[Characteristics of ethical dilemma and behavior in the support process of older adults and their families among nurses at a community general support center in Japan].

Objectives　This study was aimed at clarifying characteristics of ethical dilemmas and behaviors in the support process of older adults and their families among nurses at community general support centers.Methods　A self-administered questionnaire survey was mailed to 449 nurses at community general support centers in Tokyo. Question items enquired their age, employment license, years of experience as a nurse, the presence of ethics-related organizations, number of cases in which nurses faced difficulties in supporting older adults and their families in decision making over the past year, the ethical dilemmas they experienced and their situations, and ethical behavior in the process of supporting older adults and their families.Results　From the 143 responses (response rate: 31.8%), 135 (valid response rate: 30.1%) nurses were analyzed. Overall, 43.0% and 27.4% of the participants were in their 50s and 40s, respectively. Of these, 77.0% and 23.0% were nurses and public health nurses, respectively. In total, 52 (38.5%) respondents had an ethics-related organization. The average number of cases in which the respondents faced difficulties in supporting older adults and their families in decision making over the past year was 8.3 (standard deviation, 12.5). Of these, the average number of cases in which they faced difficulties in making ethical decisions was 4.1 (standard deviation, 6.0). Regarding the perception of ethical dilemmas, 113 (83.7%) answered "often" or "sometimes." Ethical dilemma situations included "the intentions of the user and family were different, and I had trouble deciding what to respect" 95 (84.1%); "the user's intention was different from my judgment as a professional, and I had trouble deciding what to respect" 64 (56.6%); and "the intention of the user and neighbors were different, and I had trouble deciding what to respect" 56 (49.6%). Ethical behaviors included "I observe the management rules in my organization regarding personal information data" 116 (85.9%); "I provide easy-to-understand explanations appropriate to the user's situation" 115 (85.2%); and "I decide on a support policy with several staff members when self-decision making is difficult due to the user's situation" 113 (83.7%).Conclusion　More than 80% of the nurses perceived ethical dilemmas. Characteristics of the situations were that users and their families, users and professionals, and users and their neighbors had different intentions. Further research should be conducted on ethical issues related to community-based integrated care.

Influence of social isolation and loneliness on the prognosis of advanced lung cancer patients: a prospective cohort study.

PURPOSE: The purpose of this study was to investigate the impact of social isolation and loneliness on the overall survival and death at home in patients with lung cancer. METHODS: This prospective cohort study was conducted in a Japanese tertiary hospital. The enrollment period was from April 2018 to March 2020. Patients with pathologically diagnosed advanced lung cancer were included in this study. The primary outcome was overall survival, whereas the secondary outcome was death at home. The exposures were social isolation and loneliness. RESULTS: A total of 211 patients were enrolled and divided into two groups and further into quartiles according to their social isolation and loneliness level, respectively. The hazard ratios of social isolation were 1.65 (95% confidence interval; 1.12 to 2.44) and 1.87 (95% confidence interval; 1.15 to 3.03) in the univariate analysis, while 1.40 (95% confidence interval; 0.92 to 2.13) in the multivariate analysis with complete case and multiple imputation. The odds ratio of death at home with social isolation was 3.47 (95% confidence interval; 1.08 to 11.1) in the multivariate analysis with multiple imputation. Loneliness was not associated with overall survival or death at home. CONCLUSIONS: Our study suggests that social isolation may be related to overall survival and death at home among patients with advanced lung cancer. More attention should be given to such patients at the time of diagnosis.

Mother-to-infant transmission of the carcinogenic colibactin-producing bacteria.

BACKGROUND: The Escherichia coli strain that is known to produce the genotoxic secondary metabolite colibactin is linked to colorectal oncogenesis. Therefore, understanding the properties of such colibactin-positive E. coli and the molecular mechanism of oncogenesis by colibactin may provide us with opportunities for early diagnosis or prevention of colorectal oncogenesis. While there have been major advances in the characterization of colibactin-positive E. coli and the toxin it produces, the infection route of the clb + strain remains poorly characterized. RESULTS: We examined infants and their treatments during and post-birth periods to examine potential transmission of colibactin-positive E. coli to infants. Here, analysis of fecal samples of infants over the first month of birth for the presence of a colibactin biosynthetic gene revealed that the bacterium may be transmitted from mother to infant through intimate contacts, such as natural childbirth and breastfeeding, but not through food intake. CONCLUSIONS: Our finding suggests that transmission of colibactin-positive E. coli appears to be occurring at the very early stage of life of the newborn and hints at the possibility of developing early preventive measures against colorectal cancer.

Subclass distribution of low-density lipoprotein triglyceride and the clustering of metabolic syndrome components in Japanese children.

BACKGROUND: Recent studies demonstrated that low-density lipoprotein-tryglyceride (LDL-TG) may represent another marker of cardiovascular risks. We therefore measured LDL-TG including the low-density lipoprotein (LDL) subclass distribution and investigated the association between LDL-TG subclass profile and the clustering of metabolic syndrome (MetS) components and insulin resistance in Japanese children. METHODS: The study included 237 schoolchildren (boys 115, girls 122). Four subclasses of low-density lipoprotein-tryglyceride (large, medium, small, and very small) was quantified using high-performance liquid chromatography. Total LDL-TG and TG levels in LDL subclasses were evaluated among four MetS component groups; non-abdominal obesity, abdominal obesity, pre-MetS, and MetS. RESULTS: Total LDL-TG (P = 0.0003, P = 0.0175) and triglyceride levels in LDL subclasses were significantly different among four MetS component groups (large: P = 0.0002, P = 0.0084; medium: P = 0.0009, P = 0.0491; small: P =0.0025, P = 0.0509; very small: P = 0.0808, P = 0.0228; boys and girls, respectively). Total LDL-TG (r = 0.411, P < 0.0001, r = 0.378. P < 0.0001) and triglyceride levels in LDL subclasses correlated positively with the homeostasis model of assessment ratio (large: r = 0.396, P < 0.0001, r = 0.346, P < 0.0001; medium: r = 0.274, P = 0.0030, r = 0.228, P = 0.0115; small: r = 0.342, P = 0.0002, r = 0.292, P = 0.0011; very small: r = 0.385, P < 0.0001, r = 0.426, P < 0.0001, boys and girls, respectively). CONCLUSIONS: Subclass distribution of LDL-TG was significantly associated with the clustering of MetS components in both sexes, and insulin resistance is a significant determinant of LDL-TG in all LDL subclasses. Lipoprotein-tryglyceride subclass analysis, rather than LDL-C, may provide a precise evaluation for cardiovascular disease risks in children with MetS.

Maternal ω3 docosapentaenoic acid inhibits infant allergic dermatitis through TRAIL-expressing plasmacytoid dendritic cells in mice.

BACKGROUND: Maternal dietary exposures are considered to influence the development of infant allergies through changes in the composition of breast milk. Cohort studies have shown that ω3 polyunsaturated fatty acids (PUFAs) in breast milk may have a beneficial effect on the preventing of allergies in infants; however, the underlying mechanisms remain to be investigated. We investigated how the maternal intake of dietary ω3 PUFAs affects fatty acid profiles in the breast milk and their pups and reduced the incidence of allergic diseases in the pups. METHODS: Contact hypersensitivity (CHS) induced by 2,4-dinitrofluorobenzene (DNFB) and fluorescein isothiocyanate was applied to the skin in pups reared by mother maintained with diets mainly containing ω3 or ω6 PUFAs. Skin inflammation, immune cell populations, and expression levels of immunomodulatory molecules in pups and/or human cell line were investigated by using flow cytometric, immunohistologic, and quantitative RT-PCR analyses. ω3 PUFA metabolites in breast milk and infant's serum were evaluated by lipidomics analysis using LC-MS/MS. RESULTS: We show that maternal intake of linseed oil, containing abundant ω3 α-linolenic acid, resulted in the increased levels of ω3 docosapentaenoic acid (DPA) and its 14-lipoxygenation products in the breast milk of mouse dams; these metabolites increased the expression of TNF-related apoptosis-inducing ligand (TRAIL) on plasmacytoid dendritic cells (pDCs) in their pups and thus inhibited infant CHS. Indeed, the administration of DPA-derived 14-lipoxygenation products to mouse pups ameliorated their DNFB CHS. CONCLUSION: These findings suggest that an inhibitory mechanism in infant skin allergy is induced through maternal metabolism of dietary ω3 PUFAs in mice.

Clinical predictors of surgical outcomes of severe carpal tunnel syndrome patients: utility of palmar stimulation in a nerve conduction study.

BACKGROUND: Carpal tunnel syndrome is a common peripheral nerve compression disorder. However, there is no established opinion regarding the predictors of symptom improvement after surgery. This study aimed to identify the predictors of surgical outcomes of severe carpal tunnel syndrome patients. METHODS: In the patients who underwent a carpal tunnel syndrome surgery, we selected the patients who had a preoperative Bland's classification of grade 5 or 6, and assessed for the changes in Bland's classification grade before and after surgery. Those who showed improvement from preoperative grades 5-6 to postoperative grades 1-4 comprised the improvement group. In contrast, those who did not show improvement and had postoperative grades 5 or 6 comprised the non-improvement group. In a nerve conduction study, amplitudes of the compound muscle action potential and sensory nerve action potential of the palms were assessed between the improvement and non-improvement groups. RESULTS: Among the 60 hands of 46 patients who had a preoperative Bland's classification of grade 5 or 6, 49 hands of 37 patients comprised the improvement group, and 11 hands of 9 patients comprised the non-improvement group. The amplitudes of the compound muscle action potential and sensory nerve action potential of the palms before surgery were significantly higher in the improvement group. The degree of improvement in Bland's classification grade was correlated with the degree of clinical symptom improvement. CONCLUSIONS: Amplitudes of compound muscle action potential and sensory nerve action potential before surgery induced by palmar stimulation can predict improvements in nerve conduction study scores and clinical findings after surgical treatment.

[Health status and support needs of low-income people admitted to supportive housing in urban areas of Japan: Research on new residents across several age groups].

Objectives　The aim of this study is to report on the health status of residents in supportive housing in urban areas of Japan, and to explore the differences in health conditions across different age groups within this population.Methods　The participants were 341 residents who had newly been admitted to supportive housing managed by a nonprofit organization. We examined their admission records and documented their health conditions. Differences in health conditions across age groups were also explored.Results　More than 90 percent of the participants were single men, aged 40 or older, and living on welfare. The main reasons for their utilization of supportive housing were the lack of accommodation after leaving a hospital or facility, decrease in physical function, and progression of dementia. A high proportion of participants under 40 years had an addiction problem, schizophrenia, intellectual disorders, or developmental disorders. Participants aged 40-59 years had high rates of lifestyle-related diseases in addition to mental illnesses. Furthermore, for those aged 60 years and older, the prevalence of geriatric syndromes such as dementia, hearing impairment, and visual impairment was high. Additionally, there was a high proportion of elderly participants whose health status was unknown when they were admitted to supportive housing.Conclusion　Most residents who had been admitted to supportive housing in the urban areas of Japan had physical or mental illnesses, and their life and support needs varied by age group. These findings suggest that it may be necessary for residents living in urban supportive housing in Japan to receive not only increased medical and psychological care but also age group-specific care.

The evaluation of public health nursing students' skill achievement levels by educational improvement.

OBJECTIVE: This study aimed to evaluate the educational improvement outcomes after introducing undergraduate public health nursing electives from the perspective of students, teachers, and public health nurses. DESIGN AND SAMPLE: Post-test design with control group was used. We surveyed three groups of participants on the relevance of achieved skill items. These groups were as follows: fourth-year students, teaching staff from seven universities, and public health nurses from special districts of Tokyo who had pioneered the introduction of public health nursing electives. MEASURES: The three participant groups were surveyed in 2013 and 2014 to compare the students' levels of achievement in the 98 skill items presented by the Japanese Ministry of Health, Labour, and Welfare. Practical training introduced educational reform in 2014. Anonymous self-administrated questionnaires were used. RESULTS: The mean achievement rates of the 98 items in 2013 and 2014 were 67.9% and 72.6%, respectively, for students; 40.9% and 59.7% for teachers; and 44.4% and 59.4% for PHNs. A significant difference was observed between ratios of 2013 and 2014 in all three groups. CONCLUSIONS: The results demonstrated that the introduction of educational reform increased the achievement rates of students through the electives.

Factors related to care burden among parents of adults with developmental disabilities.

