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In the field of respiratory clinical practice, the importance of measuring carbon dioxide (CO2) concentrations cannot be overemphasized. Within the body, assessment of the arterial partial pressure of CO2 (PaCO2) has been the gold standard for many decades. Non-invasive assessments are usually predicated on the measurement of CO2 concentrations in the air, usually using an infrared analyzer, and these data are clearly important regarding climate changes as well as regulations of air quality in buildings to ascertain adequate ventilation. Measurements of CO2 production with oxygen consumption yield important indices such as the respiratory quotient and estimates of energy expenditure, which may be used for further investigation in the various fields of metabolism, obesity, sleep disorders, and lifestyle-related issues. Measures of PaCO2 are nowadays performed using the Severinghaus electrode in arterial blood or in arterialized capillary blood, while the same electrode system has been modified to enable relatively accurate non-invasive monitoring of the transcutaneous partial pressure of CO2 (PtcCO2). PtcCO2 monitoring during sleep can be helpful for evaluating sleep apnea syndrome, particularly in children. End-tidal PCO2 is inferior to PtcCO2 as far as accuracy, but it provides breath-by-breath estimates of respiratory gas exchange, while PtcCO2 reflects temporal trends in alveolar ventilation. The frequency of monitoring end-tidal PCO2 has markedly increased in light of its multiple applications (e.g., verify endotracheal intubation, anesthesia or mechanical ventilation, exercise testing, respiratory patterning during sleep, etc.).

Obstructive sleep apnea (OSA) patients are at risk for increased blood pressure and carotid intima-media thickness (IMT), with pulmonary hypertension and right-sided heart failure potentially developing as well. Chronic intermittent hypoxia (IH) has been used as an OSA model in animals, but its effects on vascular beds have not been evaluated using objective unbiased tools. Previously published and current experimental data in mice exposed to IH were evaluated for IMT in aorta and pulmonary artery (PA) after IH with or without normoxic recovery using software for meta-analysis, Review Manager 5. Because IMT data reports on PA were extremely scarce, atherosclerotic area percentage from lumen data was also evaluated. IH significantly increased IMT parameters in both aorta and PA as illustrated by Forest plots (P < 0.01), which also confirmed that IMT values after normoxic recovery were within the normal range in both vascular beds. One-sided scarce lower areas in Funnel Plots were seen for both aorta and PA indicating the likelihood of significant publication bias. Forest and Funnel plots, which provide unbiased assessments of published and current data, suggest that IH exposures may induce IMT thickening that may be reversed by normoxic recovery in both aorta and PA. In light of the potential likelihood of publication bias, future studies are needed to confirm or refute the findings. In conclusion, OSA may induce IMT thickening (e.g., aorta and/or PA), but the treatment (e.g., nasal continuous positive airway pressure) will likely lead to improvements in such findings.

IntroductionThe rapid spread of COVID-19 posed a global burden. Substantial number of people died of the disease in the acute phase of infection. In addition, a significant proportion of patients have been reported to suffer from post-acute phase symptoms, sequelae of COVID-19, which may negatively influence the quality of daily living and/or socioeconomic circumstances of the patients. However, no previous study has comprehensively and objectively assessed the quality of life of patients by using existing international scales. Further, evidence of socioeconomic consequences among patients with COVID-19 is scarce. To address the multidimensional issues from sequelae of COVID-19, evidence from comprehensive surveys beyond clinical perspectives is critical that investigates health, and social determinants of disease progression as well as socioeconomic consequences at a large scale.Methods and analysisIn this study, we plan to conduct a nationwide and comprehensive survey for the sequelae of COVID-19 in a total of 1000 patients diagnosed at 27 hospitals throughout Japan. This study will evaluate not only the health-related status of patients from clinical perspectives but also the Health-related Quality of Life (HRQoL) scores, socioeconomic status and consequences to discuss the sequelae of the disease and the related risk factors. The primary endpoint is the frequency of long-term complications of COVID-19 infection. The secondary endpoints are risk factors for progression to sequelae of COVID-19 infection. The study will provide robust and important evidence as a resource to tackle the issues from the sequelae of COVID-19 from the multi-dimensional perspectives.Ethics and disseminationThis trial was approved by the Keio University School of Medicine Ethics Committee (20200243, UMIN000042299). The results of this study will be reported at a society meeting or published in a peer-reviewed journal.

Some patients with severe asthma also have fungal sensitization and are considered to have severe asthma with fungal sensitization. However, there is limited information on the clinical features of SAFS.To investigate the clinical characteristics of severe asthma with fungal sensitization.The present study enrolled 124 patients with severe asthma. We evaluated clinical aspects, such as various serum cytokines, fractional exhaled nitric oxide, pulmonary function, and serum immunoglobulin E (IgE). Fungal sensitization was assessed by determining serum levels of IgE specific to fungal allergens (Aspergillus, Alternaria, Candida, Cladosporium, Penicillium, and Trichophyton species and Schizophyllum commune). The protocol was registered at a clinical trial registry (www.umin.ac.jp/ctr/index-j.htm; UMIN 000002980).Thirty-six patients (29%) showed sensitization to at least 1 fungal allergen. The most common species were Candida (16%), Aspergillus (11%), and Trichophyton (11%). The rate of early-onset asthma (16 years of age) was higher in patients with fungal sensitization than in those without fungal sensitization (45% vs 25%; P = .02). Interleukin-33 levels were higher in patients with fungal sensitization than in those without fungal sensitization. Of patients with atopic asthma, Asthma Control Test scores were worse in patients with multiple fungal sensitizations than in patients with a single fungal sensitization or those without fungal sensitization.Severe asthma with fungal sensitization is characterized by early onset of disease and high serum levels of interleukin-33. Multiple fungal sensitizations are associated with poor asthma control.UMIN Clinical Trials Registry (UMIN-CTR; www.umin.ac.jp/ctr/index-j.htm): UMIN 000002980.

Although the incidence of postbulbar duodenal ulcers is low, many complications occur, such as hemorrhage, stenosis and perforation, and there are many points to be paid attention to with regard to its pathology. A high acid level has been pointed out as a cause, but this is not conclusive, and its association with Helicobacter pylori (Hp) infection is also unclear. We investigated chronic cases excluding acute cases such as acute duodenal mucosal lesion we encountered between 2001 and 2015. Five cases corresponded, accounting for 1.4% of all chronic duodenal ulcer cases, and there were more male patients (four patients were male), as previously reported. All cases were solitary punched-out ulcer on the medial side near the superior duodenal flexure, and many complications were observed such as melena in all patients, narrowing in 2, and penetration in 1. No specific pathology, such as Crohn’s disease, vasculitis, or Zollinger-Ellison syndrome, was noted, no patient was previously medicated with NSAIDs or low dose aspirin, and 3 patients were infected with Hp. All cases were healed by proton pump inhibitor administration or gastric acid secretion-suppressing treatment with selective proximal vagotomy. Recurrence after Hp eradication occurred in all of the 3 Hp-infected patients, suggesting that involvement of Hp in the cause of disease is unlikely.

Background and objective Body weight of patients with obstructive sleep apnea after initiation of nasal continuous positive airway pressure appears to increase. We hypothesized that intermittent hypoxia (IH) will decrease energy expenditure (EE), and that normoxic recovery will lead to body weight gains. Methods C57BL/6 J male mice were exposed to either 12 h/day of mild IH (alternating FIO2-10-11% and 21%; 640 s cycle), or severe IH (FIO2-6-7%-21%; 180 s cycle) or sham IH daily for 4 or 8 weeks. After exposures, EE was evaluated while mice were kept under normoxia for 5 weeks and organ histology was evaluated. Results EE was not decreased by IH. However, visceral white adipocyte size after normoxic recovery was significantly increased in severe IH in an intensity-dependent manner. Conclusion Our hypothesis that IH would decrease EE was not corroborated. However, IH and normoxic recovery seem to promote severity-dependent enlargement of visceral adipocytes, likely reflecting altered energy preservation mechanisms induced by IH.

BackgroundUsual clinical practice for arterial blood gas analysis (BGA) in conscious patients involves a one-time arterial puncture to be performed after a resting period of 20–30 min. The aim of this study was to evaluate the use of transcutaneous BGA for estimating this gold standard arterial BGA.MethodsSpontaneously breathing Asian adults (healthy volunteers and respiratory patients) were enrolled (n = 295). Transcutaneous PO2(PtcO2) and PCO2(PtcCO2) were monitored using a transcutaneous monitor (TCM4, Radiometer Medical AsP, Denmark) with sensors placed on the chest, forearm, earlobe or forehead. Transcutaneous BGA at 1-min intervals was compared with arterial BGA at 30 min. Reasonable steps to find severe hypercapnia with PaCO2 > 50 mmHg were evaluated.ResultsSensors on the chest and forearm were equally preferred and used because of small biases (n = 272). The average PCO2bias was close to 0 mmHg at 4 min, and was almost constant (4–5 mmHg) with PtcCO2being higher than PaCO2at ≥8 min. The limit of agreement for PCO2narrowed over time: ± 13.6 mmHg at 4 min, ± 7.5 mmHg at 12–13 min, and ± 6.3 mmHg at 30 min. The limit of agreement for PO2also narrowed over time (± 23.1 mmHg at 30 min). Subgroup analyses showed that the PaCO2and PaO2levels, gender, and younger age significantly affected the biases. All hypercapnia subjects with PaCO2 > 50 mmHg (n = 13) showed PtcCO2 ≥ 50 mmHg for until 12 min.ConclusionsAlthough PtcCO2is useful, it cannot completely replace PaCO2because PCO2occasionally showed large bias. On the other hand, the prediction of PaO2using PtcO2was unrealistic in Asian adults. PtcCO2 ≥ 50 mmHg for until 12 min can be used as a screening tool for severe hypercapnia with PaCO2 > 50 mmHg.

A 42-year-old Japanese man developed Churg–Strauss syndrome 7 years after being diagnosed with chronic eosinophilic pneumonia. Prominent eosinophilia, subcutaneous nodules, and neuropathy in the left leg were seen. A pathological diagnosis of necrotizing vasculitis was determined by a biopsy of a subcutaneous nodule. The leg pain was severe and there was prominent atrophy of the thigh and calf, but the muscle weakness was mild. Serum anti-myeloperoxidase anti-neutrophil cytoplasmic antibody was positive. Because the initial treatment with an intravenous methylprednisolone pulse at 1 g/day for 3 days was not sufficient, a onetime treatment with intravenous cyclophosphamide at 15 mg/kg and intravenous immunoglobulin therapy (IVIG) at 400 mg/kg/day for 5 days were administered. Peripheral eosinophilia improved and the leg pain significantly improved. IVIG was repeated 1 month later and symptoms gradually improved further. The early diagnosis of Churg–Strauss syndrome and the early initiation of IVIG with cyclophosphamide were thought to be important.

Objectives: Recent reports on venous blood gas analysis have shown that venous bicarbonate concentration is useful in the evaluation of the body acid-base status. Most of these reports have been based on the Bland-Altman analysis comparing arterial and venous blood gas values. We intended to elucidate any factors that decrease the agreement between venous and arterial bicarbonate concentrations, which might impair the usefulness of venous blood gas analysis. Methods: Healthy volunteers and patients with various diseases (n = 141) were evaluated by simultaneous arterial and venous blood sampling and Bland-Altman analysis. The venous-arterial bicarbonate concentration difference was compared between healthy volunteers and untreated respiratory alkalosis patients. Intentional hyperventilation (30 or 60 breaths/min, for 3 min) was also performed on 6 healthy volunteers and the venous-arterial bicarbonate concentration difference was evaluated. Results: The relative average bias in bicarbonate concentration was 2.00 mEq/l with venous bicarbonate higher than arterial bicarbonate with 95% limits of agreement of ±4.15 mEq/l. Hyperventilation challenges increased the venous-arterial bicarbonate concentration difference in an intensity-dependent manner. The venous-arterial bicarbonate concentration difference was higher in untreated respiratory alkalosis patients than in healthy volunteers (P Conclusion: Although venous bicarbonate may be useful to evaluate the body acid-base status, hyperventilation increases the venous-arterial bicarbonate concentration difference. Physicians should keep this phenomenon in mind.

Objective: The Japanese drug use system allowed the “once-daily use” of inhaled corticosteroid (ICS) fluticasone furoate (FF) combined with a long acting beta-2 agonist (LABA) vilanterol (VI) against asthma for the first time in 2013. Until then, patients with asthma had to use ICS at least twice-daily. We investigated the real-world efficacy and problems of this drug (FF/VI). Methods: This was an open-label, uncontrolled, within-group time-series (before-after) design. Prior treatments of asthma (twice-daily use of ICS with or without LABA) were switched to once-daily use of FF/VI (200 μg/25 μg). Subjects were evaluated by lung function tests prior to, and 2–3 months after, the initiation of FF/VI. Questions on the asthma control test (ACT) and preference of drugs were asked to patients. Results: One hundred and twenty-eight Japanese asthma outpatients were enrolled from 2014–2018 and 107 subjects completed the study. Peak flow, instantaneous flow at 75% of the forced vital capacity (V75), V50, maximum mid-expiratory flow rate, forced expiratory volume in 1 s, and ACT score in FF/VI-using subjects were significantly increased (all p

A 55-year-old man visited our department because of epigastric pain. Upper gastrointestinal endoscopy revealed a small, undermined ulcer in the gastric cardia. He had no history of taking NSAIDs, and was positive for Helicobacter pylori (Hp) infection. After Hp eradication therapy followed by 8 weeks of proton pump inhibitor (PPI) administration, re-endoscopy showed that the ulcer had slightly shrunk without scarring, and the surrounding mucosa was markedly elevated, like in a submucosal tumor. Endoscopic ultrasonography, performed at the same time, showed thickening of the submucosal and muscular layers around the ulcer. After continuous PPI administration, the mucosal elevation disappeared, and the ulcer shrunk and later scarred. However, when the dose of PPI was reduced with the aim of discontinuing it after the confirmation of successful Hp eradication, the ulcer recurred. We report this case of gastric ulcer because of its peculiar clinical presentation.

A man taking antithrombotic agents was admitted because of melena. Upper gastrointestinal endoscopy revealed a large, pedunculated polyp bleeding from erosions on its top. The polyp was endoscopically resected, and histopathologically diagnosed as Brunner ’ s gland hyperplasia. It is commonly encountered as a small, raised lesion, but may enlarge or bleed. We report this case, with a review of the Japanese literature and discussion of the mechanism of bleeding. doi: http://dx.doi.org/10.4021/gr532e

Microplasma technology was used in many applications from biomedical to surface treatment of polymers. A new application could be the surface treatment of glass panels for the electronic industry in order to improve the surface wettability. The remote microplasma method is proposed for the surface treatment of glass. It can be easily applied as an industrial process due to the relatively low discharge voltage around 1 kV and small size of the reactor. This paper presents the surface treatment of glass by microplasma using Ar and mixtures of Ar with N2 and O2. A microplasma process was analyzed by the emission spectroscopy method. A Marx generator with MOSFET switches, a neon transformer, and a pulsed power supply were used to energize the electrodes. The emission spectrum was measured by an intensified charge-coupled device camera and a spectrometer. An optic fiber was used to have an accurate measurement of a small part of the microplasma discharge. Surface wettability of glass was confirmed, measuring the contact angle before and after the microplasma treatment. The surface of glass was modified due to the action of the radicals and active species generated by microplasma. The emission spectrum of the microplasma discharge in Ar and mixtures of Ar with and showed ArI peaks, OH peaks, second positive band system peaks, and first positive band system peaks.

