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Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated in the Japanese population. Methods: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The clinical characteristics and outcomes were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. Results: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10-26 days] and was longer in the HHS group (19.5 days) compared to the DKA groups (16 days). The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0% to 100%. The median ICU stay was 3 days for all groups. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. The most common complication was infection (18%), followed by pulmonary edema (2.7%), stroke (2.1%), ventricular arrhythmia (1.6%), and deep vein thrombosis (1%). Conclusions: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. Trial registration: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered 23th December 2016)

Objectives Zinc deficiency (Zn < 60 μg/dL) is known to play an important role for vascular calcification. However, little data is available regarding the association between zinc deficiency and aorta stiffness in dialysis patients. Thus, we studied the relationship between zinc deficiency and aorta stiffness in non-diabetic hemodialysis (HD) patients. Methods Of 150 patients receiving maintenance HD at our hospital, we included 79 non-diabetic HD patients (age: 70±11 years, 49 men) after excluding 71 diabetic HD patients. Zinc deficiency was defined as Zn Results The zinc deficiency group (ZD group) included 45 patients (57.0%). Compared to the zinc non-deficiency group (ZND group), patients with ZD group were significantly older, higher levels of CRP and hypoalbuminemia. Moreover, they had significantly higher levels of baPWV, and lower levels of ankle-brachial pressure index (ABI) (p Conclusion The study suggested that zinc deficiency may be an independent risk factor for aorta stiffness, even after adjusting for malnutrition and inflammation.

This study focuses on the conditions for the implementation of the APP, in the form of a concession for the management of the sewerage business. Three uncertainties were identified as limiting factors for PPPs; a) level of service to ensure sustainability, aging of machinery and equipment; b) public spending on rain and the national government subsidy system; c) residents' perception of the water business and the provision of equitable services. The methodology includes case studies (cities of Hamamatsu, Osaka and Nara in Japan). It consists of two parts: a) analysis of relevant published materials and b) application of surveys and semi-structured interviews with municipal officials and, in the case of Osaka, an affiliated company established to operate the sewer business. RESUMEN: Este estudio se centra en las condiciones para la implementación de la APP, en forma de concesión para la gestión del negocio de alcantarillado. Se identificaron tres incertidumbres como factores limitantes para las APP; a) nivel de servicio para asegurar la sostenibilidad, deterioro de maquinaria y equipo; b) gasto público en lluvia y sistema de subsidios del gobierno nacional; c) percepción de los residentes sobre el negocio del agua y la provisión de servicios equitativos. La metodología incluye estudios de casos (ciudades de Hamamatsu, Osaka y Nara en Japón). Consta de dos partes: a) análisis de materiales publicados relevantes y b) aplicación de encuestas y entrevistas semiestructuradas con funcionarios municipales y, en el caso de Osaka, una empresa afiliada establecida para operar el negocio de alcantarillado. RÉSUMÉ: Cette étude se concentre sur les conditions de mise en œuvre du PPP, sous la forme d'une concession pour la gestion de l'entreprise d'assainissement. Trois incertitudes ont été identifiées comme des facteurs limitatifs pour les PPP ; a) niveau de service pour assurer la durabilité, détérioration des machines et des équipements ; b) dépenses publiques en pluie et système de subventions du gouvernement national ; c) perception par les résidents du commerce de l'eau et de la fourniture de services équitables. La méthodologie comprend des études de cas (villes de Hamamatsu, Osaka et Nara au Japon). Il se compose de deux parties : a) l'analyse des documents publiés pertinents et b) l'application d'enquêtes et d'entretiens semi-structurés avec des fonctionnaires municipaux et, dans le cas d'Osaka, une société affiliée établie pour gérer l'entreprise d'assainissement. RESUMO: Este estudo tem como foco as condições de implantação da APP, na forma de concessão para a gestão do negócio de esgotamento sanitário. Três incertezas foram identificadas como fatores limitantes para as PPPs; a) nível de serviço para garantir a sustentabilidade, deterioração de máquinas e equipamentos; b) gastos públicos em chuva e sistema de subsídios do governo nacional; c) A percepção dos residentes sobre o negócio da água e a prestação de serviços equitativos. A metodologia inclui estudos de caso (cidades de Hamamatsu, Osaka e Nara no Japão). Consiste em duas partes: a) análise de materiais publicados relevantes e b) aplicação de enquetes e entrevistas semiestruturadas com funcionários municipais e, no caso de Osaka, uma empresa afiliada estabelecida para operar o negócio da rede de esgotamento sanitário.

FeSe is a unique high-$$T_c$$ T c iron-based superconductor in which nematicity, superconductivity, and magnetism are entangled with each other in the P-T phase diagram. We performed $$^{77}$$ 77 Se-nuclear magnetic resonance measurements under pressures of up to 3.9 GPa on 12% S-substituted FeSe, in which the complex overlap between the nematicity and magnetism are resolved. A pressure-induced Lifshitz transition was observed at 1.0 GPa as an anomaly of the density of states and as double superconducting (SC) domes accompanied by different types of antiferromagnetic (AF) fluctuations. The low-$$T_{\mathrm{c}}$$ T c SC dome below 1 GPa is accompanied by strong AF fluctuations, whereas the high-$$T_{\mathrm{c}}$$ T c SC dome develops above 1 GPa, where AF fluctuations are fairly weak. These results suggest the importance of the $$d_{xy}$$ d xy orbital and its intra-orbital coupling for the high-$$T_{\mathrm{c}}$$ T c superconductivity.

Aim More than 90% of pediatric solid organ abdominal injuries are treated non-operatively. It remains difficult to decide who should graduate to surgical management, more so if adult physicians must make these decisions on pediatric patients. The purpose of this study was to examine outcomes of all pediatric abdominal trauma cases in a single center, focusing on the decision-making algorithm for operative or non-operative treatment by pediatric and adult physicians. Methods We undertook a retrospective review of a pediatric trauma database from April 2006 to March 2016. Groups were divided into operative and non-operative, single or multi-organ injury, and adult or pediatric physician. Operative treatments included laparotomy or interventional radiology procedures. Primary outcome was survival within 30 days. Results There were 53 abdominal trauma cases; among them, 48 (90.6%) survived and 5 (9.4%) died within 30 days. The probability of survival for mortalities was less than 11%. Forty-two cases were treated non-operatively and 11 operatively. Injury Severity Score was higher in operative group (17 [9, 41]/9 [4, 16.3]). Adult physicians saw 33 patients including seven operative, whereas pediatric physicians saw 20 including four operative cases. There was no statistical difference for the management decision between adult and pediatric physicians. Conclusion Our decisions for intervention were within acceptable rates. Adult physicians did not tend to operate more, but there were cases that did not fit the criteria of the algorithm. Further investigation is needed to look at which factors should be focused on to determine whether or not operative treatments are indicated.

We demonstrate high-power continuous-wave (CW) lasing oscillation of 1.3-µm wavelength InP-based photonic-crystal surface-emitting lasers (PCSELs). Single-mode operation with an output power of over 100 mW, a side-mode suppression ratio (SMSR) of over 50 dB, and a narrow single-lobe beam with a divergence angle of below 1.2° are successfully achieved by using a double-lattice photonic crystal structure consisting of high-aspect-ratio deep air holes. The double lattice is designed to enhance both the in-plane optical feedback and the surface radiation effects in the photonic crystal. The coupling coefficients for 180 ∘ , +90 ∘ , and -90 ∘ diffractions are estimated from the measurements of the photonic band structure as κ1D = 417 cm−1, κ2D+ = 135 cm−1, and κ2D− = 65 cm−1, respectively. The stable single-mode, high-beam-quality operation is attributed to these large coupling coefficients introduced by the asymmetric double-lattice structure.

We report on electrically driven InP-based photonic-crystal surface-emitting lasers (PCSELs), which possess a deep-air-hole photonic crystal (PC) structure underneath an active region formed by metal-organic vapor-phase-epitaxial (MOVPE) regrowth. Single-mode continuous-wave (CW) lasing operation in 1.3-μm wavelength is successfully achieved at a temperature of 15°C. It is shown that the enhancement of lateral growth during the MOVPE regrowth process of air holes enables the formation of deep air holes with an atomically flat and thin overlayer, whose thickness is less than 100 nm. A threshold current of 120 mA (threshold current density = 0.68 kA/cm2) is obtained in a device with a diameter of 150 μm. A doughnut-like far-field pattern with the narrow beam divergence of less than 1° is observed. Strong optical confinement in the PC structure is revealed from measurements of the photonic band structure, and this strong optical confinement leads to the single-mode CW lasing operation with a low threshold current density.

To overcome the limitation of the small tuning range of 1.3-µm-wavelength distributed Bragg reflector (DBR) lasers using the carrier-plasma effect, we designed a DBR structure with InAlAs carrier confinement layers and an InGaAlAs core layer. We found that the enhanced carrier density and small effective mass of electrons in the core layer of the DBR regions resulted in a wide Bragg wavelength shift. The enhanced refractive-index change due to the new structure enabled us to fabricate the world’s first 1.3-µm-wavelength superstructure-grating DBR laser with a quasi-continuous tuning range of over 30 nm.

A “palm” cubic-anvil pressure cell (PCAC) having an outer diameter of 60 mm, the smallest cubic-anvil cell to date, was fabricated to insert in a large-bore superconducting magnet. The pressure cell has a sample space of ϕ 2.5 × 1.5 mm^2, which is fairly large for a pressure cell that can reach a high pressure above 4 GPa. Pressure homogeneity was monitored from the ^(63)Cu nuclear-quadrupole-resonance linewidth of Cu₂O up to 6.7 GPa. The linewidth first increased with increasing pressure up to 4 GPa and then saturated above 4 GPa. The pressure homogeneity was better than that of a piston-cylinder pressure cell. The PCAC is advantageous because a large sample space and high pressure homogeneity are secured even at high pressures.

We demonstrate low-loss and broadband light transition from III-V functional layers to a Si platform via two-stage adiabatic-crossing coupler waveguides. A 900-µm-long and 2.7-µm-thick III-V film waveguide consisting of a GaInAsP core and InP cladding layers is transferred onto an air-cladding Si photonic chip by the µ-transfer printing (µ-TP) method. An average optical coupling loss per joint of 1.26 dB is obtained in C + L telecommunication bands (1530-1635 nm). The correlation between alignment offset and measured optical coupling loss is discussed with the frequency distribution of µ-TP samples. We also performed a photoluminescence measurement to investigate the material properties in the GaInAsP layer to see if they are distorted by the strong bending stress produced during the pick-up and print steps of the µ-TP process. The peak intensity reduction of 80-90% and a wavelength shift of 0-5 nm (blue shift) were observed after the process. The series of fundamental studies presented here, which combine multiple analyses, contribute to improving our understanding of III-V/Si photonic integration by µ-TP.

In tooth root development, periodontal ligament (PDL) and cementum are formed by the coordination with the fragmentation of Hertwig's epithelial root sheath (HERS) and the differentiation of dental follicle mesenchymal cells. However, the function of the dental epithelial cells after HERS fragmentation in the PDL is not fully understood. Here, we found that TGF-β regulated HERS fragmentation via epithelial-mesenchymal transition (EMT), and the fragmented epithelial cells differentiated into PDL fibroblastic cells with expressing of PDL extracellular matrix (ECM). In the histochemical analysis, TGF-β was expressed in odontoblast layer adjacent of HERS during root development. Periostin expression was detected around fragmented epithelial cells on the root surface, but not in HERS. In the experiment using an established mouse HERS cell line (HERS01a), TGF-β1 treatment decreased E-cadherin and relatively increased N-cadherin expression. TGF-β1 treatment in HERS01a induced further expression of important ECM proteins for acellular cementum and PDL development such as fibronectin and periostin. Taken together, activation of TGF-βsignaling induces HERS fragmentation through EMT and the fragmented HERS cells contribute to formation of PDL and acellular cementum through periostin and fibronectin expression.

A prototypical electron-doped iron-based superconductor $LaFeAsO_{1-x}H_x$ undergoes an antiferromagnetic (AF) phase for $x \geq 0.49$. We performed NMR measurements on $LaFeAsO_{0.4}H_{0.6}$ at 3.7 GPa to investigate the magnetic properties in the vicinity of a pressure-induced QCP. The linewidth of $~^1H$-NMR spectra broadens at low temperatures below 30 K, suggesting that the ordered spin moments remain at 3.7 GPa. The coexistence of gapped and gapless spin excitations was confirmed in the ordered state from the relaxation time $T_1$ of $~^{75}As$. The pressure-induced QCP is estimated to be 4.1 GPa from the pressure dependence of the gapped excitation. Edited by: A. Goñi, A. Cantarero, J. S. Reparaz

An iron-based superconductor ${\mathrm{LaFeAsO}}_{1\ensuremath{-}x}{\mathrm{H}}_{x}\phantom{\rule{0.16em}{0ex}}(0\ensuremath{\le}x\ensuremath{\le}0.6)$ undergoes two antiferromagnetic (AF) phases upon H doping. We investigated the second AF phase ($x=0.6$) using NMR techniques under pressure. At pressures up to 2 GPa, the ground state is a spin-density-wave state with a large gap; however, the gap closes at 4.0 GPa, suggesting a pressure-induced quantum critical point. Interestingly, the gapped excitation coexists with gapless magnetic fluctuations at pressures between 2 and 4 GPa. This coexistence is attributable to the lift up of the ${d}_{xy}$ orbital to the Fermi level, a Lifshitz transition under pressure.

Various safety devices are provided to ensure the safety of the lift passengers. A number of safety systems are employed to prevent injury in case or uncontrolled movement. The car and counterweight buffers (shock absorber) play an important role. This paper considers appropriate performance of the car and counterweight buffers. Buffer performance is examined to satisfy a safe condition in the revised JIS A 4306.

During tooth development, oral epithelial cells differentiate into ameloblasts in order to form the most mineralized tissue in the vertebrate body: enamel. During this process, ameloblasts directionally secrete enamel matrix proteins and morphologically change from low columnar cells to polarized tall columnar cells, both of which are essential for the proper formation of enamel. In this study, we elucidated the molecular mechanism that integrates ameloblast function and morphology. Immunohistochemistry revealed that the restricted expression of semaphorin 4D (Sema4D) and RhoA activation status are closely associated with ameloblast differentiation in mouse incisors. In addition, in vitro gain-of-function and loss-of-function experiments demonstrated that Sema4D acts upstream of RhoA to regulate cell polarity and amelogenin expression via the Plexin B1/Leukemia-associated RhoGEF (LARG) complex during ameloblast differentiation. Experiments in transgenic mice demonstrated that expression of a dominant-negative form of RhoA in dental epithelium hindered ameloblast differentiation and subsequent enamel formation, as well as perturbing the establishment of polarized cell morphology and vectorial amelogenin expression. Finally, we showed that spatially restricted Akt mediates between Sema4D-RhoA signaling and these downstream cellular events. Collectively, our results reveal a novel signaling network, the Sema4D-RhoA-Akt signal cascade, that coordinates cellular function and morphology and highlights the importance of specific spatiotemporally restricted components of a signaling pathway in the regulation of ameloblast differentiation. © 2016 American Society for Bone and Mineral Research.

We propose a model-based fringe analysis technique that enables the Fourier transform method to analyze dense fringe patterns with large phase variations. The conventional Fourier-transform method has a limited dynamic range of measurable phase because the Fourier spectra broadened by large phase variations cannot be separated by the spatial carrier frequency. Our model-based iterative technique effectively narrows the broad spectrum and reduces phase errors. Results of simulations and experiments are presented that demonstrate the validity of the proposed spectrum-narrowing technique for high-density fringe patterns.

The huge amount of data traffic behind the rapid growth of cloud computing is putting pressure on the operation of mobile fronthauls and data center networks so there is a need to improve their power consumption and latency. We developed an electro-optically tunable laser diode employing a tunable filter that is practically tuned even with small refractive index change of the electro-optic effect. The laser shows a small tuning power dissipation of less than 10 mW for a practical tuning range of over 35 nm with a linewidth of about 350 kHz. We also achieved high-speed optical switching of less than 50 ns for 100 Gb/s coherent signals. In addition to its application in optical communications, the electro-optically tunable laser diode is also beneficial to laser sensing applications because its higher tuning speed increases the time resolution of the sensing system. Furthermore, a narrow linewidth, conventionally difficult to reconcile with high-speed tuning, can also enable a longer sensing distance and/or a higher signal-to-noise ratio when using coherent detection. Our result shows that we can use the electro-optic effect to overcome the limitations of conventional tunable laser diodes and drastically change optical communications and laser sensing systems.

Hydrogen (H)-doped LaFeAsO is a prototypical iron-based superconductor. However, its phase diagram extends beyond the standard framework, where a superconducting (SC) phase follows an antiferromagnetic (AF) phase upon carrier doping; instead, the SC phase is sandwiched between two AF phases appearing in lightly and heavily H-doped regimes. We performed nuclear magnetic resonance (NMR) measurements under pressure, focusing on the second AF phase in the heavily H-doped regime. The second AF phase is strongly suppressed when a pressure of 3.0 GPa is applied, and apparently shifts to a highly H-doped regime, thereby a ``bare'' quantum critical point (QCP) emerges. A quantum critical regime emerges in a paramagnetic state near the QCP, however, the influence of the AF critical fluctuations to the SC phase is limited in the narrow doping regime near the QCP. The optimal SC condition (${T}_{c}\ensuremath{\sim}48$ K) is unaffected by AF fluctuations.

In tooth root development, periodontal ligament (PDL) and cementum are formed by the coordination with the fragmentation of Hertwig's epithelial root sheath (HERS) and the differentiation of dental follicle mesenchymal cells. However, the function of the dental epithelial cells after HERS fragmentation in the PDL is not fully understood. Here, we found that TGF-β regulated HERS fragmentation via epithelial-mesenchymal transition (EMT), and the fragmented epithelial cells differentiated into PDL fibroblastic cells with expressing of PDL extracellular matrix (ECM). In the histochemical analysis, TGF-β was expressed in odontoblast layer adjacent of HERS during root development. Periostin expression was detected around fragmented epithelial cells on the root surface, but not in HERS. In the experiment using an established mouse HERS cell line (HERS01a), TGF-β1 treatment decreased E-cadherin and relatively increased N-cadherin expression. TGF-β1 treatment in HERS01a induced further expression of important ECM proteins for acellular cementum and PDL development such as fibronectin and periostin. Taken together, activation of TGF-βsignaling induces HERS fragmentation through EMT and the fragmented HERS cells contribute to formation of PDL and acellular cementum through periostin and fibronectin expression.

Rationale:Acquired inhibitors of coagulation are antibodies that either inhibit the activity or increase the clearance of a clotting factor. Acquired factor V deficiency is a rare coagulation disorder, and it can sometimes be life threatening.Patient concerns:We describe a case of a 90-year

Charge mosaic (CM) membranes with semi-interpenetrating network structures were prepared by blending poly(vinyl alcohol) as a membrane matrix, poly(allyl amine) as a polycation and poly(vinyl alcohol- co -2-acrylamido-2-methyl propane sulfonic acid) as a polyanion with varying polyelectrolyte contents under different cross-linking conditions. Our method can prepare CM membranes of a large area easily at low manufacture cost. Although the flux of electrolytes through the membrane is less than that through a typical charge mosaic membrane such as Desalton ® (Tosoh Co., Ltd.), which was prepared using micro-phase separation, the permselectivity for electrolytes through the CM membrane was more than 4 times higher than Desalton ® . These CM membranes have enough mechanical strength to form thin layer on a porous support membrane, thereby increasing the flux of electrolytes.

A 49-year-old man with malignant hypertension, acute kidney injury and mental deterioration was referred to our hospital. We initially observed microangiopathic hemolytic anemia, thrombocytopenia and kidney damage, indicating he had thrombotic microangiopathy (TMA). We considered TMA was caused by malignant hypertension and therefore did not start plasma therapy. The French TMA reference center reported that platelet counts and serum creatine levels have high values for predicting severe ADAMTS13 deficiency. The patient fully recovered from his illness after treatment with antihypertensive drugs and intermittent hemodialysis. This case might thus be useful to understand the proper differential diagnosis and treatment of TMA.

エナメル質の基本構造をなすエナメル小柱には横紋が観察される.この横紋は概日リズムを刻んだ成長線のひとつとして知られているが,形成メカニズムについては様々な説がある.非脱灰凍結切片で基質形成期のエナメル基質を抗アメロゲニン抗体で免疫染色すると横紋様パターンを示した.この結果から,横紋は基質形成期のアメロゲニンのタンパク量に依存した石灰化パターンであり,アメロゲニンの発現は概日的に変動するのではないかと推測した.そこで,アメロゲニンの発現に周期があるか観察するために,アメロゲニンプロモーターの下流にルシフェラーゼを繋いだコンストラクト(pGL3-1730-luc)をラットエナメル芽細胞株HAT7に遺伝子導入してアメロゲニンの転写活性を計測したところ,一定の周期をもって変動することが認められた.次に,プロモーター領域のDeletion-mutant (pGL3-464, -74, -48-luc)を作製して周期性の制御に関わる領域を検索した結果, C/EBPαのbindingモチーフが有力な候補と考えられた.その転写はMsx2によって制御を受けることが知られていることから, Msx2の発現ベクターを用いた強制発現の影響を調べたところ,そのリズムが消失した.またMsx2の遺伝子欠損マウスには基質形成の横紋様パターンが見られなかった.以上の結果から, Msx2がアメロゲニンの発現周期に影響していることが推測され,さらにアメロゲニンの発現量の周期的変化によって生じた基質形成パターンが,横紋形成に関与していると考えられた., In enamel rods, periodic bands referred to as 'cross-striations' are observed, and known as incremental lines of circadian rhythm. Though it is considered that the cross-striation is involved in the biological circadian rhythm during the secretion of enamel matrix protein by ameloblasts, the developmental mechanism involved has not been examined in detail. By immunostaining amelogenin in fresh frozen sections of mouse lower incisor, we could observe fluorescent periodic bands in the enamel matrix, which were identical to the pattern of these cross-striations. Accordingly, we focused on the biological rhythm in the section of amelogenin. We examined amelogenin mRNA transcriptional activity in an ameloblast cell line (HAT7) by using real-time luminescence microscopy. The results showed that amelogenin mRNA transcriptional activity exhibited periodic rhythmicity and that Msx2 over-expression led to the disappearance of the periodic change. Further, in the lower incisors of Msx2-deficient mice, the periodic bands were not observed. Taken together, our findings suggest that the formation of cross-striations in the enamel rods was associated with the expression of amelogenin regulated by the transcriptional activity.

We have found that the extinction ratio (ER) of an electroabsorption modulator integrated with a distributed feedback laser strongly depends on the incident power to the modulator. Our theoretical consideration based on full device simulation reveals that the temperature change in the modulator dominates the phenomenon. To obtain the intrinsic extinction characteristics of the modulator, we use microscopic theory, which takes into account quantum mechanical many-body interactions in semiconductors and makes it possible to exclude unknown experimental fitting parameters. A heat-flux analysis is performed for the calculation of the temperature distribution in the entire device. As the incident power to the modulator increases, the photocurrent also increases, leading to an increase in the temperature of the modulator by some tens of degrees Celsius by Joule heating. The increase red-shifts the absorption spectrum of the modulator, and the detuning, which is the difference between the lasing wavelength and the band-edge wavelength of the modulator, becomes small, leading to a larger ER. The calculated results are in good agreement with the experiment, showing the validity of our discussion, and indicate that the ER of electroabsorption modulators is strongly affected by the internal heating of the device.