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We utilised a cast preoperatively prepared on the basis of the patient’s computed tomography data to clarify unusual orientation of the great arteries (transposition of great arteries, coarctation of the aorta, and abnormally branching central pulmonary arteries) in a 2.2-kg neonate. The three-dimensional model was very useful for designing the surgical procedure – being easy to handle for real and precise simulation of the reparative manoeuvres.
Nivolumab has become an effective treatment option for cancer in various sites; however, this drug may cause immune-related adverse effects due to its mechanism of action. Furthermore, little has been reported on thiamine deficiency (TD) in patients receiving nivolumab treatment.
From a series of cancer patients, we reported a patient with recurrent renal cell carcinoma who developed TD after the start of nivolumab treatment.
A 74-year-old man with recurrent renal cell carcinoma was referred to the psycho-oncology department as he had lost about 4 kg and displayed a loss of energy after four cycles of nivolumab treatment. Psychiatric interviews revealed a decrease in energy. Neurological examination did not reveal any impairment in consciousness, ataxia, or ocular symptoms. He did not develop appetite loss. The malabsorption or overconsumption of some nutrients is thought to occur due to the rapid loss of weight; thus, a reduction in vitamin B1, which has a short storage period in the body and is often deficient in cancer patients, was suspected. The diagnosis of TD was supported by the patient's abnormally low serum thiamine level.
Significance of results
In patients treated with nivolumab, it is necessary to pay careful attention to TD when proceeding with the treatment. It is hoped that future research may reveal the link between nivolumab administration and TD.
Reconstructing past ocean currents in the coastal regions is necessary to better understand the relationship between oceanographic changes and coastal ecosystems. It is known that variations have occurred with large-scale climate changes such as ENSO (El Niño Southern Oscillations) and PDO (Pacific Decadal Oscillations). Thus, reconstruction of past seawater conditions in coastal regions is needed to better understand the relationship between oceanographic changes and coastal ecosystems. Seawater radiocarbon is a unique proxy to understand the properties of water masses. Reef-building corals have been employed extensively and successfully in conducting this type of research into past ocean circulation histories. However, their distribution is limited to the low latitudes and hence alternative archives are required for studies in mid to high-latitude locations. Here, we use abalone shell samples obtained from Otsuchi Bay located in the Tohoku region on the Pacific coast of Northern Japan. Radiocarbon in abalone shells was compared with dissolved inorganic carbon in two-year-long records of river water as well as seawater. The data indicate that abalone shells can be used to reconstruct past seawater radiocarbon variations in northern Japan where coral skeletons are not available for ocean mixing studies.
We prove a new linear relation for multiple zeta values. This is a natural generalisation of the restricted sum formula proved by Eie, Liaw and Ong. We also present an analogous result for finite multiple zeta values.
This is a copy of the slides presented at the meeting but not formally written up for the volume.
In order to characterize and control the adhesive behaviors of nanometer scaled stimuli-responsible gel particles designed for oral peptide delivery, their interaction with artificial mucin layer in the small intestinal solutions was determined by the colloid probe atomic force microscope method. The prepared nanometer scaled gel particles with a core-shell structure were designed to exhibit behaviors responsive to temperature and pH in solutions, consequently protect the incorporated peptide drug under harsh acidic conditions in the stomach, adhere and penetrate to the mucin layer in the small intestine, and thereafter release the drugs. Spherical agglomerates of the nano-gel particles with several micron meters in diameter were prepared by the spray freeze drying method and adhered on the top of tip of commercial atomic force microscope. The interaction between the artificial mucin layer and nano-gel surface with different molecular structure of shell determined by the colloid probe method depended on pH and counter-ion concentration of the solution. Based on the possible transition of the surface-microstructure of nano-gel particles following the pH change and the measured results from the colloid probe AFM method, the relationship between surface interaction and microstructure of nano-gel was discussed.
Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer. However, it has not been recognized to date in bereaved partners after spousal loss from cancer.
From a series of bereaved partners who lost a spouse to cancer, we report on those who developed TD after bereavement.