A 60-year-old male presented with cough and fever (case 1), and a 77-year-old female patient with hemoptysis (case 2) were admitted to IUHW Shioya Hospital. Interferon gamma release assay (IGRA: QFT-3G and T-SPOT. TB) were both performed on each patient; the QFT-3G was positive and T-SPOT.TB was negative in both cases despite different final diagnosis. While case 1 was determined to have active tuberculosis, in case 2 active tuberculosis was eliminated as the diagnosis. The contradictory results in these patients should serve as a reminder to clinicians that they should not rely on the results of IGRA testing for the diagnosis of active tuberculosis. Keywords: Interferon Gamma Release Assay; Negative; Tuberculosis; T-SPOT; QFT

A middle-aged man with no symptom or history visited our hospital due to duodenal abnormality and fecal occult blood detected by health screening. Upper gastrointestinal endoscopy showed marked enlargement of the papilla of Vater surrounded by nodules, and biopsy disclosed non-caseating granuloma. Colonoscopy yielded findings suggestive of intestinal tuberculosis such as annular ulcers. Examination of the biopsy samples failed to make a diagnosis of tuberculosis, and no pulmonary lesion was found, but whole-blood interferon gamma release assay was positive. The duodenal lesion was also suspected to be tubercular, so antitubercular drugs were administered. As this resulted in the resolution of both lesions, a definite diagnosis of tubercular papillitis of Vater was made. Duodenal tuberculosis is rare, and a localized lesion of the major duodenal papilla is extremely rare. However, this case suggests that tuberculosis must be considered in the differential diagnosis of lesions of the papilla of Vater.

Introduction Since the invention of the pulse oximeter, physicians often or even routinely perform venous blood gas analysis (VBGA). However, it has not been generally agreed that the application of VBGA is practically meaningful in routine clinical situations such as in an ED. Methods We measured venous-arterial P co 2 difference ((v-a)P co 2) and arterial-venous pH difference ((a-v)pH), and analyzed the physiological factors that affect these differences in healthy volunteers and hyperventilation patients. Results In healthy volunteers, both (v-a)P co 2 and (a-v)pH increased during finger exercise or hyperventilation in an intensity-dependent manner. Doppler echography indicated that increases in (v-a)P co 2 and (a-v)pH during hyperventilation are induced by reduction of peripheral blood flow. Approximately 40% of patients with untreated respiratory alkalosis were found to be incorrectly diagnosed if based only on VBGA. Conclusions It must be noted that VBGA may lead to overestimation of acidosis and to underestimation of respiratory alkalosis when extremities muscles are active or patients are hyperventilating. Physicians should keep these limitations in mind when conducting VBGA.

Hepatopulmonary syndrome (HPS) (hypoxaemia due to intrapulmonary vasodilation and a right-to-left shunt associated with liver disease) resolves after liver transplantation. The authors describe a case of spontaneous resolution of HPS prior to liver transplantation. This patient was diagnosed with HPS associated with extra-hepatic biliary atresia when she was 10 years old. She exhibited digital clubbing, facial vascular dilation, cyanosis, and suffered from dyspnoea during exercise. The patient's PaO(2) at rest was 53.8 mm Hg in room air and a Technetium-99m macro-aggregated albumin lung perfusion scan demonstrated a right-to-left shunt. Although her symptoms and laboratory data supported a diagnosis of HPS, she nevertheless showed spontaneous resolution within 2 years. When she was 14 years old, pulmonary hypertension was evident upon examination of her echocardiogram. HPS may be improved or masked by an accidental overlap with pulmonary hypertension in the terminal stage of liver disease.

This report describes the calibration of accelerometers. The theory for the calibration is based on acceleration as a vector quantity, and the sensitivity derived by the theory is defined as a matrix. The experiment was conducted using a three-dimensional vibration generator and three one-channel laser interferometers. The accelerometer used in the experiment is a three-axis type. Comparison with the conventional calibration method places an importance on the transverse sensitivities, because their influence on the acceleration measurement is impossible to disregard. The relation between the transverse sensitivities derived by the matrix concept and the conventional transverse sensitivities defined by ISO-5347 Part 11 is stated. Importance of the dimension of the motion space created by the vibration generator is stated in terms of the calibration.

