[Four Cases of Resected cN2 Stage III A Non-Small-Cell Lung Cancer after Induction Chemotherapy]

Four patients with non-small-cell lung cancer(NSCLC), diagnosed with cN2 stage III A disease, by using CT and FDG-PET/ CT imaging, received 2 or 3 courses of platinum-based combination chemotherapy.The patients achieved partial response after chemotherapy and underwent surgery.Complete tumor resection was performed via upper lobectomy for 3 patients, but in 1 patient, interlobar metastatic lymph nodes remained after middle and lower bilobectomy.Two courses of postoperative chemotherapy were administered to 3 patients, but 1 patient could not receive postoperative chemotherapy due to complications.One patient, in whom lymph node metastasis completely disappeared after induction chemotherapy, is still alive and without disease recurrence for 7 years.Another patient, with the presence of only one intralobar metastatic lymph node after chemotherapy, died of brain and meningeal metastases, 3 years after surgery.Two other patients, with multiple pN2 lymph nodes after chemotherapy, died of early intrathoracic local relapse, indicating that prognosis is influenced by response to chemotherapy, especially in patients with poor N-downstaging.Improvements in response to induction therapy by using intensive chemotherapeutic regimens, concurrent radiotherapy, and strict patient selection, limited to N-downstaged cases, are needed for successful surgery outcomes in patients with cN2 stage III A NSCLC who have received induction therapy.

Application of the Self- Assembling Peptide P11-4 for Prevention of Acidic Erosion

The aim of this study was to use ultrasonography to evaluate the effect of the self-assembling peptide P11-4 on acid erosion prevention. Curodont Repair (CR), which includes peptide P11-4, was used. Rectangular prisms of bovine enamel (4×1×1 mm) were immersed in pure orange juice for a period of 5 minutes six times per day for 28 days. These samples were divided into four groups of six specimens each and treated differently for an additional period of 28 days: 1) baseline group specimens were stored in artificial saliva; 2) CR group specimens were exposed to curodont without acid challenge; 3) NCRA (no curodont+acid challenge) specimens were treated with orange juice without curodont exposure; and 4) CRA (CR+acid challenge) specimens were treated with curodont before treatment with orange juice. The propagation time of longitudinal ultrasonic velocity (UV) was measured. Ultrastructural observation of each tested enamel surface was carried out using field-emission scanning electron microscopy (SEM). The UV data were analyzed using two-way analysis of variance with time and treatment as confounding factors. Post hoc pairwise tests among groups were performed using the Tukey honestly significant difference test. The average UV in intact bovine enamel for the baseline group ranged from 4,483 to 4,549 m/s and did not vary significantly within the test period. The average ultrasonic velocity (UV) in all samples decreased after the initial erosion. The UV in NCRA decreased further over time. Increased UVs were found for CR and CRA. For CR and CRA, there was no significant difference in UV at the end of the experiment from the initial value before erosion. In the results of SEM observation, the CR and CRA groups had similar morphologic features in that etching patterns were not clearly due to precipitation between the enamel rods. From the results of this in vitro study, it might be concluded that applying enamel matrix derivatives and self-assembling peptides on erosive lesions can improve remineralization.

Effects of long-term cigarette smoke exposure on bone metabolism, structure, and quality in a mouse model of emphysema

Smoking is a common risk factor for both chronic obstructive pulmonary disease (COPD) and osteoporosis. In patients with COPD, severe emphysema is a risk factor for vertebral fracture; however, the effects of smoking or emphysema on bone health remain largely unknown. We report bone deterioration in a mouse model of emphysema induced by nose-only cigarette smoke (CS) exposure. Unexpectedly, short-term exposure for 4-weeks decreased bone turnover and increased bone volume in mice. However, prolonged exposure for 20- and 40-weeks reversed the effects from suppression to promotion of bone resorption. This long-term CS exposure increased osteoclast number and impaired bone growth, while it increased bone volume. Strikingly, long-term CS exposure deteriorated bone quality of the lumbar vertebrae as illustrated by disorientation of collagen fibers and the biological apatite c-axis. This animal model may provide a better understanding of the mechanisms underlying the deterioration of bone quality in pulmonary emphysema caused by smoking.

Surgical Results of Combined Pars Plana Vitrectomy, Phacoemulsification, and Intraocular Lens Implantation for various Vitreoretinal Diseases

PURPOSE

To evaluate the results and complications of combined pars plana vitrectomy (PPV), phacoemulsification and aspiration (PEA), and intraocular lens (IOL) implantation.

