Physical frailty recovery is slower than mental frailty recovery after non-cardiac surgery in older adult patients.

PURPOSE: Frailty is characterized by fragility and decline in physical, mental, and social activities; it is commonly observed in older adults. No studies have reported frailty status changes between the preoperative and postoperative periods, including mental and cognitive factors. Therefore, this study investigated frailty factors, including mental and cognitive functions, that change after non-cardiac surgery in older adults. METHODS: Patients aged ≥ 75 years who underwent non-cardiac surgery were surveyed using five tools (Eastern Cooperative Oncology Group-Performance Status (PS); handgrip strengths; Japan-Cardiovascular Health Study index (J-CHS index); Mini-Mental State Examination (MMSE); and Geriatric Depression Scale) for comprehensive evaluation of perioperative functions. The results before surgery, at discharge, and during follow-up at the outpatient clinic were compared. RESULTS: Fifty-three patients with a median age of 80 (IQR, 77-84) years were evaluated. MMSE scores did not change during the perioperative period. The PS and J-CHS index worsened significantly at discharge and did not improve at the outpatient clinic follow-up. The dominant handgrip strength decreased after surgery (p < 0.001) but improved during follow-up. Additionally, nondominant handgrip strength decreased after surgery (p < 0.001) but did not recover as much as the dominant handgrip strength during follow-up (p = 0.015). CONCLUSION: Changes in physical frailty and mental and cognitive functions were not identical perioperatively in older adult patients undergoing non-cardiac surgery. Physical frailty did not improve 1 month after surgery, mental function recovered early, and cognitive function did not decline. This study may be important for frailty prevention in older adult patients.

In situ characterization of the agglutination of lectins via cross-linking of carbohydrates by time-resolved measurement of forward static light scattering.

We present real-time observations of a structurally variable process for cross-linking agglutination between multivalent lectins and glycoclusters using a small-angle forward static light scattering (F-SLS) technique. In this study, a cross-linking agglutination reaction was carried out using a tetravalent Neu5Acα2,6LacNAc-glycocluster and Sambucus sieboldiana agglutinin (SSA). The scattering intensity of time-resolved F-SLS increased with formation of the Neu5Acα2,6LacNAc-glycocluster-SSA cross-linked complex. Using this approach, fine sequential cross-linking agglutination between glycoclusters and lectins was observed in real-time. The rate of increase in the intensity of time-resolved F-SLS increased with the concentration of sialo-glycoclusters and SSA. Structural analysis based on the fractal dimension using time-resolved F-SLS patterns revealed that the density of the aggregates changed with progression of the cross-linking reaction until equilibrium was reached. This is the first report to evaluate the cross-linking agglutination reaction between glycoclusters and lectins and analysis of the subsequent structure of the obtained aggregates using time-resolved measurements of F-SLS.

Intraoperative Colonoscopy in Laparoscopic Rectal Cancer Surgery Reduces Anastomotic Leakage.

Objectives: Anastomotic leakage (AL) is the most severe complication of colorectal surgery and is a frequent cause of postoperative mortality. This study aimed to identify the risk factors for AL, including the type of air leak test (ALT) performed, in patients undergoing laparoscopic colorectal cancer surgery. Methods: This study involved a retrospective review of 201 patients who underwent elective laparoscopic procedures using circular stapled anastomosis for colorectal cancer between January 2015 and December 2020 at Kyorin University Hospital, Tokyo, Japan. In all cases, the distance from the anal verge to the anastomotic site was within 15 cm. Results: Overall, AL was observed in 16 patients (8.0%). Univariate analysis revealed that the risk factors for AL included diabetes (P = 0.068), tumor location (P = 0.049), level of anastomosis (P = 0.002), number of linear stapler firings (P = 0.007), and intraoperative colonoscopy (IOCS; P = 0.069). Multivariate analysis revealed that the level of anastomosis (P = 0.029) and IOCS (P = 0.039) were significant and independent risk factors for AL. One of the 107 patients undergoing ALT without IOCS and 3 of the 94 patients undergoing ALT with IOCS were proven to be positive for air leak. However, these four patients underwent additional suturing intraoperatively and developed no AL following surgery. Conclusions: This study identified the level of anastomosis and ALT with IOCS as predictors for AL. The results of our study indicate that ALT with IOCS may be more effective than ALT without IOCS in the diagnosis and prevention of AL.

Site-specific risk factors for local recurrence after rectal cancer surgery.

