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Abstract: A 65-year-old male with four-channel aortic dissection successfully underwent replacement of the thoracoabdominal aorta, reconstruction of the celiac, superior mesenteric artery, renal arteries, and 5 pairs of intercostals or lumbar arteries using deep hypothermic technique. [Copyright &y& Elsevier]

A 75-year-old woman who had suffered type B dissection had coronary artery bypass grafting surgery using a mechanical aortic connector. Four days after the operation, she had a sudden syncope. CT demonstrated type A dissection, and an emergency operation was done, and postoperative course was uneventful. This case demonstrates that this connector should be used carefully in patients with a history of type B dissection. [Copyright &y& Elsevier]

Degradation behavior of oxide–nitride–oxide (ONO) stacked gate dielectrics used in metal–oxide–nitride–oxide–silicon (MONOS)-based flash memories has been studied. Occurrence of the soft breakdown (SBD), which is well known in single-layer ultrathin silicon dioxides, has been revealed even in these thick and stacked dielectrics. The SBD of ONO dielectrics shows similar characteristics with that of silicon dioxides in locality, current/voltage fluctuation, and the dependencies of the ratio of SBD on the gate area and stress condition. These findings require the countermeasure for SBD even in MONOS-based flash memories and also give useful information on the reliability of high-k stacked gate dielectrics. © 2003 American Institute of Physics. [ABSTRACT FROM AUTHOR]

A 59-year-old male underwent Bio-Bentall + total arch replacement with a frozen elephant trunk for acute type A aortic dissection before at another hospital. He was diagnosed as mediastinitis and previous graft infection, followed by wound closure with omental flap installation. However, the recurrent graft infection from the aortic root to the FET in the descending aorta was diagnosed by 18-fluorodeoxyglucose positron emission tomography. Redo modified Bio-Bentall procedure, total arch replacement, and descending aortic replacement for previous graft infection using anterolateral thoracotomy with partial sternotomy was successfully performed. Anterolateral thoracotomy with partial sternotomy provided not only the excellent exposure from the aortic root to the descending aorta but also sure myocardial protection with antegrade and selective delivery of cold crystalloid cardioplegia and stable brain protection with antegrade selective cerebral perfusion. The patient is doing well without recurrent of infection after 2 years of the operation. [ABSTRACT FROM AUTHOR]

Investigates the electrical stress-induced variable range hopping conduction in ultrathin silicon dioxides. Proposal of a model for the conduction mechanism of the B-mode stress-induced leakage current (B-SILC); Function of B-SILC; Discussion on the empirical expression for the current-voltage characteristics of the B-SILC.

Background Methods Results Conclusions The COVID‐19 pandemic has affected the lives of people of all ages. Most reports on pediatric cases suggest that children experience fewer and milder symptoms than do adults. This is the first nationwide study in Japan focusing on pediatric cases reported by pediatricians, including cases with no or mild symptoms.We analyzed the epidemiological and clinical characteristics and transmission patterns of 840 pediatric (<16 years old) COVID‐19 cases reported between February and December 2020 in Japan, using a dedicated database which was maintained voluntarily by members of the Japan Pediatric Society.Almost half of the patients (47.7%) were asymptomatic, while most of the others presented mild symptoms. At the time of admission or first outpatient clinic visit, 84.0% of the cases were afebrile (<37.5°C). In total, 609 cases (72.5%) were exposed to COVID‐19‐positive household members. We analyzed the influence of nationwide school closures that were introduced in March 2020 on COVID‐19 transmission routes among children in Japan. Transmission within households occurred most frequently, with no significant difference between the periods before and after declaring nationwide school closures (70.9% and 74.5%, respectively).COVID‐19 symptoms in children are less severe than those in adults. School closure appeared to have a limited effect on transmission. Controlling household transmission from adult family members is the most important measure for prevention of COVID‐19 among children. [ABSTRACT FROM AUTHOR]

We have developed a Monte Carlo wavefunction (MCWF) approach to the singlet fission (SF) dynamics of linear aggregate models composed of monomers with weak diradical character. As an example, the SF dynamics for a pentacene dimer model is investigated by considering the intermolecular electronic coupling and the vibronic coupling. By comparing with the results by the quantum master equation (QME) approach, we clarify the dependences of the MCWF results on the time step (Δt) and the number of MC trajectories (MC). The SF dynamics by the MCWF approach is found to quantitatively (within an error of 0.02% for SF rate and of 0.005% for double-triplet (TT) yield) reproduce that by the QME approach when using a sufficiently small Δt (~0.03 fs) and a sufficiently large MC (~105). The computational time (treq) in the MCWF approach also exhibits dramatic reduction with increasing the size of aggregates (N-mers) as compared to that in the QME approach, e.g., ~34 times faster at the 20-mer, and the size-dependence of treq shows significant reduction from N5.15 (QME) to N3.09 (MCWF). These results demonstrate the promising high performance of the MCWF approach to the SF dynamics in extended multiradical molecular aggregates including a large number of quantum dissipation, e.g., vibronic coupling, modes. [ABSTRACT FROM AUTHOR]

Objectives: Synchrotron radiation-based X-ray phase-contrast tomography (XPCT) has proven innovative modality for analyzing 3D morphology and is useful for understanding the pathophysiology of various cardiovascular disease. To elucidate mechanisms of aneurysmal wall enlargement after endovascular aortic repair (TEVAR or EVAR), we evaluated aortic wall samples after TEVAR and EVAR with XPCT. Methods: Human aortic samples of the descending aorta or abdominal aorta were obtained during open aortic repair for aortic aneurysm (Group-A; n=5),and for aneurysm expansion after endovascular repairs (Group-E: n=7). Normal aorta (Group-N: n=10), obtained from autopsy, were also investigated. Effective resolution of XPCT in Japan Synchrotron Radiation Research Institute / SPring-8 is 11.7 μm. Pathological analysis was performed, subsequently. Results: Age of patients was 76.8 ± 5.4 years old in Group-A, 83.4 ± 5.2 in Group-E, and 57.5 ± 9.5 in Group-N. In Group-E, time from endovascular repair to open aortic repair was 64.2 ± 7.2 months, and initial endovascular repair included TEVAR (n=2) and EVAR (n=5). Representative findings of three groups were demonstrated in figures, including XPCT findings (Fig.A), changes of wall density (B), and pathological findings (C). In Group-N, density of the tunica media was not different within tunica media and average of medial density was 1.085 ± 0.003g/cm3. In Group-A, thickness of aortic wall was lower than Group-N, but density of the tunica media was unchanged (1.079 ± 0.022g/cm3). On contrast, in Group-E, density of the tunica media was significantly lower than Group-N (1.063 ± 0.008; p < 0.005), and differences in density within tunica media were well correlated with distribution of elastic fibers and existence of medial necrosis in pathological analysis. Conclusions: X-ray phase-contrast tomography was a cutting-edge modality to understand aortic structures and degeneration of tunica media in aneurysm expansion after endovascular repair was clearly demonstrated. [ABSTRACT FROM AUTHOR]

