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We report on the high potential of a honeycomb reactor for the use in aerobic oxidation under continuous-flow conditions. The honeycomb reactor is made of porous material with narrow channels separated by porous walls allowing for high density accumulation in the reactor. This structure raised the mixing efficiency of a gas–liquid reaction system, and it effectively accelerated the aerobic oxidation of benzyl alcohols to benzaldehydes under continuous-flow conditions. This reactor is a promising device for streamlining aerobic oxidation with high process safety because it is a closed system.

This paper examines the use of punctuation in Japanese in order to investigate its role in formulaic expressions. Specifically, we will study the use of a comma before the copula complex dakedone at the end of an utterance. Typically, punctuation is considered a matter of style in written representations and is generally not included in studies about the structure of formulaic expressions. However, in a corpus-based study on language use on social media (e.g., blogs, Twitter, online forums), we found that this comma is frequently used for a distinct pragmatic effect. The patterns of use, both structural and functional, are observed to be regular and predictable, enough to suggest that the comma is part of a fixed formal complex that has a unique meaning, i.e., a construction. This in turn suggests that commas, even though they are punctuation, can be a formal resource that constitutes part of a formulaic expression.

Iliac artery rupture during endovascular therapy (EVT) is a life-threatening complication requiring prompt diagnosis and treatment. However, delayed rupture of the iliac artery after EVT is rare, and its predictive value remains unknown. Herein, we present the case of a 75-year-old woman who developed delayed iliac artery rupture 12 h after balloon angioplasty and placement of a self-expandable stent in the left iliac artery. Hemostasis was achieved with a covered stent graft. However, the patient died of hemorrhagic shock. From the review of previous case reports and the pathological findings of the current case, increased radial force due to overlapping stent and kinking of the iliac artery may be associated with delayed iliac artery rupture. LEARNING OBJECTIVE: Delayed iliac artery rupture after endovascular therapy is rare but with a poor prognosis. Hemostasis can be achieved using a covered stent; however, the outcome could be fatal. Based on pathological findings and previous case reports, increased radial force at the stent site and kinking of the iliac artery may be associated with delayed iliac artery rupture. Self-expandable stent probably should not be overlapped at the site where kinking is likely to occur, even if long stenting is needed.

Background: Mycobacterium lentiflavum is a slow-growing nontuberculous mycobacterium that is widely distributed in soil and water systems, but it is sometimes pathogenic to humans. Although cases of M. lentiflavum infections are rare, 22 isolates of M. lentiflavum were identified at a single hospital in Japan. We suspected a nosocomial outbreak; thus, we conducted transmission pattern and genotype analyses. Methods: Cases of M. lentiflavum isolated at Kushiro City General Hospital in Japan between May 2020 and April 2021 were analyzed. The patient samples and environmental culture specimens underwent whole-genome sequencing (WGS). Additionally, we retrospectively collected clinical data from patient medical records. Results: Altogether, 22 isolates of M. lentiflavum were identified from sputum and bronchoalveolar lavage samples. Clinically, the instances with M. lentiflavum isolates were considered contaminants. In the WGS analysis, 19 specimens, including 18 patient samples and 1 environmental culture from the hospital’s faucet, showed genetic similarity. The frequency of M. lentiflavum isolation decreased after we prohibited the use of taps where M. lentiflavum was isolated. Conclusions: WGS analysis identified that the cause of M. lentiflavum pseudo-outbreak was the water used for patient examinations, including bronchoscopy.

In fungi, the cell wall plays a crucial role in morphogenesis and response to stress from the external environment. Chitin is one of the main cell wall components in many filamentous fungi. In Aspergillus nidulans, a class III chitin synthase ChsB plays a pivotal role in hyphal extension and morphogenesis. However, little is known about post-translational modifications of ChsB and their functional impacts. In this study, we showed that ChsB is phosphorylated in vivo. We characterized strains that produce ChsB using stepwise truncations of its N-terminal disordered region or deletions of some residues in that region and demonstrated its involvement in ChsB abundance on the hyphal apical surface and in hyphal tip localization. Furthermore, we showed that some deletions in this region affected the phosphorylation states of ChsB, raising the possibility that these states are important for the localization of ChsB to the hyphal surface and the growth of A. nidulans. Our findings indicate that ChsB transport is regulated by its N-terminal disordered region.

