Evaluation of Setup Errors at the Skin Surface Position for Whole Breast Radiotherapy of Breast Cancer Patients

We used image-processing software to analyze the setup errors at the skin surface position of breast cancer patients (n=66) who underwent post-operative whole breast irradiation at our hospital in 2014-2015. The sixty-six digital reconstructed radiographs (DRR) were created at the treatment planning for each patient. The lineacgraphies (n=377) were taken after the patients’ setup during radiotherapy. The lineacgraphies and DRR were superimposed at the skin surface position for each patient with the image-processing software. We measured the deviations of the isocenters for the nipple-lung (X) direction and craniocaudal (Y) direction and the deviation of the rotation angle of the XY axes between the lineacgraphy and DRR on the superimposed images. The systematic error (μ, Σ) and random error (σ) were calculated from the X and Y deviations and rotation angle deviation. The μ of X, Y, and rotation angle were 0.01 mm, −1.2 mm, and 0.05°, respectively. The Σ of X, Y, and rotation angle were 1.8 mm, 1.5 mm, and 0.9°, respectively. The σ of X, Y, and rotation angle were 2.0 mm, 1.5 mm, and 1.0°, respectively. Our analyses thus revealed that evaluations using image-processing software at the skin surface position in routine breast radiotherapy result in sufficiently small setup errors

Comparative study of the work load between one-man buses and two-man buses.

The differences in physiological and safety conditions of one-man buses and two-man buses were examined from the view point of occupational fatigue. This survey consisted of a work load study which included a time study, study of subsidiary behavior, auditory task, memory test, Galvanic Skin Response (GSR) and physiological function tests and a self-administered questionnaire which involved items concerning safety and subjective fatigue complaints. The visual and postural restrictions in the one-man bus were greater than in the two-man bus. The mental capacity of the one-man bus drivers was found to be less. Greater mental fatigue and stress were observed in the one-man bus. More subjective fatigue complaints were observed in the one-man bus. More cases of near accidents were observed in the one-man bus. From these results it was concluded that the one-man bus caused bus drivers a greater mental and physical work load.</p

Polymorphism Located between CPT1B and CHKB, and HLA-DRB1*1501-DQB1*0602 Haplotype Confer Susceptibility to CNS Hypersomnias (Essential Hypersomnia)

Background: SNP rs5770917 located between CPT1B and CHKB, and HLA-DRB1*1501-DQB1*0602 haplotype were previously identified as susceptibility loci for narcolepsy with cataplexy. This study was conducted in order to investigate whether these genetic markers are associated with Japanese CNS hypersomnias (essential hypersomnia: EHS) other than narcolepsy with cataplexy. Principal Findings: EHS was significantly associated with SNP rs5770917 (Pallele = 3.6610 23; OR = 1.56; 95 % c.i.: 1.12–2.15) and HLA-DRB1*1501-DQB1*0602 haplotype (Ppositivity = 9.2610 211; OR = 3.97; 95 % c.i.: 2.55–6.19). No interaction between the two markers (SNP rs5770917 and HLA-DRB1*1501-DQB1*0602 haplotype) was observed in EHS. Conclusion: CPT1B, CHKB and HLA are candidates for susceptibility to CNS hypersomnias (EHS), as well as narcolepsy with cataplexy

