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Although surgical approaches for infected or failing cardiac implantable electronic device (CIED) leads are more invasive than transvenous approaches, they are still required for patients considered unsuitable for transvenous procedures. In this study, surgical management with transvenous equipment for CIED complications was examined in patients unsuitable for transvenous lead extraction.Methods and Results: We retrospectively examined 152 consecutive patients who underwent CIED extraction between April 2009 and December 2021 at the Department of Cardiovascular Surgery, Nippon Medical School. Nine patients (5.9%; mean [±SD] age 61.7±16.7 years) who underwent open heart surgery were identified as unsuitable for the isolated transvenous approach. CIED types included 5 pacemakers and 4 implantable cardioverter-defibrillators; the mean [±SD] lead age was 19.5±7.0 years. Indications for surgical management according to Heart Rhythm Society guidelines included failed prior to transvenous CIED extraction (n=6), intracardiac vegetation (n=2), and severe lead adhesion (n=1). Transvenous CIED extraction tools were used in all patients during or before surgery. Additional surgical procedures with CIED extraction included epicardial lead implantation (n=4) and tricuspid valve repair (n=3). All patients were discharged; during the follow-up period (mean 5.7±3.7 years), only 1 patient died (non-cardiac cause).Surgical procedures and transvenous extraction tools were combined in the removal strategy for efficacious surgical management of CIED leads. Intensive surgical procedures were safely performed in patients unsuitable for transvenous extraction.

Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

Hydroxy group containing methacrylamide polymers exhibited excellent permeability into the hepatocyte multicellular tumor spheroids.

Facile techniques are required for the debonding of polymeric adhesives from metals for material recycling. A promising solution is a pulsed discharge debonding method. In this approach, a pulsed discharge with a high voltage is applied to the system over a short time. Rapid expansion of gasified materials and shock-wave emissions are produced from the discharge passage, which results in debonding. A drawback of the conventional pulsed discharge method is that it must be conducted in water, otherwise, the pulsed discharge creeps along the material surface without destroying the adhesion. In this study, filler was added to the structure adhesive for the effective pulsed discharge debonding of metal adherend. Epoxy resins with fillers of carbon black, copper and barium titanate particles were fabricated, and their properties and adhesive strength before and after application of the pulsed discharge were investigated. We succeeded in introducing the pulsed discharge inside the adhesive by adding 3.4 vol% of carbon black to the epoxy adhesive; the rapid expansion of gasified adhesion that was caused by the discharge, resulted in debonding. The threshold volume fraction of carbon black for effective pulsed discharge inside the adhesive was discussed based on the percolation model with experimental data.

Summary Fast and wide field-of-view imaging with single-cell resolution, high signal-to-noise ratio, and no optical aberrations have the potential to inspire new avenues of investigations in biology. However, such imaging is challenging because of the inevitable tradeoffs among these parameters. Here, we overcome these tradeoffs by combining a resonant scanning system, a large objective with low magnification and high numerical aperture, and highly sensitive large-aperture photodetectors. The result is a practically aberration-free, fast-scanning high optical invariant two-photon microscopy (FASHIO-2PM) that enables calcium imaging from a large network composed of ∼16,000 neurons at 7.5 Hz from a 9 mm2 contiguous image plane, including more than 10 sensory-motor and higher-order areas of the cerebral cortex in awake mice. Network analysis based on single-cell activities revealed that the brain exhibits small-world rather than scale-free behavior. The FASHIO-2PM is expected to enable studies on biological dynamics by simultaneously monitoring macroscopic activities and their compositional elements.

Far-red and near-infrared (NIR) genetically encoded calcium ion (Ca

The rapid progress of calcium imaging has reached a point where the activity of tens of thousands of cells can be recorded simultaneously. However, the huge amount of data in such records makes it difficult to carry out cell detection manually. Consequently, because the cell detection is the first step of multicellular data analysis, there is a pressing need for automatic cell detection methods for large-scale image data. Automatic cell detection algorithms have been pioneered by a handful of research groups. Such algorithms, however, assume a conventional field of view (FOV) (i.e. 512 × 512 pixels) and need a significantly higher computational power for a wider FOV to work within a practical period of time. To overcome this issue, we propose a method called low computational-cost cell detection (LCCD), which can complete its processing even on the latest ultra-large FOV data within a practical period of time. We compared it with two previously proposed methods, constrained non-negative matrix factorization (CNMF) and Suite2P. We found that LCCD makes it possible to detect cells from a huge-amount of high-density imaging data within a shorter period of time and with an accuracy comparable to or better than those of CNMF and Suite2P.

