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Objective: To identify factors related to decisional conflict among surrogate decision makers for home medical care (HMC) patients. Design: Prospective Cohort Study. Setting/Subjects: For older patients receiving HMC from four different primary care clinics in Japan from January 2016 to June 2017, we studied the family member with the main potential for surrogate decision making. Measurements: At the baseline, surrogates filled out a baseline questionnaire on their characteristics and decision readiness, while the attending doctors provided information about the patients' characteristics. Patient-and-surrogate pairs were tracked for up to six months after the baseline or for three months in the case of death, hospitalization, or admittance to a nursing home. After this tracking, surrogates filled out a follow-up questionnaire on their decision-making experiences, including decisional conflict. Results: Of the original 159 patient-and-surrogate pairs, 121 (76.1%) responded to the follow-up questionnaire. During the follow-up period, 32 patients (26.4% of the patients followed up) died and 69 (57.0%) experienced decision making. Among surrogates who made decisions, the mean score of decisional conflict was 36.2 (standard deviation 14.7), and 43.5% were above the threshold relating to decision delay. Anticipatory guidance and discussion on the patient's care goals at the beginning of HMC were the two variables significantly associated with less decisional conflict of surrogates. Conclusions: Families felt less conflict with surrogate decision making if they had participated in previous discussions with doctors regarding the patients' care goals. Early-stage anticipatory guidance and discussion are a good opportunity for families to prepare for surrogate decision making.

For the advancement and development of nuclear systems used in heavy irradiation environments such as fusion DEMO reactors, fission reactors, fast reactors, and accelerator driven target systems, it is necessary to fully understand the changes of mechanical properties and the other properties of the materials induced by irradiation and to clarify the synergistic effect of displacement damage and helium generation. In this study the mechanical property changes and microstructural development induce by displacement damage and helium production have been mainly examined in austenitic stainless steels, 316FR and type304, and ferritic/martensitic steel, HCM12A, irradiated at around 550oC in JRR-3M reactor and/or JOYO fast reactor. At 550°C, 316FR steel was superior to 304 steel in terms of the amount of ductility and strength with respect to irradiation resistance. It is noteworthy that at 550 °C as well as room temperature, the higher fracture strength of the 316FR steels is a remarkable result. It is found that helium atoms strongly influenced on creep lifetime of the irradiated austenitic stainless steel, 316FR. It was found that the ratio of creep rupture time is slightly lower than the lower limit of previous study's Miyaji and co-workers in the region from 0.01 appm to 1 appm. It is also found that the lower limit of reduction ratio of creep rupture time (irradiation specimen to unirradiation one) does not decrease linearly with the helium production above 10 appm up to about 33 appm. dpa enhanced the reduction of creep lifetime. Recent R&D of high-energy accelerator driven target systems used under heavy irradiation environment is also introduced and discussed for high radiation resistance materials such as Ti alloys with very high number density of nano size precipitate, which have been studying under RaDIATE collaboration, from points of view of irradiation damage and materials development.

Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making.We investigated the decision readiness of HMC patients and their family surrogates.Cross-sectional survey.We collected data from dyads, consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016.Surrogates completed a questionnaire on their sociodemographic and health status and their decision readiness. Primary HMC physicians provided information on their patients.A total of 337 dyads were screened, and 159 were included. The mean age of patients and surrogates was 86 and 64 years, respectively, and 29% of patients were cognitively impaired. Only 1.9% of the patients left written advance directives, and 32% were entrusting all decision making to the doctor or their families. Regarding the surrogate's preferred decision-making role, 21.9% of the surrogates preferred doctors to assume decision-making responsibility. A multivariate analysis revealed that no discussion of care goals (odds ratio [OR] 2.88, 95% confidence interval [CI] 1.02-8.17) and patients having expressed their wishes verbally, including entrusting decision making to others (OR 2.51, 95% CI 1.07-5.89), were associated with surrogates' preference for doctors to have decision-making responsibility.Many patients preferred to entrust the end-of-life decisions to others rather than utilizing advance directives, which made surrogates more dependent on doctors for decision making. Qualified advance care planning is required to promote familial discussion and surrogates' decision readiness.

Determining topological charge (TC) of optical vortex (OV) beams is important for many applications, such as optical measurement and information transmission through long-distance propagation. In this application, the OV beams usually have an annular intensity profile at the receiving end and are inevitably distorted by aberrations during propagation. In this paper, we propose a simple, direct, and aberration-resistible method to determine the TC value of this annular-shaped OV beam with a Shack-Hartmann wavefront sensor (SH-WFS). Our approach involves finding a closed-path along the annular intensity distribution ridge, and then determining the TC value by a discrete circulation calculation with only the phase-slope vectors along the closed-path. Verification experiments were performed using a phase-only spatial light modulator to generate OV beams and aberrations, while SH-WFS to measure the intensity profile and phase-slopes. The results show that our method can determine the TC value of up to ± 20. The robustness against wavefront aberration and simulated atmospheric turbulence was evaluated. We also verified the proposed closed-path’s superiority to other circular closed-paths for TC determination.

