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The prognosis of patients with advanced squamous cell carcinoma of the external auditory canal and middle ear has been improved by advances in skull base surgery and multidrug chemoradiotherapy during the last two decades.
Methods
Ninety-five patients with squamous cell carcinoma of the external auditory canal and middle ear who were treated between 1998 and 2017 were enrolled. The number of patients with tumour stages T1, T2, T3 and T4 was 15, 22, 24 and 34, respectively. Oncological outcomes and prognostic factors were retrospectively investigated.
Results
Among patients with T4 disease, invasion of the brain (p = 0.024), carotid artery (p = 0.049) and/or jugular vein (p = 0.040) were significant predictors of poor prognosis. The five-year overall survival rate of patients with at least one of these factors (T4b) was significantly lower than that of patients without these factors (T4a) (25.5 vs 65.5 per cent, p = 0.049).
Conclusion
It is proposed that stage T4 be subclassified into T4a and T4b according to the prognostic factors.
Although treatment-resistant schizophrenia (TRS) is a highly heterogeneous disorder, an established and efficacious treatment for those patients to date is pharmacotherapy with clozapine. Dopamine supersensitivity psychosis (DSP) is characterized by profound unstable positive symptoms and tardive dyskinesia, and its mechanism is related to up-regulation of dopamine D2 receptors (DRD2) which can be induced by long-term treatment with antipsychotics. Patients with DSP take generally excessive high dosages of neuroleptics and thus meet easily the criteria of TRS. A drug with secure and stable pharmacokinetic, which can keep an appropriate blockade of DRD2, may contribute to amelioration and prevention of the dopamine supersensitivity state. Risperidone long-acting injection (RLAI) is a candidate agent which meets this hypothesis.
Methods:
For 115 patients with TRS, we divided them into two groups; the one is those with a history of DSP and the other is without DSP, and treatment with RLAI was conducted for 12-month duration. This is an observational study which did not control concomitant medications or dosage of RLAI.
Results:
Clinical symptomatology and medications at baseline did not differ between the two groups. The results from the final analysis for remaining 95 patients revealed that the group with DSP showed greater improvements in the change of BPRS total score than the group without DSP.
Conclusions:
These results suggested strongly that the dopamine supersensitivity state could be related partly with the etiology of TRS. An atypical agent with long half-life time such as RLAI, can provide beneficial effect for patients with DSP.
Edingtonite and yugawaralite showing sectoral textures were studied by polarized optical microscopy and X-ray analysis. In edingtonite, the m{110} sector (2Vα = 22°) is optically triclinic and the c{001} sector (2Vα = 52°) is orthorhombic. In yugawaralite, the k{011} sector is optically monoclinic, whereas the v{120} sector is triclinic. Their crystal structures were determined. The results of refinement showed that the space groups of the k{011} (Rw = 4.5%) and v{120} (Rw = 5.1%) growth sectors are monoclinic Pc and triclinic P1, respectively. In the v{120} sector, several interatomic distances, bond angles and site occupancies are different with respect to a symmetrical plane of the structure, and therefore the monoclinic c glide is extinct. Thus, the X-ray symmetry correlates with the optical one. From the relationship between the surface and internal texture, the symmetry and sector can be explained by cation (Al/Si) ordering during non-equilibrium crystal growth.
Based on experimental evidence that vortex reconnection commences with the approach of nearly antiparallel segments of vorticity, a linearised model is developed in which two Burgers-type vortices are driven together and stretched by an ambient irrotational strain field induced by more remote vorticity. When these Burgers vortices are exactly antiparallel, they are annihilated on the strain time-scale, independent of kinematic viscosity $\def \xmlpi #1{}\def \mathsfbi #1{\boldsymbol {\mathsf {#1}}}\let \le =\leqslant \let \leq =\leqslant \let \ge =\geqslant \let \geq =\geqslant \def \Pr {\mathit {Pr}}\def \Fr {\mathit {Fr}}\def \Rey {\mathit {Re}}\nu $ in the limit $\nu \rightarrow 0$. When the vortices are skew to each other, they are annihilated under this action over a local extent that increases exponentially in the stretching direction, with clear evidence of reconnection on the same strain time-scale. The initial helicity associated with the skewed geometry is eliminated during the process of reconnection. The model applies equally to the reconnection of weak magnetic flux tubes under the action of a strain field, when Lorentz forces are negligible.
