In Tethered solar power satellite on GEO, changes in the angle of the sunlight cause changes in the amount of power generated by solar cells. These variations result in changes in the DC-RF ...conversion efficiency of RF power amplifiers. This variation of the DC-RF conversion efficiency has been estimated in a previous study by using prototypes of the RF amplifiers. This estimated variation of the DC-RF conversion efficiency must be suppressed. This paper reports a new method to maintain high power efficiency during the variation of the power supply by applying the pulse modulation for RF amplifier.
Background
Preoperative risk assessment is important in older patients because they often have comorbidities and impaired organ function. We performed preoperative comprehensive geriatric assessment ...(CGA) for older patients with esophageal cancer.
Patients and Methods
A total of 217 patients over 75 years old who underwent esophagectomy for thoracic esophageal cancer were analyzed. The CGA was performed preoperatively and included the Mini-Mental State Examination (MMSE), Geriatric Depression Score (GDS), vitality index, Barthel index, and instrumental activities of daily living (IADL). We defined the robust group as patients with normal function on every instrument, and the pre-frail and frail groups as those with functional impairment on one instrument or two or more instruments, respectively. We assessed how the CGA correlated with postoperative complications and prognosis.
Results
Of the 217 patients, 86 (39.6%) were in the robust group, 68 (31.3%) in the pre-frail group, and 63 (29.0%) in the frail group. Postoperative pneumonia (
P
= 0.026) and anastomotic leakage (
P
= 0.032) were significantly more common in the frail group. The frail group had a significantly longer postoperative hospitalization period (
P
= 0.016) and significantly lower rate of discharge to home (
P
= 0.016). Overall survival (OS) was significantly worse in the frail group (5-year overall survival rate, frail group versus others, 37.8% versus 52.0%,
P
= 0.046), but it was not significant on multivariate analysis.
Conclusions
The preoperative CGA in older patients with esophageal cancer was associated with risk of postoperative complications.
Abstract
Background
The 1st line regimens including Immunocheckpoint Inhibitor (ICI) have lately been approved for unresectable advanced or recurrent esophageal squamous cell carcinoma (ESCC). ...However, evidence of these regimens in clinical practice remains limited.
Methods
A total of 67 unresectable advanced or recurrent ESCC patients who received FP (5-FU + CDDP) + Pembrolizumab/Nivolumab (FP + ICI group; n = 43) or Ipilimumab+Nivolumab (ICI + ICI group; n = 24) as the 1st line treatment from December 2017 to March 2023 at our hospital were evaluated.
Results
Patient characteristics(FP + ICI: ICI + ICI) were as follows; age = 69:74 year-old, male/female = 36/7:22/2, recurrent/unresectable = 17(40%)/26(60%):13(54%)/11(46%), number of administered courses = 4 1–35: 2 1–17, follow up period = 9: 6 months. Best response rate was CR/PR/SD/PD = 6/22/9/6:4/9/6/5 cases, while response/disease control rates were 65:54% and 86:79%, respectively. Regarding survival analysis, median OS = 23 months:did not reach, and 1-year OS = 83.7:87.5%, median PFS = 8:5 months, 1-year PFS = 48.8:49.3%, and DOR (duration of response) = 42–38:55–9 months. The most common treatment-related adverse events (CTCAE Grade 3 or higher) were neutropenia in 18 cases, followed by anorexia in 7 cases (FP + ICI group), and adrenal hypofunction in 2 cases and pruritus in 2 cases (ICI + ICI group).
Conclusion
Both 1st line regimens for unresectable advanced or recurrent esophageal squamous cell carcinoma seemed to be feasible and promising in clinical use.
Abstract
Background
Advantages of robot-assisted esophagectomy (RAMIE) includes operator-led stable surgical field with stereoscopic HD surgical vision and robotic instruments with EndoWrist ...technology. However, feasibility and potential benefit of RAMIE for cT4b thoracic esophageal cancer remain unclear.
Patients
A total of 16 cases with cT4b esophageal cancer treated with RAMIE between Feb, 2019 and April, 2023 were reviewed. Surgical technique and peri-operative factors in addition to short term outcome were evaluated in the present study.