Background. Long-term care for the elderly is largely shouldered by their family, representing a serious burden in a hyper-aging society. However, although family dynamics are known to play an important role in such care, the influence of caring for the elderly on burden among caregiving family members is poorly understood. Objective. To examine the influence of family dynamics on burden experienced by family caregivers. Methods. We conducted a cross-sectional study at six primary care clinics, involving 199 caregivers of adult care receivers who need long-term care. Participants were divided into three groups based on tertile of Index of Family Dynamics for Long-term Care (IF-Long score), where higher scores imply poorer relationships between care receivers and caregiving family: best

目的．肺癌術後患者にみられた肺抗酸菌症例についての検討を行った．方法．1996～2007年に当院で経験した，肺癌術後の肺結核症（pulmonary tuberculosis：PTB）および肺非結核性抗酸菌症（pulmonary non-tuberculous mycobacteriosis：PNTM）の24例を対象に，病歴や経過，検査所見，X線所見などを後ろ向きに解析した．結果．肺抗酸菌症の内訳はPTB 14例，PNTM 10例（肺M. avium complex症9例，肺M. kansasii症1例）で，男性（17例），高齢者（15例），術後5年以内（15例），術側肺（18例）に多くみられた．PTB例では肺癌再発（7例），結核治療歴（6例），他臓器癌の既往，performance status（PS）2以上（各5例）などを認め，全身状態の悪化に基づく内因性再燃が示唆された．PNTMでは全身的要因をほとんど認めなかったが，術側肺の発症が9例を占め，手術に伴う肺局所環境の悪化に伴う感染，増悪が示唆された．治療について，PTBでは診断の遅れがなければ治療経過，予後は良好であったが，PNTMでは治療にも関わらず，病変が進展し，肺アスペルギルス症などを併発し，死亡する症例もみられた．結論．肺癌術後患者の管理においては全身状態やX線所見に注意を払い，肺抗酸菌症を的確に診断することが重要である．

Irradiation-assisted stress corrosion cracking (IASCC) is one of the critical concerns when stainless steel components have been in service in light water reactors for a long period. In-core IASCC growth tests have been carried out using the compact tension-type specimens of type 304 stainless steel that had been pre-irradiated up to a neutron fluence level around 1 × 1025 n/m2 under a pure water simulated boiling water reactor (BWR) coolant condition at the Japan Materials Testing Reactor (JMTR). In order to investigate the effect of synergy of neutron/gamma radiation and stress/water environment on SCC growth rate, we performed ex-core IASCC tests on irradiated specimens at several dissolved oxygen contents under the same electrochemical potential condition. In this paper, results of the in-core SCC growth tests are discussed and compared with the results obtained by ex-core tests from a viewpoint of the synergistic effects on IASCC. From results of in-core and ex-core tests using pre-irradiated specime...

The low intensity regions existed around the singular point of optical vortex (OV) beams influence the position detection accuracy of phase singular points, especially for OVs of large topological charge. A new method using Shack-Hartmann wavefront sensor (SH-WFS) is proposed to solve this problem. In the method, we combine several phase slopes obtained at individual lenses of a lens array into one to avoid the influence of the low intensity region and use correlation matching with pre-calculated simulation data to get the accurate singular point position. The experimental results show that the position detection precision of this method is maintained less than 0.2 in unit of lens-size for OVs of charges -20 to 20.

Optical vortex (OV) beams have null-intensity singular points, and the intensities in the region surrounding the singular point are quite low. This low intensity region influences the position detection accuracy of phase singular point, especially for high-order OV beam. In this paper, we propose a new method for solving this problem, called the phase-slope-combining correlation matching method. A Shack-Hartmann wavefront sensor (SH-WFS) is used to measure phase slope vectors at lenslet positions of the SH-WFS. Several phase slope vectors are combined into one to reduce the influence of low-intensity regions around the singular point, and the combined phase slope vectors are used to determine the OV position with the aid of correlation matching with a pre-calculated database. Experimental results showed that the proposed method works with high accuracy, even when detecting an OV beam with a topological charge larger than six. The estimated precision was about 0.15 in units of lenslet size when detecting an OV beam with a topological charge of up to 20.