Serotonin Augments Gut Pacemaker Activity via 5-HT3 Receptors

Serotonin (5-hydroxytryptamine: 5-HT) affects numerous functions in the gut, such as secretion, muscle contraction, and enteric nervous activity, and therefore to clarify details of 5-HT's actions leads to good therapeutic strategies for gut functional disorders. The role of interstitial cells of Cajal (ICC), as pacemaker cells, has been recognised relatively recently. We thus investigated 5-HT actions on ICC pacemaker activity. Muscle preparations with myenteric plexus were isolated from the murine ileum. Spatio-temporal measurements of intracellular Ca2+ and electric activities in ICC were performed by employing fluorescent Ca2+ imaging and microelectrode array (MEA) systems, respectively. Dihydropyridine (DHP) Ca2+ antagonists and tetrodotoxin (TTX) were applied to suppress smooth muscle and nerve activities, respectively. 5-HT significantly enhanced spontaneous Ca2+ oscillations that are considered to underlie electric pacemaker activity in ICC. LY-278584, a 5-HT3 receptor antagonist suppressed spontaneous Ca2+ activity in ICC, while 2-methylserotonin (2-Me-5-HT), a 5-HT3 receptor agonist, restored it. GR113808, a selective antagonist for 5-HT4, and O-methyl-5-HT (O-Me-5-HT), a non-selective 5-HT receptor agonist lacking affinity for 5-HT3 receptors, had little effect on ICC Ca2+ activity. In MEA measurements of ICC electric activity, 5-HT and 2-Me-5-HT caused excitatory effects. RT-PCR and immunostaining confirmed expression of 5-HT3 receptors in ICC. The results indicate that 5-HT augments ICC pacemaker activity via 5-HT3 receptors. ICC appear to be a promising target for treatment of functional motility disorders of the gut, for example, irritable bowel syndrome

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Absorption of Iron by MuSty-Odor Producing Cyanobacteria (Anabaena macrospora, Phormidium tenue, Oscillatoria tenuis and Oscillatoria brevis)

近年、琵琶湖の南湖をはじめ、霞々浦や相模湖など多くの湖沼や水道水源地において、人間活動に付随すると富栄養化問題となり、ラン藻類、特にかび臭物質を産生するラン藻の発生が憂慮されている。琵琶湖を水源とする大津、京都、大阪、神戸など関西の各都市の水道では、同湖で毎年発生するラン藻、すなわちAnabaena macrospora｛ジオスミン（geosmin）を産生｝やPhormidium tenue, Oscillatoria tenuis｛2-メチルイソボルネオール（2-methylisoborneol, MIB）を産生｝などが作り出すこれらのかび臭物質（ジオスミンまたはMIB）による水道水の異臭味が大きな問題となっている。こうした水圏環境における異臭味は世界各地でも問題となり、近年この問題に関する国際シンポジウム（International Symposium on Off-Flavors in the Aquatic Environment）が開かれるようになり、1982年6月には第1回（ヘルシンキ）、1987年10月には第2回（鹿児島）、そして1991年3月には第3回（ロサンゼルス）のシンポジウムがそれぞれ開催された。しかしこうしたラン藻が異常増殖する要因はまだ明らかではない。そのためかび臭物質を産生するラン藻類の発生を予測あるいは抑制する情報に関する研究は強い要請があるにもかかわらずあまり進展をみていない。A recent problem for water utilities is musty-odor, which is caused by geosmin or 2-methylisoborneol produced by cyanobacteria. In order to clarify the mechanism of growth of musty-odor producing cyanobacteria, the effect of iron on the growth of Anabaena macrospora, Phormidium tenue, Oscillatoria tenuis and Oscillatoria brevis was studied. The growth of A. macrospora, P. tenue and O. tenuis was suppressed at low levels of iron (colloidal iron, 1 μM as Fe) in the EDTA-free CT medium. However, at high levels of iron (18 μM as Fe) using colloidal iron kept in a refrigerator, A. macrospora and P. tenue were able to grow although O. tenuis could not. When autoclaved colloidal iron was used as the iron source, none of the cyanobacteria except O. brevis were able to grow. The effect of spongy or powdery iron on the growth of cyanobacteria was also investigated. A. macrospora, P. tenue and O. brevis were capable of growing in media containing spongy or powdery ion, which release Fe(Ⅱ) continuously, but the growth of O. tenuis was suppressed. The culture experiments and photoreduction of Fe(Ⅲ) to Fe(Ⅱ) show that A. macrospora, P. tenue and O. brevis can utilize iron even in the absence of EDTA if there are large amounts of iron present in a form photoreducible to Fe(Ⅱ). However, O. tenuis was found to require chelated and photoreducible iron for its growth. The present results and previous studies {Nogaku Kenkyu, 62:253-270(1991)} indicate that O. brevis has the ability to utilize a wide variety of iron forms such as Fe(Ⅲ)-EDTA, Fe(Ⅱ)-BPDS, Fe(Ⅲ)-Desferrioxamine B(microbial siderophore) chelates, colloidal iron, iron oxides (Fe2O3, Fe3O4), spongy iron and powdery iron. On the other hand, O. tenuis seems to have very specific requirements for the from of iron it can utilize for growth

