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Abstract Background Endoscopic submucosal dissection (ESD) is a potentially efficient therapeutic intervention for superficial esophageal cancer. Additional treatment such as chemoradiotherapy (CRT) or esophagectomy is recommended in cases of muscularis mucosa invasion with positive resection margins or lymphovascular invasion or submucosal layer invasion, which are considered noncurative ESD, due to an increased risk of lymph node metastasis. However, the adequacy of additional CRT after near-circumferential or full-circumferential noncurative ESD has not been fully discussed. In this study, we retrospectively evaluated the efficacy and toxicity of additional CRT for superficial esophageal squamous cell carcinoma (SCC) after near-circumferential or full-circumferential noncurative ESD, which was defined as a mucosal defect measuring ≥ 3/4 of the esophageal circumference. Methods We retrospectively evaluated 24 patients who received additional CRT for superficial esophageal SCC after near-circumferential or full-circumferential noncurative ESD between 2012 and 2018. Elective nodal irradiation (ENI) was performed in all patients and boost irradiation (BI) was performed after ENI in 4 patients with positive resection margins. The prescription doses of ENI and BI were 41.4 Gy in 23 fractions and 9 Gy in 5 fractions, respectively. Concurrent chemotherapy (a combination of cisplatin or nedaplatin and 5-fluorouracil) was administered to all patients. Results The 3-year and 5-year overall survival rates were 92% and 78%, respectively, while the 3-year and 5-year progression-free survival rates were 83% and 70%, respectively. Grade 2 esophageal stenosis occurred in 8 (33%) patients. There was no case of Grade 3 or worse esophageal stenosis. Among them, 4 (17%) patients developed stenosis before additional CRT, which persisted after the completion of additional CRT. The remaining 4 (17%) patients developed de novo stenosis within 5 months following the completion of additional CRT. One patient (4%) still requires regular bougie dilation. Grade 3 and Grade 4 acute toxicity, including anemia, neutropenia, thrombocytopenia, and esophagitis occurred in 1 (4%) and 0 (0%), 6 (25%) and 1 (4%), 1 (4%) and 0 (0%), and 1 (4%) and 0 (0%) patients, respectively. One (4%) patient who underwent salvage CRT for the out-of-field lymph node recurrence died with acute myeloid leukemia. Conclusions Additional CRT is a viable treatment option even in patients who have undergone near-circumferential or full-circumferential noncurative ESD. Esophageal stenosis after additional CRT following near-circumferential or full-circumferential noncurative ESD is manageable and acceptable.

Abstract Introduction This study evaluated the clinical outcomes of stereotactic body radiotherapy (SBRT) for both pathologically diagnosed (PD) and clinically diagnosed (CD) early‐stage non‐small cell lung cancer (NSCLC) and explored the significance of accurate expert computed tomography (CT) interpretation. Methods We retrospectively analyzed 95 patients with early‐stage NSCLC who received SBRT at our institution. Patients were classified into CD and PD groups. Two chest radiologists retrospectively interpreted the pre‐SBRT CT images to determine the tumor subtype and probability of malignancy (PM). Clinical findings, CT features, and treatment outcomes were compared between the two groups. The survival rate of the CD group was analyzed separately according to the PM grade. Results Median overall survival for the CD and PD groups was 6.0 and 5.4 years (P = 0.57), respectively. Median cause‐specific survival was 10.2 years in the CD group and not reached in the PD group (P = 0.76). In the CD group, lung cancer mortality was lower in the low PM group (25% [1 of 4]) than in the high PM group (47.4% [9 of 19]). Conclusion It may be desirable to evaluate the PM of the nodule using expert CT interpretation to decide whether SBRT is indicated in CD early‐stage NSCLC.

