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This randomized trial of fractionation after breast reconstruction (FABREC) sought to compare quality-of-life (QOL) and clinical outcomes of hypofractionated (HF) vs. conventionally-fractionated (CF) postmastectomy radiation therapy (PMRT) in the setting of immediate prosthetic reconstruction. Between 3/2018 and 11/2021, 400 patients at 18 centers with Stage 0-III breast cancer and immediate placement of tissue expander (TE) or implant (I) after mastectomy were randomized 1:1 to HF or CF photon PMRT. Respective doses in the two arms were 42.56 Gy/16 fractions to the chest wall (CW), with or without axillary/supraclavicular lymph node (LN) radiation (39.9 Gy/15 fractions) and 50 Gy in 25 fractions to CW (46-50 Gy to axillary LNs). A boost was not permitted; bolus was used at physician discretion. CW toxicity was defined as any grade ≥3 adverse event (CTCAE) after PMRT initiation. Patients were censored at study withdrawal or at diagnosis of distant recurrence. Participants completed QOL instruments (FACT-B, BREAST-Q, Lymph-ICF) at baseline, 6, 12 and 18-months from PMRT initiation. Questions regarding financial burden were included with the 6-month survey. Primary endpoint of the study was improvement in the Physical Well-Being (PWB) domain of FACT-B at 6 months with pre-specified stratification by age (younger than 45 vs. 45 years or older). QOL scores were compared using Student's t-test. Median follow-up for the 385 patients analyzed was 31.8 months (range, 6.9-54.4); median age was 47.0 years (range, 23-79). Preoperative chemotherapy was used in 67.8% and preoperative endocrine therapy (ET) in 21.5% of the cohort. There were 16 distant (8 in each arm), and 2 local-regional (1 in each arm) recurrences. CW toxicity occurred in 35 patients (19 HF, 16 CF, p=0.58) at medians of 3.4 and 4.8 months after RT initiation in the HF and CF arms, respectively (p=0.82). Post-operative infection before RT (HR=3.31, p=0.03), irradiation of TE vs I (HR=7.74, p=0.046), preoperative endocrine therapy (HR=3.45, p=0.0007) and number of LNs removed (HR=1.06/node, p=0.02) were significant for developing CW toxicity on multivariate analysis, while fractionation was not (HF HR=1.19, p=0.63). There was no significant difference in overall change in PWB scores at 6 months between the two treatment arms (p=0.71) or separately in younger (p=0.15) and older cohorts (p=0.27). However, HF patients younger than 45 were less bothered by side-effects of treatment (p=0.045) and nausea (p=0.02) vs. CF patients younger than 45. Among patients who took unpaid time off from work during treatment (n=51), those receiving HF required fewer hours off than those receiving CF (73.7 vs. 125.8, p=0.046). Physical well-being and overall toxicity profile of HF PMRT were comparable between HF and CF PMRT. HF was associated with better 6-month QOL in some domains among younger patients. Our early results support the use of HF PMRT in the setting of TE- or implant-based breast reconstruction. [ABSTRACT FROM AUTHOR]

Ferromagnetic layered structure has been made at sub-surface of the antiferromagnetic FeRh bulk samples by high energy He ion beam irradiation. In accordance with the Transport of Ions in Matter simulation, such ion beam can effectively deposit the elastic collision energy in several lm regions in the depth from the surface. Measurement with a superconducting quantum interference device reveals the irradiated samples to be ferromagnetic. Assuming that only the part the energy deposited can be modified to be ferromagnetic, the corresponding irradiation induced magnetization is consistent with the data that we previously reported. On the other hand, the X-ray magnetic circular dichroism (XMCD) spectra for the irradiated samples are totally unchanged as those for the unirradiated samples. Since XMCD signal in total emission yield method is considered to be surface sensitive with a typical probing depth of several nm, the surface magnetic state is maintained to be antiferromagnetic. By utilizing these phenomena, three-dimensional magnetic patterning of FeRh can be realized, which may potentially be used for future magnetic exchange device application such as nano-scale sensors and memories. [ABSTRACT FROM AUTHOR]