Absorption of Iron by MuSty-Odor Producing Cyanobacteria (Anabaena macrospora, Phormidium tenue, Oscillatoria tenuis and Oscillatoria brevis)

近年、琵琶湖の南湖をはじめ、霞々浦や相模湖など多くの湖沼や水道水源地において、人間活動に付随すると富栄養化問題となり、ラン藻類、特にかび臭物質を産生するラン藻の発生が憂慮されている。琵琶湖を水源とする大津、京都、大阪、神戸など関西の各都市の水道では、同湖で毎年発生するラン藻、すなわちAnabaena macrospora｛ジオスミン（geosmin）を産生｝やPhormidium tenue, Oscillatoria tenuis｛2-メチルイソボルネオール（2-methylisoborneol, MIB）を産生｝などが作り出すこれらのかび臭物質（ジオスミンまたはMIB）による水道水の異臭味が大きな問題となっている。こうした水圏環境における異臭味は世界各地でも問題となり、近年この問題に関する国際シンポジウム（International Symposium on Off-Flavors in the Aquatic Environment）が開かれるようになり、1982年6月には第1回（ヘルシンキ）、1987年10月には第2回（鹿児島）、そして1991年3月には第3回（ロサンゼルス）のシンポジウムがそれぞれ開催された。しかしこうしたラン藻が異常増殖する要因はまだ明らかではない。そのためかび臭物質を産生するラン藻類の発生を予測あるいは抑制する情報に関する研究は強い要請があるにもかかわらずあまり進展をみていない。A recent problem for water utilities is musty-odor, which is caused by geosmin or 2-methylisoborneol produced by cyanobacteria. In order to clarify the mechanism of growth of musty-odor producing cyanobacteria, the effect of iron on the growth of Anabaena macrospora, Phormidium tenue, Oscillatoria tenuis and Oscillatoria brevis was studied. The growth of A. macrospora, P. tenue and O. tenuis was suppressed at low levels of iron (colloidal iron, 1 μM as Fe) in the EDTA-free CT medium. However, at high levels of iron (18 μM as Fe) using colloidal iron kept in a refrigerator, A. macrospora and P. tenue were able to grow although O. tenuis could not. When autoclaved colloidal iron was used as the iron source, none of the cyanobacteria except O. brevis were able to grow. The effect of spongy or powdery iron on the growth of cyanobacteria was also investigated. A. macrospora, P. tenue and O. brevis were capable of growing in media containing spongy or powdery ion, which release Fe(Ⅱ) continuously, but the growth of O. tenuis was suppressed. The culture experiments and photoreduction of Fe(Ⅲ) to Fe(Ⅱ) show that A. macrospora, P. tenue and O. brevis can utilize iron even in the absence of EDTA if there are large amounts of iron present in a form photoreducible to Fe(Ⅱ). However, O. tenuis was found to require chelated and photoreducible iron for its growth. The present results and previous studies {Nogaku Kenkyu, 62:253-270(1991)} indicate that O. brevis has the ability to utilize a wide variety of iron forms such as Fe(Ⅲ)-EDTA, Fe(Ⅱ)-BPDS, Fe(Ⅲ)-Desferrioxamine B(microbial siderophore) chelates, colloidal iron, iron oxides (Fe2O3, Fe3O4), spongy iron and powdery iron. On the other hand, O. tenuis seems to have very specific requirements for the from of iron it can utilize for growth

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Abstract Background In recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients. Methods Data of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching. Results The study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p = 0.61) with reference to conservative treatment. Conclusions All-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD