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The prognosis of patients with advanced squamous cell carcinoma of the external auditory canal and middle ear has been improved by advances in skull base surgery and multidrug chemoradiotherapy during the last two decades.
Ninety-five patients with squamous cell carcinoma of the external auditory canal and middle ear who were treated between 1998 and 2017 were enrolled. The number of patients with tumour stages T1, T2, T3 and T4 was 15, 22, 24 and 34, respectively. Oncological outcomes and prognostic factors were retrospectively investigated.
Among patients with T4 disease, invasion of the brain (p = 0.024), carotid artery (p = 0.049) and/or jugular vein (p = 0.040) were significant predictors of poor prognosis. The five-year overall survival rate of patients with at least one of these factors (T4b) was significantly lower than that of patients without these factors (T4a) (25.5 vs 65.5 per cent, p = 0.049).
It is proposed that stage T4 be subclassified into T4a and T4b according to the prognostic factors.
We performed family psychoeducation for depression, and investigated the association between the education and expressed emotion of patients’ families and relapse of depression.
Of 103 patients diagnosed with major depressive disorder, and their primary family members, 53 patients and their primary family members gave consent. The patients were randomly allocated to an intervention or control group, consisting of 24 and 30 patients, respectively. The intervention group underwent 4 educational sessions and education in coping techniques. The relapse rate was compared between the intervention and control groups. In addition, the subjects were divided into high- and low-EE groups based on the EE judgment, and the effect of psychoeducation was compared in each group.
The relapse rate during a 9-month period was 8.3% in the intervention group, being significantly lower than that (50%) in the control group. The relapse rate in the intervention group was slightly lower than that in the control group in the high-EE group, and significantly lower in the low-EE group. Regarding the influence of EE, in the control group, the relapse rate was 70% in the high-EE group, being significantly higher than that (40%) in the low-EE group. On multiple logistic regression analysis, psychoeducation (odds ratio: 25.53, 95% CI: 2.83-229.92) and the Hamilton score at the time of entry (odds ratio: 1.16, 95% CI: 1.045-1.298) were significantly associated with relapse.
It was suggested that the psychoeducation of families is very effective for the prevention of relapse in adult depressive patients.
Recent studies suggest that depression is associated with somatic pain. Despite growing research interest in the topic, the effects of depression-related somatic pain remain unclear. The present study sought to investigate the relationships between depression-related somatic pain, treatment satisfaction, and functions of daily living, and to compare them with the relationships between these factors and mental health measures.
We administered an Internet-based survey to 663 patients with depression in Japan, including questions about pain symptoms, mental health, functions of daily living, and dissatisfaction with depression treatment. The SF-8 questionnaire was used to assess functions of daily living. We conducted a multiple linear regression analysis to examine the associations between depression-related somatic pain, functions of daily living and treatment satisfaction, and between mental health measures, somatic pain and functions of daily living.
An increase per unit in the number of pain symptoms was associated with a 1.04-unit decrease in physical functioning score (P < 0.001), a 0.67-unit decrease in the role functioning-physical score (P < 0.001), and a 0.53-unit decrease in role functioning-emotional score (P = 0.0010). Meanwhile, we found no significant association between the number of pain symptoms and patients’ satisfaction with treatment, and no significant association between the number of pain symptoms and social functioning.
These results suggest that even when patients report satisfaction with their treatment, they may be suffering from reduced physical functioning and role functioning. These impairments may escape clinical recognition when clinicians or patients fail to discuss pain symptoms.
There is increasing recognition that pain often coexists with depression. the current survey was undertaken to ascertain patients’ and clinicians’ perceptions of pain as a physical symptom associated with depression.
Web-based surveys were undertaken for patients with depression, and for physicians treating patients with depression (psychiatrists, psychosomatic physicians, general internists).
848 patients aged 20–59 years entered the main survey, of whom 663 returned the completed survey (78.2%). of the respondents, 424 (64.0%) experienced at least one painful symptom, with almost three-quarters (72.1%) reporting that the pain affected mental symptoms and 68.6% indicating that it prevented recovery from depression itself. Among 337 patients who discussed their painful symptoms with their physician, 52.5% initiated the discussion.
456 physicians completed the physician survey. When asked about the influence of pain associated with depression, 61.7% of physicians indicated that they ask their patients about pain during a consultation, and 79.9% considered that painful symptoms might disturb the patients’ daily life and 52.8% felt that they would delay recovery from depression.
The survey provides further evidence of the association between depression and pain, highlighting the fact that pain is prevalent in this patient population. Increased patient and physician awareness of pain in association with depression and improved doctor-patient communication, enabling patients to discuss painful symptoms with their physicians, and vice-versa, should lead to better overall management and treatment strategies.
Background: Chronic intravenous immunoglobulin (IVIg) is used to treat refractory myasthenia gravis (MG). This subgroup analysis evaluated response to eculizumab in patients receiving chronic IVIg before entry to REGAIN, a phase 3, randomized, double-blind, placebo-controlled study of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalized MG. Methods: IVIg was only permitted during REGAIN as rescue therapy; previously treated patients underwent a 4-week washout before randomization. Patients included in this analysis had received chronic IVIg ≥4 times in 1 year, with ≥1 dose within 6 months before REGAIN entry. Exacerbations and MG status changes were assessed. Results: Eighteen patients were evaluated; four experienced exacerbations (eculizumab-treated, 1/9; placebo-treated, 3/9). Clinically relevant improvements were larger with eculizumab than placebo, respectively (mean change, standard deviation [SD]: MG Activities of Daily Living score [MG-ADL], -5.3 [4.0] vs -2.1 [2.8]; Quantitative MG score [QMG], -4.1 [6.1] vs -1.3 [3.5]). More patients receiving eculizumab (7/9) had clinically meaningful responses (MG-ADL ≥3 and/or QMG ≥5 points) than those receiving placebo (3/9). Eculizumab safety was consistent with previous reports. Interim data from the open-label extension of REGAIN will be presented. Conclusions: In patients previously receiving chronic IVIg, eculizumab showed a trend toward meaningful clinical improvements and fewer exacerbations compared with placebo. (NCT01997229, NCT02301624).
Background: Patients with anti-acetylcholine receptor antibody-positive (AChR+) generalized myasthenia gravis (MG) unresponsive to conventional treatment experience greater disease burden than responsive patients. This is partly due to exacerbations, which may result in significant healthcare resource utilization. Eculizumab is well tolerated and gives clinically meaningful benefits in these patients. We evaluated the effect of long-term eculizumab treatment on exacerbations, hospitalizations and rescue therapy in the REGAIN study and its open-label extension. Methods: Exacerbations were defined as clinical worsening/deterioration, MG crises or rescue therapy usage; pre-study exacerbations/hospitalizations were defined from patient records. Event rates adjusted for patient-years were calculated for all patients in the pre-study year, patients receiving placebo during REGAIN, and patients receiving eculizumab during REGAIN and its open-label extension (median exposure, 27.5 months [range, 22 days–42.8 months]); rates were compared using a Poisson regression model. Results: Eculizumab treatment reduced exacerbations by 65% (p=0.0057), hospitalizations by 71% (p=0.0316) and rescue therapy use by 66% (p=0.0072) versus placebo. Eculizumab treatment reduced exacerbations by 74% and hospitalizations by 83% (both p<0.0001) versus the pre-study year. Conclusions: Long-term eculizumab treatment reduces disease burden and healthcare resource utilization, demonstrating continuing improvements in clinical endpoints that lead to additional meaningful outcomes for patients with AChR+ generalized MG. (NCT01997229, NCT02301624).
Documenting past changes in the East Antarctic surface mass balance is important to improve ice core chronologies and to constrain the ice-sheet contribution to global mean sea-level change. Here we reconstruct past changes in the ratio of surface mass balance (SMB ratio) between the EPICA Dome C (EDC) and Dome Fuji (DF) East Antarctica ice core sites, based on a precise volcanic synchronization of the two ice cores and on corrections for the vertical thinning of layers. During the past 216 000 a, this SMB ratio, denoted SMBEDC/SMBDF, varied between 0.7 and 1.1, being small during cold periods and large during warm periods. Our results therefore reveal larger amplitudes of changes in SMB at EDC compared with DF, consistent with previous results showing larger amplitudes of changes in water stable isotopes and estimated surface temperature at EDC compared with DF. Within the last glacial inception (Marine Isotope Stages, MIS-5c and MIS-5d), the SMB ratio deviates by up to 0.2 from what is expected based on differences in water stable isotope records. Moreover, the SMB ratio is constant throughout the late parts of the current and last interglacial periods, despite contrasting isotopic trends.