This case pertains to a 72-year-old man who visited the emergency department with a complaint of upper abdominal pain. On examination, we suspected gastric perforation due to gastric cancer and decided to perform emergency surgery. We performed laparoscopic omentoplasty and collected #4d lymph nodes that were enlarged on CT. The pathological diagnosis was lymph node metastasis. Based on CT findings, we determined it was Bulky N. For initial management, we performed 3 preoperative chemotherapy(SOX therapy)courses and staging laparoscopy. On surgery, extensive disseminated nodules on the abdominal wall, stomach wall, and liver surface were found, and ascites cytology revealed positive findings. Therefore, we did not perform primary lesion resection. Although the disseminated nodule did not pathologically show tumor cells, CY1 was found, resulting to a diagnosis of unresectable gastric cancer. Since the tumor was HER2 3+, we initiated SOX/trastuzumab therapy. After 16 courses, staging laparoscopy was performed as the lymph nodes had shrunk significantly. The results showed no tumor cells in ascites and the disseminated nodules, and laparoscopic total gastrectomy was subsequently performed. Pathological findings showed no tumor cells in the primary lesion or lymph nodes; therefore, a diagnosis of pathological complete response was made. Currently, the patient is alive without recurrence for 6 months after surgery.

Information in the brain is represented by the collective and coordinated activity of single neurons. Activity is determined by a large amount of dynamic synaptic inputs from neurons in the same and/or distant brain regions. Therefore, the simultaneous recording of single neurons across several brain regions is critical for revealing the interactions among neurons that reflect the computational principles of the brain. Recently, several wide-field two-photon (2P) microscopes equipped with sizeable objective lenses have been reported. These microscopes enable large-scale in vivo calcium imaging and have the potential to make a significant contribution to the elucidation of information-processing mechanisms in the cerebral cortex. This review discusses recent reports on wide-field 2P microscopes and describes the trade-offs encountered in developing wide-field 2P microscopes. Large-scale imaging of neural activity allows us to test hypotheses proposed in theoretical neuroscience, and to identify rare but influential neurons that have potentially significant impacts on the whole-brain system.

The rapid progress of imaging devices such as two-photon microscopes has made it possible to measure the activity of thousands to tens of thousands of cells at single-cell resolution in a wide field of view (FOV) data. However, it is not possible to manually identify thousands of cells in such wide FOV data. Several research groups have developed machine learning methods for automatically detecting cells from wide FOV data. Many of the recently proposed methods using dynamic activity information rather than static morphological information are based on non-negative matrix factorization (NMF). In this review, we outline cell-detection methods related to NMF. For the purpose of raising issues on NMF cell detection, we introduce our current development of a non-NMF method that is capable of detecting about 17,000 cells in ultra-wide FOV data.

We investigate the timelike geodesics and the periapsis precession of orbits in the Fisher-Janis-Newman-Winicour-Wyman spacetime. This spacetime represents the naked singularity spacetime in the Einstein-massless scalar system. We revisit the results in the previous studies and relax the assumptions about the eccentricity of a bound orbit and the size of a semilatus. We find that the negative periapsis precession occurs when the spacetime sufficiently deviates from the Schwarzschild spacetime. In particular, for the small eccentric orbits, we show the negative periapsis precession occurs for $\gamma < 1/2$, where $\gamma$ is the deviation parameter from the Schwarzschild spacetime. We also obtain the analytical solutions for the special cases of $\gamma=0,1/2,1/4$. Then, we show that the negative precession never occurs for $\gamma=1/2$., Comment: 26 pages, 7 figures

Hyperkalemic cardioplegia using St. Thomas’ Hospital solution No. 2 (STH2) is commonly used to protect the myocardium during surgery. Mice deficient in the myocyte channel aquaporin 7 (AQP7) show significantly reduced glycerol and ATP contents and develop obesity; however, the influence of AQP7 on cardioplegia effectiveness remains unclear. After determining the influence of ischemic duration on cardiac function, isolated hearts of male wild-type (WT) and AQP7-knockout (KO) mice (> 13 weeks old) were aerobically Langendorff-perfused with bicarbonate buffer, and randomly allocated to the control group (25 min of global ischemia) and STH2 group (5 min of STH2 infusion before 20 min of global ischemia, followed by 60 min of reperfusion). Final recovery of left ventricular developed pressure (LVDP) of WT and AQP7-KO hearts in the control group was 24.5 ± 12.4% and 20.6 ± 8.4%, respectively, which were significantly lower than those of the STH2 group (96.4 ± 12.7% and 92.9 ± 27.6%). Troponin T levels of WT and AQP-KO hearts significantly decreased in the STH2 groups (142.9 ± 27.2 and 219.9 ± 197.3) compared to those of the control (1725.0 ± 768.6 and 1710 ± 819.9). AQP7 was not involved in the protective efficacy of STH2 in this mouse model, suggesting its clinical utility even in complications of metabolic disease.

Neuronal ensemble inference is a significant problem in the study of biological neural networks. Various methods have been proposed for ensemble inference from experimental data of neuronal activity. Among them, Bayesian inference approach with generative model was proposed recently. However, this method requires large computational cost for appropriate inference. In this work, we give an improved Bayesian inference algorithm by modifying update rule in Markov chain Monte Carlo method and introducing the idea of simulated annealing for hyperparameter control. We compare the performance of ensemble inference between our algorithm and the original one, and discuss the advantage of our method., 23 pages, 8 figures, partially overlapped with arXiv:1911.06509

The 11th Symposium on Polar Science/Ordinary sessions: [OM] Polar Meteorology and Glaciology, Poster presentations, Mon. 16 Nov. - Fri. 18 Dec.

Physical findings of auscultation cannot be quantified at the arteriovenous fistula examination site during daily dialysis treatment. Consequently, minute changes over time cannot be recorded based only on subjective observations. In this study, we sought to supplement the daily arteriovenous fistula consultation for hemodialysis patients by recording the sounds made by the arteriovenous fistula and evaluating the sounds using deep learning methods to provide an objective index. We sampled arteriovenous fistula auscultation sounds (192 kHz, 24 bits) recorded over 1 min from 20 patients. We also extracted arteriovenous fistula sounds for each heartbeat without environmental sound by using a convolutional neural network (CNN) model, which was made by comparing these sound patterns with 5000 environmental sounds. The extracted single-heartbeat arteriovenous fistula sounds were sent to a spectrogram and scored using a CNN learning model with bidirectional long short-term memory, in which the degree of arteriovenous fistula stenosis was assigned to one of five sound types (i.e., normal, hard, high, intermittent, and whistling). After 100 training epochs, the method exhibited an accuracy rate of 70&ndash, 93%. According to the receiver operating characteristic (ROC) curve, the area under the ROC curves (AUC) was 0.75&ndash, 0.92. The analysis of arteriovenous fistula sound using deep learning has the potential to be used as an objective index in daily medical care.

Fast and wide imaging with single-cell resolution, high signal-to-noise ratio and no optical aberration has the potential to open up new avenues of investigation in biology. However, this imaging is challenging because of the inevitable tradeoffs among those parameters. Here, we overcome the tradeoffs by combining a resonant scanning system, a large objective with low magnification and high numerical aperture, and highly sensitive large-aperture photodetectors. The result is a practically aberration-free, fast scanning high optical invariant two-photon microscopy (FASHIO-2PM) that enables calcium imaging from a large network composed of ∼16k neurons at 7.5 Hz in a 9 mm2 contiguous image plane including more than 10 sensory-motor and higher-order regions of the cerebral cortex in awake mice. Through a network analysis based on single-cell activities, we discover that the brain exhibits small-world-ness rather than scale-freeness. FASHIO-2PM will enable revealing biological dynamics by simultaneous monitoring of macroscopic activity and its composing elements.

A boy with 22q11.2 deletion was diagnosed with pulmonary atresia with ventricular septal defect (PAVSD) and major aortopulmonary collateral arteries (MAPCAs). At 8 months, unifocalization of left MAPCAs and BT shunt was performed at another hospital. However, they occluded directly after surgery. An angiography revealed 2 MAPCAs supplying all segments of the right lung. Qp:Qs was 2.24. At 1 year 6 months, we performed VSD closure with unifocalization of the only right lung vascularity, using intraoperative PA flow study. We report a successful case of complete repair with unilateral lung in PAVSD and MAPCAs.

A 2-year-old boy underwent repeat right ventricular outflow tract reconstruction (re-RVOTR) with a bovine jugular vein (BJV) graft. He presented with high fever on postoperative day 6. Blood and drainage effusion cultures were all positive for Staphylococcus lugdunensis and vancomycin was prescribed. Echocardiography showed vegetation at the BJV. Re-re-RVOTR was performed 51 days after re-RVOTR. In the operation, vegetation was adhered to the right-sided leaflet and three leaflets were degenerated. After complete BJV graft resection, an expanded polytetrafluoroethylene conduit with trileaflets was implanted. There was no sign of recurrent infection 8 months after the surgery.