METHODS

A total of 117 eyes from 114 patients who had undergone PPV combined with PEA and IOL implantation were retrospectively analyzed. Combined surgery was performed for a wide variety of vitreoretinal diseases. Intraoperative and postoperative complications were also reviewed.

RESULTS

The postoperative BCVA improved by 2 lines or more in 85 eyes (72.6%). Intraoperative complications consisted of retinal tears in 14 eyes (12.0%) and posterior capsular rupture in 2 eyes (1.7%). Iatrogenic retinal tears occurred more frequently in eyes with a macular hole than in eyes with any other disease (p=0.005, chi-square test). Postoperative complications consisted of posterior capsule opacification (PCO) (21 eyes), transient IOP elevation (29 eyes), vitreous hemorrhage (6 eyes), anterior chamber fibrin exudation (11 eyes), posterior iris synechia (8 eyes), neovascular glaucoma (1 eye), and recurrent retinal detachment (RD) (2 eyes). Fibrin exudation occurred more frequently in eyes with proliferative diabetic retinopathy (PDR) and RD than in eyes with any other disease (p=0.03, chi-square test). PCO occurred more frequently in eyes with PDR than in eyes with any other disease (p=0.03, chi-square test).

CONCLUSIONS

The present study suggests that a high success rate can be achieved when recently improved PPV techniques are combined wi th PEA and IOL implantation. The complications that were observed following this combined treatment varied with respect to the vitreoretinal disease present prior to surgery.

The Psychological Impact of the Great East Japan Earthquake on Japan Ground Self-Defense Force Personnel: A Three-Wave, One-Year Longitudinal Study

OBJECTIVE

Approximately 70,000 Japan Ground Self-Defense Force (JGSDF) personnel were dispatched in the wake of the 2011 Great East Japan Earthquake and the tsunami and nuclear disaster that followed. This study was conducted to evaluate the mental health of the JGSDF personnel and the correlates.

METHODS

Data collected from 56,753 participants at three time points (one, six, and 12 months after mission completion) were analyzed. Those who scored 25 or more points on the Impact of Events Scale-Revised (IES-R) and the Kessler Psychological Distress Scale (K10) were allocated into the high posttraumatic stress response (high-PTSR) group, and the high general psychological distress (high-GPD) group, respectively.

RESULTS

The multiple logistic regression analysis identified the following factors as the significant risk factor related to high-PTSR or high-GPD status, with odds ratios of 2.0 or higher: deployment length of three or more months, being personally affected by the disaster, and being overworked continuously for three or more months after mission completion. No significant association was observed for duties with radiation exposure risk.

CONCLUSIONS

Our findings suggest that disaster workers may be able to conduct disaster relief activities more safely with mission-related considerations of shorter deployment length and recognizing the effects on personnel personally affected by the disaster, in addition to avoiding overworking personnel after mission completion.

A visible-light driven electrochemical biofuel cell with the function of CO2conversion to formic acid: coupled thylakoid from microalgae and biocatalyst immobilized electrodes

A new visible-light driven electrochemical biofuel cell consisting of the thylakoid membrane of microalgae immobilized on a TiO₂layer electrode as a photoanode, a formate dehydrogenase/viologen co-immobilized electrode as a cathode, and a CO₂-saturated buffer solution as the redox electrolyte, was developed.

Polymerization Behavior and Mechanical Properties of High-Viscosity Bulk Fill and Low Shrinkage Resin Composites

The present study determined the mechanical properties and volumetric polymerization shrinkage of different categories of resin composite. Three high viscosity bulk fill resin composites were tested: Tetric EvoCeram Bulk Fill (TB, Ivoclar Vivadent), Filtek Bulk Fill posterior restorative (FB, 3M ESPE), and Sonic Fill (SF, Kerr Corp). Two low-shrinkage resin composites, Kalore (KL, GC Corp) and Filtek LS Posterior (LS, 3M ESPE), were used. Three conventional resin composites, Herculite Ultra (HU, Kerr Corp), Estelite ∑ Quick (EQ, Tokuyama Dental), and Filtek Supreme Ultra (SU, 3M ESPE), were used as comparison materials. Following ISO Specification 4049, six specimens for each resin composite were used to determine flexural strength, elastic modulus, and resilience. Volumetric polymerization shrinkage was determined using a water-filled dilatometer. Data were evaluated using analysis of variance followed by Tukey's honestly significant difference test (α=0.05). The flexural strength of the resin composites ranged from 115.4 to 148.1 MPa, the elastic modulus ranged from 5.6 to 13.4 GPa, and the resilience ranged from 0.70 to 1.0 MJ/m3. There were significant differences in flexural properties between the materials but no clear outliers. Volumetric changes as a function of time over a duration of 180 seconds depended on the type of resin composite. However, for all the resin composites, apart from LS, volumetric shrinkage began soon after the start of light irradiation, and a rapid decrease in volume during light irradiation followed by a slower decrease was observed. The low shrinkage resin composites KL and LS showed significantly lower volumetric shrinkage than the other tested materials at the measuring point of 180 seconds. In contrast, the three bulk fill resin composites showed higher volumetric change than the other resin composites. The findings from this study provide clinicians with valuable information regarding the mechanical properties and polymerization kinetics of these categories of current resin composite.

