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Purpose Coronavirus disease 2019 (COVID-19) has placed a great burden on critical care services worldwide. Data regarding critically ill COVID-19 patients and their demand of critical care services outside of initial COVID-19 epicenters are lacking. This study described clinical characteristics and outcomes of critically ill COVID-19 patients and the capacity of a COVID-19-dedicated intensive care unit (ICU) in Kobe, Japan. Methods This retrospective observational study included critically ill COVID-19 patients admitted to a 14-bed COVID-19-dedicated ICU in Kobe between March 3, 2020 and June 21, 2020. Clinical and daily ICU occupancy data were obtained from electrical medical records. The last follow-up day was June 28, 2020. Results Of 32 patients included, the median hospital follow-up period was 27 (interquartile range 19–50) days. The median age was 68 (57–76) years; 23 (72%) were men and 25 (78%) had at least one comorbidity. Nineteen (59%) patients received invasive mechanical ventilation for a median duration of 14 (8–27) days. Until all patients were discharged from the ICU on June 5, 2020, the median daily ICU occupancy was 50% (36–71%). As of June 28, 2020, six (19%) died during hospitalization. Of 26 (81%) survivors, 23 (72%) were discharged from the hospital and three (9%) remained in the hospital. Conclusion During the first months of the outbreak in Kobe, most critically ill patients were men aged ≥ 60 years with at least one comorbidity and on mechanical ventilation; the ICU capacity was not strained, and the case-fatality rate was 19%. Supplementary Information The online version contains supplementary material available at 10.1007/s00540-021-02897-w.

Supplemental Digital Content is available in the text., Objectives: We conducted a pilot study using an experimental study protocol to evaluate the measurement error of arterial pulse contour analysis-derived stroke volume due to improper transducer leveling during the passive leg raising test and the impact of such error on the determination of fluid responsiveness. Design: Prospective observational study. Setting: A medical-surgical ICU at a tertiary referral center in Kobe, Japan. Patients: Consecutive critically ill adult patients using the FloTrac system Version 4.0 (Edwards Lifesciences, Irvine, CA) for hemodynamic monitoring between September 1, 2018, and November 31, 2018. Interventions: None. Measurements and Main Results: Using 20 patients, we estimated the change in the zero-reference level of an arterial transducer during head-down tilting as the vertical distance between the zero-reference levels of the transducer in the 45° semi-recumbent and supine positions. Using the FloTrac system Version 4.0, we recorded the hemodynamic variables every 20 seconds for 180 seconds at each of the following three points: 1) baseline, 2) after the transducer was elevated by the predetermined distance, and 3) after the transducer had returned to baseline. With respect to the predetermined change in the transducer level, a mean value of 18 ± 3 cm resulted in an increase in stroke volume measurement (mean value, 11 mL/beat; 95% CI, 10–13). This value corresponded to 20% (95% CI, 18–23%) of the baseline value 20 seconds after changing the transducer level. A significant correlation was observed between the predetermined change in the transducer level and the increase in the measured stroke volume (r2 = 0.58; p < 0.001). CONCLUSIONS: When using the FloTrac system Version 4.0, a rapid increase in stroke volume was observed after elevating the arterial transducer. Clinicians and researchers are advised that proper leveling of the arterial transducer is necessary in order to accurately assess the change in arterial pulse contour analysis-derived stroke volume during the passive leg raising test.

Purpose: To assess the physical performance of deep learning image reconstruction (DLIR) compared with those of filtered back projection (FBP) and iterative reconstruction (IR) and to estimate the dose reduction potential of the technique. Approach: A cylindrical water bath phantom with a diameter of 300 mm including two rods composed of acrylic and soft tissue-equivalent material was scanned using a clinical computed tomography (CT) scanner at four dose levels (CT dose index of 20, 15, 10, and 5 mGy). Phantom images were reconstructed using FBP, DLIR, and IR. The in-plane and [Formula: see text] axis task transfer functions (TTFs) and in-plane noise power spectrum (NPS) were measured. The dose reduction potential was estimated by evaluating the system performance function calculated from TTF and NPS. The visibilities of a bar pattern phantom placed in the same water bath phantom were compared. Results: The use of DLIR resulted in a notable decrease in noise magnitude. The shift in peak NPS frequency was reduced compared with IR. Preservation of in-plane TTF was superior using DLIR than using IR. The estimated dose reduction potentials of DLIR and IR were 39% to 54% and 19% to 29%, respectively. However, the [Formula: see text] axis resolution was decreased with DLIR by 6% to 21% compared with FBP. The bar pattern visibilities were approximately consistent with the TTF results in both planes. Conclusions: The in-plane edge-preserving noise reduction performance of DLIR is superior to that of IR. Moreover, DLIR enables approximately half-dose acquisitions with no deterioration in noise texture in cases that permit some [Formula: see text] axis resolution reduction.

