magnetosheath flow predominantly in the duskward direction, although the D-shaped ion distribution cannot be observed. These results indicate that the satellite initially observes one part of a reconnected flux tube formed by FTEs whose magnetospheric side is anchored to the Southern Hemisphere. The ions confined in this partial flux tube are flowing in the south-dawnward direction. Then, the satellite observes the other part of the reconnected flux tube whose magnetospheric side is anchored to the Northern Hemisphere. The ions confined in this flux tube flow dominantly in the north-duskward direction. Furthermore, it can be considered that the second MPCL crossing is a direct cut through the diffusion region of FTEs because the LLBL is absent in the vicinity of the MPCL. On the basis of these results, it can be concluded that the satellite was passing near the tilted X-line. The information obtained through this study is expected to be of great use in discriminating between the anti-parallel (steady-state) reconnection and tilted X-line models on the dayside MPCL.

A high-acceleration-gradient linear accelerator (LINAC) for an x-ray free electron laser (XFEL) offers the advantages of a short accelerator length and low construction costs. In addition, the high pulse repetition rate of the LINAC, which can drive multiple x-ray beam lines, provides additional user opportunities for experiments involving XFEL. A C-band disk-loaded-type accelerating structure was developed to achieve a high acceleration gradient of >50 MV/m and an rf-pulse repetition rate of 120 pps, which is twice as high as that of the XFEL facility, SACLA (60 pps). The structure has a quasiconstant gradient and a traveling wave type with an accelerating mode of TM01−2π/3. To reduce the surface electric fields, we employed a cross section with an ellipsoidal curvature around an iris aperture. The accelerating structure was manufactured for SACLA. High-power rf conditioning was conducted to investigate its performance. Owing to the conditioning, the acceleration gradient reached a value of more than 50.1 MV/m. The structure was operated without any serious issues at a repetition rate of 120 pps. The accelerating structures were installed in the dedicated accelerator for EUV-FEL at SACLA beam line-1. Finally, we obtained accelerated electron beams with the structures operated at an acceleration gradient of 41.4 MV/m.

We have developed a simple and safe method for the determination of a transcription-initiation site. In this method, reverse transcriptase of the avian myeloblastosis virus or rTth DNA polymerase from Thermus thermopilus was used with a fluorescein isothiocyanate (FITC)-labeled primer. The primer-extension reaction can be performed at a high temperature, which reduces the hindering effect of the secondary structure in RNA, and can omit the annealing step between RNA and the primer. Almost all steps can be done in one tube. This procedure can provide reliable and reproducible data when compared with the conventional procedure at low temperature. Moreover, the sequencing ladder that is required for determining the position of extended products can be obtained with the same FITC-labeled primer.

An electron linac using a C-band rf frequency, 5.712 GHz, has enabled us to obtain an acceleration gradient of more than 35 MV/m reliably. A C-band accelerator system has been developed and constructed for the compact x-ray FEL facility, SACLA, in order to fit within the available site length at SPring-8, and to reduce construction costs. An accelerator unit consists of two 1.8 m-long accelerator structures, a cavity-type rf pulse compressor and a 50 MW pulsed klystron. In order to achieve a compact rf source and to obtain extremely stable rf fields in the accelerator structures, an oil-filled, high-voltage pulse modulator combined with an extremely stable, inverter-type, high voltage charger was developed. SACLA uses 64 sets of these accelerator units in order to achieve a final beam energy of 8.5 GeV. After rf conditioning for 1 700 hours, the maximum acceleration gradient achieved was 38 MV/m. The typical trip rate for each accelerator unit at 35 MV/m and 30 pps is about once per day. Dark current from the accelerator structures is less than 5 pC, which causes a negligible effect on the beam monitors. The phase and amplitude stability of the rf fields were measured to be 0.03 degree and 0.01% rms, respectively, which is sufficient for the XFEL operation of SACLA. Since the first beam commissioning in 2011, the C-band accelerator has demonstrated fairly stable performance under continuous operation for 20 000 hours.

Highly L10-ordered FePt thin films with a strong (001) texture were successfully fabricated on amorphous substrates simply by co-sputtering and rapid thermal annealing at a low temperature of 400 °C. The morphology of FePt thin films depended strongly on the heating rate, changing from a continuous structure with an atomically flat surface to an island-like structure. The change of the morphology resulted in a drastic increase of coercivity, indicating that the magnetization process could be controlled by the heating condition. This fabrication method of ordered FePt thin films is favorable in view of the compatibility for a practical device fabrication process.