Mucosal mast cells (MMC) play a crucial role in the expulsion of Strongyloides ratti adults from the small intestine of mice. We reported the large intestinal parasitism of S. ratti in rats, and there has been no report on MMC in the large intestine of the natural host. We studied kinetics of MMC, together with eosinophils, in the upper and lower small intestines, caecum and colon of infected rats. Two distinct phases of mastocytosis were revealed: one in the upper small intestine triggered by stimulation of ‘ordinary’ adults, and the other in the colon stimulated by ‘immune-resistant’ adults that started parasitizing the colon around 19 days post-infection. In all 4 intestinal sites, the MMC peaks were observed 5–7 days after the number of adult worms became the maximum and the height of MMC peaks appeared to be dependent on the number of parasitic adults, suggesting an important role played by worms themselves in the MMC buildup.
The prevalence and epidemiological traits of human immunodeficiency virus (HIV)/hepatitis B virus (HBV) infections in high-risk populations (HRPs) remained unclarified in Japan. We determined the prevalence of HIV, HBV and Treponema pallidum (TP) and the viral genotypes in HRPs who attended primary sexually transmitted infection (STI) clinics in Osaka province during 2006–2011. Of 7898 specimens, 133 (1·7%) were HIV positive, which was significantly higher than the figures reported by Japanese Red Cross (0·0019%) and public health centres (0·27%) in Japan. The frequency of HIV-1 subtype B was 88·7%, followed by CRF01_AE (2·3%) and C (0·8%), which were almost identical to the national trend. HBV seroprevalence was surprisingly high in the HIV-positive group (63·2%), which was significantly higher than that in the HIV-negative group (25·6%). By contrast, there was no statistical correlation between HIV and TP infection. Interestingly, the distinct HBV genotypes Ae and G were prevalent in the HIV-positive population (60·0% and 20·0%, respectively), although both were rarely detected during nationwide surveillance. The transmission of HIV and HBV appeared to occur largely within a closed community early in life. Of note, about one-quarter of HIV-positive cases would have remained untested if health professionals had not motivated individuals to undergo HIV testing. This is the first evidence-based assessment of HIV positivity and HIV/HBV co-infection in HRPs at primary STIs in Japan and the effect of the involvement of health professionals in the diagnosis of HIV infections in asymptomatic carriers. The genotyping of HBV provided valuable information for understanding HIV epidemical traits.
During the development of oocytes from early antral follicles (EAFs) to antral follicles (AFs), the mitochondrial DNA copy number (Mt DNA number) increases, and granulosa cells markedly proliferate. This study examined the effect of supplementation of culture medium with estradiol-17β (E2) on the in vitro growth of oocytes, and increases in the Mt DNA number, and telomere length during the in vitro culture of oocytes derived from EAFs (0.4–0.7 mm in diameter). The E2 supplementation improved antrum formation and the ratio of oocytes reaching the metaphase II (MII) stage, and there was a significant difference in these values between addition E2 concentrations of 10 μg/ml and 0.1 μg/ml. When the oocytes were cultured in the medium containing 10 μg/ml E2, the Mt DNA number determined by real-time polymerase chain reaction (PCR) significantly increased, and the ratio of the Mt DNA number at the end of culture to the Mt DNA number at the beginning of the culture was greatly different among cows, and could be predicted by the degree of the difference between the Mt DNA number of oocytes derived from EAFs and that of oocytes derived from AFs (3–6 mm in diameter). When oocytes were cultured for 16 days in a medium containing 10 μg/ml E2 or 0.1 μg/ml E2, the Mt DNA number of oocytes grown in vitro did not differ, but the telomere length of the granulosa cells was significantly greater in the 10 μg/ml E2 group than in the 0.1 μg/ml group. In conclusion, E2 supplementation in culture medium improved the growth of oocytes derived from EAFs, and a high E2 concentration increased the telomere length of the granulosa cells.
We investigate homogeneous incompressible turbulence subjected to a range of degrees of stratification. Our basic method is pseudospectral direct numerical simulations at a resolution of . Such resolution is sufficient to reveal inertial power-law ranges for suitably comprised horizontal and vertical spectra, which are designated as the wave and vortex mode (the Craya–Herring representation). We study mainly turbulence that is produced from randomly large-scale forcing via an Ornstein–Uhlenbeck process applied isotropically to the horizontal velocity field. In general, both the wave and vortex spectra are consistent with a Kolmogorov-like range at sufficiently large . At large scales, and for sufficiently strong stratification, the wave spectrum is a steeper , while that for the vortex component is consistent with . Here is the horizontally gathered wavenumber. In contrast to the horizontal wavenumber spectra, the vertical wavenumber spectra show very different features. For those spectra, a clear dependence for small scales is observed while the large scales show rather flat spectra. By modelling the horizontal layering of vorticity, we attempt to explain the flat spectra. These spectra are linked to two-point structure functions of the velocity correlations in the horizontal and vertical directions. We can observe the power-law transition also in certain of the two-point structure functions.