There has been no report about in vivo active cholesterol-lowering dipeptide in any protein origin, despite their potential health benefits. Cattle heart protein hydrolysate ultra-filtrate (HPHU, molecular weight < ca. 1,000 Da peptide mixture) exhibits cholesterol-lowering activity in hypercholesterolemic rats, but the active peptide in HPHU that lowers serum cholesterol levels and its molecular mechanism are unknown. In this study, we separated and purified HPHU to identify a novel cholesterol-lowering dipeptide (phenylalanine-proline, FP) and characterized the mechanism underlying its effects in vivo and in vitro. We identified FP as an active peptide from HPHU by MALDI-TOF mass spectrometry. FP significantly decreased serum total and non-HDL cholesterol and hepatic cholesterol levels in rats. FP significantly increased serum HDL cholesterol, accompanied by a significant decrease in the atherogenic index. FP also significantly increased fecal cholesterol and acidic steroid excretion. Moreover, FP significantly decreased ATP-binding cassette transporter A1 (ABCA1) expression in the rat jejunum and reduced cholesterol absorption in Caco-2 cells. We found a novel cholesterol-lowering dipeptide FP that could improve cholesterol metabolism via the down-regulation of intestinal ABCA1. The cholesterol-lowering action induced by FP was disappeared in PepT1KO mice. FP-induced cholesterol-lowering action is mediated via PepT1 in mice. [ABSTRACT FROM AUTHOR]

Purpose: The present study analyzed the outcomes of our experience with abdominal aortic aneurysm (AAA) repair over 20 years using endovascular aortic repair (EVAR) with commercially available devices or open aortic repair (OAR) and reviewed our surgical strategy for AAA. Methods: From 1999 to 2019, 1077 patients (659 OAR, 418 EVAR) underwent AAA repair. The OAR and EVAR groups were compared retrospectively, and a propensity matching analysis was performed. Results: EVAR was first introduced in 2008. Our strategy was changed to an EVAR-first strategy in 2010. Beginning in 2018, this EVAR-first strategy was changed to an OAR-first strategy. After propensity matching, the overall survival in the OAR group was significantly better than that in the EVAR group at 10 years (p = 0.006). Two late deaths due to AAA rupture were identified in the EVAR group, although there were no significant differences between the OAR and EVAR groups with regard to the freedom from AAA-related death at 10 years. The rate of freedom from aortic events at 10 years was significantly higher in the OAR group than in the EVAR group (p < 0.0001). Conclusion: The rates of freedom from AAA-related death in both the OAR and EVAR groups were favorable, and the rate of freedom from aortic events was significantly lower in the EVAR group than in the OAR group. Close long-term follow-up after EVAR is mandatory. [ABSTRACT FROM AUTHOR]

Aims Post-extubation dysphagia (PED), an often overlooked problem, is a common and serious complication associated with mortality and major morbidity after cardiovascular surgery. Dysphagia is considered an age-related disease, and evaluating its long-term effects is a pressing issue with rapidly progressing ageing worldwide. Therefore, we examined the effect of PED on functional status and long-term cardiovascular events in patients undergoing cardiovascular surgery. Methods and results This single-centre, retrospective cohort study included 712 patients who underwent elective cardiovascular surgery and met the inclusion criteria. Patients were divided into PED and non-PED groups based on their post-operative swallowing status. The swallowing status was assessed using the Food Intake Level Scale. Functional status was evaluated as hospital-associated disability (HAD), defined as a decrease in activities of daily living after hospital discharge compared with preoperative values. The patients were subsequently followed up to detect major adverse cardiac and cerebrovascular events (MACCEs). Post-extubation dysphagia was present in 23% of the 712 patients and was independently associated with HAD (adjusted odds ratio, 2.70). Over a 3.5-year median follow-up period, MACCE occurred in 14.1% of patients. Multivariate Cox proportional hazard analysis revealed HAD to be independently associated with an increased risk of MACCE (adjusted hazard ratio, 1.85), although PED was not significantly associated with MACCE. Conclusion Post-extubation dysphagia was an independent HAD predictor, with the odds of HAD occurrence being increased by 2.7-fold due to PED. Hospital-associated disability accompanied by PED is a powerful predictor of poor prognosis. Perioperative evaluation and management of the swallowing status, and appropriate therapeutic interventions, are warranted. [ABSTRACT FROM AUTHOR]

Controlling metal–organic framework (MOF) growth on different substrates is crucial for device fabrication. An Australian–Japanese collaboration between M. Takahashi, P. Falcaro, and co‐workers demonstrates on page 1969 how MOF coatings on flat plates, 3D surfaces, and patterns can be fabricated using a facile, two‐step conversion process at room temperature with aqueous/alocholic solutions. Using copper substrates, nanotubes are grown and then quickly converted to MOF crystals, and MOF patterns are fabricated using sunlight. [ABSTRACT FROM AUTHOR]

• In Japan, Prenatal DTaP vaccination lacks required safety information. • Pertussis seroprevalence is approximately 70% among pregnant Japanese women. • Maternal antibody titers in early pregnancy reflect infant antibody titers. • Preconception DTaP vaccination is one way to obtain maternal immunity. • A national survey to evaluate the safety information of prenatal DTaP is necessary. An increasing number of countries have been introducing acellular pertussis vaccination during pregnancy for the prevention of neonatal pertussis. In response to the fact that infantile pertussis cases of 0–5 months age groups remained unchanged despite the universal vaccination program, prenatal pertussis vaccination has been a rising issue in Japan. Hence, we investigated the seroprevalence of pertussis, diphtheria, and tetanus antibodies in Japanese pregnant women and neonates, and evaluated the necessity of diphtheria-tetanus-acellular pertussis (DTaP) vaccination during the preconception or prenatal period. Maternal PT-IgG (EIA) and FHA-IgG (EIA) for the first trimester, within 1 week after delivery, and cord blood were collected, along with colostrum pertussis-IgA (ELISA), diphtheria-IgG (EIA), tetanus-IgG (EIA), and blood samples from the first trimester. The maternal seroprevalence of PT-IgG and FHA-IgG was 69 % and 75 %, respectively. All tested participants were positive for diphtheria-IgG and tetanus-IgG (100 %). First trimester PT-IgG/FHA-IgG antibody titers were significantly associated with cord blood PT-IgG/FHA-IgG titers (P < 0.001). We found that pertussis seroprevalence among pregnant Japanese women was approximately 70 %. The antibody seropositivity rate of pertussis was lower than that of diphtheria and tetanus. Fetal acquired passive immunity against pertussis is higher when the level of maternal antibody in the first trimester is sufficient. At least 30 % of study population did not reach to the threshold value to provide sufficient pertussis immunity for the neonates and themselves. The acellular pertussis vaccine (DTaP) approved in Japan lacks safety information for pregnancy, hence, a solution for prompt administration of prenatal acellular pertussis vaccination might be introducing DTaP in the preconception period. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES The goal of this study was to evaluate the fate of the downstream aorta following total arch replacement. METHODS Between October 1999 and March 2018, a total of 740 patients underwent total arch replacement. After excluding connective tissue disease, previous descending or thoracoabdominal aortic surgery, patients without adequate preoperative images or operative mortality, late outcomes consisting of additional surgery for distal dilation and distal aortic events were evaluated in 623 survivors (240 aortic dissections, including 139 patients with acute dissection and 383 with a non-dissection aneurysm). The mean follow-up was 5.0 ± 4.0 years. RESULTS The mean preoperative maximum diameter of the descending aorta was 36.9 ± 8.0 mm. An elephant trunk was inserted in 232 patients, including 183 patients with aortic dissection. Freedom from additional surgery for distal dilation was 88.5% at 5 years and 80.2% at 10 years. Freedom from distal aortic events was 81.9% at 5 years and 70.5% at 10 years. Multivariable regression analysis demonstrated that the preoperative diameter of the descending aorta was a significant risk factor for unfavourable distal aortic events. Computed tomography evaluation demonstrated a significant increase in the descending aortic diameter over time (P  < 0.001). Positive aortic remodelling was observed in the proximal descending (P  < 0.001) to mid-descending (P  < 0.001) aorta exclusively in patients with acute aortic dissection. CONCLUSIONS The diameter of the descending aorta increased significantly after total arch replacement, particularly in the distal descending aorta. The preoperative descending aortic diameter portended a significant risk for unfavourable distal aortic events. [ABSTRACT FROM AUTHOR]