The aim of this study was to evaluate the dosimetric aspects of whole brain radiotherapy (WBRT) using an irregular surface compensator (ISC) in contrast to conventional radiotherapy techniques.
Treatment plans were devised for 20 patients. The Eclipse treatment planning system (Varian Medical Systems) was used for dose calculation. For the ISC, a fluence editor application was used to extend the range of optimal fluence. The treatment plan with the ISC was compared with the conventional technique in terms of doses in the planning target volume (PTV), dose homogeneity index (DHI), three-dimensional (3D) maximum dose, eye and lens doses and monitor unit (MU) counts required for treatment.
Compared with conventional WBRT, the ISC significantly reduced the DHI, 3D maximum dose and volumes receiving 105% of the prescription dose, in addition to reducing both eye and lens doses (p<0·05 for all comparisons). In contrast, MU counts were higher for the ISC technique than for conventional WBRT (828 versus 328, p<0·01).
The ISC technique for WBRT considerably improved the dose homogeneity in the PTV. As patients who receive WBRT have improved survival, the long-term side effects of radiotherapy are highly important.
The mode of onset and the course of schizophrenia illness exhibit substantial individual variations. Previous studies have pointed out that the mode of onset affects the duration of untreated psychosis (DUP) and clinical outcomes, such as cognitive and social functioning. This study attempted to clarify the association between the DUP and clinical features, taking the different modes of onset into consideration, in a prospective longitudinal study examining patients with first-episode schizophrenia.
This study was conducted in six areas of Japan. Patients with first-episode schizophrenia were followed for over 18 months. Cognitive function, psychopathology, and social functioning were assessed at baseline and at 6, 12, and 18-month follow-up points.
We identified 168 patients and sufficient information was available to determine the DUP and the mode of onset for 156 patients (92.9%): 79 had an acute onset, and 77 had an insidious onset. The DUP was significantly associated with quality of life (QOL), social functioning, and cognitive function at most of the follow-up points in the insidious-onset group. The DUP and negative symptoms at baseline were significant predictors of cognitive function at the 18-month follow-up in the insidious-onset group.
The present results further support the hypothesis that the DUP affects QOL, social functioning, and cognitive function over the course of illness, especially in patients with an insidious onset. Effective strategies for detecting and caring for individuals with insidious onset early during the course of schizophrenia will be essential for achieving a full patient recovery.
The current trends in stimulated Brillouin scattering and optical phase conjugation are overviewed. This report is formed by the selected papers presented in the “Fifth International Workshop on stimulated Brillouin scattering and phase conjugation 2010” in Japan. The nonlinear properties of phase conjugation based on stimulated Brillouin scattering and photo-refraction can compensate phase distortions in the high power laser systems, and they will also open up potentially novel laser technologies, e.g., phase stabilization, beam combination, pulse compression, ultrafast pulse shaping, and arbitrary waveform generation.
Epitaxial Fe-Te-Se thin films were deposited by pulsed laser deposition at 250 ~ 600 °C on SrTiO3 (100, STO), MgO (100), LaAlO3 (100, LAO) and CaF2 (100) single crystal substrates. Best superconducting film was grown on CaF2: Tconset = 20.0 K and Tc0 = 16.18 K with Tdep = 300 °C, 45000 pulses, 3 Hz. The critical current density Jc at 4.2 K was 0.41×106A/cm2 at 0 T and 0.23×106 A/cm2 at 9 T. Angular dependence of Jc showed broad c-axis correlated peak when B ≥ 3 T.
