Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC). Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p=0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p=0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC

Transabdominal Ultrasound Real-time Tissue Elastography as a Screening Method for Early Chronic Pancreatitis

Background and Purpose: The concept of early chronic pancreatitis was proposed in Japan with the aim to improve the prognosis of patients with chronic pancreatitis. Endoscopic ultrasonography plays an important role in early diagnoses, but is limited by its invasiveness and poor objectivity. Hence, this study aimed to determine the usefulness of transabdominal ultrasound real-time tissue elastography as a screening method for early chronic pancreatitis. Methods: We retrospectively examined 73 patients who underwent simultaneous ultrasound real-time tissue elastography and endoscopic ultrasonography from 2011 to 2014. The correlation between feature values (MEAN, %AREA, COMP) calculated by real-time tissue elastography and the Rosemont classification of endoscopic ultrasonography diagnostic criteria for chronic pancreatitis, and the diagnostic ability of ultrasound real-time tissue elastography to recognize “indeterminate for chronic pancreatitis” findings, which correspond to early chronic pancreatitis, were evaluated. Main Results: Based on the Rosemont classification, 26 patients were “normal”, 16 were “indeterminate for chronic pancreatitis”, 13 were “suggestive of chronic pancreatitis”, and 18 were “consistent with chronic ancreatitis”. There were significant correlations between the feature values (MEAN, %AREA, COMP) and the Rosemont classification (p < 0.001; ρ = –0.788, 0.779, and 0.489, respectively). The area under the curve for the ability of MEAN to diagnose “indeterminate for chronic pancreatitis” was 0.889 (sensitivity, 93.8%; specificity, 76.9%). Conclusions: The feature values calculated by ultrasound real-time tissue elastography were correlated with the Rosemont classification. Ultrasound real-time tissue elastography may be a useful screening method for early chronic pancreatitis

DECIGO pathfinder

DECIGO pathfinder (DPF) is a milestone satellite mission for DECIGO (DECi-hertz Interferometer Gravitational wave Observatory) which is a future space gravitational wave antenna. DECIGO is expected to provide us fruitful insights into the universe, in particular about dark energy, a formation mechanism of supermassive black holes, and the inflation of the universe. Since DECIGO will be an extremely large mission which will formed by three drag-free spacecraft with 1000m separation, it is significant to gain the technical feasibility of DECIGO before its planned launch in 2024. Thus, we are planning to launch two milestone missions: DPF and pre-DECIGO. The conceptual design and current status of the first milestone mission, DPF, are reviewed in this article

The Relationship between Individual Difference in Repressive Stles and Grief Reaction Coping Behaviors, and Onset of Pathological Grief, Anxiety and Mood Disorders after Child Loss

We examined the relationship between parental repressive styles, grief reaction/post-bereavement coping behavior and psychiatric symptoms in parents who had lost young children, In Study I, we administered a set of questionnaires to a sample of 177 parents who had experienced bereavement of children within the past several years in order to inquire about grief response, coping behavior, repressive styles, and social support .After controlling for sex, age, income, and self esteem, 1) subjects who had high anxiety (sensitizer and repressive-anxiety) showed stronger grief response whereas those with low anxiety (repressor and low-anxiety) showed weak response; 2) repressors were more likely to accept death and resolute grief after the loss than others; 3) those who had higher anxiety were more likely to ruminate after death; and 4) sensitizers were less likely to satisfy perceived social support. In Study II we interviewed 60 bereaved parents using a semi-structured diagnostic interview schedule to yield diagnoses of the parents based on the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV). Parents with repressive-anxiety were more likely to manifest pathological grief and those parents recognized as sensitizers were more likely to have an onset of DSM-IV Major Depression or Social Phobia after the child\u27s death.抑圧様式と悲嘆反応、死別後の対処行動、精神症状との関連性について検討した。研究Iでは幼い子どもと死別した親177名を対象に悲嘆反応、対処行動、抑圧様式、ソーシャルサポートを測定した。性別、年齢、収入などを統制し分析した結果、①不安水準の高い sensitizer, repressive Anxiety 各群では悲嘆反応が強心不安水準の低い repressor, low-anxiety各群では悲嘆反応が弱い、②repressor群では悲嘆がすでに解決したことと認知し、死別体験を肯定的に捉える傾向が強い、③不安水準が高いと死別後に内的に考え込む対処を多く行う、④sensitizer群では知覚されたソーシャルサポートに対する満足度が低い傾向にあった。研究IIでは60名に半構造化面接を行い、死別後に罹患した精神疾患の診断を行った。その結果，⑤病的悲嘆はrepressive- anxiety傾向と，⑥大うつ病性障害や社会恐怖はsensitization傾向とそれぞれ関連することが示された

The Measurement of Grief and Coping after Loss of a Child

We administered Grief Response Scale (GRS), Japanese translation of "Core Bereavement Items," and a set of newly developed coping　behavior items (Scale for Coping with　Bereavement; SCB) to 48 fathers and 127　mothers who experienced the loss of a child within several years. Although a confirmatory factor analysis of GRS did not support the original seven-factor model byBurnett et al., an exploratory factor analysis yielded four factors: lmage and sorrow, Sense of presence， Non-resolution and conflict, and Resolution of grief. Grief reaction was significantly greater in mothers than in fathers. An exploratory factor analysis of SCB produced five factors: Distraction, Ruminative response, A cceptance and overcome, Support-seeking behavior, and Religious activity and existential meaning. As compared to fathers, mothers ruminated, sought support from others, and had religious activity more frequently. These results suggest that different aspects of grief were related with coping with bereavement after controlling for age, sex, income, and level of manifest anxiety

The status of DECIGO

DECIGO (DECi-hertz Interferometer Gravitational wave Observatory) is the planned Japanese space gravitational wave antenna, aiming to detect gravitational waves from astrophysically and cosmologically significant sources mainly between 0.1 Hz and 10 Hz and thus to open a new window for gravitational wave astronomy and for the universe. DECIGO will consists of three drag-free spacecraft arranged in an equilateral triangle with 1000 km arm lengths whose relative displacements are measured by a differential Fabry-Perot interferometer, and four units of triangular Fabry-Perot interferometers are arranged on heliocentric orbit around the sun. DECIGO is vary ambitious mission, we plan to launch DECIGO in era of 2030s after precursor satellite mission, B-DECIGO. B-DECIGO is essentially smaller version of DECIGO: B-DECIGO consists of three spacecraft arranged in an triangle with 100 km arm lengths orbiting 2000 km above the surface of the earth. It is hoped that the launch date will be late 2020s for the present

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension