Changes in enamel hardness, wear resistance, surface texture, and surface crystal structure with glass ionomer cement containing BioUnion fillers

This study investigated the potential of BioUnion filler containing glass ionomer cement (GIC) to enhance the properties of enamel surrounding restorations, with a specific focus on the effect on hardness. The hardness of the bovine enamel immersed in the cement was measured using Vickers hardness numbers. Following sliding and impact wear simulations, the enamel facets were examined using confocal-laser-scanning microscopy and scanning-electron microscopy. Surface properties were further analyzed using energy-dispersive X-ray spectroscopy and X-ray diffraction (XRD). A significant increase in Vickers hardness numbers was observed in the BioUnion filler GIC after 2 days. Furthermore, the mean depth of enamel facets treated with BioUnion filler GIC was significantly less than that of untreated facets. Characteristic XRD peaks indicating the presence of hydroxyapatite were also observed. Our findings imply that GIC with BioUnion fillers enhances the mechanical properties of the tooth surface adjacent to the cement.

Association of gut microbiome with COPD in Japanese male residents: the SESSA study

Background

Altered gut microbiota may contribute to COPD development or progression. Herein, we investigated the association of gut microorganisms with COPD, taking into account the impact of smoking status.

Methods

This cross-sectional observational study was a part of the Shiga Epidemiological Study of Subclinical Atherosclerosis, a population-based cohort study of Japanese men aged 46-76 years, conducted from 2010 to 2016. The gut microbiome, determined using 16S rRNA gene sequencing, was compared among 99 never-smokers, 306 non-COPD ever-smokers and 76 patients with COPD while adjusting for age, body mass index, ethanol consumption and treatment for type 2 diabetes mellitus.

Results

The abundance of phylum Firmicutes was comparable between patients with COPD and non-COPD ever-smokers but tended to be higher in never-smokers. Similarly, the α- and β-diversity analysis showed similarity between patients with COPD and non-COPD ever-smokers, which tended to differ from never-smokers. Discriminant analysis identified the genus [Prevotella] to be more prevalent in patients with COPD than in never-smokers or non-COPD ever-smokers. Post hoc analysis confirmed similarity of gut microbiome between COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) I and non-COPD ever-smokers, which was different from GOLD II.

Conclusion

Smoking may alter the overall gut microbial composition, but gut microbial composition itself may not play a role in the development of COPD. Rather, specific gut bacteria, such as [Prevotella], could be a risk factor for the development of COPD; this may be a potential therapeutic target.

Erratum: Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande [Phys. Rev. Lett. 130, 031802 (2023)]

This corrects the article DOI: 10.1103/PhysRevLett.130.031802.

Measurements of neutrino oscillation parameters from the T2K experiment using 3.6×1021 protons on target

The T2K experiment presents new measurements of neutrino oscillation parameters using 19.7 ( 16.3 ) × 10 20 protons on target (POT) in (anti-)neutrino mode at the far detector (FD). Compared to the previous analysis, an additional 4.7 × 10 20 POT neutrino data was collected at the FD. Significant improvements were made to the analysis methodology, with the near-detector analysis introducing new selections and using more than double the data. Additionally, this is the first T2K oscillation analysis to use NA61/SHINE data on a replica of the T2K target to tune the neutrino flux model, and the neutrino interaction model was improved to include new nuclear effects and calculations. Frequentist and Bayesian analyses are presented, including results on sin 2 θ 13 and the impact of priors on the δ CP measurement. Both analyses prefer the normal mass ordering and upper octant of sin 2 θ 23 with a nearly maximally CP-violating phase. Assuming the normal ordering and using the constraint on sin 2 θ 13 from reactors, sin 2 θ 23 = 0 . 561 - 0.032 + 0.021 using Feldman-Cousins corrected intervals, and Δ m 32 2 = 2 . 494 - 0.058 + 0.041 × 10 - 3 eV 2 using constant Δ χ 2 intervals. The CP-violating phase is constrained to δ CP = - 1 . 97 - 0.70 + 0.97 using Feldman-Cousins corrected intervals, and δ CP = 0 , π is excluded at more than 90% confidence level. A Jarlskog invariant of zero is excluded at more than 2 σ credible level using a flat prior in δ CP , and just below 2 σ using a flat prior in sin δ CP . When the external constraint on sin 2 θ 13 is removed, sin 2 θ 13 = 28 . 0 - 6.5 + 2.8 × 10 - 3 , in agreement with measurements from reactor experiments. These results are consistent with previous T2K analyses.