Effect of Oxygen Inhibition Layer of Universal Adhesives on Enamel Bond Fatigue Durability and Interfacial Characteristics With Different Etching Modes

OBJECTIVE

The purpose of this study was to evaluate the effect of the oxygen inhibition layer of universal adhesive on enamel bond fatigue durability and interfacial characteristics with different etching modes.

METHODS

The three universal adhesives used were Scotchbond Universal Adhesive (3M ESPE, St Paul, MN, USA), Adhese Universal (Ivoclar Vivadent, Schaan, Lichtenstein), and G-Premio Bond (GC, Tokyo, Japan). The initial shear bond strength and shear fatigue strength to enamel was determined in the presence and absence of the oxygen inhibition layer, with and without phosphoric acid pre-etching. The water contact angle was also measured in all groups using the sessile drop method.

RESULTS

The enamel bonding specimens with an oxygen inhibition layer showed significantly higher (p<0.05) initial shear bond strengths and shear fatigue strengths than those without, regardless of the adhesive type and etching mode. Moreover, the water contact angles on the specimens with an oxygen inhibition layer were significantly lower (p<0.05) than on those without, regardless of etching mode.

CONCLUSION

The results of this study suggest that the oxygen inhibition layer of universal adhesives significantly increases the enamel bond fatigue durability and greatly changes interfacial characteristics, suggesting that the bond fatigue durability and interfacial characteristics of these adhesives strongly rely on its presence.

The influence of CYP2C19 polymorphisms on exacerbating effect of rabeprazole in celecoxib-induced small bowel injury

BACKGROUND

Simultaneous use of proton pump inhibitors (PPIs) has been shown to increase the risk of nonsteroidal anti-inflammatory drug (NSAID)-induced small bowel injury.

AIM

To investigate whether polymorphisms of the cytochrome P450 2C19 gene (CYP2C19), encoding a key metabolising enzyme for PPIs, are associated with small bowel injury induced by celecoxib in combination with the PPI rabeprazole.

METHODS

Study participants included 55 healthy Japanese volunteers, who participated in the PPI-NSAID Kyushu University Study using video capsule endoscopy. For 2 weeks, 26 subjects were treated with celecoxib plus rabeprazole (rabeprazole group), and 29 subjects received celecoxib plus placebo (placebo group). All subjects were genotyped for CYP2C19 using real-time fluorescent polymerase chain reaction. Subjects were sub-classified as poor metabolizers or extensive metabolizers. The incidence and number of small bowel injuries were compared between poor metabolizers and extensive metabolizers in each group.

RESULTS

In the rabeprazole group, the incidence of small bowel injuries was significantly higher in poor metabolizers than in extensive metabolizers (85.7% vs 31.6%, P=.026). The number of mucosal injuries in the rabeprazole group was also significantly higher in poor metabolizers compared with extensive metabolizers (median [range] 3 [0-31] vs 0 [0-7], P=.01). In addition, we found a significant interaction between CYP2C19 genotype and concomitant use of rabeprazole in subjects at risk for celecoxib-induced small bowel injury.

CONCLUSIONS

The CYP2C19 genotype might be associated with the risk of small bowel injury when celecoxib is combined with rabeprazole.

Influence of Different Curing Modes on Polymerization Behavior and Mechanical Properties of Dual-Cured Provisional Resins

