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Early detection of worsening heart failure (HF) with a telemonitoring system crucially depends on monitoring parameters. The present study aimed to examine whether a serial follow up of all-night respiratory stability time (RST) built into a telemonitoring system could faithfully reflect ongoing deterioration in HF patients at home and detect early signs of worsening HF in a multicenter, prospective study.Methods and Results: Seventeen subjects with New York Heart Association class II or III were followed up for a mean of 9 months using a newly developed telemonitoring system equipped with non-attached sensor technologies and automatic RST analysis. Signals from the home sensor were transferred to a cloud server, where all-night RSTs were calculated every morning and traced by the monitoring center. During the follow up, 9 episodes of admission due to worsening HF and 1 episode of sudden death were preceded by progressive declines of RST. The receiver operating characteristic curve demonstrated that the progressive or sustained reduction of RST below 20 s during 28 days before hospital admission achieved the highest sensitivity of 90.0% and specificity of 81.7% to subsequent hospitalization, with an area under the curve of 0.85.RST could serve as a sensitive and specific indicator of worsening HF and allow the detection of an early sign of clinical deterioration in the telemedical management of HF.

Recently, several extreme flood hazards with active sediment and driftwood transport have occurred in mountainous areas of Japan, as typically observed in the Akatani river flood disaster in 2017. Therefore, in order to mitigate such hazards, it is required to develop methods to evaluate flood, sediment, and driftwood runoff from a basin during heavy rainfall. This research proposes integrated methods to evaluate flood, sediment and driftwood runoff from a basin during heavy rainfall using numerical methods. The proposed methods are applied to the Terauchi Dam basin, where large amounts of sediment and driftwood were discharged during the 2017 Northern Kyushu heavy rainfall event, to discuss the applicability of the methods.The methods are composed of a distributed rainfall-runoff model, slope stability analysis, sediment and driftwood transport in the slope based on mass system equation, and sediment and driftwood transport in the river channel by unit channel model. These models are integrated as Rainfall-Sediment Runoff (RSR) model to evaluate sediment and driftwood runoff from a basin. As a result of its application to the Terauchi Dam basin, we found that whether or not the debris flow enters the river channel, i.e., the definition of the upstream end of the river channel, has a significant impact on the results. Therefore, we investigated whether the sediment supplied by debris flow enter the river channel during the actual event. The results show that the upstream end of the river channel in the computation should be defined as approximately 4% to 10% slope, and in case the mesh size is sufficiently fine, the debris flow inflow into the channel is sufficiently evaluated. In conclusion, this research proposes an integrate methods to evaluate flood, sediment and driftwood runoff from a basin, and discusses its applicability to the disasters such as the 2017 Northern Kyushu heavy rainfall event.

Brahmaputra River comprises the characteristics of a braided channel and suspended sediment-dominant river. Frequent changes in the river course have led to severe bank erosion. In particular, Tangail and Manikganj districts have recently become bank erosion-prone areas. To predict vulnerable locations based on bank erosion, we aimed to understand the behavior of the braided channel by conducting a numerical simulation and satellite data analysis in this study. We employed a depth-integrated 2-D numerical model for water and sediment transport, which was originally proposed by Takebayashi et al. and modified by Harada et al. by introducing a new treatment of suspended sediment. In addition, bathymetry data were created using a series of satellite data information to successfully conduct the simulation. In this study, we focused on two aspects. The first point is the skewing of flow discharge along multiple channels, which belongs to the area of interest, as a large-scale phenomenon. The second point is changing the local geometry of the sand bar and changing the flow pattern, as a small-scale phenomenon. To consider the two different scales, we employed the computation domain as an entire channel. Our results indicate that the numerical model is successfully verified using satellite data information, and the two-scale phenomena are successfully described. Regarding the large-scale phenomenon, our results indicate that the distribution of higher flow rates activates various geomorphological changes, including riverbed evolution, channel changes, and bank erosion. On the other hand, small-scale phenomena, such as the rapid appearance of sand bars and changes in the water course, are directly related to bank erosion.

BACKGROUND The heterogeneity of B-type natriuretic peptide (BNP) levels among individuals with heart failure and preserved ejection fraction (HFpEF) makes predicting the development of cardiac events difficult. This study aimed at creating high-performance Naive Bayes (NB) classifiers, beyond BNP, to predict the development of cardiac events over a 3-year period in individual outpatients with HFpEF.Methods and Results:We retrospectively enrolled 234 outpatients with HFpEF who were followed up for 3 years. Parameters with a coefficient of association ≥0.1 for cardiac events were applied as features of classifiers. We used the step forward method to find a high-performance model with the maximum area under the receiver operating characteristics curve (AUC). A 10-fold cross-validation method was used to validate the generalization performance of the classifiers. The mean kappa statistics, AUC, sensitivity, specificity, and accuracy were evaluated and compared between classifiers learning multiple factors and only the BNP. Kappa statistics, AUC, and sensitivity were significantly higher for NB classifiers learning 13 features than for those learning only BNP (0.69±0.14 vs. 0.54±0.12 P=0.024, 0.94±0.03 vs. 0.84±0.05 P

β-Hydroxy-β-methylbutyrate (HMB), a metabolite of leucine, is known to increase muscle mass and strength. However, the effect of perioperative HMB supplementation in liver surgery is unclear. Moreover, the impact of HMB on the skeletal muscle fiber type also remains unclear. We investigated the impact of HMB on the body composition and skeletal muscle fiber type in sarcopenic rats undergoing major hepatectomy. Nine-week-old male F344/NSlc rats were maintained in hindlimb suspension (HLS) and were forcedly supplemented with HMB calcium salt (HMB-Ca, 0.58 g/kg×2 times) or distilled water in addition to free feeding. After 2 wk of HLS, the rats underwent 70% hepatectomy and were sacrificed 3 d after surgery. Body composition factors and the proportion of slow-twitch fibers in hindlimb muscles were evaluated. HMB maintained the body composition and hindlimb force and acted against their deterioration in sarcopenic rats, exerting a particular effect on lean mass weight, which was significant. In the histological study, HMB significantly increased the proportion of slow-twitch fibers in the soleus (p=0.044) and plantaris (p=0.001) of sarcopenic rats. HMB ameliorated deterioration of the body composition and increased the proportion of slow-twitch fibers in sarcopenic rats undergoing major hepatectomy.

Objectives Osteogenesis imperfecta (OI) is a skeletal dysplasia characterized by recurrent fractures due to congenital bone fragility. The only bisphosphonate approved for OI in Japan is pamidronate (PAM). To investigate whether monthly intravenous alendronate (ALN) infusions can maintain bone strength in OI children following cyclical PAM treatment. Methods A prospective and non-inferiority study was conducted. Eight school-age OI patients aged 8.5±2.0 years who were treated with cyclical PAM for 6.0±2.3 years were enrolled and switched to monthly intravenous ALN (0.030 mg/kg/month). Changes in L1-4 bone mineral density (BMD) Z-scores, fracture rates, and bone turnover markers for 12 months were analyzed. Results Average BMD Z-scores were −3.0±1.9, −2.9±2.0, and −2.2±2.0 in 12 months before enrollment, at enrollment, and after 12 months of ALN treatment, respectively. BMD Z-scores increased significantly during treatment with both PAM and ALN (p=0.012), and the effect of ALN was not inferior to that of PAM (p=0.67). There was no change in fracture rates (p=0.86) and bone turnover markers during the 12 months before and after enrollment. Additionally, ALN showed no remarkable side effects. Conclusions Our results suggest that monthly intravenous ALN can maintain bone strength after primary usage of cyclical PAM. We concluded that monthly intravenous ALN as a maintenance treatment following cyclical PAM administration can be an option for OI children.

Purpose: The aim of this study was to determine the cardiovascular function and prevalence of valvular diseases in children with osteogenesis imperfecta (OI). Methods: Twenty-eight OI children (mean age: 9.9±6.0 years) underwent echocardiography. Heart function, heart dimensions, and valvular complications were assessed calculating standard deviation (SD) scores referring to body surface area, and compared retrospectively in clinical types according to Sillence’s classification and with height SD scores. Results: Of the 28 OI children, 17 (61%) were complicated with valvular diseases. The mean height SD scores was lower in more severe clinical types (pConclusions: Valvular dysfunction is a frequent complication of OI patients, even in childhood. Aortic root enlargement and hypertrophic IVS appeared to be negatively impacted by the disease. Thus, careful echocardiographic follow-up during childhood, especially for patients with severe short stature, should be performed.

This study reveals the characteristics of flood flow with active sediment transport that caused the Sozu River flood disaster in July 2018. The results of field surveys revealed that the basin contains steep mountains and flat areas, facilitating the rapid transport of sediment produced in the mountains to downstream areas during the disaster. Two-dimensional numerical simulations of flood flow with sediment transport are conducted to realize the flood flow characteristics. As a result of the simulation, a huge amount of sediment deposition in the channel near the top of the alluvial fan increases the inundation damage at downstream areas. The results indicate that within two flood peaks during the disaster, the inundation in the second flood peak is more severe than that in the first peak, whereas the discharge of the second peak is much less than that in the first peak, caused by the reduction in the capacity of the original channel owing to the sand deposition during the first and second flood peaks.

The next generation electron-positron colliders are designed for precision studies of the Standard Model and its extensions, in particular in the Higgs sector. We consider the potential for discovery of composite Higgs models in Higgs pair production through photon collisions. This process is loop-generated, thus it provides access to all Higgs couplings and can show new physics effects in polarized and unpolarized cross-sections starting at relatively low collider energies. It is, therefore, relevant for all electron-positron colliders planned or in preparation. Sizeable deviations from the Standard Model predictions are present in a general class of composite Higgs models, as couplings of one or more Higgs bosons to fermions, or fermionic and scalar resonances, modify the destructive interference present in the Standard Model. In particular, large effects are due to the new quartic coupling of the Higgs to tops and to the presence of a light scalar resonance., Comment: v2: 31 pages, 17 figures, version accepted by JHEP. arXiv admin note: text overlap with arXiv:2105.11030

Objectives X-linked hypophosphatemic rickets (XLH) is a congenital fibroblast growth factor (FGF)23-related metabolic bone disease that is treated with active vitamin D and phosphate as conventional therapies. Complications of these therapies include nephrocalcinosis (NC) caused by excessive urine calcium and phosphate concentrations. Recently, an anti-FGF23 antibody, burosumab, was developed and reported to be effective in poorly-controlled or severe XLH patients. This study aimed to reveal the impact of switching treatments in relatively well-controlled XLH children with the Rickets Severity Scale less than 2.0. Methods The effects of the two treatments in eight relatively well-controlled XLH children with a mean age of 10.4 ± 1.9 years were compared retrospectively for the same treatment duration (31 ± 11 months) before and after the baseline. Results Actual doses of alfacalcidol and phosphate as conventional therapy were 150.9 ± 43.9 ng/kg and 27.5 ± 6.3 mg/kg per day, respectively. Renal echography revealed spotty NC in 8/8 patients, but no aggravation of NC was detected by switching treatments. Switching treatments increased TmP/GFR (p=0.002) and %TRP (p Conclusions Our results suggest that a high dose of alfacalcidol was needed to control the disease, but it caused hypercalciuria and NC. We concluded that switching treatments in relatively well-controlled XLH children improved renal phosphate reabsorption and decreased urine calcium extraction, and may have the potential to prevent NC.

The objective of this study was to determine the relationship between glucose dosage in parenteral nutrition and reductions in levels of body thiamine in rats. Vitamin-free infusions with differing amounts of glucose were administered to normal or thiamine-deficient rats for 5 days, after which urinary thiamine excretion and the amounts of thiamine in the blood, liver, brain, and skeletal muscles were measured. The total energy dosage was set at three levels (98, 140, and 196 kcal/kg), and the dose of amino acids was constant among all groups. Urinary thiamine excretions on Day 5 decreased with increasing glucose dosage in the infusions. In normal rats, the amount of thiamine in the blood and all organs decreased compared with the diet group; however, no significant differences were found among the infusion groups. In thiamine-deficient rats, on the other hand, the amount of thiamine in the liver and skeletal muscles did not differ significantly among infusion groups; however, the amount of thiamine in the brain and blood decreased with increasing glucose dosage. An organ-specific correlation was found between glucose dosage in infusions and reductions in levels of thiamine. To prevent thiamine deficiencies from affecting the central nervous system, greater caution must be exercised during high-caloric parenteral nutrition. However, a constant supply of thiamine seemed to be essential, irrespective of the amount of energy supplied via parenteral nutrition, to maintain a sufficient level of thiamine in the body.

We represent the photovoltaic performance of n-type crystalline silicon (n-Si) heterojunction with organic thin-layer (HOT) solar cell module using poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate)(PEDOT:PSS) together with 4,4′-cyclohexylidenebis [N,N-bis(4-methylphenyl) benzenamine] (TAPC) as a protecting layer of PEDOT:PSS for air storage and barium hydroxide, Ba(OH)2 as a hole blocking layer at the rear c-Si/cathode interface, respectively. PEDOT:PSS/n-Si front-junction solar cell showed a power conversion efficiency (PCE) of 13–14% (11–12%) with a short-circuit density, JSC of 29–31 mA/cm2 (25–26 mA/cm2), an open-circuit voltage, VOC of 0.62 V (0.625 V), and a fill factor, FF of 0.72 (0.704) for a 2 × 2 cm2 (4 in.) size device. Solar cell module consisting of ten-units of series-connected 2 × 2 cm2 (4 in.) sized cells exhibited a output power of 0.37 W (7.3 W) with a VOC of 6.1 V (6.2 V), a JSC of 0.084 A (1.78 A), and a FF of 0.712 (0.71). We also confirmed that it worked as a stand-alone photovoltaic system for remote monitoring of wireless camera drive.

Hypophosphatasia (HPP) is a metabolic bone disease characterized by failure of bone calcification and vitamin B6 dependent seizures. It is caused by loss-of-function mutations in the ALPL gene. A newborn girl required respiratory support by nasal-directional positive airway pressure at birth, and pyridoxine hydrochloride administration for vitamin B6-dependent seizures observed from day two. Umbilical cord blood showed low alkaline phosphatase (ALP) activity and high pyridoxal phosphate levels. Radiographs showed severe rickets-like appearance of the bones. Genetic analysis of the ALPL gene revealed compound heterozygous mutations, c.1559delT/p.Ser188Pro. We diagnosed her with perinatal severe HPP, and started the patient on asfotase alfa from day six. Following enzyme replacement therapy (ERT), skeletal mineralization and respiratory insufficiency improved with no remarkable side-effects. Crying vital capacity (CVC) was used to evaluate respiratory status, which continuously improved from 13.3 mL/kg (day 22) to 20.6 mL/kg (day 113). Since no seizures occurred, pyridoxine hydrochloride was tapered off at one year of age. Strategies to manage perinatal severe HPP cases following ERT have not been established till date. A review of the literature shows that CVC may be a good indicator for weaning from ventilatory support. In addition, ERT will most likely enable withdrawal of pyridoxine treatment.

To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent ‘Y’ descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p

Respiratory instability in chronic heart failure (CHF) is characterized by irregularly rapid respiration or non-periodic breathing rather than by Cheyne-Stokes respiration. We developed a new quantitative measure of respiratory instability (RSI) and examined its independent prognostic impact upon CHF.In 87 patients with stable CHF, respiratory flow and muscle sympathetic nerve activity (MSNA) were simultaneously recorded. RSI was calculated from the frequency distribution of respiratory spectral components and very low frequency components.During a mean follow-up of 85±38 months, 24 patients died. Sixteen patients who died of cardiac causes had a lower RSI (16±6 vs. 30±21, p0.01), a lower specific activity scale (4.3±1.4 Mets vs. 5.7±1.4 Mets, p0.005), a higher MSNA burst area (16±5% vs. 11±4%, p0.001), and a higher brain natriuretic peptide (BNP) level (514±559pg/ml vs. 234±311pg/ml, p0.05) than 71 patients who did not die of cardiac causes. Multivariate analysis revealed that RSI (p=0.015), followed by MSNA burst area (p=0.033), was an independent predictor of subsequent all-cause deaths and that RSI (p=0.026), MSNA burst area (p=0.001), and BNP (p=0.048) were independent predictors of cardiac deaths. Patients at very high risk of fatal outcome could be identified by an RSI20.The daytime respiratory instability quantified by a new measure of RSI has prognostic importance independent of sympathetic nerve activation in patients with clinically stable CHF. An RSI of20 identifies patients at very high risk for subsequent all-cause and cardiovascular death.