This paper presents a new hysteresis model, consisting of the differential equations, that is capable of generating various hysteresis loops. Its hysteresis model is expanded using the author’s ...hysteresis model to capture the pinching phenomena and degrading stiffness due to the cyclic loading. The force and displacement relationships for structures against major earthquakes, which exceed the design basis ground motion, would be nonlinear characteristics with hysteresis loops. In order to accurately verify the seismic response of structures, a hysteresis model that can generate hysteresis loops close to actual phenomena is necessary because the seismic response of structures to be assessed depends on the hysteresis characteristics. The seismic fragility assessment has been performed as one approach to clarify the seismic performance and is assessed through the seismic response against the major earthquakes exceeded the design basis ground motion. However, the hysteresis laws and the programing code to implement the seismic response analysis result in complexity according as increasing the response deformation for the structures. They will lead to difficulty for the seismic response assessment considered of ultimate behavior for the structures. The author’s proposed the hysteresis model which can reflect any skeleton curve functions, as the differential equation type. Although this model can generate the various hysteresis loops, it cannot model a hysteresis loops with the pinching phenomena and degrading stiffness. To overcome these problems, this paper describes the coefficients to capture the hysteresis loops with the pinching phenomenon and the degrading stiffness using the author’s hysteresis model. The most significant feature of this model is that it can generate the hysteresis loops without the hysteresis rules even in the hysteresis loops with pinching phenomena. The extended author’s model was verified by comparing of tests and analytical results. This paper is divided into three main groups. The first is to describe the basic author’s hysteresis model, which is without the pinching phenomena. The second is to propose the coefficient to control the hysteresis loops. The third is to demonstrate the applicability of hysteresis model into the SC structure and the RC structures by comparing of test and analytical data. The primary results are summarized as follows: The extended hysteresis model can: 1) Express the hysteresis loops with the pinching phenomenon and the degrading stiffness by multiplying the proposed coefficient, h, by the force, F, of the hysteresis loops having arbitrary skeleton curves, which includes the non-point symmetry of the skeleton curves. 2) Capture the hysteresis loops due to the cyclic loading using the coefficient, h, of the cumulative energy type. 3) Accurately represent the measured hysteresis loops and the cumulative energy by defining the skeleton curve functions which are combined with the different functions according as the measured hysteresis loops even when the measured hysteresis loops have the discontinuous skeleton curves.
Background: Although adjuvant radiotherapy was proved to be effective for local control of rectal cancer even after standardized mesorectal excision, the role of adjuvant chemotherapy after such ...standardized surgery remains to be clarified. We aimed to assess the efficacy of a combination of uracil and tegafur for pathological stage III rectal cancer treated by standardized mesorectal excision with selective lateral pelvic lymphadenectomy. Methods: We randomly assigned patients with completely resected stage III rectal cancer, who underwent standardized mesorectal excision with selective lateral pelvic lymphadenectomy, to receive either oral uracil–tegafur (400 mg/m2 tegafur per day) for one year or no treatment. Standardization and quality control of the surgery and pathological techniques were ensured by use of the guidelines of the Japanese Society for Cancer of the Colon and Rectum. The primary endpoint was relapse-free survival. The secondary endpoint was overall survival. Results: We enrolled and randomized 276 patients. Excluding two ineligible patients, 274 were included in the analysis. Planned interim analysis 2 years after accrual termination revealed significant prolongation of relapse-free survival (P = 0.001) and overall survival (P = 0.005) in the uracil–tegafur group. The 3-year relapse-free survival and overall survival rates were 78 and 91% in the chemotherapy group and 60 and 81% in the surgery-alone group, respectively. Local recurrence rates were low in both groups. Grade 3 events occurred in 17% of the chemotherapy patients, but no grade 4 or more events occurred. Conclusion: Adjuvant chemotherapy with uracil–tegafur improves survival of patients with stage III rectal cancer after standardized mesorectal excision with selective lateral pelvic lymphadenectomy.
Aim: The autosomal recessive hypercholesterolemia (ARH) gene is located on chromosome 1p35 and encodes a 308-amino acid protein containing a phosphotyrosine-binding domain. Several researchers have ...identified mutations of ARH that cause autosomal recessive hypercholesterolemia; however, it remains unknown whether this gene is involved in common hypercholesterolemia. Methods and Results: We searched for polymorphisms of the ARH gene by denaturing high-performance liquid chromatography and direct sequencing. We identified 18 single nucleotide polymorphisms of the gene, including 9 novel polymorphisms, and determined 2 haplotype blocks. No association was observed between common hypercholesterolemia and any polymorphisms or haplotypes of the ARH gene; however, we newly identified a rare Thr56Met missense mutation located in the phosphotyrosine-binding domain, which is the functional domain responsible for cholesterol metabolism. Among 1,800 Japanese individuals enrolled in the Suita study, only 4 were heterozygous for Thr56Met and all had hypercholesterolemia. The total cholesterol level and low-density lipoprotein cholesterol level of diabetic patients with the Thr56Met missense mutation was 276.3±13.8mg/dL and 185.3±7.37mg/dL, respectively. Conclusions: Because the Thr56Met missense mutation occurs in an orthologously conserved functional domain and all subjects with the mutation had hypercholesterolemia resembling familiar hypercholesterolemia, it may be a cause of familial hypercholesterolemia.
Objective
Many endoscopists have reported their own classifications of early gastric carcinoma (EGC) using magnifying narrow‐band imaging (M‐NBI). However, few reports on classifying the margin ...around lesions by M‐NBI have been published. The aim of this study was to advocate the usefulness of the demarcation area classification for the diagnosis of EGC.
