Purpose: To investigate the clinical significance of adaptive radiotherapy (ART) in locally advanced nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: Eligible patients were treated with concurrent chemoradiotherapy using IMRT. Planning computed tomography in ART was performed during radiotherapy, and replanning was performed. Since ART was started in May 2011 (ART group), patients who were treated without ART up to April 2011 (non-ART group) were used as the historical control. The Kaplan-Meier method was used to calculate overall survival (OS), locoregional recurrence-free survival (LRFS), progression-free survival (PFS), and distant metastasis-free survival (DMFS). LRFS for the primary tumor (LRFS_P) and regional lymph node (LRFS_LN) were also studied for more detailed analysis. Statistical significance was evaluated using the log-rank test for survival. Results: The ART group tended to have higher radiation doses. The median follow-up period was 127 months (range, 10 to 211 months) in the non-ART group and 61.5 months (range, 5 to 129 months) in the ART group. Compared to the non-ART group, the ART group showed significantly higher 5-year PFS (53.8% vs. 81.3%, p = 0.015) and LRFS (61.2% vs. 85.3%, p = 0.024), but not OS (80.7% vs. 80.8%, p = 0.941) and DMFS (84.6% vs. 92.7%, p = 0.255). Five-year LRFS_P was higher in the ART group (61.3% vs. 90.6%, p = 0.005), but LRFS_LN did not show a significant difference (91.9% vs. 96.2%, p = 0.541). Conclusion Although there were differences in the patient backgrounds between the two groups, this study suggests the potential effectiveness of ART in improving locoregional control, especially in the primary tumor.

Objective: To evaluate the efficacy of high-flow nasal cannula oxygen (HFNC) for dyspnea in patients with advanced disease. Methods: A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Ichu-shi Web. Inclusion criteria were: 1) randomized controlled trials evaluating the effect of HFNC on dyspnea; 2) aged 18 years or older with advanced disease with hypoxemia; 3) control group was conventional oxygen therapy or noninvasive positive pressure ventilation. Exclusion criteria were: 1) patients in intensive care unit, 2) weaning from ventilator. Results: Six studies (4 from database searches, and 2 from hand searches) were included. In the 2 studies evaluating short-term intervention, one showed HFNC was more efficacious, and the other conventional oxygen was more efficacious. In the 2 studies evaluating long-term interventions: one showed HFNC was more efficacious, and the other showed no significant difference. In the 2 studies evaluating the intervention during exercise, one showed HFNC was more efficacious, and the other showed no significant difference. Conclusion: HFNC may be effective for dyspnea in patients with advanced disease associated with hypoxemia.

Objective: This study aimed to investigate the accuracy and precision of continuous, non-invasive blood pressure obtained using the ClearSight system by comparing it with invasive arterial blood pressure, and to assess the hemodynamic changes using invasive methods and the ClearSight system in patients undergoing cesarean section. Methods: Arterial pressure was measured invasively with an intra-arterial catheter and non-invasively using the ClearSight system during cesarean section in patients with placenta previa or placenta accreta. Blood pressure measurements obtained using these two means were then compared. Results: Total 1,277 blood pressure measurement pairs were collected from 21 patients. Under Bland-Altman analysis, the ClearSight system demonstrated an acceptable accuracy with a bias and standard deviation of 8.8±13.4 mmHg for systolic blood pressure, -6.3±7.1 mmHg for diastolic blood pressure, and -2.7±8.0 mmHg for median blood pressure. Cardiac index levels were significantly elevated during fetal delivery and 5 minutes after placental removal, and systemic vascular resistance index levels were significantly decreased during fetal delivery and 40 minutes after placental removal. Conclusion In patients undergoing cesarean section, the ClearSight system showed excellent accuracy and precision compared to that of the currently used invasive monitoring system.

BACKGROUND: We investigated factors associated with prolonged viral clearance of SARS-CoV-2 among non-severe adult patients in Osaka, Japan. A total of 706 laboratory-confirmed COVID-19 patients were enrolled in this longitudinal observational study between 29 January 2020 and 31 May 2020, across 62 hospitals and three non-hospital recuperation facilities. METHODS: Logistic regression analysis was performed to investigate the factors associated with prolonged (29 days: upper 25% in duration) viral clearance of SARS-CoV-2. Linear regression analysis was conducted to assess these factors 14 days after symptom onset. RESULTS: The median duration of viral clearance was 22 days from symptom onset. After adjustment for sex, age, symptoms, comorbidity, and location of recuperation, comorbidities were associated with prolonged duration: (OR, 1.77 [95% CI, 1.11-2.82]) for one, (OR, 2.47 [95% CI, 1.32-4.61]) for two or more comorbidities. Viral clearance 14 days after symptom onset was 3 days longer for one comorbidity and 4 days longer for two or more comorbidities compared to clearance when there was no comorbidity. CONCLUSION The presence of comorbidity was a robust factor associated with a longer duration of viral clearance, extending by 3 to 4 days compared to patients with no comorbidity.
Adult ; COVID-19 ; Humans ; Japan/epidemiology* ; RNA, Viral ; SARS-CoV-2 ; Virus Shedding