Purpose We evaluated whether longer term hemodialysis (HD) is associated with a higher incidence of vasoplegic syndrome (VS) after cardiac surgery. Methods This retrospective, single-center cohort study included 562 consecutive patients who underwent cardiac surgery in a tertiary hospital from January 2015 to December 2016. We assessed VS occurrence and its relationship with HD duration and other risk factors. To assess the effect of the HD duration on VS occurrence, we constructed ordinal variables: HD = 0 (non-HD), 0 180 min were significantly more common in the VS group (P 180 min) were subjected to multivariate regression analysis. Long-term HD was identified as an independent predictor of VS (odds ratio, 2.29, 95% confidence interval, 1.66–3.18). Conclusions Longer term HD may be associated with a higher VS incidence after cardiac surgery. VS should be given attention after cardiac surgery in chronic HD-dependent patients.

We herein report the successful management of a condition mimicking acquired laryngomalacia using conservative methods in an elderly man with a progressive neurological disorder. The patient developed stridor and was transferred to the intensive-care unit. Flexible laryngoscopy revealed a collapsed epiglottis during inspiration, as seen in acquired laryngomalacia, with mucinous material firmly adhered to the epiglottis. The stridor resolved after the removal of this material. Pathology revealed keratinized material, suggesting a collection of sputum or epithelial tissue. Thus, flexible laryngoscopy can differentiate the cause of airway obstruction and avoid unnecessary endotracheal intubation in patients with neurological disorders.

Background Amiodarone and warfarin are sometimes administered immediately after cardiac surgery. Although the interaction between long-term oral amiodarone and warfarin has been reported, the interaction between warfarin and short-term intravenous amiodarone has not been reported. In this study, we investigated the effect of short-term intravenous amiodarone on the anticoagulant effect of warfarin in patients who underwent cardiac surgery. Methods We retrospectively reviewed the medical records of 11 patients who received oral warfarin before and after cardiac surgery, and loading doses of 125–150 mg or a 750 mg continuous infusion of amiodarone, or both in the intensive care unit (ICU) within 5 days after the surgery between July 2011 and January 2017. The prothrombin time-international normalized ratio (PT-INR)/daily warfarin dose (PT-INR/dose) was used as an indicator of anticoagulant effect. The values before surgery were considered as the baseline. Results The PT-INR and PT-INR/dose values were elevated in 7 and 10 patients, respectively, after amiodarone administration. The mean PT-INR values were not significantly different before and after amiodarone administration (2.13 ± 0.58 vs 2.29 ± 0.50, respectively, p = 0.643). In contrast, the mean PT-INR/dose values were significantly elevated after the administration of amiodarone (0.93 ± 0.46 vs 1.54 ± 0.63, respectively, p = 0.002). Conclusions Short-term intravenous amiodarone enhanced the anticoagulant effect of warfarin in patients admitted to the ICU after cardiac surgery. We suggest that the dose of warfarin should be carefully adjusted for a few days after cardiac surgery if intravenous amiodarone is coadministered.

The present case report presents a rare case of Epstein-Barr virus (EBV)-associated early gastric carcinoma with lymphoid stroma, accompanied by lymph node metastasis. A 61-year-old woman was referred to our hospital following observation of a gastric mass lesion that was initially diagnosed at a medical check-up. Esophagogastroduodenoscopy revealed a slightly elevated lesion with a central irregular depression in the middle third of the stomach. Endoscopic ultrasonography revealed a well-circumscribed hypoechoic mass located predominantly within the submucosa and the mucosa. Biopsy specimens of the lesion indicated the possibility of carcinoma with lymphoid stroma with a lymphoepithelial lesion. Abdominal contrast-enhanced computed tomography (CT) revealed a well-defined mass with homogeneous enhancement approximately 1.2 cm in diameter in the middle part of the stomach, demonstrating lymphadenopathy in the perigastric area at a maximum size of 1.4 cm in diameter. The patient underwent laparoscopic distal gastrectomy with regional lymphadenectomy due to suspicion of a gastric carcinoma with lymphoid stroma. Histopathological and immunohistochemical findings verified the diagnosis of carcinoma with lymphoid stroma, which were positive for EBV-encoded RNA (EBER-ISH) by in situ hybridization. There was one lymph node metastasis, which was in line with the CT imaging. Marked infiltration of lymphoid cells was observed in the tumor stroma, which were negative for EBER-ISH. The present case is informative of the pathological characteristics of this condition, and clinicians should recognize the features of this disease to make an accurate diagnosis and select the appropriate treatment.

