Quantitative measurement of airborne particles during endoscopic and microscopic ear surgery in the operating room

OBJECTIVE

This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy.

METHOD

In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter.

RESULTS

The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes.

CONCLUSION

Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.

Upward-directed exit-site of the swan-neck catheter and "Easy-to-disinfect the backside area of exit-site" may prevent PD complications

BACKGROUND

Upward-directed exit-site has been believed to be the worst for frequent ESI by an old retrospective study using straight catheters. No comparison study of 3 exit-site directions using swan-neck catheter has been performed regarding which direction is the best for our endpoints, Easy-to-see the backside area of exit-site: ESBE, Easy-to-disinfect the backside area of exit-site: EDBE, reduction of both exit-site infection (ESI), symptomatic catheter dislocation and peritonitis.

METHODS

We assessed the relationship of exit-site direction with our endpoints in a quantitative cross-sectional, multicentered questionnaire survey. Patients who received either non-surgical catheter implantation or exit-site surgery were excluded.

RESULTS

The numbers (percentage) of exit-site directions in included 291 patients were upward 79 (26.0), lateralward 108 (37.5) and downward 105 (36.5). Cochran-Armitage analysis showed a significant step-ladder increase in the prevalence of ESI as the direction changed from upward to lateralward to downward (0.15 ± 0.41, 0.25 ± 0.54, 0.38 ± 0.69 episodes/patient-year, p = 0.03). Multivariable regression analysis revealed the upward exit-site independently associates with both higher frequency of ESBE (OR 5.55, 95% CI 2.23-16.45, p < 0.01) and reduction of prevalence of ESI (OR 0.55, 95%CI 0.27-0.98, p = 0.04). Positive association between the prevalence of symptomatic catheter dislocation and ESI (OR 2.84, 95% CI 1.27-7.82, p = 0.01), and inverse association between EDBE and either prevalence of symptomatic catheter dislocation (OR 0.27, 95% CI 0.11-0.72) or peritonitis (OR 0.48, 95% CI 0.23-0.99) observed.

CONCLUSION

Upward-directed swan-neck catheter exit-site may be the best for both ESBE and prevention of ESI. EDBE may reduce catheter dislocation and peritonitis. Symptomatic catheter dislocation may predict ESI.

Prevention of atopic dermatitis in high-risk neonates via different types of moisturizer application: A randomized, blinded, parallel, three-group, phase II trial (PAF study)

BACKGROUND

The effectiveness of moisturizers in preventing infant atopic dermatitis (AD) remains unclear. We previously showed that using 2e moisturizer of commercial moisturizer (Shiseido Japan Co., Ltd.) at least once a day significantly prevented AD in infants as compared with as-needed petroleum jelly. This trial aimed to determine the effectiveness of twice- or once-daily application of Fam's Baby moisturizer (Fam's Inc.) in preventing AD compared with once-daily 2e moisturizer.

METHODS

This trial was a single-centre, three-parallel-group, assessor-blinded, superiority, individually randomized, controlled, phase II trial that was conducted from 25 August 2020 to 28 September 2021. We randomly assigned 60 newborns with at least one parent or sibling who has AD to receive Fam's Baby moisturizer twice daily (Group A) or once daily (Group B), or 2e once daily (Group C) in a 1:1:1 ratio until they were 32 weeks old. The primary outcome was the time of AD onset.

RESULTS

Atopic dermatitis was observed in 11/20 (55%), 5/20 (25%) and 10/20 (50%), infants in Groups A, B and C, respectively. Cumulative incidence values for AD according to the Kaplan-Meier method showed that infants in Group B tended to maintain an intact skin for a longer period than those in Group C (median time, not reached [NR] vs. 212 days, log-rank test, p = 0.064). Cox regression analysis showed that the risk of AD tended to be lower in Group B (hazard ratio with group C as control, 0.36; 95% confidential intervals: 0.12-1.06). No serious adverse events occurred in any of the enrolled infants.

CONCLUSION

Fam's Baby moisturizer may better prevent AD than 2e. Further large-scale trials should be performed to confirm the efficacy of Fam's Baby moisturizer in preventing AD in infants.