We report the case of a 46-year-old Chinese male patient who visited our clinic complaining of infertility. Semen analysis revealed azoospermia, and azoospermia factor c region partial deletion (b1/b3) was detected using Y chromosome microdeletion analysis. Testicular sperm extraction was performed after genetic counseling. The bilateral ductus deferens and a portion of the epididymis were absent, whereas the remaining epididymis was expanded. Motile intratesticular spermatozoa were successfully extracted from the seminiferous tubule. On histopathology, nearly complete spermatogenesis was confirmed in almost every seminiferous tubule. To our knowledge, this is the first case report of b1/b3 deletion with a congenital bilateral absence of the vas deferens and almost normal spermatogenesis.
Asian Continental Ancestry Group ; Azoospermia ; Epididymis ; Genetic Counseling ; Humans ; Infertility ; Infertility, Male ; Male ; Middle Aged ; Semen Analysis ; Seminiferous Tubules ; Spermatogenesis* ; Spermatozoa ; Vas Deferens* ; Y Chromosome*

Onco-testicular sperm extraction is used to preserve fertility in patients with bilateral testicular tumors and azoospermia. We report the case of a testicular tumor in the solitary testis of a patient who had previously undergone successful contralateral orchiectomy and whose sperm was preserved by onco-testicular sperm extraction. A 35-year-old patient presented with swelling of his right scrotum that had lasted for 1 month. His medical history included a contralateral orchiectomy during childhood. Ultrasonography revealed a mosaic echoic area in his scrotum, suggesting a testicular tumor. The lesion was palpated within the normal testicular tissue along its edge and semen analysis showed azoospermia. Radical inguinal orchiectomy and onco-testicular sperm extraction were performed simultaneously. Motile spermatozoa were extracted from normal seminiferous tubules under microscopy and were frozen. Eventual intracytoplasmic sperm injection using the frozen spermatozoa is planned. Onco-testicular sperm extraction is an important fertility preservation method in patients with bilateral testicular tumors or a history of a previous contralateral orchiectomy.
Adult ; Azoospermia* ; Fertility ; Fertility Preservation ; Humans ; Infertility, Male ; Male ; Methods ; Microscopy ; Orchiectomy ; Scrotum ; Semen Analysis ; Seminiferous Tubules ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval ; Spermatozoa* ; Testicular Neoplasms* ; Testis* ; Ultrasonography

Introduction: The purpose of this study is to elucidate the influence of drugs on infants and to provide information about safe drug treatments during breastfeeding using the FDA’s Adverse Event Reporting System (FAERS).
Study Design: Case series based on FAERS data.
Methods: We used the cleaned FAERS data in JAPIC AERS, extracted cases of adverse events from the category “neonatal exposure through breastfeeding (2000189)” in Standardized MedDRA Queries, and collected “the cases of breast-feeding infants” by system organ class, the type of adverse event, therapeutic category of first suspected drugs, and the generic name of the drugs.  We aggregated the data of the most reported cases of suspected drugs from first to fifth by the name of the adverse event.  Additionally, we investigated the properties and disposition of each suspected drug and verified the transitivity of breast milk as well.
Results: Only 551 cases of breast-feeding infants (0.01%) were extracted from the data of JAPIC AERS.  The aggregated data of adverse events in terms of system organ class showed high numbers of gastrointestinal disease (such as diarrhea and vomiting) and impairment of the nervous system (such as drowsiness), and drugs which acted on the nervous system were the most suspected drugs.  There were 26 cases of adverse events associated with lamotrigine, which was the most frequently reported.
Discussion: We could observe the characteristics of adverse events and suspected drugs that were shown as the influence of drugs taken during breastfeeding which were exposed to infants.  Our study showed 2 conclusions: 1) the drugs that have had adverse events frequently reported have the characteristic of facilitating the drug’s migration into breast milk, and 2) the most frequently reported cases were those in which nursing mothers or medical experts could recognize the correlation between breast milk and the adverse event(s) immediately after breast milk was given to the infant.

  The purpose of this study was to clarify the effects of ingesting chloridquellen and bicarbonate spring waters on electrogastrography and heart rate variability in humans. The subjects were ten young adults (average age 21.9 years old). Three and six cycles per minute (cpm) frequency of electrogastrography (EGG) were measured, as well as the high-frequency (HF: 0.15-0.40Hz) components, and the ratio of low-frequency (LF: 0.04-0.15Hz) components to HF components in heart rate variability (HRV) during 90 minutes. The taste of the water and pain or abnormalities in the stomach were also assessed by having the subjects answer a questionnaire. The subjects ingested the spa water or purified water and were asked to respond to the questionnaire after thirty minutes, and they also ingested no water on a different day and were questioned. The EGG-6 cpm frequency, presumably reflecting intestinal activity, did not change under any conditions. The EGG-3 cpm frequency, presumably reflecting stomach activity, significantly increased with bicarbonate spring waters immediately after ingestion and decreased after 30 min. Additionally, the 3 cpm frequency significantly increased with ingestion of purified water over the course of 30 min. The HF components in HRV, presumably reflecting cardiac parasympathetic activity, did not change under any conditions. The ratio of LF to HF components in HRV, presumably reflecting cardiac sympathetic activity, significantly increased with ingestion of purified water immediately and after 15 min, and bicarbonate spring waters after 30 min. There was a difference between ingestion of chloridquellen and purified water in the answers concerning the taste of the water in the questionnaire. These findings suggest that the constituent parts of chloridquellen water and other factors activate stomach and autonomic nervous activities in humans.