Case 1 was a 57-year-old woman who sought consultation at our “bereavement clinic.” Her husband had been diagnosed with pancreatic cancer one year earlier and had died one month previously. At the first visit, she was observed to suffer depression, anxiety, and decreased appetite. Neurological, blood, and biochemical examinations did not reveal any noteworthy findings. She was diagnosed with uncomplicated bereavement. Detailed examination revealed that her appetite had been markedly decreased for approximately five weeks. The diagnosis of TD was supported by her abnormally low serum thiamine level. Case 2 was a bereaved 73-year-old male who had lost his wife to hypopharyngeal cancer one month previously after a five-year illness. He had shown a lack of energy for the month preceding his wife's death, but because there was no improvement after her death, his family recommended he seek consultation at our “bereavement clinic.” He was suffering from major depressive disorder. Detailed examination revealed that his appetite had been decreased for more than two weeks. Again, the diagnosis of TD was supported by his abnormally low serum thiamine level.
Significance of results
These reports demonstrate that there is a possibility that bereaved could develop TD after the loss of a loved one. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of the bereaved to prevent complications because of TD.
Effects of microstructure constituents of α2-Ti3Al/γ-TiAl lamellae, β-Ti grains and γ grains, with various volume fractions on room-temperature ductility of γ-TiAl based alloys have been studied. The ductility of the alloys containing β phase of about 20% in volume increases to more than 1% as the volume fraction of γ phase increases to 80%. However, γ single phase alloys show very limited ductility of less than 0.2%. The present results, thus, confirmed the significant contribution of β phase to enhancement of the room-temperature ductility in multi-component TiAl alloys.
Children are a vulnerable population in disasters. However, there were few pediatricians, neonatologists, and obstetricians in the Japan Disaster Medical Assistance Team (DMAT), so disaster medical headquarters had limited knowledge to solve these problems. Pediatric and perinatal disaster liaison coordinators were trained to improve disaster medical management for children and pregnant women since the 2016 Kumamoto earthquake.
To analyze and report the activity of PPDML during these years in Osaka, Japan.
The records of PPDML in major disasters and disaster drills from 2017 to 2018 were reviewed.
The DMAT had disaster drills twice a year in Osaka, and PPDML participated in the drill for the first time in July 2017. In the drill, PPDML coordinated the pediatric and perinatal issues with DMAT and Japan Ground Self-Defense Force (JGSDF) in disaster headquarters. In June 20184. months after the drill, PPDML participated for the second time in February 2018 when the North Osaka Earthquake occurred. PPDML coordinated transport of 22 children and babies with congenital heart disease from the damaged National Cerebral and Cardiovascular Center Hospital. The operation was finished within 5 hours after requested transportation.
To protect children and pregnant women, cooperation between the disaster medical network and the pediatric and perinatal network is absolutely important for any phase in disaster. Because PPDML had attended in disaster drills before, the experience could make PPDML achieve good performance in a real disaster in North Osaka Earthquake. It can be concluded that cooperation between disaster medical network and PPDML is very useful to manage the disaster issues for children and pregnant women, and the most important thing is to cooperate not only in disaster but also in ordinary days.
Micro and trace element analysis by X-ray fluorescence was carried out using synchrotron radiation from a bending magnet and an undulator for hard and soft X-ray excitation respectively. The minimum detection limits obtained in the hard X-ray region were less than pg, which corresponds to a spatial resolution of less than a hundred micronmeters, with a detection limit of a few ppm. Light elements such as oxygen, nitrogen and carbon in silicon compounds were analyzed by soft X-ray emission spectroscopy using undulator radiation. The minimum detectable amount of the light elements was greatly improved, since undulator radiation is very strong in intensity, and is highly collimated.
X-ray diffraction observation of the material internal structure beneath fracture surfaces provide fracture analysis with useful information to investigate the conditions and mechanisms of fracture. X-ray fractography is a generic name given to this technique.
In the present study, X-ray fractography was applied to fatigue fracture surfaces of austenitic stainless steel (AISI 304) which consisted of solution treatment. The fatigue tests were carried out on compact tension (CT) specimens. The plastic strain on the fracture surface was estimated from measuring the line broadening of X-ray diffraction profiles. The line broadening of X-ray diffraction profiles was measured on and beneath fatigue fracture surfaces. The depth of the plastic zone left on fracture surfaces was evaluated from the line broadening. The results are discussed on the basis of fracture mechanics.
Reflection and fluorescence intensity profile curves for thin films were measured under the grazing incidence conditions using synchrotron radiation. A titanium layer and a carbon / titanium bilayer sputtered on a silicon wafer were subjected to heat treatment. The analysis of the reflection and fluorescence profile curves shows that the sample without the heat treatment has another high-density layer on the surface or interface, and that the heat treatment results in the removal of the high-density layer and the formation of a thick homogeneous layer.
Design approaches and achievements for the development of wrought TiAl alloys to be used for LPT and HPC blades are constructed. In case of Ti-Al-M1-M2 quaternary systems, conventional equivalency concept does not work for the alloy design, and a new thermodynamic database for phase diagram calculations in multi-component systems of the alloys is built by introducing the interaction parameters among four phases of β−Ti, α2−Ti3Al, α−Ti and γ−TiAl phases in the systems, in order to reproduce the experimentally determined phase diagrams. Based on the phase diagram calculations, the composition range of a unique phase transformation pathway of β+α→α→β+γ in the multi-component system can be identified, and thus model alloys with excellent hot workability even at higher strain rate and mechanical properties can be successfully proposed. It can be concluded that an introduction of bcc β phase and the morphology control through the phase transformation pathway make it possible to improve the room temperature ductility, creep and fatigue crack propagation resistance.
Effects of Cr addition to TiAl alloy on the phase equilibria among β/α/α2/γ Phases and phase transformation pathways within the temperature range of 1523 K∼1073 K were investigated using several alloys in the composition of interest. In between 1473 K and 1373 K, The slope of β/α tie-line in the three-phase coexisting region of β+α+γ remains basically unchanged. However, this slope drastically rotates in a clockwise direction, in between 1373 K and 1273 K and below the eutectoid reaction temperature in the binary system (1400 K). This is a strong indication that α-phase exists even below the 1400 K, i.e. addition of Cr stabilizes α against α2 and the three-phase coexisting region of β+α2+γ at lower temperatures is formed through a ternary eutectoid reaction (α → β+α2+γ) with decreasing temperature. This three-phase tie-triangle moves towards lower Al content in phase diagram. This suggests that Cr addition results in increase of the volume fraction of γ-phase with decreasing temperature even in alloys with low Al content.
Thiamine deficiency (TD) is recognized in various kinds of disease with associated loss of appetite including cancer; however, TD has not been recognized in the family caregivers of cancer patients to date.
From a series of cancer patient caregivers, we reported an aged family caregiver who developed TD while caring for the cancer patient.
The caregiver was a 90-year-old male. He had been accompanying his wife, who was diagnosed with colon cancer 4 years previously, on hospital visits as the primary caregiver, but because of psychological issues, he was recommended to visit the psycho-oncology department's “caregiver's clinic” for a consultation. Detailed examination revealed that his appetite had been only about 50% of usual from about one year before, and he had lost 12 kg in weight in one year. The diagnosis of TD was supported by his abnormally low serum thiamine level.
Significance of the results
This report demonstrates that there is a possibility that care providers could develop TD from the burdens associated with caregiving. TD should be considered whenever there is a loss of appetite lasting for more than 2 weeks, and medical staff should pay careful attention to the physical condition of care providers to prevent complications resulting from TD.
We quantified an absolute imbalance of the medical risks and the support needs for children at each disaster-based hospital in Kanagawa immediately following the occurrence of a large earthquake by using the risk resource ratio (RRR) and need for medical resources (NMR).
The RRR and NMR of 33 disaster-based hospitals were estimated through dividing the estimated number of pediatric victims by the number of critically patients. We calculated the ratio of the NMR of each hospital.