Purpose To clarify the care burden and associated factors among parents of adults with developmental disabilities in order to obtain suggestions for the family supports.Methods Subjects included 125 parents of adults (aged 18 or older) with developmental disabilities. All parents belonged to and/or contacted parents' associations, mental health welfare centers, and support centers for persons with developmental disabilities in the Tokyo metropolitan area. Participants completed self-report questionnaire surveys from October to November 2011. Questionnaire items included parent and adult demographic factors, parent care burden, disability state, and support available from family and others. The level of care burden was measured using the short Japanese version of the Zarit Burden Interview (J-ZBI_8).Results A total of 64 responses were analyzed. The mean J-ZBI_8 score was 12.8 (SD=7.2). Adults' most common diagnoses were autism (50%), Asperger's syndrome (25%), and pervasive developmental disorder (20%). state of daily life (P=0.041) and presence of secondary disability (P=0.001) were associated with parents' care burden in age-adjusted multiple linear regression analysis.Discussion Overall, the results suggest that it is important to assess developmental disability status and family support when developing programs to reduce parental care burden.

Evaluation of skill achievement levels and practical experiences of public health nursing students before and after the introduction of the public health nursing course as an elective.

Objective To equip public health nurses (PHNs) with higher qualifications, PHN education is shifting from an integrated curriculum for PHNs and registered nurses to a specific elective system of undergraduate or postgraduate programs. Most colleges in the special wards of Tokyo introduced the elective system in 2014 before the remaining areas. The outcomes of this must be evaluated. This study aimed to evaluate the achievement levels and practical experiences of PHN students at seven colleges in the special wards before and after introduction of the PHN course as an elective.Method Self-administered, anonymous questionnaires were completed by senior PHN students at seven colleges in the special wards who underwent training in 2013, the last year of an integrated curriculum, and in 2014, the first year of the elective system. The target numbers of participants were 663 in 2013 and 136 in 2014 with 20 students from each school exposed to the elective system. Our study focused on whether they achieved the 98 "technical items of PHN training and achievement levels at the time of graduation" required by the Ministry of Health, Labour and Welfare. The study also determined whether participants obtained practical experience in 15 items developed by the special wards based on the standards set for training.Results In 2013, there were 348 total responses (52.5%) and 310 valid responses. In 2014, there were 136 total responses (88.2%) and 120 valid responses. The average achievement rate at which the student answered, "I was able to arrive at it," at an arrival degree level for the 98 technical items was 72.6% in 2014, an increase compared to the 67.9% obtained in 2013. Moreover, the average practical experience rate at which the student answered, "I was able to have an experience," regarding the 15 items was 85.7% in 2014, which constituted an increase compared to 70.5% attained in 2013. However, the number of items with an achievement rate of more than 80% remained at 31 (31.6%) in 2014.Conclusion Increasing percentages of average achievement and experience rate suggest that the lecture and training have improved, and highly motivated students could have been selected in the PHN program. However, students did not achieve the target rate for many of the items. Thus, there was a time limit to experience the technical item/the experience item.

Risk factors of functional disability among community-dwelling elderly people by household in Japan: a prospective cohort study.

BACKGROUND: Although the number of elderly people needing care is increasing rapidly in the home setting in Japan, family size and ability to provide such support are declining. The purpose of this study was to identify the risk factors of functional disability by household composition among community-dwelling elderly people. METHODS: A total of 1347 elderly people aged 70 years and over participated in a baseline geriatric health examination for this prospective cohort study. In the health examination, we conducted an interview survey using a questionnaire in July 2004 and July 2005. Questionnaire items covered the following: age, sex, household, medical history, instrumental activities of daily living, intellectual activity, social role, Motor Fitness Scale, falls experienced during the past year, Dietary Variety Score, frequency of going outdoors, cognitive impairment, and depressive status. We defined the occurrence of functional disability as certification for long-term care needs of the subjects. The certification process started with a home visit for an initial assessment to evaluate nursing care needs using a questionnaire on current physical and mental status. The onset of functional disability was followed from July 2004 to March 2011. Cox proportional hazard regression analysis was used to estimate the risk factors related to the onset of functional disability, adjusted for age and sex. RESULTS: Of the 1084 participants, 433 were male (39.9%), and the average age was 77.8 (standard deviation, 5.4). Up to March 2011, functional disabilities occurred in 226 participants (20.9%). Elderly people living only with their children demonstrated a significantly higher risk for functional disability than the three-generation household group (hazard ratio, 1.61; 95% confidence interval, 1.08-2.40). The risk factors for functional disability varied according to household group. CONCLUSIONS: In Japan, the number of vulnerable households with elderly people in need of care has increased steadily over the years. Appropriately identifying the risks related to functional disability requires a means of assessment that takes the household composition into consideration.