Although daprodustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, and dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, have been approved for the treatment of renal anemia in Japan, their efficacy and safety for patients aged 80 years or older with low-risk myelodysplastic syndrome (MDS)-related anemia have not been demonstrated. Our case series comprised two men and one woman aged >80 years with low-risk MDS-related anemia and diabetic mellitus (DM)-related chronic kidney disease who were dependent on red blood cell transfusions and in whom erythropoiesis-stimulating agents had been insufficient. All three patients received daprodustat and additional dapagliflozin achieved red blood cell transfusion independence and were followed up for >6 months. Daily oral daprodustat was well tolerated. There were no fatalities or progression to acute myeloid leukemia during the >6-month follow-up after daprodustat initiation. On the basis of these outcomes, we consider 24 mg of daprodustat combined with 10 mg of dapagliflozin daily an effective form of treatment for low-risk MDS-related anemia. Further studies are required to clarify the synergistic effects of daprodustat and dapagliflozin, which correct chronic kidney disease-related anemia by promoting endogenous erythropoietin production and normalizing iron metabolism to manage low-risk MDS in the long term.

The aim of the EMPA-AHF trial is to clarify whether early initiation of a sodium-glucose co-transporter 2 inhibitor before clinical stabilization is safe and beneficial for patients with acute heart failure (AHF) who are at a high risk of adverse events.The EMPA-AHF trial is a randomized, double-blind, placebo-controlled, multicentre trial examining the efficacy and safety of early initiation of empagliflozin (10 mg once daily). In total, 500 patients admitted for AHF will be randomized 1:1 to either empagliflozin 10 mg daily or placebo at 47 sites in Japan. Study entry requires hospitalization for AHF with dyspnoea, signs of volume overload, elevated natriuretic peptide, and at least one of the following criteria: estimated glomerular filtration rate60 mL/min/1.73 mThe EMPA-AHF trial is the first to evaluate the efficacy and safety of early initiation of empagliflozin in patients with AHF considered to be at high risk under conventional treatment.

Background: Dementia has become a public health problems due to its association with behavioural risk factors; smoking, alcoholism, sedentary behaviour, western type diet, obesity, diabetes, and hypercholesterolemia. Most of these behavioural risk factors appear to be associated with dementia as well as with risk of cardiovascular diseases (CVDs) and diabetes. This study aims to find out the prevalence of behavioural risk factors and their association with cognitive deficit and dementia. Study design and setting: Cross-sectional survey in a hospital. Subjects and methods: After written informed consent and approval from hospital ethic committee, all subjects (n=2002) above 25 years of age (1016 males and 986 females) were randomly selected and recruited from urban population of Moradabad, North India. Clinical data and risk factors were recorded with the help of case record form and validated questionnaires. Assessment of cognitive decline and dementia was made by a new memory function rating scale and behavioural risk factors by validated questionnaires. The association of behavioral risk factors with dementia was calculated by multivariate logistic regression analysis after adjustment of age and sex, obesity, diabetes and CVDs. Results: Low cognitive activity, low education, sedentary behavior, sleep duration, tobacco intake, alcoholism and western diet, were highly prevalent independent risk factors of dementia. Low education was not associated with risk. Logistic regression analysis revealed that regardless of age and body mass index, sedentary behavior, odds ratio and confidence intervals: (men 0.74 (0.69 - 0.79), women, 0.71 (0.63 - 0.74) and tobacco intake (men 0.88 (0.79 - 0.94), women 0.90 (0.84 - 0.97) and sleep disruption (men 0.80 (0.71 - 0.89), women 0.85 (0.79 - 0.91) were strongly (p

Intracranial angioplasty/stenting is a treatment option for patients with symptomatic intracranial atherosclerotic disease refractory to aggressive medical treatment. However, it carries a risk of procedure-related embolism as well as reperfusion hemorrhage and in-stent thrombosis. We have devised a new embolic protection system which can achieve both total ipsilateral internal carotid artery (ICA) embolic protection and real-time visualization of the target lesion during endovascular revascularization of intracranial atherosclerotic disease below the carotid T junction. Herein, we describe a case of medically refractory symptomatic intracranial atherosclerotic ICA stenosis successfully treated with this method.

To address recent energy and environmental issues, such as global warming and resource depletion, significant interest has been shown in carbon dioxide (CO2) fixation based on photoelectrochemical processes under solar light irradiation. The present paper describes the applicability of gold nanoparticles-decorated silicon nanowire arrays (Au/SiNW) as photoelectrodes to promote CO2 reduction. The decoration with Au nanoparticles of SiNW was performed by an electroless plating utilizing surface hydrogen-terminated silicon groups, generated during the nanowire formation process. Au/SiNW exhibits efficient photoelectrochemical performance for CO2 reduction to produce CO selectively in an aqueous medium under simulated solar light irradiation owing to its vertically aligned nanowire structure and Au nanoparticles as cocatalysts. The former provides high specific surface area and light trapping effect, and the latter induces selective interaction with CO2. Moreover, a unique two-steps method for Au decoration that consists of photo-assisted deposition of copper nanoparticles and the following electroless plating to replace Cu atoms to Au ones achieves more uniform decoration of SiNW with highly dispersed core-shell structured Cu@Au nanoparticles. The resulting photoelectrode, termed Cu@Au/SiNW, shows improved selectivity toward CO production and gives a good Faradic efficiency of 72% in an aqueous medium.