A 61-year-old man took loxoprofen sodium hydrate, a prodrug NSAID, for acute upper respiratory infection for 5 days, developed melena 2 days later, and was admitted to our hospital. Upper gastrointestinal endoscopy revealed a giant and deeply undermined ulcer mainly in the greater curvature of the antrum, which occupied halfway around the lumen. His medical history was unremarkable. He was negative for Helicobacter pylori infection, and was diagnosed with NSAID-induced acute gastric ulcer in the absence of other causes of gastric ulcer. Giant gastric ulcers, as in this patient, are rare. Moreover, deeply undermined or huge gastric ulcers sometimes develop during the long-term administration of NSAIDs, but very rarely after their short-term administration, which prompted us to report this case.

This paper proposes a novel fabrication technique of TiNi shape memory alloy (SMA) film and verifies the validity by showing the actual fabrication process and the final results. Special attention is paid to the characterization of differential scanning calorimetry (DSC). An essential part of the fabrication process is the co-sputtering from separate pure Ti and Ni targets. Co-sputtering is carried out using a multi-target sputtering system where RF power for each target can be controlled independently. As-sputtered film is vacuum-annealed. The phase transformation behavior of the fabricated film is investigated by DSC and temperature-controlled X-ray diffractometry (XRD). Finally, shape recovery behavior is observed. The proposed novel fabrication technique is validated by these results.

To study the inflammatory responses of small-airway epithelium in smokers, we harvested enough living epithelial cells (1.97 × 106± 0.74 × 106) with a new ultrathin fiberscope from the very peripheral airways of 22 current smokers and 17 subjects who never smoked after informed consent was obtained. The cells were keratin positive and composed mainly of nonciliated cells. The expression levels of inflammatory markers [interleukin (IL)-8 and intercellular adhesion molecule (ICAM)-1] were evaluated with RT-PCR. The magnitude of the mRNA levels corrected by β-actin transcripts of IL-8 and ICAM-1 was significantly higher in the smokers than in the nonsmokers ( P < 0.001). Furthermore, among current smokers, IL-8 mRNA levels correlated positively with the extent of smoking history [in pack ⋅ years (packs/day × no. of years of smoking); r = 0.754, P < 0.001]. Spontaneously released IL-8 and soluble ICAM-1 levels ( n = 12) from cultured epithelial cells were elevated in subjects with a smoking history than in those without it (IL-8, 1,580 ± 29.6 vs. 354 ± 39.4 pg ⋅ 106cells−1⋅ 24 h−1; P < 0.001; soluble ICAM-1, 356.0 ± 45.9 vs. 112.9 ± 12.9 pg ⋅ 106cells−1⋅ 24 h−1; P < 0.01 by Student's t-test ). In contrast, the epithelial cells from the main bronchi did not show such differences between smokers and nonsmokers. Our study highlighted a close link between smoking and the expression of inflammatory mediators such as IL-8 and ICAM-1 in small airways. Our results also suggested that this new ultrathin bronchofiberscope promised a good approach for the evaluation of cellular changes in the small airways.

Dynamic response of foil strain gages is investigated in the ranges of up to approximately 300 kHz in frequency, 2000 μe in strain and 750 s−1 in strain rate. Impulsive input is applied to the gages using elastic wave pulses in a circular bar. The input is determined by measuring the velocity of the bar end with a laser interferometer. It was confirmed that deviations from the static gage factors do not exceed−5 percent within the frequency range up to 45 kHz, 110 kHz and more than 290 kHz for 20-mm, 10-mm and 3-mm gages, respectively, and that the gage length is the dominant factor in the gages' frequency characteristics. This paper also mentions self-generated voltages.

Smoking cessation decreases oxidative stress and restores vascular endothelial function. However, a recent meta-analysis suggests that the use of varenicline, a α4β2 nicotinic acetylcholine receptor partial agonist, increases the risk of cardiovascular events. This study was designed to determine the effect of varenicline-assisted smoking cessation on vascular endothelial function. Study subjects were 11 healthy Japanese males (mean age, 54.4 years) without evidence of cardiovascular disease who were eager to quit smoking. Each subject was treated with varenicline titrated up to 1.0 mg twice daily. We evaluated serum derivatives of reactive oxygen metabolites (d-ROMs) as a marker of oxidative stress, and flow-mediated dilation (FMD) of the brachial artery as a marker of vascular endothelial function. Both measurements were performed before and 3 months after completing smoking cessation. All subjects gained weight (average, 1.7 kg) after smoking cessation. However, there were no significant differences in the following parameters before and after smoking cessation: systolic blood pressure, diastolic blood pressure, heart rate, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, glucose and hemoglobin A1c. Serum d-ROM levels significantly decreased from 340.7±70.4 to 300.0±43.2 U.CARR (P=0.012), and FMD significantly increased from 3.36±1.26 to 5.25±1.33% (P=0.00067) after smoking cessation. There was an inverse correlation between FMD and serum d-ROM levels (R=-0.377; P=0.043). Our observations suggest that varenicline-assisted smoking cessation restores vascular endothelial function, and this is associated with decreased oxidative stress, despite an increase in body weight. As varenicline-assisted smoking cessation possibly has beneficial effects on vascular endothelial function, it might also reduce cardiovascular risk.