Results
Background parameters of all 16 cases are as follows; median age = 70.5(42–81), gender (male/female) = 10/6, histology (SCC/Adenoca) =13/3, tumor location (Ut/Mt/Lt) = 4/6/6, invaded organs (Tr/Br/Ao/other) = 7/2/2/5, cN0/1/2/3 = 1/10/4/1, cM0/1 = 11/5, cStage3/4 = 11/5, and preoperative treatment (none/chemotherapy/CRT/both) = 0/9/6/1. In terms of surgical outcomes, median operation time/console time (thoracic procedure) were 506 (403–833)/253 (194–459) min while estimated blood loss was 116 (15–2090) ml. R0 resection was achieved in all cases without conversion to open procedure. Overall postoperative morbidity (Clavien-Dindo classification≧grade3) was 31.3% and the common morbidities were palsy of recurrent laryngeal nerve (n = 2) and anastomotic leakage (n = 2), followed by chylothorax (n = 1), pneumonia (n = 1), and non-occlusive mesenteric ischemia (n = 1). No hospital death (within 90 days) was identified and median postoperative hospital stay was 21 (14–142) days. Surgical videos of cT4b cases to show in our presentation include #1; Mt cT4 (Ao, ltPV) case previously treated with definitive CRT followed by immunotherapy where combined resection of aortic adventitia layer was performed by RAMIE and #2; Ut, cT4 (Tr, ltSCA) case previously treated with definitive CRT. We also discuss potential advantages of RAMIE over conventional approach together with protective measures to be taken in cT4b cases.
Conclusion
RAMIE for cT4b esophageal cancer seems to be feasible and might have potential advantage over conventional approach.
CONTRADICTIONS IN DŌGEN Tanaka, Koji
Philosophy east & west,
07/2013, Volume:
63, Issue:
3
Journal Article
Peer reviewed
In "The Way of the Dialetheist: Contradictions in Buddhism,'' Yasuo Deguchi, lay L. Garfield, and Graham Priest argue that some (though not all) of the contradictions that appear in Buddhist texts ...should be accepted. An examination of their argument depends on what sort(s) of negation is (are) used in the texts. In order to see apparently contradictory statements as affirmations of true contradictions, we must assume that 'not' (or its variance) is used as a contradiction-forming operator. In this article, the conception of negation(s) that is (are) salient in the writings of Dõgen is examined, and it is argued that he would not agree that his sentences are to be considered, and accepted, as contradictory.
The catalytic organic-hydride transfer to CO
was first achieved through the photoinduced two-electron reduction of the Ru(bpy)
(pbn)
/Ru(bpy)
(pbnHH)
(bpy=2,2'-bipyridine, ...pbn=2-(pyridin-2-yl)benzob-1,5-naphthyridine, and pbnHH=2-(pyridin-2-yl)-5,10-dihydrobenzob-1,5-naphthyridine) redox couple in the presence of 1,3-dimethyl-2-phenyl-2,3-dihydro-1H-benzodimidazole (BIH). The active species for the catalytic hydride transfer to carbon dioxide giving formate is Ru(bpy)(bpy⋅
)(pbnHH)
formed by one-electron reduction of Ru(bpy)
(pbnHH)
with BI⋅.
A new pincer ruthenium complex (
1) having a κ
3NCN pincer ligand with two imidazoline units and related ruthenium complexes were synthesized and characterized. The imidazoline units of
1 were ...oxidized in air to give an imidazole-ligated pincer complex (
2). Results of the
1H NMR spectroscopic and cyclic voltammetric studies of the complexes indicate that the σ-donor character of the pincer ligand of
1 induces the Ru-promoted oxidative dehydrogenation of coordinated imidazoline moieties to imidazole units with oxygen in air.
A new pincer ruthenium complex (
1; RuL
1(tpy)(PF
6);
L
1
=
1,3-di(2-imidazoline-2-yl)benzene, tpy
=
2,2′:6′,2″-terpyridine) having a κ
3NCN pincer ligand with two imidazoline units and related ruthenium complexes were synthesized and characterized. The imidazoline units of
1 were oxidized in air to give an imidazole-ligated pincer complex (
2; RuL
2(tpy)(PF
6);
L
2
=
1,3-di(2-imidazolyl)benzene). Results of the
1H NMR spectroscopic and cyclic voltammetric studies of the complexes indicate that the σ-donor character of the pincer ligand of
1 induces the Ru-promoted oxidative dehydrogenation of coordinated imidazoline moieties to imidazole units with oxygen in air.