We propose a new method, based on Shack-Hartmann wavefront sensor (SH-WFS), to achieve high-accuracy position detection of phase singular points of optical vortex (OV) beam. The method calculates evaluation values related to phase slopes of incoming wavefront from Hartmanngram recorded by SH-WFS, and then determines precisely the position of the singular points by calculating the centroid of the 3x3-evaluation-value distribution centered at peak position. A main point is that, in evaluation-value calculation, we use a closed contour connecting the centers of 8-connected, instead of 2x2, lenslet apertures. Theoretical analysis shows that the measurement errors can be greatly reduced in comparison to that of 2x2 closed contour. Proof experiments were performed to confirm its accuracy by measuring singular points of OV beams generated by a liquid crystal on silicon spatial light modulator. The root-mean-square error of the measured position of singular points was approximately 0.052, in units of the lens size of lenslet array used in the SH-WFS. The method achieves fast-speed and sub-lens size spatial resolution detection, is suitable for real-time control applications.

Nano-dots array whose diameter and interval were approximately 200 nm and 750 nm, respectively, were made parallel to the atomic step edges on sapphire wafers by focused ion beam (FIB) system. Upon annealing a bunched multi-steps structure formed at regularintervals and straight because the steps were pinned at the nano-dots. The step heights andterrace widths were approximately 2.0 nm, 700 nm in off-angle 0.15° and 10.0 nm, 350 nm in off-angle 1.0°, respectively.

Outgassed species from 157 nm irradiated resists were directly investigated using a quadrupole mass spectrometer in a wide mass range of 1–300 amu. As for the dependence of outgassing characteristics on the structures of the base polymer, the information obtained is as follows: (1) Regarding base polymers and corresponding resists employed, the total amount of outgassed species decreases in the following order, base polymers with ester groups in their side chains, base polymers having side chains other than ester groups, and base polymers without side chains. (2) The incorporation of alicyclic structures into the polymer backbone suppresses the alicyclic outgassed species. (3) Some kinds of fluoropolymers produce HF during the 157 nm exposure. (4) A base polymer having fluorine in its side chain produces fluorinated outgassed species that are photodecomposed products of the side chains. The structure of the resist base polymer, particularly its side chain, has a great influence on the outgassing characters and the total amount of outgassed species at a 157 nm exposure.

Transient absorption spectra of ion radicals were observed for tetrasilanes with rigid syn or anti Si units by electron beam pulse radiolysis. Two transient absorption bands at 4.1 and 2.8 eV were clearly resolved for the anion radical of syn-tetrasilane, while for anti-tetrasilane, the anion radical produced a broad absorption band at 4.4 eV. Cation radicals of the tetrasilanes gave similar optical transitions at 3.6 and 2.1 eV for the syn form, and 3.8 eV for the anti form. The spectra for the ion radicals of anti-tetrasilane are identical to those of ion radicals of permethylated pentasilanes or hexasilanes, suggesting that the ion radicals of oligosilane without configurational constraint take an anti conformation. The unique spectra of ion radicals of syn-tetrasilane reflect the large gap between the second and third HOMO (LUMO) of neutral molecules, which is also induced by the configurational constraint.

A novel polysilane having a tetraphenylporphyrin (TPP) side chain was synthesized. Intramolecular charge transfer between the σ-conjugated main chain and TPP side chain was investigated by the pulse radiolysis technique. The excess electrons are intramolecularly transferred to the TPP side chain with an apparent rate of electron transfer of >10 8 s - 1 , although a hole in the σ-conjugated main chain ofthe polysilanes is not transferred to the TPP side chain.

In the Japan Atomic Energy Research Institute (JAERI), in-pile strain measurement techniques have been developed using the Japan Materials Testing Reactor (JMTR). In order to evaluate the performance of fiber optic grating sensors under irradiation environment, heat-up and performance tests at elevated temperatures before irradiation and in-pile tests were performed in JMTR. It was determined that it is possible to measure strain under irradiation environment below 1×1023 n m−2 (E>1 MeV) by a fiber optic grating sensor, because in-pile temperature characteristics were in good agreement with out-of-pile test results.

The degree of electron delocalization along polymer skeletons was discussed for ion radicals of poly[bis(p-alkylphenyl)silane]s by electron beam pulse radiolysis. The degree of delocalization of ne...

A direct observation of energy migration processes in σ-conjugated polymers has been firstly done to a very large extent by ultra-fast transient absorption spectroscopy in near infrared (IR) region. Especially, following new results were obtained: (1) The very broad transient absorption due to excited states in various conjugated segments immediately after 266-nm excitation; (2) The shift from the very broad absorption toward the absorption with the maximum at 0.95 eV; (3) Decrease in energetic dispersion of excited states with observation time; (4) Some excited states remain in shorter conjugated segments than the radiative segments associated with the absorption maximum at 0.95 eV.

