乳癌術前化学療法において腋窩リンパ節転移が陰性化するための効果予測因子の検討

Purpose: We investigated the role of tumor-infiltrating lymphocytes (TILs) in pretreatment primary breast cancer to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with clinical node-positive disease (cN +). Methods: The subjects of this study were 60 patients with cN + , who received NAC followed by breast surgery with axillary lymph node dissection (ALND). We conducted a semi-quantitative assessment of TILs in pretreatment primary tumors and their association with clinicopathological factors and axillary lymph node metastasis. Results: We observed a higher number of TILs in tumors with negative hormone receptors, positive human epidermal growth factor receptor 2, or high Ki67. TILs were associated with a favorable response to NAC in primary tumors. The rate of axillary pathologic complete response (Ax-pCR) was significantly higher in patients with a high number of TILs than in patients with a low number of TILs (72.0% versus 17.1%, p < 0.001). In multivariable analysis, a high number of TILs was a significant predictor of Ax-pCR as well as of pCR of the primary tumor after NAC. Importantly, all patients with HER2-positive tumors in the high TILs group showed Ax-pCR on ALND. Conclusion: TILs in pretreatment primary breast cancer had the potential to predict therapeutic efficacy of NAC in patients with clinical node-positive disease.博士（医学）・乙第1498号・令和3年3月15日© Springer Nature Singapore Pte Ltd. 2020This is a post-peer-review, pre-copyedit version of an article published in Surgery today. The final authenticated version is available online at: https://doi.org/10.1007/s00595-020-02157-6

乳房ソナゾイド造影超音波における背景乳腺の造影効果についての検討

Purpose: The objective of this study was to retrospectively evaluate the association between background parenchymal enhancement (BPE) on contrast-enhanced ultrasound (CEUS) with Sonazoid® and patient characteristics. Additionally, background parenchymal tissues with the high-contrast effect were pathologically observed compared to those showing the low-contrast effect. Methods: A total of 65 patients who underwent breast CEUS with Sonazoid® between January 2010 and November 2013 were enrolled. Regions of interest (ROIs) were put on the tumor and on the background parenchymal tissue. The dB values during the nonenhanced time and at peak contrast enhancement were measured based on the time intensity curve (TIC) drawn by the ROI. The differences in the dB values of pre- and post-enhanced time were obtained separately for ROIs on the tumor and ROIs on the parenchymal tissue. The patient characteristics studied were age, menstrual status, mammographic density, BPE on magnetic resonance imaging (MRI), and pathological diagnoses of breast tumors. Results: There was a weak negative correlation between BPE on CEUS and age. As for the contrast effect of parenchymal tissue, there was a significant difference between the menstruating and menopausal groups. There was no significant difference among the levels of mammographic density, and among the degrees of contrast effect on MRI. BPE on CEUS was the same between those with a malignant tumor and those with a benign tumor in each menstrual status. The parenchymal tissue with the low-contrast effect showed pathological atrophy. Conclusion: The degree of BPE on CEUS appeared related to age, menstruating or menopausal, and atrophy of breast tissue. BPE on CEUS was the same between those with a malignant tumor and those with a benign tumor in each menstrual status.博士（医学）・乙第1508号・令和3年3月15日© Springer Nature Singapore Pte Ltd. 2020.© The Japan Society of Ultrasonics in Medicine 2020.This is a post-peer-review, pre-copyedit version of an article published in Journal of medical ultrasonics. The final authenticated version is available online at: https://doi.org/10.1007/s10396-020-01052-4

The Far-Infrared Surveyor (FIS) for AKARI

The Far-Infrared Surveyor (FIS) is one of two focal plane instruments on the AKARI satellite. FIS has four photometric bands at 65, 90, 140, and 160 um, and uses two kinds of array detectors. The FIS arrays and optics are designed to sweep the sky with high spatial resolution and redundancy. The actual scan width is more than eight arcmin, and the pixel pitch is matches the diffraction limit of the telescope. Derived point spread functions (PSFs) from observations of asteroids are similar to the optical model. Significant excesses, however, are clearly seen around tails of the PSFs, whose contributions are about 30% of the total power. All FIS functions are operating well in orbit, and its performance meets the laboratory characterizations, except for the two longer wavelength bands, which are not performing as well as characterized. Furthermore, the FIS has a spectroscopic capability using a Fourier transform spectrometer (FTS). Because the FTS takes advantage of the optics and detectors of the photometer, it can simultaneously make a spectral map. This paper summarizes the in-flight technical and operational performance of the FIS.Comment: 23 pages, 10 figures, and 2 tables. Accepted for publication in the AKARI special issue of the Publications of the Astronomical Society of Japa

