Sol–gel synthesis of TiO2/SiO2 multilayers was studied for application to structural color materials. The purpose of this study is to achieve crack-free thick films, which are indispensable for high ...reflectance and color vividness. We investigated the effect of polymer additives and heating conditions on the fracture of TiO2 gel films. The critical cracking thickness increased more than three-fold at maximum by adding poly(vinyl pyrrolidone) (PVP) to precursor sols and by using a low heating rate. From stress measurement based on Stoney’s model, we found that the addition of PVP extensively reduced residual stress, proving the mechanism suggested so far that PVP hinders the evolution of the Ti–O network and reduces drying stress. Under the restriction of the critical thickness, TiO2/SiO2 multilayered films and flakes were prepared as a feasibility test of structural coloration. A high-order interference condition was used for the optical design, which allows us to obtain narrow spectral peaks and the primary colors of light. Theoretically expected reflection spectra that corresponded to blue and green colors were attained for five-layered films.
Backgrounds
No confirmatory randomized controlled trials (RCTs) have evaluated the efficacy of laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG). We performed ...an RCT to confirm that LADG is not inferior to ODG in efficacy.
Methods
We conducted a multi-institutional RCT. Eligibility criteria included histologically proven gastric adenocarcinoma in the middle or lower third of the stomach, clinical stage I tumor. Patients were preoperatively randomized to ODG or LADG. This study is now in the follow-up stage. The primary endpoint is relapse-free survival (RFS) and the primary analysis is planned in 2018. Here, we compared the surgical outcomes of the two groups. This trial was registered at the UMIN Clinical Trials Registry as UMIN000003319.
Results
Between March 2010 and November 2013, 921 patients (LADG 462, ODG 459) were enrolled from 33 institutions. Operative time was longer in LADG than in ODG (median 278 vs. 194 min,
p
< 0.001), while blood loss was smaller (median 38 vs. 115 ml,
p
< 0.001). There was no difference in the overall proportion with in-hospital grade 3–4 surgical complications (3.3 %: LADG, 3.7 %: ODG). The proportion of patients with elevated serum AST/ALT was higher in LADG than in ODG (16.4 vs. 5.3 %,
p
< 0.001). There was no operation-related death in either arm.
Conclusions
This trial confirmed that LADG was as safe as ODG in terms of adverse events and short-term clinical outcomes. LADG may be an alternative procedure in clinical IA/IB gastric cancer if the noninferiority of LADG in terms of RFS is confirmed.
Background
Neoadjuvant chemotherapy (NAC) followed by radical surgery is a promising strategy to improve survival of patients with stage III gastric cancer, but is associated with the risk of ...preoperative overdiagnosis by which patients with early disease may receive unnecessary intensive chemotherapy.
Methods
We assessed the validity of a preoperative diagnostic criterion in a prospective multicenter study. Patients with gastric cancer with a clinical diagnosis of T2/T3/T4, M0, except for diffuse large tumors and extensive bulky nodal disease, were eligible. Prospectively recorded clinical diagnoses (cT category, cN category) were compared with postoperative pathological diagnoses (pT category, pN category, and pathological stage). The primary endpoint was the proportion of pathological stage I tumors among those diagnosed as cT3/T4, which we expected to be 5% or less.
Results
Data from 1260 patients enrolled from 53 institutions were analyzed. The proportion of pathological stage I tumors in those with a diagnosis of cT3/T4 (primary endpoint) was 12.3%, which was much higher than the prespecified value. The positive predictive value and the sensitivity for pathological stage III tumors were 43.6% and 87.8% respectively. The sensitivity and specificity of contrast-enhanced CT for lymph node metastasis were 62.5% and 65.7% respectively. After exploring several diagnostic criteria, we propose, for future NAC trials in Japan, a diagnosis of “cT3/T4 with cN1/N2/N3,” by which inclusion of pathological stage I tumors was reduced to 6.5%, although its sensitivity for pathological stage III tumors decreased to 64.5%.
Conclusion
Clinical diagnosis of T3/T4 tumors was not an optimal criterion to select patients for intensive NAC trials because more than 10% of patients with pathological stage I disease were included. We propose the criterion “cT3/T4 and cN1/N2/N3” instead.
This paper presents a microfluidic device that can separate and extract blood plasma from several microliters of blood without external mechanical driving sources such as a centrifugal machine and a ...syringe pump. This device consists of a main-channel, many side-channels, a reservoir, and two electrodes. After blood was automatically injected into the main-channel by capillary force, blood cells blocked the side-channel entrances and prevented blood plasma from entering them. Next, when AC voltage application between the two electrodes separated blood into cells and plasma by dielectrophoresis (DEP), cells were removed from the side-channel entrances. This permitted plasma to be injected into the side-channels connecting to the reservoir. Experiments using diluted blood samples (dilution 1:9) showed that blood cell removal and blood plasma extraction were affected by channel geometry and magnitude/frequency of applied AC voltage. In case of applied AC voltage of 10
V and 1
MHz, blood cells were removed by about 97%, and blood plasma of about 300
nL was extracted from 5
μL blood. Moreover, we found that optimal dimension of the side-channels for blood plasma extraction is 5
μm wide and 2
μm deep.