Active flare of IgA nephropathy during long-term therapy with anti-tumor necrosis factor-α antibody drugs for Crohn's disease: three case reports and literature review

In recent years, increasing numbers of reports have described new onset or active disease flare of IgA nephropathy (IgAN) during administration of TNF-α inhibitor (TNFi) therapy for chronic inflammatory diseases. Crohn's disease (CD) is the most common indication for TNFi therapy in this clinical setting, but the underlying etiology of IgAN in such patients remains unclear. We report our experience with three patients who developed acute worsening of preexisting urinalysis abnormalities and kidney dysfunction approximately 2 to 6 years after TNFi administration for CD. Kidney biopsies at the time of kidney disease flare revealed IgAN in two patients and IgAN complicated by acute tubulointerstitial nephritis in one patient. The CD and IgAN in all three patients were successfully managed with additional corticosteroid therapy and tonsillectomy without discontinuing TNFi therapy. The clinical course of our patients and similar patients described in the literature suggests that TNFi therapy for CD is associated with a relatively high risk for new onset or disease flare of IgAN. This report discusses the possible involvement of Th1/Th2 imbalance on the immunological background of CD or IgAN.

Fast-sampling fast-ion D-alpha measurement using multi-anode photomultiplier tube in large helical device

A fast-sampling fast-ion D-alpha (F-FIDA) measurement has been developed in the large helical device in order to investigate fast ion dynamics associated with helically trapped fast-ion-driven Magnetohydrodynamic (MHD) bursts. F-FIDA consists of a multi-anode photomultiplier tube (PMT) and achieves a sampling rate of 10 kHz. During the deuterium experiment campaign in 2022, F-FIDA measured the spectrum of perpendicular fast ions, using perpendicular lines of sight. We compared F-FIDA with conventional FIDA, using an electron multiplying charge coupled device, and confirmed that the time-averaged images were generally consistent between the two. The statistical properties of the temporal evolution associated with MHD bursts were analyzed using a conditional sampling technique. The results showed that the PMT signal varied in different spatial and wavelength channels. Although the signal-to-noise ratio was poor and there was room for improvement, it could provide useful information for studies on the phase-space dynamics of fast ions.

Optimization of a fast deuterium diagnostic method based on visible energetic 3He spectroscopy for high electron density plasmas

Fast ions play a crucial role in plasma heating, and their behavior in the plasma must be accurately understood. A diagnostics method based on charge exchange emission from the n = 4 - 3 transition (λ0 = 468.6 nm) of energetic 3He produced by the deuteron-deuteron reaction has been proposed as a for fast deuterons with energies in the order of MeV. The proposed method has the following advantages: No beam emission interferes with the spectra, the direction of the measuring line of sight, and the injection angle of the diagnostic beam can be freely determined. In previous studies, due to competing bremsstrahlung, it was expected that the proposed method will not be practical in the case of high electron density operation. This paper makes the proposed method available for measurement even at high electron densities by optimizing the measurement line of sight direction and the diagnostic beam incidence angle. This allows an electron density five times larger than the range of applications shown in previous studies. This result will contribute to measure of DT alpha in ITER.

Formation and evolution of carbonaceous asteroid Ryugu: Direct evidence from returned samples

Samples of the carbonaceous asteroid Ryugu were brought to Earth by the Hayabusa2 spacecraft. We analyzed 17 Ryugu samples measuring 1 to 8 millimeters. Carbon dioxide-bearing water inclusions are present within a pyrrhotite crystal, indicating that Ryugu's parent asteroid formed in the outer Solar System. The samples contain low abundances of materials that formed at high temperatures, such as chondrules and calcium- and aluminum-rich inclusions. The samples are rich in phyllosilicates and carbonates, which formed through aqueous alteration reactions at low temperature, high pH, and water/rock ratios of <1 (by mass). Less altered fragments contain olivine, pyroxene, amorphous silicates, calcite, and phosphide. Numerical simulations, based on the mineralogical and physical properties of the samples, indicate that Ryugu's parent body formed ~2 million years after the beginning of Solar System formation.

Impact of the Comprehensive Awareness Modification of Mouth, Chewing and Meal (CAMCAM) Program on the Attitude and Behavior Towards Oral Health and Eating Habits as Well as the Condition of Oral Frailty: A Pilot Study

OBJECTIVES

Preserving sufficient oral function and maintaining aadequate nutrition are essential for preventing physical frailty and the following long-term care. We recently developed the 6-month Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program, in which participants gather monthly to learn about oral health and nutrition while eating a textured lunch together. This study examined whether the CAMCAM program could improve attitude and behavior towards oral health, mastication, and diet as well as ameliorate oral frailty in community-dwelling older adults.

DESIGN

Single-arm pre-post comparison study.

SETTING AND PARTICIPANTS

A total of 271 community-dwelling adults (72.3 ± 5.7 years of age; 159 women [58.7%]) in 4 Japanese municipalities were recruited, of which 249 participants (92%) were assessed at the final evaluation.

INTERVENTION

Participants gathered once a month at community centers to learn about oral health and nutrition while eating a "munchy" textured lunch containing proper nutrition.

MEASUREMENTS

Oral frailty, frailty, and eating behavior were evaluated with the Oral Frailty Index-8 (OFI-8), Kihon checklist (KCL), and CAMCAM checklist, respectively. Participants were divided into Oral frailty (OF) and Robust groups according to OFI-8 scores. The differences in KCL and CAMCAM checklist results between the OF and Robust groups were statistically tested along with changes in scores after the program.

RESULTS

KCL and CAMCAM checklist scores were significantly lower in the OF group at the initial assessment. OFI-8 and KCL findings were significantly improved in the OF group after completing the program (all P <0.05). Regarding the CAMCAM checklist, awareness of chewing improved significantly in the Robust group (P=0.009), with a similar tendency in the OF group (P=0.080).

CONCLUSION

The findings of this pilot study suggest that the CAMCAM program may improve both oral and systemic frailty in addition to attitudes towards chewing, oral health, and meals, especially in individuals with oral frailty. The CAMCAM program merits expansion as a community-based frailty prevention program.

Persistent SARS-CoV-2 Infection in a Patient with Nephrotic Syndrome under Rituximab Therapy: Successful Treatment with a Combination of Remdesivir and Monoclonal Antibodies

Rituximab is an effective treatment for frequently relapsing/steroid-dependent nephrotic syndrome, but there is concern about infections caused by humoral immunodeficiency. We herein report a case of prolonged (>7 weeks) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old man with minimal change disease treated with rituximab developed SARS-CoV-2 infection. The clinical response to remdesivir was soon transiently abolished. Treatment with casirivimab and imdevimab (REGEN-COV) monoclonal antibodies in combination with remdesivir resulted in complete clearance of the infection. The REGEN-COV antibody cocktail may improve the outcome of SARS-CoV-2 infection in patients with humoral immunodeficiency.

Initial operation of perpendicular line-of-sight compact neutron emission spectrometer in the large helical device

The perpendicular line-of-sight compact neutron emission spectrometer (perpendicular CNES) was newly installed to understand the helically trapped fast-ion behavior through deuterium-deuterium (D-D) neutron energy spectrum measurement in the Large Helical Device (LHD). The energy calibration of the EJ-301 liquid scintillation detector system for perpendicular CNES was performed on an accelerator-based D-D neutron source. We installed two EJ-301 liquid scintillation detectors, which view the LHD plasma vertically from the lower side through the multichannel collimator. The D-D neutron energy spectrum was measured in a deuterium perpendicular-neutral-beam-heated deuterium plasma. By the derivative unfolding technique, it was found that the D-D neutron energy spectrum had a double-humped shape with peaks at ∼2.33 and ∼2.65 MeV. D-D neutron energy spectrum was calculated based on the fast ion distribution function using guiding center orbit-following models considering the detector's energy resolution. The calculated peak energies in the D-D neutron energy spectrum almost match the experiment. In addition, a feasibility study toward the measurement of the energy distribution of ion-cyclotron-range-of-frequency-wave-accelerated beam ions was performed.

Pebbles and sand on asteroid (162173) Ryugu: In situ observation and particles returned to Earth

The Hayabusa2 spacecraft investigated the C-type (carbonaceous) asteroid (162173) Ryugu. The mission performed two landing operations to collect samples of surface and subsurface material, the latter exposed by an artificial impact. We present images of the second touchdown site, finding that ejecta from the impact crater was present at the sample location. Surface pebbles at both landing sites show morphological variations ranging from rugged to smooth, similar to Ryugu's boulders, and shapes from quasi-spherical to flattened. The samples were returned to Earth on 6 December 2020. We describe the morphology of >5 grams of returned pebbles and sand. Their diverse color, shape, and structure are consistent with the observed materials of Ryugu; we conclude that they are a representative sample of the asteroid.

Search for a Light Higgs Boson in Single-Photon Decays of ϒ(1S) Using ϒ(2S)→π^{+}π^{-}ϒ(1S) Tagging Method

We search for a light Higgs boson (A^{0}) decaying into a τ^{+}τ^{-} or μ^{+}μ^{-} pair in the radiative decays of ϒ(1S). The production of ϒ(1S) mesons is tagged by ϒ(2S)→π^{+}π^{-}ϒ(1S) transitions, using 158×10^{6} ϒ(2S) events accumulated with the Belle detector at the KEKB asymmetric energy electron-positron collider. No significant A^{0} signals in the mass range from the τ^{+}τ^{-} or μ^{+}μ^{-} threshold to 9.2  GeV/c^{2} are observed. We set the upper limits at 90% credibility level (C.L.) on the product branching fractions for ϒ(1S)→γA^{0} and A^{0}→τ^{+}τ^{-} varying from 3.8×10^{-6} to 1.5×10^{-4}. Our results represent an approximately twofold improvement on the current world best upper limits for the ϒ(1S)→γA^{0}(→τ^{+}τ^{-}) production. For A^{0}→μ^{+}μ^{-}, the upper limits on the product branching fractions for ϒ(1S)→γA^{0} and A^{0}→μ^{+}μ^{-} are at the same level as the world average limits, and vary from 3.1×10^{-7} to 1.6×10^{-5}. The upper limits at 90% credibility level on the Yukawa coupling f_{ϒ(1S)} and mixing angle sinθ_{A^{0}} are also given.

Cardiac metastasis after esophagogastrectomy for esophageal adenocarcinoma with an antemortem diagnosis

Cardiac metastasis is uncommon and rarely diagnosed antemortem. Here, we describe a case of symptomatic cardiac metastasis from esophageal adenocarcinoma. A 64-year-old man developed chest symptoms 26 months after curative esophagogastrectomy for esophageal adenocarcinoma. Initially, ischemic cardiac disease was suspected based on electrocardiography findings, but an infiltrative tumor was seen morphologically in the wall of the interventricular septum and apex. No other lesions were detected. Histological examination of a transcatheter biopsy specimen indicated that the cardiac tumor was metastasis from esophageal adenocarcinoma. Chemoradiotherapy with cisplatin relieved his symptoms, and he had resumed normal activities. However, he opted not to undergo further aggressive treatment due to severe adverse effects from cisplatin. Seventeen months after completion of chemoradiotherapy, metastases to the right ventricle and the left thighbone were detected and he died 27 and 24 months after the diagnosis of cardiac metastasis and completion of chemoradiotherapy, respectively.

Fast deuteron diagnostics using visible light spectra of 3He produced by deuteron-deuteron reaction in deuterium plasmas

The fast deuteron (non-Maxwellian component) diagnostic method, which is based on the higher resolution optical spectroscopic measurement, has been developed as a powerful tool. Owing to a decrease in the D-H charge-exchange cross section, the diagnostic ability of conventional optical diagnostic methods should be improved for ∼MeV energy deuterons. Because the ³He-H charge-exchange cross section is much larger than that of D-H in the ∼MeV energy range, the visible light (VIS) spectrum of ³He produced by the dueteron-dueteron (DD) reaction may be a useful tool. Although the density of ³He is small because it is produced via the DD reaction, improvement of the emissivity of the VIS spectrum of ³He can be expected by using a high-energy beam. We evaluate the VIS spectrum of ³He for the cases when a fast deuteron tail is formed and not formed in the ITER-like beam injected deuterium plasma. Even when the beam energy is in the MeV energy range, a large change appears in the half width at half maximum of the VIS spectrum. The emissivity of the VIS spectrum of ³He and the emissivity of bremsstrahlung are compared, and the measurable VIS spectrum is obtained. It is shown that the VIS spectrum of ³He is a useful tool for the MeV beam deuteron tail diagnostics.

Test of Lepton-Flavor Universality in B→K^{*}ℓ^{+}ℓ^{-} Decays at Belle

We present a measurement of R_{K^{*}}, the branching fraction ratio B(B→K^{*}μ^{+}μ^{-})/B(B→K^{*}e^{+}e^{-}), for both charged and neutral B mesons. The ratio for the charged case R_{K^{*+}} is the first measurement ever performed. In addition, we report absolute branching fractions for the individual modes in bins of the squared dilepton invariant mass q^{2}. The analysis is based on a data sample of 711  fb^{-1}, containing 772×10^{6}  BB[over ¯] events, recorded at the ϒ(4S) resonance with the Belle detector at the KEKB asymmetric-energy e^{+}e^{-} collider. The obtained results are consistent with standard model expectations.

Evidence for X(3872)→J/ψπ^{+}π^{-} Produced in Single-Tag Two-Photon Interactions

We report the first evidence for X(3872) production in two-photon interactions by tagging either the electron or the positron in the final state, exploring the highly virtual photon region. The search is performed in e^{+}e^{-}→e^{+}e^{-}J/ψπ^{+}π^{-}, using 825  fb^{-1} of data collected by the Belle detector operated at the KEKB e^{+}e^{-} collider. We observe three X(3872) candidates, where the expected background is 0.11±0.10 events, with a significance of 3.2σ. We obtain an estimated value for Γ[over ˜]_{γγ}B(X(3872)→J/ψπ^{+}π^{-}) assuming the Q^{2} dependence predicted by a cc[over ¯] meson model, where -Q^{2} is the invariant mass squared of the virtual photon. No X(3915)→J/ψπ^{+}π^{-} candidates are found.

Surgical treatment of otosclerosis using a unique stapes prosthesis without a hook

BACKGROUND

During stapes surgery, the Teflon wire piston prosthesis is prone to postoperative 'slips' and subsequent necrosis and fracture of the long process of the incus.

AIMS/OBJECTIVE

We invented and used a novel cup-shaped apatite prosthesis to reduce the incidence of necrosis of the long process of the incus and analysed the postoperative results.

MATERIAL AND METHODS

Thirty-one ears in 25 patients with otosclerosis who underwent stapes surgery with our apatite prosthesis were evaluated.

RESULTS

The air conduction improved by 24.0 dB (the average) from pre- to post-operation. Additionally, 84.8% of patients achieved an air-bone gap of ≤10 dB for the 4-frequency measurements (p < .01).

CONCLUSIONS

Our findings indicate that our new prosthesis was associated with a good postoperative prognosis in patients with otosclerosis.

SIGNIFICANCE

Our unique prosthesis yielded good outcomes for the treatment of otosclerosis even in the short term.

The efficacy and safety of a novel method of peritoneal dialysis catheter insertion from the McBurney point

Background

Catheter dysfunction, especially omental wrapping, is a serious complication of peritoneal dialysis (PD). Although catheter implantation at a lower site was reported to prevent omental wrapping, this method could induce insufficient drainage of the PD solution and cause pain or a persistent desire to defecate, when the intraperitoneal catheter is of insufficient length or when its tip is in direct contact with the pelvic floor, respectively. The aim of this study was to assess the efficacy and safety of a novel PD catheter insertion method of approaching from the McBurney point, from the outer side of the abdomen.

Methods

This retrospective study included 23 patients with end-stage renal disease who were started on PD from January 2017 to July 2018 at Ashikaga Red Cross Hospital, Tochigi, Japan. Among them, 16 patients underwent a PD catheter insertion using a conventional method, whereas 7 patients underwent a novel method of approaching from the McBurney point. Infectious and mechanical complications were evaluated until August 2020.

Results

There were 18 men and 5 women, with a mean age of 63.1 ± 13.6 years. All patients were followed up postoperatively for a mean duration of 27.2 ± 13.4 months. No patient experienced omental wrapping, insufficient drainage of the PD solution, and pain or persistent desire to defecate in both groups. Both the incidence of infectious and mechanical complications (times per patient-year) were not statistically different between patients undergoing a conventional and a novel PD catheter insertion (0.18 vs. 0.24; p = 0.79 and 0.03 vs. 0.16; p = 0.16, respectively).

Conclusions

This novel method of PD catheter insertion from the McBurney point was safe, caused less discomfort, and was effective in preventing catheter dysfunction.

Conceptual design of a collimator for the neutron emission profile monitor in JT-60SA using Monte Carlo simulations

Materials and structures of a collimator for a new neutron emission profile monitor in JT-60SA are examined through Monte Carlo simulations using the Monte Carlo N-Particle transport code. First, the shielding properties of various material combinations are compared in order to determine a combination with high shielding performances against both neutrons and gamma-rays. It is found that a collimator consisting of borated polyethylene and lead has a high shielding performance against neutrons. Moreover, a high shielding performance against gamma-rays is obtained when a lead pipe with a radial thickness of 0.01 m is inserted into a collimation tube. Second, we demonstrate that it is possible to improve the spatial resolution to a desired level by installing a thin tubular extension structure that fits into the limited space available between the main collimator block and the tokamak device. Finally, the collimator structures that meet both the targeted spatial resolutions (<10% of the plasma minor radius) and the targeted counting rate (10⁵ cps order) are discussed.

Neutron-induced signal on the single crystal chemical vapor deposition diamond-based neutral particle analyzer

A diamond-based neutral particle analyzer (DNPA) array composed of single-crystal chemical vapor deposition (sCVD) diamond detectors was installed on the Large Helical Device (LHD) for measuring the helically trapped energetic particles. In high neutron flux experiments, the unwanted neutron-induced pulse counting rate should be estimated using the neutron diagnostics because a diamond detector is sensitive to neutrons as well as energetic neutral particles. In order to evaluate the quantitative neutron-induced pulse counting rate on the DNPA, the response functions of the sCVD diamond detector for mono-energetic neutrons were obtained using accelerator-based D-D and D-⁷Li neutron sources in Fast Neutron Laboratory (FNL). As a result of the neutron flux estimation by the Monte Carlo N-Particle code at the NPA position in the LHD and the response function obtained in the FNL experiment, the counting rate of the neutron-induced signal was predicted to be 1.1 kcps for the source neutron emission rate of S_n = 1 × 10¹⁵ n/s. In the LHD experiment, the neutron-induced signals were observed by closing the gate valve during the plasma discharges. It is found that the counting rates of the neutron-induced signals proportional to S_n reached 1.1 kcps at S_n = 1 × 10¹⁵ n/s. As a result of the quantitative estimation of the neutron-induced signals on the DNPA using other neutron measurements, it has become possible to accurately measure energetic neutral particles in the high neutron flux experiment.

Search for Axionlike Particles Produced in e^{+}e^{-} Collisions at Belle II

We present a search for the direct production of a light pseudoscalar a decaying into two photons with the Belle II detector at the SuperKEKB collider. We search for the process e^{+}e^{-}→γa, a→γγ in the mass range 0.2<m_{a}<9.7  GeV/c^{2} using data corresponding to an integrated luminosity of (445±3)  pb^{-1}. Light pseudoscalars interacting predominantly with standard model gauge bosons (so-called axionlike particles or ALPs) are frequently postulated in extensions of the standard model. We find no evidence for ALPs and set 95% confidence level upper limits on the coupling strength g_{aγγ} of ALPs to photons at the level of 10^{-3}  GeV^{-1}. The limits are the most restrictive to date for 0.2<m_{a}<1  GeV/c^{2}.

Performance of the newly installed vertical neutron cameras for low neutron yield discharges in the Large Helical Device

Two new vertical neutron cameras characterized by high detection efficiency were developed on the Large Helical Device in order to observe poloidal structures of helically trapped beam ions created by the perpendicularly injected positive-ion based neutral beam (P-NB) and are newly operated since 2018. In this work, the neutron fields at the vertical neutron cameras are investigated using the Monte Carlo N-particle transport code to evaluate the performance of its collimators. The results indicate that neutrons are attenuated by the heavy concrete and are well collimated through the collimator to detectors. Neutron spectra at the detector position show over 99% of uncollided 2.45 MeV neutrons. Time evolution of neutron emission profiles during the short pulse of P-NB injection is measured by the vertical neutron cameras. Peaks on the neutron emission profiles corresponding to the helically trapped beam ion are successfully obtained, as designed. The decrease in line integrated neutron flux at the peak positions after the P-NB stops is consistent with the behavior of the total neutron emission rate measured by the neutron flux monitor.

Reduced induction of human β-defensins is involved in the pathological mechanism of cutaneous adverse effects caused by epidermal growth factor receptor monoclonal antibodies

Epidermal growth factor receptor inhibitors (EGFRIs) frequently cause cutaneous adverse effects such as papulopustular eruptions. However, the mechanism of the reactions remains unclear. To assess the pathological mechanism of cutaneous adverse reactions caused by EGFRIs, we investigated whether EGFRIs have an influence on the innate immune response of the skin. Levels of human β-defensins (hBDs), which serve as the first line of defence against infection by pathogenic microorganisms, in the stratum corneum samples of patients treated with EGFR. monoclonal antibodies were measured before and after starting therapy. There were no obvious trends in hBD production in patients without eruptions, whereas a significant decrease in hBD1 and hBD3 production and a nonsignficant decrease in hBD2 production were observed in patients who developed papulopustular eruptions. Our results suggest that a reduction in hBD contributes to the increased incidence of papulopustular eruptions.

P0814NEW STRATEGIES TO DECREASE THE ANNUAL RATE OF DIALYSIS INITIATIONS AT A HOSPITAL IN CENTRAL TOKYO

Background and Aims

The Japanese Government and the Japanese Society of Nephrology (JSN) have enacted measures against chronic kidney disease (CKD) since 2008. Since then, the number of age-adjusted dialysis initiations has decreased. However, the absolute number has not decreased due to aging of the population. In response, the Japanese Government launched new CKD measures in 2018, with a focus on earlier intervention by nephrologists, utilizing referral criteria from family doctors to nephrologists. The primary goal of the new measures is to decrease the annual number of dialysis initiations nationwide by 10% by 2028. The Japan Kidney Association (JKA), also established in 2018, has appointed representatives in each prefecture to work on CKD measures according to the local requirements in cooperation with the Government, family doctors, and organizations. The large number of family doctors and medical examinations facilities that refer to the hospital in central Tokyo lead to difficulty determining the referral criteria that is used. Therefore, the aim of this study is to formulate new CKD measures in our hospital as one of the JKA representatives of Tokyo.

Method

A retrospective survey of medical history was conducted for 104 patients who initiated hemodialysis or peritoneal dialysis at our hospital in 2018. These patients represent approximately 3% of the total number of dialysis initiations in Tokyo, with 33 patients originating from outside Tokyo prefecture. Of the 104 patients, 80 were male with an average age 65.9 years. The primary disease of patients was comprised of 30 with diabetic nephropathy, 25 with renal sclerosis, 16 with chronic glomerulonephritis, 4 with polycystic kidney disease, and 29 from other or unknown diseases.

Results

Of the 86 patients whose information was confirmed, 45 patients were referred to nephrologists from 15 departments in our hospital, including 12 from diabetic departments, 7 from urology departments, 4 from cardiovascular departments, 3 from the emergency department, oncology department, and neurology department, and 11 from various other departments. The remaining 41 patients were from outside our hospital (30 from family doctors and 11 from medical examination facilities). Of the 57 patients whose eGFR was confirmed at referral, 21 were referred with eGFR&lt;15, 27 at 15≦eGFR&lt;30, and only 9 were referred at eGFR≧30. Criteria of eGFR&lt;45 or proteinuria≧1+ or 0.5g/gCr is recommended in the 2018 Evidence-based Clinical Practice Guideline for CKD by the JSN.

Conclusion

According to the medical history of 104 patients who initiated dialysis at our hospital in 2018, the timing of referral to nephrologists was often later than recommended. Patients were referred to nephrologists from at least 15 departments in our hospital. Therefore, it is important for the referral criteria to be widely disseminated not only among family doctors but also among hospital departments and medical examination facilities. Specifically, in-hospital referrals are considered to be less burdensome for patients than out-of-hospital referrals and are therefore expected to be first-targets for new strategies. In addition, in recent years, the frequency of measurement of sCr and eGFR has increased in medical examinations, where the dissemination of referral criteria becomes even more important. Furthermore, the JSN and the JKA have committed to develop medical staff, including nurses/public health nurses, registered dietitians, and pharmacists, to be certified kidney disease educators who have basic knowledge of CKD. Since these occupations can intervene before referral to nephrologists, they are expected to have a significant effect on CKD measures.

Measurement of R(D) and R(D^{*}) with a Semileptonic Tagging Method

The experimental results on the ratios of branching fractions R(D)=B(B[over ¯]→Dτ^{-}ν[over ¯]_{τ})/B(B[over ¯]→Dℓ^{-}ν[over ¯]_{ℓ}) and R(D^{*})=B(B[over ¯]→D^{*}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]→D^{*}ℓ^{-}ν[over ¯]_{ℓ}), where ℓ denotes an electron or a muon, show a long-standing discrepancy with the standard model predictions, and might hint at a violation of lepton flavor universality. We report a new simultaneous measurement of R(D) and R(D^{*}), based on a data sample containing 772×10^{6}  BB[over ¯] events recorded at the ϒ(4S) resonance with the Belle detector at the KEKB e^{+}e^{-} collider. In this analysis the tag-side B meson is reconstructed in a semileptonic decay mode and the signal-side τ is reconstructed in a purely leptonic decay. The measured values are R(D)=0.307±0.037±0.016 and R(D^{*})=0.283±0.018±0.014, where the first uncertainties are statistical and the second are systematic. These results are in agreement with the standard model predictions within 0.2, 1.1, and 0.8 standard deviations for R(D), R(D^{*}), and their combination, respectively. This work constitutes the most precise measurements of R(D) and R(D^{*}) performed to date as well as the first result for R(D) based on a semileptonic tagging method.

Search for an Invisibly Decaying Z^{'} Boson at Belle II in e^{+}e^{-}→μ^{+}μ^{-}(e^{±}μ^{∓}) Plus Missing Energy Final States

Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→μ^{+}μ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}μ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{μ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6  GeV/c^{2}.

An artificial impact on the asteroid (162173) Ryugu formed a crater in the gravity-dominated regime

The Hayabusa2 spacecraft investigated the small asteroid Ryugu, which has a rubble-pile structure. We describe an impact experiment on Ryugu using Hayabusa2's Small Carry-on Impactor. The impact produced an artificial crater with a diameter >10 meters, which has a semicircular shape, an elevated rim, and a central pit. Images of the impact and resulting ejecta were recorded by the Deployable CAMera 3 for >8 minutes, showing the growth of an ejecta curtain (the outer edge of the ejecta) and deposition of ejecta onto the surface. The ejecta curtain was asymmetric and heterogeneous and it never fully detached from the surface. The crater formed in the gravity-dominated regime; in other words, crater growth was limited by gravity not surface strength. We discuss implications for Ryugu's surface age.

P5697J-wave elevation in the inferior leads is a predictor of lethal ventricular arrhythmia initiated by premature ventricular contractions with right bundle branch block and superior axis

Background

Lethal-ventricular-arrhythmia (VA) could be sometimes initiated by idiopathic Premature Ventricular Contractions (PVCs) originated form inferior wall. Furthermore, J-wave elevation in inferior leads was sometimes associated with lethal-VA. However, it was unclear the relationship between these PVCs and J-wave elevation in patients with lethal-VA.

Purpose

The aim of this study was to investigate the relationship between PVCs and J-wave elevation.

Methods and results

We studied 32 patients who underwent radiofrequency (RF) ablation of idiopathic PVCs with RBBB and superior axis. These PVCs were originating from inferior wall of left ventricular. Lethal-VA was defined as ventricular fibrillation (VF) or ventricular tachycardia (VT) with loss of consciousness (LOC). Among 32 patients, 3 had VF and 2 had VT with LOC. Other 27 had non-lethal-VA. Baseline clinical characteristics were not significantly difference between lethal and non-lethal-VA. The ratio of J-wave elevation in lethal-VA was significant higher as compared to those with non-lethal-VA (5/5 (100%) vs. 3/27 (11.1%), p<0.0001). Furthermore, no patients had recurrence of lethal-VA with J wave elevation in inferior leads after RF ablation of these PVCs with RBBB and superior axis,

Conclusions

We speculated that J-wave elevation in inferior leads might be a predictor of lethal-VA initiated by PVCs with RBBB and superior axis. RF ablation of these PVCs were useful method of treating lethal-VA.

Acknowledgement/Funding

None

Room-Temperature Low-Field Colossal Magnetoresistance in Double-Perovskite Manganite

We have discovered room-temperature low-field colossal magnetoresistance (CMR) in an A-site ordered NdBaMn_{2}O_{6} crystal. The resistance changes more than 2 orders of magnitude at a magnetic field lower than 2 T near 300 K. When the temperature and magnetic field sweep from an insulating (metallic) phase to a metallic (insulating) phase, the insulating (metallic) conduction changes to the metallic (insulating) conduction within 1 K and 0.5 T, respectively. The CMR is ascribed to the melting of the charge and orbital ordering. The entropy change which is estimated from the B-T phase diagram is smaller than what is expected for the charge and orbital ordering. The suppression of the entropy change is attributable to the loss of the short-range ferromagnetic fluctuation of Mn spin moments, which is an important key of the high temperature and low magnetic field CMR effect.