Relationship Between Cerebrospinal Fluid Alzheimer's Disease Biomarker Values Measured via Lumipulse Assays and Conventional ELISA: Single-Center Experience and Systematic Review.

Background: Although Lumipulse assays and conventional ELISA are strongly correlated, the precise relationship between their measured values remains undetermined. Objective: To determine the relationship between Lumipulse and ELISA measurement values. Methods: Patients who underwent cerebrospinal fluid (CSF) Alzheimer's disease (AD) biomarker measurements and consented to biobanking between December 2021 and June 2023 were included. The relationship between values measured via Lumipulse assays and conventional ELISA were evaluated by Passing-Bablok analyses for amyloid-ß 1-42 (Aß42), total tau (t-tau), and phospho-tau 181 (p-tau 181). Studies using both assays were systematically searched for in PubMed and summarized after quality assessment. Results: Regression line slopes and intercepts were 1.41 (1.23 to 1.60) and -77.8 (-198.4 to 44.5) for Aß42, 0.94 (0.88 to 1.01) and 98.2 (76.9 to 114.4) for t-tau, and 1.60 (1.43 to 1.75) and -21.1 (-26.9 to -15.6) for p-tau181. Spearman's correlation coefficients were 0.90, 0.95, and 0.95 for Aß42, t-tau, and p-tau181, respectively. We identified 13 other studies that included 2,117 patients in total. Aß42 slope varied among studies, suggesting inter-lab difference of ELISA. The slope and intercept of t-tau were approximately 1 and 0, respectively, suggesting small proportional and systematic differences. Conversely, the p-tau181 slope was significantly higher than 1, distributed between 1.5-2 in most studies, with intercepts significantly lower than 0, suggesting proportional and systematic differences. Conclusions: We characterized different relationship between measurement values for each biomarker, which may be useful for understanding the differences in CSF biomarker measurement values on different platforms and for future global harmonization.

[Dermatitis in early infancy as a risk factor for sensitization and allergic diseases during the first year of life].

BACKGROUND: A recent study hypothesized that a skin-mediated immune response leads to atopic sensitization. However, prospective studies investigating sensitization during infancy are limited. METHODS: This cohort study included unselected infants born at NTT Medical Center Tokyo between March 2008 and February 2009. At age 3, 6, 9, and 12 months, they underwent physical examinations and a skin prick test (SPT). Associations of predictor variables with sensitization, atopic dermatitis (AD), and food allergy (FA) at ≤1 year were analyzed. RESULTS: Of 317 infants, the SPT was positive in 25 (8%) at 3 months and 133 (42%) at least once. Of the SPT-positive infants at 3 months, 19 (76%) had atopic diseases at ≤1 year (OR, 13.9; 95% 95%CI, 5.3-36.6). The presence of dermatitis at ≤3 months was significantly associated with sensitization (aOR, 3.0; 95%CI, 1.8-5.0), AD (aOR, 13.0; 95%CI, 4.5-37.3), and FA (aOR, 28.4; 95%CI, 3.3-240.6) by the age of 1 year. Point prevalence of sensitization paralleled the incidence of dermatitis. Almost all FA infants had experienced dermatitis at ≤3 months. In infants with dermatitis at ≤3 months, breast-feeding was significantly associated with sensitization (OR, 2.5; p=0.005) and FA (OR, 3.0; p=0.004). Infants without eczema at ≤3 months rarely developed AD or FA. CONCLUSIONS: The presence of dermatitis in the first few months after birth is a strong risk factor for atopic sensitization and FA during the first year of life.

Comorbidity of eosinophilic chronic rhinosinusitis in chronic eosinophilic pneumonia.