Background
Patients undergoing dialysis experience decreases in physical function; however, few data exist on physical function in pre-dialysis patients with chronic kidney disease (CKD). The primary ...objective of this study was to clarify physical function in pre-dialysis patients according to CKD stage.
Methods
This was a cross-sectional study of 120 ambulant pre-dialysis CKD stage 2 or higher patients (85 male, 35 female; mean age 66.5 years) who visited St. Marianna University School of Medicine Hospital. Participants were grouped according to CKD stage as follows: stage 2 (
n
= 17), stage 3 (
n
= 55), stage 4 (
n
= 25), and stage 5 (
n
= 23). Handgrip strength, knee extensor muscle strength, single-leg stance time, and maximum gait speed were used to assess physical function. Clinical laboratory tests were also examined at the same time as physical function measurements.
Results
All indices of physical function decreased according to the progression of CKD. Each physical function index was significantly lower in CKD stage 4 or 5 patients than CKD stage 2 or 3 patients. All physical function indices showed a positive correlation with estimated glomerular filtration rate (eGFR), blood hemoglobin level, and serum albumin level, and a negative correlation with urinary protein levels. In multiple regression analysis, age, female sex, body mass index, eGFR and urinary protein were significantly correlated with indices of physical function.
Conclusion
Physical function in pre-dialysis CKD patients decreased as the disease progressed according to stage. Early intervention in CKD patients might delay the loss of physical function.
Oral lichen planus (OLP) is an autoimmune inflammatory disease of the oral mucosa whose etiology remains unknown. Moreover, the possibility of OLP being a premalignant change is under debate. Various ...types of immune cells infiltrate the OLP lesion and affect its clinicopathological features. However, the diversity of infiltrating immune cells has not been fully clarified in relation to OLP diagnosis. In this study, we quantitatively examined CD8+ lymphocyte infiltration by immunohistochemistry, which is the principal effector of cytotoxic immune reaction in 123 cases of OLP specimens. Our examination revealed that high-grade intraepithelial CD8+ lymphocyte infiltration was associated with a high remission rate. Evaluation of the infiltration of T-bet+ and FoxP3+ lymphocytes, which corresponded to the Th1 and Treg CD4+ subsets, respectively, showed that intraepithelial CD8+ lymphocytes were associated with the remission rate in the subgroup with a higher T-bet/FoxP3 subset balance that is inducible for cytotoxic immunity. We also investigated the cutoff value of CD8+ lymphocyte infiltration for histopathological diagnosis. By microscopic counting, 16 cells/high-power field, which was also confirmed in the validation cohort, was established as the cutoff value for intraepithelial CD8+ lymphocyte infiltration for predicting the remission of OLP. Remitting OLP might be different from refractory OLP in terms of etiology and clinical behavior. Thus, intraepithelial CD8+ lymphocytes may serve not only as a predictive biomarker for remission but also as an area for further biomedical research regarding the etiology and premalignant potential of OLP.
•CD8+ T-cell infiltration predicts remission of oral lichen planus.•High-grade CD8+ T-cell infiltration relates to high remission rate.•Diagnostic cutoff value of CD8+ T cell to predict remission is established.
Only a few research is available on the effects of home-based exercise training on pre-dialysis chronic kidney disease (CKD) patients. Therefore, we aimed to elucidate the effect of home-based ...exercise therapy on kidney function and arm and leg muscle strength in pre-dialysis CKD patients.
Thirty-six male stage 3-4 pre-dialysis CKD patients (age, 68.7 ± 6.8 years; estimated glomerular filtration rate (eGFR), 39.0 ± 11.6 ml/min/1.73 m
) who were being treated as outpatients were included. The subjects were randomly assigned to an exercise intervention group (Ex group: 18) and a control group (C group: 18). The Ex group wore accelerometer pedometers and were instructed to perform home-based aerobic and resistance exercises, such as brisk walking for 30 min per day, for 12 months. The C group subjects wore accelerometer pedometers but received no exercise therapy guidance; the number of steps covered during normal daily activities was recorded for the C group. The outcome measures were changes in kidney function and handgrip and knee extension muscle strength. Values at the baseline (T1) and 12 months later (T2) were compared.
There were no significant differences in baseline characteristics between the two groups; however, the C group was more physically active than the Ex group. Eight subjects dropped out, and 28 subjects (14 in each group) were included in the final analysis. Physical activity increased significantly only in the Ex group. Grip strength (F = 7.0, p = 0.01) and knee extension muscle strength (F = 14.3, p < 0.01) were found to improve only in the Ex group. Further, the changes in eGFR were not significantly different between the two groups (F = 0.01, p = 0.93).
Home-based exercise therapy for pre-dialysis CKD patients was feasible and improved arm and leg muscle strength without affecting kidney function.
UMIN Clinical Trials Registry ( UMIN000005091 ). Registered 2/15/2011.
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