BACKGROUND: Quite few studies examined risk factors for local recurrence after rectal cancer surgery with respect to local recurrence sites. METHODS: Local recurrence sites were categorized into axial, anterior, posterior, and lateral (pelvic sidewall), and axial, anterior, and posterior type were combined as the "other" type of local recurrence. Among 76 patients enrolled into our prospective randomized controlled trial to determine the indication for pelvic autonomic nerve preservation (PANP) in patients with advanced lower rectal cancer (UMIN000021353), multivariate analyses were conducted to elucidate risk factors for either lateral or the "other" type of local recurrence. RESULTS: Univariate analyses showed that tumor distance from the anal verge was significantly (p = 0.017), and type of operation (sphincter preserving operation (SPO) vs. abdominoperineal resection (APR)) was marginally (p = 0.065) associated with pelvic sidewall recurrence. Multivariate analysis using these two parameters showed that tumor distance from the anal verge was significantly and independently correlated with pelvic sidewall recurrence (p = 0.017). As for the "other" type of local recurrence, univariate analyses showed that depth of tumor invasion (p = 0.011), radial margin status (p < 0.001), and adjuvant chemotherapy (p = 0.037) were significantly associated, and multivariate analysis using these three parameters revealed that depth of tumor invasion (p = 0.004) and radial margin status (p < 0.001) were significantly and independently correlated with the "other" type of local recurrence. CONCLUSION: Risk factors for local recurrence after rectal cancer surgery were totally different with respect to the intra-pelvic recurrent sites. Site-specific probability of local recurrence can be inferred using these risk factors. TRIAL REGISTRATION NUMBER: UMIN000021353.

Changing Patterns of Distant Metastasis in Patients With Lower Rectal Cancer Undergoing Intraoperative Radiotherapy.

BACKGROUND/AIM: Local radiotherapy for primary tumors may increase the incidence of distant metastasis. However, the patterns of target organs have not been clarified yet. PATIENTS AND METHODS: In our randomized controlled trial examining the oncological efficacy of intraoperative radiotherapy (IORT) for advanced lower rectal cancer, the details of the metastatic organs were evaluated. RESULTS: In the IORT group (38 patients), 2 patients had metastasis in the liver and lung simultaneously, 9 in the liver, and 4 in the lung. In the control group (38 patients), 3 had metastasis in the lung, and 2 in the liver. The IORT group tended to have liver metastases more frequently (p=0.058). Among patients with liver metastases, distant metastasis-free intervals were significantly shorter in the IORT group, however, no significant difference was observed among patients with lung metastases. CONCLUSION: After curative rectal cancer surgery with IORT, liver metastasis may be increased and accelerated.

[A Case Report of Sigmoid Colon Cancer with Multiple Lung Metastases Successfully Treated with S-1].

A patient in his 70s was diagnosed with sigmoid colon cancer[pT3pN1cM1(PUL1), pStage IV ]for which he underwent sigmoid colectomy and received S-1 adjuvant therapy for the lung metastases. The patient received a total of 10 courses of S- 1, administered orally on days 1-14 of a 21-day cycle. The lung metastases showed a complete response, and the patient completed the S-1 chemotherapy. No recurrence of lung metastases was detected up to 6 months later.

Emission waveguiding in organic thin films supported by metal.

On silver thin film, an organic semiconductor rubrene layer consisting of a planar waveguide exhibits spectrally narrowing photoluminescence (PL) spectra with an increasing emission angle, which are compared with those of rubrene thin films on glass. The PL spectra of rubrene on Ag have a polarization characteristic. In the side direction of the multilayer structure, spectrally very sharp PL was observed. The PL characteristics are discussed from the viewpoint of waveguided modes allowed only for a phase-matching condition. The narrowed PL spectra are attributable to generation of a leaked waveguided mode in the rubrene layer, which is supported by the underlying Ag thin film.

Method and apparatus for characterization of electric field-induced aggregation in pre-crystalline protein solutions.

The article presents a method and an apparatus for the characterization of protein aggregation under an applied internal electric field. The method is based on a forward light scattering technique that is highly sensitive to aggregates in pre-crystalline protein solutions. Transparent conductive films are used as electrodes for a planar thin sample cell, which enables precise measurement of the forward light scattering at small angles through the electrodes. Evaluation of the protein aggregation under applied electric fields was demonstrated for a model lysozyme protein. In situ measurements of crystallizing lysozyme solutions under a low applied voltage revealed that the forward static light scattering profiles changed with time into power law profiles. This indicates the formation of lysozyme fractal clusters under applied electric fields in the pre-crystalline state. The method and the apparatus presented here can sensitively evaluate the promotion process in protein crystallization under an applied electric field.

[A Case of Rectal Cancer with Multiple Liver, Lung, and Para-Aortic Lymph Node Metastases Successfully Treated with FOLFOX4 plus Bevacizumab].

A patient in his 70s was diagnosed with rectal cancer (pT3, pN1, cM0, and pStage IIIa) for which he underwent low anterior resection of the rectum and received adjuvant therapy with UFT/LV. Multiple liver, lung, and para-aortic lymph node metastases were detected after 6 months, and the patient then received a total of 24 courses of FOLFOX4 plus bevacizumab instead of UFT/LV. The liver and para-aortic lymph node metastases showed a complete response (CR), and the lung metastases markedly diminished. Therefore, the patient completed the FOLFOX4 plus bevacizumab chemotherapy regimen. After 2 years, a recurrence of the initial liver metastases was detected. A CR on radiological imaging does not correspond to a pathological CR. Therefore, a careful follow-upis required even when a CR on radiological imaging is achieved.