Neutrophil extracellular traps (NETs) are fibrous mesh-like, web-like, or string-like structures which are composed of DNA, histones, and granule proteins such as neutrophil elastase or ...myeloperoxidase. When activated by phorbol myristate acetate, interleukin-8, lipopolysaccharide (LPS), and various pathogens, neutrophils release NETs. We reported that NETs were classified as two distinct forms; cell-free NETs that were released away from neutrophils and anchored NETs that were anchored to neutrophils. In general, extracellular DNAs are used as a surrogate marker of NETs. Here, we describe a protocol regarding quantitative procedures of extracellular DNAs released from ex vivo neutrophils activated by LPS using fluorometric double-stranded DNA (dsDNA) quantification assay.
Background
Multidisciplinary treatment combining chemotherapy, chemo radiation therapy (CRT), and surgery has been utilized for advanced esophageal cancer. However, preoperative treatment could cause ...postoperative inflammation and complications. We hypothesized that fibrosis surrounding tumor tissue caused by preoperative treatment could induce postoperative systemic inflammation and influence postoperative complications.
Methods
Surgical specimens from patients with thoracic esophageal cancer who underwent preoperative CRT (38 cases) or chemotherapy (77 cases) and those who received no preoperative treatment (49 cases) were evaluated to measure the fibrotic area adjacent to the tumor (10 mm from the tumor edge) by applying Azan staining. Pleural effusion and peripheral blood serum interleukin‐6 levels were analyzed to evaluate local and systemic postoperative inflammation in 37 patients.
Results
The fibrotic areas around the tumors were significantly larger in patients who underwent preoperative CRT than in patients who underwent chemotherapy (p < 0.001) or who had received no preoperative therapy (p < 0.001). Infectious complications were higher in patients who underwent preoperative CRT than chemotherapy (p = 0.047) or surgery alone (p < 0.001). The patients with larger fibrotic areas had more infectious complications (p = 0.028). Multivariate analysis showed that both a large fibrotic area and preoperative CRT were correlated with infectious complications, but not significantly. Pleural effusion interleukin‐6 was significantly higher in patients who underwent preoperative CRT than in patients who received no preoperative therapy (p = 0.013).
Conclusions
A large fibrotic peritumoral esophageal tissue area after preoperative treatment could cause postoperative inflammatory response and infectious complications.
The optimal treatment strategy for cT4b esophageal cancer has not been established yet. Although curative surgery is sometimes performed after induction treatments, the prognostic factor of cT4b ...esophageal cancer cases who underwent R0 resection remains unknown.
A total of 200 patients with cT4b esophageal cancer who underwent R0 resection after induction treatments between 2001 and 2020 in our institute were included in the present study. The relationship between clinicopathological factors and patient survival is evaluated to identify useful prognostic factors.
The median and 2-year overall survival were 40.1 months and 62.8%, respectively. Disease recurrence occurred in 98 (49%) patients after surgery. Compared to induction chemotherapy alone, chemoradiation-based induction treatments were associated with decreased locoregional recurrence (34.0% vs 60.8%, P = .0077) but increased pulmonary metastases (27.7% vs 9.8%, P = .0210) and dissemination (19.1% vs 3.9%, P = .0139) after surgery. Multivariate analysis of overall survival identified the preoperative C-reactive protein/albumin ratio (hazard ratio 1.7957, P = .0031), response to induction treatments (hazard ratio 2.9663, P = .0009), postoperative pneumonia (hazard ratio 2.3784, P = .0010), and pN (2-3) (hazard ratio 1.5693, P = .0355) as independent prognostic factors. Preoperative C-reactive protein/albumin ratio (hazard ratio 1.6760, P = .0068) and postoperative pneumonia (hazard ratio 1.8365, P = .0200) were also independent prognostic factors for recurrence-free survival.
Curative surgery after induction therapy for cT4b esophageal cancer achieved favorable survival. Preoperative C-reactive protein/albumin ratio, postoperative pneumonia, response to induction treatments, and pN were useful prognostic factors.
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