The aim of this study was to evaluate the therapeutic efficacy and safety of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy in elderly patients with locally ...advanced oral cancer. Between February 2009 and October 2019, 42 oral cancer patients aged ≥75 years were treated with this therapy. Median age was 80 years (range 75–90 years) and the median follow-up duration was 39 months (range 2–106 months). Of the 42 patients, 34 (81%) were diagnosed with stage IV cancer. The 3-year overall survival, local control, progression-free survival, and disease-specific survival rates were 56%, 69%, 32%, and 67%, respectively. Regarding acute toxicities, grade 3 neutropenia was observed in six patients (14%), anaemia in five (12%), acute kidney injury in one (2%), and oral mucositis in 18 (42%). Late toxicities of grade 3 were observed in seven patients: dysphagia in six (14%) and osteonecrosis of the jaw in one (2%). This study showed that proton beam therapy combined with retrograde intra-arterial infusion chemotherapy was effective for elderly patients with oral cancer, and toxicities were tolerable and manageable. The study findings suggest that this therapy is a potential treatment option for elderly oral cancer patients with difficulty in surgery and systemic chemotherapy.
We have developed a unique experimental device of so-called double plasma gun, which consists of two magnetized coaxial plasma gun (MCPG) devices, in order to clarify effects of vapor shielding on ...material erosion due to transient events in magnetically confined fusion devices. Two ELM-like pulsed plasmas produced by the two MCPG devices were injected into a target chamber with a variable time difference. For generating ablated plasmas in front of a target material, an aluminum foil sample in the target chamber was exposed to a pulsed plasma produced by the 1st MCPG device. The 2nd pulsed plasma was produced with a time delay of 70μs. It was found that a surface absorbed energy measured by a calorimeter was reduced to ∼66% of that without the Al foil sample. Thus, the reduction of the incoming plasma energy by the vapor shielding effect was successfully demonstrated in the present experiment.
Objectives: To identify the effects of indium on the lung and to assess exposure-effect and exposure-response relations between indium exposure and effects on the lungs. Methods: Ninety three male ...indium exposed and 93 male non-exposed workers from four ITO manufacturing or ITO recycling plants were analysed in a cross-sectional study. Indium in serum (In-S) was determined as a biological exposure index. Geometric means (GSD) of In-S were 8.25 ng/ml (4.55) in the exposed workers and 0.25 (2.64) in the non-exposed workers. The maximum concentration of In-S was 116.9 ng/ml. A questionnaire for respiratory symptoms and job histories, spirometry, high-resolution computerised tomography (HRCT) of the chest, serum KL-6, serum SP-A, serum SP-D and serum CRP were measured as the effect indices. Results: Spirometry, subjective symptoms and the prevalence of interstitial or emphysematous changes on lung HRCT showed no differences between exposed and non-exposed workers. Geometric means (GSD) of KL-6, SP-D and SP-A in the exposed workers were 495.4 U/ml (2.26), 85.2 ng/ml (2.02) and 39.6 ng/ml (1.57), and were significantly higher than those in the non-exposed workers. The prevalence (%) of the exposed and non-exposed workers exceeding the reference values were also significantly higher in KL-6 (41.9 vs 2.2), SP-D (39.8 vs 7.5), and SP-A (43.0 vs 24.7). Very sharp exposure-effect and exposure-response relations were discovered between In-S and KL-6 and between In-S and SP-D when the exposed workers were classified into seven groups by In-S. Conclusions: The study outcomes with regard to the basis of serum immunochemistry biomarkers and HRCT indicate that exposure to hardly soluble indium compound dust may represent a risk for interstitial lung damage.
An experimental demonstration was carried out in a ballistic range at high Mach numbers with the low specific heat ratio gas hydrofluorocarbon HFC-134a to observe the unstable bow-shock wave ...generated in front of supersonic blunt objects. The shadowgraph images obtained from the experiments showed instability characteristics, in which the disturbances grow and flow downstream and the wake flow appears wavy because of the shock oscillation. Moreover, the influence of the body shape and specific heat ratio on the instability was investigated for various experimental conditions. Furthermore, the observed features, such as wave structure and disturbance amplitude, were captured by numerical simulations, and it was demonstrated that computational fluid dynamics could effectively simulate the physical instability. In addition, it was deduced that the shock instability is induced by sound emissions from the edge of the object. This inference supports the dependence of the instability on the specific heat ratio and Mach number because the shock stand-off distance is affected by these parameters and limits the sound wave propagation.
