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We report a 50‐year‐old man who developed fatal brainstem infarction five days after traumatic cervical vertebral artery dissection (CVAD). Autopsy revealed multiple fresh infarcts in the territory of the vertebrobasilar system. No thrombus was found in the infarct lesions. The cervical vertebral artery (CVA) showed severe atherosclerotic stenosis extending to the proximal half of the left side, similar stenosis at the origin on the right side, fresh thrombotic occlusion extending to the proximal half of the right side, and multiple dissections in the distal foraminal segments on both sides. In the distal half of the basilar artery (BA) and the origin of the right posterior cerebral artery (PCA), the lumen was extensively filled with fresh thrombus. Although an intricate mixture of white and red thrombi filled the lumen at the origin of the right PCA, the white thrombus gradually appeared at the periphery whereas the red thrombus occupied the central and more proximal part of the BA. We confirm that cerebral infarction associated with CVAD is due not only to emboli originating from the dislodged thrombus at sites of arterial dissection, as reported previously, but also to newly formed thrombus in the cerebral arteries caused by impaired blood flow, as was seen in the present case. [ABSTRACT FROM AUTHOR]

Background and Aim: Although previous studies compared the efficacy of infliximab (IFX) versus adalimumab (ADA) as the first‐line biologics for Crohn's disease (CD), the difference in long‐term prognosis based on which biologic was used first has scarcely been reported. In particular, the clinical courses after loss of response (LOR) of the first‐line biologics are largely unknown. Methods: A multicenter, retrospective study was performed. Disease courses of biologic‐naïve CD patients who were started on IFX or ADA treatment were evaluated, even after LOR of the initial biologics. Results: In total, 263 CD patients were eligible for analysis, 183 were treated with IFX first, and 80 were treated with ADA first. The median observation period was 64.2 months. The cumulative steroid‐free remission rates and surgery‐free rates did not differ significantly between the patients treated with IFX first and those treated with ADA first (log‐rank test P = 0.42 and P = 0.74, respectively). In addition, no significant difference was observed in the rate of occurrence of events associated with ineffectiveness (modification of anti‐tumor necrosis factor treatment including intensification, switch, discontinuation, or surgery) between the patient groups (log‐rank test P = 0.62). The patients treated with IFX first were likely to discontinue the agent due to adverse events, whereas those treated with ADA first were likely to discontinue due to treatment failure or LOR. Conclusions: No significant difference was observed in the long‐term prognosis between biologic‐naïve patients with CD who were started treatment with IFX first and ADA first. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective Idiopathic pulmonary fibrosis ( IPF) is a specific form of chronic, progressive fibrosing interstitial pneumonia. Nintedanib significantly reduced the annual rate of decline in forced vital capacity ( FVC) compared with placebo in patients with IPF in two replicate trials ( INPULSIS®). We examined the efficacy and safety of nintedanib in Japanese patients. Methods We conducted pre-specified subgroup analyses of the annual rate of decline in FVC, time to first acute exacerbation ( AE), change from baseline in St George's Respiratory Questionnaire ( SGRQ) total score and safety using pooled data from the INPULSIS® trials for Japanese patients. Results In the overall population, 76 of 638 and 50 of 423 patients in the nintedanib and placebo groups, respectively, were Japanese. Results in Japanese patients were consistent with those in the overall population. In Japanese patients, the adjusted annual rate of decline in FVC was −135.9 mL/year in the nintedanib group and −267.7 mL/year in the placebo group (difference (95% CI): 131.9 (50.7, 213.1) mL/year); the hazard ratio for the time to first AE was 0.25 (0.06, 1.02); and the adjusted mean change from baseline in SGRQ total score at week 52 was 5.81 in the nintedanib group and 9.68 in the placebo group (difference: −3.87 (−8.51, 0.76)). Diarrhoea and liver-related adverse events were the most common events in the nintedanib group, but were reversible following dose reduction, drug interruption or symptomatic therapy. Conclusion The present results indicate that the efficacy and safety of nintedanib in Japanese patients are comparable with those in the overall population. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective In the two-replicate randomized Phase III INPULSIS® trials in patients with idiopathic pulmonary fibrosis ( IPF), nintedanib 150 mg bd significantly reduced the annual rate of decline in forced vital capacity ( FVC) compared with placebo. The key secondary endpoints were time to first investigator-reported acute exacerbation and change from baseline in St George's Respiratory Questionnaire total score, both over 52 weeks. Here, we assessed the effect of nintedanib in Asian patients. Methods Pre-specified subgroup analyses of the effect of nintedanib on the primary and key secondary endpoints in Asian versus White patients were undertaken based on pooled data from the two INPULSIS® trials. Safety data were analyzed descriptively. Results Of the treated patients, 322 were Asian (nintedanib n = 194; placebo n = 128) and 608 were White (nintedanib n = 360; placebo n = 248). In Asian patients, the nintedanib versus placebo difference in the adjusted annual rate of decline in FVC was 94.1 mL/year (95% CI: 33.7, 154.6). The treatment effect of nintedanib on the annual rate of decline in FVC in Asian and White patients was similar (treatment-by-subgroup interaction P = 0.72) and consistent with the overall population. No significant treatment-by-subgroup interaction was observed for the key secondary endpoints between Asian and White patients. In Asian patients, the most common adverse event in the nintedanib group was diarrhoea (56.2% of patients vs 15.6% for placebo). Conclusion In pre-specified subgroup analyses of Asian versus White patients with IPF in the INPULSIS® trials, race did not influence the effect of nintedanib on disease progression. [ABSTRACT FROM AUTHOR]

In commercializing the superconducting Maglev system it is important to reduce the cost, especially that of ground coils constructed along the whole length of the guideway. For this purpose we have examined the combined propulsion, levitation and guidance system (PLG system) which can generate levitation, guidance and propulsion, forces by the same coil. This paper describes the test run of the PLG system, whose ground coils (PLG coil) are constructed in one part of the Miyazaki test track. In designing the PLG coil, we make clear the magnitudes of the force acting both under normal and unusual conditions because the electromagnetic force, which levitates, guides, and propels the vehicle, directly acts on the magnet winding of the PLG coil. In the experiment, we examine both the performance of the vehicle and the force of a PLG coil. The measurement of the force at the PLG coil gives not only propulsion force and levitation force directly, but also guidance stiffness by sifting the measured coil. Good correlation recognized between the calculation and the experiment in the propulsion force, levitation force, and guidance stiffness proves that the required characteristics can be expected from the PLG system even under combination of propulsion, levitation and guidance. [ABSTRACT FROM AUTHOR]

A levitation method has been introduced which uses 8-shape levitation coils arranged on the vertical surface of the guideway. These coils can act as a guidance means as well as the levitation means. The characteristics of this system are examined using numerical examples and experimental data. The cables connecting right and left coils are not connected to a high-voltage power source unlike the usual guidance system which is combined with propulsion. Thus the electric insulation of the cables is not a problem at present. Numerical examples show that the levitation characteristics of the combined levitation and guidance system are almost the same as in the system without the guidance function, and that it attains reduced running resistance with necessary guidance stiffness obtained. A test run was done at Miyazaki Test Line equipped with coils of this type arranged about 120 m, and the result show stable running and balanced displacement which agrees with calculated values. [ABSTRACT FROM AUTHOR]

This paper describes a new contour line extraction algorithm which makes better contour line continuation and accelerates processing speed. When obtaining a contour line from an original gray-scale image, the contour line extraction algorithm generally requires the following conditions: (1) extracted contour lines representing a good feature of the original image; (2) less invalid data such as noise; (3) contour line width is one pixel thickness; and (4) better contour connectedness. Many contour line extraction algorithms have been proposed. However, usually the user has employed the contour line extraction algorithm selecting by experience and a sixth sense. In the conventional method, differential operators are carried out on an original image with thresholding at a given value. Afterward, a thinning operation is carried out to obtain a one-pixel thickness contour line. However, this process takes considerable computing time because the thinning process needs recursive processing. The new algorithm presented here carries out the process which performs the edge detection and thinning operation simultaneously eliminating the extra step. The process is effectively integrated in two ways; one is maximum point extraction in the differential image; and the other is the thresholding by introducing, the selection of threshold values by using observance of the contour line connectedness in the differential image. As a result, the proposed algorithm is 10 times faster than the conventional methods in processing speed, and provides almost the same quality in contour line image. [ABSTRACT FROM AUTHOR]