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Introduction VA ECMO is effective in cardiogenic shock, but complications of cardiogenic pulmonary edema due to increased afterload are problematic. The advent of percutaneous left ventricular assist devices (Impella) has enabled effective reduction of left ventricular intraventricular pressure and has avoided these complications, but differential hypoxia can still occur during VA ECMO + Impella (Ecpella) management, requiring conversion to V-AV ECMO. Cases may be experienced. Purpose Elucidate the frequency of differential hypoxia and its pathogenesis, which requires the transition from VA ECMO to V-AV ECMO. Methods We retrospectively reviewed 52 consecutive patients who underwent E-CPR from January 2017 through November 2021 in our institute. 8 patients who received ECMO alone were excluded, and 44 patients were recruited. 22 patients underwent VA ECMO with IABP (VA ECMO + IABP group) and 22 patients underwent VA ECMO with Impella (VA ECMO + Impella group). The 30-day survival rate and the rate of transition VA ECMO to VA-V ECMO, The date just before VA ECMO to V-AV ECMO were assessed. Results The 30-day all-cause mortality was no significant difference between the two groups. 2 patients (9%) in the VA ECMO + IABP group and 8 patients (36%) in the VA ECMO + Impella group were transferred to V-AV ECMO (P=0.025). At the time of addition of V-AV ECMO, SaO2 (right radial artery) was 87±7.1% and 91.3±1.9% (p=0.112) in the VA ECMO + IABP and VA ECMO + Impella groups, respectively, and the P/F ratio was 86±37.1 and 95±24.6 (p=0.685). Mean pulmonary artery wedge pressure was 23±1.4 mmHg in the VA ECMO + IABP group and 16.3±3 mmHg in the VA ECMO + Impella group (p=0.0193), significantly lower in the Impella group. Conclusion The Impella group was more likely to have hypoxia due to factors other than cardiogenic pulmonary edema. In cases of cardiopulmonary arrest requiring V-AV ECMO management, differential hypoxia due to causes other than cardiogenic pulmonary edema may become apparent earlier in the Impella group, suggesting that careful management, including the addition of V-AV ECMO, is required. Funding Acknowledgement Type of funding sources: None.

The Nearby Evolved Stars Survey (NESS) is a volume-complete sample of $\sim$850 Galactic evolved stars within 3\,kpc at (sub-)mm wavelengths, observed in the CO $J = $ (2$-$1) and (3$-$2) rotational lines, and the sub-mm continuum, using the James Clark Maxwell Telescope and Atacama Pathfinder Experiment. NESS consists of five tiers, based on distances and dust-production rate (DPR). We define a new metric for estimating the distances to evolved stars and compare its results to \emph{Gaia} EDR3. Replicating other studies, the most-evolved, highly enshrouded objects in the Galactic Plane dominate the dust returned by our sources, and we initially estimate a total DPR of $4.7\times 10^{-5}$ M$_\odot$ yr$^{-1}$ from our sample. Our sub-mm fluxes are systematically higher and spectral indices are typically shallower than dust models typically predict. The 450/850 $\mu$m spectral indices are consistent with the blackbody Rayleigh--Jeans regime, suggesting a large fraction of evolved stars have unexpectedly large envelopes of cold dust., Comment: 20 pages, 13 figures, 5 tables, accepted for publications in MNRAS

The objective of this study was to investigate the age difference in the response to endotoxin in calves related to the plasma endotoxin activity and mRNA expression of cytokines. Fifteen calves were divided into three groups: control (191 ± 21 days), weaning (162.4 ± 17.5 days), and calf (22.4 ± 8.2 days). The weaning and calf groups received 2.5 μg/kg of ultrapure O111:B4 LPS in 10 mL of each autologous serum, whereas the control calves received a similar volume of saline. Blood samples were collected at 0, 0.5, 1, 2, 4, 8, 12, and 24 h. Liver samples were collected by ultrasound-guided liver biopsy at 0, 2, 4, and 24 h. Plasma endotoxin activity was measured by the limulus amebocyte lysate kinetic turbidimetric assay. The mRNA expression level of GAPDH, TLR-4, NF-κB2, TNF-α, IL-6, and STAT3 in leukocytes and the liver was measured by real-time PCR. Following LPS challenge, the maximal plasma endotoxin activity, and leukocytic expression of TLR4, NF-κB2, TNF-α, and STAT3 were reached at 0.5, 4, 2-4, 2-4, and 4 h, respectively, in weaning and calf groups. The endotoxin activity in calf remained high until 2 h. Furthermore, the expression of leukocytic STAT3 mRNA in calf was not significantly different from the pre-value. In contrast, STAT3 mRNA in weaning markedly increased at 2 and 4 h. Therefore, this study provides new information to the literature of immune and inflammatory responses in calves.

