Purpose It is currently recommended that patients with congenital bladder anomalies managed by enterocystoplasty undergo annual surveillance with urine cytology and endoscopy. We reviewed our ...experience with this protocol and suggest modifications based on this experience. Materials and Methods A total of 65 patients 10 years or more after enterocystoplasty were placed on an annual surveillance protocol consisting of interval medical history, renal-bladder ultrasound, serum B12, electrolytes, creatinine, urinalysis, urine cytology and endoscopy. Results Of the 65 patients 50 (77%) with enterocystoplasty (ileal in 40 and colonic in 10) remain on the protocol. Median age at the initiation of surveillance was 28 years (range 24 to 40) with a median time from augmentation of 15 years (range 12 to 29). During the first 5 years of surveillance 26 of 250 cytology results (10.5%) were suspicious for cancer. Further evaluation revealed no evidence of malignancy. Specificity for cytology was 90% with unknown sensitivity. Of 250 surveillance endoscopic evaluations 4 lesions (1.6%) were identified and biopsied/removed. Pathological evaluation revealed 1 adenomatous polyp, 1 squamous metaplasia and 2 nephrogenic adenomas. Due to the low event rate and high cost routine cytology and endoscopy were discontinued after each patient completed 5 years of followup and annual evaluations were maintained. No tumors developed during the median surveillance interval of 15 years (range 12 to 20). Currently median patient age is 42 years (range 36 to 59) and median time since augmentation is 27 years (range 23 to 40). Conclusions Due to the low incidence of malignancy, lack of proven benefit and enhanced cost containment we recommend that annual surveillance endoscopy and cytology be discontinued.
Embedded Region 1 and 2 field‐aligned currents (FACs), intense FAC layers of mesoscale latitudinal width near the interface between large‐scale Region 1 and Region 2 FACs, are related to dramatic ...phenomena in the ionosphere such as discrete arcs, inverted‐V precipitation, and dawnside auroral polarization streams. These relationships suggest that the embedded FACs are potentially important for understanding ionospheric heating and magnetosphere‐ionosphere (M‐I) coupling and instabilities. Previous case studies of embedded FACs have led to the speculation that they may result from enhanced M‐I convection during active times. To explore this idea further, we investigate statistically their occurrence rates under a variety of geomagnetic conditions with a large event list constructed from 17 years of Defense Meteorological Satellite Program observations. The identification procedure is fully automated and explicit. The statistical results indicate that embedded Region 1 and 2 FACs are common, and that they have a higher chance to occur when the level of geomagnetic activity is higher (given by various indices), supporting the idea that they result from enhanced M‐I convection.
Plain Language Summary
Earth's magnetosphere is coupled to its ionosphere by electric currents of different scales flowing along magnetic fields. Sometimes a special type of medium‐scale currents may significantly impact the ionosphere. From this statistical study, we found that these medium‐scale currents appear frequently and more often when the magnetosphere and ionosphere are characterized by a higher level of activity. These findings provide important information on how these medium‐scale systems are generated.
Key Points
We designed an automated, explicit selection algorithm to build a large database of embedded Region 1 and 2 currents
Embedded Region 1 and 2 (ER1 and ER2) currents appear frequently and preferentially under geomagnetically active conditions
The latitudinal widths of ER1 and ER2 currents increase with geomagnetic activity but not as much as those of R1 and R2 currents do
The present study statistically examines the location of various precipitation boundaries introduced by Newell et al. (1996) relative to R2 and R1 currents on the night side. Results are summarized ...as follows: (1) The electron and ion zero‐energy boundaries, b1e and b1i, are located mostly inside the R2 current at dusk‐to‐midnight and near the equatorward boundary of the R2 current or farther equatorward at midnight‐to‐dawn. (2) The maximum energy flux of ion precipitation (b2i) occurs inside the R2 current irrespective of magnetic local time. (3) The occurrence distributions of the most equatorward (b3a) and poleward (b3b) electron acceleration events indicate that mono‐energetic electron precipitation is mostly confined in the upward R1 current at dusk‐to‐midnight, whereas at midnight‐to‐dawn, it is more widely distributed including the downward R1 current. (4) The transition between structured and unstructured electron precipitation (b4s) tends to occur around the R2/R1 demarcation, but its occurrence distribution has extending tails. (5) The distributions of the poleward boundaries of the electron and ion auroral ovals, b5e and b5i, are centered around the poleward boundary of the R1 current but have extending tails especially at midnight‐to‐dawn. Result 1 suggests that the overlap between the ring current and the plasmasphere is more significant at dusk than at dawn. Result 2 indicates that the b2i boundary can be used as an identifier of the R2 current. Results 3–5 suggest that the R1 current is more structured than the R2 current and that the field‐aligned current structure is more complex at midnight‐to‐dawn than at dusk‐to‐midnight.
