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Abstract Genetic testing identified novel compound heterozygous missense variants in the HEXA gene (NM_00520.6: c.775A>C and NM_000520.6: c.508C>T) in a 16-month-old girl diagnosed with Tay‒Sachs disease. The patient gradually became unable to consume food orally. She suffered severe aspiration pneumonia and underwent gastrostomy and laryngotracheal separation at 2 years and 4 months of age. Despite an initially good prognosis, she died at 3 years of age.

Abstract Background Patients with early‐stage lung cancer and interstitial lung disease have a poorer prognosis than those without interstitial lung disease. This study aimed to compare the long‐term outcomes of lobar and sublobar resections in these patients. Methods We retrospectively analyzed 138 consecutive patients with clinical stage I non‐small cell lung cancer and interstitial lung disease who underwent surgical treatment at two institutions between January 2010 and December 2020. Propensity score matching analysis was performed to adjust for baseline characteristics. Results Thirty‐six patients underwent sublobar resection and 102 underwent lobar resection. The median follow‐up was 45.7 months. In all patients, 5‐year overall survival (OS) rates were 33.2% and 73.2%, and 5‐year recurrence‐free survival (RFS) rates were 24.2% and 60.1% in the sublobar and lobar resection groups, respectively (p

Abstract One of the most common causes of peritoneal dialysis withdrawal is ultrafiltration failure which is characterized by peritoneal membrane thickening and fibrosis. Although previous studies have demonstrated the inhibitory effect of p38 MAPK inhibitors on peritoneal fibrosis in mice, it was unclear which specific cells contribute to peritoneal fibrosis. To investigate the role of p38 MAPK in peritoneal fibrosis more precisely, we examined the expression of p38 MAPK in human peritoneum and generated systemic inducible p38 MAPK knockout mice and macrophage-specific p38 MAPK knockout mice. Furthermore, the response to lipopolysaccharide (LPS) was assessed in p38 MAPK-knocked down RAW 264.7 cells to further explore the role of p38 MAPK in macrophages. We found that phosphorylated p38 MAPK levels were increased in the thickened peritoneum of both human and mice. Both chlorhexidine gluconate (CG)-treated systemic inducible and macrophage-specific p38 MAPK knockout mice ameliorated peritoneal thickening, mRNA expression related to inflammation and fibrosis, and the number of αSMA- and MAC-2-positive cells in the peritoneum compared to CG control mice. Reduction of p38 MAPK in RAW 264.7 cells suppressed inflammatory mRNA expression induced by LPS. These findings suggest that p38 MAPK in macrophages plays a critical role in peritoneal inflammation and thickening.

IntroductionHypertension is the leading noncommunicable disease case affecting 1.28 billion individuals worldwide, with most cases located in low- and middle-income countries. While there are numerous techniques for treating mild to moderate hypertension, properly controlling severe or resistant hypertension poses substantial challenges. Ultrasound-based renal denervation (uRDN) has emerged as a promising non-pharmacological approach. This study aims to investigate the safety and efficacy of uRDN in hypertensive patients.MethodsThe literature search across PubMed, ScienceDirect, BMJ Journals, ProQuest, and Springer databases yielded 419 articles. A total of 395 articles were filtered, leading to 24 articles assessed for eligibility and overall analysis, which resulted in eight included studies for quantitative synthesis. Quality appraisal used RoB 2.0, while meta-analysis used RevMan 5.4.ResultsOur analysis results indicated significant improvements in 24-hour, daytime, and home ambulatory blood pressure measurements, favoring the uRDN over control. The mean difference (MD) for 24-hour measurements was -0.84 mmHg [95% CI -1.14, -0.55; p < 0.00001], for daytime measurements -1.27 mmHg [95% CI -1.59, -0.95; p < 0.00001], and for home measurements -1.98 mmHg [95% CI -2.32, -1.64; p < 0.00001], with moderate heterogeneity observed. Office ambulatory measurements also favored the uRDN with a significant MD of -1.51 mmHg [95% CI -1.91; -1.10; p < 0.00001]. Funnel plots revealed some outliers, indicating true heterogeneity among the studies.ConclusionuRDN was associated with a significant reduction (-2.32 to -0.10 mmHg) in blood pressure of hypertensive patients.

Semiconductor p‐n homojunction is a requisite building block of operating transistors and diodes which make up the modern electronic circuits and optoelectronic applications. However, it has been so far limited to bulk form of single crystals such as silicon (Si) or gallium arsenide. Herein, a brand‐new method of constructing p‐n homojunction architectures that breaks through the limitation is presented. Colloidal inks of p‐type and n‐type Si quantum dots (QDs) are synthesized by thermal disproportionation of (HSiO1.5)n doped with boron or phosphorus, followed by surface ligand engineering. Analysis combining UV photoelectron spectroscopy, electron spin resonance, and current–voltage characteristics confirms that an orthogonal solvent trick makes clean interfaces between n‐type and p‐type SiQD layers without disruption on film formation. The forward and reverse current–voltage characteristics of the diode, along with various spectroscopic characterizations, demonstrate the formation of the first p‐n homojunction of SiQDs. The self‐powered photodiode provides a tunable response specific to the wavelength.

This report is on the characterization of active Ti center in heterogeneous Ziegler-Natta catalysts with Soft X-ray Emission Spectrometer (SXES). Since titanium in the catalyst has various chemical bonds, it is important to grasp the chemical bond state. The outermost shell electrons are very important for understanding the chemical bond state. SXES is the only method that can easily observe outermost shell electrons with current analytical instruments. Here, a co-milled solid of MgCl2, TiCl4, and Phthalate was used as a catalyst precursor, and three types of catalysts with significantly different catalytic activity levels were synthesized by changing the subsequent preparation process. The correlation between catalytic activity and the signal shape of Lα,β emission, which is the outermost shell electron of Ti in SXES analysis, was investigated. Lα,β emission was detected as broad signal. It could be observed that the high active catalyst had relatively strong signal intensity at the high energy side. The shape changes were also checked when the catalyst solids were treated by triethylaluminium. By this treatment, the relative intensity of the high energy side signal was further enhanced, suggesting that triethylaluminium treatment induced the elimination of inactive Ti from the catalyst solid. By comparing with the solid 13C-NMR analyses data of the Ziegler-Natta catalyst described in our previous report, the high energy side signal of Ti Lα,β in SXES results implies the relationship with the NMR results for carbonyl function.

Abstract Colloidal carbon dots (CDs) have garnered much attention as metal‐free photoluminescent nanomaterials, yet creation of solid‐state fluorescent (SSF) materials emitting in the deep red (DR) to near‐infrared (NIR) range poses a significant challenge with practical implications. To address this challenge and to engineer photonic functionalities, a micro‐resonator architecture is developed using carbonized polymer microspheres (CPMs), evolved from conventional colloidal nanodots. Gram‐scale production of CPMs utilizes controlled microscopic phase separation facilitated by natural peptide cross‐linking during hydrothermal processing. The resulting microstructure effectively suppresses aggregation‐induced quenching (AIQ), enabling strong solid‐state light emission. Both experimental and theoretical analysis support a role for extended π‐conjugated polycyclic aromatic hydrocarbons (PAHs) trapped within these microstructures, which exhibit a progressive red shift in light absorption/emission toward the NIR range. Moreover, the highly spherical shape of CPMs endows them with innate photonic functionalities in combination with their intrinsic CD‐based attributes. Harnessing their excitation wavelength‐dependent photoluminescent (PL) property, a single CPM exhibits whispering‐gallery modes (WGMs) that are emission‐tunable from the DR to the NIR. This type of newly developed microresonator can serve as, for example, unclonable anti‐counterfeiting labels. This innovative cross‐cutting approach, combining photonics and chemistry, offers robust, bottom‐up, built‐in photonic functionality with diverse NIR applications.

ABSTRACT Non-tuberculosis mycobacteria (NTM), particularly Mycobacterium abscessus subsp. abscessus (M. abscessus), are increasingly being recognized as etiological agents of NTM pulmonary disease. However, treatment options for M. abscessus are limited owing to their natural resistance to most antibiotics, including β-lactams. M. abscessus produces a class A β-lactamase, whose activity is inhibited by cyclic boronic acid β-lactamase inhibitors. We aimed to evaluate the in vitro effects of xeruborbactam, a cyclic boronic acid β-lactamase inhibitor, against M. abscessus when combined with five β-lactams (amoxicillin, tebipenem, cefdinir, cefuroxime, and cefoxitin). The drug susceptibilities of 43 M. abscessus clinical isolates obtained from 43 patients between August 2005 and May 2014 were tested. The MIC results for each β-lactam with or without 4 µg/mL xeruborbactam were examined. Xeruborbactam lowered the MIC90 values of tebipenem, amoxicillin, cefuroxime, and cefdinir by 5, ≥4, 3, and 3 dilutions, respectively. The MIC90 values of cefoxitin without xeruborbactam were 32 µg/mL and did not change upon the addition of xeruborbactam. The lowest MIC90 value was obtained for tebipenem with xeruborbactam. Almost all isolates had an MIC of 4 µg/mL; one isolate had an MIC of 2 µg/mL. With respect to the susceptibility to the same family drug, the number of susceptible isolates increased from 1/43 (2%) to 43/43 (100%) for tebipenem with xeruborbactam. Combining tebipenem and xeruborbactam could be considered an effective all-oral regimen that benefits outpatient treatment of M. abscessus pulmonary disease.IMPORTANCEMycobacterium abscessus subsp. abscessus (M. abscessus) disease is treated in two phases; injectable drugs for initial followed by others for continuation. There is a need to develop all-oral treatment methods for M. abscessus infection, especially in the continuation phase. However, treatment options for M. abscessus are limited owing to their natural resistance to most antibiotics. This is the first report to evaluate the in vitro effects of xeruborbactam, a cyclic boronic acid β-lactamase inhibitor capable of inhibiting the class A β-lactamase produced by M. abscessus, against 43 M. abscessus clinical isolates when combined with five β-lactam antibiotics. Xeruborbactam lowered the MIC90 values of tebipenem by five dilutions, and the number of susceptible isolates increased from 1/43 (2%) to 43/43 (100%). We showed that the tebipenem-xeruborbactam combination might be of interest to explore further as a potentially effective oral regimen for outpatient treatment of M. abscessus pulmonary disease.

Emissivity is a crucial property in quantitative thermographic testing, a leading technique in nondestructive inspections for exterior wall diagnosis. We propose a method for measuring emissivity that exploits the angle dependence of polarized reflectivity. This approach involves measuring the reflected energy from a heat source near the Brewster angle using an infrared thermographic instrument equipped with an infrared polarizer. However, the emissivity measurements for insulators exhibited significant discrepancies when compared with values obtained via FT-IR, attributable to two main factors: diffuse reflection caused by surface roughness and approximation errors inherent in the simplistic theoretical formula. To address these issues, we applied a correction for specular reflectivity considering surface roughness and refined the theoretical formula by incorporating polarization theory and the extinction coefficient. This enhancement enabled accurate emissivity measurements for ceramic tiles with rough surfaces. Notably, this method only requires a heat source and does not necessitate precise temperature measurements with an infrared thermographic instrument, which is significant since standard instruments used in nondestructive inspections often fail to measure temperature accurately. Additionally, we achieved thermal imaging without background reflection through subtraction image processing, beneficial for field measurements. Consequently, this improved method is highly effective for nondestructive inspections.

