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Naoki Hashimoto,1 Atsuhito Toyomaki,1 Matsuhiko Oka,1 Keisuke Takanobu,1 Ryo Okubo,2 Hisashi Narita,1 Kan Kitagawa,1 Niki Udo,1 Tamaki Maeda,1 Shinya Watanabe,1 Yuka Oyanagi,1 Akane Miyazaki,1 Koki Ito,1 Ichiro Kusumi1 1Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan; 2Department of Clinical Epidemiology, Translational Medical Center, National Center for Neurology and Psychiatry, Tokyo 187-8551, JapanCorrespondence: Naoki HashimotoDepartment of Psychiatry, Hokkaido University Graduate School of Medicine, 060-8638 North 15, West 7, Sapporo, JapanTel +81-11-706-5160Fax +81-11-706-5081Email hashinao@med.hokudai.ac.jpPurpose: The brief negative symptoms scale (BNSS) is a concise instrument used to assess negative symptoms of subjects with schizophrenia covering five domains of negative symptoms and is suitable for use in clinical, experimental, and epidemiological settings. The original and translated version of BNSS has thus far been shown to have adequate psychometric properties. This study aimed to examine internal consistency, inter-rater and test-retest reliability, discriminant and convergent validity, and factor structure of the Japanese version of BNSS.Patients and methods: The assessment was performed by 11 raters using interview videos of nine subjects. Reliability was calculated with Cronbach’s alpha for internal consistency and intra class correlation coefficient (ICC) for inter-rater reliability. Pearson’s correlation coefficients were calculated to estimate the test-retest reliability. In addition to BNSS, Scale for assessment of negative symptoms (SANS) and scale for assessment of positive symptoms (SAPS) was obtained to assess the convergent and discriminant validity. Factor structure was assessed using principle factor analysis.Results: The Japanese BNSS showed excellent internal consistency (Cronbach’s alpha=0.95), inter-rater reliability (intra class correlation coefficient=0.97), and test-retest reliability (r=0.94, p

A classical symphony orchestra consists of up to 29 musical instruments manufactured from up to 758 distinct natural materials. The interrelationships between the extraction of raw materials for instrument making, the international trade conditions, and the protection status of endangered species and their ecosystems are highly complex and have yet to be sufficiently scientifically examined. However, rapidly progressing climate and ecological change call for sustainable solutions. To address this challenging task, we present MusEcology, a new interactive decision support system based on visualizations. The interactive visualizations offer entry points for users of various backgrounds to explore the interrelationships between musical instruments, natural resources and ecosystems. The tool’s fundamental objectives are to guarantee that the (1) data processing correlates related data resources, that (2) visual interfaces and interaction schemes encourage new interdisciplinary research on complex systems interactions, and that (3) high-level decision-making is supported to identify alternative pathways towards sustainable instrument making.

In Central Europe, climate change is increasing the frequency and intensity of extreme events and weather variability. We need to better understand the interrelations between natural hazards and related extreme events and their impacts on gray, blue, and green infrastructures. According to literature research, a broad spectrum of hazard impacts can lead to transmission line and tower failures in Germany. A spatial assessment in a case study area in western Germany, using a geographic information system reveals the spatial exposure of forests, settlements, roads, rail, and waterways to transmission line failure. The main purpose of this study is to map this spatial exposure risk. In some districts, there is a higher risk of forest fires ignited by dropping transmission lines and impacts of winter storms or earthquakes.The result indicates that better integration of climate change and other natural, technical, and man-made hazards is required and needs to be researched. We also need to better understand the linkages with critical infrastructure, such as emergency management, and the different cascades of impact on primary, secondary, and tertiary infrastructure.The findings can inform fellow scientists, planners, and practitioners on better capturing and applying interconnected risks through spatial assessments. Moreover, the results can also inform operators and emergency managers on preparing for rare and unexpected risks.

An elastoplastic constitutive model based on the Modified Cam Clay (MCC) model is developed to describe the mechanical behaviour of soils cemented via microbially induced calcite precipitation (MICP). It considers the increase of the elastic stiffness, the change of the yield surface due to MICP cementation and the degradation of calcium carbonate bonds during shearing. Specifically, to capture the typical contraction-dilation transition in MICP soils, the original volumetric hardening rule in the MCC model is modified to a combined deviatoric and volumetric hardening rule. The model could reproduce a series of drained triaxial tests on MICP-treated soils with different calcium carbonate contents. Further, we carry out a parametric study and observe numerical instability in some cases. In combination with an analytical analysis, our numerical modelling has identified the benefits and limitations of using MCC-based models in the simulation of MICP-cemented soils, leading to suggestions for further model development.

This study investigated the perception of drought by cocoa farmers and explored the effectiveness of adaptive strategies (ASs) used in smallholding farms in the transboundary region between Ghana and Togo. Drought significantly threatens cocoa production in this region, affecting farmers’ livelihoods and cocoa supply chains. This study used a multistage sampling approach, which involved surveys with questionnaires administered to 330 cocoa farmers throughout the study area, along with on-site observations. Statistical analysis included binary logistic and Poisson regression models to explore the relationship between farmer socioeconomic characteristics and adaptation practices. The findings revealed that cocoa farmers in the region have a nuanced understanding of drought, attributed to changing climatic patterns and unsustainable land management practices such as deforestation. To mitigate its impacts, farmers employ a variety of ASs, including investment in farm management, soil management, and intercropping with crop diversification. Furthermore, socioeconomic factors, including age, formal education, household size, land tenure right, adaptation cost assessment, and an underestimation of self-efficacy, were shown to affect the choice in the AS. Among the ASs adopted, only farm management practices (weeding, pruning, fertilizer application, etc.) significantly improved the cocoa yield. This study contributes to understanding drought as a critical issue for cocoa farmers and the adaptation practices used by smallholder cocoa farmers. Given that among the strategies adopted, only farm management practices, also known as good agricultural practices (GAPs), significantly improves yield, this study recommends well-designed and innovative packages of sustainable farm management based on farm and owner characteristics. These include irrigation schemes, timely soil fertilizer monitoring and supply, and the provision of drought-resistant varieties along with technical itineraries. Additional interventions require drought emergency responses, with other factors such as education and financial support mechanisms expected to improve farmers’ timely decision-making to adapt and improve cocoa production resilience to drought episodes in international transboundary regions with complex governance structures.

Cytokinesis in fission yeast involves actomyosin ring constriction concurrent to septum synthesis followed by septum digestion resulting in cell separation. A recent report indicates that endocytosis is required for septum synthesis and cell separation. The conserved GTPase Cdc42 is required for membrane trafficking and promotes endocytosis. Cdc42 is activated by Guanine nucleotide exchange factors (GEFs). Cdc42 GEFs have been shown to promote timely initiation of septum synthesis and proper septum morphology. Here we show that Cdc42 promotes the recruitment of the major primary septum synthesizing enzyme Bgs1 and consequent ring constriction. Cdc42 is also required for proper localization of the septum digesting glucanases at the division site. Thus, Cdc42 is required to promote multiple steps during cytokinesis. [ABSTRACT FROM AUTHOR]

Incremental nonlinear dynamic inversion (INDI) is a widely used approach to controlling UAVs with highly nonlinear dynamics. One key element of INDI-based controllers is the control allocation realizing pseudo controls using available actuators. However, the tracking of commanded pseudo controls is not the only objective considered during control allocation. Since the approach only works locally due to linearization and the solution is often ambiguous, additional aspects like control efforts or penalizing the deviation of certain states must be considered. Conducting the control allocation by solving a quadratic program this results in a considerable number of weighting parameters, which must be tuned during control design. Currently, this is conducted manually and is therefore time consuming. An automated approach for tuning these parameters is therefore highly beneficial. Thus, this paper presents and evaluates a model-based approach automatically tuning the control allocation parameters of a tiltrotor VTOL using an optimization algorithm. This optimization algorithm searches for optimal parameters minimizing a cost functional that reflects the design target. This cost functional is calculated based on a test mission for the VTOL which is conducted within a simulation environment. The test mission represents the common operating range of the VTOL. The simulation environment consists of an aircraft model as well as a model of the INDI-based controller which is dependent on the control allocation parameters. On this basis, model-based optimization is conducted and the optimal parameters are identified. Finally, successful real-world tests on a 4-degrees-of-freedom testbench using the identified parameters are presented. Since the control allocation parameters can significantly influence the aircraft’s stability, the 4-DOF testbench for the aircraft is required for rapid validation of the parameters at a minimum amount of risk.