Rat hippocampal dissociated culture on multi electrodes array dish (MED) is useful as minimalized brain model to investigation of principles of brain information processing. Rat hippocampal neuronal cells were cultured on MED with 64 microelectrodes and they reconstructed a complex network. We analyzed stability of neuronal electrical activity pattern after two distinct electrical stimuli. Distances between averaged spike pattern and spike pattern after electrical stimulation for summarizing the activity pattern to temporal axis direction and trial (sweep) axis direction. The distances of the analysis for summarized to temporal axis direction increased immediately after stimulation and after it, recovered to standard level. Moreover, stabilizing points emerge every 100 ms on both analysis for summarizing the activity pattern to temporal axis direction and trial axis direction. These results suggest that the neural network buttress by electrical stimulation and it be complex by two-point inputs.

High lateral density and well-aligned quantum dot (QD) structures are self-formed by growing the (GaP) 1.5 (InP) 1.88 short period superlattices (SLs) on GaAs (311) A substrates. Growth sequence dependence of the QD structures is studied with scanning tunneling spectroscopy and time-resolved photoluminescence spectroscopy. The self-formed dot size for the GaP/InP SLs (GaP is the first growth) is smaller than that for the InP/GaP SLs (InP is the first growth). This difference is considered to be caused by the difference in the strain between the first layer and the substrate. Photoluminescence decay time for the QDs self-formed in the GaP/InP SLs is a little bit shorter than that in the InP/ GaP SLs, which is explained by the enhancement of carrier localization due to the increase in overlapping of wave function.

In Japan Atomic Energy Research Institute, in-pile strain measurement techniques have been developing by using JMTR. In order to evaluate the performance of capsule type strain gage and fiber optic grating sensor under irradiation environment, the heat-up tests in electric furnace before irradiation and in-pile tests were performed. As for capsule type strain gage, it is found that gage factor almost did not change and both its electric resistance and strain output decreased by irradiation effect. A correlation was found between the change ratio of the electric resistance of the capsule type strain gage and fast neutron fluence. As for fiber optic grating sensor, it is possible to measure strain under irradiation environment below 1×1023n/mm2(E>1MeV) by this sensor, because in-pile temperature characteristic was in agreement with out-of-pile test results.

The study of neutron irradiation damage is inevitable for the development of fusion reactors such as the International Thermonuclear Experimental Reactor (ITER). In general, it is difficult to simulate the characteristics of irradiation damage, such as the relationship between helium production and displacement damage, expected in fusion reactors by using the existing test reactors. This is due to the neutron spectrum of test reactors, which are more thermalized than expected in fusion reactors. Despite such limitation, irradiation damage expected to occur in fusion reactors can be simulated in test reactors by spectrum tailoring techniques and/or a combination of irradiation at different conditions, so called irradiation–coupling. In Japan Atomic Energy Research Institute (JAERI), the technique of re-irradiation for irradiated specimens was developed to realize irradiation–coupling as stated above. The key technology in establishing such a technique is the development of a specially designed coupling capsule which can be assembled and loaded with irradiated specimens by remote handling devices in the hot cell. JAERI has recently developed the coupling capsule and successfully completed its irradiation in the Japan Materials Testing Reactor (JMTR).

By growing (GaP)1.5(InP)1.88 and (InP)1.88(GaP)1.5 short-period superlattices (the former material is the first layer on the GaAs (311) substrate) by gas source MBE, composition-modulated quantum dots were self-formed in both cases. The dot size is about 20 nm in GaP/InP and 22 nm in InP/GaP sample. The photoluminescence energy is higher for the GaP/InP sample, corresponding to the difference in the dot size. The photoluminescence decay time of the InP/GaP sample is less dependent on the emission wavelength and temperature than that of the GaP/InP sample.

A precipitation hardening type 630 stainless steel was irradiated in the Japan Materials Testing Reactor (JMTR) in contact with the reactor primary coolant. The temperature of the irradiated specimens was about 330 K. The fast neutron (E > 1 MeV) fluence for the specimens ranged from 1024 to 1026 m−2. Tension tests and fracture toughness tests were carried out at room temperature, while Charpy impact tests were done at temperatures of 273–453 K. Tensile strength data showed a peak of 1600 MPa at around 7 × 1024 m−2, then gradually decreased to about 1500 MPa at 1.2 × 1026 m−2. The elongation decreased with irradiation from 12% for unirradiated material to 6% at 1.2 × 1026 m−2. The fractography after the tension test revealed that the fracture was ductile. Fracture toughness decreased to about a half of the value for unirradiated material with irradiation. The cleavage fracture was dominant on the fractured surface. Charpy impact tests showed an increase of ductile–brittle transition temperature (DBTT) by 60 K with irradiation.