A beam-monitor system for XFEL/SPring 8, “SACLA,” has been constructed. In order to maintain a stable self-amplified spontaneous emission (SASE) interaction, the straightness and overlap of the axes to within 3 μm between the electron beams and the radiated x rays for an undulator section of about 100 m length is necessary. This straightness means relative alignment to an experimental target sample. Furthermore, a temporal stability of 30 fs in order to maintain a constant peak beam current is also necessary to conduct stable SASE lasing. The monitor system was developed to satisfy these spatial and temporal stability and resolution criteria. The system comprises spatial monitors, such as cavity-type beam-position monitors and screen monitors, as well as temporal measurement instruments, such as current monitors, waveguide spectrometers, coherent synchrotron-radiation detectors, a streak camera, and an rf deflector. Commissioning of SACLA started from March 2011, and the monitors performed sufficient roles to tune the beams for lasing. The achieved overall performances of the system, including data acquisition, are: the beam position monitor has a spatial resolution of 600 nm in rms; the bunch-length monitors show ability to observe bunch lengths from 1 ns in an injector with velocity bunching to less than 30 fs after three-stage bunch compressors. The less than 3 μm spatial resolution of the screen monitor was also confirmed during practical beam operation. Owing to these fulfilled performances, such as the high spatial and temporal resolutions, stable lasing of SACLA has been achieved.

Objective: To compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization in patients with congenital heart disease., Design: Retrospective observational study., Setting: A single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually., Participants: Patients younger than 15 years who underwent cardiac catheterization under general anesthesia between March 1, 2021, and December 31, 2022. Exclusion criteria were general anesthesia maintained with other than remimazolam or sevoflurane, receipt of remifentanil, American Society of Anesthesiologists score 4 or 5, emergency procedures, and no direct arterial pressure measurement., Interventions: General anesthesia was maintained with remimazolam or sevoflurane., Measurements and Main Results: A total of 309 patients were analyzed, including 28 in the remimazolam group and 281 in the sevoflurane group. Propensity score matching adjusted for confounding factors resulted in 28 patients in each arm, with no apparent differences in background factors. Hypotension was defined as a time-averaged area > 1, in which systolic arterial pressure fell below 80% of the baseline from the start of anesthesia to the end of procedure. The significance level was set at P < .05. The incidence of hypotension was 39.3% in the remimazolam arm and 46.4% in the sevoflurane arm, with no significant difference (P = .79), although the ratio of the median systolic arterial pressure to the baseline value was significantly higher in the remimazolam arm (91.4 ± 15.2% vs 83.2 ± 11.4% in the sevoflurane arm; P = .03)., Conclusions: Remimazolam was not associated with a lower incidence of hypotension compared to sevoflurane during pediatric cardiac catheterization for congenital heart disease while maintaining significantly higher blood pressure overall., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The small intestine and liver play important role in determining oral drug's fate. Both organs are also interconnected through enterohepatic circulation, which imply there are crosstalk through circulating factors such as signaling molecules or metabolites that may affect drug metabolism. Coculture of hepatocytes and intestinal cells have shown to increase hepatic drug metabolism, yet its crosstalk mechanism is still unclear. In this study, we aim to elucidate such crosstalk by coculturing primary human hepatocytes harvested from chimeric mouse (PXB-cells) and iPSc-derived intestinal cells in a microphysiological systems (MPS). Perfusion and direct oxygenation from the MPS were chosen and confirmed to be suitable features that enhanced PXB-cells albumin secretion, cytochrome P450 (CYP) enzymes activity while also maintaining barrier integrity of iPSc-derived intestine cells. Results from RNA-sequencing showed significant upregulation in gene ontology terms related to fatty acids metabolism in PXB-cells. One of such fatty acids, arachidonic acid, enhanced several CYP enzyme activity in similar manner as coculture. From the current evidences, it is speculated that the release of bile acids from PXB-cells acted as stimuli for iPSc-derived intestine cells to release lipoprotein which was ultimately taken by PXB-cells and enhanced CYP activity., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Remimazolam is a new ultrashort-acting benzodiazepine sedative, the use of which has not been reported for pediatric cardiac surgery. This case report describes the use of remimazolam in a 6-year-old girl who underwent minimally invasive cardiac surgery with right-sided thoracotomy for an atrial septal defect. Under electroencephalographic monitoring, remimazolam (2-4 mg kg-1 h-1) and remifentanil (0.05 μg kg-1 min-1) were administered with an intercostal nerve block during the procedure. The patient awoke and was extubated promptly after surgery, without any serious adverse events, including intraoperative awareness. Remimazolam may be a viable option for general anesthesia during pediatric cardiac surgery., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Hemolysis is a complication of cardiopulmonary bypass (CPB). Carboxyhemoglobin (COHb) and methemoglobin (MetHb) were suggested as potential hemolysis biomarkers. This retrospective study was based on a prospective registry aimed to determine the association of COHb and MetHb levels with hemolysis in pediatric patients <4 years old who underwent cardiac surgery with CPB. Plasma-free hemoglobin (PFH), COHb, and MetHb levels were measured before CPB; every 30 minutes during CPB; and on postoperative days 1, 2, and 3. Patients were classified into hemolysis and nonhemolysis groups based on the maximum PFH levels during CPB. A total of 193 patients were included. No significant difference was observed in the maximum COHb levels during CPB (COHb CPB ) between the hemolysis and nonhemolysis groups (1.2% [interquartile range {IQR} 0.9-1.4%] vs. 1.1% [IQR: 0.9-1.4%]; p = 0.17). The maximum MetHb levels during CPB (MetHb CPB ) were significantly higher in the hemolysis group than in the nonhemolysis group (1.3% [IQR: 1.1-1.5%] vs. 1.2% [IQR: 1.0-1.4%]; p = 0.007). Areas under the receiver operating curves of COHb CPB and MetHb CPB were 0.557 (95% confidence interval: 0.475-0.640) and 0.615 (95% confidence interval: 0.535-0.695), respectively. Therefore, the predictive ability of both hemolysis biomarkers during CPB is limited., Competing Interests: Disclosure: S.K. received research funding “Grant-in-Aid for Research Activity Start-up” from the Japan Society for the Promotion of Science. The other authors have no conflicts of interest to report., (Copyright © ASAIO 2023.)

Background: Studies have reported a poor diet quality among children in Ghana and other developing countries. Inadequate dietary diversity among children may lead to deficiencies in micronutrient intake necessary for growth and other cognitive functions. Understanding factors associated with infants' diverse diets is a key step to promoting adequate infant and young child nutrition. This study sought to determine the factors associated with food consumption and dietary diversity (DD) among infants., Methods: In this cross-sectional study among 1503 mothers-infant (aged 6-18 months) pairs from rural, urban, and peri-urban districts of Ashanti Region, factors associated with food consumption and DD were evaluated. The FAO 18-food group DD questionnaire was used to determine previous food group intake, while a structured questionnaire was used to capture data on the mother's socio-demographic parameters and child morbidity. Data were analyzed using descriptive statistics, the Chi-square test, and binary logistic regression to compare mothers and infants who had adequate and inadequate DDS of 9 out of 18 food groups and the predictors of dietary diversity., Results: About 64.7% of the infants did not meet the minimum dietary diversity. Over two-third (77.4%) of the children consumed maize porridge the previous day. Foods which were less consumed included vegetables (35%), animal milk (38.9%), and meat (organ 14%, any meat 26%). The mean food group intake from 18 food groups was 7.0, and the majority (64.7%) did not meet the recommended 9 food group intake. Significantly more younger children (6-11 months) (74%, p<0.001) compared with older children (12-18 months) (52.5%) did not meet the minimum DDS. Also compared with the older children, the younger ones had above two times increased odds of inadequate DD (OR = 2.5, p<0.001, 95% CI = 1.4-4.4). When controlled for gender, children from peri-urban areas (OR = 5.2, p = 0.260, 95% CI = 0.2-93.2) and rural areas (OR = 1.8, p = 0.650, 95% CI = 0.2-9.3) had increased odds of lower DD than urban children. Children of unemployed caregivers had an increased odds of low DD (OR = 2.3 p<0.001, 95% CI 1.7-3.2) compared with children of employed caregivers. Finally, children of caregivers with better nutrition knowledge (nine correct answers from 12 questions) had lower odds of having lower dietary diversity (adjusted OR = 0.9, p = 0.85, 95%CI = 0.5-1.6) than those with less knowledge., Conclusions: Low DD was common among infants and associated with infants age, caregivers' areas of residence, employment status, and level of nutrition education. Children who did not meet the minimum dietary diversity were not fed particular foods such as vegetables, animal milk, and organ meat. Proper maternal nutrition education and feeding practices targeting age-specific needs and community livelihood support systems are necessary to improve dietary diversity of infants., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Opoku Agyemang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: This study investigated the incidence of postoperative pulmonary complications (PPC) when high-flow nasal cannula therapy (HFNC) is used prophylactically after pediatric cardiac surgery, and evaluated its efficacy., Methods: This was a single-arm prospective interventional study that was conducted in a tertiary teaching hospital with eight beds in the pediatric cardiac ICU after approval by the Ethics Committee. One-hundred children under the age of 48 months who were scheduled for cardiac surgery for congenital heart disease were recruited. HFNC was used for 24 h after extubation at a 2 L/kg/min flow rate. The primary outcome was the incidence of PPC within 48 h after extubation. PPC was defined as atelectasis and acute respiratory failure meeting certain criteria. We considered prophylactic HFNC as effective if the prevalence of PPC was < 10%, based on previous reports of reintubation rates of 6%-9% after pediatric cardiac surgery., Results: A total of 91 patients were finally included in the analysis. The incidence of PPC within 48 h after extubation was 18.7%, whereas atelectasis was observed in 13.2%, and acute respiratory failure in 8.8%. Reintubation rate within 48 h after extubation was 0%., Conclusions: We found the incidence of PPC with prophylactic HFNC after planned extubation after pediatric cardiac surgery. However, the incidence was > 10%; therefore, we could not demonstrate its efficacy in this single-arm study. Further studies are needed to investigate whether the HFNC could be adapted as first-line oxygen therapy after pediatric cardiac surgery., (© 2023. The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.)