Objectives: Radon (222Rn) is a noble gas and a component of water in many hot spring spas. The Hot Springs Law and the Guideline of Analytical Methods of Mineral Springs (revised edition) of Japan classify springs containing 74 Bq/kg or more of radon as “hot springs” and those with radon levels exceeding 111 Bq/kg as “medical springs”, also called “radioactive springs”. Komono Town, one of the foremost spa and health resort destinations in Mie Prefecture, is the site of many radioactive springs. For the purpose of regional vitalization of this area through radioactive springs, it is necessary to confirm the safety and effectiveness of their use. To evaluate the exposure dose due to radioactive spring usage, it is important to measure radon concentration in air, especially in high-humidity air such as in bathing rooms. Methods: The concentration of radon in air was analyzed using an activated charcoal detector (PICO-RAD; AccuStar Labs) with a desiccant (Drierite; 8-mesh anhydrous calcium sulfate; W.A. Hammond Drierite Company, Ltd.) and a liquid scintillation counter (LSC LB-5; Hitachi Aloka Medical, Ltd.). A DPO (2,5-diphenyloxazole) + POPOP (1,4-bis- (5-phenyl-2-oxazolyl)-benzene) toluene solution (Wako Pure Chemical Industries, Ltd.) was used as a liquid scintillator. Activated charcoal detectors were set up in and around the radioactive spring facilities. Results and Discussion: In a radioactive spring facility, radon concentration in air in the bathing room and changing room were relatively high at about 50 Bq/m3. In the corridor on all floors and at the entrance, these values were approximately 10-30 Bq/m3, indicating that radon in hot spring water diffuses into the air and spreads within the facility. Outdoors, radon concentration was 12.5 Bq/m3 at a campsite near the discharge point of the radioactive spring.   Exposure dose is calculated under the assumption of a two-day stay, during which the visitor will use the bath for several hours. The results obtained show that the exposure dose at the hot spring facility is lower than the exposure dose from daily environmental radiation or medical devices. These conclusions are considered sufficient to confirm the safety of the hot spring facility.

Objectives: Radon (222Rn) is a noble gas found in the water of hot spring spas (“onsen”). In Japan, the Hot Springs Law and the Guideline of Analytical Methods of Mineral Springs (revised) classify springs containing 74 Bq/kg of radon as “hot springs” and those with levels exceeding 111 Bq/kg as “medical springs”, also called “radioactive springs”. According to the notification article (the Nature Conservation Bureau of the Ministry of the Environment in Japan), bathing in a radioactive springs may alleviate the effects of gout, arteriosclerosis, and hypertension as well as chronic conditions such as cholecystitis, gallstones, and skin and gynecological diseases. Drinking water from these springs may treat gout, chronic digestive disorders, chronic cholecystitis, gallstones, neuralgia, muscle pain, and arthralgia. To determine exposure doses from radioactive springs, it is important to establish an easy and accurate method of measuring radon concentration in water and humid air in bathing areas. Methods: This study measured the concentration of airborne radon using an activated charcoal detector (PICO-RAD: AccuStar Labs), desiccant (Drierite; 8 mesh of anhydrous calcium sulfate: W.A. Hammond Drierite Company, Ltd.), a liquid scintillation counter (LSC LB-5: Hitachi Aloka Medical, Ltd.), and 2,5-diphenyloxazole(DPO) + 1,4-bis (5-phenyl-2-oxazolyl) benzene(POPOP) toluene solution (Wako Pure Chemical Industries, Ltd.) were used as the liquid scintillator. Results and Conclusions: This study evaluated radon exposure doses due to radioactive spring at a spa in Komono town, Mie prefecture. After water was piped from hot spring storage tanks into bathtubs, only 5.3-18.0% of the radon remained in the water. Two days later, only 0.25% remained, likely due to radioactive decay and increased diffusion into the air from bathing and recirculating filters. Thus, we investigated radon levels in the humid bathroom air around the radioactive hot spring and determined the total radon exposure from spa water and air. The total exposure dose was calculated assuming a two-day stay, during which customers used the bath for some number of hours. Our findings confirm the safety and efficacy of the hot spring facility. This study was supported in part by a grant from the Daido Life Welfare Foundation.