In this study, we carried out a comparative study of two different numerical strategies for the modeling of the biogeochemical processes in microbially induced calcite precipitation (MICP) process. A simplified MICP model was used, which is based on the mass transport theory. Two numerical strategies, namely the operator splitting (OS) and the global implicit (GI) strategies, were adopted to solve the coupled reactive mass transport problems. These two strategies were compared in the aspects of numerical accuracy, convergence property and computational efficiency by solving the presented MICP model. To look more into the details of the model, sensitivity analysis of some important modeling parameters was also carried out in this paper.

In recent years, numerous studies have addressed the theme of ecosystem services as a means of promoting the protection, sustainable use, and recovery of ecosystems. However, these studies mainly have not been fully evaluated the soil-related ecosystem services and the different land uses and land cover. Taking this as a background, our main goal is to evaluate the trade-offs and synergies in the provision of soil-related ecosystem services in a watershed located in the highlands of Rio de Janeiro state - Brazil. To do so, we evaluated soil properties as indicators. In addition, statistical methods were applied to analyze any significant differences between the variables for the different land use classes, and Spearman correlation matrix to evaluate the trade-offs and synergies. No significant difference (p > 0.05) was found between the different land uses for soil fertility parameters, bulk density, and organic matter; however, the trade-offs analysis demonstrated the impact of anthropogenic actions in ecosystem services provision. The methodology showed potential to be used in different studies that focus on ecosystem services evaluations.

The one-dimensional propagation of electromagnetic waves and the propagation of the resulting thermal waves in conducting material are analysed in a coherent way. The heat release due to resistive losses has a static and an oscillating part. Both are considered as heat source terms for the thermal diffusion equation. The time dependence of the temperature is described by analytical solutions. Electrically and thermally conducting materials are classified by the ratio of thermal penetration depth to the skin depth. Experiments performed on ferritic steel, stainless steel and carbon-fibre-reinforced polymer show the time dependence of the thermal signal after heating begins, as described by the theory. At low induction frequencies, an oscillating part of the surface temperature at the double of the induction frequency is detected in accordance with the theory. The results point out new opportunities for induction thermography.

The wood of the pau-brasil tree (Paubrasilia echinata Lam., formerly Caesalpinia echinata Lam.) is used worldwide as raw material for the construction of high-quality bows for string instruments. Alternative tree species are rarely accepted by professional musicians, or by bow and violin makers. Historical overexploitation of this endemic species in the Brazilian Atlantic Forest biome (Mata Atlântica), a global biodiversity hotpot including UNESCO World Natural Heritage Sites, and illegal trade have caused drastic declines in its natural abundance. Pau-brasil is now classified as an endangered species and listed in Appendix II of the Convention on International Trade in Endangered Species. Traditional bow-making craftsmanship, an intangible cultural heritage, depends heavily on the high-quality pau-brasil wood. This complex situation presents unprecedented cross-continental transdisciplinary challenges. In order to target the protection of this coupled natural/cultural heritage, this work frames and examines the pau-brasil/bow-making cultural-ecological system as a complex telecoupled system linked by cultural ecosystem services provided by the pau-brasil, as well as the relationships and cultural exchanges among key actors. Using historical trajectory analysis, we identify past, present, and potential future trigger events, key drivers, and key system variables that explain the dynamics, feedback, and resilience of this complex multi-dimensional system. Furthermore, with a cross-scale social and power relations analysis, we examine the level of dependencies and influences of contemporary key actors on the ecosystem services provided by the pau-brasil and their interconnections, in order to ultimately identify their level of disadvantage regarding the pau-brasil. Finally, we discuss the potential of this novel cultural-ecological system approach to (i) interlink science, nature, and art, (ii) reconcile the currently competing protection aims of natural and cultural heritage elements, and (iii) provide future trajectories regarding the resilience and sustainable development of this pau-brasil/bow-making cultural-ecological system. We advocate for this novel path forward toward sustainable transformation of complex cultural-ecological systems urgently needed to navigate our increasingly telecoupled world.

Single planar fuel cell elements consisting of metallic interconnectors that are bonded and sealed by a thin glass solder layer form the core of a solid oxide fuel cell. For reliable operation, the bonding layer has to adhere well and must be without voids or foreign material inclusions, which might cause gas leakage, electrical shorts or mechanical weakening and structural failure. Nondestructive testing (NDT) by the high-frequency ultrasound in immersion technique and by air-coupled ultrasound was optimized to find such defects. Another technique was flash light excited thermography for detection of voids. The NDT techniques used are complementary to each other, as they are based on different physical principles. Voids and small steel platelets of different sizes were prepared in the glass solder layer before the high-temperature bonding process and then monitored by the NDT techniques through the interconnector plates. Two selected NDT techniques were then validated in a probability of detection (POD) study. The study resulted in detection limits for the two main types of defects. As a step towards production testing, a demonstrator was built combining testing by air-coupled ultrasound and that by flash thermography. During the testing steps, the cell elements were handled by a collaborative robot.