Purpose Agar and gellan gum have been considered to have different effects on polyploidy-dependent growth in plants. We aim to demonstrate that agar and gellan gum differently affect the change in root elongation in Arabidopsis thaliana by polyploidization and examined the physico-chemical parameters in each gelling agent to elucidate key factors that caused the differences. Methods Each polyploid strain was cultured vertically on agar and gellan gum solidified medium under fixed conditions. Root elongation rate was measured during 4–10 days after sowing. Water potential, gel hardness, and trace elements of each medium were quantified. Subsequently, the physical properties of agar medium were altered and aluminum was added to identify the factor important for change in growth by polyploidization. Results Agar promoted root elongation of polyploids more than the gellan gum. Water potential and gel hardness of agar medium were significantly higher than those of gellan gum medium. Lower water potential and gel hardness of agar medium did not affect the effects on change in polyploidy-dependent growth. Elemental analysis showed that gellan gum contained more aluminum than agar. When the polyploids were grown on agar media with additional aluminum, root elongation in tetraploids and octoploids was significantly suppressed. Conclusion This study revealed that agar and gellan gum affect the change in growth of root elongation in A. thaliana by polyploidization in different ways. The different effects on change in polyploidy-dependent growth is partially caused by aluminum in the gellan gum, which may be due to cell wall composition of polyploids.

Cytological diagnosis using endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for gastric submucosal spindle cell tumors, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas, is challenging because of their similar morphological characteristics.To clarify the cytological differential points, we reviewed the EUS-FNA cytology specimens of GISTs (37 cases), leiomyomas (11 cases), and schwannomas (4 cases).Twelve cytomorphological features were evaluated: lymphocytes, crushed nuclei, naked spindle nuclei, mast cell, length of the streaming arrangement, cellularity, nuclei at the cluster margin (nuclei located at the periphery of the cell cluster), peripheral feathering (loosely aggregated cells at the margin of a cell cluster tended to taper like feathers), metachromasia, wavy nuclei, fishhook-type nuclei, and anisonucleosis.Among these features, lymphocytes, naked spindle nuclei, length of the streaming arrangement, cellularity, nuclei at the cluster margins, peripheral feathering, and anisonucleosis were statistically significant for differentiation. Based on these findings, we developed an algorithm for cytodiagnosis. The algorithm was taught to four cytologists, and the interobserver agreement and correct diagnosis rates were compared before and after education, which showed a significant improvement.The histological types of gastric submucosal spindle cell tumors can be estimated using this algorithm for EUS-FNA cytology. Furthermore, this algorithm can be applied for cytological diagnosis at bedside during rapid on-site evaluation.

NF-E2-related factor 2 (NRF2) is a transcription factor that regulates cytoprotective gene expression in response to oxidative and electrophilic stresses. NRF2 activity is mainly controlled by Kelch-like ECH-associated protein 1 (KEAP1). Constitutive NRF2 activation by NRF2 mutations or KEAP1 dysfunction results in a poor prognosis for esophageal squamous cell carcinoma (ESCC) through the activation of cytoprotective functions. However, the detailed contributions of NRF2 to ESCC initiation or promotion have not been clarified. Here, we investigated the fate of NRF2-activated cells in the esophageal epithelium.We generated tamoxifen-inducible, squamous epithelium-specific Keap1 conditional knockout (Keap1-cKO) mice in which NRF2 was inducibly activated in a subset of cells at the adult stage. Histologic, quantitative reverse-transcription polymerase chain reaction, single-cell RNA-sequencing, and carcinogen experiments were conducted to analyze the Keap1-cKO esophagus.KEAP1-deleted/NRF2-activated cells and cells with normal NRF2 expression (KEAP1-normal cells) coexisted in the Keap1-cKO esophageal epithelium in approximately equal numbers, and NRF2-activated cells formed dysplastic lesions. NRF2-activated cells exhibited weaker attachment to the basement membrane and gradually disappeared from the epithelium. In contrast, neighboring KEAP1-normal cells exhibited accelerated proliferation and started dominating the epithelium but accumulated DNA damage that triggered carcinogenesis upon carcinogen exposure.Constitutive NRF2 activation promotes the selective elimination of epithelial cells via cell competition, but this competition induces DNA damage in neighboring KEAP1-normal cells, which predisposes them to chemical-induced ESCC.

