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Background Patients with Fontan circulation may develop heart failure resulting in atrial fibrillation during the late phase. Inotropic effects to ameliorate hemodynamics on the Fontan circulation are not well understood, especially when in atrial fibrillation. This study was performed to determine whether dobutamine therapy in patients with Fontan circulation has limited effects on improving hemodynamics. Methods Lumped computational models (sinus and atrial fibrillation) were employed including biventricular, atriopulmonary connection (APC), and extracardiac total cavopulmonary connection (TCPC) Fontan models. The condition of atrial fibrillation including lack of atrial beat, irregular ventricular contraction, and time-varying elastance for the ventricle was introduced. A different dose of dobutamine was given by varying the elastance of the ventricle, heart rate, and peripheral resistance. Results In all models, the cardiac output decreased by 22.5% to 25.8% in atrial fibrillation. At 10 μg/kg/min of dobutamine in sinus rhythm, the cardiac output increased by 32.3% in the biventricular model but by only 9.2% (p Conclusions In the Fontan circulation, atrial fibrillation itself reduced the cardiac output by approximately 25%, and dobutamine had a limited effect on increasing the cardiac output, especially when in atrial fibrillation. Maintaining sinus rhythm in patients with Fontan circulation is very important.

OBJECTIVE Tailored surgery to extensively resect epileptogenic lesions using intraoperative electrocorticography (ioECoG) may improve seizure outcomes. However, resection of large areas is associated with decreased memory function postoperatively. The authors assessed whether ioECoG could provide useful information on how to minimize the focus resection and obtain better seizure outcomes without memory deterioration. They examined the postoperative seizure-free period and memory alteration in a retrospective cohort of patients with mesial temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) in whom the extent of removal was determined using ioECoG findings. METHODS The authors enrolled 82 patients with TLE associated with HS who were treated surgically. Transsylvian amygdalohippocampectomy was indicated as the first step. When visual inspection identified interictal epileptic discharges from the lateral temporal lobe on ioECoG, anterior temporal lobectomy (ATL) was eventually performed. The patients were divided into the selective amygdalohippocampectomy (SA, n = 40) and ATL (n = 42) groups. Postoperative seizure outcomes were assessed at 1, 2, 3, 5, and 7 years postoperatively using the International League Against Epilepsy classification. The Kaplan-Meier survival analysis was applied to evaluate the period of seizure recurrence between the SA and ATL groups. Factors attributed to seizure recurrence were analyzed using the Cox proportional hazards model, and they were as follows: epileptic focal laterality; age at seizure onset (< 10 or ≥ 10 years old); seizure frequency (more than weekly or less than weekly seizures); history of focal to bilateral tonic-clonic seizure; infectious etiology; and surgical procedure. The Wechsler Memory Scale–Revised was used to evaluate memory function pre- and postoperatively. RESULTS Seizure outcomes were significantly worse in the SA group than in the ATL group at 2 years postoperatively (p = 0.045). The International League Against Epilepsy class 1 outcomes at 7 years postoperatively in the SA and ATL groups were 63% and 81%, respectively. Kaplan-Meier analysis showed that seizure recurred significantly earlier in the SA group than in the ATL group (p = 0.031). The 2-way ANOVA analysis was used to compare the SA and ATL groups in each memory category, and revealed that there was no significant difference regardless of the side of surgery. CONCLUSIONS Visual assessment of ioECoG cannot be used as an indicator to minimize epileptic focus resection in patients with TLE associated with HS. ATL is more effective in obtaining seizure-free outcomes; however, both ATL and SA can preserve memory function.

Two-degree-of-freedom control of field distribution on the pseudotraveling wave resonator using nonreciprocal metamaterial lines is demonstrated for the first time. Dynamic control of current distribution on the resonator is given based on circuit theory. We employed a normally magnetized ferrite microstrip line-based composite right-/left-handed (CRLH) transmission line as a metamaterial with variable phase-shifting nonreciprocity. Numerical simulation results show that the phase gradient of the fields along the resonator is controlled by the applied dc magnetic field to the ferrite. By changing the reflection coefficients of two reflectors inserted at both ends of the CRLH line section, current distribution along series and shunt branches of the unit cell is continuously and drastically changed under the resonance. The variable field distribution was implemented to polarization-plane-rotation and beam-scanning leaky-wave antennas. The experimental demonstration verifies our basic concept and shows the performance of the prototype antenna with a beam scanning angle of 20° and a continuous rotation angle of polarization plane by ±70° at the fixed frequency.

Purpose The removal of the bottom of sulcus dysplasia (BOSD) often includes the gyral crown; however, this method has been controversial. We hypothesized that the epileptogenic zone of the BOSD does not include the gyral crown. To reveal the depth and extent of the epileptogenic zone of the BOSD, we applied the two electrophysiological modalities: (1) the occurrence rate (OR) of high-frequency oscillations (HFOs) and (2) modulation index (MI), reflecting the strength of phase-amplitude coupling between HFOs and slow oscillations. Methods We investigated the ripples [80-200 Hz] and fast ripples [200-300 Hz]) in HFOs and MI (HFOs [80-300 Hz] and slow oscillations [3-4 Hz]). We opened the sulcus at the BOSD and implanted the subdural electrodes directly over the MRI visible lesion. All patients (n = 3) underwent lesionectomy and the gyral crown was preserved. Results Pathological findings demonstrated focal cortical dysplasia type IIb and seizure freedom was achieved. The OR of the HFOs was not significantly different between the BOSD and the gyral crown. In contrast, the MI between HFOs and slow oscillations in the BOSD was significantly higher than that in the gyral crown. Conclusion High MI values distinguished the epileptogenic BOSD from the non-epileptogenic gyral crowns. MI could be a more informative biomarker of epileptogenicity than the OR of HFOs in a subset of patients with the BOSD.

Background Individuals with Sturge-Weber syndrome (SWS) often expereince intractable epilepsy and cognitive decline. We hypothesized that the extent of the leptomeningeal capillary malformation (LCM) may correlate with the severity of neurological impairment due to SWS. We tested the hypothesis in a cross-sectional study of seizure severity and electroencephalographic (EEG) findings and a retrospective cohort study for surgical indications related to the extent of the LCM. Methods We enrolled 112 patients and classified them according to LCM distribution: (1) bilateral, (2) hemispheric, (3) multilobar, and (4) single lobe. Age at seizure onset, seizure semiology and frequency, and EEG findings were compared. Surgical indications were evaluated for each group by Fisher exact test, and predictors for surgery were evaluated by univariate and multivariate analyses. Therapeutic efficacy was evaluated by the SWS-Neurological Score (SWS-NS). Results The bilateral and hemispheric groups had early seizure onset (4.0 months old and 3.0 months old), frequent seizures (88.9% and 80.6% had more than one per month), focal-to-bilateral tonic-clonic seizures (88.9% and 74.2%), and status epilepticus (100% and 87.1%). The groups’ EEG findings did not differ substantially. Surgical indications were present in 77.8% of the bilateral, 88.1% of the hemispheric, and 46.8% of the multilobar groups. Seizure more than once per month was a predictor of surgical treatment. Seizure subscore improved postoperatively in the hemispheric and multilobar groups. Even after surgical treatment, the bilateral and hemispheric groups exhibited higher SWS-NSs than members of the other groups. Conclusion Our study demonstrated a strong association between extensive LCM and epilepsy severity. Surgical intervention improved seizure outcome in patients with SWS with large LCMs.

Background: Previous reports have documented ground-glass opacities (GGOs), followed by appearance of the crazy pavement pattern and consolidation as the typical findings on chest computed tomography (CT) in patients with Coronavirus Disease-2019 (COVID-19) Case: A 69-year-old man with chronic renal failure and diabetes mellitus presented with a 2-day history of fever and fatigue, without cough or sputum production Chest auscultation revealed coarse crackles at the right base Laboratory findings included a normal leukocyte count, normal serum procalcitonin level, and a slightly elevated serum C-reactive protein level Chest CT performed on day 2 after symptom onset revealed consolidation in the right lower lobe with an air bronchogram The patient was tentatively diagnosed as having bacterial pneumonia, however, antibiotic treatment with ampicillin/sulbactam yielded no improvement of the symptoms, respiratory status, or laboratory findings A repeat chest CT revealed changes in the findings of the right lower lobe from areas of focal consolidation to GGOs GGOs and areas of consolidation were also detected in the other lung lobes A polymerase chain reaction test for Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) returned a positive result Discussion: Focal areas of lung consolidation is an atypical radiological presentation of coronavirus pneumonia It is possible that the initial findings of CT represented those of bacterial pneumonia which responded to the antibiotic therapy, and that the GGOs that developed subsequently reflected new-onset SARS-CoV-2 pneumonia However, the symptom of fatigue without cough or sputum, a normal leukocyte count, and a poor response to antibiotics are not typical findings of bacterial pneumonia Our experience suggests that it is important to consider other or concomitant diseases when the initial treatment is followed by a deteriorating clinical course in patients with pneumonia Moreover, it is essential to prevent the spread of hospital-acquired infection, especially if epidemic diseases need to be included in the initial differential diagnosis

Late relapse of herpes simplex encephalitis (HSE) is defined as the recurrence of HSE more than 3 months after the initial exposure. The postoperative diagnosis of HSE following neurosurgery is complicated because the clinical presentation can mimic other common complications of neurosurgery. Cerebrospinal fluid polymerase chain reactions (CSF-PCR) is the gold standard for the diagnosis of HSE. We describe a case of late HSE relapse after epilepsy surgery in a patient who required a brain biopsy due to repeated negative CSF-PCR results. A 38-year-old woman had a history of HSE from the age of 3 years. She had intractable epilepsy from the age of 20 years and underwent right posterior quadrant disconnection (PQD) at the age of 38 years. Postoperatively, she had a right hemispheric intracerebral hemorrhage (ICH) and her consciousness was gradually worsening. Her consciousness improved after removal of the ICH. However, her consciousness gradually deteriorated again. Fluid-attenuated inversion recovery (FLAIR) revealed bilateral hyperintensity in the frontal lobes, including the white matter. CSF-PCR for herpes simplex virus (HSV) was performed twice, but yielded negative results. We performed a brain biopsy to target FLAIR hyperintensity in the right frontal lobe. PCR of the brain specimen was positive for HSV. Her consciousness improved with acyclovir, methylprednisolone, and cyclophosphamide. To our knowledge, this is a case of HSE induced by epilepsy surgery which had the longest duration until relapse after the initial HSE episode. A brain biopsy can be used to confirm the diagnosis of suspected HSE when CSF-PCR results are negative.

Objectives: The usefulness of serial procalcitonin (PCT) measurements for predicting the prognosis and treatment efficacy for hospitalised community-acquired pneumonia (CAP) patients was investigated. Methods: This prospective, multicentre, cohort study enrolled consecutive CAP patients who were hospitalised at 10 hospitals in western Japan from September 2013 to September 2016. PCT and C-reactive protein (CRP) were measured on admission (PCT D1 and CRP D1), within 48–72 h after admission (PCT D3 and CRP D3), and within 144–192 h after admission. CURB-65 and the Pneumonia Severity Index (PSI) were assessed on admission. The primary outcome was 30-day mortality; secondary outcomes were early and late treatment failure rates. Results: A total of 710 patients were included. The 30-day mortality rate was 3.1%. On multivariate analysis, only PCT D3/D1 ratio >1 [odds ratio (95% confidence interval): 4.33 (1.46–12.82),P = 0.008] and PSI [odds ratio (95% confidence interval): 2.32 (1.07–5.03), P = 0.03] were significant prognostic factors. Regarding treatment efficacy, PCT D3/D1 >1 was a significant predictor of early treatment failure on multivariate analysis. PCT D3/D1 with the PSI significantly improved the prognostic accuracy over that of the PSI alone. Conclusions: PCT should be measured consecutively, not only on admission, to predict the prognosis and treatment efficacy in CAP. Keywords: Biomarker, C-reactive protein, Pneumonia, Procalcitonin, Prognosis

Microwave transmission measurements were performed for a three-dimensional (3D) layer-by-layer chiral photonic crystal (PhC), whose photonic band structure contains 3D singular points, Weyl points. For the frequency and wavevector in the vicinity of a Weyl point, the transmitted intensity was found to be inversely proportional to the square of the propagation length. In addition, the transmitted wave was well-collimated in the plane parallel to the PhC layers, even for point-source incidence. When a plane wave was incident on the PhC containing metal scatters, the planar wavefront was reconstructed after the transmission, indicating a cloaking effect., 10 pages, 8 figures

BACKGROUND AND DESIGN: The coronavirus disease (COVID-19) pandemic is having a devastating effect worldwide. Host genome differences between populations may influence the severity of COVID-19. The Japan COVID-19 Task Force is conducting host genome analysis of hospitalized patients with COVID-19 from more than 70 institutions nationwide in Japan. This report describes the clinical characteristics of patients enrolled to date. RESULTS: The median (interquartile range) age of the 1674 patients included in the analysis was 59 (45-71) years, and more than half of the patients (66.2%) were male. Less than half of the patients (41.2%) had severe disease. The case fatality rate was 3.2%. CONCLUSIONS: Since this is a hospital-based study, the number of severe cases was relatively high, but the case fatality rate was relatively low, when compared to that of other countries. In the future, we will continue to enroll patients and conduct genome analyses of patients with COVID-19.

We propose a buried nanomagnet (BNM) realizing high-speed/low-variability silicon spin qubit operation, inspired by buried wiring technology, for the first time. High-speed quantum-gate operation results from large slanting magnetic-field generated by the BNM disposed quite close to a spin qubit, and low-variation of fidelity thanks to the self-aligned fabrication process. Employing TCAD-based simulation, we demonstrate that the BNM realizes 10 times faster Rabi oscillation (faster spin-flip) than previous works and >99% fidelity under certain process variations. Also, the proposed BNM arrangement is implementable for error-correctable large-scale quantum computers employing a 2D-latticed qubit layout. This technology paves the way to practical large-scale quantum computers with silicon.

The mechanism of epileptic spasms (ES) in Aicardi syndrome (AS) remains obscure. We compared intraoperative high-frequency oscillations (HFOs) and phase-amplitude coupling (PAC) before and after subtotal hemispherotomy in a 3-month-old girl with drug-resistant ES secondary to AS. Fetal ultrasonography showing corpus callosum agenesis, bilateral ventricular dilatation, and a large choroid plexus cyst confirmed AS diagnosis. Her ES started when she was 1 month old and had ten series of clustered ES per day despite phenobarbital and vitamin B6 treatment. After subtotal hemispherotomy, her ES dramatically improved. We analyzed two intraoperative electrocorticography modalities: (1), occurrence rate (OR) of HFOs; (2), PAC of HFOs and slow wave bands in the frontal, central, and parietal areas. We hypothesized that HFOs and PAC could be the biomarkers for efficacy of subtotal hemispherotomy in AS with ES. PAC in all three areas and OR of HFOs in the frontal and parietal areas significantly decreased, while OR of HFOs in the central area remained unchanged after subtotal hemispherotomy. We have demonstrated the usefulness of evaluating intraoperative HFOs and PAC to assess subtotal hemispherotomy effectiveness in AS patients with ES. Disconnecting the thalamocortical and subcortical pathways in the epileptic network plays a role in controlling ES generation.

Background Electroconvulsive therapy (ECT) is indicated for critical psychiatric conditions, which themselves constitute a risk for deep venous thrombosis (DVT) owing to prolonged immobility, dehydration, and venous stasis. Objective We describe challenging instances of ECT implementation while taking direct oral anticoagulants (DOACs). Method We report on 8 patients receiving DOACs for DVT who were successfully treated with ECT at the University of Yamanashi Hospital. We also provide a literature review on this topic. Results There were 6 female patients (the average age was 60.9+/-13.4 y.o.) and diagnoses included major depression, bipolar depression and schizophrenia. DOACs were edoxaban for 4 patients, rivaroxaban for 2, and apixaban for 2. A total of 92 ECT sessions were cautiously and safely completed in collaboration with multidisciplinary medical professionals without problematic adverse events, such as bleeding. A literature search found one case series of warfarin but currently available evidence is confined to sporadic case reports regarding ECT and DOACs for DVT. These reports were represented by successful implementation of ECT to patients receiving treatment with anticoagulants for DVT or thromboembolism. Ours is the first of a successful treatment with ECT while taking apixaban or edoxaban. Conclusion A clinical dilemma is that ECT is indicated for critical conditions that are likely to predispose patients to developing DVT. Paucity of data clearly highlights the need for more studies to support a contention that ECT, when carefully performed in consultation with other medical experts, is a viable treatment for those with DVT receiving oral anticoagulants.

In this paper, the enhancement of bandwidth for beam squint reduction in leaky-wave antennas has been numerically and experimentally demonstrated based on the pseudo-traveling-wave resonance by using nonreciprocal composite right-/left-handed metamaterial lines with almost dispersion-free phase-shifting nonreciprocities. We consider two different types of metamaterials governed by the edge-guided mode propagation in normally magnetized ferrite microstrip lines and operating at frequencies far above or below the magnetic resonance. Both metamaterials are separately designed and implemented in leaky-wave antennas based on the pseudo-traveling-wave resonance. The numerical simulation and measurement results verify the beam squint reduction for both cases with the enhanced bandwidths of 6%–10%.