We demonstrated the accurate imaging of steep ridges by scanning tunneling microscopy (STM) with a carbon nanotube (CNT) tip coated with a PtIr thin layer. Compared with the conventional tungsten tip, the PtIr-coated CNT tip could trace the shape of steep ridges (140 nm in width, 50 nm in height) more precisely with reduced artifacts originating from the finite shape of the tips. We also estimated the tip radius from the line profiles in the STM image, and proved that the tunneling current exactly flowed through the apex of the PtIr-coated CNT without bending or tilting of the tip during STM.

The IASCC is one of the major concerns on the integrity of in-core materials not only for the LWRs but also for the materials to be cooled by water in fusion reactor. It is desired to irradiate test materials in a high temperature water environment in order to investigate simultaneous effects of irradiation and corrosive environments, which are essential for the study of IASCC. In the JMTR, an irradiation rig named the SATCAP was developed and applied for the IASCC study. Inside of this capsule, cooling water is boiling during irradiation due to heat generated by gamma heating, thus the temperature of the specimens is kept nearly at saturation temperature of water. Recently a new hybrid type SATCAP with electric heaters and vacuum control systems was developed to improve temperature control capability of the original SATCAP. A design and results of performance test of the new hybrid type SATCAP are reported.

Neutron irradiation effects on a Ti–Ni shape memory alloy (SMA) are not understood regarding the engineering behavior of tightening and connecting core parts. Irradiation response on shape memory capabilities for Ti–Ni SMA couplers was investigated by measuring the inner diameter of a SMA coupler. Ti–Ni SMA couplers were irradiated to a fast neutron fluence ( E > 1 MeV) of 1.4 × 10 25 m −2 at 323 and 503 K in the Japan Materials Testing Reactor of JAERI. The inner diameter versus temperature curves showed a large hysteresis for the SMA coupler irradiated at 323 K. At a neutron fluence above 10 25 m −2 , the hysteresis after 323 K irradiation increased by 50% more than that after 503 K irradiation. The maximum amount of reversible stroke of the irradiated two-way Ti–Ni SMA coupler during heating and cooling was reduced to 70% that of an unirradiated one and the two-way Ti–Ni SMA coupler is more resistant to neutron irradiation than the one-way Ti–Ni SMA coupler.

The effect of a soil conditioner, consisting mainly of chitosan oligosaccharides on the flowering and fruiting of pot-grown purple passionfruit (Passiflora edulis Sims var. edulis) under high and low N level from 1993 to 1995 was investigated. The number of flowers and harvested fruits, fruit weight and juice production were increased significantly by the annual addition of soil conditioners and high N. Under low N condition, the soil conditioner reduced flower formation in the first growing season and had little effect on the flowering the next two season, but in 1994 and 1995, the treatment increased the fruit and juice weights to nearly the same degree as those at high N level without the soil conditioner. Neither the soil conditioner nor N level affected fruit set, the days between anthesis and harvest, or total soluble solid and acids contents of the juice. These results indicate that the application of a soil conditioner with enough N stabilize fruit production of purple passionfruit, and that continuous supply of the soil conditioner ensure the yield to a certain degree even if N dosage is reduced.

The austenitic stainless steels of type 304 and type 316 and the precipitation hardened type 630 stainless steel were irradiated to doses ranging from 5 × 1024 to 1.2 × 1026 at 323 K in the Japan Materials Testing reactor (JMTR). Tensile and fracture toughness tests have been carried out at 293 K. Type 304 and 316 steels in the solution annealed condition hardened by irradiation to about 700 MPa. Fracture toughness values for these steels decreased with dose. Only a small hardening occurred after irradiation for cold worked type 304 and precipitation hardened type 630 steels. The effect of irradiation on the fracture surfaces was small.

A low impurity Fe 18Cr 12Ni (HP) and its heats doped with Si and C (HP + Si and HP + C) were irradiated to 6.7 × 10 24 n/m 2 ( E ≫ 1 MeV) at 513 K. The slow strain rate tensile (SSRT) tests were carried out at a constant strain rate of 1.7 × 10 −7 s −1 in high purity, 573 K water. Scanning electron microscopy on the fracture surface revealed that HP and HP + Si failed mainly by the intergranular stress corrosion cracking (SCC), while the major failure mode in HP + C was the transgranular SCC. All alloys exhibited radiation hardening. HP + Si exhibiting the smallest hardening showed uniform elongation of 17%, while HP and HP + C did not. Transmission electron microscopy was also carried out. Frank loops and unidentified small clusters were formed in HP and HP + C, while only small clusters were observed in HP + Si.