We have studied the in vitro transfection of a plasmid DNA with thelacZgene to HeLa-S3 cells and hemolysis in a red blood cell (RBC) suspension under pulsed ultrasound with duty cycles?of 10, 20 and 30% using a digital sonifier at a frequency of 20 kHz and an intensity of 6.2 W/cm2 on the surface of a horn tip. Cultured HeLa-S3 cells in suspension were exposed to pulsed ultrasound for an apparent exposure timet' from 0 to 60 s. HeLa-S3 viability decreased as a single exponential function of the total exposure timet=?t' with a common time constantt=3.8 s for three duty cycles. Transfection was evaluated by counting the number of ß-galactosidase(ß-Gal)-positive cells relative to the total number of cells. Pulsed ultrasound provided an enhanced transfer of the ß-Gal plasmid to HeLa-S3 cells, 3.4-fold as compared with that in the case of the control. The optimal transfection efficiencies were 0.75, 0.80 and 0.74% neart=twith?=10, 20 and 30%, respectively. The number ratio of ß-Gal-positive cells to the surviving cells after exposure increased witht' according to a modified logistic equation. The degree of hemolysis also increased exponentially witht' at a time constantt'=t0/?for the RBC suspension in physiological saline at a hematocrit concentration of 0.5% witht0=0.9 s. Thus the total exposure time for the optimal transfection efficiency wast, that is, nearly four times oft0. Hemolysis in the RBC suspension may be a useful model for determining optimal transfection by pulsed ultrasound of various duty cycles. [ABSTRACT FROM AUTHOR]

In patients with severe hypertension, chronic heart failure or a history of stroke, the lower limit of autoregulation of cerebral blood flow (CBF) is shifted to higher levels of blood pressure (BP) than those observed in healthy subjects. The aim of pharmacotherapy for hypertensive patients with an impaired autoregulation of CBF should be to reduce BP while preserving an appropriate CBF. In the present study, 16 hypertensive patients who had had an episode of stroke more than 4 weeks previously were administered the angiotensin II (AT1) receptor antagonist losartan at daily doses of 25-100?mg for 4 weeks. Systolic and diastolic blood pressures were recorded for 24?h using an ambulatory BP monitoring system. CBF in both hemispheres of the cerebrum and cerebellum was quantified using single photon emission tomography with N-isopropyl-p-[123I]iodoamphetamine. At baseline, CBF was 29.7±6.7?ml/min/100?g in the cerebrum and 31.5±7.5?ml/min/100?g in the cerebellum. At the end of treatment, BP was lower, while CBF increased by 7.7%in the cerebrum, and remained at the baseline level in the cerebellum. Thus, CBF was preserved despite the reduction in BP. We consider the use of losartan is advantageous for hypertensive patients with a history of stroke in whom autoregulation of CBF is potentially impaired.Journal of Human Hypertension (2004) 18, 693-699. doi:10.1038/sj.jhh.1001735 Published online 6 May 2004 [ABSTRACT FROM AUTHOR]

HLA antigens of patients with adult T cell leukaemia (ATL), T cell malignant lymphoma (T-ML), and healthy carriers of human T cell leukaemia virus type I (HTLV-I) were investigated in an endemic area of ATL in Japan. Sixty-two patients with ATL were subdivided into three groups based on their clinical features, including two unclassified patients; 36 acute type. 10 chronic type, and 14 smouldering type. The frequency of HLA-Bw62 was significantly increased in acute ATL, compared with control (Pc <0.0002). Increased frequency of HLA-DQw3 was observed in patients with ATL. T-ML positive for the antibody to HTLV-I (Ab-positive), and Ab-positive healthy carriers, compared with control (Pc < 0.001, Pc< 0.01 and Pc < 0.0001, respectively). In addition, class I HLA antigens of peripheral lymphocytes of patients with ATL, especially acute ATL, showed altered expression, either extra antigens or decreased antigens. Analysis of 21 families, where more than two members were Ab-positive, showed that there was no linkage between the HLA complex and susceptibility to the virus infection. In 44 couples, in which either or both spouses were Ab-positive, no association with class ! HLA antigens was found in either Ab-positive spouses or Ab-negative sprouses. These findings might indicate that one class II HLA-linked gene controlled susceptibility to HTLV-I infection, and another class I HLA-linked gene exerted an influence on the clinical course of ATL. [ABSTRACT FROM AUTHOR]

Little is known about the ecology of insect species in the hyporheic zone of rivers, despite its importance in understanding how species survive in specialized habitats. We report on the life history and trophic characteristics of the hyporheic stonefly species Alloperla ishikariana Kohno, 1953 (Order: Plecoptera, Family: Chloroperlidae) in a gravel-bed river in northern Japan, using year-round sampling of both benthic and hyporheic larvae, as well as flying adults in the riparian zone. Adults emerged between May and August, and the larval cohort structure consisted of three sized groups with some sex dimorphism in their body size, with an average growth rate of 0.0043 mg/day. Diet analyses based on C and N stable isotope ratios indicated minimal ontogenetic diet shifts. In contrast, the temporal diet shift was more apparent with higher dependence on Oligochaeta in winter, with an increasing dependence on Chironomidae in spring and early summer. Other insect taxa, namely, Leuctridae and small-sized Lepidostoma, demonstrated a high to moderate affinity for the hyporheic zone. Alloperla ishikariana spent most of its larval stage in the hyporheic zone. With adults living from 7 to 10 days, A. ishikariana completes a life span of approximately 3 years with its larval stage in the dark. [ABSTRACT FROM AUTHOR]

Abstract: The development of low decontaminated mixed oxide (MOX) fuel, which contains minor actinoides (MA) and fission products (FP), is in progress to established Advanced Fast Reactor (FR) Fuel Cycle system. This paper describes the study on the sintering characteristics and the physical properties of MOX fuel containing Am, Np, and simulated FP. MOX powder containing Am, Np and simulated FP were sintered at high temperature in various oxygen partial pressure. From the result of ceramography, it is found that the grain growth rate of the pellets sintered in high oxygen partial pressure is high. From the result of EPMA analysis (Pu, Am, Ln) oxide was observed in the pellets. The melting points of the pellets with oxygen to metal (O/M) ratio of 1.95 are higher than those with O/M ratio of 1.98. This tendency is similar to that of MOX fuel containing about 30% Pu. [Copyright &y& Elsevier]

A survey and inventory of tree canopy biodiversity for cryptogams (myxomycetes, macrofungi, mosses, liverworts, lichens and ferns) in the Great Smoky Mountains National Park resulted in the discovery of an undescribed myxomycete species. This taxon is classified in the order Physarales, family Didymiaceae and genus Diachea. A combination of morphological characteristics distinguishes Diachea arboricola H.W. Keller & M. Skrabal sp. nov. from all other species in the genus: peridium iridescent gold to silvery gray; stalk reddish orange above and whitish below, filled with crystals; capillitial threads stiff, dichotomously branched and arising from the tip of the columella; spore ornamentation uniformly covering the entire spore surface, appearing spiny with light microscopy, with scanning electron microscopy as vertical processes with capitate, clustered, spike-like tips. This type of spore ornamentation has not been found in any other Diachea species. Diachea arboricola is known only from the tree canopy, ranging in height from roughly 3 to 21 m, on three tree species, Fraxinus americana, Juniperus virginiana and Quercus alba. Observations of plasmodial growth and fruiting body development are described based on moist chamber cultures. Tree canopy observations in situ suggest that the plasmodium of this species migrates over extensive vertical areas of tree bark. Ecological factors are discussed that include pH of bark substrata. The species description is based on abundant sporangia from 17 different collections. A key to the species of Diachea is provided to aid in the identification of this taxon. [ABSTRACT FROM AUTHOR]