Methods
Altogether 197 lesions that could be investigated by M‐NBI were included in this study, consisting of 115 EGC and 82 intestinal metaplasias (IM). We hypothesized that the changes in white zone (fusion and erasure signs) and blood vessel (extend and draw sign) were the indications of EGC and we retrospectively investigated this hypothesis.
Results
For the investigation of the white zone in the demarcation area, both fusion (P < 0.0001) and erasure signs (P < 0.0001) were observed more often in EGC than in IM, with an accuracy of 80.7%. For the investigation of blood vessel in the demarcation area, both the extend (P < 0.001) and the draw sign (P < 0.0001) were observed more often in EGC than in IM, with an accuracy of 59.9%.
Conclusion
Estimations of the white zone and blood vessels in the demarcation area are useful for the diagnosis of EGC.
Recent genome-wide association studies have identified several genetic variants as susceptibility loci for serum uric acid (UA) levels. We also identified a common nonsense mutation, W258X, ...responsible for renal hypouricemia. Here, we investigated clinical implications of these genetic variants by cross-sectional and longitudinal genetic epidemiological analysis.
The study enrolled 5,165 Japanese subjects aged 64 ± 12 years from the general population. Clinical parameters were obtained from the personal health records, evaluated at medical checkups.
Serum UA levels were significantly different between the SLC22A12 rs11231825 (CC/CT/TT: 4.5 ± 1.6, 5.0 ± 1.4, 5.3 ± 1.4 mg/dl; p = 7.6 × 10(-20)), SLC2A9 rs1014290 (TT/TG/GG: 4.9 ± 1.4, 5.1 ± 1.4, 5.3 ± 1.4 mg/dl; p = 3.1 × 10(-11)) and ABCG2 rs2231142 (TT/TG/GG: 5.3 ± 1.5, 5.2 ± 1.4, 5.1 ± 1.4 mg/dl; p = 2.0 × 10(-5)) genotypes. During 9.4 years of follow-up, 87 new cases of hyperuricemia were diagnosed. Multiple logistic regression analysis identified the accumulation of risk alleles as a significant determinant of future development of hyperuricemia (OR = 7.94; 95% CI: 1.97-53.6). In contrast, subjects with nonsense mutation predominantly showed lower UA levels (XX/XW/WW: 1.3 ± 1.7, 3.6 ± 1.0, 5.2 ± 1.4 mg/dl; p = 9.3 × 10(-82)). However, these subjects showed significantly reduced renal function (β = -0.111; p < 0.001) independently of possible covariates.
Accumulation of risk genotypes was an independent risk factor for future development of hyperuricemia. Genetically developed hypouricemia was an independent risk factor for decreased renal function.
We report a suspected case of Cronkhite-Canada syndrome accompanied by intractrable anemia and hypoproteinemia, which was successfully treated with surgical intervention. A 36-year-old woman without ...a familial history of gastrointestinal polyposis was given a diagnosis of gastric hyperplastic polyps. During a long-term follow-up, the polyps had gradually grown in size and increased in number. She suffered gradual progression of anemia and hypoproteinemia refractory to any medical treatments in her 50s. Although the polyps were observed from the stomach to the duodenum including the papilla of Vater, swollen polyps were limitedly distributed in the stomach and the bulb of the duodenum. At age 54, total gastrectomy and duodenal bulb resection with jejunal-pouch interposition were performed. The resected specimen showed numerous polyps of various sizes in the stomach and duodenum, and their histological findings revealed Cronkhite-Canada-type polyps. After the operation, anemia and hypoproteinemia immediately improved. Her overt medication-resistant disorders caused by the disease were relieved remarkably with removal limited to swollen polyps. Surgical intervention to refractory anemia and hypoproteinemia caused by gastrointestinal polyposis can be an optimal therapeutic option because it is generally difficult to cure gastrointestinal polyposis by medication only. In the case of benign polyps, it may be an acceptable option to resect only swollen polyps, and observe carefully after surgical intervention.
Background:
Limited information is available on the relationship between C-reactive protein (CRP) levels and pain in advanced cancer.
Objectives:
To investigate the relationship between serum levels ...of CRP and subtypes of pain.
Design:
A secondary cross-sectional analysis of a prospective cohort study.
Setting/Subjects:
Patients with advanced cancer admitted to 23 palliative care units in Japan.
Measurements:
Patients rated the severity of pain on the numerical rating scale (NRS) and physicians evaluated pain on the integrated palliative care outcome scale (IPOS). Physicians assessed neuropathic pain and breakthrough pain based on their presence or absence. Patients were divided into four groups according to CRP levels. Comparisons were performed using the Kruskal–Wallis test or chi-squared test. To evaluate the relationship between CRP and subtypes of pain, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in logistic models were calculated.
Results:
We divided 1513 patients into four groups: low CRP (
n
= 234), moderate CRP (
n
= 513), high CRP (
n
= 352), and very high CRP (
n
= 414). Spearman's correlation coefficient between CRP and pain NRS and that between CRP and pain IPOS were 0.15 (
p
< 0.001) and 0.16 (
p
< 0.001), respectively. In the models of pain NRS and pain IPOS, significantly higher adjusted ORs than in the low CRP group were observed in the very high CRP group (1.81 95% CI 1.14–2.88,
p
= 0.01; 1.74 95% CI 1.18–2.57,
p
= 0.005, respectively). Relationships were not observed between CRP, neuropathic pain, and breakthrough pain.
Conclusions:
The results indicated direct relationships between CRP, pain NRS, and pain IPOS.
PDF