Background: Depression is a family and public health condition that has negative consequences for the victim, family, friends, and society with significant socio-family dysfunction, especially when it is undiagnosed. Aim: The present study was aimed at determining the role of family bio-social variables in depression among ambulatory adult patients in a primary care clinic in the Eastern Nigerian. Materials and Methods: A clinic-based cross-sectional descriptive study was carried out on 400 adult patients in a primary care clinic in Nigeria. Data were collected using Patient Health Questionnaire-9, Family Assessment Device, Multidimensional Scale of Perceived Social Support and Brief Family Relationship Scale. Results: The age of the study participants ranged from 18 to 78 years. There were 40.5% of male and 59.5% of female. The prevalence of depression was 48.5% with the most common pattern being mild depression (32.3%). Depression was significantly associated with unhealthy family functioning (P = 0.002), low-acuity family support (P = 0.039), family with least cohesion (P = 0.044), least expressiveness (P = 0.013), and most conflict (P = 0.013). The most significant predictor of depression was unhealthy family functioning (Odds ratio = 3.14 [1.82–3.77]; P = 0.001). Depressed patients who had unhealthy family functioning were three times more likely to experience depressive illness compared to their counterparts who were from healthy functional family. Conclusion: Depression occurred among the study participants and was significantly associated with unhealthy family functioning, low family support, least family cohesion and expressiveness and most family conflict. Assessment of family biosocial factors should be part of the reason for encounter during consultation to unravel family variables that positively or negatively influence depression.

Abstract Background Perchlorate contamination of water and food poses potential health risks to humans due to the possible interference of perchlorate with the iodide uptake into the thyroid gland. Perchlorate has been found in food and drinking, surface, or swimming pool waters in many countries, including the United States, Canada, France, Germany, and Switzerland, with ion chromatography (IC) being the preferred analytical method. The standardization of a robust ion chromatographic method is therefore of the high interest for public health and safety. This article summarizes the experiments and results obtained from analyzing untreated samples, considering the sample’s electrical conductance as guidance for direct sample injection as described in EPA 314.0. Results The suitability of ion chromatography with suppressed conductivity detection was tested for water samples in order to check the influence of matrix effects on the perchlorate signal of untreated samples. A sample injection volume of 750 μL was applied to the selected 2 mm IC column. The IC determination of perchlorate at low µg/L levels is challenged by the presence of high loads of matrix ions (e.g., chloride, nitrate, carbonate, and sulfate at 100 mg/L and above). Perchlorate recovery is impaired with the increasing matrix ion concentrations, and its chromatographic peak is asymmetric particularly at low perchlorate concentrations. The identification of the individual maximum concentration of interfering anions like chloride, nitrate, and sulfate that influence perchlorate recovery helps to reduce the number of sample preparation steps or an obligatory measurement of the electrical conductivity of the sample. Within the scope of this study, samples containing less than 125 mg/L of either anion did not need sample preparation. Conclusion The identification of the maximum concentration of interfering anions like chloride, nitrate, and sulfate influencing perchlorate recovery provides a simplified alternative to the EPA 314.0 method. This approach reduces unnecessary sample preparation steps while allowing a reliable prognosis of possible interferences and maintaining result quality. This study was performed to support the development of a respective international standard, which is being established by the International Organization for Standardization (ISO). The results of the study are also intended to be used as guidance for interested laboratories to optimize the analytical workflow for trace perchlorate determination.