We aimed to elucidate details of comorbid chronic rhinosinusitis (CRS) in chronic eosinophilic pneumonia (CEP) under the collaboration between otolaryngologists and pulmonologists in a prospective study. The CEP diagnosis was performed by pulmonologists based on clinical symptoms, laboratory findings, and/or eosinophilia detected in bronchoalveolar lavage. All patients were referred to otolaryngologists before undergoing oral corticosteroid treatment for CEP. Ten CEP cases visited to otolaryngologists. All cases showed bilateral sinonasal inflammation in computed tomography (CT), indicating comorbid CRS. Nasal polyps (NPs) were observed in 50% of patients on endoscopy. Eighty percent of patients were diagnosed with eosinophilic CRS. In blood eosinophil levels and the mucosal eosinophil count, there were no significant differences between CRS without and with NPs. In Lund-Mackay CT total scores, among-individual variability was observed in CRS with NPs. The collaboration revealed blood/sinonasal eosinophilia and the variability in Lund-Mackay CT total scores as remarkable findings about the comorbid CRS.

Demonstration of 12.5-Gbps optical interconnects integrated with lasers, optical splitters, optical modulators and photodetectors on a single silicon substrate.

One of the most serious issues in information industries is the bandwidth bottleneck in inter-chip interconnects. We propose a photonics-electronics convergence system to solve this issue. We fabricated a high density optical interposer to demonstrate the feasibility of the system by using silicon photonics integrated with an arrayed laser diode, an optical splitter, silicon optical modulators, germanium photodetectors, and silicon optical waveguides on a single silicon substrate. Error-free data transmission at 12.5 Gbps and a transmission density of 6.6 Tbps/cm2 were achieved with the optical interposer. We believe this technology will solve the bandwidth bottleneck problem in the future.

[Diagnosis of patients with thoracic outlet syndrome (TOS) using physiological measures of the medial antebrachial cutaneous nerve].

The diagnosis of thoracic outlet syndrome (TOS) remains difficult; therefore, reliable and objective tests are required. We examined the process to diagnose TOS, and assessed the validity of measuring the medial antebrachial cutaneous nerve (MAC), also the ulnar nerve (UN) as a diagnostic tool. Between 2008 and 2011, 86 sides in 73 patients admitted to our hospital for the treatment of TOS were analyzed. In the process for the diagnosis as TOS, the narrow parts of the subclavian artery that was compressed by the anterior scalene muscle were confirmed with a three-dimensional CT angiography. All patients were taken a brachial plexus anesthesiological block to aim at both for diagnosis and treatment of TOS. For the diagnosis of TOS, measurements of latency (LT) and sensory nerve action potential (SNAP) of MAC and UN were analyzed between the TOS side and the non-TOS side and separated into traumatic type or disputed type. In our research, the LT of MAC and UN did not differ much between the TOS side and the non-TOS side; however, the amplitude of SNAP of MAC and UN were lower on the TOS side, especially in traumatic TOS. We concluded that comparison of the amplitude of SNAP of MAC on the injured or non-injured side was comparatively helpful for the diagnosis of TOS.

Subclavian Artery Flow Dynamics Evaluated by Analytical Intraoperative Indocyanine Green Videoangiography During Surgical Treatment of Thoracic Outlet Syndrome: A Case Series.

BACKGROUND: Indocyanine green (ICG) videoangiography is rarely used during the surgical treatment of thoracic outlet syndrome (TOS). OBJECTIVE: To evaluate subclavian artery (SA) flow dynamics using the analytical ICG videoangiography during TOS surgeries. METHODS: We examined patients with neurogenic TOS who received surgical treatment and whose SA blood flow at the interscalene space was evaluated using ICG videoangiography equipped with an analytical function (FLOW800). Anterior scalenectomy with or without middle scalenectomy and first rib resection were conducted for decompression of the brachial plexus. ICG videoangiography was performed before and after decompression of the brachial plexus. After acquisition of grayscale and color-coded maps, a region of interest was placed in the SA to obtain time-intensity diagrams. Maximum intensity (MI), rise time (RT), and blood flow index (BFi) were calculated from the diagram, in arbitrary intensity (AI) units. We compared values before and after decompression. Comparisons of the three parameters before and after decompression were assessed statistically using the paired t-tests and Wilcoxon signed-rank test. RESULTS: We evaluated nine procedures in consecutively presenting patients. The observed mean values of MI, RT, and BFi before decompression were 174.1 ± 61.5 AI, 5.2 ± 1.1 s, and 35.2 ± 13.5 AI/s, respectively, and the observed mean values of MI, RT, and BFi after decompression were 299.3 ± 167.4 AI, 6.6 ± 0.8 s, and 44.6 ± 28.3 AI/s, respectively. These parameters showed higher values after decompression than before decompression, and the increase in MI and RT was statistically significant (P < .05). CONCLUSION: ICG videoangiography allows semiquantitative evaluation of hemodynamic changes during TOS surgery. A marked decrease in the velocity of SA flow was observed after decompression.