Nearly half of the world's population is at risk of being infected by Plasmodium falciparum, the pathogen of malaria. Increasing resistance to common antimalarial drugs has encouraged investigations to find compounds with different scaffolds. Extracts of Artocarpus altilis leaves have previously been reported to exhibit in vitro antimalarial activity against P. falciparum and in vivo activity against P. berghei. Despite these initial promising results, the active compound from A. altilis is yet to be identified. Here, we have identified 2-geranyl-2', 4', 3, 4-tetrahydroxy-dihydrochalcone (1) from A. altilis leaves as the active constituent of its antimalarial activity. Since natural chalcones have been reported to inhibit food vacuole and mitochondrial electron transport chain (ETC), the morphological changes in food vacuole and biochemical inhibition of ETC enzymes of (1) were investigated. In the presence of (1), intraerythrocytic asexual development was impaired, and according to the TEM analysis, this clearly affected the ultrastructure of food vacuoles. Amongst the ETC enzymes, (1) inhibited the mitochondrial malate: quinone oxidoreductase (PfMQO), and no inhibition could be observed on dihydroorotate dehydrogenase (DHODH) as well as bc 1 complex activities. Our study suggests that (1) has a dual mechanism of action affecting the food vacuole and inhibition of PfMQO-related pathways in mitochondria., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest in this study., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This multicentre, phase 2, randomized, controlled study of allogeneic haematopoietic stem cell transplantation (allo-HSCT) recipients compared the immunogenicity of two anti-pneumococcal vaccine regimens: four doses of 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) (3+1+1 experimental group), and three doses of PCV13 followed by PPSV23 (3+0+1 group)., Methods: Allo-HSCT recipients without active graft-versus-host disease at enrolment were eligible. The primary endpoint was the IgG response rate (≥0.20 mg/mL) for all eight measured serotypes at 5 months after the PPSV23 booster., Results: Seventy-two recipients were randomized, and seventy recipients who received over one PCV13 dose were analysed. The mean ages were 47.2 years (standard deviation, 14.4) in the 3+1+1 group (n = 35) and 49.0 years (standard deviation, 14.3) in the 3+0+1 group (n = 35). There was no significant difference in the overall IgG response rate at 5 months after the PPSV23 booster between the 3+1+1 and 3+0+1 groups (100% (26/26) vs. 93% (27/29), respectively, relative risk (RR): 1.07; 95% confidence interval (CI): 0.97-1.19). This rate was high immediately before the PPSV23 booster in the 3+1+1 group (100% (26/26) compared with 81% (21/26), respectively, RR: 1.24; 95% CI: 1.03-1.49), but this difference disappeared 1 month after the PPSV23 booster (100% (26/26) vs. 97% (28/29), respectively, RR: 1.04; 95% CI; 0.97-1.11). No serious adverse events leading to study dropout occurred., Discussion: We were not able to determine the efficacy of the experimental arm based on the IgG response rate at 5 months after the PPSV23 booster in allo-HSCT recipients., (Copyright © 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)