Methotrexate (MTX)-induced intestinal mucosal injury in animals has been studied to understand how MTX can cause gastrointestinal disorders, but the pathogenesis of gastrointestinal disorders is ...still uncertain. We have attempted to reveal how dietary factors influence intestinal toxicity due to MTX. Mice were fed normal chow (NC) or a high-fat high-sucrose diet (HFHSD) before oral administration of MTX. While MTX significantly decreased the survival rates of mice fed HFHSD, the intestinal epithelial injury was detected. MTX excretion in the feces of mice fed HFHSD was reduced. Change of diets between NC and HFHSD influences the survival. The survival rates of the mice fed a high-sucrose diet or control diet were higher than those fed HFHSD. Higher survival rates were observed in mice fed a high-fat high-sucrose diet modified (HFHSD-M) in which casein was replaced by soybean-derived proteins. The survival rates of mice treated with vancomycin were lower than those administered neomycin. Microbiome and metabolome analyses on feces suggest a similarity of the intestinal environments of mice fed NC and HFHSD-M. HFHSD may modify MTX-induced toxicity in intestinal epithelia on account of an altered MTX distribution as a result of change in the intestinal environment.
We present an experiment to sympathetically cool single protons and antiprotons in a Penning trap by resonantly coupling the particles to laser cooled beryllium ions using a common endcap technique. ...Our analysis shows that preparation of (anti)protons at mK temperatures on timescales of tens of seconds is feasible. Successful implementation of the technique will have immediate and significant impact on high-precision comparisons of the fundamental properties of protons and antiprotons. This in turn will provide stringent tests of the fundamental symmetries of the Standard Model.
Osteosarcoma is the most common primary malignant bone tumor, and its standard treatment is a combination of surgery and chemotherapy. A poor response to chemotherapy causes unfavorable oncological ...outcomes. We investigated the correlation between osteoclast differentiation in biopsy specimens and the efficacy of neoadjuvant chemotherapy in resected specimens. Forty-nine patients who underwent neoadjuvant chemotherapy and subsequent surgical treatment at our institution between 1999 and 2018 were enrolled. Using medical records, we investigated the age, sex, tumor size, location, subtype, staging, chemotherapy agents (doxorubicin, cisplatin, ifosfamide, and methotrexate), number of neoadjuvant chemotherapy courses, number of osteoclasts in biopsy specimens, and efficacy of neoadjuvant chemotherapy according to the Rosen and Huvos classification (Grade I-IV) in resected specimens. Univariate and multivariate analyses were performed to identify factors predictive of a good response in resected specimens after neoadjuvant chemotherapy. A good response (Grade III/IV) was detected in 25, while a poor response (Grade I/II) was detected in 24. According to the multivariate analysis, ≥ 46 years old (odds ratio OR, 0.05; 95% confidence interval CI, 0.01-0.45; p < 0.01) and ≥ 5 mature osteoclasts in a biopsy specimen (OR, 36.9; 95% CI, 6.03-225; p < 0.01) were significantly associated with the neoadjuvant chemotherapy efficacy. The accuracy for predicting a good response to chemotherapy based on ≥ 5 osteoclasts in a biopsy specimen in patients < 46 years old was 85%. The number of mature osteoclasts in biopsy specimens is a simple factor for predicting the efficacy of chemotherapy before treatment, although further studies will be required to determine the underlying mechanism.
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