This study determined the influence of curing mode on polymerization behavior and mechanical properties of dual-cured provisional resins. Three dual-cured bisacryl-based provisional resins were used: Tempsmart (TS; GC Corp), Luxatemp Automix Solar (LX; DMG Chemisch Pharmazeutishe Fabrik GmbH), and Integrity Multi·Cure (IG; Dentsply Caulk). A self-cured bisacryl-based provisional resin, Protemp Plus (PP; 3M ESPE) and a conventional poly(methyl methacrylate) (PMMA) provisional resin, Unifast III (UF; GC Corp) were used as controls. The inorganic filler content and coefficients of linear thermal expansion of the test materials were measured. Six specimens of each material were used to determine the flexural strength, elastic modulus, and resilience. The changes in ultrasound velocity during polymerization were measured. The average inorganic filler contents of the provisional resins, apart from UF, ranged from 24.4 to 39.3 wt%. The highest inorganic filler content was determined for LX, whereas TS showed the lowest value among the tested materials. The average coefficients of thermal expansion of the tested provisional resins ranged from 77.3 to 107.7 (×10^-6/°C). TS and IG showed significantly lower thermal expansions than the other tested provisional resins. The mean flexural strengths of the provisional resins ranged from 70.4 to 122.6 MPa, the mean elastic moduli ranged from 1.8 to 3.7 GPa, and the mean resilience of the provisional resins ranged from 1.1 to 2.3 MJ/mm³, respectively. Dual-cured provisional resins showed significantly higher flexural strengths than the PMMA resin. However, in all cases, the light-curing mode showed significantly higher flexural strengths than the self-curing mode. In the initial polymerization phase, dual-cured resins in the light-curing mode showed a rapid increase in the speed of sound (V) during light irradiation, followed by a slower increase. Conversely, the dual-cured resins in the self-curing mode showed a slower initial increase, followed by a rapid increase. Although no significant difference in V was observed between 10 and 15 minutes in the light-curing mode of all tested dual-cured resins, a significantly higher V value was obtained at 15 minutes than at 10 minutes in the self-curing modes for LX and IG. Regardless of the curing mode, tested dual-cured provisional resins showed superior mechanical properties than the conventional PMMA provisional resin. However, dual-cured provisional resin flexural properties and polymerization behavior were affected by the curing mode. This study indicated that the light-curing mode might be recommended for all dual-cured provisional resins because of the enhancement of their mechanical properties and reduction of chair time.

Interfacial Characteristics and Bond Durability of Universal Adhesive to Various Substrates

Objective: This study investigated the interfacial characteristics and bond durability of universal adhesives to various substrates.

Methods and Materials: Two universal adhesives were used: 1) Scotchbond Universal and 2) G-Premio Bond. The substrates used were bovine enamel and dentin with or without phosphoric acid etching, resin composite, lithium disilicate and leucite-reinforced glass ceramics, zirconia, and metal alloys. The surface free energy and the parameters of various substrates and of substrates treated by adhesive after light irradiation were determined by measuring the contact angles of three test liquids. Resin composite was bonded to the various substrates to determine shear bond strength after 24 hours water storage and 10,000 thermal cycles. A one-way analysis of variance (ANOVA) and the Tukey post hoc test were used for the surface free energy data, and a two-way ANOVA and the Tukey post hoc test were used for analysis of shear bond strength data (α=0.05).

Results: The interfacial characteristics of the various substrates show significant differences depending on the type of substrate, but the interfacial characteristics of substrate treated by adhesive after light irradiation did not show any significant differences regardless of the substrate used. The bond durability of two universal adhesives to various substrates differs depending on the type of substrate and the adhesive.

Conclusions: The results of this study suggest that universal adhesives modify the interfacial characteristics of a wide range of substrates and create a consistent surface, but the bond durability of universal adhesive to various substrates differs depending on the type of substrate and the adhesive.

Erlotinib as second- or third-line treatment in elderly patients with advanced non-small cell lung cancer: Keio Lung Oncology Group Study 001 (KLOG001)

The aim of this study was to assess the efficacy and safety of erlotinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), as second- or third-line treatment for elderly Japanese patients with non-small-cell lung cancer (NSCLC). The patients eligible for this phase II trial were aged ≥70 years, had stage III/IV or recurrent NSCLC, and had previously received 1 or 2 chemotherapy regimens that did not include EGFR-TKIs. The patients received erlotinib at a dose of 150 mg/day. The primary endpoint was overall response rate (ORR), and the secondary endpoints were progression-free survival (PFS), overall survival (OS) and toxicity. A total of 38 patients with a median age of 76 years were enrolled. The majority of the patients were men (66%), had an Eastern Cooperative Oncology Group performance status of 1 (58%), stage IV disease (66%) and adenocarcinoma (74%). Of the 35 patients, 13 (34%) had tumors with EGFR mutations. The ORR was 26.3% (95% confidence interval: 12.1-40.5%) and the disease control rate was 47.4%. The median PFS was 3.7 months and the median OS was 17.3 months. The grade 3 adverse events observed included rash (13%), diarrhea (5%), interstitial pneumonitis (5%), anorexia (3%) and gastrointestinal bleeding (3%). Grade 4 or 5 adverse events were not observed. The median OS did not differ significantly between patients aged <75 years (14.9 months) and those aged ≥75 years (19.0 months; P=0.226). Therefore, erlotinib was found to be effective and well-tolerated in elderly patients with previously treated NSCLC.