Background: Myocardial infarction-related left ventricular pseudoaneurysm (LVP), covered by the adjacent pericardial or scar tissue, is a fatal sequela of left ventricular rupture. Whereas hypertrophic cardiomyopathy (HCM) may cause left ventricular true aneurysm. Differentiating LVP from left ventricular true aneurysm is crucial because their natural histories and treatment strategies are distinct. However, the incidence and management of HCM-related LVP remain unknown. Case presentation: An 88-year-old man was admitted to our hospital with sudden-onset chest pain. Upon initial examination, vital signs were stable, and a grade 4/6 systolic murmur was noted. An electrocardiogram revealed atrial fibrillation and poor R-wave progression without ST-T changes or negative T-waves. An echocardiography showed mild left ventricular hypertrophy, mid-ventricular obstruction with a significant intraventricular pressure gradient, left ventricular outflow tract obstruction, and a small left ventricular apical outpouching. Cardiac computed tomography angiography (CCTA) assisted in the diagnosis of LVP, and an accompanying pericardial effusion suggested impending cardiac rupture. Because the patient initially refused our proposed urgent surgery, medication was initiated with continuous hemodynamic monitoring in the intensive care unit; however, the patient's condition did not improve. During a semi-urgent surgical repair of the aneurysmal wall, LVP was observed and confirmed by pathology. Myocardial tissue adjacent to the pseudoaneurysm was consistent with that of HCM. Subsequently, a final diagnosis of HCM-related LVP was made. The postoperative course was notable for transient profound hypotension. Thereafter, the patient died of non-occlusive mesenteric ischemia on day 6. Conclusions: To our knowledge, this is the first reported case of HCM-related LVP mimicking impending cardiac rupture. Our case highlights the importance of considering HCM-related LVP in patients with left ventricular outpouching and CCTA in the LVP diagnosis. In further research, data on the appropriate management of HCM-related LVP should be accumulated.

Abstract Background The COVID-19 pandemic has affected every aspect of our lives, including the decision to become pregnant. Existing literature suggests that infertility and the decision to delay childbearing at a younger age are associated with a lower level of well-being and regrets when women start to desire a baby. Thus, the decision to delay childbearing due to the pandemic could negatively affect the well-being of women. This study focuses on how pregnancy decisions affect the well-being of women during the COVID-19 pandemic. Methods From the Japan COVID-19 and Society Internet Survey, a nationally representative web-based survey, 768 observations of married women aged 18 to 50 years who had the intention of getting pregnant during the pre-pandemic period (conducted in 2020 and 2021) were used. Loneliness, severe psychological distress, and suicidal ideation were used as well-being indicators. For pooled data, a generalised estimated equation (GEE) model was used to estimate how pregnancy decision related to well-being indicators. For a sub-analysis, the sample was divided by the survey year and a Poisson regression model was used. Results The GEE analysis showed an association between delaying childbearing and severe psychological distress, with the prevalence ratio (PR) being 2.06 [95% CI (1.40–3.03)]. Furthermore, loneliness and suicidal ideation that occurred after the beginning of the pandemic were significantly related to the decision to delay childbearing—1.55 [95% CI (1.03,2.34)] and 2.55 [95% CI (1.45–4.51)], respectively. Moreover, these PRs were larger for 2021 compared to 2020. Conclusion During the COVID-19 pandemic, approximately one-fifth of married women who had childbearing intentions before the pandemic decided to postpone pregnancy. They exhibited a deteriorated mental health state. Furthermore, the negative associations were larger in 2021 compared to 2020. Loneliness has negative consequences for both mental and physical health, as well as elevated severe psychological distress and suicidal ideation among those who decided to postpone pregnancy. Therefore, the current results should not be overlooked by society.

Introduction Cryosurgery is recognized as a treatment option for various types of oral lesions. Although cryosurgery is less invasive and easier to perform than surgical treatments, adverse events, such as stomatitis and scarring can occur if the freezing is excessive. There are few studies regarding the effects of cryosurgery on the surrounding soft tissues. Thus, this study investigated the extent of tissue destruction and healing progress in tongues of mice who underwent cryosurgery. Methods Eight-week-old male BALB/c mice were used. An instrument cooled with liquid nitrogen was lightly touched on the right side of the tongue for 5 s, and a second test was performed 10 s later. Histological evaluation was performed 3, 7, and 14 days after cryosurgery. Blood vessels were evaluated with India ink at 1, 3, 7, 14, and 21 days after cryosurgery. Results Destruction of the soft tissue spread to the left side of the tongue after 3 days. At 7 days, it was confirmed that the muscle tissue was in the process of repair and was completely repaired at 14 days. Although blood vessels were not confirmed at 3 days, they were visible after seven days and were confirmed at 21 days all over the tongue. Discussion and Conclusion These results indicated that the tissue destruction caused by cryosurgery was extensive and suggest that the duration and frequency of freezing should be minimized for clinical use. Lay Summary Cryosurgery is a treatment method for various types of oral lesions. Freezing the lesion causes the tissue to collapse, resulting in its disappearance. Although cryosurgery is less invasive and easier to perform than surgical treatments, adverse events, such as stomatitis and scarring can occur if the freezing is excessive. This study investigated the extent of tissue destruction and healing progress in tongues of mice who underwent cryosurgery. The right side of mice tongues were frozen by an instrument cooled with liquid nitrogen for 5 s, and a second test was performed 10 s later. The tissue destruction was evaluated at 3, 7, and 14 days after freezing. Blood vessels were evaluated with India ink at 1, 3, 7, 14, and 21 days after freezing. Tissue destruction spread to the left side of the tongue after 3 days. At 7 days, it was confirmed that the muscle tissue was in the process of repair and was completely repaired at 14 days. Blood vessel repair was confirmed at 21 days in the throughout tongue. These results indicated that the tissue destruction caused by cryosurgery was large and suggest that the duration and frequency of freezing should be minimized for clinical use.