Rock mass characterization is required for many applications in rock engineering practice including excavation design, support design, stope design, amongst others. For these purposes, it is necessary to obtain design input parameters such as deformation moduli and strength parameters for numerical modeling. Although such parameters can ultimately be determined from in situ tests, at the preliminary design stage, where access to underground is limited, the practical way to obtain these parameters is to apply a rock mass classification system to characterize the rock mass and estimate the rock mass properties. Over the years, many classification systems, such as RQD, Rock Mass Rating, Q and Geological Strength Index (GSI) systems, have been developed. Amongst them, the Q system is widely used for rock support system design and the GSI system is used for estimating design parameters. The GSI system is the only rock mass classification system that is directly linked to engineering parameters such as Mohr–Coulomb, Hoek–Brown strength parameters or rock mass modulus. However, the application of the existing GSI system is hindered by the facts that the use of the system is to some extent subjective and requires long-term experience.In the present study, a quantitative approach to assist in the use of the GSI system is presented. It employs the block volume and a joint condition factor as quantitative characterization factors. The approach is built on the linkage between descriptive geological terms and measurable field parameters such as joint spacing and joint roughness. The newly developed approach adds quantitative means to facilitate use of the system, especially by inexperienced engineers.The GSI system is applied to characterize the jointed rock masses at two underground powerhouse cavern sites in Japan. GSI values are obtained from block volume and joint condition factor, which in turn are determined from site construction documents and field mapping data. Based on GSI values and intact rock strength properties, equivalent Mohr–Coulomb strength parameters and elastic modulus of the jointed rock mass are calculated and compared to in situ test results. The point estimate method is implemented to approximate the mean and variance of the mechanical properties of the jointed rock masses. It is seen that both the means and variances of strength and deformation parameters predicted from the GSI system are in good agreement with field test data. [Copyright &y& Elsevier]

Abstract: The aim of this paper is to fabricate the planar type patch clamp ion-channel biosensor, which is suitable for the high throughput screening, using silicon-on-insulator (SOI) substrate. The micropore with 1.2 μm diameter is formed through the top Si layer and the SiO2 box layer of the SOI substrate by focused ion beam (FIB). Then the substrate is assembled into the microfluidic circuit. The human embryonic kidney 293 (HEK-293) cell transfected with transient receptor potential vanilloid type 1 (TRPV1) is positioned on the micropore and the whole-cell configuration is formed by the suction. Capsaicin is added to the extracellular solution as a ligand molecule, and the channel current showing the desensitization unique to TRPV1 is measured successfully. [Copyright &y& Elsevier]

For a two-group comparative study, a stratified inference procedure is routinely used to estimate an overall group contrast to increase the precision of the simple two-sample estimator. Unfortunately, most commonly used methods including the Cochran-Mantel-Haenszel statistic for a binary outcome and the stratified Cox procedure for the event time endpoint do not serve this purpose well. In fact, these procedures may be worse than their two-sample counterparts even when the observed treatment allocations are imbalanced across strata. Various procedures beyond the conventional stratified methods have been proposed to increase the precision of estimation when the naive estimator is consistent. In this paper, we are interested in the case when the treatment allocation proportions vary markedly across strata. We study the stochastic properties of the two-sample naive estimator conditional on the ancillary statistics, the observed treatment allocation proportions and/or the stratum sizes, and present a biased-adjusted estimator. This adjusted estimator is asymptotically equivalent to the augmentation estimators proposed under the unconditional setting. Moreover, this consistent estimation procedure is also equivalent to a rather simple procedure, which estimates the mean response of each treatment group first via a stratum-size weighted average and then constructs the group contrast estimate. This simple procedure is flexible and readily applicable to any target patient population by choosing appropriate stratum weights. All the proposals are illustrated with the data from a cardiovascular clinical trial, whose treatment allocations are imbalanced. [ABSTRACT FROM AUTHOR]

A method for fabricating adhesively bonded joints with graded properties along the bond-line was proposed. By utilizing two types of acrylic adhesives, one hard and the other soft, the properties of the mixture were changed by controlling the mixing ratio. An applicator for the adhesives was developed and used for the experiments, in which property-graded adhesive layers were actually produced. The properties, i.e., stress-strain curves at various points of the property-graded adhesive layer, were experimentally measured, and the validity of the proposed method was confirmed. The Young's moduli at multiple points of the adhesive layer changed from 34.7 MPa to 634 MPa by changing the mixing ratio of the adhesives. [ABSTRACT FROM AUTHOR]