Histones are intracellular proteins that are structural elements of nuclear chromatin and regulate gene transcription. However, the extracellular histones released in response to bacterial challenges have been identified as mediators contributing to endothelial dysfunction, organ failure, and death during sepsis. In the present study, the adsorption of histones as well as plasma proteins (α 1 -acid glycoprotein (AGP), albumin, and γ-globulin) on alginic acid, pectin, dextran, and chitosan was examined in order to evaluate the potential of natural polysaccharides as therapeutic agents for multiple organ failure in sepsis. Alginic acid and pectin strongly adsorbed histones, whereas the adsorption abilities of dextran and chitosan toward histones were very low or negligible. Among the natural polysaccharides examined, only alginic acid did not adsorb any of the plasma proteins. These results demonstrated that alginic acid strongly adsorbed histones, but not plasma proteins; therefore, it has potential as a candidate drug for the treatment of multiple organ failure in sepsis. [ABSTRACT FROM AUTHOR]

The degree of pore filling is an important parameter for defining guest@MOF properties in applications including electronics, optics, and gas separation. However, the interplay of key aspects of host–guest interactions, such as a quantitative description of the guest alignment or the structural integrity of the host as function of pore filling are yet to be determined. Polarisation‐dependent infrared spectroscopy in attenuated total reflection configuration combined with gas sorption allowed to simultaneously study the orientation of the guest molecule and structural changes of the MOF framework during the pore filling process. Thereby we found, that initially randomly oriented guest molecules align with increasing pore filling during adsorption from the gas phase. At the same time, the framework itself undergoes a reversible, guest molecule‐dependent rotation of the aromatic linker and a linker detachment process, which induce defects. [ABSTRACT FROM AUTHOR]

Der Grad der Porenfüllung definiert die Gast@MOF‐Eigenschaften in Anwendungen wie Elektronik, Optik und Gastrennung. Das Zusammenspiel von Schlüsselaspekten der Wirt‐Gast‐Wechselwirkungen, wie eine quantitative Beschreibung der Gastausrichtung oder die strukturelle Integrität des Wirts als Funktion der Porenfüllung, muss jedoch noch bestimmt werden. Polarisationsabhängige Infrarotspektroskopie in abgeschwächter Totalreflexionskonfiguration in Kombination mit Gassorption ermöglichten es, gleichzeitig die Orientierung des Gastmoleküls und strukturelle Änderungen des MOF‐Gerüsts während des Porenfüllprozesses zu untersuchen. Dabei stellten wir fest, dass sich zunächst zufällig orientierte Gastmoleküle mit zunehmender Porenfüllung während der Adsorption aus der Gasphase ausrichten. Gleichzeitig erfährt das Gerüst selbst eine reversible, vom Gastmolekül abhängige Rotation des aromatischen Liganden und einen Prozess der Ligandenablösung, wodurch Defekte induziert werden. [ABSTRACT FROM AUTHOR]

OBJECTIVES Presenting a surgical strategy for aorto-oesophageal fistula (AEF). METHODS From October 1999 to August 2013, 16 patients with AEF were treated at Kobe University Hospital. The mean age was 65.5 ± 10.2 years, and the male/female ratio was 13/3. Eight patients had non-dissecting thoracic aneurysm, 3 had chronic aortic dissection, 5 had oesophageal cancer and 1 had fish bone penetration. Five patients were in shock. Four patients had previous thoracic endovascular aortic repair (TEVAR) in the descending aorta and 1 had hemi-arch replacement. As treatment for AEF, 8 patients underwent TEVAR, 2 had a bridge TEVAR to open surgery, 2 had extra-anatomical bypass (EAB) and 5 had in situ reconstruction of the descending aorta. The oesophagus was resected in 8 patients, and an omental flap was installed in 7 patients. For the 4 most recent cases, simultaneous resection of the aorta and oesophagus, in situ reconstruction of the descending aorta using rifampicin-soaked Dacron graft and omental flap installation were performed. RESULTS Hospital mortality was noted in 4 patients (25.0%; persistent sepsis n = 3 and pneumonia n = 1). However, since 2007, only 1 of 5 patients died (pneumonia). All patients with oesophageal cancer died during follow-up. Two patients underwent oesophageal reconstruction using a pedicled colon graft and one is on the waiting list for oesophageal reconstruction. CONCLUSIONS Bridging TEVAR is a useful adjunct in treating AEF patients with shock. One-stage surgery consisting of resection of the aneurysm and oesophagus, in situ reconstruction of the descending aorta and omental flap installation provided a better outcome in the AEF surgical strategy compared with conservative treatment. [ABSTRACT FROM AUTHOR]

Abstract: Coffee stain-driven self-assembly is a general non equilibrium phenomenon which leaves ring-like structures upon evaporation of a colloidal droplet; we have used mesoporous monodispersed beads to form rings with a particular close packed monolayer structure. The mesoporous beads have been characterized by transmission electron microscopy which has revealed a porous radial structure with pores of around 3nm in diameter. During evaporation the mesoporous beads are driven to organize in circular rings which show a 2D long-range ordered structure in the outer part. Arrays of mesoporous rings have been easily produced by casting small colloidal droplets on silicon and soda-lime glass substrates, after solvent evaporation, the rings are stable towards washing with variety of solvents. Absorption of fluorescent molecules into the mesoporous rings has been preliminary studied for lithography-free fabrication of micro sensing arrays. The rings have been used as functional “pits” for droplets containing fluorescent analyte. After removal of the droplets, the rings showed a strong fluorescence resulting from the analyte absorption. [Copyright &y& Elsevier]

Abstract: Etch damage of TiO2 thin films with the anatase phase by capacitively coupled RF Ar plasmas has been investigated. The plasma etching causes a mixed phase of anatase and rutile or the rutile phase. The effect of Ar plasma etching damage on degenerating TiO2 thin films is dependent on gas pressure and etching time. The physical etching effect at a low gas pressure (1.3Pa) contributes to the degradation: the atomic O concentration at the thin film surface is strongly increased. At a high gas pressure (13–27Pa) and long etching time (60min), there are a variety of surface defects or pits, which seem to be similar to those for GaN resulting from synergy effect between particle and UV radiation from the plasmas. For the hydrophilicity, the thin film etched at the high gas pressure and a short etching time (5min) seems to have no etch damage: its contact angle property is almost similar to that for the as-grown thin film, and is independent of the black light irradiation. This result would probably result from formation of donor-like surface defects such as oxygen vacancy. [Copyright &y& Elsevier]

Abstract: This paper compares in detail the resistivity behavior of transparent conducting Al-doped and Ga-doped ZnO (AZO and GZO) thin films for use in an air environment at high temperatures. AZO and GZO thin films with thicknesses in the range from approximately 30 to 100nm were prepared on glass substrates at a temperature of 200°C by rf superimposed dc or conventional dc magnetron sputtering deposition, pulsed laser deposition or vacuum arc plasma evaporation techniques. In heat-resistance tests, the resistivity was measured both before and after heat tests for 30min in air at a temperature up to 400°C. The resistivity stability of AZO thin films was found to be always lower than that of GZO thin films prepared with the same thickness under the same deposition conditions, regardless of the deposition technique. However, the resistivity of all AZO and GZO thin films prepared with a thickness above approximately 100nm was stable when heat tested at a temperature up to approximately 250°C. It was found that the resistivity stability in both GZO and AZO thin films is dominated by different mechanisms determined by whether the thickness is below or above approximately 50nm. With thicknesses above approximately 100nm, the increase in resistivity found in GZO and AZO films after heat testing at a temperature up to 400°C exhibited different characteristics that resulted from a variation in the behavior of Hall mobility. [Copyright &y& Elsevier]

Summary: Recently, the incidence of reported pertussis cases of adults has dramatically increased in Japan. In the present study, we analyzed seven Bordetella pertussis isolates recovered from adults in Japan using pulsed-field gel electrophoresis (PFGE) and sequencing of their antigenic and virulence-associated proteins, compared with those from children. PFGE analysis demonstrated that the adult strains were closely related to the child strains (78–100% genetic similarity). On the other hand, the genotyping revealed that 71% (5/7) of the adult strains and 47% (25/53) of the child strains had the same combination of antigenic/virulence-associated allelic variants (ptxS1B/prn1/fim2-1/fim3A/fhaB1/tcfA2) as the Japanese vaccine strain Tohama, respectively. In comparison to the child strains, there was no apparent antigenic and genetic shift in the adult strains. Our result suggests that (i) there is no B. pertussis circulating strain specific to adults and (ii) the antigenic/virulence-associated proteins are unrelated to the rise in adult pertussis incidence in Japan. [Copyright &y& Elsevier]

Abstract: Vaccinations for children with allergic diseases often need to be postponed or terminated because of the presumed risk of an immediate-type allergic reaction such as anaphylaxis. A new skin test protocol for predicting allergic reactions using the vaccine itself and the following stepwise vaccination method were developed and tested. Intradermal tests using 1:10 and 1:100 diluted measles vaccine indicated that the former was superior to the latter because a positive reaction against 1:10 diluted vaccine was found in 28.6% of 49 patients with severe allergic diseases including bronchial asthma, atopic dermatitis, food allergies and allergies to two or more allergens with high levels of IgE, as compared with the reaction against 1:100 diluted vaccine in 10.2% of the patients. Patients negative for 1:10 skin tests were safe from the following full-dose vaccine shots. Three patients showed very strong local reactions against measles vaccine, and avoided receiving the following full-dose shot. Positive reactions to skin tests of 1:10 diluted vaccine were found in 11 patients, who were given stepwise vaccinations. Three patients had adverse reactions, and two of them had been negative for 1:100 skin tests. In the case of influenza vaccine, skin tests were again more sensitive to 1:10 than to 1:100 diluted vaccine, because 3 out of 14 patients with positive reactions showed immediate-type adverse reactions against the following stepwise vaccinations, and 1 of them was negative for the 1:100 skin test. Moreover, the results of the skin prick test (undiluted vaccine) and the intradermal skin test (1:10 diluted vaccine) indicated that the latter was more useful in both cases of measles (54 patients) and influenza vaccine (69 patients). Overall, the skin test using 1:10 diluted vaccine was the more suitable for predicting an immediate-type reaction to measles and influenza vaccinations. Patients having negative 1:10 skin tests can be expected to show no adverse reactions to the remaining injections and even the positive subjects will complete the course of vaccine doses by the stepwise method. [Copyright &y& Elsevier]

Abstract: In reliability assessment of mechanical structures in the long period, it is important to clarify the fatigue characteristics in such a long sequence of cyclic loading. Thus, ultra-long life fatigue properties of SCM435 steel were experimentally examined in rotating bending. In addition, high cycle fatigue data of the same kind of steels were extracted from the database on fatigue strength of metallic materials published by JSMS (The Society of Materials Science, Japan). These results and original data obtained by the authors were put together, and the statistical fatigue properties of these kinds of steels were analyzed as duplex P–S–N characteristics. [Copyright &y& Elsevier]

Abstract: Objective: Although computed tomography, angiography, or magnetic resonance imaging is most commonly used for diagnosing mesenteric ischemia caused by acute aortic dissection, use of these modalities is often limited in the perioperative period. Thus, we have introduced transesophageal echocardiography to cover this deficit. Purpose of this study is to report the feasibility and accuracy of transesophageal echocardiographic diagnosis on mesenteric ischemia. Methods: The consecutive 24 cases with acute aortic dissection which involved abdominal aorta and underwent surgery were examined. The celiac artery and superior mesenteric artery was visualized with 5MHz biplane transesophageal echocardiography and was assessed for presence of dissection and blood flow in each of true and false lumen. The transesophageal echocardiographic findings were then correlated to the clinical course, computed tomographic findings, and laboratory data. Results: The celiac artery and superior mesenteric artery was successfully visualized in 24 cases (100%) and 23 cases (95.8%), respectively. Perfusion patterns in superior mesenteric artery were categorized into four patterns: (1) intact artery with adequate perfusion (type A: 14 cases); (2) dissection in the artery but with adequate perfusion in true lumen (type B: 5 cases); (3) dissection in the artery with narrowed true lumen compressed by false lumen without detectable blood flow (type C: 1 case); and (4) obstruction of arterial orifice by the intimal flap with narrowed true lumen in the proximal aorta (type D: 2 cases). One case with immediate postoperative death and another case with unsuccessful visualization of superior mesenteric artery were excluded from the analysis. Clinically apparent intestinal ischemia was present in three cases: one case with type C and two cases with type D, but in none of the remaining 19 cases with type A or type B (both sensitivity and specificity were 100%). The superior mesenteric artery was opacified in all of these three cases with ischemia. Conclusions: The transesophageal echocardiographic assessment is feasible in nearly all patients and potentially provides correct diagnosis on intestinal ischemia in the perioperative period of acute aortic dissection. Types C and D indicate significant mesenteric malperfusion. [Copyright &y& Elsevier]

Abstract: The carrier conduction and the degradation mechanism in n+gate p-channel metal-insulator-semiconductor field-effect-transistors with HfAlO X (Hf: 60at.%, Al: 40at.%)/SiO2 dielectric layers have been investigated using carrier separation method. Since gate current depends on substrate bias and both electron and hole currents are independent of temperature over the range of 25–150°C, the conduction mechanism for both currents is controlled by a tunneling process. As the interfacial SiO2 layer (IL) thickness increases in a fixed high-k layer thickness (T high-k), a dominant carrier in the leakage current changes from hole to electron around 2.2-nm-thick IL. This is due to an asymmetric barrier height for electrons and holes at the SiO2/Si interface. On the contrary, in the case of a fixed IL thickness of 1.3nm, the hole current is dominant in the leakage current, regardless of T high-k. It is shown that the dominant carrier in the leakage current depends on the structure of the high-k stack. Both electron and hole currents for the stress-induced-leakage-current (SILC) state increase slightly relative to the initial currents, which means that the trap generation in the high-k stack occurs near both the conduction band edge of n+poly-Si gate and the valence band edge of Si substrate. The electron current at soft breakdown (SBD) state dramatically increases over that for the SILC state, while the hole currents for both the SILC state and SBD are almost the same. This indicates that the defect sites generated in the high-k stack after SBD are located at energies near the conduction band edge of n+poly-Si gate. Both the defect generation rate and the defect size in the HfAlO X /SiO2 stacks are large compared with those in SiO2. It is inferred that, in high-k dielectric stack, the defect generation mainly occurs in the high-k side rather than the IL side, and the defect size larger than the case of SiO2 could be related to a larger dielectric constant of the high-k layer. [Copyright &y& Elsevier]

Abstract: Objective: Although malposition of a catheter for selective cerebral perfusion can lead to postoperative neurologic complications, the clinical relevance or even an incidence of this event is not clear because there have been no measures to diagnose it. The purpose of this study is to report the results of intraoperative diagnosis of catheter malposition by means of near-infrared spectroscopy, orbital ultrasound, and transesophageal echocardiography. Methods: The 35 consecutive patients of aortic arch aneurysm undergoing total arch replacement (13 patients) or transaortic stent graft implantation (22 patients) were examined. The regional oxygen saturation in the frontal lobe was continuously monitored with near-infrared spectroscopy. When cerebral malperfusion was suspected with saturation drop and reduced blood flow in orbital ultrasound, blood flow in the cervical branches and catheter position were examined with transesophageal echocardiography. Results: Catheter malposition was detected in 4 of 35 cases (11.4%). The echo findings included: (1) reduced or absent flow and/or collapsed lumen in the common carotid artery despite an adequate perfusion rate; and (2) the balloon of catheter blocking the inflow to the common carotid artery. There was no unusual changes in parameters of other conventional monitors. After the catheter was withdrawn (three cases) or replaced (one case) based on the above diagnosis, cerebral perfusion was restored, confirmed by these three modalities. An accidental entry of catheter into the right common carotid artery was detected by transesophageal echocardiography in one case, in which there was no abnormal finding of oxygen saturation or orbital blood flow. Conclusions: Catheter malposition on the right side is not a rare event during selective cerebral perfusion. The catheter can migrate into the right subclavian artery or common carotid artery. Pressure monitoring cannot reliably detect an occurrence of catheter migration into the right subclavian artery. Combined use of near-infrared spectroscopy, orbital ultrasound, and transesophageal echocardiography can be useful for detecting this event and making an appropriate decision without delay to prevent irreversible brain damage. [Copyright &y& Elsevier]

Objective: To minimize the neurological complications following cardiovascular surgery, it is essential to prevent an occurrence of cerebrovascular embolism and to detect and solve cerebral malperfusion without delay in the operating theater. Although we have introduced near-infrared spectroscopy (NIRS) monitoring for the purpose of detecting cerebral malperfusion, no criterion has been available. We searched for this criterion by examining the relationship of sustained drop in the regional oxygen saturation (rSO2) of the frontal lobes to the occurrence of neurological events. Methods: The 59 consecutive patients undergoing aortic surgery with selective cerebral perfusion (SCP) were examined. The rSO2 was monitored throughout the surgery and the durations of drops in rSO2 to below 55% and those below 60% were determined for each patient. The durations of rSO2 drop and other surgery-related parameters were compared between the patients in whom neurological events occurred and those without such events. Results: A total of 16 cases (27.1%) presented with neurological events. Newly developed cerebral infarction was documented in 6 of these 16 cases. Operation time and the durations for which rSO2 dropped were significantly longer for the 16 patients with neurological events than for the 43 patients without events (Op time: 546.8 versus 448.1min, P=0.0064; rSO2 below 60%: 141.2 versus 49.8min, P=0.0032; rSO2 below 55%: 66.6 versus 10.6min, P=0.0011), while there was no significant difference in age, bypass time, aortic clamping time, SCP time, and circulatory arrest time between the two groups. In the 3 patients with infarcts suggestive to hypoperfusion, sustained decrease in rSO2 was observed, while it was not significant in the remaining 3 patients with infarcts suggestive to embolism. Among the 53 patients without infarction, transient neurological events occurred more frequently in patients with sustained drop in rSO2 below 55% for over 5min (44.4% versus 5.7%, P=0.0014). Conclusions: A sustained drop in rSO2 during aortic surgery is closely related to the occurrence of neurological events following surgery. We recommend that recovery of drop in rSO2 below 55% should be addressed without delay. However, use of NIRS is limited for detecting embolic events or hypoperfusion in the basilar region. [Copyright &y& Elsevier]

Objectives: Although endovascular stent-grafting is available for atherosclerotic thoracic aneurysms, it is unknown whether the excluded thrombosed aneurysms shrink. We evaluated serial changes in distal aortic arch or proximal descending aortic aneurysms excluded space after transaortic stent-grafting. Methods: Thirty-four patients with true distal aortic arch or proximal descending thoracic aortic aneurysms were treated by stent-grafts introduced via proximal arch aortic incisions. Follow-up included computed tomographs (CT) every 6 months in 31 patients. The maximum dimensions for excluded space and aneurysmal diameters were measured and evaluated to determine whether the aneurysmal space had decreased or shrunken following this alternative procedure. Results: Two hospital deaths (5.9%) were caused by a cerebral embolism and a peri-operative myocardial infarction. Another case died from pneumonia a year after surgery. Thirty-one cases (91%) survived during follow-up, but one case suffered from paraplegia (2.9%). The follow-up period ranged from 10 to 72 months (average 39.3±27.2 months). There were no aneurysmal ruptures during follow-up. Post-operative serial CTs showed a disappearance or a significant shrinkage of the excluded aneurysmal space in 30 of the 31 cases (97%); one case suffered endoluminal leakage. Conclusions: Transaortic endovascular stent-grafting is feasible for distal aortic arch or proximal descending aortic aneurysms. The excluded aneurysmal space disappears or shrinks after successful stent-graft placement. [Copyright &y& Elsevier]

Assessment of frailty is important for risk stratification among the elderly with severe aortic stenosis (AS) when considering interventions such as surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR). However, evidence of the impact of preoperative frailty on short-term postoperative outcomes or functional recovery is limited. This retrospective study included 234 consecutive patients with severe AS who underwent SAVR or TAVR at Kobe University Hospital between Dec 2013 and Dec 2019. Primary outcomes were postoperative complications, postoperative 6-min walking distance (6MWD), and home discharge rates. The mean age was 82 ± 6.6 years. There were 169 (SAVR: 80, TAVR: 89) and 65 (SAVR: 20, TAVR: 45) patients in the non-frail and frail groups, respectively (p = 0.02). The postoperative complication rates in the frail group were significantly higher than those in the non-frail group [30.8% (SAVR: 35.0%, TAVR: 28.9%) vs. 10.7% (SAVR: 15.0%, TAVR: 6.7%), p < 0.001]. The home discharge rate in the non-frail group was significantly higher than that in the frail group [85.2% (SAVR: 81.2%, TAVR: 88.8%) vs. 49.2% (SAVR: 55.0%, TAVR: 46.7%), p < 0.001]. The postoperative 6MWD in the non-frail group was significantly longer than that in the frail group [299.3 ± 87.8 m (SAVR: 321.9 ± 90.8 m, TAVR: 281.1 ± 81.3 m) vs. 141.9 ± 92.4 m (SAVR: 167.8 ± 92.5 m, TAVR: 131.6 ± 91.3 m), p < 0.001]. The TAVR group did not show a decrease in the 6MWD after intervention, regardless of frailty. We report for the first time that preoperative frailty was strongly associated with postoperative complications, 6MWD, and home discharge rates following both SAVR and TAVR. Preoperative frailty assessment may provide useful indications for planning better individualized therapeutic interventions and supporting comprehensive intensive care before and after interventions. [ABSTRACT FROM AUTHOR]

Acrylic rubber (ACM) nanocomposites reinforced with cellulose nanocrystals (CNCs) were prepared and the properties were characterized. CNCs were produced by hydrochloric acid hydrolysis of microcrystalline cellulose powder and used without further chemical modification of the surfaces. The CNCs were already aggregated in aqueous suspension. However, their aggregated sizes and uniform distribution in the ACM did not change with increase in the concentration of CNC. This result suggested good compatibility of the CNC with ACM. Fourier-transform infrared/attenuated total reflection spectroscopy revealed that the good compatibility could be attributed to attractive interactions between CNC and ACM. The good compatibility led to an increase in breaking stress of the ACM/CNC nanocomposites, up to about 10 MPa at a high concentration of 24 phr of CNC. Thermal decomposition of the nanocomposites occurred due to first the CNC followed by the ACM. More weight residues of the nanocomposites were found above 400 °C with increase in the concentration of CNC. The char produced by the decomposition of CNC is suggested the act as a flame retardant for ACM. In addition, the swelling ratio of the ACM/CNC nanocomposites against hydrophobic solvents decreased with increase in the concentration of CNC. The hydrophilic properties of the unmodified CNC from the surface hydroxyl groups increased the oil-resistant properties of the ACM. [ABSTRACT FROM AUTHOR]

The management of non-operable chronic thromboembolic pulmonary hypertension (CTEPH) has evolved with the availability of balloon pulmonary angioplasty (BPA) and pulmonary vasodilators. We launched the BPA program in 2011. The aim was to analyze the survival and treatment efficacy of our CTEPH treatment program in the modern management era. We retrospectively reviewed data from 143 consecutive CTEPH patients diagnosed from January 2011 (i.e. after the availability of BPA) to December 2019. Of forty-one patients who underwent pulmonary endarterectomy (PEA), 25 underwent additional BPA (Combination group) and the others were treated with only PEA (PEA group). Ninety patients underwent BPA (BPA group). The remaining 12 patients did not undergo any interventional treatments. The 1- and 5-year survival rates of operated patients (n = 41) were 97.4% and 90.0%, compared to 96.9% and 86.9% in not-operated patients (n = 102), respectively (p = 0.579). There was no mortality in the Combination group. Mean pulmonary artery pressure after treatments in the PEA only, Combination, and BPA only groups was 20.5 ± 6.7, 17.9 ± 4.9, and 20.7 ± 4.6 mmHg, respectively (p = 0.067, one-way ANOVA). Percent decrease of pulmonary vascular resistance in each treatment groups was −73.7 ± 11.3%, −74.3 ± 11.8%, and − 54.9 ± 22.5%, respectively (p < 0.01, one-way ANOVA). There was no significant difference in long-term survival between operated and not-operated CTEPH. Moreover, the Combination approach might have the potential to introduce notable improvements in the prognosis of CTEPH. BPA and PEA appear to be mutually complementary therapies in the modern management era. • Almost all CTEPH can be treated mechanically with PEA or BPA or both, and this may lead to a notable improvement in the prognosis. [ABSTRACT FROM AUTHOR]

There is some evidence that Bordetella pertussis (B. pertussis) can co-infect with viral respiratory infections in young infants. B. pertussis infection was studied by culture, polymerase chain reaction (PCR), and loop-mediated isothermal amplification (LAMP) from nasopharyngeal swabs (NPSs) in 49 infants < 12 months of age, who were admitted for lower respiratory tract infections during the winter season. Seven other possible viral pathogens were documented by antigen detection or PCR in NPSs. The clinical feature of infants with mixed infection of B. pertussis and respiratory viruses were examined. Overall, B. pertussis infection was found in 10 (20.4%) cases, nine were less than 6 months of age and seven were unvaccinated. Viral etiology was found in 41 (84%) cases and pertussis-viral co-infection was present in eight patients, five of whom had mixed infection with respiratory syncytial virus. Only the presence of staccato coughing, cyanosis, and lymphocytosis were significantly different in B. pertussis -positive cases compared with B. pertussis -negative cases. Of the 10 pertussis cases, only the culture-positive cases showed the typical symptoms and laboratory findings of pertussis in addition to virus-associated respiratory symptoms with severe hospital course, whereas cases identified as DNA-positive lacked the characteristics of pertussis and their clinical severities were the same as B. pertussis -negative cases. In the absence of typical paroxysmal cough and lymphocytosis, we should carefully consider diagnosis of pertussis in young children hospitalized for presumed viral respiratory illness according to local epidemiological surveillance. [ABSTRACT FROM AUTHOR]

OBJECTIVES We aimed to identify predictors of postoperative permanent neurological deficits (PNDs) and evaluate the early management of cerebral perfusion in patients undergoing surgical repair of acute type A aortic dissection with cerebral malperfusion. METHODS Between October 2009 and September 2018, a total of 197 patients with acute type A aortic dissection underwent aortic replacement. Of these, 42 (21.3%) patients had an imaging cerebral malperfusion (ICM). ICM was assessed preoperatively, which also revealed whether dissected supra-aortic branch vessels were occluded or narrowed by a thrombosed false lumen. After September 2017, early reperfusion and extra-anatomic revascularization were performed in cases with ICM. RESULTS Hospital mortality rates for cases with ICM were 4.8% (2/42). Before September 2017, PND were observed in 6 patients (54.5%) with preoperative neurological symptoms (n  = 11), and 7 patients (33.3%) without neurological symptoms (n  = 21) in patients with ICM. Occlusion or severe stenosis of supra-aortic branch vessels (odds ratio, 7.66; P  <   0.001), regardless of preoperative clinical neurological symptoms, was a risk factor for PND. After September 2017, 7 of 10 patients with ICM underwent early reperfusion and extra-anatomic revascularization. PND did not occur in any of these 7 patients. CONCLUSIONS Occlusion or severe stenosis of supra-aortic branch vessels is a predictor of PND risk in patients undergoing surgery for acute type A aortic dissection. Early reperfusion and extra-anatomic revascularization may reduce the risk of neurological complications in patients with ICM, with or without neurological symptoms. [ABSTRACT FROM AUTHOR]

The ideal situation in constructing a broadband communication network is that all kinds of services are provided by a single network. Such a structure is not necessarily advantageous at the present state of technology. From such a viewpoint, the best approach would be first to construct an economically-optimum system, mostly considering the C - E type broadband distribution service, which is estimated to have the highest demand, and gradually extend the network for other services. This paper first describes that the configuration combining the star-type subscriber link and the tree-type trunk lines is economical and has the functional expendability. Next another configuration is considered, in which the optical fiber is used for the subscriber link and the frequency division switch is used for the channel selections in the conversion of network topology. It is shown that the system is the optimum from the viewpoint of the cost per subscriber. By applying the notion of the cross-contact switch, it is shown that the proposed system can be ex- tended to the C - E type video retrieval service and E - E type transmission service. The optical distribution system will be utilized effectively in the future new media, providing the basis for the broadband communication network. [ABSTRACT FROM AUTHOR]

Thirty-one Japanese nonresponders to subcutaneous hepatitis B vaccination and 15 medical personnel who were accidentally exposed to specimens positive for hepatitis B e antigen and were given hepatitis B immunoglobulin were intradermally immunized with 5 micrograms of plasma-derived hepatitis B vaccine every 2 weeks until delayed type hypersensitivity skin reaction to hepatitis B surface antigen became positive. Thirty (97%) of the 31 nonresponders developed delayed type hypersensitivity skin reactions to hepatitis B surface antigen after 2.3 +/- 1.2 (mean +/- SD) revaccinations. Twenty-nine (94%) of the 31 nonresponders had anti-hepatitis B surface antigen antibody levels greater than 10 IU/L. The immunoglobulin subclass of the antibody to hepatitis B surface antigen was mainly IgG1. After 1 year, 23 (74%) of the 31 nonresponders continued to have anti-hepatitis B surface antigen antibody levels greater than 10 IU/L. Persons accidentally exposed to specimens positive for hepatitis B e antigen developed delayed type hypersensitivity skin reactions to hepatitis B surface antigen following 3.1 +/- 1.1 revaccinations. None developed clinical hepatitis. There was no production of anti-hepatitis B core antigen antibody 1 year after exposure, indicating that protection was 100%. Intradermal hepatitis B vaccination is useful in reversing nonresponsiveness to hepatitis B surface antigen and for prophylaxis after exposure. [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that human pluripotent stem cell-derived cardiomyocytes can affect "heart regeneration", replacing injured cardiac scar tissue with concomitant electrical integration. However, electrically coupled graft cardiomyocytes were found to innately induce transient post-transplant ventricular tachycardia in recent large animal model transplantation studies. We hypothesised that these phenomena were derived from alterations in the grafted cardiomyocyte characteristics. In vitro experiments showed that human embryonic stem cell-derived cardiomyocytes (hESC-CMs) contain nodal-like cardiomyocytes that spontaneously contract faster than working-type cardiomyocytes. When transplanted into athymic rat hearts, proliferative capacity was lower for nodal-like than working-type cardiomyocytes with grafted cardiomyocytes eventually comprising only relatively matured ventricular cardiomyocytes. RNA-sequencing of engrafted hESC-CMs confirmed the increased expression of matured ventricular cardiomyocyte-related genes, and simultaneous decreased expression of nodal cardiomyocyte-related genes. Temporal engraftment of electrical excitable nodal-like cardiomyocytes may thus explain the transient incidence of post-transplant ventricular tachycardia, although further large animal model studies will be required to control post-transplant arrhythmia. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Valve repair for aortic insufficiency (AI) requires a tailored surgical approach determined by the leaflet and aortic disease. In this study, we used a repair-oriented system for the classification of AI, and we elucidated long-term outcomes of aortic root reimplantation with this classification system. METHODS From 1999 to 2018, a total of 197 patients underwent elective reimplantation (mean age: 52.7 ± 17.7 years; 80% male). The aortic valve was tricuspid in 143 patients, bicuspid in 51 patients and quadricuspid in 3 patients. A total of 93 patients had type I AI (aortic dilatation), 57 patients had type II AI (cusp prolapse) and 47 patients had type III AI (restrictive). In total, 104 of the 264 patients (39%) had more than 1 identified mechanism. RESULTS In-hospital mortality was 0.5% (1/197). Mid-term follow-up (mean follow-up duration: 5.5 years) revealed a late mortality rate of 4.2% (9/197). Aortic valve reoperation was performed on 16 patients (8.0%). Rates of freedom from aortic valve replacement and freedom from aortic valve-related events at 10 years of follow-up were 87.0 ± 4.0% and 60.6 ± 6.0%, respectively; patients with type Ib AI (98.3 ± 1.7%; 80.7 ± 7.5%) had better outcomes than patients with type III AI (59.6 ± 15.6%; 42.2 ± 13.1%, P  = 0.01). In patients with types II and III AI who had bicuspid aortic valves, rates of freedom from aortic valve-related events at 5 years of follow-up were 95.2 ± 4.7% and 71.7 ± 9.1%, respectively (P  = 0.03). CONCLUSIONS This repair-oriented system for classifying AI could help to predict the durable aortic valve repair techniques. Patient selection according to the classification is particularly important for long-term durability. Clinical trial registration number B190050. [ABSTRACT FROM AUTHOR]

Background Japanese encephalitis (JE) is the leading cause of viral encephalitis with high mortality and morbidity in Asia. In Japan, however, the active recommendation of JE vaccine was retracted in 2005 because of the potential risk of acute disseminated encephalomyelitis. We aimed to determine the recent incidence of childhood-onset JE after the domestic change of vaccination policy in Japan, and to analyze the clinical features of affected children. Methods A retrospective nationwide survey was conducted for pediatric patients with JE in Japan from 1995 to 2015. The national surveillance system was used to identify the pediatric patients with JE. Follow-up questionnaires were sent to analyze their clinical and neuroimaging profiles. Results Among a total of 109 patients registered to the national surveillance, 10 (9%) were less than age 15 years. The annual incidence rate of childhood-onset JE was higher during 2005–15 than that during 1995–2004 (4.3 × 10–3 vs 1.1 × 10–3 per 100000, respectively; P =.04). Endemic regions overlapped with prefectures that farmed pigs harboring antibodies against JE virus with high prevalence. Detailed clinical data were collected from 9 patients. None of them died, but 5 of 9 patients (56%) had neurological sequelae after recovery. One patient who was partially vaccinated with 2 doses of JE vaccine fully recovered from a coma. The age of 3 years or less was associated with unfavorable neurological prognosis. Conclusions Our data provide evidence for the importance and prophylactic effect of the JE vaccine in young children in the endemic area. [ABSTRACT FROM AUTHOR]

Introduction: We have been developing a closed-circuit cardiopulmonary bypass (CPB) system ("Dihead CPB") for application during coronary artery bypass grafting (CABG) and valve surgery. To strive for minimal hemolysis during Dihead CPB, we compared the hemolysis caused by three different suction systems and performed a clinical study with the newly applied suction system. Materials & Methods: We evaluated the hemolysis caused by roller-pump suction, the SmartSuction® Harmony® and wall suction systems with respect to suction speed and compared the systems by means of in vitro studies. A clinical study was also performed on 15 volunteers to assess hemolysis and the adequacy of the newly applied suction system with Dihead CPB. Results: Pressure inside the suction cannula was −22.5 ± 0.1 mmHg at a maximum flow of 1.5 L/min for roller-pump suction and −43.4 ± 0.1 mmHg at −150 mmHg of the set vacuum pressure of wall suction. With the SmartSuction, the pressure inside the cannula varied from −76.3 ± 1.0 to −130.3 ± 1.5 mmHg, depending on suctioning conditions. Suction speed (to suction 50 ml of blood) was fastest with the SmartSuction (69.7 ± 3.58 s) whereas, with roller suction, it was 117.3 ± 8.47 s and with wall suction 96.9 ± 7.10 s. The SmartSuction had the highest hemolysis rate (2.00 ± 0.33%) vs. 0.61 ± 0.10% for roller suction and 0.41 ± 0.11% for wall suction (p<0.001). The clinical study with wall suction showed no significant increase in plasma free hemoglobin during or after CPB compared with before surgery. Conclusions: Wall suction had less hemolysis than roller suction or the SmartSuction in the in vitro study and the clinical study with wall suction showed efficient suction speed and acceptable hemolysis, suggesting that Dihead CPB with wall suction is feasible for CABG. [ABSTRACT FROM AUTHOR]

The singlet fission (SF) dynamics of pentacene linear aggregate models are investigated using the quantum master equation method by focusing on the Frenkel excitonic (FE) coupling effects on the SF rate and double triplet (TT) yield as well as on their aggregate size dependences. It is found that for the dimer model, unrealistically large FE couplings are needed to provide significant effects on the SF dynamics, while for the larger aggregate models a realistic FE coupling causes significant variations in the SF dynamics: as increasing the aggregate size, the SF rate rapidly increases, attains the maximum at 8‐mer (~3 times enhancement as compared to the non‐FE‐coupling case) and then decreases, approaching a stationary value after 12‐mer, although the stationary TT yield at 20‐mer remains slightly smaller than that in the non‐FE‐coupling case. These features are explained based on the relative relaxation factors between the adiabatic exciton states. The present results contribute to constructing the design guidelines for highly efficient SF aggregates. © 2018 Wiley Periodicals, Inc. The singlet fission (SF) dynamics of pentacene linear aggregates are investigated using the quantum master equation method by focusing on the Frenkel excitonic (FE) coupling effects on the SF rate and double triplet yield as well as on their aggregate size dependences. It is found that a realistic FE coupling causes significant size‐dependent variations in the SF rate, which are explained by the relative relaxation factor analysis. [ABSTRACT FROM AUTHOR]

Highlights • An active surveillance through a phased introduction of the Hib vaccine in Japan was studied. • Hib disease incidence decreased significantly after vaccine introduction. • Hif and non-typeable H. influenzae were isolated from a few cases. • Serotype replacement was not observed after the introduction of the Hib vaccine. • Continuous capsular typing and strain identification surveillance is important. Abstract Background Haemophilus influenzae type b (Hib) vaccine was introduced as a voluntary vaccine in December 2008 and was included in the national routine immunization program in April 2013 in Japan. Currently, no nationwide data are available to evaluate the effectiveness of Hib vaccine in Japan. Methods To evaluate the effectiveness of Hib vaccine in Japan, nationwide active population-based surveillance of culture-proven invasive infections caused by H. influenzae in children was performed in 2008–2017 in 10 prefectures in Japan (covering approximately 23% of the total Japanese population). Clinical data were recorded on a standardized case report form. Capsular type and antimicrobial susceptibility of the H. influenzae isolates were examined. The incidence rate ratio (IRR) and its confidence interval (CI) were calculated to compare data from 5 years before and that from after the introduction of the national routine Hib vaccine immunization program. Results During the 10-year study period, 566 invasive H. influenzae disease cases including 336 meningitis cases were identified. The average number of invasive H. influenzae disease cases among children <5 years of age during 2013–2017 decreased by 93% (IRR: 0.07, 95%CI 0.05–0.10, p < 0.001) compared with those occurring during 2008–2012. Hib strains have not been isolated from invasive H. influenzae disease cases since 2014; however, non-typeable H. influenzae and H. influenzae type f isolates have been noted as causes of invasive H. influenzae diseases among children <5 years in the post-Hib vaccine era. Conclusions After the governmental subsidization of the Hib vaccine, invasive Hib disease cases decreased dramatically in the study population, as per our surveillance. Continuous surveillance is necessary to monitor the effectiveness of Hib vaccine and for detecting any emerging invasive capsular types. [ABSTRACT FROM AUTHOR]

Abstract: The aromaticity of dicyclopenta‐fused acenes (DPAs) and polyacenes (PAs) of increasing size has been studied by evaluation with the GIMIC method at the DFT level of the magnetically‐induced currents (MICs), and by analyzing their spatial distributions. For these open‐shell singlet molecules, spin‐restricted and ‐unrestricted treatments provide very different MICs, the latter ones providing the most reliable solution. These MICs and the differences between spin‐restricted and ‐unrestricted treatments are interpreted in terms of the bond current strengths and the current gradients, which indicate the bond aromaticity and enable the spatial distributions of the diatropic and paratropic currents to be analyzed, respectively. In particular, they allow the rationalization of the MICs in correlation with the odd‐electron density distributions and their diradical characters. These calculations demonstrate that 1) in increasingly large PAs the bond current strengths get smaller and smaller than in benzene and get almost similar in the central and terminal rings, 2) for DPAs the MICs increase from dominant paratropic currents and antiaromaticity in the small compounds to diatropic currents and aromaticity in the larger ones, and 3) in the largest DPAs, the central rings are characterized by large diatropic currents and the terminal five‐membered rings, for which the odd‐electron densities are localized by weak ones. [ABSTRACT FROM AUTHOR]

Background In September 2015, Japan experienced an unusual increase in acute asthma hospitalizations of children that coincided with an enterovirus D68 (EV-D68) epidemic. The objective of this study is to investigate whether EV-D68 had a causal relationship with the spike in asthma hospitalizations. Methods A nation-wide retrospective survey of asthma hospitalizations of children was performed for the period from January 2010 through October 2015. The Japanese Society of Pediatric Allergy and Clinical Immunology asked its affiliated hospitals to report monthly numbers of hospitalizations, ICU admissions and mechanical ventilations due to acute asthma exacerbation. The data were retrieved from medical databases using predefined search criteria: diagnosis of asthma or asthmatic bronchitis, admission, and age <20 years. Monthly numbers of EV-D68 detection were also obtained from the Infectious Disease Surveillance Center of Japan. A Granger causality test was used to analyze the association of EV-D68 detections for asthma exacerbation. Results A total of 157 hospitals reported 87,189 asthma hospitalizations, including 477 ICU admissions and 1193 mechanical ventilations, during the survey period of 5 years and 10 months. The numbers of these events increased drastically in September 2015. The Granger causality test verified the association between EV-D68 and asthma hospitalizations/mechanical ventilations. The most-affected age group was 3–6 years old. Conclusions The spike in pediatric asthma hospitalizations in Japan in September 2015 was found to be associated with the EV-D68 epidemic. Respiratory pathogens can cause “epidemics” of asthma exacerbation. Coordinated surveillance of infectious diseases and asthma may be beneficial for prevention and better control of both illnesses. [ABSTRACT FROM AUTHOR]

We describe our experience with a patient who had metastasized pulmonary artery sarcoma, but survived 7 years after diagnosis. A 61-year-old man was diagnosed with pulmonary artery intimal sarcoma after resection of metastatic tumours to the bilateral lungs. The primary lesion in the pulmonary artery trunk extending into the bilateral branches was treated by tumour endoarterectomy followed by chemotherapy. He underwent resections of lung metastases two more times before detection of recurrent obstructive pulmonary artery sarcoma 4 years after the tumour endoarterectomy. En bloc resection of the tumour including the pulmonary artery trunk, valve and interventricular septum was performed, and the right ventricular out flow tract was reconstructed with a stentless pulmonary valve and equine pericardium. He died of the disease soon after an operation for metastatic brain tumour 3 years later. Pulmonary artery sarcoma has a dismal prognosis, but aggressively repeated surgical interventions may lengthen survival. [ABSTRACT FROM AUTHOR]

The elephant trunk technique is used as a standard method in the approach to staged repair of extensive thoracic aneurysms. Here, we present a rare case of a graft infection, in which vegetation was attached to the distal end of the elephant trunk. A 36-year old male who had undergone total arch replacement with elephant trunk installation for type A aortic dissection was readmitted for high-grade fever. At the time of admission, Osler's nodules were present and brain magnetic resonance imaging showed multiple small emboli and haemorrhages. Transoesophageal echocardiography could not locate any sign of infection within the cardiac chambers, but disclosed vegetation attached to the elephant trunk. He underwent successful emergent graft replacement of the lesion, and no recurrence of the infection has been observed. [ABSTRACT FROM AUTHOR]