BACKGROUND: Globally, medical care have an age long history, but the rights of patients are more recent and occupy front burner in the quality of care metrics and medical jurisprudence and are on the rise, particularly in emerging and developing economies. AIM: The study was aimed at describing the attitude and practice of patients' rights among medical professionals in Abia State, Nigeria. MATERIALS AND METHODS: A descriptive study was carried out on a cross-section of 185 medical practitioners in Abia State, Nigeria. Data collection was done using pretested, self-administered questionnaire that elicits information on awareness, attitude, and practice of basic patients' rights. Each item of attitude and practice of patients' rights was scored on a five-point Likert scale ordinal responses of all-times, most-times, sometimes, rarely, and none. Attitude and practice of patient's rights were assessed in the previous 1 year. RESULTS: The age of the participants ranged from 28 to 71 years. There were 166 males and 19 females. All the participants were aware of the patient's rights. The overall positive attitude to patients' rights was 87.3% with the most common positive attitudinal orientation being right to confidentiality (100.0%), and the least was right to know the identity/professional status of the physician (52.4%). The overall practice of patient rights was 85.8% with the most commonly practiced being right to confidentiality (100.0%) and the least was right to know the identity/professional status of the physician (51.4%). Attitude (P = 0.037) and practice (P = 0.048) of the right to know the identity/professional status of the physician were significantly associated with >10 years of medical practice. CONCLUSION: The level of awareness of patient's rights was very high but did not translate to comparative overall positive attitude and practice orientation. Patient rights should be the focus of intensive continuing medical education and professional development in addition to greater administrative and governmental support, especially in developing economies where there are limited options to safeguard patients' rights.

Climate variations and historical land use had a major impact on landscape development in the Brazilian Atlantic Forest (Mata Atlântica). In southeast Brazil, rainforest expanded under warm-humid climate conditions in the late Holocene, but have been dramatically reduced in historical times. Nevertheless, the numerous remaining forest fragments are of outstanding biological richness. In our research in the Atlantic Forest of Rio de Janeiro we aim at the reconstruction of the late Quaternary landscape evolution and an assessment of human impact on landscapes and rainforests. In this context, special focus is given on (a) effects of climate variations on vegetation cover, soil development, and geomorphological processes, and (b) spatial and temporal land use and landscape degradation patterns. In this paper we present some new results of our interdisciplinary research in the Serra dos Órgãos mountain range, state of Rio de Janeiro.

Within the last decades, Kathmandu Valley in Nepal has been characterized by rapid population growth and related urbanization processes, leading to environmental degradation, pollution and supply bottlenecks in the metropolitan area. Effects of climate change are now putting additional stress on the urban system. In our research in Kathmandu, we carried out community and household surveys to analyze community perception on climate change and climate-related disaster preparedness. For this purpose, three categories of communities, 12 in all, were surveyed and interviewed: Squatter settlements, agricultural villages, and traditional villages. All settlements are located close to main rivers and therefore especially exposed to floods and droughts, and in slope position also to landslides. As a main result, we can conclude that people are generally aware of climate change and its potential consequences, such as climate change-related disasters. However, in their daily lives, climate change does not play a significant role and most communities have not taken any adaptation measures so far.

OBJECTIVES: Percutaneous Renal Surgery (PRS) is a demanding procedure and success is mostly hampered by the lacking of training facilities. Thus, the purpose of the study was to evaluate a significantly improved pre-existing porcine kidney-training model for percutaneous renal access and PRS. MATERIALS AND METHODS: A biologic training model using porcine kidneys coated by a full-thickness porcine skin flap was prepared. The ureter was dissected, stones were placed into the collecting system using an 18F amplatz sheath, and a catheter was placed in the ureter for further irrigation with saline or contrast medium. For initial training with an easy access, a standard guide-wire was inserted in the ureter through the renal parenchyma. The kidney was punctured with radiographic or ultrasound guidance. Minimally invasive percutaneous nephrolithotomy (MIP) was then tested using the model under radiographic or ultrasound guidance. The model was then evaluated in MIP training courses, which are regularly held at The Hannover Medical School. RESULTS: All trainees were urologists with experience in endourologic surgery but lacked practice in PRS. In conclusion, all 36 participants attained access to the collecting system using models with readily placed guide-wires. Subsequently, PRS was successful in all cases. Percutaneous puncture under ultrasound guidance and following intrarenal surgery was successful in 30 (83.3%) cases. Therefore, all participants rated the model useful for simulating percutaneous renal surgery. CONCLUSIONS: This new porcine kidney model is easy to build and is made cost effective by using readily available material. Moreover, it provides realistic and reproducible training model for PRS. The "organ" model mimics the retroperitoneum by having a full-thickness skin flap with a layer of subcutaneous fatty tissue.