Predictors of longitudinal changes in body weight, muscle and fat in patients with and ever-smokers at risk of COPD

BACKGROUND AND OBJECTIVE

Weight and muscle loss are predictors of poor outcomes in chronic obstructive pulmonary disease. However, to our knowledge, no study has investigated the predictors of longitudinal weight loss or its composition from functional and morphological perspectives.

METHODS

This longitudinal observational study with a median follow-up period of 5 years (range: 3.0-5.8 years) included patients with COPD and ever-smokers at risk of COPD. Using chest computed tomography (CT) images, airway and emphysematous lesions were assessed as the square root of the wall area of a hypothetical airway with an internal perimeter of 10 mm (√Aaw at Pi10) and the percentage of low attenuation volume (LAV%). Muscle mass was estimated using cross-sectional areas (CSAs) of the pectoralis and erector spinae muscles, and fat mass was estimated using the subcutaneous fat thickness at the level of the 8th rib measured using chest CT images. Statistical analyses were performed using the linear mixed-effects models.

RESULTS

In total, 114 patients were enrolled. Their body mass index remained stable during the study period while body weight and muscle CSA decreased over time and the subcutaneous fat thickness increased. Reduced forced expiratory volume in 1 s and peak expiratory flow (PEF) at baseline predicted the future decline in muscle CSA.

CONCLUSION

Severe airflow limitation predicted future muscle wasting in patients with COPD and ever-smokers at risk of COPD. Airflow limitation with a PEF slightly below 90% of the predicted value may require intervention to prevent future muscle loss.

Prophylactic treatment of dacomitinib-induced skin toxicities in epidermal growth factor receptor-mutated non-small-cell lung cancer: A multicenter, Phase II trial

BACKGROUND

Dacomitinib significantly improves progression-free survival and overall survival (OS) compared with gefitinib in patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR)-activating mutations. However, dacomitinib often causes skin toxicities, resulting in treatment discontinuation. We aimed to evaluate a prophylactic strategy for skin toxicity induced by dacomitinib.

METHODS

We performed a single-arm, prospective, open-label, multi-institutional phase II trial for comprehensive skin toxicity prophylaxis. Patients with NSCLC harboring EGFR-activating mutations were enrolled and received dacomitinib with comprehensive prophylaxis. The primary endpoint was the incidence of skin toxicity (Grade ≥2) in the initial 8 weeks.

RESULTS

In total, 41 Japanese patients participated between May 2019 and April 2021 from 14 institutions (median age 70 years; range: 32-83 years), 20 were male, and 36 had a performance status of 0-1. Nineteen patients had exon 19 deletions and L858R mutation. More than 90% of patients were perfectly compliant with prophylactic minocycline administration. Skin toxicities (Grade ≥2) occurred in 43.9% of patients (90% confidence interval [CI], 31.2%-56.7%). The most frequent skin toxicity was acneiform rash in 11 patients (26.8%), followed by paronychia in five patients (12.2%). Due to skin toxicities, eight patients (19.5%) received reduced doses of dacomitinib. The median progression-free survival was 6.8 months (95% CI, 4.0-8.6 months) and median OS was 21.6 months (95% CI, 17.0 months-not reached).

CONCLUSION

Although the prophylactic strategy was ineffective, the adherence to prophylactic medication was quite good. Patient education regarding prophylaxis is important and can lead to improved treatment continuity.

Inspiratory and Expiratory Computed Tomography Imaging Clusters Reflect Functional Characteristics in Chronic Obstructive Pulmonary Disease

Purpose

Disease probability measure (DPM) is a useful voxel-wise imaging assessment of gas-trapping and emphysematous lesions in patients with chronic obstructive pulmonary disease (COPD). To elucidate the progression of COPD, we performed a cluster analysis using the following DPM parameters: normal (DPM_Normal), gas-trapping (DPM_GasTrap), and emphysematous lesions (DPM_Emph). Our findings revealed the characteristics of each cluster and the 3-year disease progression using imaging parameters.

Patients and Methods

Inspiratory and expiratory chest computed tomography (CT) images of 131 patients with COPD were examined, of which 84 were followed up for 3 years. The percentage of low attenuation volume (LAV%) and the square root of the wall area of a hypothetical airway with an internal perimeter of 10 mm (√Aaw at Pi10) were quantitatively measured using inspiratory chest CT. A hierarchical cluster analysis was performed using the DPM parameters at baseline. Five clusters were named according to the dominant DPM parameters: normal (NL), normal-GasTrap (NL-GT), GasTrap (GT), GasTrap-Emphysema (GT-EM), and Emphysema (EM).

Results

Women were predominantly diagnosed with GT. Forced expiratory volume in 1 s gradually decreased in the following order: NL, NL-GT, GT, GT-EM, and EM. DPM_Emph correlated well with LAV%. Four clusters other than NL showed significantly higher values of √Aaw at Pi10 than NL; however, no significant differences were observed among them. In all clusters, DPM_Emph increased after 3 years. DPM_Normal only increased in the GT cluster.

Conclusion

Clusters using DPM parameters may reflect the characteristics of COPD and help understand the pathophysiology of the disease.

Autobullectomy with COVID-19 in a patient with chronic obstructive pulmonary disease

A 72-year-old man with chronic obstructive pulmonary disease (COPD) was admitted for coronavirus disease 2019 (COVID-19). He was discharged on day 30; however, he was readmitted 6 days later due to a left lung organizing pneumonia secondary to COVID-19. After methylprednisolone treatment, the patient was discharged on day 15. One year later, computed tomography showed shrinkage of emphysematous lesions, and both total lung capacity measured using computed tomography and fraction of low attenuation volume decreased in the left lung compared to that before COVID-19. Here, we report a rare case of autobullectomy with COVID-19 in a patient with COPD.

Multicenter, single-blind, randomized controlled study of the efficacy and safety of favipiravir and nafamostat mesilate in patients with COVID-19 pneumonia

OBJECTIVES

To evaluate the efficacy and safety of nafamostat combined with favipiravir for the treatment of COVID-19.

METHODS

We conducted a multicenter, randomized, single-blind, placebo-controlled, parallel assignment study in hospitalized patients with mild-to-moderate COVID-19 pneumonia. Patients were randomly assigned to receive favipiravir alone (n = 24) or nafamostat with favipiravir (n = 21). The outcomes included changes in the World Health Organization clinical progression scale score, time to improvement in body temperature, and improvement in oxygen saturation (SpO₂).

RESULTS

There was no significant difference in the changes in the clinical progression scale between nafamostat with favipiravir and favipiravir alone groups (median, -0.444 vs -0.150, respectively; least-squares mean difference, -0.294; P = 0.364). The time to improvement in body temperature was significantly shorter in the combination group (5.0 days; 95% confidence interval, 4.0-7.0) than in the favipiravir group (9.0 days; 95% confidence interval, 7.0-18.0; P =0.009). The changes in SpO₂ were greater in the combination group than in the favipiravir group (0.526% vs -1.304%, respectively; least-squares mean difference, 1.831; P = 0.022). No serious adverse events or deaths were reported, but phlebitis occurred in 57.1% of the patients in the combination group.

CONCLUSION

Although our study showed no differences in clinical progression, earlier defervescence, and recovery of SpO₂ were observed in the combination group.

Search for Cosmic-Ray Boosted Sub-GeV Dark Matter Using Recoil Protons at Super-Kamiokande

We report a search for cosmic-ray boosted dark matter with protons using the 0.37  megaton×years data collected at Super-Kamiokande experiment during the 1996-2018 period (SKI-IV phase). We searched for an excess of proton recoils above the atmospheric neutrino background from the vicinity of the Galactic Center. No such excess is observed, and limits are calculated for two reference models of dark matter with either a constant interaction cross section or through a scalar mediator. This is the first experimental search for boosted dark matter with hadrons using directional information. The results present the most stringent limits on cosmic-ray boosted dark matter and exclude the dark matter-nucleon elastic scattering cross section between 10^{-33}cm^{2} and 10^{-27}cm^{2} for dark matter mass from 1  MeV/c^{2} to 300  MeV/c^{2}.

Immune-related aseptic meningitis diagnosed by Cube FLAIR on enhanced magnetic resonance imaging for a lung cancer patient administered atezolizumab: A case report

Immune checkpoint inhibitors (ICIs) can cause immune-related adverse events (irAEs), such as neurological toxicity. A 46-year-old man was diagnosed with squamous cell lung cancer. Lung cancer recurred 3 years after he experienced left segmental lung rejection. Therefore, he received atezolizumab as fourth-line chemotherapy. He experienced fever, headache, and decreased consciousness 10 days after the first dose of atezolizumab. Plain head computed tomography and cerebrospinal fluid examination showed no significant findings. Magnetic resonance imaging (MRI) with a Gadolinium (Gd)-enhanced Cube fluid-attenuated inversion recovery (FLAIR) sequence showed nodular abnormalities with contrast enhancement. Thus, aseptic meningitis caused by ICIs was suspected. His consciousness level gradually improved with glucocorticoid therapy. Moreover, most nodular abnormalities observed on cerebral MRI disappeared concurrently. Thus, Gd-enhanced Cube FLAIR sequence has the unique ability to reveal immune-related aseptic meningitis.

Risk factors for pneumonitis in advanced extrapulmonary cancer patients treated with immune checkpoint inhibitors

BACKGROUND

Immune-mediated pneumonitis has a high mortality rate; however, information regarding the related risk factors remains limited. This study aimed to analyze risk factors for pneumonitis, including smoking and lung metastasis (LM), in patients with extrapulmonary primary tumors.

METHODS

Data of 110 patients treated with immune checkpoint inhibitors (ICIs) (nivolumab/pembrolizumab) for treating extrapulmonary primary tumors at the Shiga University of Medical Science Hospital between January 2015 and December 2019 were retrospectively collected. The association between the onset of pneumonitis and treatment-related factors was analyzed by logistic regression. The severity of pneumonitis was graded according to the Common Terminology Criteria for Adverse Events version 5.0. Risk factors, such as the absence or presence of interstitial lung disease (ILD) and LM, or other clinical factors, including smoking status before ICI administration, were analyzed.

RESULTS

Multivariate analyses indicated that the amount of smoking was significantly associated with an increase in the development of all-grade pneumonitis types (odds ratio (OR) = 20.33, 95% confidence interval (CI) = 20.03-20.66; p = 0.029). LM and ILD were significantly related to an increase in the development of symptomatic pneumonitis (≥ Grade 2) (OR = 10.08, 95% CI = 1.69-199.81; p = 0.076, and OR = 6.76, 95% CI = 1.13-40.63; p = 0.037, respectively).

CONCLUSIONS

Pre-screening for ILD and LM and recognizing patients' smoking history is important for determining the risk of ICI-induced pneumonitis and allowing safe ICI administration.

Influence of masticating cycles and chewing patterns on inadvertent enamel wear caused by zirconia brackets

Little information is available about enamel wear caused by zirconia brackets, an inadvertent side effect of orthodontic treatment. The purpose of this study was to examine potential enamel damage induced by contact with zirconia brackets. Sliding and impact wear simulations were performed using bovine enamel specimens positioned at a 25° slant to a zirconium ball to determine wear behaviour. Different chewing patterns, tapping and grinding, were simulated. Specimens were profiled using confocal laser scanning microscopy, and the mean maximum depth and surface roughness were measured. Scanning electron microscopy was also performed. The mean maximum depth of wear values differed according to the number of mastication cycles, with a higher number of cycles producing higher depths of wear. The facet wear depth was significantly greater with the tapping pattern than with the grinding pattern. Scanning electron microscopic observation of the wear facets revealed that surface textures at the edges were rougher than those at the centre of all facets. The results of this study indicated that enamel wear was induced by contact with zirconia brackets during the early period of mastication, and that the patterns and number of cycles of mastication affected the wear progression of enamel.

Earliest pulmonary vein potential guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: a result from two randomized clinical studies

Background

With regards to short-term outcome in atrial fibrillation (AF), the benefit of cryoballoon ablation (CBA) by pressing a balloon against the earliest pulmonary vein (PV) potential site during pulmonary vein isolation, (earliest potential [EP]-guided CBA) has been previously demonstrated.

Objective

The present study aimed to evaluate the long-term outcome of the EP-guided CBA.

Methods

This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time to isolation (TTI) after cryoapplication exceeded 60 s and 45 s in the first and second studies, respectively. The patients were followed up for 1 year after procedure. We compared the clinical outcomes between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients).

Results

No significant differences in baseline characteristics were observed between the two groups. Compared with the conventional CBA group, the EP-guided CBA group had a significantly higher success rate at TTI ≤90 s (98.5% vs. 90.0%, P<0.001); lower touch-up rate and total cryoapplication; and shorter procedure time, and fluoroscopy time. The recurrence at 1-year after ablation was significantly lower in the EP-guided CBA group than in the conventional CBA group (6.0% vs. 19.4%; P=0.019).

Conclusions

The EP-guided CBA approach can facilitate the ablation procedure and achieve low recurrence at 1-year after ablation.

Funding Acknowledgement

Type of funding sources: None. Earliest potential [EP]-guided CBAThe recurrence at 1-year after ablation

Pain and removal force associated with bracket debonding: a clinical study

Objective:

Pain is a problem during bracket removal, and more comfortable treatment is needed. This study examined the association of pain with the removal force required for ceramic brackets, compared with metal and plastic brackets, to determine which removal method resulted in less pain and discomfort.

Methodology:

81 subjects (mean age, 25.1 years; 25 males and 56 females) were enrolled, from whom 1,235 brackets (407 ceramic, 432 plastic, and 396 metal) were removed. Measured teeth were distinguished at six segments. Pain was measured with a visual analogue scale (VAS) during the removal of each bracket. An additional grip was placed on the grips of debonding pliers with right-angled beaks; a mini loading cell sensor pinched by the grips was used to measure removal force during debonding. VAS and force values were statistically analyzed. The Kruskal–Wallis test followed by the Mann–Whitney U test with Bonferroni correction were performed for multiple comparisons; multiple regression analysis was also performed.

Results:

Forces in the upper and lower anterior segments were significantly smaller (p<0.05) than those in the other segments. Pain tended to be greater in the upper and lower anterior segments than in the posterior segments. In all segments, the removal force was greater for metal brackets than for plastic or ceramic brackets. Ceramic brackets caused significantly greater pain than plastic brackets for the upper and lower anterior segments. Debonding force was involved in the brackets, following adjustments for pain, upper left segment, age, and sex.

Conclusions

Pain and discomfort are likely to occur during bracket debonding.

Influence of pre-drilling diameter on the stability of orthodontic anchoring screws in the mid-palatal area

PURPOSE

The aim of this study was to investigate the stability of orthodontic anchor screws (OASs) in the mid-palatal area according to pre-drilling diameter.

METHODS

The success rate of 161 OASs (83 patients, φ2.0 mm, 6.0 mm in length) placed in a corresponding area to the mesial and distal borders of the first molar (mesial zone and distal zone) was assessed according to placement location and pre-drilling diameter (1.2 and 1.5 mm). Placement torque values from 73 OASs with a pre-drilling diameter of 1.2 mm were compared between success and failure groups.

RESULTS

The success rates of OASs pre-drilled with φ1.2 and 1.5 mm were 94.5% and 83.0%, respectively (P < 0.05); corresponding rates in the mesial zone were 100.0% and 77.3% (P < 0.005), and those in the distal zone were 89.2% and 88.6%, respectively. Placement torques of OASs predrilled with φ1.2 mm in the success and failure groups were 25.9 and 19.2 N·cm, respectively (P < 0.05).

CONCLUSION

A smaller pre-drilling diameter was associated with a higher success rate of OASs in the mid-palatal area, especially in the mesial zone. When pre-drilling diameter of 1.2 mm was used for φ2.0 mm OAS, greater placement torque was indicative of greater OAS stability.

Exploring the human hair follicle microbiome

Human hair follicles (HFs) carry complex microbial communities that differ from the skin surface microbiota. This likely reflects that the HF epithelium differs from the epidermal barrier in that it provides a moist, less acidic, and relatively ultraviolet light-protected environment, part of which is immune-privileged, thus facilitating microbial survival. Here we review the current understanding of the human HF microbiome and its potential physiological and pathological functions, including in folliculitis, acne vulgaris, hidradenitis suppurativa, alopecia areata and cicatricial alopecias. While reviewing the main human HF bacteria (such as Propionibacteria, Corynebacteria, Staphylococci and Streptococci), viruses, fungi and parasites as human HF microbiome constituents, we advocate a broad view of the HF as an integral part of the human holobiont. Specifically, we explore how the human HF may manage its microbiome via the regulated production of antimicrobial peptides (such as cathelicidin, psoriasin, RNAse7 and dermcidin) by HF keratinocytes, how the microbiome may impact on cytokine and chemokine release from the HF, and examine hair growth-modulatory effects of antibiotics, and ask whether the microbiome affects hair growth in turn. We highlight major open questions and potential novel approaches to the management of hair diseases by targeting the HF microbiome.

Prediction of radiation pneumonitis using dose-volume histogram parameters with high attenuation in two types of cancer: A retrospective study

The constraint values of dose-volume histogram (DVH) parameters for radiation pneumonitis (RP) prediction have not been uniform in previous studies. We compared the differences between conventional DVH parameters and DVH parameters with high attenuation volume (HAV) in CT imaging in both esophageal cancer and lung cancer patients to determine the most suitable DVH parameters in predicting RP onset. Seventy-seven and 72 patients who underwent radiation therapy for lung cancer and esophageal cancer, respectively, were retrospectively assessed. RP was valued according to the Common Terminology Criteria for Adverse Events. We quantified HAV with quantitative computed tomography analysis. We compared conventional DVH parameters and DVH parameters with HAV in both groups of patients. Then, the thresholds of DVH parameters that predicted symptomatic RP and the differences in threshold of DVH parameters between lung cancer and esophageal cancer patient groups were compared. The predictive performance of DVH parameters for symptomatic RP was compared using the area under the receiver operating characteristic curve. Mean lung dose, HAV30% (the proportion of the lung with HAV receiving ≥30 Gy), and HAV20% were the top three parameters in lung cancer, while HAV10%, HAV5%, and V10 (the percentage of lung volume receiving 10 Gy or more) were the top three in esophageal cancer. By comparing the differences in the threshold for parameters predicting RP between the two cancers, we saw that HAV30% retained the same value in both cancers. DVH parameters with HAV showed narrow differences in the threshold between the two cancer patient groups compared to conventional DVH parameters. DVH parameters with HAV may have higher commonality than conventional DVH parameters in both patient groups tested.

Finite element analysis of stress caused by palatal orthodontic anchor screws

This study used finite element (FE) analysis to investigate the stability of miniscrews (screws) placed at the median palate. FE models with variable suture maturity and screw-suture distances were used to examine the relationship with screw stability. Four groups were classified by extent of maturation of the midpalatal suture (0%, 60%, 75%, and 100%). The placement position was set at the center of the suture (0.0 mm), or 0.5, 1.0, and 1.5 mm to the side of the suture, and von Mises stress values in bone and screw displacement were compared among models. The stress value for the unsutured model, in which the screw was placed at the center of the suture, was greater than 30 MPa. Stress values for models in which screws were placed to the side (0.5-1.5 mm) were less than 28 MPa. Maximum screw displacement was greater in the 0.0-mm incomplete suture model than at other placement positions. Because bone conditions vary among patients, placement position and suture maturation should be examined on cone beam-computed tomography images, to ensure screw stability.

Final Results from a Phase II Trial of Osimertinib for Elderly Patients with Epidermal Growth Factor Receptor t790m-Positive Non-Small Cell Lung Cancer That Progressed during Previous Treatment

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are used for treating EGFR-mutated lung cancer, and osimertinib is effective in cases that acquired T790M mutations after treatment with the first- and second-generation EGFR-TKIs. However, no study has evaluated its safety and efficacy in older patients. This phase II trial (jRCTs071180002) evaluated osimertinib in T790M mutation-positive Japanese patients who were ≥75 years old and had experienced relapse or progression after previous EGFR-TKI treatment. Our previous report that enrolled 36 patients showed the overall response rate (58.3%) and disease control rate (97.2%), while this report describes the results for the progression-free survival (PFS), overall survival (OS), and safety analyses. The median PFS was 11.9 months (95% confidence interval (CI): 7.9-17.5), and the median OS was 22.0 months (95% CI: 16.0 months-not reached). The most frequent adverse events were anemia/hypoalbuminemia (27 patients, 75.0%), thrombocytopenia (21 patients, 58.3%), and paronychia/anorexia/diarrhea/neutropenia (15 patients, 41.7%). Pneumonitis was observed in four patients (11.1%), including two patients (5.6%) with Grade 3-4 pneumonitis. These results suggest that osimertinib was relatively safe and effective for non-small cell lung cancer that acquired T790M mutations after previous EGFR-TKI treatment, even among patients who were ≥75 years old.

Changes in surface properties of dental alloys with atmospheric plasma irradiation

Chemical transitions after atmospheric pressure plasma irradiation were investigated by evaluating intermolecular attractions and atomic and molecular reactions. Gold, titanium and stainless-steel alloy samples were ground with #800 grit SiC waterproof paper and nitrogen gas atmospheric plasma irradiation was conducted. The surface free energies of the treated alloys were calculated and compared statistically. X-ray photoelectron spectroscopy analysis was performed.The surface free energies of all metal surfaces treated by plasma irradiation were 1.5-times higher than those of the untreated metals. The energy of the hydrogen bonding component increased, and all alloy surfaces were coated with metal oxide after only a short period of plasma irradiation. The surfaces oxidized by plasma exhibited a high active energy, mainly due to an increase in the hydrogen bonding component. Reactions with oxygen in the air were promoted on the clean surfaces with exposed reactive elements.

Search for Electron Antineutrino Appearance in a Long-Baseline Muon Antineutrino Beam

Electron antineutrino appearance is measured by the T2K experiment in an accelerator-produced antineutrino beam, using additional neutrino beam operation to constrain parameters of the Pontecorvo-Maki-Nakagawa-Sakata (PMNS) mixing matrix. T2K observes 15 candidate electron antineutrino events with a background expectation of 9.3 events. Including information from the kinematic distribution of observed events, the hypothesis of no electron antineutrino appearance is disfavored with a significance of 2.40σ and no discrepancy between data and PMNS predictions is found. A complementary analysis that introduces an additional free parameter which allows non-PMNS values of electron neutrino and antineutrino appearance also finds no discrepancy between data and PMNS predictions.

Visualization of Nigrosome 1 from the Viewpoint of Anatomic Structure

BACKGROUND AND PURPOSE

Parkinson disease is related to neurodegeneration and iron deposition in the substantia nigra pars compacta and nigrosome 1. However, visualization of nigrosome 1 via MR imaging is poor owing to the bilateral asymmetry, regardless of whether it is healthy. We focused on the magic angle and susceptibility effect and evaluated the anatomic slant structure of nigrosome 1 by tilting subjects' heads in the B₀ direction.

MATERIALS AND METHODS

To investigate the effectiveness of the magic angle, we tilted the volunteers' heads to the right and left in the B₀ direction or not at all for evaluating correlations between the degree of head tilting and visualization of the right nigrosome 1 and left nigrosome 1 using 3D spoiled gradient-echo sequences with multiecho acquisitions. We evaluated the susceptibility of nigrosome 1 and the local field using quantitative susceptibility mapping to assess static magnetic field inhomogeneity.

RESULTS

The heads tilted to the right and left showed significantly higher contrasts of nigrosome 1 and the substantia nigra pars compacta than the nontilted heads. No significant differences were observed in the visualization and susceptibility between the right nigrosome 1 and left nigrosome 1 for each head tilt. The effect of the magic angle was remarkable in the nontilted heads. This finding was supported by quantitative susceptibility mapping because the anatomic slant structure of nigrosome 1 was coherent between the axis of nigrosome 1 and the magic angle.

CONCLUSIONS

The asymmetric visualization of nigrosome 1 is affected by the magic angle and susceptibility. The anatomic slant structure of nigrosome 1 causes these challenges in visualization.

Comparison of posterior alveolar canal location measured on computer tomography scan with cadaveric measurement of posterior superior alveolar foramen in Japanese samples

The aim of this study was to analyse anatomical characteristics of the most posterior alveolar canal (PAC) on computed tomography (CT) images and the posterior superior alveolar foramen (PSAF) physically identified in cadaveric samples, to avoid injuring the posterior superior alveolar artery (PSAA) during surgery in the maxillary tuberosity region. The study included 125 hemi-heads of 64 Japanese cadavers. Simple CT data of the maxillary bone region of the samples were obtained and analysed using measurement software. The alveolar crest (AC) and the PAC were identified to calculate the shortest distance between the AC and the PAC (AC-PAC). Then the samples were dissected to measure physically the shortest distance between the AC and the PSAF (AC-PSAF). The data were analysed statistically. The mean value and standard deviation were 20.7±4.2mm for AC-PAC and 20.7±4.3mm for AC-PSAF. The intraclass correlation coefficient between AC-PAC and AC-PSAF was 0.98. The CT-measured PAC locations were found to be almost identical to the PSAF positions identified physically in the samples. Preoperative CT localization of the PAC aids in avoiding injury to PSAA, while preoperative CT evaluation is important for each case due to significant individual variability in the anatomical PAC and PSAF locations.

Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery

Background

Visceral obesity is one of the risk factors for clinically relevant pancreatic fistula after pancreatic resection. The objective of this study was to evaluate the impact of intraperitoneal lipolysis on postoperative pancreatic fistula.

Methods

The degree of intraperitoneal lipolysis was investigated by measuring the free fatty acid concentration in drain discharge in patients after pancreatic resection. An experimental pancreatic fistula model was prepared by pancreatic transection, and the impact of intraperitoneal lipolysis was evaluated by intraperitoneal administration of triolein (triglyceride) with, or without orlistat (lipase inhibitor).

Results

Thirty-three patients were included in the analysis. The free fatty acid concentration in drain discharge on postoperative day 1 was significantly associated with the development of a clinically relevant pancreatic fistula (P = 0·004). A higher free fatty acid concentration in drain discharge was associated with more visceral adipose tissue (P = 0·009). In the experimental model that included 98 rats, intraperitoneal lipolysis caused an increased amount of pancreatic juice leakage and multiple organ dysfunction. Intraperitoneal administration of a lipase inhibitor reduced lipolysis and prevented deterioration of the fistula.

Conclusion

Intraperitoneal lipolysis significantly exacerbates pancreatic fistula after pancreatic resection. Inhibition of lipolysis by intraperitoneal administration of a lipase inhibitor could be a promising therapy to reduce clinically relevant postoperative pancreatic fistula.

Osimertinib in Elderly Patients with Epidermal Growth Factor Receptor T790M-Positive Non-Small-Cell Lung Cancer Who Progressed During Prior Treatment: A Phase II Trial

LESSONS LEARNED

Non-small-cell lung cancer (NSCLC) represents 85% of lung cancer in elderly patients.In the present study performed in the 36 elderly subjects with epidermal growth factor receptor (EGFR) T790M mutation-positive NSCLC, osimertinib 80 mg demonstrated statistically significant improvement in the objective response rate, which was comparable to those in the nonelderly population.Osimertinib appears to be an effective and safe treatment option in elderly patients with advanced NSCLC with EGFR mutation; further research in larger scale is warranted.

BACKGROUND

Previous findings suggest the possibility of relatively safe use of osimertinib for patients with T790M-positive non-small-cell lung cancer (NSCLC), with few serious adverse events for the elderly in comparison with conventional endothelial growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), and with an antitumor effect.

METHODS

This phase II study was performed to prospectively investigate the efficacy and safety of osimertinib for elderly patients aged ≥75 years with ineffective prior EGFR TKI treatment or with recurrence in T790M EGFR TKI resistance mutation-positive NSCLC.

RESULTS

A total of 36 patients were included in the analyses. Among the 36 subjects, 63.9% were female, with mean age of 79.9 years. The objective response rate (ORR) was 58.3% (95% confidence interval [CI], 42.2%-72.9%), demonstrating statistically significant efficacy of osimertinib (p = .0017). The median duration of response (DOR) was 27.9 weeks (95% CI, 21.1-82.0). Complete response (CR) and partial response (PR) were 2.8% and 55.6%, respectively. Disease control rate (DCR) was 97.2%. A waterfall plot revealed that 33 (91.6%) subjects exhibited tumor shrinkage during treatment, including 12 of 14 subjects who had stable disease (SD). All adverse events were not reason for discontinuation of the study drug.

CONCLUSION

Osimertinib may be an effective and safe treatment option in elderly patients with advanced NSCLC with EGFR mutation.

Nintedanib prevented fibrosis progression and lung cancer growth in idiopathic pulmonary fibrosis

A 76-year-old man with a past history of acute exacerbation (AE) and idiopathic pulmonary fibrosis (IPF) was treated with nintedanib because of decline in his forced vital capacity over time. A new small nodular lesion was visible on a computed tomography scan of the chest before initiation of nintedanib. Disease progression in IPF and change in size of the nodular lesion were not detected during administration of nintedanib. Nine months after starting nintedanib, the patient was diagnosed with acute gangrenous appendicitis, and nintedanib treatment was discontinued. The nodular lesion increased in size four months after the cessation of nintedanib. The nodular lesion was diagnosed as squamous cell carcinoma. In this case, nintedanib inhibited the disease progression of IPF and lung cancer simultaneously. Nintedanib may play an important role in the treatment of IPF-associated lung cancer.

Search for CP Violation in Neutrino and Antineutrino Oscillations by the T2K Experiment with 2.2×10^{21} Protons on Target

The T2K experiment measures muon neutrino disappearance and electron neutrino appearance in accelerator-produced neutrino and antineutrino beams. With an exposure of 14.7(7.6)×10^{20} protons on target in the neutrino (antineutrino) mode, 89 ν_{e} candidates and seven anti-ν_{e} candidates are observed, while 67.5 and 9.0 are expected for δ_{CP}=0 and normal mass ordering. The obtained 2σ confidence interval for the CP-violating phase, δ_{CP}, does not include the CP-conserving cases (δ_{CP}=0, π). The best-fit values of other parameters are sin^{2}θ_{23}=0.526_{-0.036}^{+0.032} and Δm_{32}^{2}=2.463_{-0.070}^{+0.071}×10^{-3}  eV^{2}/c^{4}.

Search for Boosted Dark Matter Interacting with Electrons in Super-Kamiokande

A search for boosted dark matter using 161.9 kt yr of Super-Kamiokande IV data is presented. We search for an excess of elastically scattered electrons above the atmospheric neutrino background, with a visible energy between 100 MeV and 1 TeV, pointing back to the Galactic center or the Sun. No such excess is observed. Limits on boosted dark matter event rates in multiple angular cones around the Galactic center and Sun are calculated. Limits are also calculated for a baseline model of boosted dark matter produced from cold dark matter annihilation or decay. This is the first experimental search for boosted dark matter from the Galactic center or the Sun interacting in a terrestrial detector.