Purpose Whereas whole-brain radiotherapy (WBRT) has been the standard treatment of brain metastases (BMs), stereotactic radiosurgery (SRS) is increasingly preferred to avoid cognitive dysfunction; however, it has not been clearly determined whether treatment with SRS is as effective as that with WBRT or WBRT plus SRS. We thus assessed the noninferiority of salvage SRS to WBRT in patients with BMs. Patients and Methods Patients age 20 to 79 years old with performance status scores of 0 to 2-and 3 if caused only by neurologic deficits-and with four or fewer surgically resected BMs with only one lesion > 3 cm in diameter were eligible. Patients were randomly assigned to WBRT or salvage SRS arms within 21 days of surgery. The primary end point was overall survival. A one-sided α of .05 was used. Results Between January 2006 and May 2014, 137 and 134 patients were enrolled in the WBRT and salvage SRS arms, respectively. Median overall survival was 15.6 months in both arms (hazard ratio, 1.05; 90% CI, 0.83 to 1.33; one-sided P for noninferiority = .027). Median intracranial progression-free survival of patients in the WBRT arm (10.4 months) was longer than that of patients in the salvage SRS arm (4.0 months). The proportions of patients whose Mini-Mental Status Examination and performance status scores that did not worsen at 12 months were similar in both arms; however, 16.4% of patients in the WBRT arm experienced grade 2 to 4 cognitive dysfunction after 91 days postenrollment, whereas only 7.7% of those in the SRS arm did ( P = .048). Conclusion Salvage SRS is noninferior to WBRT and can be established as a standard therapy for patients with four or fewer BMs.
Water mass formation in the intermediate and deep layers of the Okinawa Trough is investigated using two distinct data sets: a quasi‐climatological data set of the water properties of the minimum salinity surface produced from Argo float profiles and historical CTD data, and a velocity data set in the Kerama Gap measured by moored current meters during June 2009 to June 2011. The formation process of Okinawa Trough Intermediate Water is explained on the basis of horizontal advection and mixing of North Pacific Intermediate Water (NPIW) and South China Sea Intermediate Water (SCSIW). The salinity‐minimum water intruding into the Okinawa Trough through the channel east of Taiwan is approximately composed of 45% NPIW and 55% SCSIW, while that through the Kerama Gap is 75% NPIW and 25% SCSIW. Salinities of these water masses increase in the Okinawa Trough due to strong diapycnal diffusion; its coefficient is estimated as 6.8–21.5 × 10−4 m2 s−1 based on a simple advection‐diffusion equation. On the other hand, deep water in the Okinawa Trough, below the sill depth of the Kerama Gap (∼1100 m), is ventilated by overflow in the bottom layer of the Kerama Gap down to the deepest layer (∼2000 m) in the southern Okinawa Trough. A simple box model predicts that this bottom overflow (0.18–0.35 Sv) causes strong upwelling (3.8–7.6 × 10−6 m s−1) in the southern Okinawa Trough, which must be maintained by buoyancy gain of the deep water due to strong diapycnal diffusion (4.8–9.5 × 10−4 m2 s−1).
Pacific Decadal Oscillation (PDO) index is strongly correlated with vertically integrated transport carried by the Kuroshio through the East China Sea (ECS). Transport was determined from satellite altimetry calibrated with in situ data and its correlation with PDO index (0.76) is highest at zero lag. Total PDO‐correlated transport variation carried by the ECS‐Kuroshio and Ryukyu Current is about 4 Sv. In addition, PDO index is strongly negatively correlated, at zero lag, with NCEP wind‐stress‐curl over the central North Pacific at ECS latitudes. Sverdrup transport, calculated from wind‐stress‐curl anomalies, is consistent with the observed transport variations. Finally, PDO index and ECS‐Kuroshio transport are each negatively correlated with Kuroshio Position Index in the Tokara Strait; this can be explained by a model in which Kuroshio path is steered by topography when transport is low and is inertially controlled when transport is high.
Horizontal patterns and meander motions of the Kuroshio paths in the northern Okinawa Trough between the continental slope and the Tokara Strait are investigated using surface drifter buoy trajectory data, NOAA sea surface temperature (SST) measurements, and shipboard acoustic Doppler current profiler (ADCP) current observations. Temporal variations are also examined by spectral analyses of 1‐year moored velocity/temperature records along the continental slope near 28.8°–30.5°N and of the Kuroshio position time series in the Tokara Strait. Drifter buoy trajectories show that the Kuroshio paths in the northern Okinawa Trough are quasibimodal in character consisting of the northern paths and southern ones, which are associated with anticyclonic and cyclonic Kuroshio circulations, respectively. The Kuroshio position time series show that the northern paths tend to be persistent and intermittently undergo transition to southern paths at periods of 1–3 months. Moored current variations in the slope area and the Kuroshio path variations in the Tokara Strait are highly coherent near a period of 34 days due to the meander motions resulting from the transitions between the northern and southern paths. Successive NOAA SST images and shipboard ADCP current fields show that the transition from the northern path to the southern one is associated with a spatially growing cyclonic eddy, which is initially generated from a downstream‐propagating frontal meander with wavelength of about 200 km. When the cyclonic eddy grows into the scale of the northern Okinawa Trough (about 200‐km E–W, 250‐km N–S), the Kuroshio path changes from the northern path to the southern one.
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