Maternal food restriction is known to cause developmental hypertension in offspring. We have previously shown that maternal high-protein diet can reverse fetal programming of hypertension and that branched-chain amino acid (BCAA) concentrations in maternal and fetal plasma were increased by maternal high-protein intake. Then, we hypothesized that isocaloric supplementation with BCAA to a maternal food restriction can reverse the adverse outcome. Pregnant rats were divided into four groups at 7.5 days postcoitum: normally nourished (NN) and 70% undernourished (UN) groups with and without BCAA supplementation (NN–standard diet (SD), NN–BCAA, UN–SD and UN–BCAA groups). Compared with pups in the NN groups, those in the UN–SD group had significantly increased systolic blood pressure (SBP) at 8 and 16 weeks of age (P < 0.05). However, the elevation of SBP was not observed in offspring in the UN–BCAA group. Offspring glomeruli number of the UN groups was significantly lower (P < 0.05) than that of the NN groups, independent of BCAA supplementation. Angiotensin II receptor type 2 (ATR2) mRNA and protein expression in the kidney was significantly augmented in the UN–BCAA group at 30 weeks of age. In conclusion, BCAA supplementation during maternal food restriction prevents developmental hypertension together with increased ATR2 expression in adult offspring kidney.
In order to measure precisely the polarization of Crab Nebula and Cygnus X-1, we have been developing a hard X-ray polarimeter for balloon-borne experiments called PHENEX (Polarimetry of High ENErgy X-rays). It consists of several detectors called unit counters. The unit counter has a detection efficiency of 20% and a modulation factor of 53% at 80 keV. Up to now, we have finished the installation of eight unit counters to the polarimeter, that will be launched in Spring 2009 to observe the Crab Nebula. If the polarization of this source is more than 30%, the PHENEX polarimeter will be able to measure the degree and the direction of the polarization with errors less than 10% and 10°, respectively.
X-ray astronomy has been much advanced by three observations: spectroscopy, timing, and imaging. Also in the hard X-ray region, these three observations will be realized by ASTRO-H and XEUS. However, the observation of the polarization is at the moment left out in spite of its potential usefulness. This is because of the difficulty of developing polarimeters with high sensitivity. Since the origin of the polarization is often due to nonthermal radiation processes such as synchrotron radiation, observations in the hard X-ray region are possibly more important than those in the soft X-ray region: it is expected that the degree of polarization in the hard X-ray region would be higher than that at lower energies.
The coupling mechanism of boundary sheaths and a wave launcher immersed in a collisionless plasma is experimentally clarified by the addition of an electron emission from the launcher. The wave amplitude increases rapidly with increasing electron emission. The strong increase in a directly coupled signal is a clear observation of ion-acoustic waves which are simultaneously excited at the sheaths.
An overview on current trends in stimulated Brillouin scattering and optical phase conjugation is given. This report is based on the results of the “Second International Workshop on stimulated Brillouin scattering and phase conjugation” held in Potsdam/Germany in September 2007. The properties of stimulated Brillouin scattering are presented for the compensation of phase distortions in combination with novel laser technology like ceramics materials but also for e.g., phase stabilization, beam combination, and slow light. Photorefractive nonlinear mirrors and resonant refractive index gratings are addressed as phase conjugating mirrors in addition.
Field rodent surveys for Babesia infection were performed from 2002 to 2005 in the vicinities of human babesiosis occurrences in Taiwan and mainland China. Babesia microti was identified by microscopical examination and/or PCR in 1 Rattus coxinga and 1 Crocidura horsfieldii in central Taiwan and in 13 Niviventer confucianus and 1 Apodemus agrarius in Zhejiang and Fujian Provinces of southeastern China. Of 15 B. microti samples detected by PCR, all except 1 were shown to be the Kobe-type, the aetiological small subunit rRNA gene-type of the first Japanese patient; the exception was also a Kobe-related type. The Kobe-type had been found in rodents only in a few places including the human infection occurrence place in Japan. The internal transcribed spacer 1 to 2 sequences of the Taiwanese and Chinese Kobe-types were very similar to each other but considerably different (approx. 94% pairwise identities) from that of the Japanese Kobe-type. A Taiwanese Kobe-type strain was serologically differentiated from the Kobe strain originating from the Japanese first patient. The distribution of the Kobe-type in the vicinities of human babesiosis occurrences in Taiwan and China as well as in Japan is suggestive of involvement of the Kobe-type in Asian human babesiosis.