Surface damage of pure tungsten (W), W alloys with 2wt.% tantalum (W–Ta) and vacuum plasma spray (VPS) W coating on a reduced activation material of ferritic steel (F82H) due to repetitive ELM-like ...pulsed (∼0.3ms) deuterium plasma irradiation has been investigated by using a magnetized coaxial plasma gun. Surface cracks appeared on a pure W sample exposed to 10 plasma pulses of ∼0.3MJm−2, while a W–Ta sample did not show surface cracks with similar pulsed plasma irradiation. The energy density threshold for surface cracking was significantly increased by the existence of the alloying element of tantalum. No surface morphology change of a VPS W coated F82H sample was observed under 10 plasma pulses of ∼0.3MJm−2, although surface melting and cracks in the resolidification layer occurred at higher energy density of ∼0.9MJm−2. There was no indication of exfoliation of the W coating from the substrate of F82H after the pulsed plasma exposures.
In patients with metastatic brain tumors after gamma knife radiosurgery, the superiority of PET using
C-methionine for differentiating radiation necrosis and recurrent tumors has been accepted. To ...evaluate the feasibility of MR permeability imaging, it was compared with PET using
C-methionine, FDG-PET, and DWI for differentiating radiation necrosis from recurrent tumors.
The study analyzed 18 lesions from 15 patients with metastatic brain tumors who underwent gamma knife radiosurgery. Ten lesions were identified as recurrent tumors by an operation. In MR permeability imaging, the transfer constant between intra- and extravascular extracellular spaces (/minute), extravascular extracellular space, the transfer constant from the extravascular extracellular space to plasma (/minute), the initial area under the signal intensity-time curve, contrast-enhancement ratio, bolus arrival time (seconds), maximum slope of increase (millimole/second), and fractional plasma volume were calculated. ADC was also acquired. On both PET using
C-methionine and FDG-PET, the ratio of the maximum standard uptake value of the lesion divided by the maximum standard uptake value of the symmetric site in the contralateral cerebral hemisphere was measured (
C-methionine ratio and FDG ratio, respectively). The receiver operating characteristic curve was used for analysis.
The area under the receiver operating characteristic curve for differentiating radiation necrosis from recurrent tumors was the best for the
C-methionine ratio (0.90) followed by the contrast-enhancement ratio (0.81), maximum slope of increase (millimole/second) (0.80), the initial area under the signal intensity-time curve (0.78), fractional plasma volume (0.76), bolus arrival time (seconds) (0.76), the transfer constant between intra- and extravascular extracellular spaces (/minute) (0.74), extravascular extracellular space (0.68), minimum ADC (0.60), the transfer constant from the extravascular extracellular space to plasma (/minute) (0.55), and the FDG-ratio (0.53). A significant difference in the
C-methionine ratio (
< .01), contrast-enhancement ratio (
< .01), maximum slope of increase (millimole/second) (
< .05), and the initial area under the signal intensity-time curve (
< .05) was evident between radiation necrosis and recurrent tumor.
The present study suggests that PET using
C-methionine may be superior to MR permeability imaging, ADC, and FDG-PET for differentiating radiation necrosis from recurrent tumors after gamma knife radiosurgery for metastatic brain tumors.
Urate, a naturally occurring product of purine metabolism, is a scavenger of biological oxidants implicated in numerous disease processes, as demonstrated by its capacity of neuroprotection. It is ...present at higher levels in human blood (200-500 µM) than in other mammals, because humans have an effective renal urate reabsorption system, despite their evolutionary loss of hepatic uricase by mutational silencing. The molecular basis for urate handling in the human kidney remains unclear because of difficulties in understanding diverse urate transport systems and species differences. Here we identify the long-hypothesized urate transporter in the human kidney (URAT1, encoded by SLC22A12), a urate-anion exchanger regulating blood urate levels and targeted by uricosuric and antiuricosuric agents (which affect excretion of uric acid). Moreover, we provide evidence that patients with idiopathic renal hypouricaemia (lack of blood uric acid) have defects in SLC22A12. Identification of URAT1 should provide insights into the nature of urate homeostasis, as well as lead to the development of better agents against hyperuricaemia, a disadvantage concomitant with human evolution.
The Borromean halo nucleus 6He has been studied by a kinematically complete measurement of Coulomb and nuclear breakup into α + 2n on Pb and C targets at 70 MeV/nucleon. Fully quantum-mechanical ...four-body breakup calculations reproduce the energy and angular differential cross sections below Erel∼1 MeV for both targets. The model used here reproduces the 6He ground-state properties as well as α-n and n-n scattering data and predicts an average opening angle 〈θnn〉 of 68∘ between the two halo neutrons. However, the model underestimates the breakup cross sections for higher Erel, indicating a possible contribution from the inelastic breakup. Alternatively, we examine the empirically modified calculations that reproduce the energy-differential cross sections for a wide range of scattering angles for both targets. The extracted B(E1) peaks at Erel∼1.4 MeV and amounts to 1.6(2) e2fm2 for Erel ≤ 20 MeV, resulting 〈θnn〉 = 56−10+9 degrees. In either interpretation, the current results show evidence of the dineutron spatial correlation in 6He.
