Jejunal interposition reconstruction with a stomach preserving esophagectomy improves postoperative weight loss and reflux symptoms for esophageal cancer patients

Background: Conventional reconstruction after an esophagectomy uses a gastric tube, which commonly causes several postoperative complaints such as gastric acid reflux in long-term survival cases. Intestinal interposition between the remnant esophagus and the stomach is an option to reduce complaints, and in this study, the advantages of jejunal interposition reconstruction with a stomach preserving esophagectomy (SPE) were assessed. Materials and methods: Eleven cases of jejunal interposition with an SPE and 16 cases with gastric tube reconstruction as a control were subject to a comparison of operation time, amount of bleeding, postoperative quality of life, and endoscopic findings. Results: The SPE group had a longer operation time (SPE: 560 +/- 121 min, control 414 +/- 83 min, P = 0.038), whereas there was no significant difference in blood loss. Postoperative weight loss was significantly recovered in the SPE group (SPE versus control = 94.0 +/- 5.4% versus 87.5 +/- 4.7% at 3 mo, P = 0.017; 97.2 +/- 7.5% versus 85.0 +/- 5.2% at 6 mo, P = 0.010), and there was a significant decrease in the occurrence of reflux symptoms such as heartburn, odynophagia, and cough when jejunal interposition with an SPE was done. Furthermore, reflux esophagitis and Barrett's epithelium were found in six out of 12 cases (50%) of the control group by postoperative endoscopy, while no cases in the SPE group had either condition (P < 0.01). Conclusions: This reconstruction method is a promising option to improve postoperative quality of life, mainly due to the long-term elimination of reflux esophagitis, which assists in the recovery of postoperative weight loss

解体新書に描かれた図譜の現代解釈 : 肝胆膵編

　解体新書は当時の日本において最先端の医学書であったが，改めて観察すると，現代医学との相違点がいくつか存在する。そこで解体新書の図譜を現代医学の視点から考察し，原図に沿って現代医学の要素をメディカルイラストレーションの手法を用いて加筆修正した。また江戸時代と現代において各臓器の見せ方の違いを考察した。本論文では解体新書の「肝臓篇」「膵臓，脾臓篇」の２章の中の，肝臓，胆嚢，膵臓の３臓器の図譜について現代医学の視点から考察して相違点を抽出した。それを基に，原図に沿って現代医学の要素を加筆修正した。加筆修正するポイントとして，臓器の構造や機能を，強調や省略を駆使して的確に表現した。また，臓器は生体的構図で描画し，関連する周囲組織も含めた構図を作成した。肝臓前面の図譜では，形状を整理し，間膜と肝円索を加筆した。肝門の図譜では，脈管を修正し，間膜と圧痕を加筆した。胆嚢の図譜では，形状と層の表現を修正し，胆嚢管の表現を修正した。膵臓の図譜では，前面と背面の２枚の図を作成した。また，肝門部を加筆，胆管と膵管を修正，胃と膵臓の前後関係を修正，脾臓の脈管を修正したうえで，腎臓を削除し，横行結腸を加筆した。Kaitai-Shinsho was one of the state-of-the-art medical books in Japan during the Edo period.However, on closer observation, there are several differences between the illustrations and modern medicine. Therefore, we nvestigated the illustrations in the Kaitai-Shinsho from a modern medical point of view, and retouched them using medical illustration techniques in accordance with the original figures. We also discussed the differences in how to show each organ in the Edo and modernperiods. Regarding the three organs of the liver, gallbladder, and pancreas, we extracted the differences and discussed from a modern medical point of view. The structures and functions of these organs that have been scientifically proven were adequately drawn through the use of emphasis and omission techniques. These organs were drawn with anatomical composition, which can be easily understood, including the relevant surrounding tissues. For the figure of “Liver: front", we 1) organized the shape of the entire liver, 2) retouched the surrounding membrane, and 3) retouched the round ligament. For the figure of “Liver: hilum", we 1) modified the vessels flowing into the liver, 2) retouched the surrounding membrane, and 3) retouched the impressions on the surface. For the figure of “Gallbladder", we 1) modified the layers of the wall, 2) retouched the shape, and 3) retouched the cystic duct. For the figure of “Pancreas", we drew two views of the pancreas front and pancreas back. In addition, we 1) retouched the hepatic hilum, 2) modified the bile duct and pancreatic duct, 3) modified the position of stomach and pancreas, 4) modified the vessels of the spleen, 5) removed the kidney, and 6) retouched the transverse colon

InAs Quantum Dot Formation Studied at the Atomic Scale by Cross-sectional Scanning Tunnelling Microscopy

Self-assembled quantum dots (QDs) have attracted much attention in the last years. These nanostructures are very interesting from a scientifi c point of view because they form nearly ideal zero-dimensional systems in which quantum confi nement effects become very important. These unique properties also make them very interesting from a technological point of view. For example, InAs QDs are employed in QD lasers, single electron transistors, midinfrared detectors, single-photon sources, etc. InAs QDs are commonly created by the Stranski–Krastanov growth mode when InAs is deposited on a substrate with a bigger lattice constant, like GaAs or InP [10] . Above a certain critical thickness of InAs, three-dimensional islands are spontaneously formed on top of a wetting layer (WL) to reduce the strain energy. Once created, the QDs are subsequently capped, a step which is required for any device application. Self-assembled quantum dots (QDs) have attracted much attention in the last years. These nanostructures are very interesting from a scientifi c point of view because they form nearly ideal zero-dimensional systems in which quantum confi nement effects become very important. These unique properties also make them very interesting from a technological point of view. For example, InAs QDs are employed in QD lasers, single electron transistors, midinfrared detectors, single-photon sources, etc. InAs QDs are commonly created by the Stranski–Krastanov growth mode when InAs is deposited on a substrate with a bigger lattice constant, like GaAs or InP. Above a certain critical thickness of InAs, three-dimensional islands are spontaneously formed on top of a wetting layer (WL) to reduce the strain energy. Once created, the QDs are subsequently capped, a step which is required for any device application

Nuclear modification of Y states in pPb collisions at √SNN_{NN} = 5.02 TeV

Production cross sections of Υ(1S), Υ(2S), and Υ(3S) states decaying into μ+μ− in proton-lead (pPb) collisions are reported using data collected by the CMS experiment at √sNN = 5.02 TeV. A comparison is made with corresponding cross sections obtained with pp data measured at the same collision energy and scaled by the Pb nucleus mass number. The nuclear modification factor for Υ(1S) is found to be RpPb(Υ(1S)) = 0.806±0.024 (stat)±0.059 (syst). Similar results for the excited states indicate a sequential suppression pattern, such that RpPb(Υ(1S)) > RpPb(Υ(2S)) > RpPb(Υ(3S)). The suppression of all states is much less pronounced in pPb than in PbPb collisions, and independent of transverse momentum pΥT and center-of-mass rapidity yΥCM of the individual Υ state in the studied range p ΥT < 30 GeV/c and |yΥCM| <1.93. Models that incorporate final-state effects of bottomonia in pPb collisions are in better agreement with the data than those which only assume initial-state modifications

Electron and photon reconstruction and identification with the CMS experiment at the CERN LHC

The performance is presented of the reconstruction and identification algorithms for electrons and photons with the CMS experiment at the LHC. The reported results are based on proton-proton collision data collected at a center-of-mass energy of 13 TeV and recorded in 2016-2018, corresponding to an integrated luminosity of 136 fb(-1). Results obtained from lead-lead collision data collected at root S-NN = 5.02 TeV are also presented. Innovative techniques are used to reconstruct the electron and photon signals in the detector and to optimize the energy resolution. Events with electrons and photons in the final state are used to measure the energy resolution and energy scale uncertainty in the recorded events. The measured energy resolution for electrons produced in Z boson decays in proton-proton collision data ranges from 2 to 5%, depending on electron pseudorapidity and energy loss through bremsstrahlung in the detector material. The energy scale in the same range of energies is measured with an uncertainty smaller than 0.1 (0.3)% in the barrel (endcap) region in proton-proton collisions and better than 1(3)% in the barrel (endcap) region in heavy ion collisions. The timing resolution for electrons from Z boson decays with the full 2016-2018 proton-proton collision data set is measured to be 200 ps.Peer reviewe

Using Z boson events to study parton-medium interactions in Pb-Pb collisions

The spectra measurements of charged hadrons produced in the shower of a parton originating in the same hard scattering with a leptonically decaying Z boson are reported in lead-lead nuclei (Pb-Pb) and proton-proton (pp) collisions at a nucleon-nucleon center-of-mass energy of 5.02 TeV. Both Pb-Pb and pp data sets are recorded by the CMS experiment at the LHC and correspond to an integrated luminosity of 1.7  nb^{-1} and 320  pb^{-1}, respectively. Hadronic collision data with one reconstructed Z boson candidate with the transverse momentum p_{T}>30  GeV/c are analyzed. The Z boson constrains the initial energy and direction of the associated parton. In heavy ion events, azimuthal angular distributions of charged hadrons with respect to the direction of a Z boson are sensitive to modifications of the in-medium parton shower and medium response. compared to reference data from pp interactions, the results for central Pb-Pb collisions indicate a modification of the angular correlations. The measurements of the fragmentation functions and p_{T} spectra of charged particles in Z boson events, which are sensitive to medium modifications of the parton shower longitudinal structure, are also reported. Significant modifications in central Pb-Pb events compared to the pp reference data are also found for these observables

Constraints on the Initial State of Pb-Pb Collisions via Measurements of Z-Boson Yields and Azimuthal Anisotropy at root s(NN)=5.02 TeV

The CMS experiment at the LHC has measured the differential cross sections of Z bosons decaying to pairs of leptons, as functions of transverse momentum and rapidity, in lead-lead collisions at a nucleon-nucleon center-of-mass energy of 5.02 TeV. The measured Z boson elliptic azimuthal anisotropy coefficient is compatible with zero, showing that Z bosons do not experience significant final-state interactions in the medium produced in the collision. Yields of Z bosons are compared to Glauber model predictions and are found to deviate from these expectations in peripheral collisions, indicating the presence of initial collision geometry and centrality selection effects. The precision of the measurement allows, for the first time, for a data-driven determination of the nucleon-nucleon integrated luminosity as a function of lead-lead centrality, thereby eliminating the need for its estimation based on a Glauber model.Peer reviewe

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

Performance of the CMS muon trigger system in proton-proton collisions at root s=13 TeV

The muon trigger system of the CMS experiment uses a combination of hardware and software to identify events containing a muon. During Run 2 (covering 2015–2018) the LHC achieved instantaneous luminosities as high as 2 × 1034 while delivering proton-proton collisions at √(s) = 13. The challenge for the trigger system of the CMS experiment is to reduce the registered event rate from about 40MHz to about 1kHz. Significant improvements important for the success of the CMS physics program have been made to the muon trigger system via improved muon reconstruction and identification algorithms since the end of Run 1 and throughout the Run 2 data-taking period. The new algorithms maintain the acceptance of the muon triggers at the same or even lower rate throughout the data-taking period despite the increasing number of additional proton-proton interactions in each LHC bunch crossing. In this paper, the algorithms used in 2015 and 2016 and their improvements throughout 2017 and 2018 are described. Measurements of the CMS muon trigger performance for this data-taking period are presented, including efficiencies, transverse momentum resolution, trigger rates, and the purity of the selected muon sample. This paper focuses on the single- and double-muon triggers with the lowest sustainable transverse momentum thresholds used by CMS. The efficiency is measured in a transverse momentum range from 8 to several hundred