Changes in radiocesium contamination from Fukushima in foliar parts of 10 common tree species in Japan between 2011 and 2013.

Yearly changes in radiocesium ((137)Cs) contamination, primarily due to the Fukushima accident of March 2011, were observed in the foliar parts of 10 common woody species in Japan (Chamaecyparis obtusa, Cedrus deodara, Pinus densiflora, Cryptomeria japonica, Phyllostachys pubescens, Cinnamomum camphora, Metasequoia glyptostroboides, Prunus × yedoensis, Acer buergerianum, and Aesculus hippocastanum). The samples were obtained from Abiko (approximately 200 km SSW of the Fukushima Dai-ichi Nuclear Power Plant) during each growing season between 2011 and 2013, and the foliar parts were examined based on their year of expansion and location in each trees. The radiocesium concentrations generally decreased with time; however, the concentrations and rates of decrease varied among species, age of foliar parts, and locations. The radiocesium concentrations in the 2012 current-year foliar parts were 29%-220% of those from 2011, while those from 2013 fell to between 14% and 42% of the 2011 values. The net decontamination in the foliage was higher in evergreen species than in deciduous species. The radiocesium concentrations in the upper foliar parts were higher than those in the lower parts particularly in C. japonica. In addition, the radiocesium concentrations were higher in the current-year foliar parts than in the 1-year-old foliar parts, particularly in 2013. Thus, the influence of the direct deposition of the fallout was reduced with time, and the translocation ability of radiocesium from old to new tissues became more influential. Similar to the behavior of potassium in trees, Cs redistribution probably occurred primarily due to internal nutrient translocation mechanisms.

Emission-angle-dependent photoluminescence of rubrene thin films on silver.

Rubrene layers with thickness comparable to a visible light wavelength on silver thin film exhibit anomalous photoluminescence (PL) spectra that depend strongly on emission angle. The PL properties demonstrated for rubrene (500 nm)/Ag (50 nm) were modulated from yellow green to red luminescence with an increasing emission angle. The factors influencing the emission-angle-dependent PL spectra are discussed from two viewpoints: spectral modulation of rubrene PL by loss of fluorescence photon energy and additional luminescence resulting from optical interference in the rubrene layer or optical modes excited by rubrene molecules.

Enhanced photoluminescence spectroscopy for thin films using the attenuated total reflection method.

We present a powerful spectral photoluminescence measurement method for thin films that utilizes the enhanced absorption of the fluorescent thin films on metal thin films with attenuated total reflection (ATR). The photoluminescence measurement has the advantageous effects of avoiding transmitted light and preventing the loss of luminescence through waveguiding in the film substrates. The ATR modes excited by low-power incident light provide fluorescence intensities that are considerably larger than that of conventional photoluminescence measurements and preserve the spectral profile of the photoluminescence.

Characteristics of metal enhanced evanescent-wave microcavities.

This article presents the concept of storing optical energy using a metallic air gap microcavity. Evanescent waves are stored in the air gap of a dielectric/metal/air gap/metal planar microcavity. For an air gap with a micron scale distance between the two metals, incident light excites the optical interface modes on the two metal-air interfaces simultaneously, being accompanied by enhanced evanescent fields. Numerical simulations show that the reflected light depends remarkably upon distributions of the enhanced electric fields in the air-gap at the optical mode excitations. The metallic microcavities have a Q value on the order of 10(2), as determined from calculations. Experimentally, a small mechanical variation of the air-gap distance exhibited a change of reflectivity.

Low-refractive-index dye-aggregate films with small absorption based on anomalous dispersion.

Complex-refractive-index spectra of Squarylium (SQ) dye-aggregate films deposited upon metal films have been investigated by measurements of properties of the films including absorption spectra (AS) and attenuated total reflection. Complex refractive indices are estimated by Kramers-Kronig analysis for the AS and by a theoretical curve-fitting analysis for attenuated total reflection. The dye-aggregate films exhibited an absorption that was blueshifted from that of a monomer, as a result of the H-aggregate formation of SQ molecules, and had a changing refractive index with anomalous dispersion about the H-absorption band. From both measurements of the SQ films it was found that there is a region of low absorption in the short-wavelength side of the absorption band and that the refractive index there is lower than that of glass.

Thermal-changeable complex-refractive-index spectra of merocyanine aggregate films.

Thermal behaviors of complex refractive index of merocyanine (MC) Langmuir-Blodgett (LB) films have been investigated with absorption spectrum measurements, which are obtained from the Kramers-Kronig (K-K) analysis. The complex-refractive-index spectra with an anomalous dispersion around a J-aggregate absorption band of MC molecules are changed by annealing temperatures. This thermal characteristic is attributed to the annealing-changeable MC J-aggregates. The MC J-aggregates in the LB films collapse in the annealing and become a monomer state. The refractive-index dispersion decreased with the collapse of MC J-aggregates. These behaviors are confirmed from the reflection spectrum measurements under the different conditions of incident light to the MC film samples.