Cationic polyethers with imidazolium-based ionic liquid moieties were synthesized and characterized thoroughly for their properties and functions. Poly(epichlorohydrin) (poly(ECH)) was quaternized by 1-methylimidazole to provide poly(N-glycidyl-N′-methylimidazolium chloride) (poly(ECH-MeIm+Cl−)). Anion exchange of the poly(ECH-MeIm+Cl−) with Li salts provided other cationic polyethers: hydrophobic poly(N-glycidyl-N′-methylimidazolium bis(trifluoromethanesulfonyl)imide) (poly(ECH-MeIm+TFSI−)) and hydrophilic poly(N-glycidyl-N′-methylimidazolium tetrafluoroborate) (poly(ECH-MeIm+BF4−)). The 5% thermal decomposition temperatures of these cationic polyethers are quite high (300–400 °C). Contrary to poly(ECH) (glass transition temperature (Tg) = −49 °C), the poly(ECH-MeIm+Cl−) is a polymer plastic (Tg = 92 °C) when completely dry. Poly(ECH-MeIm+TFSI−) is elastomeric (Tg = −12 °C), whereas poly(ECH-MeIm+BF4−) is a plastic (Tg = 67 °C). Poly(ECH-MeIm+Cl−) rapidly absorbed a large amount of moisture from the atmosphere, changing its appearance from solid to a viscous fluid even under relatively dry conditions (23 °C, and 40% relative humidity (RH); water uptake = 29 wt%), suggesting its highly deliquescent nature. The hydrated poly(ECH-MeIm+Cl−) possesses neither a glass transition nor a phase transition between −60 °C and 80 °C. The ionic conductivity of the hydrated polymer is as high as 1.8 × 10−2 S cm−1 under humid conditions (23 °C, and 80% RH; water uptake = 72 wt%) and is dependent mainly on water uptake. The miscibility between the cationic polyethers and ionic liquids is quite high; mixtures of ethylmethylimidazolium bis(trifluoromethanesulfonyl)imide and the cationic polyethers had no phase transitions between −70 °C and 100 °C. Since the cationic polyethers were miscible with each other to exchange anions, random copolymers with desired copolymerization ratios can be prepared through simple mixing.

Proton-exchange-membrane fuel cells (PEMFCs) are of considerable interest as a sustainable, renewable, efficient, and eco-friendly electrochemical conversion systems of energy. Sluggish oxygen reduction reaction (ORR) as the cathodic reaction have mainly dragged down the PEMFCs in practical use. The most effective catalyst for ORR today is a Pt-based catalyst, which have a high scarcity value and low durability for methanol. Therefore, major efforts have recently been devoted to exploring transition metal and hetero-atom doped carbon materials in fuel cells for large-scale and commercial applications. Herein, we report a facile synthesis route of Co-N doped meso/microporous carbon catalysts (Co/N/MPC-act) via self-assembly of resorcinol-based resin, triblock co-polymer and Co containing ionic liquid followed by CO2 activation. The obtained catalyst exhibited outstanding oxygen reduction activity in an alkaline medium. It yields an onset potential of 0.960 V (vs. RHE) and a limiting current density of 5.0 mA/cm2, which are comparable to that of the commercial Pt/C catalyst. This high activity is contributed by the combination of inter-connected meso/microporous structures and highly dispersed CoNx species with metallic Co. The Co/N/MPC-act catalyst exhibited excellent long-term operation stability and methanol tolerance, making it a promising non-precious metal-based ORR catalyst for PEMFCs.

Introduction In endovascular embolization for intracranial aneurysms, it is important to properly control the coil insertion force. However, the force can only be subjectively detected by the subtle feedback experienced by neurointerventionists at their fingertips. The authors envisioned a system that would objectively sense and quantify that force. In this article, coil insertion force was measured in cases of intracranial aneurysm using this sensor, and its actual clinical application was investigated. Methods The sensor consists of a hemostatic valve (Y-connector). A little flexure was intentionally added in the device, and it creates a bend in the delivery wire. The sensor measures the change in the position of the bent wire depending on the insertion force and translates it into a force value. Using this, embolization was performed for 10 unruptured intracranial aneurysms. Results The sensor adequately recorded the force, and it reflected the operators' usual clinical experience. The presence of the sensor did not affect the procedures. The sensor enabled the operators to objectively note and evaluate the insertion force and better cooperative handling was possible. Additionally, other members of the intervention team shared the information. Force records demonstrated the characteristic patterns according to every stage of coiling (framing, filling, and finishing). Conclusions The force sensor system adequately measured coil insertion force in intracranial aneurysm coil embolization procedures. The safety of this sensor was demonstrated in clinical application for the limited number of patients. This system is useful adjunct for assisting during coil embolization for an intracranial aneurysm.