BACKGROUND: More strokes were observed in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT) among patients assigned to darbepoetin alfa. We sought to identify baseline characteristics and postrandomization factors that might explain this association. METHODS AND RESULTS: A multivariate logistic regression model was used to identify baseline predictors of stroke in 4038 patients with diabetes mellitus, chronic kidney disease, and anemia randomized to receive darbepoetin alfa or placebo. To determine whether postrandomization blood pressure, hemoglobin level, platelet count, or treatment dose were responsible for the increased risk related to darbepoetin alfa, we performed a nested case-control analysis (1:10 matching) identifying nonstroke controls with propensity matching. The risk of stroke was doubled with darbepoetin alfa. Overall, 154 patients had a stroke, 101/2012 (5.0%) in the darbepoetin alfa arm and 53/2026 (2.6%) in the placebo arm (hazard ratio 1.9; 95% confidence interval, 1.4-2.7). Independent predictors of stroke included assignment to darbepoetin alfa (odds ratio 2.1; 95% confidence interval, 1.5-2.9), history of stroke (odds ratio 2.0; 95% confidence interval, 1.4-2.9), more proteinuria, and known cardiovascular disease. In patients assigned to darbepoetin alfa, postrandomization systolic and diastolic blood pressure, hemoglobin level, platelet count, and darbepoetin alfa dose did not differ between those with and without stroke. Additional sensitivity analyses using maximal values, latest values, or changes over varying periods of exposure yielded similar results. CONCLUSIONS: The 2-fold increase in stroke with darbepoetin alfa in TREAT could not be attributed to any baseline characteristic or to postrandomization blood pressure, hemoglobin, platelet count, or dose of treatment. These readily identifiable factors could not be used to mitigate the risk of darbepoetin alfa-related stroke. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT00093015. [ABSTRACT FROM AUTHOR]

Improving the quality of ulcer healing (QOUH) is one of the valid methods of prevention of relapse of gastric ulcers. We investigated the effect of lafutidine on the QOUH of gastric ulcer compared with famotidine in a randomized, multi-centre controlled trial. Consecutive 80 patients with a gastric ulcer were randomly assigned to receive twice daily either lafutidine (10 mg) or famotidine (20 mg) for 12 weeks. Esophagogastroduodenoscopy was performed to examine the ulcer healing rate and rate of fl at type ulcer scars using dye-contrast. The gastric ulcer healing rate was 92.1% in the lafutidine group (35/38) and 94.7% in the famotidine group (36/38). The rate of flat-type ulcer scars was significantly higher in the lafutidine group (68.4%, 26/38) than in the famotidine group (42.1%, 16/38) (P = 0.021). In conclusion, the present study demonstrated that lafutidine, as compared to famotidine, yields a signifi cantly superior QOUH in patients with gastric ulcers in the clinical setting. [ABSTRACT FROM AUTHOR]

Aim: To determine the diagnostic accuracy of computed tomography (CT)-guided percutaneous cutting needle biopsy (PCNB) for thymic tumours in accordance with the World Health Organization (WHO) classification. Material and methods: We retrospectively analysed a consecutive series of 138 cases in which CT-guided PCNB had been performed for an anterior mediastinal tumour. Its sensitivity and specificity for thymic epithelial tumours were evaluated, and the concordance between the histopathological diagnosis according to the WHO classification of thymic tumours based on PCNB and the diagnosis is based on the surgical specimens was assessed by Kappa statistic. Results: The diagnostic sensitivity and specificity of CT-guided PCNB for thymic tumours were 93.3 and 100%, respectively. The overall concordance between the diagnosis according to the WHO classification established by PCNB specimen and by the surgical specimen was 79.4% (weighted kappa=0.79). Conclusion: CT-guided PCNB is a reliable method of diagnosing thymic tumours, and there was good concordance for the WHO classification between the diagnosis based on CT-guided PCNB specimen and that based on the surgical specimen. [Copyright &y& Elsevier]