In this study, we are doing R&D for directional dark matter search with nuclearemulsion. First of all, higher resolution nuclear emulsion with fine silver halidecrystals was developed in the production facility of emulsion at Nagoya university, and weconfirmed that it can detect the expected nuclear recoil tracks. The readout of submicrontracks was required the new technology. We developed the expansion technique, and couldreadout the signal by shape analysis with optical microscopy. The two dimensional angularresolution is 36 degrees at the original track length of range from 150 nm to 200 nm withoptical microscopy. Finally we demonstrated by using recoiled nuclei induced by 14.8 MeVneutron, and confirmed the technique. Moreover, we developed the X-ray microscope systemwith SPring-8 as final check with higher resolution of selected candidate tracks withoptical microscopy. The angular resolution was improved from 31 degree with opticalmicroscopy to 17 degree with X-ray microscopy at the track length of range from 150 nm to250 nm. We are developing the practical system and planning for start of the test runningwith prototype detector.
Strongyloides ratti (Nagoya strain) is unique in that a portion of adults parasitizing the small intestine withstands ‘worm expulsion’, which starts at around day 8 post-infection (p.i.) by host immunity, and establishes in the large intestine after day 19 p.i. To investigate the mechanism, adults obtained from the small intestine at day 7 or 19 p.i. were transplanted into the colon of infection-primed immune rats. Adults obtained at day 7 p.i. were rejected quickly, whereas those obtained at day 19 p.i. could establish infection. Moreover, the body length and the number of intrauterine eggs increased in the large intestine. In a separate experiment, large intestinal parasitism was abolished by the treatment of host rats with an anti-oxidant, butylated hydroxyanisole. These results indicate that small intestinal adults between days 7 and 19 p.i. acquired the ability to parasitize the large intestine of immune rats, and that free radicals produced by the host may have played a significant role in the process.
This study aimed to analyse vocal performance and to investigate the nature of the neoglottal sound source in patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy, using a high-speed digital imaging system.
Methods:
High-speed digital imaging analysis of neoglottal kinetics was performed in two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy; laryngotopography, inverse filtering analysis and multiline kymography were also undertaken.
Results:
In case one, laryngotopography demonstrated two vibrating areas: one matched with the primary (i.e. fundamental) frequency (75 Hz) and the other with the secondary frequency (150 Hz) at the neoglottis. In case two, laryngotopography showed two vibrating areas matched with the fundamental frequency (172 Hz) at the neoglottis. The interaction between the two areas was considered to be the sound source in both patients. The waveform of the estimated volume flow at the neoglottis, obtained by inverse filtering analysis, corresponded well to the neoglottal vibration patterns derived by multiline kymography. These findings indicated that the specific sites identified at the neoglottis by the present method were likely to be the sound source in each patient.
Conclusions:
High-speed digital imaging analysis is effective in locating the sites responsible for voice production in patients who have undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. This is the first study to clearly identify the neoglottal sound source in such patients, using a high-speed digital imaging system.
In December 2006, an outbreak of gastroenteritis occurred involving 372 guests and 72 employees at a hotel after a guest vomited in corridors on the third (F3) and 25th (F25) floors. Norovirus with identical genotype was confirmed by real-time reverse transcription–polymerase chain reaction in faecal samples from guest cases and employees. Spread of the outbreak on F25 was compared with that on F3. The attack rate in the guests who visited F25 alone (15·0%, 106/708 guests) was significantly higher than in those who visited F3 alone (3·5%, 163/4710 guests) (relative risk 4·3, 95% confidence interval 3·4–5·5, P<0·001). The outbreak on F3 ended within 2 days, while that on F25 extended over 7 days. The environmental ratios of F3 to F25 were 7·4 for volume, 6·9 for floor area and 7·6 for ventilation rate. This outbreak suggests that environmental differences can affect the propagation and persistence of a norovirus outbreak following environmental contamination.
Patients suspected of having cervical tuberculous lymphadenitis are diagnosed using investigations such as fine needle aspiration cytology and the polymerase chain reaction for Mycobacterium tuberculosis. However, these investigations are intended for primary tuberculosis infection. The majority of cervical tuberculous lymphadenitis cases in the elderly are thought to be caused by reactivation.