The solution of structural problems with nonlinear material behaviour in a model order reduction framework is investigated in this paper. In such a framework, greedy algorithms or adaptive strategies are interesting as they adjust the reduced order basis (ROB) to the problem of interest. However, these greedy strategies may lead to an excessive increase in the size of the ROB, i.e., the solution is no more represented in its optimal low-dimensional expansion. Here, an optimised strategy is proposed to maintain, at each step of the greedy algorithm, the lowest dimension of a Proper Generalized Decomposition (PGD) basis using a randomised Singular Value Decomposition (SVD) algorithm. Comparing to conventional approaches such as Gram–Schmidt orthonormalisation or deterministic SVD, it is shown to be very efficient both in terms of numerical cost and optimality of the ROB. Examples with different mesh densities are investigated to demonstrate the numerical efficiency of the presented method.

Ecosystems provide a wide range of goods, services or ecosystem services (ES) to society. Estimating the impact of land use and land cover (LULC) changes on ES values (ESV) is an important tool to support decision making. This study used remote sensing and GIS tools to analyze LULC change and transitions from 2001 to 2016 and assess its impact on ESV in a tropical forested landscape in the southern plains of Nepal. The total ESV of the landscape for the year 2016 is estimated at USD 1264 million year−1. As forests are the dominant land cover class and have high ES value per hectare, they have the highest contribution in total ESV. However, as a result of LULC change (loss of forests, water bodies, and agricultural land), the total ESV of the landscape has declined by USD 11 million year−1. Major reductions come from the loss in values of climate regulation, water supply, provision of raw materials and food production. To halt the ongoing loss of ES and maintain the supply and balance of different ES in the landscape, it is important to properly monitor, manage and utilize ecosystems. We believe this study will inform policymakers, environmental managers, and the general public on the ongoing changes and contribute to developing effective land use policy in the region.

Land use and land cover (LULC) change causes biodiversity decline through loss, alteration, and fragmentation of habitats. There are uncertainties on how LULC will change in the future and the effect of such change on biodiversity. In this paper we applied the Land Change Modeler (LCM) and Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) Scenario Generator tool to develop three spatially explicit LULC future scenarios from 2015 to 2030 in the Pulang Pisau district of Central Kalimantan, Indonesia. The district is experiencing a rapid loss of biodiversity as a result of unprecedented LULC changes. Further, we used the InVEST Habitat Quality model to map habitat quality as a proxy to biodiversity in each of the scenarios. We find habitat quality decline is largest in a scenario where past trends of LULC change continue, followed by a scenario with planned agricultural expansion. Alternately, a conservation-oriented scenario results in significant improvements in habitat quality for biodiversity. This information can support in developing appropriate land use policy for biodiversity conservation in Indonesia.

Objectives: Whereas local control is often insufficient in conservative management of T4 bladder cancer, neoadjuvant chemotherapy delays definite treatment, which could result in increased therapy-associated morbidity and mortality during the course of the disease. Primary cystectomy has been reported to be associated with a high complication rate and unsatisfactory clinical efficacy. Herein, we report postoperative outcome in 21 T4 bladder cancer patients subjected to primary cystectomy. Materials and Methods: Twenty-one patients underwent radical cystectomy for T4 (T4a/b: 14 and seven cases, respectively) bladder cancer. At the time of surgery, eight patients had regional lymph node metastases (N2: 6; N3: 2). The average age was 64 (52-77) years (≥70 years: n = 7). The postoperative follow-up was 13 (1-36) months for the whole group. Results: Mean duration of postoperative hospitalization was 19 (11-50) days. Whereas 10 patients received no intra - or postoperative blood transfusions, an average number of 3 (1-7) blood units were administered in the remaining cases. The mean postoperative hemoglobin value of patients not receiving any blood transfusions was 10 (8.5 - 11.4) g/dl. Major therapy-associated complications were paresthesia affecting the lower extremities (n = 3) as well as insignificant pulmonary embolism, enterocutaneous fistulation and acute renal failure in one patient, respectively. At the time of data evaluation, 11 patients were still alive after a follow-up of 20 (6-36) months. Four patients ≥70 years at the time of cystectomy were still alive 11, 11, 22 and 31 months following surgery, respectively. Conclusion: Primary cystectomy for T4 bladder cancer is a technically feasible approach that is associated with a tolerable therapy-related morbidity/mortality. Additionally, a satisfactory clinical outcome is observed even in a substantial number of elderly patients.