Pelvic fistulas affect a significant number of patients globally, with a relatively low prevalence in the United States. Virtual education offers an effective, scalable solution to bridge this ...educational gap and lead to a deeper understanding of more common conditions, such as urinary and fecal incontinence.IntroductionPelvic fistulas affect a significant number of patients globally, with a relatively low prevalence in the United States. Virtual education offers an effective, scalable solution to bridge this educational gap and lead to a deeper understanding of more common conditions, such as urinary and fecal incontinence.We developed two virtual cases on rectovaginal and vesicovaginal/ureterovaginal fistulas to enhance medical students' exposure, knowledge, and confidence regarding assessment of pelvic fistulas. The cases could be completed in approximately 30 minutes, asynchronously, and at students' own pace. The cases were integrated into an OB/GYN clerkship. We conducted a survey among students receiving the cases to gather feedback on usability, acceptability, and educational value, which guided subsequent improvements.MethodsWe developed two virtual cases on rectovaginal and vesicovaginal/ureterovaginal fistulas to enhance medical students' exposure, knowledge, and confidence regarding assessment of pelvic fistulas. The cases could be completed in approximately 30 minutes, asynchronously, and at students' own pace. The cases were integrated into an OB/GYN clerkship. We conducted a survey among students receiving the cases to gather feedback on usability, acceptability, and educational value, which guided subsequent improvements.Forty medical students, ranging from first to third year, participated in the urogynecology elective; 21 (53%) completed the survey. Ninety-one percent agreed or strongly agreed they were satisfied with the cases. All respondents found the format easy to use and appropriate for their level of learning. Most reported the cases improved their confidence in nonsurgical and surgical management options for pelvic fistulas.ResultsForty medical students, ranging from first to third year, participated in the urogynecology elective; 21 (53%) completed the survey. Ninety-one percent agreed or strongly agreed they were satisfied with the cases. All respondents found the format easy to use and appropriate for their level of learning. Most reported the cases improved their confidence in nonsurgical and surgical management options for pelvic fistulas.Offering virtual and interactive patient cases on e-learning platforms represents an innovative approach to increasing clinical exposure to urogynecologic disorders. By providing medical students with the opportunity to interact with pelvic fistulas virtually, these cases can help bridge a gap in clinical education. Future exploration is valuable for examining knowledge deficiencies and developing cost-effective, self-paced, easily accessible educational resources to advance medical training and optimize patient care.DiscussionOffering virtual and interactive patient cases on e-learning platforms represents an innovative approach to increasing clinical exposure to urogynecologic disorders. By providing medical students with the opportunity to interact with pelvic fistulas virtually, these cases can help bridge a gap in clinical education. Future exploration is valuable for examining knowledge deficiencies and developing cost-effective, self-paced, easily accessible educational resources to advance medical training and optimize patient care.
A retrospective analysis was performed to evaluate the clinical characteristics and prognostic factors in the patients with clear cell carcinoma (CCC) of the ovary. After central pathological review ...and scanning of the medical records of nine Japanese institutions between 1992 and 2003, a total of 254 patients with CCC of the ovary were enrolled in the present study. Mean age was 52.4 years (range 23-73 years). Tumours were 13% (33/254) stage Ia, 36% (92/254) stage Ic, 13% (33/254) stage II, 30% (80/254) stage III, and 6% (16/254) stage IV. Five-year progression-free survival and overall survival was 84 and 88% in stage I, 57 and 70% in stage II, 25 and 33% in stage III and 0 and 0% in stage IV, respectively. Retroperitoneal lymph node metastasis was observed in 9% in pT1a tumours, 7% in pT1c tumours, 13% in pT2 tumours, and 58% in pT3 tumours, respectively. There was no survival benefit according to chemotherapeutic differences in the patients who received complete surgical staging procedures and conventional chemotherapy. Peritoneal cytological status was an independent prognostic factor in stage Ic patients (P=0.03) and only residual tumour diameter was an independent prognostic factor in stage III, IV patients (P=0.02). Our results suggest that cytoreductive surgery resulting in no residual tumour only could improve the prognosis of advanced CCC patients.
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