The extreme axial twist of a Pd2L4 cage facilitates tight encapsulation of mono-anions through prolate-oblate cavity adaptation. In the absence of a suitable guest, the helical cage exists in equilibrium with an ‘unwound’ mesocate isomer.

Resorcin[4]arene-based molecular hosts can accommodate coordination complexes in a noncovalent manner to afford a unique host–guest systems, in which the chemical and physical properties of the guests are altered by encapsulation.

Scholars and practitioners often argue that the United States’ identity as a democracy contributes to the effectiveness and endurance of US military alliances. One way to test this claim is to ask: what would happen if citizens of allied countries came to perceive US democracy as severely flawed or diminished? In the context of now well-documented Russian interference in recent US elections, we examine whether Russia’s election interference and its perceived impact on American democracy damage foreign public opinion about the United States. The results of our survey experiment fielded in Japan suggest that information about successful Russian election interference—that is, interference that had an impact on the election outcome—reduces foreign citizens’ faith in the United States as an ally. This pattern most clearly manifests in reduced belief in the US capacity to defend Japan. Our study sheds light on the connections between the image of the United States, both as a trustworthy and effective state, and the foreign public’s attitudes toward US alliances, with theoretical and practical implications.

The best strategy to manage direct-acting oral anticoagulants (DOACs) for patients undergoing cold snare polypectomy remains unclear. This study compared the effect of continuing versus stopping DOACs only on the day of the procedure on bleeding after cold snare polypectomy.This prospective, observational, single-center cohort study enrolled consecutive patients receiving antithrombotic agents and undergoing cold snare polypectomy of colorectal polyps ≤10 mm in diameter. During period 1 (2017 and 2018) antithrombotic agents including DOACs were not discontinued (DOAC continued group). In period 2 (2019 and 2020) DOACs were withheld only on the day of the procedure (DOAC withheld group) and restarted the next day after the procedure. The primary outcome was delayed bleeding requiring endoscopic treatment occurring within 2 weeks after cold snare polypectomy. Secondary outcomes were immediate bleeding and the number of hemostatic clips used.For the 2 groups, 204 (DOAC continued group; 34% women; mean age, 75 years) and 264 (DOAC withheld group; 36% women; mean age, 74 years) patients were enrolled. Clinical features were similar between the 2 groups. Delayed bleeding after cold snare polypectomy occurred in 4 of 47 patients (8.5%) in the DOAC continued group versus 0 of 66 (0%) in the DOAC withheld group (P .001). Immediate postpolypectomy bleeding occurred in 12 of 47 patients (25.5%) in the DOAC continued group versus 4 of 66 (6.1%) in the DOAC withheld group (P .008).Cold snare polypectomy may be safely preformed if DOACs are withheld only on the day of the procedure. (Clinical trial registration number: NCT02594813.).

Nonsteroidal anti-inflammatory drug (NSAID)-induced enteropathy, the mechanism of which is involved in oxidative stress, can be lethal due to hemorrhage. Thus, we aimed to investigate the effect of hydrogen-rich water (HRW), in terms of oxidative stress, on intestinal mucosal damage as well as changes in the gut microbiome and the short-chain fatty acids (SCFAs) content in feces.Hydrogen-rich water was orally administered for 5 days to investigate the effectiveness of indomethacin-induced enteropathy in mice. Small intestinal damage and luminal reactive oxygen species (ROS) were evaluated to investigate the ameliorating effects of hydrogen. Then, components of the gut microbiome were analyzed; fecal microbiota transplantation (FMT) was performed using the cecal contents obtained from mice drinking HRW. The cecal contents were analyzed for the SCFAs content. Finally, cells from the macrophage cell line RAW264 were co-cultured with the supernatants of cecal contents.Hydrogen-rich water significantly ameliorated IND-induced enteropathy histologically and reduced the expression of IND-induced inflammatory cytokines. Microscopic evaluation revealed that luminal ROS was significantly reduced and that HRW did not change the gut microbiota; however, FMT from HRW-treated animals ameliorated IND-induced enteropathy. The SCFA content in the cecal contents of HRW-treated animals was significantly higher than that in control animals. The supernatant had significantly increased interleukin-10 expression in RAW264 cells in vitro.Hydrogen-rich water ameliorated NSAID-induced enteropathy, not only via direct antioxidant effects but also via anti-inflammatory effects by increasing luminal SCFAs. These results suggest that hydrogen may have therapeutic potential in small intestinal inflammatory diseases.