The total number of pediatric victims in Kanagawa was estimated at 8,391. The total number of vacant beds for pediatric victims was 352. The median RRR and NMR of the total number of pediatric victims were 27 and 224. The median RRR and NMR of the number of critically ill pediatric patients were 27 and 12.
The absolute imbalance of the RRR and NMR for children in Kanagawa was quantified. This suggests that we might embark on preparedness strategies for children in advance. (Disaster Med Public Health Preparedness. 2018;13:672–676)
Ductal patency is mandatory to manage patients with ductal-dependent pulmonary circulation. The aim of this study is to elucidate the morphological and haemodynamic features of ductus arteriosus with right ventricular outflow tract obstruction, and investigate the appropriate perinatal management.
Patients and methods
Patients with prenatal diagnosis of right ventricular outflow tract obstruction at our institution between 2010 and 2015 were included in the study. Reverse orientation of the ductus arteriosus is defined as an inferior angle of <90° at the aortic junction, and normal orientation of the ductus arteriosus as an angle of >90°. We retrospectively reviewed the shape and flow pattern of ductus arteriosus and the clinical characteristics of the cases.
A total of 39 patients were enrolled. The shape was divided into normal orientation (n=15) and reverse orientation (n=24) of the ductus arteriosus. There was no significant difference in the type of oxygen saturation at birth and age at shunt operation between both the groups. However, the median narrowest diameter of ductus arteriosus in the normal orientation group was significantly smaller than that in the reverse orientation group (2.0 [1.0–5.4] versus 3.0 [1.3–4.4] mm, p<0.05). In two patients of the normal orientation group, ductus arteriosus had closed at birth, and one of whom died because of severe cyanosis.
Normal orientation pattern might have high incidence of an early narrowing or closure of ductus arteriosus at birth. The critical patients need careful evaluation by repeated foetal echocardiography and further maternal interventions.
Although thiamine deficiency (TD) and Wernicke encephalopathy (WE) are not rare in cancer patients, the cases reported to date developed TD and/or WE after treatment had started.
From a series of cancer patients, we report a patient diagnosed with TD without the typical clinical symptoms of WE at the preoperative psychiatric examination.
A 43-year-old woman with ovarian cancer was referred by her oncologist to the psycho-oncology outpatient clinic for preoperative psychiatric evaluation. Her tumor had been growing rapidly before the referral. Although she did not develop delirium, cerebellar signs, or eye symptoms, we suspected she might have developed TD because of her 2-month loss of appetite as the storage capacity of thiamine in the body is approximately 18 days. The diagnosis of TD was supported by abnormally low serum thiamine levels.
Significance of results
Cancer therapists need to be aware that thiamine deficiency may occur even before the start of cancer treatment. In cases with a loss of appetite of more than 2 weeks’ duration, in particular, thiamine deficiency should be considered if the tumor is rapidly increasing, regardless of the presence or absence of delirium.
Wernicke encephalopathy (WE) is a neuropsychiatric disorder caused by thiamine deficiency. It is recognized in various stages of the cancer trajectory but has not previously been recognized during nivolumab treatment.
From a series of WE patients with cancer, we report a lung cancer patient who developed WE during treatment with nivolumab.
A 78-year-old woman with lung cancer was referred to our psycho-oncology clinic because of depressed mood. Psychiatric examination revealed disorientation to time, date, and place, which had not been recognized 1 month previously. Her symptoms fulfilled the diagnostic criteria for delirium. No laboratory findings or drugs explaining her delirium were identified. WE was suspected as she experienced a loss of appetite lasting 4 weeks. This diagnosis was supported by abnormal serum thiamine and the disappearance of delirium after intravenous thiamine administration.
Significance of results
We found WE in an advanced lung cancer patient receiving treatment with nivolumab. Further study revealed the association between nivolumab and thiamine deficiency. Oncologists should consider thiamine deficiency when a patient experiences a loss of appetite of more than 2 weeks regardless of the presence or absence of delirium.