In this study, a kerosene-fueled premixed burner system with a thick and large pore-sized (“coarse”) porous matrix was developed to achieve less-soot stable premixed combustion with variable combustion loads, i.e., turn-down ratio, TDR, defined as the ratio between the maximum and minimum loads. The present burner system mainly consists of the thick and coarse porous matrix made by packed ceramic balls of 8 mm-diameter, which acts as a vaporizer, mixer, and flame holder. The liquid fuel is fed into the porous matrix along with air. As the air and vaporized fuel are supplied toward the top-end (surface) of the porous matrix, a premixed flame is formed at this surface. Benefits of the adopted porous matrix include reduced wettability of the liquid fuel to pores of the porous matrix, which prevents its direct supply to the flame, promotes vaporization and mixing, and functions as a flame holder, allowing the flame to be sustained within the porous matrix. Combustion experiments were then carried out under various equivalence ratios (φ) between 0.47 and 1.34, and temperature measurement was conducted to evaluate the vaporization capability within the porous matrix. The experimental results confirmed that the quasi-steady and stable premixed combustion across the entire surface of the porous matrix throughout the burning event was successfully achieved under all φ values considered in this study. A simplified (one-dimensional) analytical model was developed to examine achievable range of TDR. It was found that the expected achievable TDR was higher than the value for the conventional spray combustion technology (∼ 6). Thus, the present burner system with a thick and coarse porous matrix was effective for attaining stable premixed combustion and a high TDR.

Abstract Background Recent developments in mass spectrometry (MS) have revealed target antigens for membranous nephropathy (MN), including phospholipase A2 receptor and exostosin 1/exostosin 2 (EXT1/2). EXT1/2 are known antigens of autoimmune disease-related MN, especially membranous lupus nephritis. We describe the case of an elderly man who developed nephrotic syndrome followed by progressive renal dysfunction. Case presentation A 78-year-old man presented with rapidly progressive renal dysfunction with proteinuria and hematuria. Three years previously, he had developed leg edema but did not receive any treatment. Laboratory tests showed elevated anti-nuclear antibody (Ab), anti-dsDNA Ab titer, and hypocomplementemia, indicating systemic lupus erythematous. Myeloperoxidase anti-neutrophil cytoplasmic Ab (ANCA) and anti-glomerular basement membrane (GBM) Ab were also detected. The renal pathologic findings were compatible with crescentic glomerulonephritis (GN), whereas non-crescentic glomeruli exhibited MN without remarkable endocapillary or mesangial proliferative change. Immunofluorescence microscopy revealed glomerular IgG, C3, and C1q deposition. All IgG subclasses were positive in glomeruli. Anti-PLA2R Ab in serum was negative. MS analysis was performed to detect the antigens of MN, and EXT1/2 was detected in glomeruli. Therefore, we reached a diagnosis of membranous lupus nephritis concurrent with both ANCA-associated vasculitis and anti-GBM-GN. The simultaneous occurrence of these three diseases is extremely rare. Conclusions This is the first report of EXT1/2-related membranous lupus nephritis concurrent with ANCA-associated vasculitis and anti-GBM-GN. This case demonstrates the usefulness of MS in diagnosing complicated cases of MN.

An experimental study was made on burning velocity in powder-gas hybrid combustion in order to investigate the determination factor to alter the burning velocity caused by the addition of power in the premixed gas. A burner system was newly developed to visualize the dynamic flame behavior originally stabilized in a stagnation point flow field. Using the system, the instantaneous burning velocity and burning area by powder loading were obtained and analyzed. It was found that the burning velocity and burning area varied substantially in accordance with the powder loading amount. Data analyses exhibited that a positive correlation was found between them, suggesting that wrinkling shall be a major cause to alter the burning velocity. To understand the mechanism of wrinkle formation, the change of the flow field ahead of the flame with powder loading was measured. It is suggested that the wrinkles could be attributed to the pyrolysis gases evolved in the preheating zone, which could both increase the local burning velocity by increasing the local equivalence ratio and change the flow field due to the divergence flow generated by each powder. Further study would be needed to confirm the suggested mechanism.

Abstract Background Combination chemotherapy is used to treat advanced thymic carcinoma; however, the effects are insufficient. Methods Previously untreated patients with unresectable locally advanced thymic carcinoma received two cycles of 80 mg/m2/day S‐1 orally on days 1–14 plus 60 mg/m2/day cisplatin intravenously on day 1, and concurrent radiotherapy (60 Gy). Results Three patients were enrolled into the study. Toxicity and survival were assessable in all patients, but the treatment response was only assessable in one patient. The study was terminated because of poor case recruitment. The patients' characteristics were as follows: male/female = 2/1; PS 0/1 = 2/1; median age (range) = 59 (55–72); and stage III/IV = 2/1. The patient in which the treatment response was assessed exhibited SD (response rate: 0%). In both nonevaluable cases, the second course of chemotherapy was judged to be post‐protocol treatment because it was delayed by ≥14 days, but a CR and PR were achieved after the end of the study, respectively. G4 leukopenia/neutropenia and G3 febrile neutropenia occurred in one patient each (33%). The median time to tumor progression was 17.6 months, and the 1‐, 2‐, 3‐, and 4‐year survival rates were 67, 33, 33, and 33%, respectively. The median overall survival time was not reached, and the 1‐, 2‐, 3‐, and 4‐year survival rates were 100, 67, 67, and 67%, respectively. Conclusions Although it was difficult to recruit patients, there was a long‐term survivor >4 years who appeared to have achieved a CR, indicating that such chemoradiotherapy may be effective against locally advanced thymic carcinoma.

Purpose: The aim of this study was to understand the income and employment status of patients at the start of and during follow-up after palliative radiation therapy for bone metastasis. Methods and Materials: From December 2020 to March 2021, a prospective multi-institutional observational study was conducted to investigate income and employment of patients at the start of administration of radiation therapy for bone metastasis and at 2 and 6 months after treatment. Of 333 patients referred to radiation therapy for bone metastasis, 101 were not registered, mainly because of their poor general condition, and another 8 were excluded from the follow-up analysis owing to ineligibility. Results: In 224 patients analyzed, 108 had retired for reasons unrelated to cancer, 43 had retired for reasons related to cancer, 31 were taking leave, and 2 had lost their jobs at the time of registration. The number of patients who were in the working group was 40 (30 with no change in income and 10 with decreased income) at registration, 35 at 2 months, and 24 at 6 months. Younger patients (P = 0), patients with better performance status (P = 0), patients who were ambulatory (P = .008), and patients with lower scores on a numerical rating scale of pain (P = 0) were significantly more likely to be in the working group at registration. There were 9 patients who experienced improvements in their working status or income at least once in the follow-up after radiation therapy. Conclusions: The majority of patients with bone metastasis were not working at the start of or after radiation therapy, but the number of patients who were working was not negligible. Radiation oncologists should be aware of the working status of patients and provide appropriate support for each patient. The benefit of radiation therapy to support patients continuing their work and returning to work should be investigated further in prospective studies.

Abstract Background Etoposide plus cisplatin (EP) combined with concurrent accelerated hyperfractionated thoracic radiotherapy (AHTRT) is the standard treatment strategy for unresectable limited‐disease (LD) small cell lung cancer (SCLC), which has remained unchanged for over two decades. Based on a previous study that confirmed the non‐inferiority of amrubicin (AMR) plus cisplatin (AP) when compared with EP for extensive‐disease (ED) SCLC, we have previously conducted a phase I study assessing AP with concurrent TRT (2 Gy/time, once daily, 50 Gy in total) for LD‐SCLC therapy. Our findings revealed that AP with concurrent TRT could prolong overall survival to 39.5 months with manageable toxicities. Therefore, we plan to conduct a phase I study to investigate and determine the effect of AP combined with AHTRT, recommended dose (RD), maximum tolerated dose (MTD), and dose‐limiting toxicity (DLT) of AP in patients with LD‐SCLC. Methods Treatment‐naive patients with LD‐SCLC, age between 20 and 75 years, who had a performance status of 0 or 1 and adequate organ functions will be enrolled. For chemotherapy, cisplatin 60 mg/m2/day (day 1) and AMR (day 1 to 3) will be administered with AHTRT (1.5 Gy/time, twice daily, 45 Gy in total). The initial AMR dose is set to 25 mg/m2/day. RD and MTD will be determined by evaluating toxicities. Discussion Based on our previous study, the initial dose of AMR 25 mg/m2 is expected to be tolerated and acceptable. Here, we aim to determine whether treatment with AP and concurrent AHTRT would be an optimal choice with manageable toxicities for LD‐SCLC.

Capital is viewed as an essential instrument for highly skilled migrants (HSMs) to gain employment in a host country. Although scholars analyse the impact of capital on the labour market integration, the difference between capital and resources is rarely made. Treating resources such as a degree or networks as capital is too unspecific and disguises what is truly counted as capital that affects the occupational attainment of HSMs. This study addresses this issue by analysing what resources are used by HSMs to gain employment in a host country and what makes resources capital in HSMs’ occupational attainment. To do so, the study conducts semi-structured interviews with Japanese from the Finnish university who seek employment in Finland. An analysis of these interviews yields cultural and social resources used during their job search. It also identifies the Finnish job market and the job-seeking intention of highly skilled Japanese as key elements to create capital out of resources. Eventually, this study contributes to the debate on the concept of capital and its role in the labour market integration of HSMs. Furthermore, it offers an extensive viewpoint on the topic of HSMs and integration in the Finnish context through the empirical data.

Abstract Background Tetralogy of Fallot is the most common cyanotic congenital heart disease. Patients with the condition have a high risk of developing chronic kidney disease. Treatment of kidney disease in patients with complex hemodynamics presents unique challenges. However, there are very few reports on the treatment of end-stage renal failure in patients with tetralogy of Fallot. Case presentation We present a rare case of peritoneal dialysis in a 47-year-old man with tetralogy of Fallot who had not undergone intracardiac repair. Peritoneal dialysis successfully removed fluids and solutes without adversely affecting the patient’s hemodynamics. Our patient was managed with peritoneal dialysis for 5 years before he succumbed to sepsis secondary to digestive tract perforation. Conclusions In this paper, we discuss the importance of monitoring acid–base balance, changes in cyanosis, and hyperviscosity syndrome during peritoneal dialysis in patients with tetralogy of Fallot. Lower leg edema and B-type natriuretic peptide level were useful monitoring parameters in this case. This case illustrates that with attention to the patient’s unique requirements, peritoneal dialysis can provide successful renal replacement therapy without compromising hemodynamics in patients with tetralogy of Fallot.

Abstract Background Carbamazepine-induced acute kidney injury is mainly caused by acute tubulointerstitial nephritis. Only one case of carbamazepine-induced eosinophilic granulomatosis with polyangiitis (EGPA) with acute kidney injury has been reported. But the patient’s condition improved with the immediate discontinuation of carbamazepine. We present a case requiring hemodialysis and steroid therapy for carbamazepine-induced EGPA with acute kidney injury. Case presentation A 77-year-old man with allergic rhinitis was prescribed carbamazepine for trigeminal neuralgia 1 year ago. He developed rash and itching on the left forearm 1 month ago and was diagnosed with polymorphic exudative erythema and admitted to our hospital. Laboratory data revealed leukocytosis eosinophilia and renal failure (serum creatinine 9.2 mg/dL). Carbamazepine was discontinued, and hemodialysis was initiated because of acute uremia and oliguria. A lymphocyte stimulation test for carbamazepine was positive. Polyneuropathy in the upper and lower extremities was observed by electromyogram, and a renal biopsy indicated EGPA. The main clinical findings were allergic rhinitis, eosinophilia, and vasculitis symptoms, such as multiple mononeuritis and muscle weakness. Renal biopsy showed diffuse cellular infiltration dominated by eosinophils in the interstitium, with granulomatous changes in particular observed around the arteriole. Fibrinoid necrosis was also observed around the arteriole. We therefore made a diagnosis of carbamazepine-induced EGPA. Following steroid therapy after the discontinuation of carbamazepine, the patient was discharged from our hospital without hemodialysis. In contrast with the previous case of EGPA, the present case had the following characteristics: (1) elderly male patient, (2) hemodialysis required for acute kidney injury, and (3) improved renal function following steroid therapy after discontinuation of carbamazepine. Conclusion Our case report indicates that early diagnosis and appropriate therapy can improve acute kidney injury caused by carbamazepine and allow the patient to discontinue dialysis.

Thymic carcinoma is a rare epithelial tumor of the thymus with a poor prognosis, and multimodal approaches are important for its treatment. Recently, a number of studies have indicated that S‐1 treatment is effective against thymic carcinoma. S‐1 plus cisplatin with concurrent radiotherapy is a commonly used treatment for other malignancies, including non‐small cell lung cancer (NSCLC). In addition, its safety has been confirmed, and it has been reported to have a marked effect against thymic carcinoma. Therefore, we conducted a phase II study of S‐1 plus cisplatin with concurrent thoracic radiotherapy for locally advanced thymic carcinoma, in which the overall response rate was employed as the primary endpoint. The secondary endpoints were overall survival, progression‐free survival, and safety.