Purpose Diffusion tensor image analysis along the perivascular space (DTI-ALPS) index is intended to reflect the glymphatic function of the brain; however, head rotation may reduce reproducibility and reliability. This study aimed to evaluate whether reorientation of DTI data improves the reproducibility of the ALPS index using the OASIS-3 dataset. Materials and methods 234 cognitively normal subjects from the OASIS-3 dataset were included. Original and reoriented ALPS indices were calculated using a technique that registered vector information of DTI to another space and created reoriented diffusivity maps. The F test was used to compare variances of the original and reoriented ALPS indices. Subsequently, subjects with head rotation around the z- (inferior-superior; n = 43) or x axis (right-left; n = 25) and matched subjects with neutral head position were selected for evaluation of intra- and inter-rater reliability. Intraclass correlation coefficients (ICCs) of the original and reoriented ALPS indices for participants with head rotation and neutral head position were calculated separately. The Bland–Altman plot comparing the original and reoriented ALPS indices was also evaluated. Results The reoriented ALPS index exhibited a significantly smaller variance than the original ALPS index (p 0.85). A wider range of the 95% limit of agreement of the Bland–Altman plot for subjects with x axis rotation was identified, indicating that x axis rotation may remarkably affect calculation of the ALPS index. Conclusion The technique used in this study enabled the creation of reoriented diffusivity maps and improved reproducibility in calculating the ALPS index.

Embolic protection devices are commonly used to prevent cerebral embolism during carotid artery stenting (CAS). However, the PercuSurge Guardwire device, a distal balloon protection device, was discontinued in April 2021. We present a case of successful CAS using a new distal balloon protection system. The procedure, referred to as the jailbreak technique, was performed via transradial access.A 67-year-old man underwent CAS, using the jailbreak technique, for right carotid stenosis with a vulnerable plaque. 6-French (Fr) and 4-Fr Simmons guiding sheaths were delivered into the right common carotid artery via the right and left transradial access, respectively. Distal balloon protection was provided using a 2.6-Fr dual-lumen balloon microcatheter (Pinnacle Blue 20, Tokai Medical Products, Aichi, Japan) via the 4-Fr Simmons guiding sheath. A 4.2-Fr catheter was coaxially delivered proximal to the balloon and distal to the lesion.After CAS was successfully performed via the 6-Fr Simmons guiding sheath, the Pinnacle Blue 20 was retrieved through the 4.2-Fr catheter without interfering with the distal stent flare and stent struts. Postprocedural neuroimaging revealed no evidence of ischemic stroke.The jailbreak technique allows distal balloon protection during transradial CAS. This is a useful treatment option for patients with carotid stenosis.

Abstract: In coronavirus disease 2019 (COVID-19), thrombus formation is related to the pathogen-esis of acute respiratory distress syndrome (ARDS) and the progression of clinical symptoms. Se-vere damage to vascular endothelial cells and the associated cytokine storm after SARS-CoV-2 in-fection cause thrombogenesis and contribute to the development of more severe and unique throm-boses compared to other infectious diseases. Thromboses occur more often in critically ill patients. In addition to pulmonary thromboembolism (PE) and deep vein thrombosis, acute myocardial in-farction, peripheral arterial thrombosis, and aortic thrombosis have also been reported. In PE, thrombi develop in both pulmonary arteries and alveolar capillaries. These, together with intra-alveolar fibrin deposition, interfere with effective gaseous exchange in the lungs and exacerbate the clinical symptoms of ARDS in patients with COVID-19. Pharmacological thromboprophylaxis is recommended for all hospitalized patients to prevent both thrombosis and aggravation of ARDS, and other organ failures. Although the pediatric population is mostly asymptomatic or develops mild disease after SARS-CoV-2 infection, a new inflammatory disorder affecting the cardiovascular system, multisystem inflammatory syndrome in children (MIS-C), has been reported. Similar to Kawasaki disease, acute myocarditis, coronary vasculitis, and aneurysms are typically seen in MIS-C, although these two are now considered distinct entities. A similar acute myocarditis is also ob-served in young male adults, in which a hyperinflammatory state after SARS-CoV-2 infection seems to be involved. Several side effects following vaccination against COVID-19 have been re-ported, including vaccine-induced immune thrombotic thrombocytopenia and acute myocarditis. Although these could be serious and life-threatening, the cases are very rare, thus, the benefits of immunization still outweigh the risks.