Objectives: A meta-analysis suggested that the use of varenicline, which is a partial agonist of nicotinic acetylcholine receptors and is effective in smoking cessation, increases the risk of cardiovascular events within 52 weeks of starting treatment. Defining these events as occurring during drug treatment (usually for 12 weeks) or within 30 days of discontinuation, another meta-analysis showed that the risk was statistically insignificant. In the present study, we aimed to clarify the effect of varenicline-assisted smoking cessation on vascular endothelial function assessed by flow-mediated vasodilation (FMD). Design: Before–after and time-series. Setting: Tochigi Prefecture, Japan. Participants: Data of 85 participants who visited nicotine-dependent outpatient services were reviewed. FMD was repeatedly measured in 33 of the 85 participants. Inclusion criteria: 20 years and older, Brinkman index ≥200, Tobacco Dependence Screener ≥5 and stated motivation to quit smoking. Interventions: Each participant was treated with varenicline titrated up to 1.0 mg twice daily (for 12 weeks in total). Primary and secondary outcome measures: Participants were evaluated by FMD prior to, and 3 months after, complete smoking cessation. Follow-up FMD measurements were carried out every 3 months if possible. Changes in FMD during varenicline use were also evaluated. Results: FMD was significantly increased from 4.0±1.8% to 5.5±2.2% (p

This report presents a novel method for characterizing accelerometers under medium and high accelerations ranging from 2 × 10 2 to 1 × 10 6 m s −2 . The reflection of longitudinal elastic waves in a thin circular bar is used for the excitation of a test accelerometer that is attached to the end of the bar. A newly designed laser interferometer can determine the input acceleration accurately. By improving the resolution of the interferometer, the lower acceleration limit of this method can be extended from 2000 m s −2 , the previous limit, to 200 m s −2 . The effectiveness of the method is confirmed through an experiment in which a piezoelectric-type accelerometer is characterized.

In this paper, we propose a novel method for evaluating the frequency response of shock accelerometers using Davies bar and interferometry. The method adopts elastic wave pulses propagating in a thin circular bar for the generation of high accelerations. The accelerometer to be examined is attached to one end of the bar and experiences high accelerations of the order of 103∼105 m/s2. A laser interferometer system is newly designed for the absolute measurement of the bar end motion. It can measure the motion of a diffuse surface specimen at a speed of 10−3 ∼100 m/s. Uncertainty of the velocity measurement is estimated to be±6×10−4 m/s, proving a high potential for use in the primary calibration of shock accelerometers. Frequency characteristics of the accelerometer are determined by comparing the accelerometer's output with velocity data of the interferometry in the frequency domain. Two piezoelectric-type accelerometers are tested in the experiment, and their frequency characteristics are obtained over a wide frequency range up to several ten kilohertz. It is also shown that the results obtained using strain gages are consistent with those by this new method.

胸部X線所見分類で孤立結節性陰影1例, 多発粟粒状結節性陰影1例, 肺炎様陰影3例の細気管支肺胞上皮癌5例を胸部単純X線写真, X線CTと細気管支鏡所見を対比し検討した. 内視鏡所見は肺炎様陰影を呈した症例では細気管支は漿液性の分泌物が多く肺胞の方から湧き出てくる像がみられ, また, 細気管支に粘膜下主体型の腫瘍および閉塞像が認められた. 散在するポリープ様変化も認められ本症の進展形式を示唆した. 孤立結節性陰影の症例では結節隆起型の腫瘍がみられた. 多発粟粒状結節性陰影の症例では細気管支は全般的に狭窄を起こし粘膜面が蒼白に認められた. 初めて本症を内視鏡で観察することが出来た.

Six cases of gastric antral ulcer with an unknown cause encountered at our hospital and related facilities during the last 5 years were evaluated. The frequency of the disease was 1.3% of all gastric ulcers. The lesions were multiple in 3 and solitary in 3. All these lesions were ellipsoidal and small ulcers 1 cm or less in long diameter with mucosal elevations around them, located primarily in the greater curvature, and accompanied by reddened erosions in other areas of the antrum. The patients were middle-aged or older, 5 of them were females, half of them had a history of bleeding, and 4 showed resistance to treatment with proton pump inhibitors. The 6 patients had common clinical features, suggesting that they had the same disease. From the presence of reddened erosion, mutual friction of the antral mucosa was suspected to be a cause of the disease. Similar ulcers are found in the literature, but they have not been described or evaluated in detail. The further accumulation of cases and clarification of details of the disease are desired.

With the rising demand for LNG in recent years, expansion of existing LNG terminals and construction of new ones are planned in many places around the world, and some of such projects are already in progress. Sites selected for these projects may not necessarily have favorable soil conditions from the viewpoint of seismic protection. Seismic demand tends to be higher for LNG storage tanks to be built on such sites. Severe seismic deign conditions require precise estimation of the uplift at the annular part during the earthquake. Depending on the estimation results, either of the following measures needs to be taken: increase of the plate thickness; installation of anchors or seismic isolators; and, occasionally, modification of the tank proportion. Uplift estimation is usually based on conventional design methods in which seismic load is converted into static load, because dynamic behavior of uplift is hardly taken into account in the design process due to its complexity. Some previous fundamental studies revealed that tank uplift and other dynamically induced responses would tend to be smaller than those simulated by static loads. This indicates a possibility of optimizing tank structure based on these research results. As a step toward introducing the uplift response in tank design properly, a time-history FEM analysis with fluid-structure coupling was carried out to understand the tank uplift behavior. This paper reports the findings from the analysis, including comparison with conventional analysis and previous fundamental studies. Since the rocking response may reduce overturning moment and base shear of tanks, structural design may have benefits if such mechanisms are properly taken into account.Copyright © 2011 by ASME

This paper proposes a novel method for evaluating the dynamic characteristics of shock accelerometers under high acceleration levels and a wide frequency bandwidth. High accelerations of 103∼105m/s2 can be generated by the reflection of an elastic wave pulse propagating in a metal bar known as the Davies bar. The elastic wave pulse is produced by the collision of a projectile against one end of the bar, and is detected by straingages. The accelerometer to be characterized is attached to the other end of the bar. The one-dimensional theory of elastic waves enables the derivation of an input acceleration to the accelerometer from the measured strain. The dispersion of the elastic waves caused by the lateral inertia of the bar is compensated for by using a two-dimensional analytical solution. This method was validated by an experiment characterizing a piezoelectric-type accelerometer within the frequency band approximately 1 kHz∼70 kHz.

Microplasma technology was used in the last years for various applications such as NOx removal, sterilization of bacteria or surface treatment. The advantages of microplasma consist in reduced size of the reactor and low discharge voltage. Phenomena of microplasma could be analyzed using emission spectroscopy method. Our microplasma is atmospheric pressure nonthermal plasma. It is a dielectric barrier discharge generated between perforated metallic electrodes covered by a dielectric layer at small discharge gaps between 0 -100 μm. Thus the discharge voltage is around 1 kV Nitrogen, oxygen and argon were used as discharge gases. The emission spectra were measured by an ICCD camera, a spectrometer and a photomultiplier tube. Microplasma was pulsed powered by a Marx Generator and a high voltage amplifier.

This paper presents a new method of estimating the dynamic characteristics of a shock accelerometer using elastic wave propagation in a metal bar. The output from the accelerometer attached to a Davis bar is compared with the theoretical acceleration calculated using the relationship derived from the one-dimensional wave equation of motion in elastic media. The experiment was carried out using the 2 m long stainless steel bar, a solenoid valve air gun, a transient recorder, and a personal computer for signal processing. Details are given of the experimental equipment, the comparison of the accelerometer output with the differentiation of the strain gauge signal, the comparison of the integration of the acceleration signal with the strain gauge signal, and the response curve of the accelerometer calculated using the fast Fourier transform.

A 65-year-old man developed severe septic shock during thrombolytic treatment with urokinase for pulmonary thromboembolism associated with deep venous thrombosis of the right lower limb. Blood cultures were positive forKlebsiella pneumoniae and treatment was successful only when the antibiotics were infused via the same route as the urokinase.

The high cost of digital echocardiographs and the large size of data files hinder the adoption of remote diagnosis of digitized echocardiography data. We have developed a low-cost digital filing system for echocardiography data. In this system, data from a conventional analog echocardiograph are captured using a personal computer (PC) equipped with an analog-to-digital converter board. Motion picture data are promptly compressed using a moving pictures expert group (MPEG) 4 codec. The digitized data with preliminary reports obtained in a rural hospital are then sent to cardiologists at distant urban general hospitals via the internet. The cardiologists can evaluate the data using widely available movie-viewing software (Windows Media Player). The diagnostic accuracy of this double-check system was confirmed by comparison with ordinary super-VHS videotapes. We have demonstrated that digitization of echocardiography data from a conventional analog echocardiograph and MPEG 4 compression can be performed using an ordinary PC-based system, and that this system enables highly efficient digital storage and remote diagnosis at low cost.

A 52-year-old man with chronic granulomatous interstitial pneumonitis suffered from invasive group A streptococcal infection. His chest x-ray showed bilateral interstitial shadows in the lower lung fields since childhood. He was admitted to Keio University Hospital because of fever, productive cough, and necrosis of the distal extremity. The chest radiographic appearance worsened and he developed low blood pressure, liver dysfunction, thrombocytopenia, and lymphocytopenia. Blood culture yielded T-11 strainStreptococcus pyogenes, which generated type B and C pyrogenic exotoxins. This may be the first report to confirm T-11Streptococcus pyogenes as the causative organism for invasive group A streptococcal infection in Japan. The patient's condition improved after treatment with panipenem and subsequent combination therapy with high-dose penicillin G and gentamicin. An immunodeficiency state associated with the chronic granulomatous lung disease was strongly suspected.

The mass production of silicon accelerometers has clarified that the current acceleration standard is not perfect. The acceleration standard is usually transferred by a reference accelerometer with the so-called back-to-back connection technique. Manufacturers, however do not explain what sort of calibration technique is applied to the reference accelerometer in the impact acceleration range. This paper proposes a novel impact technique for accelerometers calibration. The input acceleration to an accelerometer to be tested is generated by the reflection of an elastic pulse at one end surface of a bar. The bar is called Davies Bar, after Prof. Davies, who measured the dynamic displacement of the end surface of a metal bar by electrodes. The experiment was the comparison between the calibration of RION PV-44A accelerometer by ENDEVCO 2270 and that by NRLM method. The paper concludes that Davies' Bar should be used as the reference for the impact acceleration, ranging from roughly 200 [m/s 2 ] to 1000,000 [m/s 2 ] for mainly following reasons: (1) NRLM method is based on laser interferometer measurement with the reliable accuracy. (2) The frequency bandwidth of the impact acceleration generated using Davies bar is much wider than that of reference accelerometers. (3) Back to back connection does not always enable the comparison between the measurement of the connecting surface motion and the accelerometers' outputs.

In the beginning stage of MITI micromachine project, the committee on the standardization established in Micromachine Center recognized the importance of measurement technique for the promotion and the systemization of the micromachine technology. Micromachine Center is the organizing body for private sectors working in the MITI micromachine project which started in 1991. MITI stands for Ministry of International Trade and Industry in Japan. In order to known the requirements on the measurement technologies, the questionnaire was organized by the measurement working group in the committee. This talk covers the questionnaire and its results, and some research results obtained at National Research Laboratory of Metrology working as a member in the project.

We developed a new type of bronchoscope (BF-2.7T) and cytology brush (BC-0.7T) that permit collection of pulmonary cells during direct observation of the small airways. This kind of cell collection has been previously impossible. With our cytology brush, 3.58 +/- 2.76 x 10(4) cells were collected from small airways. The rate of living cells was 33.13 +/- 3.61 percent from the small airways. Analysis of endoscopic findings and investigation of pulmonary cells are very important for elucidating the pathophysiologic state of the small airways. The use of the BF-2.7T allowed collection of cancer cells under direct endoscopic vision in all five patients with peripheral lung cancer. They also contribute to our understanding of the relationship between exogenous factors and cells that compose the lung, and will provide means for treatment and prevention of diseases.

In order to assess the physiological abnormalities and the pathogenesis of adult respiratory distress syndrome (ARDS), especially that associated with pulmonary fat embolism, acute lung injury caused by monounsaturated nonsterified fat oleic acid (cis-9-octadecenoic acid) has been widely used in animal experiments. This lung injury results in an extensive, multifocal, and heterogeneously distributed lung damage with alveolar flooding, interstitial edema and microatelectasis. The ability to reduce the perfusion entering into damaged and edematous areas is essentially important in preserving blood oxygenation in ARDS.

Hypoxie pulmonary vasoconstriction (HPV) is of importance in egulating the distribution of blood flow in the lung, thus allowing the lung to maintain a pertinent matching between ventilation and blood flow. Recently, several authors (cf. Archer et al, 1989b) have reported that endogenous products of reactive O2 species (ROS) in the lung are the important factor for initiating HPV.

In order to assess the physiological abnormalities and the pathogenesis of adult respiratory distress syndrome (ARDS), especially that associated with pulmonary fat embolism, acute lung injury caused by monounsaturated nonsterified fat oleic acid (cis-9-octadecenoic acid) has been widely used in animal experiments. This lung injury results in an extensive, multifocal, and heterogeneously distributed lung damage with alveolar flooding, interstitial edema and microatelectasis. These morphological changes have generally been considered to develop significant shunt flow causing severe hypoxemia and loss of lung compliance. Based on the microscopic examinations, however, Schoene et al. (1984) have failed to demonstrate a quantitative relationship between the morphological alterations and the amount of shunt in dogs with lung damage induced by oleic acid administration. Further, Brigham et al. (1983) have shown that gas exchange abnormality in patients with ARDS does not correlate with extent of pulmonary edema estimated from extravascular lung water but significantly with vascular permeability-surface area. They have inferred from their experimental findings that the ability of the lung circulation to reduce perfusion of damaged and edematous areas is essentially important in preserving blood oxygenation in ARDS.

Since the noise level of textile machinery has become more important factor to evaluate the mechanical performance, it is necessary to provide an uniform basis for both machinery producers and textile manufacturers to measure and communicate the noise information.From this necessity, I.R.I.I.P.has made a semi-anechoic room aiming mainly the acoustic investigation of textile machinery.The present investigation was planned to examine the acoustic property of this facility.To carry out the investigation planned, the free field property and noise reduction factor of the facility were examind.From the results obtained, it was found that the semi-anechoic room of I.R.I.I.P. would be effective for the noise measurement and analysis of the textile machinery proposed.

A series of our investigations has shown that a shuttle loom costs more expense of wear and tear than a shuttleless loom does.The main reason of this is that a wooden shuttle is low in mechanical durability.From this point-of-view, a plan is afoot to reduce the expense by replacing a wooden shuttle with a plastic one. To carry out the investigation, a German p lastic shuttle is used on an automatic cop changing loom for polyester textured fabric.The main results obtained are as follows : (1) A plastic shuttle can be used in the polyester textured fabric in the similiar condition to the wooden shuttle, (2) Mechanical durability of the plastic shuttle is higher than that of the wooden shuttle, and (3) Therefore, the wear and tear expense of shuttle can be reduced by using a plastic shuttle.