Experimental investigations of burning characteristics of a tested specimen consisting of a polyethylene foam soaked in 100 wt% hydrogen peroxide are made. All experiments are carried out in a large volume chamber, which newly introduced in our previous work at an initial pressure range from p = 0.1 to p = 0.35 MPa in absolute with various fuel porosity range from ε = 0.6 to ε = 0.9, which corresponds to global equivalence ratios from φ = 0.51 to φ = 3.8. Temperature measurements using an R-type thermocouple embedded into the specimen are then conducted to investigate thermal structure (e.g., profiles of temperature and temperature gradients and burning surface temperature) of the burning specimen for deep understandings of the burning process. Following forced ignition at top surface of the specimen, steady successive-burning process is successfully observed for all conditions studied in this work. Burning rates (a rate at which the top surface moves downward) are measured by carefully tracking the top surface of the specimen by adopting an image processing software. Findings show that overall burning rates at the rate from 1 to 3.2 mm/s are obtained and influenced by pressure and the fuel porosity. Additionally, results of the direct temperature measurements reveal that the temperature gradient in the gas-phase layer near the top surface (burning surface) of the specimen increases as pressure increases, resulting in an increase in the overall burning rate. The top surface temperature and its pressure dependency, and a global activation energy at the top surface temperature of the specimen are experimentally measured accordingly.

This paper numerically investigated the detail process to appear the asymmetrically spreading flames in narrow channel consisted of combustibles. We have successfully reproduced the transient process to form asymmetrically arranged spreading flame first ever in this work. 2-D, time-dependent mass and energy transport process as well as one-step chemical process in gas-phase is considered. Thick solid combustible plates (PMMA) are placed at both sides, then exactly the same ignition operation is made to initiate symmetrical processes. Pure oxygen is fed into the channel at the fixed rate to promote the spreading. Oxidizer velocity and channel height are varied as numerical parameters in this study. After the forced ignition, the combustibles are pyrolized via one-step reaction to evolve the fuel gas into the gas phase to form the opposed-mode flame spreading. Results show the distinctive three spreading modes (two-symmetric flames spreading, two-asymmetric flames spreading and one flame spreading) and transient process from one to the other mode is successfully simulated, which is hardly achieved in experiment. The asymmetric flame spreading mode appears under the limited combination of channel height and velocity. Moreover the distance between two leading edges of the flame varies depending on the imposed condition. Flow patterns are found to be sinus motion, thus the heated and accelerated oxidizer flow may enhance the reaction in the downstream. In this way, it is suggested that the flowing oxygen is effectively used to burn two fuel slabs. It is obvious that the asymmetrical configuration gives temporary stable condition. To study the details further, systematic study is demanded.

Urachal carcinoma is an extremely rare malignant tumor arising from the urachus in the fetus. We report a patient who developed urachal carcinoma 18 years after kidney transplantation. A 59-year-old man was admitted because of abdominal pain and massive ascites. He had undergone kidney transplantation 18 years earlier and had end-stage renal disease requiring dialysis. Abdominal CT showed massive ascites and an abdominal wall cystic mass separated from the peritoneal cavity. Hemodialysis was started, and paralytic ileus was diagnosed and treated. His ileus symptoms improved temporarily, but he died of myocardial infarction. An autopsy was performed, which revealed cystadenocarcinoma in the abdominal wall mass, leading to a diagnosis of urachal carcinoma.

Background/Aim: To investigate the clinical outcomes of concurrent chemoradiotherapy (CCRT) in patients with cervical esophageal carcinoma and analyze the prognostic factors. Patients and Methods: Thirty-nine patients with cervical esophageal carcinoma were retrospectively identified among consecutive patients who received CCRT between November 2009 and September 2019 at our institution. The patients were treated by intensity-modulated radiation therapy (N=13) or threedimensional conformal radiotherapy (N=26). Results: The median follow-up period was 35 months (range=2-158 months). There were 32 men and 7 women with a median age of 66 years (range=50-83 years). Clinical stages were I in 6 patients, II in 4, III in 19, and IV in 10. Hypopharyngeal invasion was noted in 8 patients. The initial treatment responses were evaluated 3-6 weeks after the final session of CCRT: a complete response (CR) in 24 patients, a partial response (PR) in 13, and stable disease (SD) in 2. Two- and 5-year overall survival (OS) rates were 73.8 and 59.4%, respectively. Two- and 5-year progression-free survival (PFS) rates were 57.8 and 48.0%, respectively. A univariate analysis identified the initial treatment response (CR or non-CR) as a significant factor for OS (p=0.0002) and PFS (p=0.0026). The CR rate was 81.0% in patients with T1-3 and 33.3% in those with T4 (p=0.0038). Conclusion: Patients with cervical esophageal carcinoma in Nagasaki University Hospital in Japan achieved superior outcomes compared with previous studies. CR rate was higher in patients with T1-3 and correlated with better OS. [ABSTRACT FROM AUTHOR]