: Several studies in Western countries showed that proton-pump inhibitors are superior to histamine2-receptor antagonists or placebo in the treatment of non-erosive gastro-oesophageal reflux disease. The efficacy of acid-suppressive drugs for non-erosive gastro-oesophageal reflux disease in Japan, in which the prevalence ofHelicobacter pyloriinfection is higher compared with Western countries, is unknown.: To compare the efficacy of famotidine and omeprazole in Japanese patients with non-erosive gastro-oesophageal reflux disease by a prospective randomized multicentre trial.: A total of 98 patients received either famotidine 20 mg b.d. (n = 48) or omeprazole once daily (n = 50). Frequency of gastro-oesophageal reflux disease symptoms and health-related quality of life were evaluated at baseline and after 4 weeks of treatment. Complete relief was defined as no gastro-oesophageal reflux disease symptoms during the 7-day interval in week 4.: Complete relief was achieved in 23 (48%) of patients receiving famotidine and 28 (56%) of patients treated with omeprazole. In the famotidine group, complete relief rate inH. pylori-negative patients was significantly lower thanH. pylori-positive patients (35% vs. 64%). Both famotidine and omeprazole improved most scales of health-related quality of life. Omeprazole significantly improved reflux score irrespective ofH. pyloriinfection while famotidine significantly improved reflux score inH. pylori-positive patients but not inH. pylori-negative patients.: Omeprazole is more effective than famotidine for the control of gastro-oesophageal reflux disease symptoms inH. pylori-negative patients, while similar efficacy is observed inH. pylori-positive patients with non-erosive gastro-oesophageal reflux disease. [ABSTRACT FROM AUTHOR]

Background: Crohn's colitis, frequently accompanied by stenosis or narrowing, can be difficult to assess through conventional methods. We evaluated the usefulness of virtual computed tomographic colonography (CTC) for the detection of colonic lesions due to Crohn's disease.Methods: Forty-two lesions in 33 patients with Crohn's disease were examined by CTC and barium enema (BE). Twenty-two patients also were examined by colonoscopy (CS). The visualization ability of CTC was compared with those of the other two methods.Results: In the visualization of elevated lesions, there was no significant difference between CTC and BE (18 of 20, p = 0.487) or between CTC and CS (15 of 16, p = 0.99); however, ulcerative lesions were less often visualized by CTC. However, CTC enabled identification of serious lesions in the colon proximal to the stenosis in nine patients and was superior to BE and CS in terms of its ability to visualize the proximal site of the stenosis (p = 0.003).Conclusion: CTC is clinically useful for the evaluation of Crohn's colitis, especially those with stenotic lesions. [ABSTRACT FROM AUTHOR]

Background: The prevalence of Helicobacter pylori infection in Crohn's disease (CD) patients was investigated to determine whether the presence and severity of gastroduodenal lesions were related to H. pylori infection.Methods: Infection rates were compared between CD group (n = 90) and the control group (n = 525). Correlations between endoscopically detected lesions and H. pylori positive rates were investigated. The relationship between drug therapy and the prevalence of H. pylori infection was also analyzed.Results: H. pylori-positive rate of the 90 CD patients attending our clinic was 16.7%, significantly lower than the rate in healthy controls (40.2%) (P = 0.0001). The involvement of H. pylori infection in the gastroduodenal lesions of CD patients was also examined. The prevalence of gastroduodenal lesions in all CD patients was high, 92.2%. The lesions observed included ulcers, erosion, and "bamboo joint-like lesions" of the stomach, and ulcers, erosion, stenosis, and elevated lesions of the duodenum. None of these lesions were found to be related to H. pylori infection. However, H. pylori infection was found to exacerbate gastric ulcers (P = 0.036). The analysis of a possible relationship between a history of drug therapy and the low prevalence of H. pylori infection in CD patients showed that the prevalence of H. pylori infection was significantly lower in patients who had received antibiotics for 2 weeks or more (P = 0.002).Conclusions: The results suggest that H. pylori infection is essentially unrelated to the gastroduodenal lesions observed in CD. It seems likely, however, that H. pylori infection may exacerbate gastric ulcers and that H. pylori can be eradicated by prolonged use of antibiotics. [ABSTRACT FROM AUTHOR]

Background: A retrospective analysis was conducted on necropsy records from a large rhesus monkey colony to evaluate the age-related prevalence of endometriosis.Methods: A total of 314 records collected over a 15-year period were analyzed, yielding 66 monkeys with histologically verified endometriosis and 248 control subjects.Results: The analyses demonstrated that the incidence of endometriosis increases progressively across the life span, ultimately impacting 21-45% of aged monkeys over 20 years of age.Conclusions: Because mild disease is often not diagnosed premortem, the endocrine and immune sequelae of endometriosis may be a potential confound in even nonreproductive research with aging primates. Prior research-related events influence the occurrence and severity of endometriosis in these long-lived animals, and specifically could have contributed to the high prevalence of endometriosis in this particular monkey colony. [ABSTRACT FROM AUTHOR]