Background Currently, the extracardiac conduit total cavopulmonary connection (eTCPC) is the most widely used for Fontan modification worldwide. Nevertheless, there have been some cases that are difficult for performing eTCPC because of their anatomical complexity, such as apicocaval juxtaposition. For such cases, in 2002, we introduced the intra-extracardiac TCPC (ieTCPC). Methods We reviewed our 20-year single-center experience with 316 TCPC patients to compare eTCPC (n = 277) and ieTCPC (n = 39) in terms of mortality and morbidity. ieTCPC was indicated for the cases in which there was concern that the TCPC conduit would be too curved for ordinary eTCPC. Results Early death occurred in 1 patient and late death occurred in 15 patients. The actuarial survival rate in the eTCPC and the ieTCPC groups at 10 years were 95.1% and 100.0%, respectively. There was no significant difference in actuarial survival between eTCPC and ieTCPC patients. In the multivariate analysis, preoperative superior vena cava pressure and preoperative oxygen saturation were found to be the independent predictor for postoperative mortality. There was also no significant difference in actuarial rate of freedom from late-occurring complications between eTCPC and ieTCPC groups. In the multivariate analysis, dominant right ventricle and preoperative SVC pressure were independent predictors for late-occurring complications. Conclusions The clinical outcomes in patients who undergo eTCPC and ieTCPC appear to be excellent, with low mortality and morbidity rates in the midterm. ieTCPC may be a good option for TCPC cases with anatomical complexity such as apicocaval juxtaposition and separated hepatic vein drainage.

The purpose of this study was to investigate the current status of thrombectomy calls for acute ischemic stroke for a single neurointerventionist in a regional hospital.We retrospectively evaluated patients with thrombectomy calls for a neurointerventionist from January to November 2016 in our hospital, where a single board-certified neurointerventionist conducts endovascular interventions. Number, frequency, and time of thrombectomy calls were analyzed. Patients ineligible for revascularization were still used in analysis even though the neurointerventionist did not perform thrombectomy.Over 11 months(334 days), there were 105 calls, of which 48 were during duty hours and 57 during off-duty hours. The neurointerventionist was called once every 3.2 days in total, once every 4.7 days during duty hours, once every 5.7 days during off-duty hours of working days, and once every 6.2 days during holidays. Thrombectomies were performed in 37 cases(35%). Thrombectomies were performed once every 9.1 days and once every 2.8 calls. Twenty-four patients presented with ischemic stroke with large vessel occlusion, but they were determined to be ineligible for thrombectomy because of progressed ischemia in 7 patients, poor clinical condition in 7, or symptom recovery or recanalization in 10. Diagnoses of 42 patients who were not indicated for thrombectomy included ischemic stroke without major artery occlusion in 24 patients and intracerebral hemorrhage in 14.In a regional hospital with a single neurointerventionist, the frequency of thrombectomy calls was about once in every 3 days, and approximately half of them occurred during off-duty hours. A thrombectomy was performed about once every 9 days and about once every 3 thrombectomy-calls. Measures should be taken to reduce the burden on neurointerventionists in stroke centers, especially in understaffed institutes.

Contrast-induced encephalopathy is a very rare complication associated with endovascular treatment of intracranial aneurysms. Patients with renal dysfunction may be prone to developing contrast medium neurotoxicity as a result of delayed elimination of the contrast medium in renal metabolism. This article focuses on our experience with contrast-induced encephalopathy in patients with end-stage renal disease requiring hemodialysis. The authors retrospectively reviewed five patients diagnosed with contrast-induced encephalopathy who underwent aneurysm coil embolization at their institution from January 2006 to December 2015. During the 10-year period, embolization was performed in 755 cases, among which contrast-induced encephalopathy occurred in five patients (0.66%). Three of the five patients were undergoing dialysis for chronic renal failure (one male and two female; mean age 66.7). Embolization for hemodialysis patients was performed in eight during the same period and the incidence of contrast-induced encephalopathy in hemodialysis patients is quite high in our series (3 of 8; 38%). Procedures were performed in one for recurrence of unruptured anterior-communicating artery aneurysm and in two for unruptured basilar-tip aneurysm. Mean approximately 220 ml of contrast media was used among three hemodialysis patients. All three patients showed an improvement or a control in symptoms soon after hemodialysis. Recovery of neurological symptoms was complete in two and almost normal in one within 1 week after intervention. Contrast-induced encephalopathy should be kept in mind as an expected complication of aneurysm embolization in hemodialysis patients. In hemodialysis patients with contrast-induced encephalopathy, performing hemodialysis is an effective treatment to improve symptoms early.