First demonstration of high density optical interconnects integrated with lasers, optical modulators, and photodetectors on single silicon substrate.

Engineers are currently facing some technical issues in support of the exponential performance growths in information industries. One of the most serious issues is a bottleneck of inter-chip interconnects. We propose a new "Photonics-Electronics Convergence System" concept. High density optical interconnects integrated with a 13-channel arrayed laser diode, silicon optical modulators, germanium photodetectors, and silicon optical waveguides on single silicon substrate were demonstrated for the first time using this system. A 5-Gbps error free data transmission and a 3.5-Tbps/cm(2) transmission density were achieved. We believe that this technology will solve the bandwidth bottleneck problem among LSI chips in the future.

Assessment of Hounsfield unit in the differential diagnosis of odontogenic cysts.

OBJECTIVES: The purpose of this study was to evaluate the usefulness of Hounsfield unit (HU) assessment with multislice-CT in the differentiation of radicular cysts (RCs), dentigerous cysts (DCs) and odontogenic keratocysts (OKCs). METHODS: In total, 307 odontogenic cysts (RCs, DCs and OKCs) were included in this study. Cysts with lesion diameter <10 mm, cysts with artefacts affecting measurement of HU values, cysts involving infection and recurrent cysts were regarded as exclusion criteria. Images were acquired in three different types of CT scanners: Aquilion ONE, Discovery CT750 HD and SOMATOM Definition Flash. Differences in HU values among scanners and among types of odontogenic cysts were assessed using one-way analysis of variance; multiple comparisons were performed post hoc, using the Tukey-Kramer honestly significant difference test. RESULTS: In total, 164 cysts were analysed in this study (64 RCs, 57 DCs and 43 OKCs). Regardless of the type of lesion, the Aquilion ONE scanner demonstrated a significant difference in HU value, compared with the Discovery CT750 HD scanner. Regardless of CT scanner model, HU values significantly differed between DCs and OKCs (p < 0.0001), as well as between OKCs and RCs (p < 0.0001). CONCLUSIONS: HU values were found to vary among CT scanners and should always be associated with other lesion imaging features while interpreting and elaboration diagnostic hypothesis. Notably, the results suggested that OKCs might be able to be differentiated from DCs and RCs by using HU values.

Influence of loneliness and social isolation on the diagnosis and treatment of Japanese patients with advanced lung cancer: a prospective cohort study.

BACKGROUND: Social determinants of health (SDHs) are social factors that affect human health; loneliness and social isolation are core SDH factors. There is a possibility that SDHs are related to passive decision-making. However, few studies have evaluated SDHs, especially social isolation and loneliness, among lung cancer patients. This study aims to investigate the effects of social isolation and loneliness on the diagnosis and treatment of Japanese lung cancer patients. METHODS: This is a prospective cohort study that was conducted in a tertiary referral hospital in Japan (University Hospital Medical Information Network registration: UMIN000031810). The enrollment period was between April 2018 and March 2020. Patients with clinical and/or pathological diagnosis of lung cancer were enrolled in this study. Exposures were social isolation and loneliness, and main outcomes were diagnosis methods and whether the initial treatment involved active therapy or best supportive care (BSC). The confounding factors were defined as sex, age, smoking status, respiratory symptoms, weight loss, presentation with any symptoms, Eastern Cooperative Oncology Group (ECOG) performance status, tumor nodes metastasis (TNM) classification, driver gene mutations [i.e., epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK)], and programmed death-ligand 1 (PD-L1) tumor proportion score. RESULTS: The study enrolled 264 patients who were divided into quartiles according to their loneliness scores and into two groups according to the social isolation level. Univariate analysis, complete case analysis, and multivariate analysis with multiple imputation failed to detect significant differences in diagnostic method or initial treatment strategy according to loneliness or social isolation level. CONCLUSIONS: Physicians may not need to consider a patient's loneliness and/or social isolation when diagnosing lung cancer and selecting treatment under universal health insurance coverage. Further studies are needed to understand the influences of loneliness and social isolation on the prognosis of lung cancer patients.