Four and a half years of experience of a clinician born and raised in Fukushima: discrepancy found through dialogues and practices

Many initiatives to measure the internal and external exposures of the residents of Fukushima have been undertaken since the accident at Fukushima Daiichi nuclear power plant. However, residents have had few, if any, opportunities for face-to-face explanations to understand the meaning of such measurements. Although the personal data of tens of thousands of residents were collected, these data were not analysed adequately, and were therefore not used to implement large-scale programmes to manage/reduce exposures. One of the lessons learned from the Fukushima accident is that it is imperative for the government to implement these measures for radiation protection, and to build an effective functioning service for the residents. The author, as a physician from the region, has worked as an explainer/interpreter of exposure dose measurements to individual residents. Another lesson learned from this experience is that local medical and health professionals can contribute to building a public system for radiation protection, by acting as 'liaising officers' to connect residents, the authorities, and experts from outside the region. This paper describes the author's experience and lessons learned in the hope that this information will be useful in the event of a future accident.

Influence of Thermal Cycling on Flexural Properties and Simulated Wear of Computer-aided Design/Computer-aided Manufacturing Resin Composites

OBJECTIVE

The purpose of this study was to evaluate the influence of thermal cycling on the flexural properties and simulated wear of computer-aided design/computer-aided manufacturing (CAD/CAM) resin composites.

METHODS

The six CAD/CAM resin composites used in this study were 1) Lava Ultimate CAD/CAM Restorative (LU); 2) Paradigm MZ100 (PM); 3) CERASMART (CS); 4) Shofu Block HC (SB); 5) KATANA AVENCIA Block (KA); and 6) VITA ENAMIC (VE). Specimens were divided randomly into two groups, one of which was stored in distilled water for 24 hours, and the other of which was subjected to 10,000 thermal cycles. For each material, 15 specimens from each group were used to determine the flexural strength and modulus according to ISO 6872, and 20 specimens from each group were used to examine wear using a localized wear simulation model. The test materials were subjected to a wear challenge of 400,000 cycles in a Leinfelder-Suzuki device (Alabama machine). The materials were placed in custom-cylinder stainless steel fixtures, and simulated localized wear was generated using a stainless steel ball bearing (r=2.387 mm) antagonist in a water slurry of polymethyl methacrylate beads. Simulated wear was determined using a noncontact profilometer (Proscan 2100) with Proscan and AnSur 3D software.

RESULTS

The two-way analysis of variance of flexural properties and simulated wear of CAD/CAM resin composites revealed that material type and thermal cycling had a significant influence (p<0.05), but there was no significant interaction (p>0.05) between the two factors. The flexural properties and maximum depth of wear facets of CAD/CAM resin composite were different (p<0.05) depending on the material, and their values were influenced (p>0.05) by thermal cycling, except in the case of VE. The volume losses in wear facets on LU, PM, and SB after 10,000 thermal cycles were significantly higher (p<0.05) than those after 24 hours of water storage, unlike CS, KA, and VE.

CONCLUSION

The results of this study indicate that the flexural properties and simulated wear of CAD/CAM resin composites are different depending on the material. In addition, the flexural properties and simulated wear of CAD/CAM resin composites are influenced by thermal cycling.

[Long-Term Local Control with Radiofrequency Ablation or Radiotherapy for Second, Third, and Fourth Lung Tumors after Lobectomy for Primary Lung Cancer]

A 78-year-old woman developed second, third, and fourth lung tumors at intervals of 1-3 years after left upper lobectomy for primary lung cancer. The tumors were controlled with radiofrequency ablation(RFA)or conventionalconformalradiotherapy for 9 years postoperatively. For the treatment of second primary lung cancer or lung metastasis after surgical resection of the primary lung cancer, reoperation is not recommended because of the impaired respiratory reserve. Thus, local therapy such as radiotherapy or RFA is applied in some cases. Among these, stereotactic body radiotherapy(SBRT)is a feasible option because of its good local control and safety, which is comparable with surgery. On the other hand, for cases of multiple lesions that are not suitable for radiotherapy or combination therapy, RFA could be an option because of its short-term local control, easiness, safety, and repeatability. After surgery for primary lung cancer, a second lung tumor could be controlled with highly effective and minimally invasive local therapy if it is recognized as a local disease but is medically inoperable. Therefore, longterm postoperative follow-up for primary lung cancer is beneficial.