Investigation of uncertainty in internal target volume definition for lung stereotactic body radiotherapy

This study evaluated the validity of internal target volumes (ITVs) defined by three- (3DCT) and four-dimensional computed tomography (4DCT), and subsequently compared them with actual movements during treatment. Five patients with upper lobe lung tumors were treated with stereotactic body radiotherapy (SBRT) at 48 Gy in four fractions. Planning 3DCT images were acquired with peak-exhale and peak-inhale breath-holds, and 4DCT images were acquired in the cine mode under free breathing. Cine images were acquired using an electronic portal imaging device during irradiation. Tumor coverage was evaluated based on the manner in which the peak-to-peak breathing amplitude on the planning CT covered the range of tumor motion (± 3 SD) during irradiation in the left–right, anteroposterior, and cranio-caudal (CC) directions. The mean tumor coverage of the 4DCT-based ITV was better than that of the 3DCT-based ITV in the CC direction. The internal margin should be considered when setting the irradiation field for 4DCT. The proposed 4DCT-based ITV can be used as an efficient approach in free-breathing SBRT for upper-lobe tumors of the lung because its coverage is superior to that of 3DCT

Current status and problems of elderly drivers in our outpatient clinic

　当院では平成29年３月12日の道路交通法改正を踏まえて平成29年４月より，もの忘れ外来とは別に「運転免許外来」を新設し，時間をかけた丁寧な診療と告知，指導，運転免許返納後の生活確保・支援ができるよう，多職種で受診者に対応している．平成31年４月までの運転免許外来受診者は31人で，平均年齢80.07±3.91歳．第一分類該当者19人，交通違反での紹介３人で，その他は自発的な受診であった．10例は既に事故を起こし，６例は既に抗認知症薬を内服していた . 受診者のほとんどが，通院，買い物，農作業など運転中止後の生活が困るとの理由から，運転継続を希望した．神経心理検査では，MMSE-J 22.32/30±3.87, Kohs IQ 66.42±11.87, DASC-21 29.53±7.07, CDR 0.58±0.19と比較的認知機能低下が軽度な者が多かった．頭部 MRI では20例に陳旧性脳梗塞や脳挫傷，12例に脳萎縮を認め，123I-IMP 脳血流 SPECT では14例にアルツハイマー病を示唆する脳血流低下を認めた．診断後，全例に運転免許返納を推奨したが，自発的に運転中止に至った例は９例のみであった．かかりつけ医による診断書作成が普及し自主返納事例も増加したためか，当院の受診者数ならびに運転免許取り消し処分となる事例は外来開設当初の予想より少なかった．認知機能低下は認めるものの明らかな認知症に至っていない MCI 症例については，診断書提出後も運転継続している事例が多かった．運転継続希望者に丁寧に現制度の意義を説明し，移動手段の確保や生活支援について地域で相談できる体制作りが必要である．　Following the revision of the Road Traffic Act, which obligates elderly drivers to undergo cognitive screening tests at license renewal, we established a new outpatient memory clinic specializing in issues surrounding elderly drivers’ driver licenses. In this new outpatient clinic, we provide guidance and information about supporting resources for life after returning their driver’s licenses and the usual medical care and education. In the past two years, 31 patients, with an average age of 80.1±3.9 years, visited this clinic. Among these, 19 were referred to our clinic because of impaired cognition by screening test (the first classification), three were referred us for traffic violations and the others visited voluntarily. Among these 31 patients, ten had already experienced car accidents and six had already been prescribed cholinesterase inhibitors. Neuropsychological examination revealed mildly impaired cognitive function including MMSE-J 22.3±3.9, Kohs IQ 66.4±11.9, DASC-21 29.5±7.1 and CDR 0.58 ±0.19. Brain MRI revealed significant brain atrophy in 20 patients and brain contusions in 12. 123I-IMP SPECT showed decreased cerebral blood flow in 14 patients. Although driving is necessary for most patients to maintain activities of daily living and quality of life, we recommended all to stop driving based on the revised Road Traffic Act, which restricts driving by people with dementia. However, only nine patients suspended their driving and returned their licenses voluntarily; most MCI patients continued driving even after diagnosis. More effort is necessary to persuade patients of the significance of the current system, as is a social system that offers alternative means of transportation and supports patients in their lives in their local community

Insights into Land Plant Evolution Garnered from the Marchantia polymorpha Genome.

The evolution of land flora transformed the terrestrial environment. Land plants evolved from an ancestral charophycean alga from which they inherited developmental, biochemical, and cell biological attributes. Additional biochemical and physiological adaptations to land, and a life cycle with an alternation between multicellular haploid and diploid generations that facilitated efficient dispersal of desiccation tolerant spores, evolved in the ancestral land plant. We analyzed the genome of the liverwort Marchantia polymorpha, a member of a basal land plant lineage. Relative to charophycean algae, land plant genomes are characterized by genes encoding novel biochemical pathways, new phytohormone signaling pathways (notably auxin), expanded repertoires of signaling pathways, and increased diversity in some transcription factor families. Compared with other sequenced land plants, M. polymorpha exhibits low genetic redundancy in most regulatory pathways, with this portion of its genome resembling that predicted for the ancestral land plant. PAPERCLIP

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

A dehydrated space-weathered skin cloaking the hydrated interior of Ryugu

Without a protective atmosphere, space-exposed surfaces of airless Solar System bodies gradually experience an alteration in composition, structure and optical properties through a collective process called space weathering. The return of samples from near-Earth asteroid (162173) Ryugu by Hayabusa2 provides the first opportunity for laboratory study of space-weathering signatures on the most abundant type of inner solar system body: a C-type asteroid, composed of materials largely unchanged since the formation of the Solar System. Weathered Ryugu grains show areas of surface amorphization and partial melting of phyllosilicates, in which reduction from Fe3+ to Fe2+ and dehydration developed. Space weathering probably contributed to dehydration by dehydroxylation of Ryugu surface phyllosilicates that had already lost interlayer water molecules and to weakening of the 2.7 µm hydroxyl (–OH) band in reflectance spectra. For C-type asteroids in general, this indicates that a weak 2.7 µm band can signify space-weathering-induced surface dehydration, rather than bulk volatile loss

Effects of Air Exposure on Hard and Soft X-ray Photoemission Spectra of Ultrananocrystalline Diamond/Amorphous Carbon Composite Films

Hard X-ray photoemission spectroscopy (HAXPES) was employed for the structural evaluation of ultrananocrystalline diamond/amorphous carbon (UNCD/a-C) composite films deposited on cemented carbide substrates, at substrate temperatures up to 550 °C by coaxial arc plasma deposition. The results were compared with those of soft X-ray photoemission spectroscopy (SXPES). Since nanocrystalline diamond grains are easily destroyed by argon ion bombardment, the structural evaluation of UNCD/a-C films, without the argon ion bombardment, is preferable for precise evaluation. For samples that were preserved in a vacuum box after film preparation, the sp3 fraction estimated from HAXPES is in good agreement with that of SXPES. The substrate temperature dependencies also exhibited good correspondence with that of hardness and Young’s modulus of the films. On the other hand, the sp3 fraction estimated from SXPES for samples that were not preserved in the vacuum box had an apparent deviation from those of HAXPES. Since it is possible for HAXPES to precisely estimate the sp3 fraction without the ion bombardment treatment, HAXPES is a feasible method for UNCD/a-C films, comprising nanocrystalline diamond grains