Structural Changes in Li₂CoPO₄F during Lithium-Ion Battery Reactions

The cobalt-based fluorophosphate Li₂CoPO₄F positive electrode has the potential to obtain high energy density in a lithium ion battery since its theoretical capacity is 287 mAh·g^–1 when two electrons can react reversibly. This material promises to charge/discharge with an extremely high redox-couple voltage of over 4.8 V vs Li/Li⁺. Bulk structural analyses including X-ray diffraction, Co K-edge X-ray absorption near-edge structure (XANES), and extended X-ray absorption fine structure (EXAFS) reveal that an orthorhombic Li_βCoPO₄F phase is produced from pristine Li₂CoPO₄F by a combination of solid-solution and two-phase reaction manners during the first charging process, and these phases reversibly transform during charge–discharge cycling. The results of ⁷Li MAS NMR and classical molecular dynamics simulations suggest that Li ions located at Li(1) sites intercalate/deintercalate through a 1D diffusion path along the <i>b</i> axis, whereas those located at Li(2) and Li(3) sites are fixed. The aforementioned analyses were successfully performed with the enhancement of electrochemical properties by use of a fluoroethylene carbonate-based electrolyte instead of an ethylene carbonate-based one and reducing its volume. Further enhancement was achieved by adding SiO₂ nanoparticles into the electrode slurry. The electrochemical results encourage the possibility of the intercalation/deintercalation of more than one Li ion from/into Li₂CoPO₄F during electrochemical cycling

Simple and Objective Evaluation Items for the Prognosis and Mortality of Delirium in Real‐World Clinical Practice: A Preliminary Retrospective Study

Objective Identifying factors associated with poor outcomes in patients with delirium is important for predicting prognosis. This retrospective study developed an easy and objective cognitive function measurement scale that can predict the prognosis and mortality related to delirium. Methods Fifty‐five patients aged ≥65 years and diagnosed with delirium were included. Objective data regarding attention and orientation related to time and place were extracted from their medical records during the first consultation, and in total, six points were evaluated. The patients were categorized into high and low cognitive function (LCF) groups. The severity at the first visit and 1‐week post‐treatment was evaluated using the Clinical Global Impressions‐Severity scale. Outcomes (survival or death) at 6 months from the initial visit were evaluated by reviewing medical records. Results Although the Clinical Global Impressions‐Severity score at the first visit was not significantly different between the two groups, 1 week after treatment, it was significantly lower in the high cognitive function (HCF) group than in the LCF group. Regarding the outcome (survival or death) after 6 months, the LCF group had significantly higher mortality than the HCF group. A multivariate logistic regression analysis revealed the same result (OR = 17.049, 95% CI = 2.415–120.373, p = 0.004). Conclusion A simple cognitive assessment of attention and orientation may help predict unfavorable outcomes, including mortality, in patients with delirium

A Case of Cryptogenic Liver Cirrhosis with Huge Splenomegaly

Introduction We never knew how the liver function goes after splenectomy in case of huge splenomegaly because of the dramatic portal flow alteration. In this report, we will present a case of cryptogenic liver cirrhosis with huge splenomegaly. Case presentation A 14 years old male was admitted with huge splenemogaly and hepatomegaly. Computed tomography showed enlarged liver and huge spleen that occupied large volume of abdominal and pelvic cavity. His ADL was significantly deteriorated, and the patient could not stand up because of exertional dyspnea. Although the etiology of the patient was not determined in spite of several liver biopsies and laboratorial tests, we planned splenectomy to improve his ADL. Also, the progression of liver insufficiency was expected because the portal flow could be dramatically changed after the removal of the huge spleen. Therefore, we prepared for the living donor liver transplantation at first, and then splenectomy was performed. After the first operation, his general condition was improved and the liver function was not deteriorated for 6 months. Unfortunately, rapid progression of jaundice from his primary disease was occurred, and living donor liver transplantation using left lobe graft from his mother was performed 4 months later. The patient survived the two-stage liver transplantation procedure without major complications. Conclusion Our case suggests that we should consider the possibility of liver deterioration after splenectomy for the huge splenomegaly. In case of rapid deterioration of liver function, liver transplantation is the only feasible option.弘前医学. 64(Suppl.), 2013, p.S113-S11