Objective:
The aims of this study were (1) to examine the efficacy of fine needle aspiration cytology, polymerase chain reaction and blood tests in the diagnosis of cervical tuberculous lymphadenitis caused by reactivation, and (2) to clarify any differences when compared with primarily infected cervical tuberculous lymphadenitis cases.
Materials and methods:
Thirty-three elderly patients with neck lumps underwent excisional biopsy from 2003 to 2008. The efficacy of fine needle aspiration cytology was examined by comparing the results of excisional biopsy with those of fine needle aspiration cytology performed at the initial medical examination for cases of suspected tuberculous disease. Furthermore, the leucocyte count and C-reactive protein concentration were compared for cases of cervical tuberculous lymphadenitis versus cases of malignant lymphoma.
Results:
Although nine cases were diagnosed with cervical tuberculous lymphadenitis using excisional biopsy, only one of these had been suspected based on fine needle aspiration cytology results. Three cases with tuberculous lymphadenitis were suspected of having malignant lymphoma on initial examination. There was no significant difference in the leucocyte count and C-reactive protein concentration, comparing cases of tuberculous lymphadenitis versus malignant lymphoma.
Conclusion:
Unlike the primary infection often seen in endemic areas, the diagnosis of early stage tuberculous lymphadenitis of the swelling type caused by reactivation in elderly people is difficult to confirm unless excisional biopsy is performed. In elderly patients with neck lumps, cervical tuberculous lymphadenitis should be included in the differential diagnosis.
The wettability of Pb-free Sn-based solder over the Cu-based Cu60Zr30Ti10 bulk metallic glass surface was investigated. We observed that the as-polished surface was nonwetting for the solder, which was due to the surface oxide layer of ZrOx formed in air. After complete removal of the oxide layer, a thin layer of Ag was deposited on the clean Cu60Zr30Ti10 surface. The Ag-covered Cu60Zr30Ti10 surface showed relatively high resistivity to the reoxidation even in air, and thus the wettability of the Cu60Zr30Ti10 surface for the Sn-based solder was greatly improved.
Aeromonas has been recognized as an important enteropathogen, but factors related to its virulence have not been clarified. For most enteric pathogens, attachment is a prerequisite for infection and for the effective delivery of toxins to the intestinal epithelial cells. We examined a total of 273 strains isolated from stool, food and environmental specimens by an assay for mannose-resistant adhesion to INT407 cells in vitro. Seventeen of the 102 faecal isolates were adhesive strains with more than 10 bacteria adhering per cell, while only 2 of the 118 isolates from foods and river water adhered to the cells (P < 0·001). It is possible that the adhesion might serve as a marker for discrimination between the pathogenic and nonpathogenic isolates. The 8 highly adhesive strains with more than 20 adhering organisms per cell were scrutinized for the mechanism of adhesion. No correlation was apparent between the adhesion to INT407 cells and hydrophobicity. It was noted that fucose inhibited the adhesion of four strains as well as haemagglutination by them. Electronmicroscopic studies showed the presence of flexible and curvilinear fimbriae in only 2 of the 8 highly adhesive strains.
Mechanisms of microstructure evolution during annealing after cold working were studied in an Fe-15%Cr ferritic stainless steel, which was processed by bar rolling/swaging to various total strains ranging from 1.0 to 7.3 at ambient temperature. Two types of recrystallization behavior were observed depending on the cold strain. An ordinary primary (discontinuous) recrystallization developed in the samples processed to conventional strains of 1.0–2.0. On the other hand, rapid recovery at early annealing resulted in ultrafine-grained microstructures in the larger strained samples that continuously coarsened on further annealing. Such annealing behavior was considered as continuous recrystallization.
We examine results of direct numerical simulations (DNS) of homogeneous turbulence in the presence of stable stratification. We focus on the effects of stratification on eddy diffusion, and the distribution of pairs of particles released in the flow. DNS results are presented over a range of stratification, and at Reynolds numbers compatible with aliased free spectral results for a resolution of 128 mesh points. We compare results for particle dispersion to simple analytic theories such as that proposed by Csanady (1964) and Pearson et al. (1983) by adapting the basic Langevin model to decaying turbulence at low Reynolds numbers. Stable stratification is found to arrest both single particle displacements and pair separation in the direction of stratification, but it leaves these quantities nearly unaltered in the transverse direction. With respect to the dynamics of stratified flows, we find that regions of strong viscous dissipation are intermittently spaced, and are associated with large horizontal vorticity, consistent with recent experimental results by Fincham et al. (1994).