Organic light emitting diodes (OLED) have been attracting attention because of their advantages in emission in a wide visible region and for applications to flat-panels or as light sources for optical signal circuits or other applications. In this paper, we report the fabrication and emission characteristics of two kinds of electroluminescence devices for enhanced red light emission utilizing energy transfer and energy confinement. The device consists of two materials systems: one is a co-doped OLED which consists of two different kinds of dye materials doped in an emissive layer, and the other type is a europium (Eu) complex doped in poly(N-vinylcarbazole), which are discussed. The results show that, in both cases, the enhancement of emission can be observed by the energy confinement of carriers. The mechanism of enhancement of emission is discussed, in terms of carrier confinement and by utilizing an energy band diagram of the emissive materials.

Bezafibrate is a commonly used medicine for hyperlipidemia and is known to have an effect of lowering biliary enzymes, alkaline phosphatase (ALP) and γ-glutamyltransferase. Recent studies showed that it upregulated mdr2/MDR3 P-glycoprotein expression which increased biliary phospholipid secretion into bile and had a cyto-protective effect against cholestasis. To evaluate the efficacy of bezafibrate in primary biliary cirrhosis(PBC), 11 pre-cirrhotic PBC patients were treated with oral administration of 400 mg/day of bezafibrate for 12–21 months. One of them was stage III and the rest was stage I–II. Two patients had pruritus and chronic fatigue, and two chronic fatigue. Bezafibrate was co-administered in seven patients who had been treated with ursodeoxycholic acid but shown incomplete responses. In 11 patients, values of ALP decreased by 50–70% and were normalized in five. After 2 months from the start, all symptoms lessened and eventually disappeared as biliary enzymes levels decreased. As for the immunological parameters, IgM decreased significantly in five patients but antimitochondrial antibody titers were not affected. The present data suggest that bezafibrate has additional effects and is safe for pre-cirrhotic primary biliary cirrhosis. The evaluations of long-term efficacy and toxicity including histological changes are needed.

Many research workers have concentrated their attention to realize high performance organic EL devices. Particularly, multicolor electroluminescent (EL) devices which emit red (R), green (G) and blue (B) lights are attractive for flat panel full color display application. This paper shows several types of multicolor EL devices which show the multicolor emission by changing the applied electric field or by applying the opposite polarity of the applied field. The multicolor emission EL devices which show three different colors (R-G-B) are composed by stacking a two-color-emission part on a single-color-emission part. The emission color can be modulated by applying different polarity of applied field to the two-color part, and by applying various voltages to the single-color part, independently.

A 57-year-old woman complained of anal bleeding. She had undergone radical hysterectomy followed by radiation total 60 gray for the treatment of uterus cancer 8 years prior. Colonoscopic examination was performed, and laterally spreading tumors were detected in the transverse, descending, and sigmoid colon. Histopathological findings of operated specimen were compatible with radiation colitis, and mucinous adenocarcinoma existed in this region and invaded to the subserosa with lymphonodi metastasis. She died of peritonitis carcinomatosa 8 months later.

Background We describe a case of a fever of unknown etiology that was caused by a caseating tubercle granuloma which produced erythropoietin. To our knowledge, this is the first report of an erythropoietin- producing granuloma. Case presentation A 48-year-old Japanese man with a 5-year history of maintenance hemodialysis for diabetic nephropathy presented with an intermittent fever over a few months. During febrile periods he developed erythema nodosum on his legs. Computed tomography showed axillary lymph node enlargement and this was further corroborated by a gallium scan that revealed high gallium uptake in these nodes. A Mantoux test was positive and an interferongamma release assay for tuberculosis diagnosis was also positive. Lymph node tuberculosis was suspected and the patient underwent lymphadenectomy. Histological analysis of the lymph nodes revealed a caseating granuloma that showed positive results on an acid-fast bacteria stain and a Mycobacterium tuberculosis polymerase chain reaction test. After lymphadenectomy, however, the patient’s hemoglobin levels rapidly decreased from 144 to 105 g/L, and this was further compounded by a decrease in serum erythropoietin from 223 mIU/mL to 10.7 mIU/mL by postoperative day 21. We suspected the tubercle to be a source of the erythropoietin and this was further confirmed by in situ hybridization. Conclusions We report for the first time ectopic erythropoietin production by a tuberculous lymph node. Our observations are substantiated by a postoperative decline in his erythropoietin level and a clinical requirement for erythropoietin treatment.