INTRODUCTION: Whereas a retrograde attempt to insert an indwelling stent is performed in lithotomy position, usually renal access is gained in a prone position. To overcome the time loss of patient repositioning, a renal puncture can be performed in a modified lithotomy position with torqued truncus and slightly elevated flank. There is a two-fold advantage of this position: transurethral and transrenal access can be obtained using a combined approach. In the present study, this simple technique is used to position a floppy guide wire through a modified needle directly through the renal pelvis into the ureter. MATERIALS AND METHODS: The kidney is punctured in the modified lithotomy position under sonographic control using an initial three-part puncture needle. A floppy tip guide-wire is inserted into the collecting system via the needle after retrieving the stylet. The retracted needle is bent at the tip while the guide-wire is secured in the needle and the collecting system. The use of the floppy tip guide-wire helps to insert the curved needle back into the kidney pelvis, which becomes the precise guidance for the now steerable wire. The desired steerable stent is positioned under radiographic control in a retrograde fashion over the endoscopically harbored tip of the guide-wire. Two patient cohorts (newly described method and conventional method) were compared. RESULTS: The presented steering procedure saves 16.5 mean minutes compared to the conventional antegrade stenting and 79.5 Euros compared to the control group. CONCLUSION: The described combined antegrade-retrograde stent placement through a bent three-part puncture needle results in both clinical superiority (OR time, success rate) and financial benefits.

Background: Alzheimer's disease (AD) dementia and mild cognitive impairment are characterised by impaired cognition accompanied by neuropsychiatric symptoms (NPS) relating to mood, including depression, anxiety, and apathy. However, the utility of AD biomarkers for predicting mood symptoms of NPS remains controversial. Herein, we analyzed the relationship between phosphorylated tau (p-tau) and depression, anxiety, and apathy of NPS. We also examined the influence of genetic factors such as apolipoprotein E (APOE) ε4 on these relationships., Methods: We conducted a cross-sectional survey in older patients (n = 122) with normal cognition (n = 12), mild cognitive impairment (n = 46), and AD (n = 64) strictly diagnosed by the board of psychiatrists and neurologists of Hokkaido University. NPS of the patients were assessed using the Neuropsychiatric Inventory Questionnaire (NPI). All patients also received a lumbar puncture to obtain cerebral spinal fluid for assessment of p-tau. The inverse probability weighting method was used to adjust for demographic differences between the p-tau present group and the p-tau absent group., Results: There was an association between p-tau accumulation and decreased incidence of depression and apathy. APOE ε4 non-carriers also showed a trend toward a negative association between p-tau and depression, which was not evident in APOE ε4 carriers., Conclusions: We provide new evidence for a negative correlation between p-tau and depression and apathy of NPS, which may be influenced by APOE ε4. Future longitudinal studies are required to confirm the utility of p-tau for predicting the course of mood symptoms in patients with cognitive decline., (© 2023 Japanese Psychogeriatric Society.)

Purpose: To develop a method for predicting amyloid positron emission tomography (PET) positivity based on multiple regression analysis of quantitative susceptibility mapping (QSM)., Materials and Methods: This prospective study included 39 patients with suspected dementia from four centers. QSM images were obtained through a 3-T, three-dimensional radiofrequency-spoiled gradient-echo sequence with multiple echoes. The cortical standard uptake value ratio (SUVR) was obtained using amyloid PET with 18 F-flutemetamol, and susceptibility in the brain regions was obtained using QSM. A multiple regression model to predict cortical SUVR was constructed based on susceptibilities in multiple brain regions, with the constraint that cortical SUVR and susceptibility were positively correlated. The discrimination performance of the Aβ-positive and Aβ-negative cohorts was evaluated based on the predicted SUVR using the area under the receiver operating characteristic curve (AUC) and Mann-Whitney U test., Results: The correlation coefficients between true and predicted SUVR were increased by incorporating the constraint, and the AUC to discriminate between the Aβ-positive and Aβ-negative cohorts reached to 0.79 (p < 0.01)., Conclusion: These preliminary results suggest that a QSM-based multiple regression model can predict amyloid PET positivity with fair accuracy., Competing Interests: Declaration of Competing Interest Tomoki Amemiya, Yasuo Kawata, Yoshitaka Bito, Toru Shirai, and Hisaaki Ochi are employees of FUJIFILM Healthcare Corporation. Kohsuke Kudo, Makoto Sasaki, and Masafumi Harada received research funding from FUJIFILM Healthcare Corporation., (Copyright © 2023 Elsevier Inc. All rights reserved.)