[Purpose] Reportedly, males take fewer steps than females among frail older adults. The step count of frail older adults may be influenced by domestic roles in the instrumental activities of daily living. In this study, we aimed to investigate the association between instrumental activities of daily living and the number of steps in frail older females. [Participants and Methods] In this cross-sectional study, we included 27 frail older females aged 84.4 ± 6.5 years who attended a day-care center. We used the Fillenbaum’s instrumental activities of daily living screener and measured the number of steps using an accelerometer, functional independence measure, grip strength, and short physical performance battery. We investigated the association between instrumental activities of daily living and daily steps. Furthermore, we compared the outcomes of the differences in the independence using a subscale of instrumental activities of daily living. [Results] Instrumental activities of daily living and step counts showed a significant correlation. Participants dependent on meal preparation and housework took significantly fewer steps per day. The dependence of their activities also caused low functional independence measure and weak grip strength. [Conclusion] In frail older females, decreased ability for instrumental activities of daily living were associated with fewer steps. Domestic roles may increase the daily steps in frail older adults.

Purpose/Method: No studies have reported on prognostic markers in patients with chronic kidney disease (CKD) according to the severity of the disease. Therefore, in this multicenter, prospective trial performed as part of the Gunma CKD SPECT Multicenter Study, we recruited 311 patients with CKD (eGFR < 60 min/mL/1.73 m(2)) including 50 patients on hemodialysis and followed them for 2 years. The study sample underwent stress (99m)Tc-tetrofosmin SPECT for suspected or possible ischemic heart disease. We evaluated the summed stress score (SSS), summed rest score (SRS), summed difference score (SDS) and cardiac function with electrocardiogram-gated SPECT. Then, we compared the differences in prognostic markers for major adverse cardiac, cerebrovascular, and renal events (MACCRE) between patients with mild CKD (30 min/mL/1.73 m(2) ≤ eGFR

In this paper, a polarization-plane-controllable beam-scanning leaky-wave antenna based on pseudo-traveling-wave resonance is proposed and demonstrated by using nonreciprocal metamaterials. The antenna is composed of a ferrite-microstrip-line-based nonreciprocal composite right/left-handed transmission-line resonator that is terminated with tunable reactive loads for reflectors and a feed line. By changing the externally applied dc magnetic field to the ferrite, beam scanning was achieved at the fixed frequency. In addition, plane of polarization can be rotated independently by changing the phase condition of the reflectors. The numerical and experimental results verified the basic concept.

Introduction: Despite improvements in management for children after cardiac surgery, a non-negligible proportion of patients suffer from cardiac arrest, having a poor prognosis. Although serum lactate levels are widely accepted markers of hemodynamic instability, measuring lactate requires discrete blood sampling. An alternative method to evaluate hemodynamic stability/instability continuously and non-invasively may assist in improving the standard of patient care. Hypothesis: We hypothesize that blood lactate in PICU patients can be predicted using machine learning applied to arterial waveforms and perioperative characteristics. Methods: Forty-eight children, who underwent heart surgery, were included. Patient characteristics and physiological measurements were acquired and analyzed using specialized software/hardware, including heart rate, lactate level, arterial waveform sharpness, and area under the curve. Predicting a patient’s blood lactate levels was accomplished using regression-based supervised learning algorithms, including regression decision trees, tuned decision trees, random forest regressor, tuned random forest, AdaBoost regressor, and hypertuned AdaBoost. All algorithms were compared with hold-out cross validation. Two approaches were considered: basing prediction on the currently acquired physiological measurements along with those acquired at admission, as well as adding the most recent lactate measurement and the time since that measurement as prediction parameters. The second approach supports updating the learning system’s predictive capacity whenever a patient has a new ground truth blood lactate reading acquired. Results: In both approaches, the best performing machine learning method was the tuned random forest, which yielded a mean absolute error of 5.60 mg/dL in the first approach, and 4.62 mg/dL when predicting blood lactate with updated ground truth. Conclusions: In conclusion, the tuned random forest is capable of predicting the level of serum lactate by analyzing perioperative variables, including the arterial pressure waveform. Machine learning can predict the patient’s hemodynamics non-invasively, continuously, and with accuracy that may demonstrate clinical utility.

[Purpose] The purpose of this study was to verify the effects of a 3-month multicomponent home-based rehabilitation program developed on the basis of the reevaluation of older people with restricted life-space mobility. [Participants and Methods] The participants were residents in Japan aged ≥65 years who had Life-Space Assessment scores ≤52.3. Multicomponent home-based rehabilitation was conducted by physical and occupational therapists. Each visit included 40-60 min of combined exercise, practicing activities of daily living, improving the home environment, and caregiver support. The programs were developed in accordance with a flow diagram. The primary outcome was life-space mobility evaluated using the Life-Space Assessment score. [Results] Overall, 30 participants completed the intervention. The mean age of the participants was 82.4 ± 7.5 years. Three months after the intervention initiation, the Life-Space Assessment scores significantly improved from 12.0 to 30.5. The proportion of participants at maximal life-space level 5 (unlimited mobility) doubled from 16.7% at baseline to 33.3%. The functional independent measure score, fall efficacy scale score, and lower limb strength associated with standing up also significantly improved. We found no significant changes in the geriatric depression scale 5 and self-rated good health scores. [Conclusion] Multicomponent home-based rehabilitation can improve life-space mobility in older people with restricted life-space mobility.

In this paper, enhancement of phase-shifting nonreciprocity is proposed by using metamaterial lines with comb-shaped capacitive stubs on the normally magnetized ferrite substrate. The insertion of capacitive stubs enhances the effective permittivity, i.e., effective propagation distance in one propagation direction due to edge-guided mode propagation along the comb-shaped stub edges. The nonreciprocity of the proposed structure was numerically compared with those of other types of metamaterial lines, and transmission characteristics of the prototype circuit were measured and reproduced by the numerical simulations, verifying the enhancement.

In this paper, an enhanced bandwidth technique for a backward-wave directional coupler is proposed. The coupler is composed of a conventional microstrip line and a nonreciprocal composite right/left-handed metamaterial line using a normally magnetized ferrite substrate in order to control the dispersion characteristics. In the numerical simulation and measurement results, enhancement of the coupling bandwidth was achieved for the designed and prototype couplers by applying the dc magnetic field to the ferrite substrate.

The effectiveness of long-term administration of tolvaptan in heart failure (HF) patients with chronic kidney disease (CKD) has not been fully studied. Hence, in this study, we investigated the effects of chronic administration of tolvaptan on patients with HF and CKD. We consecutively enrolled 31 patients with acute HF syndrome (AHFS) who were administrated tolvaptan as a long-term medication (TLV group). All patients had a history of prior HF admission and CKD. We also consecutively enrolled 27 patients with AHFS, a prior history of HF and CKD (conventional group). We compared renal function and outcomes between the two groups at discharge for AHFS and after 6 months of follow-up. The estimate glomerular filtration rate (eGFR) was maintained at approximately the same level in the TLV group exhibited approximately the same eGFR (-1.1 ± 8.3 mL/min/1.73 m2) but decreased in the conventional group (-7.4 ± 10.4 mL/min/1.73 m2). There was a significant difference in the changes observed in eGFR between the conventional and TLV groups (p = 0.01). There were no significant differences in the frequencies of rehospitalization and death. Long-term administration of tolvaptan may prevent increased renal dysfunction in HF patients with CKD. This conclusion should be confirmed in a large-scale prospective study.

A new approach to enhance the phase-shifting nonreciprocity of microstrip-line-based metamaterials with normally magnetized ferrite substrates is proposed, by using a combination of curvature of the lines and asymmetric insertion of stubs. In the analytical approach, the nonreciprocity is approximately formulated by introducing asymmetric surface admittance on the side walls at the strip edges, showing that a linear combination of two factors due to the line curvature and the difference of asymmetric admittances contributes to geometrical asymmetry of the wave-guiding structures. Numerical simulation and measurement results verify predictions from the analytical approach. It is demonstrated that a combination of larger curvature of the metamaterial lines and hybrid insertion of inductive and capacitive stubs on the inner and outer sides, respectively, provides significant enhancement of the nonreciprocity compared to the single side insertion of stubs.

Background Inhalation studies suggested "protective" roles of exogenous prostaglandin E 2 , but the clinical relevance of endogenous prostanoids in asthma is poorly known. The objective of this study is to measure sputum levels of prostanoids in asthmatic patients to correlate with clinical indices. Methods Mild ( n = 41) or moderate-to-severe (19) asthmatics and 27 normal controls were examined for pulmonary function (FEV 1 and mid-forced expiratory flow), sputum cell differentials, and sputum levels of prostaglandins D 2 , E 2 , F 2α , and thromboxane B 2 measured by sandwich enzyme immunoassay. Results Each prostanoid level did not differ among the three groups. Sputum number of bronchial epithelial cells was greater in moderate-to-severe asthmatics than in the other two groups, suggesting epithelial desquamation. Levels of prostaglandin F 2α , D 2 , and thromboxane B 2 positively correlated with the severity of airflow obstruction in the 60 asthmatic patients, whereas prostaglandin E 2 levels were unrelated to pulmonary function. The ratio of combined "contractile" prostanoids (prostaglandin D 2 /prostaglandin F 2α /thromboxane B 2 ) to prostaglandin E 2 was 2.5-fold greater in moderate-to-severe asthmatics than in controls ( p = 0.001) or in mild asthmatics ( p = 0.0002) but did not differ between the latter two groups. In the two asthmatic groups combined, this ratio positively correlated with the sputum number of epithelial cells. The combined "contractile" prostanoids levels positively correlated with prostaglandin E 2 levels in controls and in mild asthmatics but not in moderate-to-severe asthmatics. Conclusions An imbalance in production, breakdown, or both between prostaglandin E 2 and other prostanoids possibly due to epithelial damage may be involved in the pathogenesis of moderate-to-severe asthma.

Background: Falls are a serious problem among frail elderly and their prevention is an important health concern. We compared the frequency of falls among institutionalized frail elderly residents following different interventions: low-frequency exercise, vitamin D supplementation, and a combination of both. Methods: Participants (N = 91) were residents in an institution for frail elderly (84.8 ± 8.8 years of age, 69 women). Participants were randomly assigned to one of four conditions: (1) the control group (n = 23) was provided three sessions per week of individualized exercise and usual care, (2) the low-exercise group (n = 22) was provided two sessions of individualized exercise per week, (3) the nutrition group (n = 23) was given oral vitamin D (900 IU/day), and (4) the combined group (n = 23) performed low-level exercise and received vitamin D supplementation. Results: A two-way analysis of variance including interactions between experimental group and time indicated a clear benefit in the groups that received supplementation with vitamin D. A Cox proportional-hazard regression analysis, adjusted for sex and age, showed that compared to the control group, the combined group had a reduced risk of falls (hazard ratio: 0.28, 95% CI: 0.08–0.92, P

Floating wind turbine facilities installed in deep sea areas play an essential role in the promotion of green energy. One of the problems associated with the commercialization of facilities installed in the deep sea is the maintenance cost of mooring chains, because they are expensive and wear between links leads to chain breakage. Therefore, it is necessary to establish a quantitative wear evaluation method for mooring chains. An experimental facility to reproduce the wear caused by sliding between links at the scale of an actual floating wind turbine was developed to investigate the wear performance in seawater conditions, and wear tests were conducted. Substitute ocean water was applied to the experiment instead of seawater. In addition, a procedure for nonlinear finite element analysis was improved to estimate the behaviour of wear between links. Measured stress versus strain relations of the links was considered in the finite element analysis. The experiments and numerical analysis confirmed that the amount of wear in the substitute ocean water was less than that obtained in dry air and that the tensile force between links is an important factor for the degree of wear between links.

Design for dual-band operation of nonreciprocal composite right/left handed transmission lines with unidirectional wavenumber vectors independent of the transmitted power directions is proposed. An equivalent circuit model for the dual-band nonreciprocal CRLH transmission lines is given, and specific configuration to realize the performance is designed by using a normally magnetized ferrite microstrip line. The dual band operation of the nonreciprocal lines with unidirectional wavenumber vectors is demonstrated in the measurement.

An enhancement technique of phase-shifting nonreciprocity in normally magnetized ferrite metamaterial lines is proposed by applying a slow wave structure based on spoof surface plasmon. The nonreciprocity is further enhanced by inserting an appropriate value of capacitance in the corrugated metallic strip. Metamaterial lines with high dispersive characteristics and large nonreciprocity were numerically designed and demonstrated in the experiment.

Reducing sitting time, independent of physical activity, is important for health. However, few reports have been published regarding physical activity of housewives compared to that of employed women. We examined strategies to shorten housewives' sitting time using a single-blind randomized controlled trial. Forty-eight housewives (38.0 ± 4.5 years old) were randomly assigned to one of three groups: pamphlet, self-feedback, and tailored feedback groups. All participants received a pamphlet describing the risks of prolonged sitting. The self-feedback and tailored feedback groups were also given feedback on sitting time by a smartphone application. The tailored feedback group received individual suggestions regarding lifestyle to shorten sitting time. We measured physical activity using an accelerometer and health-related quality of life using the Short-Form 8. The longest prolonged sitting time significantly decreased over time, a significant reduction was observed after the intervention only in the tailored feedback group. Vitality, mental health, and role emotional components of health-related quality of life showed a significant improvement with time but no significant differences were observed among the study groups. We suggested an easy approach to shortening prolonged sitting time in housewives using a pamphlet and feedback by smartphone. However, tailored consulting was necessary to yield a more effective result.

Cerebrospinal fluid (CSF) amyloid-β (Aβ)42 and tau are biomarkers for Alzheimer's disease (AD); however, the effects of other neurodegenerative processes on these biomarkers remain unclear. We measured Aβ40, Aβ42, total tau, phosphorylated-tau, and α-synuclein in CSF and plasma using matched samples from various neurodegenerative diseases to expand our basic knowledge on these biomarkers and their practical applications. A total of 213 CSF and 183 plasma samples were analyzed from cognitively unimpaired subjects, and patients with Alzheimer's disease dementia (ADD), mild cognitive impairment (MCI), non-AD dementias, and other neurological diseases. The CSF/plasma ratios of Aβ40 and Aβ42 were approximately 25:1. Aβ40/42 ratios in CSF and plasma were both 10:1. The CSF total tau/P181tau ratio was 6:1. The CSF/plasma α-synuclein ratio was 1:65. Significantly decreased Aβ42 levels and an increased Aβ40/42 ratio in CSF in ADD/MCI suggested that these relationships were specifically altered in AD. Increased total tau levels in ADD/MCI, encephalopathy, and multiple system atrophy, and increased P181tau in ADD/MCI indicated that these biomarkers corresponded to neurodegeneration and tauopathy, respectively. Although CSF α-synuclein levels were increased in ADD/MCI, there was no merit in measuring α-synuclein in CSF or plasma as a biomarker. The combination of biomarkers by the Aβ40/42 ratio×p181tau reflected specific changes due to the AD pathology in ADD/MCI. Thus, CSF Aβ40, Aβ42, p181tau, and tau were identified as biomarkers for aggregated Aβ associated state (A), aggregated tau associated state (T), and neurodegeneration state (N) pathologies in AD based on the NIA-AA criteria. Overlaps in these biomarkers need to be considered in clinical practice for differential diagnoses of neurodegenerative diseases.

In this paper, we design and fabricate a unit cell block for 3-D isotropic left-handed metamaterials impedance-matched to free space which is composed of a dielectric cube and metallic mesh. The numerical simulation results show almost 3-D isotropic propagation characteristics in a specific frequency region with low reflection loss at the boundaries. Furthermore, near field profiles along the 1-D aligned array were simulated and measured verifying the backward wave mode propagation without serious field scatterings.

The right temporal lobe variant of frontotemporal dementia (FTD) is an uncommon progressive neurodegenerative disorder. We present the case of a 77-year-old right-handed man who presented with altered behaviour and problems with interpersonal relationships. He had no decline in cognitive function but brain perfusion single-photon emission CT demonstrated distinct hypoperfusion in the right temporal pole. At 2-year follow-up, he could not recognise his wife's relatives; and at 3-year follow-up, he had semantic aphasia. Decreased brain perfusion extended from the right temporal lobe into the contralateral temporal and both frontal lobes. These findings suggest that the right temporal lobe variant of FTD should be considered in elderly patients with altered behaviour and problems with interpersonal relationships, even if dementia is not suspected. The right anterior temporal lobe may play a key role in the onset of the early symptoms of this disease.

Dual-band and low-profile mushroom antenna with vertically-polarized and omnidirectional radiation in the horizontal direction is proposed. The mushroom antenna has multiple vias forming coaxial double ring structure at the center between a ground plane and a metallic patch. The double ring structure of vias has two different parallel resonant frequencies. It is confirmed from the numerical simulation results that the proposed antenna shows omnidirectional radiation pattern at dual-band.

Metamaterials are artificial electromagnetic structures which are composed of smaller elements compared to the wavelength, referred to as unit cell, where macroscopic constitutive relation such as effective permittivity and permeability have been designed and controlled in order to manipulate electromagnetic wave propagation for various applications. Specifically, nonreciprocal metamaterials have been investigated to discover new electromagnetic phenomena and to invent state-of-the-art functional circuits and antennas. Nonreciprocity manifests itself as a result of a combination of two factors; the one is broken time reversal symmetry and another is broken space inversion symmetry. The former factor is realized by using gyrotropic materials such as ferrite in microwave region or magneto-optic media in optical region. For example, a microstrip line constructed on a normally magnetized ferrite substrate supports an edge guided mode [1] showing the field displacement effect in which the fields are asymmetrically concentrated at one of strip edges. The field concentration side can be switched by changing the directions of wave propagation or the externally applied dc magnetic field. In such cases, when stubs are asymmetrically inserted at the strip edges to provide geometrical asymmetry to the wave-guiding structure for broken space inverse symmetry, the propagating wave regards the line as different structures for two anti-parallel propagation directions, which results in nonreciprocal transmission. In the earlier work on nonreciprocal metamaterials, nonreciprocity appearing in the magnitude of transmission coefficients was studied for applications to isolators and circulators [2]. More recently, nonreciprocity appearing in the phase of transmission coefficients was focused on, from the metamaterial point of view [3], [4]. By using the phase-shifting nonreciprocal metamaterials, we can have fascinating situations where forward wave mode is dominant with positive refractive index in one propagation direction and backward wave mode is dominant with negative refractive index in the opposite direction at the same frequency. In the special cases, we can have field profiles with unidirectional wavenumber vectors along the wave-guiding structures regardless of the transmitted power directions. Such nonreciprocal metamaterials were implemented to transmission-line resonators providing unique characteristics in that the resonance frequency is independent of the resonators’ size and that the field profiles have uniform magnitude and linearly-varying phase distribution, referred to as pseudo-traveling wave resonators [5]. The phase gradient of the fields along the resonators can be arbitrarily varied by changing the nonreciprocity of the lines under the resonant condition. This tunable phase gradient along the resonant structures was implemented to highly-efficient beam scanning leaky wave antennas [6], and to polarization switchable circularly polarized antennas [7], [8]. Nonreciprocal metamaterials can provide potential solutions to improvement of performance in microwave circuits and antennas. For beam steering antennas based on nonreciprocal metamaterials, the beam angle is determined by magnitude of the nonreciprocity in the metamaterial lines. For circularly polarized antennas based on the nonreciprocal metamaterial rings, the phase shift for one circulation corresponds to 360 degrees. Therefore, the enhancement of nonreciprocal phase gradient along the metamaterial line leads to wider beam swing in the leaky wave antennas and miniaturization of the circularly polarized antennas. Recently, it was demonstrated that an appropriate combination of curvatures of lines and asymmetric insertion of stubs enhances the geometrical asymmetry of the line, resulting in the enhancement of the nonreciprocity [9]. Not only magnitude but also dispersion of phase-shifting nonreciprocity in metamaterials have been designed and controlled for improvement of microwave circuits and antennas. For example, beam scanning leaky wave antennas generally suffer from beam squint problem where the beam direction varies with the operational frequency. For the nonreciprocal metamaterial based beam scanning antennas, the beam squint originates from the frequency dependence of phase-shifting nonreciprocity. To eliminate the beam squint, metamaterials with dispersion-less nonreciprocity was proposed and demonstrated to show the phase-shifting nonreciprocity proportional to the operational frequency [10].

Nonreciprocal metamaterials have been investigated to discover new electromagnetic phenomena and to invent state-of-THe-art functional circuits and antennas [1], [2]. By using nonreciprocal metamaterials, we can have unidirectional wavenumber vectors along the wave-guiding structures regardless of the propagation directions. Transmission-line resonators based on such noneciprocal metamaterials show unique characteristics in that the resonance frequency is independent of the resonators’ size and that the field profiles have uniform magnitude and linearly-varying phase distribution, referred to as pseudo-traveling-wave resonators [3]. In addition, phase gradient of the fields along the resonators can be arbitrarily varied by changing the nonreciprocity of the lines under the resonant condition, which is implemented to highly-efficient beam scanning leaky wave antennas [4], and to polarization-switchable circularly polarized antennas. However, most of phase-shifting nonreciprocal metamaterials have resulted in relatively small magnitude of nonreciprocity even with considerably large applied dc magnetic field with the help of strong permanent magnets or huge size of electromagnets, which limit the availability and applications to beam steering antennas for practical use. In order to make the steering beam angle wider for antenna applications or to reduce the magnitude of the dc magnetic field, enhanced nonreciprocity is essential. Recently, the phase-shifting nonreciprocity for the normally magnetized ferrite-based metamaterials was analytically formulated showing that this phenomenon is described by a product of two factors; the one corresponds to off-diagonal component in Polder permeability tensor determining gyro-magnetic characteristics. Another factor is the geometrical asymmetry which is realized by periodically and asymmetrically inserting stubs into the normally magnetized ferrite rod-embedded microstrip lines at the center [5], [6]. So far, shunt stubs periodically inserted in previous metamaterials were constructed on the non-magnetic dielectric substrates to avoid the influence of dc magnetic field on the stub performance. However, capacitive stubs constructed on the dielectric substrate suffer from the coupling between adjacent stubs and cause degradation of enhanced phase-shifting nonreciprocity. In this paper, we propose a new enhancement technique for the phase-shifting nonreciprocity in metamaterial lines loaded with comb-shaped periodic open stubs constructed on the normally magnetized ferrite substrate at one side of strip edges, as shown in Fig 1. In the configuration, the edge guided mode [7] is excited that caused zigzag propagation along each stub. This mechanism corresponds to longer distance for one propagation direction. This situation is realized by reducing the coupling between adjacent stubs. At the other side of strip edges, inductive stubs are periodically inserted to realize negative effective permittivity and to reduce the propagation distance in the opposite direction of propagation. Combination of capacitive and inductive stub insertion results in enhanced nonreciprocity. Polycrystalline Yttrium Iron Garnet was employed as the ferrite material. The configuration parameters for the prototype circuit are as follows; thicknesses of the ferrite and dielectric substrates are both 0.8 mm, dielectric constants of ferrite and dielectric substrates are 15 and 2.6, respectively. The width of the center strip is 2 mm. The length and width of capacitive stubs are 2 mm and 0.8 mm, respectively. The unit cell length is 1.9 mm. In Fig. 2, the simulated and measured phase shifting nonreciprocity Δβ are extracted from the S-parameters for five unit cells and plotted as a function of the operating frequency and externally applied dc magnetic fields. It is found from Fig. 2 that experimental results agree well with numerical simulation results. It is noted that the beam sweep of ±15 degrees in the present configuration corresponds to the nonreciprocity for the external dc magnetic field of ±26 mT only which is about a quarter compared to the typical value of 100 mT required for previous nonreciprocal metamaterials. Thus, reduction of the applied dc magnetic field required for the nonreciprocity will open up realization of tunable nonreciprocity of metamaterials and beam steering antennas for practical use.

Patients with chronic kidney disease (CKD) have an increased risk of adverse cardiovascular/cerebrovascular events. The aim of this study is to clarify whether stress myocardial perfusion single-photon emission computed tomography (SPECT) could predict cardiovascular/cerebrovascular events. In the Gunma-CKD SPECT Study, a multicenter prospective cohort trial, 311 patients with CKD (estimated glomerular filtration rate < 60 min/mL/1.73 m2) including 50 patients on hemodialysis underwent stress 99mTc-tetrofosmin SPECT for suspected ischemic heart disease and were followed for 2 years. The primary endpoint was the occurrence of cardiac death (CD), while the secondary endpoint was major adverse cardiovascular/cerebrovascular and renal events (MACCRE). MACCRE occurred in 91 out of 286 patients (CD in 13 and other MACCRE in 78 patients). According to a multivariate Cox analysis, hemoglobin (Hb) and end-systolic volume (ESV) were associated with CD (p < 0.05), while the summed difference score, diabetes mellitus (DM), and Hb were associated with MACCRE (p < 0.05). Kaplan-Meier analysis showed that the CD-free rate was higher in patients with ESV < 105 mL (log-rank, p = 0.0013), Hb > 12 g (log-rank, p = 0.0036), and a summed stress score < 6 (log-rank, p = 0.0058). The MACCRE-free rate was higher in patients with SDS = 0 (log-rank, p = 0.0097), without DM (log-rank, p = 0.0091), and with Hb > 12 g (log-rank, p = 0.0023). Myocardial perfusion SPECT parameters as well as renal anemia and DM can be reliable prognostic markers in patients with CKD including hemodialysis.

In this paper, low-profile omnidirectional antennas are proposed based on pseudo-traveling-wave resonance using phase-shifting nonreciprocal composite right/left handed transmission lines. The nonreciprocal transmission lines can steer the beam direction with the tunable phase constant, and the beam in the horizontal direction is obtained for large phase-shifting nonreciprocity in the numerical simulation.

In this paper, we review how to design geometrical asymmetry for enhancement of phase-shifting nonreciprocity and for optimizing its dispersion in composite right/left handed transmission lines for antenna applications.

An equivalent circuit model for a low-profile and wideband zeroth-order resonant antenna with omnidirectional radiation in the horizontal direction and vertical polarization is proposed. The antenna is composed of a rotationally symmetric mushroom structure with a microstrip line ring placed outside the mushroom patches. The current distribution on vias calculated by the equivalent circuit is compared with numerical simulation results with the use of finite element method, showing their good agreement.

New approach to enhance phase-shifting nonreciprocity of microstrip-line-based metamaterials with normally magnetized ferrite substrates is proposed by using a combination of curvature of the line and asymmetric insertion of shunt inductive stubs. Numerical simulation and measurement results clearly show that the nonreciprocity for the case where the shunt inductive stubs are asymmetrically inserted to the inner side of the curved line was greater than that for another case where the shunt stubs are inserted to the outer side of the curved line. Decrease in radius of the curvature increases the geometrical asymmetry resulting in enhancement of the nonreciprocity.

Study Design Single case report. Introduction A previous study clarified that spasticity and motor function were improved by combined treatment with botulinum toxin type A (BTX) injection and 1-Hz repetitive transcranial magnetic stimulation (rTMS) with intensive motor training at 4 weeks after injection. However, it is not clear whether 1-Hz rTMS with intensive motor training immediately after BTX injection also improves spasticity and motor function in stroke patients. Purpose of the Case Report The purpose of this case report is to test the short- and long-term effects of BTX injection and rTMS with intensive motor training on the spasticity, motor function, and usefulness of the paretic hand in a stroke patient. Methods A 64-year-old male, who suffered from a right cerebral hemorrhage 53 months previously, participated in the present study. BTX was injected into the spastic muscles of the affected upper limb. He then received the new protocol for a total of 24 sessions. The Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and Motor Activity Log, consisting of the amount of use and quality of movement scales, were assessed before and immediately after BTX injection, at discharge, and monthly for up to 5 months after discharge. Results For the short-term effects of the therapy, the MAS scores of the elbow and wrist, FMA score, and quality of movement score improved. For the long-term effects of the therapy, the MAS score of the fingers, FMA score, and amount of use score improved for up to 5 months after discharge. Conclusions The present case report showed the improvement of all assessments performed in the short and/or long term and suggest the possibility of shortening the intervention period of combined therapy of BTX and rTMS with intensive motor training.

In this paper, a pair of tunable reactive elements for reflectors with impedances having a relation of complex conjugate is proposed based on nonreciprocal composite right/left handed transmission lines using a ferrite rod embedded substrate. These reflectors are inserted at both ends of a zeroth-order resonator. Numerical simulation results clearly show that the field profile on the zeroth-order resonator is continuously tunable by changing the applied DC magnetic field to the ferrite rods.

Objective To investigate the effect of a tailored education program using home floor plans on falls prevention in discharged older patients. Design A single-center, parallel, pragmatic, pilot randomized controlled trial with equal allocation to the intervention and control groups. Setting Discharged hospital patients were followed-up in their home settings. Participants All discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n = 60). Interventions Both groups received standard care (exercises) and the intervention group also received a tailored education program for falls prevention using home floor plans. Measurements Falls and near-falls at the participants’ homes using a 1-month fall calendar during the 1-month period after discharge. The evaluators were blinded at the baseline assessment. Results Nine participants were withdrawn from the study, leaving 51 of 60 (85%) participants for the final analyses. No falls occurred in the intervention group (n = 25) during follow-up. However, 2 participants (7.7%) fell in the control group (n = 26). Near-falls were reported by 7 participants (28.0%) in the intervention group and 13 participants (50.0%) in the control group. The intervention group had 75% less near-falls compared with the control group, as assessed using a Cox proportional hazards model (hazard ratio, 0.25; 95% confidence interval, 0.09–0.75). Conclusions The tailored education program using home floor plans at the hospital was effective for reducing falls and near-falls among discharged orthopedic patients. Registration of clinical trials: This study was registered with the Research Ethics Committee of University Hospital Medical Information Network (UMIN) Center (000018201).