TiNi and TiPd shape memory alloys (SMA) reveals good workability and shape memory properties and these SMAs seem to be one of hopeful functional materials in a severe irradiation field. The effects of irradiation induced residual strain on the deformation processes of TiNi and TiPd SMAs after neutron irradiation with fluences ( E > 1 MeV) up to 3.9 × 10 24 m −2 at Japan Materials Testing Reactor (JMTR) were investigated by the remote controlled X-ray diffraction measurement. Residual strains of TiNi SMAs took place over damage of 0.1 dpa and the strains were not completely removed by post-irradiation annealing at 473, 523 and 573 K. On the other hand, residual strains of TiPd SMAs scarcely occurred after irradiation, and furthermore, the TiPd SMA seems to be an irradiation-resistant material. This may be explained by a difference between the irradiation response of a parent phase and that of a martensitic phase to neutron irradiation. Deformation processes of SMAs are associated with stress fields generated by irradiation in a parent phase with B2 type ordered structure or in a martensitic phase with 2H and 9R type close-packed structures.

The objective of this work is to describe the advances in 193nm photoresists using negative tone developer and key challenges associated with 20nm and beyond technology nodes. Unlike positive tone resists which use protected polymer as the etch block, negative tone developer resists must adhere to a substrate with a deprotected polymer matrix; this poses adhesion and bonding challenges for this new patterning technology. This problem can be addressed when these photo resists are coated on anti-reflective coatings with plentiful silicon in them (SiARC), which are specifically tailored for compatibility with the solvent developing resist. We characterized these modified SiARC materials and found improvement in pattern collapse thru-pitches down to 100nm. Fundamental studies were carried out to understand the interactions between the resist materials and the developers. Different types of developers were evaluated and the best candidate was down selected for contact holes and line space applications. The negative tone developer proximity behavior has been investigated through optical proximity correction (OPC) verification. The defectivity through wafer has been driven down from over 1000 adders/wafer to less than 100 adders/wafer by optimizing the develop process. Electric yield test has been conducted and compared between positive tone and negative tone developer strategies. In addition, we have done extensive experimental work to reduce negative tone developer volume per wafer to bring cost of ownership (CoO) to a value that is equal or even lower than that of positive tone CoO.

The purpose of this study was to evaluate tuberculosis treatment including levofloxacin (LVFX) and to investigate the effectiveness of changing drug regimens at our hospital.A retrospective study was conducted on 331 patients with tuberculosis admitted to Tokyo National Hospital in 2005. Out of these 331 patients, LVFX was used in 48 (14.5%), 41 of which were initial-treatment cases. We studied why and how LVFX was used and compared bacteriological negative conversion rates between the initial-treatment cases in which the initial standard regimen was changed to regimens including LVFX, and those in which the initial standard regimen was either maintained throughout or modified with drugs other than LVFX. Sputum cultures were examined with Mycobacteria Growth Indicator Tube System (BACTEC MGIT 960).LVFX was used in 41 (13.6%) of 302 initial-treatment cases and in 7 (24.1%) of 29 retreatment cases. Out of the 269 initial-treatment cases starting with the standard regimen, LVFX was later used in 26 cases (9.7%). The reasons for using LVFX were adverse reaction to antituberculosis drugs in 23 cases (88.5%) and resistance to antituberculosis drugs in 3 cases (11.5%). We investigated the bacteriological conversion rate in 228 patients who could be followed up for more than five months. The conversion rates in 105 cases under the standard regimen including PZA (PZA+) were 92.4% in three months, 98.1% in four months, and 100% in five months. The rates in 56 cases under the standard regimen without PZA (PZA-) were 92.9 %, 98.2% and 100%,respectively. The rates of 22 cases under the initial regimen modified with LVFX (LVFX +) were 68.2 %, 95.5% and 100%, respectively. In 45 cases under the initial regimen modified with drugs other than LVFX (LVFX-), the rates were 80.0%, 97.8% and 100%, respectively.This study showed that LVFX was an effective drug in terms of the bacteriological conversion rate, without adverse reaction. LVFX is not approved as an antituberculosis drug in Japan, but it is often used in cases of MDR-TB or in situations in which the patients cannot continue treatment with the standard regimen. We hope that LVFX will be approved as an antituberculosis drug as soon as possible in Japan.

A 55-year-old woman was admitted to our hospital because of chest pain, fever, and right pleural effusion that was exudative and lymphocyte-dominant with a high level of adenosine deaminase (ADA). Since her blood QuantiFERON-TB 3G test (QFT) was positive, she was diagnosed with tuberculous pleurisy. After initiation of anti-tuberculosis chemotherapy with isoniazid, rifampicin, ethambutol, and pyrazinamide, her symptoms improved. Later, liquid culture of the pleural effusion turned positive for Mycobacterium tuberculosis. On the 18th day of treatment, her chest X-ray and computed tomography exhibited pleural effusion in a moderate amount in the left thorax, with subsiding pleural effusion in the right thorax. Thoracocentesis demonstrated that the left thorax effusion was also exudative and lymphocyte-dominant, with elevated QFT response and high ADA concentration, suggesting tuberculous pleurisy. Mycobacterium tuberculosis was detected in the culture of a left pleural biopsy specimen obtained by thoracoscopy. We assumed that the left pleural effusion was due to paradoxical worsening because (1) on admission no effusion or lung parenchymal lesion was detected in the left hemithorax, (2) on the 14th day of treatment she was afebrile without pleural effusion on both sides, and (3) the bacilli were sensitive to the drugs she had been taking regularly. We performed drainage of the left effusion and continued the same anti-tuberculosis drugs, which led to the elimination of all her symptoms and of the pleural effusion on both sides. In conclusion, paradoxical worsening should be included in the differential diagnosis when contralateral pleural effusion is detected during the treatment of tuberculosis.

This paper investigates the CD correction methods to obtain better across-wafer CD uniformity (CDU) after etching for logic devices which have various types of patterns. CD optimization methods are evaluated for contact holes with a diameter of 46 nm after etching. CD optimization methods with PEB temperature and exposure-dose mapping on a wafer at a lithography step are examined in detail. Simulation study using a full physical resist model is done to analyze the detailed effects of each optimization method. The results of the simulation show that better optical and chemical image gives better CD controllability through pitches for etching CD correction. Simulation results also show that the pitch with a middle CD sensitivity makes the CD correction sensitivity difference minimum through pitches. From the simulation, the sensitivity behaviors are found to be relatively similar for both of PEB temperature and dose control. Rather than sensitivity behavior differences between the two CD control methods, the intra-wafer spatial resolution of the CD control methods is found to be an important factor for the strategy of CD optimization. Finally, by contact-layer CD optimization, across-wafer CDUs are improved by more than 50%. The variation in the electric resistance of contacts is also improved by more than 20%. As a result, the proposed method is found to be effective for CDU improvement of through-pitch contact-hole patterning for advanced logic device.

Pulmonary sarcoidosis which predominantly affects the lower lung fields is relatively rare. We performed this study to clarify the clinical manifestations of this type of sarcoidosis.Over a period of 13 years, we diagnosed pulmonary sarcoidosis in 119 patients. Among these, we reviewed the clinical characteristics of 9 patients (3 men, 6 women, mean age 62 years) with pulmonary lesions predominantly affecting the lower lung fields.Four patients had a history of dust inhalation and 6 had symptoms of dyspnea. All patients had ocular lesions and 5 had cutaneous lesions. Serum KL-6 levels were elevated in all patients, whereas angiotensin-converting-enzyme (ACE) levels were elevated in 3. Pulmonary function tests revealed stenosis in 4 patients, and decreased diffusion capacity in 7. Chest CT findings in the lower lung fields revealed bronchovascular thickening, micronodular opacities in the vessels and chest wall, and interlobular septal thickening in 8 patients; ground-glass opacities in 5; curvilinear shadows in 4; and patchy shadows, traction bronchiectasis, and pleural effusion in 3. Histopathologic findings of lung biopsy specimens featured granulomas in all patients, and pulmonary interstitium fibrosis and small round-cell infiltration in the alveoli of most patients.Patients with sarcoidosis affecting the lower lung fields often had symptoms of dyspnea, extrapulmonary lesions in the eye and/or on the skin, and elevated serum KL-6 levels but not ACE. Chest CT showed findings typical of sarcoidosis, such as lymphatic distribution, but also showed unusual findings such as ground-glass opacities, curvilinear shadows, patchy shadows, traction bronchiectasis and pleural effusion. We speculated that 1 patient with ground-glass opacities and traction bronchiectasis without lymphatic distribution on CT, and fibroblastic foci with active alveolitis histopathologically, had complications of a different type of interstitial pneumonia.

We discussed the factors which may confuse diagnosis and treatment of tuberculosis (TB) in elderly patients, in order to improve the situation.414 patients who were hospitalized for active tuberculosis in Tokyo National Hospital were divided into three groups according to their ages (in years): less than 65, 65 to 74, and greater than 75. The three groups were compared in terms of performance status (PS), serum albumin level (whether over 3 g/dl or not), underlying diseases, symptoms at onset, sputum smear findings for acid-fast bacilli, presence or absence of cavitary lesion, regimen of treatment, adverse reaction to medications, and treatment outcome.The older group had significantly poorer PS (3 or 4), lower albumin level, more complications, a larger proportion of non-respiratory to respiratory symptoms, less cavity formation, less likelihood of continuing to take drugs regularly and higher mortality. It is supposed that these characteristics are mostly due to the aging itself.Diagnosing and treating active tuberculosis among elderly people is difficult because of nonspecific and thus confusing findings due to other diseases or aging. Delay in diagnosis and start of treatment makes prognosis of their TB poorer. To improve this situation we should keep a high index to TB and make better use of novel diagnostic technologies. For satisfactory treatment that allows maintenance of a high level of activity of daily life, it is necessary to pay more attention to such aspects as nutrition and rehabilitation and to offer appropriate supports.