Controversy persists concerning the two concepts of the histogenesis and progression of colorectal cancer: the adenoma-carcinoma sequence and de novo cancer. The depressed type of colorectal tumor has attracted attention because it is thought to be a de novo cancer that has a higher rate of submucosal compared with the protruding type tumor.1-4 However, reports of small advanced colorectal cancer are rare. This is a case of a depressed type colon cancer invading the subserosa, which appears to be a case of minute advanced colorectal cancer.

A 52-year-old man suffering from a pure-type primary gastric small cell carcinoma was treated with surgery and combination chemotherapy. The small cell carcinoma, approximately 6.5 cm in diameter, was situated in the posterior wall of the antrum and there were no distant metasatses. Total gastrectomy and regional lymph node dissection was carried out. Histological examination revealed a solid pattern of proliferation of small cells with hyperchromatic, round nuclei and scant cytoplasm. Neoplastic cells infiltrated into the subserosal layer with severe lymphatic and vascular invasion. Regional lymph node cells were mostly replaced by tumor cells that stained positive for Grimelius, neuron-specific enolase (NSE), and synaptophysin. Accumulations of electron-dense core granules in the small neoplastic cells were seen by electron microscopy. Following surgery, the patient was treated with adjuvant chemotherapy consisting of cisplatin and etoposide. The patient is alive and recurrence free 3 years after surgical operation. We review 107 published cases of primary gastric small cell carcinoma, an extremely rare disease first reported in 1976. Small cell carcinoma is an aggressive, malignant tumor. Intensive chemotherapy is essential for patient survival even when curative surgical resection is carried out.

Summary form only given. Organic light emitting diodes (OLED) utilizing fluorescent dyes or conducting polymers have attracted great interest due to their advantage for an emission in the wide visible spectral range, high emissivity and low driving voltage. In the paper, we discuss optical and transmission characteristics of OLED which consist of 8-hydroxyquinoline aluminum and a diamine derivative and of a europium complex and azomethin derivative. We also discuss their transmission characteristics in polymer waveguides.

A case of solitary neurofibroma of the tongue with Becker's nevus of the skin is reported.A 20-year old man was referred to our department with a chief complaint of swelling of the tongue. He had Becker's nevi on his shoulder and dorsum of the hand but no other signs of dermal abnormality.The clinical diagnosis was a benign tumor of the tongue. The tumor was surgically resected under local anesthesia. The histopathological diagnosis was a neurofibroma. We suspected that he had been suffering from von Recklinghausen disease, but there was no evidence of a family history or associated dermal abnormalities. In addition, Becker's nevus is considered not to be accompanied by von Recklinghausen disease. The final diagnosis of the tumor was a solitary neurofibroma of the tongue.There has been no evidence of recurrence as of 2 years 3 months after the operation.

Organic light emitting diodes (OLEDs) which consists of 8-hydroxyquinoline aluminum (Alq3) and diamine derivative (TPD) were directly fabricated on a polymer waveguide device. Polymer waveguide device consists of deuterated methacrylate polymer core and UV cured epoxy resin cladding. One of the edges of the polymer waveguide was cut in 45 degree, which was served as a mirror, in order to introduce the output light from OLED to the waveguide. Indium-tin oxide (ITO) or semi-transparent aluminum metal was deposited onto the polymer waveguide, which served as anode. The OLED was directly fabricated by evaporation technique at the edge of a waveguide, whose edge served as a mirror.Emission and transmission characteristics of the light from red-light-emitting OLED are also discussed as a light source for the polymer based waveguide with low transmission loss.

Introduction: Monitoring continuous cardiac index (CCI) with pulmonary artery catheter (PAC) is valuable for postoperative management after cardiac surgery. However, some reports have shown that intermittent pneumatic compression (IPC) devices, which are used to prevent deep venous thrombosis and pu

Enhanced electroluminescence from europium (Eu) complex has been observed utilizing single, or multiple quantum–well structures consisting of a Eu complex well layer sandwiched between azomethin–zinc complex layers. Sharp emission at 614 nm has been observed from the Eu complex in the quantum-well structure. The thinner the well layer of the Eu complex, the stronger the emission intensity from it, under the same injection current. The mechanism of enhanced emission from the quantum-well structure has been discussed.