Abstract Objective We aimed to elucidate the dynamics of deglutition during head rotation by acquiring 320‐row area detector computed tomography (320‐ADCT) images and analyzing deglutition during head rotation. Methods This study included 11 patients experiencing globus pharyngeus. A 320‐ADCT was used to acquire images in two types of viscosity (thin and thick), with the head rotated to the left. We measured the movement time of deglutition‐related organs (soft palate, epiglottis, upper esophageal sphincter [UES], and true vocal cords) and pharyngeal volume (bolus ratio at the start of UES opening [Bolus ratio], pharyngeal volume contraction ratio [PVCR], and pharyngeal volume before swallowing [PVBS]). A two‐way analysis of variance was performed for statistical analysis, and all items were compared for significant differences in terms of head rotation and viscosity. EZR was used for all statistical analyses (p‐value

Observations of tropical cyclones (TC) from aircraft and in situ platforms provide critical and unique information for analyzing and forecasting TC intensity, structure, track, and their associated hazards. This report, prepared for the tenth International Workshop on Tropical Cyclones (IWTC-10), discusses the data collected around the world in TCs over the past four years since the IWTC-9, improvements to observing techniques, new instruments designed to achieve sustained and targeted atmospheric and oceanic observations, and select research results related to these observations.In the Atlantic and Eastern and Central Pacific basins, changes to operational aircraft reconnaissance are discussed along with several of the research field campaigns that have taken place recently. The changes in the use and impact of these aircraft observations in numerical weather prediction models are also provided along with updates on some of the experimental aircraft instrumentation. Highlights from three field campaigns in the Western Pacific basin are also discussed. Examples of in-situ data collected within recent TCs such as Hurricane Ian (2022), also demonstrate that new, emerging technologies and observation strategies reviewed in this report, definitely have the potential to further improve ocean-atmosphere coupled intensity forecasts.

Abstract Background Despite the possible occurrence of spontaneous movements during an apnea test, respiratory‐like movements are rare. Case Presentation A 51‐year‐old man was transferred to our hospital when a sudden disturbance of consciousness developed into cardiac arrest. After spontaneous circulation returned, we diagnosed bilateral cerebellar hemorrhage. He remained comatose with dilated pupils, absent brainstem reflexes, spontaneous breathing, and electrocerebral activity. After being considered brain dead, his family opted for organ donation. The first legal brain death examination on day 5 was aborted because of respiratory‐like movements mimicking repetitive abdominal respiration during the apnea test. However, an enhanced magnetic resonance image of the head indicated no blood flow and somatosensory evoked potential testing revealed no brain‐derived potentials. Conclusion Respiratory‐like movements can occur during the apnea test in patients considered brain dead. Further research is required to understand this phenomenon.

Abstract Background Salmonella species are a leading cause of diarrheal diseases worldwide. Recent epidemiological studies have shown that Salmonella schwarzengrund (S. schwarzengrund) is highly prevalent in various regions. Herein, we report that S. schwarzengrund caused sacroiliac joint (SIJ) infection with septic shock in a young woman, although she was immunocompetent. Case presentation A 20-year-old woman presented with left hip pain, accompanied by vasopressor-requiring hypotension. Her imaging examinations showed fluid collection in her SIJ and a small abscess in the left iliac muscle. Later, the blood and aspiration fluid culture and genetic analysis revealed the presence of S. schwarzengrund. We diagnosed sacroiliac joint (SIJ) infection with septic shock caused by S. schwarzengrund. Her condition improved after performing several interventional radiology (IVR) procedures for SIJ abscesses and providing appropriate antibiotic treatment. Finally, she was discharged without any sequelae. Screening tests and genetic analysis about her immunodeficiency did not indicate a congenital disorder. Conclusion These clinical courses indicate that S. schwarzengrund could cause the fatal SIJ infection irrespective of the host immunocompetence. Considering the recent increase in the diagnostic rate of S. schwarzengrund, this case emphasized the need to be more cautious about Salmonella species infection.

We report 4 cases of hypopharyngeal cancer preoperatively suspected with synchronous lymph node metastases. Pathologic lymph node metastasis was confirmed in three of the four cases. All 4 cases underwent endoscopic laryngopharyngeal surgery (ELPS) combined with endoscopic submucosal dissection (ESD) and subsequent lymph node dissection as an optional treatment rather than the standard treatment. Peroral resection for primary site was selected because of the expected decline in quality of life (QoL) after radical surgery. Among 4 patients, one developed local recurrence; however, the other three remained recurrence-free and survived without any additional treatment. Furthermore, the patient who developed local recurrence had a recurrence-free survival for more than 5 years, with additional chemoradiation therapy. No disorders in speech, swallowing, or breathing was observed during the follow-up period. ELPS combined with ESD is generally indicated for laryngopharyngeal cancer without synchronous lymph node metastasis. However, this can be a treatment option for patients may wish to preserve a greater QoL after treatment. In the future, when more data on the results and long-term prognosis of this treatment are accumulated, it may be possible to discuss its validity further.

Purpose: Aiming at complete excision of cholesteatoma during trympanomastoidectomy and therefore reducing the risk of recurrence, intraoperative imaging techniques are required to assist the visualization of cholesteatoma residue. Galectin-7 has been demonstrated to be a biomarker for cholesteatoma matrix and used for intraoperatively identifying the excision margins. Methods: A galectin-7-targeted DNA-aptamer library was generated for labeling the cholesteatoma matrix using cell-systematic evolution of ligands by an exponential enrichment technique. The binding characteristics of the identified aptamers were analyzed, and structure optimization of the identified aptamers was carried out both in silico and in vitro. Findings: A fluorophore-labeled structure-optimized DNA fragment was commercially synthesized as a non-invasive aptamer-based probe for intraoperative lesion detection. Using galectin-7-aptamer-guided molecular imaging, the excision margins of cholesteatoma matrix and surrounding normal tissue were successfully achieved within 15–20 min. Conclusions: Galectin-7-targeted aptamers could benefit molecular imaging-guided surgical treatment, which would enable clinicians to not only intraoperatively detect the locations of cholesteatoma matrix in the middle ear, but also assess the postoperative response of the expression profile to therapy. It is highly expected that further efforts for rational design and development should be directed towards the development of clinically translatable aptamer-based imaging agents.

Abstract Background Hodgkin lymphoma (HL) is diagnosed definitively by biopsy, and treatment is based on stage. Owing to the nature of the disease, post‐treatment efficacy is determined mainly by fluorodeoxyglucose‐positron emission tomography/computed tomography, and the efficacy of treatment is not confirmed by histopathology. We report a case of tongue cancer after treatment for HL, in which a post‐treatment lymph node with complete remission was histopathologically confirmed by neck dissection. Case The patient was a 74‐year‐old man who was referred to our hospital for cancer on the right side of his tongue. He had previously undergone chemotherapy for HL involving the right side of his neck and achieved complete remission. Because he had cT3N2cM0 tongue cancer, glossectomy and bilateral neck dissection were performed. Surprisingly, histopathological examination revealed that there was neither metastatic lymph nodes nor lymphoma cells in his right neck. Moreover, there was no lymphatic structure in his remnant lymph nodes. Conclusion This was a rare case in which complete remission of HL was confirmed by histopathological analysis. The absence of lymph node structure and lymphatic flow led to contralateral neck lymph node metastases of tongue cancer.

Xanthogranuloma is a granulomatous lesion associated with histiocytic proliferation and lipid accumulation. It occurs as solitary or multiple smooth-surfaced papules or nodules. It generally appears on the skin in infancy and childhood, in which case it is known as juvenile xanthogranuloma, although a few adult-onset cases have also been reported. Adult-onset cases are known as adult-onset xanthogranuloma, and adult-onset xanthogranuloma of the tongue is extremely rare. The disease is difficult to diagnose clinically; it is instead diagnosed histopathologically in most cases. We herein report a case of adult-onset xanthogranuloma of the tongue.

Objective: Japan's national-level healthcare insurance claims database (NDB) is a collective database that contains the entire information on healthcare services being provided to all citizens. However, existing anonymized identifiers (ID1 and ID2) have a poor capability of tracing patients' claims in the database, hindering longitudinal analyses. This study presents a virtual patient identifier (vPID), which we have developed on top of these existing identifiers, to improve the patient traceability. Methods: vPID is a new composite identifier that intensively consolidates ID1 and ID2 co-occurring in an identical claim to allow to collect claims of each patient even though its ID1 or ID2 may change due to life events or clerical errors. We conducted a verification test with prefecture-level datasets of healthcare insurance claims and enrollee history records, which allowed us to compare vPID with the ground truth, in terms of an identifiability score (indicating a capability of distinguishing a patient's claims from another patient's claims) and a traceability score (indicating a capability of collecting claims of an identical patient). Results: The verification test has clarified that vPID offers significantly higher traceability scores (0.994, Mie; 0.997, Gifu) than ID1 (0.863, Mie; 0.884, Gifu) and ID2 (0.602, Mie; 0.839, Gifu), and comparable (0.996, Mie) and lower (0.979, Gifu) identifiability scores. Discussion: vPID is seemingly useful for a wide spectrum of analytic studies unless they focus on sensitive cases to the design limitation of vPID, such as patients experiencing marriage and job change, simultaneously, and same-sex twin children. Conclusion: vPID successfully improves patient traceability, providing an opportunity for longitudinal analyses that used to be practically impossible for NDB. Further exploration is also necessary, in particular, for mitigating identification errors.

In this paper, smooth and notched bar tensile tests of austenitic stainless steel 304 are performed, covering four different multi-axial stress states and six different strain rate conditions, to investigate the effect of the stress triaxiality and strain rate on fracture strain. Test data show that the measured true fracture strain tends to decrease with increasing stress triaxiality and strain rate. The test data are then quantified using the Johnson-Cook (J-C) fracture strain model incorporating combined effects of the stress triaxiality and strain rate. The determined J-C model can predict true fracture strain overall conservatively with the difference less than 20%. The conservatism in the strain-based acceptance criteria in ASME B&PV Code, Section III, Appendix FF is also discussed.

Abstract Coronavirus disease 2019 (COVID-19) threatened human lives worldwide since first reported. The current challenge for global intensivists is to establish an effective treatment for severe COVID-19. Blood purification has been applied to the treatment of various critical illnesses. Theoretically, its technique also has an enormous possibility of treating severe COVID-19 in managing inflammatory cytokines and coagulopathy. Recent clinical studies have revealed the positive clinical effect of therapeutic plasma exchange. Other studies have also indicated the considerable potential of other blood purification techniques, such as Cytosorb, AN69 surface-treated membrane, and polymyxin b hemoperfusion. Further research is needed to elucidate the actual effects of these applications.

In cell structures, unlike in dense bodies, nonuniform deformation occurs from the impact end, even at velocities in the order of tens to hundreds of meters per second. In this study, we experimentally examine the nonuniform deformation mechanism of cell structures. They prepared two kinds of specimens: nickel foam (Ni foam) and silicone-rubber-filled nickel foam (Ni/silicone foam). As a dynamic and impact test method (compression velocity of 20 m/s or more), we used a dynamic and impact load-measuring apparatus with opposite load cells to evaluate the loads on both ends of the specimen in one test. At compression velocities of 20 m/s or less, no nonuniform deformations were observed in the Ni foam and the Ni/silicone foam, and the loads on the impact and the fixed ends achieved force equilibrium. The Ni foam showed no change with an increasing strain rate, and the Ni/silicone foam showed a strong strain rate dependence of the flow stress. At a compression velocity of approximately 26 m/s, the loads differed at the two ends of the Ni/silicone foam, and we observed nonuniform deformation from the impact end. The results of the visualization of the load and deformation behavior obtained from both ends of the specimen revealed that the velocity of the plastic stress wave and the length of the specimens are important for nonuniform deformation.

Tumoral calcinosis (TC) refers to calcium salt deposition around large joints. It rarely affects the temporomandibular joint (TMJ), and only eight cases have been reported to date. We describe a case of TC in the left TMJ with resorption of the condyle and mandibular fossa. A 37-year-old woman complaining of malocclusion and a painless swelling around the left TMJ was referred to our hospital. The patient's medical history included Sjogren's syndrome and systemic sclerosis. Computed tomography and magnetic resonance imaging revealed calcification with a maximum diameter of 25 mm and resorption of the condyle and mandibular fossa. A clinical diagnosis of tophaceous pseudogout was made on the basis of these findings. The calcification was removed, and the TMJ was reconstructed under general anesthesia using a total TMJ replacement system. Pathological examination revealed TC. The patient was considered to have secondary TC based on the patient's medical history and results of additional blood tests. At six months post-operation, the patient had stable occlusion without TC recurrence.

BackgroundHydrogen (H2) has been reported to be effective in reducing hearing loss due to several causes in animal studies. However, no study has examined the effectiveness of H2 in treating hearing loss in humans. Thus, we investigated whether H2 is effective for the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL).Materials and methodsWe conducted a double-blind randomized controlled trial at six hospitals between June 2019 and March 2022. The study protocol and trial registration have been published in the Japan Registry of Clinical Trials (jRCT, No. jRCTs06119004). We randomly assigned patients with ISSNHL to receive either H2 (H2 group) or air as a placebo (control group) through inhalation combined with the administration of systemic glucocorticoids and prostaglandin E1. The primary outcome was the hearing threshold and changes in hearing threshold 3 months after therapy. In contrast, the secondary outcomes included the proportion of patients with a good prognosis (complete recovery or marked improvement).ResultsSixty-five patients with ISSNHL (31 and 34 in the H2 and control groups, respectively) were included in this study. The hearing threshold 3 months after treatment was not significantly different between the groups; 39.0 decibels (dB) (95% confidence interval [CI]: 28.7–49.3) and 49.5 dB (95% CI: 40.3–58.7) in the H2 and control groups, respectively. In contrast, the changes in hearing threshold 3 months after treatment was 32.7 dB (95% CI: 24.2–41.3) and 24.2 dB (95% CI: 18.1–30.3) in the H2 and control groups, respectively. Consequently, the changes in hearing threshold were significantly better in the H2 group than in the control group (P = 0.048). However, no adverse effects due to the inhalation of H2 gas have been reported.ConclusionThis is the first study to investigate the efficacy of H2 for the treatment of ISSNHL in humans. The results suggest that H2 therapy may be effective for ISSNHL treatment.Clinical trial registration[https://jrct.niph.go.jp/re/reports/detail/10442], identifier [jRCTs06119004].

Introduction: Serum α-fetoprotein (AFP), Lens culinaris agglutinin-reactive AFP (AFP-L3), and des-γ-carboxy­pro­thrombin (DCP) are useful biomarkers of hepatocellular carcinoma (HCC). However, associations among molecular characteristics and serum biomarkers are unclear. We analyzed RNA expression and DNA variant data from The Cancer Genome Atlas Liver Hepatocellular Carcinoma (TCGA-LIHC) to examine their associations with serum biomarker levels and clinical data. Methods: From 371 TCGA-LIHC patients, we selected 91 seen at 3 institutions in Korea and the USA and measured AFP, AFP-L3, and DCP from preoperatively obtained serum. We conducted an integrative clinical and molecular analysis, focusing on biomarkers, and validated the findings with the remaining 280 patients in the TCGA-LIHC cohort. Results: Patients were categorized into 4 subgroups: elevated AFP or AFP-L3 alone (↑AFP&L3), elevated DCP alone (↑DCP), elevation of all 3 biomarkers (elevated levels of all 3 biomarkers [↑All]), and reference range values for all biomarkers (RR). CTNNB1 variants were frequently observed in ↑DCP patients (53.8%) and RR patients (38.5%), but ↑DCP patients with a CTNNB1 variant had worse survival than RR patients. TP53 sequence variants were associated with ↑AFP (30.8%) and ↑DCP (30.8%). The Wnt-β-catenin signaling pathway was activated in the ↑AFP&L3, whereas liver-related Wnt signaling was activated in the RR. TGF-β and VEGF signaling were activated in ↑AFP&L3, whereas dysregulated bile acid and fatty acid metabolism were dominant in ↑DCP. We validated these findings by showing similar results between the test cohort and the remainder of the TCGA-LIHC cohort. Conclusions: Serum AFP, AFP-L3, and DCP levels can help predict variants in the genetic profile of HCC, especially for TP53 and CTNNB1. These findings may facilitate development of an evidence-based approach to treatment.

Abstract The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

Aim: Maternal high-fat diet (HFD) is associated with the development of cardiovascular disease (CVD) in adult offspring. Atherosclerotic vascular calcification is well documented in patients with CVD. We examined the effect of maternal HFD on calcified plaque formation. Methods and results: Seven-week-old female apo-E−/− mice (C57BL6/J) were nourished either an HFD or a normal diet (ND) a week before mating, and during gestation and lactation. Offspring of both the groups were fed a high-cholesterol diet (HCD) from 8 weeks of age. Osteogenic activity of the thoracic aorta, assessed using an ex vivo imaging system, was significantly increased after 3 months of HCD in male offspring of HFD-fed dams (O-HFD) as compared with those of ND-fed dams (O-ND). Alizarin-red-positive area in the aortic root was significantly increased after 6 months of HCD in male O-HFD as compared to that of O-ND. Plaque size and Oil Red O-positive staining were comparable between the two groups. Primary cultured vascular smooth muscle cells (VSMCs) of the thoracic aorta were treated with phosphate and interleukinL-1β (IL-1β) to transform them into an osteochondrocytic-like phenotype. Intracellular calcium content and alkaline phosphatase activity were markedly higher in the VSMCs of O-HFD than in O-ND. IL-1β concentration in the supernatant of bone marrow-derived macrophages was markedly higher in O-HFD than in O-ND. Conclusion: Our findings indicate that maternal HFD accelerates the expansion of atherogenic calcification independent of plaque progression. In vitro phosphate- and IL-1β-induced osteochondrocytic transformation of VSMCs was augmented in O-HFD. Inhibition of VSMCs, skewing toward osteochondrocytic-like cells, might be a potential therapeutic strategy for preventing maternal HFD-associated CVD development.

Abstract Background We retrospectively analyzed the articulation, mastication, and swallowing function of patients who underwent reconstruction or used a prosthesis after resection of the upper gingiva. Methods This study included patients who underwent resection of cancer of the upper gingiva from January 2014 to December 2018. Articulatory function was evaluated with Hirose’s conversational function evaluation criteria. Mastication function was evaluated with the Yamamoto’s occlusion table. Swallowing function was assessed with the MTF (Method of intake, Time, Food) score. Results The mean articulatory function score was 8 points in the Reconstruction Surgery Group (RSG) and 8.8 points in the Prosthesis Group (PG). The mean mastication function score was 2.8 points in the RSG and 3.3 points in the PG. The mean swallowing function score was M3T4F4 in the RSG and M4T4F4.3 in the PG. Conclusions The prosthesis depends on the remaining occlusal support area. Our study suggest that prosthesis is better indication when there is more than one occlusal support area.

Abstract Objective We report our first experience of using a case‐specific three‐dimensional (3D) hologram for tumor resection in otolaryngology to show the proof of concept. In addition, a questionnaire was administered to assess the usefulness of the mixed reality technique in otolaryngology. Methods A case‐specific 3D hologram was developed from enhanced images of dynamic computed tomography, with reference to contrast‐enhanced magnetic resonance images, and used for preoperative planning and intraoperative image reference. To evaluate the usefulness of the 3D hologram with head mount displays (HMDs), 18 attendings and resident otolaryngologists completed a questionnaire with the Likert scale. Results The case‐specific 3D hologram on HMDs was successfully used by means of easy gesture‐handling without any monitors preoperatively and intraoperatively. The experience of picturing the tumor localization and evaluating the surgical approach was statistically better using the 3D hologram on HMDs than using the computer images (P

Abstract In this report, we propose a deep learning technique for high-accuracy estimation of the intensity class of a typhoon from a single satellite image, by incorporating meteorological domain knowledge. By using the Visual Geometric Group’s model, VGG-16, with images preprocessed with fisheye distortion, which enhances a typhoon’s eye, eyewall, and cloud distribution, we achieved much higher classification accuracy than that of a previous study, even with sequential-split validation. Through comparison of t-distributed stochastic neighbor embedding (t-SNE) plots for the feature maps of VGG with the original satellite images, we also verified that the fisheye preprocessing facilitated cluster formation, suggesting that our model could successfully extract image features related to the typhoon intensity class. Moreover, gradient-weighted class activation mapping (Grad-CAM) was applied to highlight the eye and the cloud distributions surrounding the eye, which are important regions for intensity classification; the results suggest that our model qualitatively gained a viewpoint similar to that of domain experts. A series of analyses revealed that the data-driven approach using only deep learning has limitations, and the integration of domain knowledge could bring new breakthroughs.

Abstract The destruction caused by ballistic ejecta from the phreatic eruptions of Mt. Ontake in 2014 and Mt. Kusatsu-Shirane (Mt. Moto-Shirane) in 2018 in Japan, which resulted in numerous casualties, highlighted the need for better evacuation facilities. In response, some mountain huts were reinforced with aramid fabric to convert them into shelters. However, a number of decisions must be made when working to increase the number of shelters, which depend on the location where they are to be built. In this study, we propose a method of using high-strength steel to reinforce wooden buildings for use as shelters. More specifically, assuming that ballistic ejecta has an impact energy of 9 kJ or more, as in previous studies, we developed a method that utilizes SUS304 and SS400 unprocessed steel plates based on existing impact test data. We found that SUS304 is particularly suitable for use as a reinforcing material because it has excellent impact energy absorption characteristics due to its high ductility as well as excellent corrosion resistance. With the aim of increasing the structural strength of steel shelters, we also conducted an impact test on a shelter fabricated from SS400 deck plates (i.e., steel with improved flexural strength provided by work-hardened trapezoidal corrugated plates). The results show that the shelter could withstand impact with an energy of 13.5 kJ (2.66 kg of simulated ballistic ejecta at 101 m/s on impact). In addition, from the result of the impact test using the roof-simulating structure, it was confirmed the impact absorption energy is further increased when artificial pumice as an additional protective layer is installed on this structure. Observations of the shelter after the impact test show that there is still some allowance for deformation caused by projectile impact, which means that the proposed steel shelter holds promise, not only structurally, but also from the aspects of transportation and assembly. Hence, the usefulness of shelters that use steel was shown experimentally. However, shelter construction should be suitable for the target environment.

Salivary duct carcinoma (SDC) is a rare and highly aggressive malignancy. A 58-year-old man presented with a right-sided submandibular mass and metastatic lesions in the right supraclavicular and inferior internal jugular nodes. He underwent right submandibulectomy and right neck dissection followed by adjuvant chemoradiotherapy. However, relapse occurred in the hilar lymph node and lumbar spine. Although radiotherapy was performed, a second relapse appeared in the hilar lymph nodes and sacral bone. Immunohistochemical analysis revealed negativity for programmed death ligand-1 (PD-L1) in the primary tumor specimen. The patient then received the anti-programmed death-1 (PD-1) antibody nivolumab. His metastatic lesions were completely eliminated after 48 weeks of therapy. This case reveals that anti-PD-1 antibodies are effective even against PD-L1-negative SDC.

Abstract Autonomous robots are expected to replace dangerous, dirty, and demanding (3D) jobs. At a theme park, surveillance, cleaning, and guiding tasks can be regarded as 3D jobs. The present paper attempts to develop an autonomous tour guide robot system and co-experience system at a large theme park. For realizing such autonomous service robots used in our daily environment, localization is one of the most important and fundamental functions. A number of localization techniques, including simultaneous localization and mapping, have been proposed. Although a global navigation satellite system (GNSS) is most commonly used in outdoor environments, its accuracy is approximately 10 m, which is inadequate for navigation of an autonomous service robot. Therefore, a GNSS is usually used together with other localization techniques, such as map matching or camera-based localization. In the present study, we adopt the quasi-zenith satellite system (QZSS), which became available in and around Japan in November 2018, for the localization of an autonomous service robot. The QZSS provides high-accuracy position information using quasi-zenith satellites (QZSs) and has a localization error of less than 10 centimeters. In the present paper, we compare the positioning performance of the QZSS and the real-time kinematic GPS and verify the stability and the accuracy of the QZSS in an outdoor environment. In addition, we introduce a tour guide robot system using the QZSS and present the results of a guided tour experiment in a theme park. On the other hand, based on the tour guide system, we also develop a co-experience robot system in a theme park, which realizes the sharing of experiences using an immersive VR display and the 5th-generation mobile communication system (5G). The robot is equipped with a 360-degree video camera and real-time 4K video is transmitted to a remote operator using the large communication capacity of the 5G network. The experimental results at a theme park showed that the guided tour experiment was successful and that the co-experience system allowed sharing of the experience with high immersion by a remote operator.

Alport syndrome (AS) is a hereditary glomerular nephritis caused by mutation in one of the type IV collagen genes α3/α4/α5 that encode the heterotrimer COL4A3/4/5. Failure to form a heterotrimer due to mutation leads to the dysfunction of the glomerular basement membrane, and end-stage renal disease. Previous reports have suggested the involvement of the receptor tyrosine kinase discoidin domain receptor (DDR) 1 in the progression of AS pathology. However, due to the similarity between DDR1 and DDR2, the role of DDR2 in AS pathology is unclear. Here, we investigated the involvement of DDR2 in AS using the X-linked AS mouse model. Mice were treated subcutaneously with saline or antisense oligonucleotide (ASO; 5 mg/kg or 15 mg/kg per week) for 8 weeks. Renal function parameters and renal histology were analyzed, and the gene expressions of inflammatory cytokines were determined in renal tissues. The expression level of DDR2 was highly elevated in kidney tissues of AS mice. Knockdown of Ddr2 using Ddr2-specific ASO decreased the Ddr2 expression. However, the DDR2 ASO treatment did not improve the proteinuria or decrease the BUN level. DDR2 ASO also did not significantly ameliorate the renal injury, inflammation and fibrosis in AS mice. These results showed that Ddr2 knockdown by ASO had no notable effect on the progression of AS indicating that DDR2 may not be critically involved in AS pathology. This finding may provide useful information and further understanding of the role of DDRs in AS.