To investigate clinical features of patients with pulmonary Mycobacterium xenopi infection treated at our hospital.We diagnosed 11 cases of M. xenopi infection at Tokyo National Hospital between 2000 and 2008 and recorded the drug susceptibility, patient characteristics, radiographic findings, treatments given and clinical courses. Eighteen other Japanese cases from the literature were discussed along with our findings.The cases of M. xenopi infection at our hospital consisted of 10 men and 1 woman with a mean age (+/- SD) of 55.1 +/- 19.4 years. Among the patients, 10 were smokers, 4 were heavy drinkers, and 6 had sequelae of pulmonary tuberculosis as an underlying disorder. Four patients had chronic obstructive pulmonary disease and 2 had diabetes mellitus, while there were 2 patients who had no underlying disease. All cases had radiographic opacities, predominantly found in the upper lung region, and cavernous lesions. These findings were demonstrated in both lungs in 5 patients, in the right lung only in 5 patients and in the left lung only in 1 patient. Concurrent aspergillosis was observed in 8 patients. The bacterial isolates from 7 cases were tested for drug sensitivity to levofloxacin (LVFX) and were found to be susceptible. M. xenopi disease was treated in 5 cases with INH+RFP+EB, in 2 cases with INH+RFP+Clarithromycin (CAM), and in 1 case with RFP+EB+CAM. Concurrent aspergillosis was treated with itraconazole in 2 cases. One patient underwent surgery for lung cancer. The duration of treatment was 16.4 +/- 12.8 months (range, 4-36 months). The radiographic findings were improved in 4 cases, deteriorated in 2 and unchanged in 5. M. xenopi was eradicated bacteriologically in 6 cases. The combination of radiographic and bacteriological findings indicated improvement in 3 cases, no change in 6 and deterioration in 2.The review of our cases disclosed that medical treatment alone was not sufficient in most cases for the control of clinical M. xenopi infection as reported overseas. Although we did not use LVFX for treatment, LVFX might be recommended for the treatment since all isolates tested proved to be susceptible to LVFX.

A 56-year-old man underwent thoracic drainage for two weeks for tuberculous pleuritis. He was put on antituberculosis chemotherapy with INH (400 mg), RFP (450 mg), and EB (750 mg). Two months later, he developed an elastic hard subcutaneous mass in the area of the previous thoracic drainage. The mass was 10 cm in diameter, warm, reddish and painful. Chest computed tomography (CT) revealed localized and encapsulated empyema in the left thoracic space and a subcutaneous abscess with rim enhancement in the left lateral chest wall. Magnetic resonance imaging (MRI) demonstrated a dumbbell abscess in the subcutaneous tissue communicating with the empyema through the chest wall. A needle aspiration of the subcutaneous abscess had acid-fast bacilli smears of 2+ and tested positive by polymerase chain reaction (PCR) for Mycobacterium tuberculosis. Thus, he was diagnosed with a cold abscess of the chest, with the empyema in the thoracic space draining into the chest wall through the cut for artificial drainage. Continuation of the anti-tuberculosis treatment and the drainage of the empyema with repeated aspiration reduced the subcutaneous mass, and the clinical and radiological course was favorable. Both the smear and culture for acid-fast test became negative. After completion of chemotherapy, there has been no disease recurrence.

A 77-year-old man with Hansen's disease was referred to our hospital because of a small nodular lesion detected adjacent to the pleura in the right lower lobe (S10) on chest CT. He had lost all ten fingers due to Hansen's disease and was using a prosthetic limb after amputation of the right lower leg. Although the patient had an 11-year history of shoulder and back pain and was suspected of having interstitial pneumonia 6 years previously, no detailed examination had been conducted. Bronchoscopy did not yield a definitive diagnosis, and a lung biopsy was performed under thoracoscopic guidance. Histological examination of the resected nodule with colliquative necrosis revealed palisading granulomas with multinucleated giant cells and plasma cell infiltration with formation of lymphoid follicles. Since serum levels of both anti-MMP3 and anti CCP antibodies were elevated, rheumatoid arthritis (RA) with rheumatoid lung was diagnosed. Therefore, the nodule was considered a rheumatoid nodule. Since diagnosis of rheumatoid arthritis is difficult when lacking characteristic joint manifestations, it is important to include rheumatoid nodules as a differential diagnosis and to measure RA specific autoantibodies, to make a comprehensive diagnosis for non-specific necrotizing granulomas.