The time to return to sport from acute hamstring strain injuries is associated with several functional and structural impairments. However, not all previous studies assessed the preinjury level before acute hamstring strain injuries directly. The purpose of this study was to examine the associations of the time to return to performance following acute hamstring strain injuries with deficits in running biomechanics, hamstring function and structure in collegiate sprinters by a prospective study.Using a prospective cohort design, 72 participants were recruited from a collegiate track and field team. At the preinjury assessment, a 60-m running-specific test, passive straight leg raise test and isometric knee flexion strength test were assessed at the beginning of the competitive season for three consecutive years (2017-2019). Afterwards, postinjury examinations were performed only in sprinters with acute hamstring strain injuries.Twelve sprinters strained their hamstring muscle (incidence rate of hamstring strain injuries: 16.7%); the majority (n = 10) were classified as grades 0-2. The running speed deficit of the running-specific test was associated with the time to return to performance as well as the passive straight leg raise test deficit. In the running-specific test, lower-limb kinetic deficits were more strongly associated with the time to return to performance compared to lower-limb kinematic deficits.A running-specific test may be considered one of the most convenient and valid tests for assessing rehabilitation progress after acute hamstring strain injuries.

PURPOSE/OBJECTIVE(S) Sequential boost (SQB) is an IMRT approach that is considered comparable to simultaneous-integrated boost. Dosimetric analysis in SQB using two planning CTs requires advanced dose-accumulation techniques, such as a deformable image registration (DIR) workflow. The purpose of this study was to assess patterns of failure and identify dosimetric features for hypopharyngeal cancer patients treated with SQB-IMRT. MATERIALS/METHODS Between 2013 and 2019, 102 hypopharyngeal cancer patients were treated with definitive SQB-IMRT. In short, both the PTV-high risk, including the primary tumor and metastatic lymph nodes, and the PTV-low risk, including elective nodal regions, received 46 Gy at 2 Gy/fraction using the first planning CT. The PTV-high risk sequentially received an additional 24 Gy using a second planning CT. The doses for the first and second plans were accumulated and registered onto the second planning CT using the DIR workflow. All locoregional recurrences were contoured on the follow-up CT and registered with the second planning CT. Recurrences were classified as in-field (more than 95% of the recurrence volume (Vrec) received 95% of the prescribed dose), marginal (20-95%), or out-of-field (less than 20%). The toxicity was also evaluated using CTCAE ver4.0. RESULTS The median age was 66 years. Stage I, II, III and IV diseases were diagnosed in 3, 23, 20 and 56 patients, respectively. Eighty-three patients (81%) received concurrent chemoradiotherapy, and 19 patients (19%) received radiation therapy alone. The median total dose was 70 Gy. The median follow-up period was 22 months for all patients and 24 months for survivors. The 2-year overall survival rate and locoregional control rate were 79% and 57%, respectively. Thirty-four (33%) locoregional recurrences were observed. All locoregional failures were defined as in-field, and there was no marginal or out-of-field recurrence. The median mean dose and of the Vrec were 72.5 Gy (range, 71.6-74.1). In the patients who experienced locoregional failure, the median mean dose to the elective nodal region was assessed to be 60.1 (range, 55.4-68.4) Gy, and no recurrence occurred in the area. Late toxicities 6 months after RT were evaluated in 34 patients, and 24%, 3%, 25% and 2% of the patients experienced grade 2 and 3 dysphagia, grade 2 dry mouth and G2 dysgeusia, respectively. There were no grade 4/5 late toxicities. CONCLUSION In the detailed dosimetric analysis using DIR, all locoregional relapses after SQB-IMRT were in-field recurrences in the high-dose region. There was no recurrence in the prophylactic dose area, in which the accumulated dose reached as high as 60 Gy. More aggressive treatment for gross tumors and lower prophylactic doses may contribute to improved treatment outcomes and reduced side effects.

Background Quantitative flow ratio (QFR) is an image-based virtual fractional flow reserve (FFR) computed by three dimensional quantitative coronary angiography (3D-QCA) and estimated flow velocity. Several studies have reported that QFR had a good diagnostic performance as compared with wire-based FFR or instantaneous wave-free ratio (iFR). Purpose We compared the diagnostic reliability of QFR for detection of myocardial ischemia with other angiographic and visual predicted indices. Methods In 301 coronary lesions (263 patients) from our QFR database for previously-reported two studies, the diagnostic reliability of QFR, several angiographic and visual predicted indices were investigated using ROC analysis as reference of FFR≤0.8 or iFR≤0.89. Visual predicted FFR were estimated by 3 physicians (25-year experienced expert, 10-year experienced senior physician and 3-year experienced trainee) blinded to other indices. Results Area under the curve (AUC) of each index in ROC analysis is shown in Table. Conclusion QFR was reliable index detecting myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices. Funding Acknowledgement Type of funding source: None

The Commelina erecta L. (C. erecta) also known as erva-de-santa-luzia is reported by local population to have medical properties against some pathological conditions. In this study, two extracts of C. erecta leaves (aqueous and ethanolic) were phytochemically analysed and evaluated for their in-vitro antioxidant activities by DPPH, TBARS, NO assays and cell viability assays. The ultra-high performance liquid chromatography followed by tandem mass spectrometry analysis showed the presence of rutin and caffeic acid in aqueous and ethanolic extract. The total polyphenols in aqueous and ethanolic extracts found were 142.7 ± 3.0 and 123.1 ± 5.8 μg/mL of GAE, respectively. The ethanolic extract (5 mg/mL) inhibits TBARS by 33.8%, and the aqueous extract (5 mg/mL) exhibited scavenger property against nitric oxide derivatives to an extent of 77.8%. In cell culture, both extracts improved cell survivability under H2O2 induced oxidative stress. Thus, C. erecta extract is a good candidate to become a phytotherapic medicine.

Background Anti-programmed cell death protein 1 (PD-1) antibody monotherapy (PD1) has led to favorable responses in advanced non-acral cutaneous melanoma among Caucasian populations; however, recent studies suggest that this therapy has limited efficacy in mucosal melanoma (MCM). Thus, advanced MCM patients are candidates for PD1 plus anti-cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) combination therapy (PD1 + CTLA4). Data on the efficacy of immunotherapy in MCM, however, are limited. We aimed to compare the efficacies of PD1 and PD1 + CTLA4 in Japanese advanced MCM patients. Patients and methods We retrospectively assessed advanced MCM patients treated with PD1 or PD1 + CTLA4 at 24 Japanese institutions. Patient baseline characteristics, clinical responses (RECIST), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier analysis, and toxicity was assessed to estimate the efficacy and safety of PD1 and PD1 + CTLA4. Results Altogether, 329 patients with advanced MCM were included in this study. PD1 and PD1 + CTLA4 were used in 263 and 66 patients, respectively. Baseline characteristics were similar between both treatment groups, except for age (median age 71 versus 65 years; P < 0.001). No significant differences were observed between the PD1 and PD1 + CTLA4 groups with respect to objective response rate (26% versus 29%; P = 0.26) or PFS and OS (median PFS 5.9 months versus 6.8 months; P = 0.55, median OS 20.4 months versus 20.1 months; P = 0.55). Cox multivariate survival analysis revealed that PD1 + CTLA4 did not prolong PFS and OS (PFS: hazard ratio 0.83, 95% confidence interval 0.58-1.19, P = 0.30; OS: HR 0.89, 95% confidence interval 0.57-1.38, P = 0.59). The rate of ≥grade 3 immune-related adverse events was higher in the PD1 + CTLA4 group than in the PD1 group (53% versus 17%; P < 0.001). Conclusions First-line PD1 + CTLA4 demonstrated comparable clinical efficacy to PD1 in Japanese MCM patients, but with a higher rate of immune-related adverse events., Highlights • Anti-PD-1 plus anti-CTLA-4 antibody therapy (PD1 + CTLA4) is an option for patients with advanced mucosal melanoma (MCM). • Data on the efficacy of PD1 + CTLA4 compared with PD-1 monotherapy (PD1) for MCM, however, are limited. • We retrospectively analyzed data from 329 Japanese patients with advanced MCM treated with PD1 or PD1 + CTLA4. • No significant differences in objective response rate, progression-free survival, or overall survival were observed. • Immune-related adverse events resulting in treatment cessation were higher in the PD1 + CTLA4 group.

In this work we used atomistic simulation based on lattice energy minimization combined with crystal field models to study the effects of Eu incorporation in the LiMgPO4 structure. We showed that the most favorable intrinsic defect type is formed by the anti-site defect, in which Li+ and Mg2+ ions exchange positions. The results revealed that Eu3+ prefers to enter in the Mg site with a LiMg' anti-site charge compensation. The local structure of Eu3+ was used to obtain the crystal field parameters and 7F1 energy sub-levels. Also, we estimated the photoionization cross-section of localized traps in the bandgap and associated it with the presence of defects to understand the high sensitivity.

PURPOSE/OBJECTIVE(S) Apparent diffusion coefficient (ADC) values extractable by diffusion-weighted imaging (DWI) are reported as useful in predicting the outcome of surgery and radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC). However, their relationship with local tumor control (LC) after proton beam therapy (PBT) has not been fully evaluated. This study aimed to investigate interobserver variability in ADC histogram metrics and their usefulness in predicting LC in HCC patients who underwent PBT. MATERIALS/METHODS The ADC maps of the liver of HCC patients who underwent PBT between 2015 and 2020 were reviewed. The inclusion criteria were imaging DWI at 1.5T within 6 weeks before PBT and the largest tumor dimension between 2 and 10 cm. Twenty-nine patients and 32 tumors were eligible. Axial DWI was acquired using a single-shot spin-echo echo-planar sequence and the b values of 0 and 1000 s mm-2. The ADC maps generated were transferred to a workstation. Five board-certified radiation oncologists (ROs) contoured the whole tumor regions-of-interest (ROIs) on these maps, using anatomical images obtained together as reference. For each ROI, the minimum (ADCmin), mean (ADCmean), maximum (ADCmax), and the 5th (ADC5), 25th (ADC25), 50th (ADC50), 75th (ADC75), and 95th (ADC95) percentiles were extracted. The intraclass correlation coefficient (2,1) (ICC) was calculated to determine interobserver reproducibility: ICC of 0.75 - 0.90 was considered good and > 0.90 excellent. The ADC metrics were averaged among 5 ROs. The optimal cut-off values that determined LC, i.e., non-progressive disease (PD) based on the modified RECIST, were identified using receiver-operating characteristics (ROC) analysis. The LC rates were calculated using the Kaplan-Meier method, and statistical significance was assessed by log-rank test. RESULTS The median calculated biologically effective dose (α / β = 10) was 97 GyE. With a median follow-up of 39 months (5 - 62), 5 tumors had local PD. The ADCmin, ADCmean, ADCmax, ADC5, ADC25, ADC50, ADC75, and ADC95 of all tumors ranged between 0 - 1131, 748 - 1726, 1566 - 3149, 396 - 1430, 600 - 1566, 723 - 1719, 858 - 1874, and 1166 - 2426 (×10-6 mm 2 s-1), respectively. The ICC were 0.761, 0.969, 0.513, 0.864, 0.978, 0.983, 0.974, and 0.859, respectively. For ADCmean, ADC25, ADC50, and ADC75 which showed excellent reproducibility, the optimal cut-off values to determine LC were 1025, 1005, 1156, and 1132 (×10-6 mm 2 s-1), respectively. The tumors with higher ADC metrics had higher 2-year LC rates than their counterparts (100 % vs 40 %, P = 0.002; 100% vs 74%, P = 0.011; 100% vs 76%, P = 0.024; 100% vs 25%, P < 0.001, respectively). CONCLUSION ADCmean, ADC25, ADC50, and ADC75 showed excellent interobserver reproducibility. Pre-treatment ADC histogram metrics may be useful in predicting LC after PBT in HCC.

The response of structural and mechanical properties under chemical (internal) and hydrostatic (external) pressures in RNiO 3 (R = Pr, Nd, Sm, Eu, Gd, Dy, Y, Ho, Er, Tm, Yb, and Lu) orthorhombic structures were investigated using atomistic simulation. A set of interatomic potentials that satisfactorily reproduces their properties was obtained and the transferability of potentials found in the literature was verified. The calculations reveal that the behavior of the lattice parameters and the volume of the unit cell with increasing hydrostatic pressure are in agreement with the data found in related literature. Such agreement is also verified in the evolution of the anisotropy as a function of chemical pressure. The influence of both pressures on the bond lengths (R O, Ni O) and the bond angles (Ni O1 Ni, Ni O2 Ni) also was investigated. Anomalous behavior was obtained for the mean bonding angle (〈Ni O Ni〉) with hydrostatic pressure, which is argued as related to the low sensitivity of the metal-insulating transition temperature ( T MI ) for compounds with the smallest R ions. Regarding the mechanical part, the elastic constants, the bulk and the shear moduli were studied. The analysis of these quantities under internal and external pressure also suggests the possibility of a structural phase transition.

Hepatic disorders such as steatosis and alcoholic steatohepatitis are common diseases that affect thousands of people around the globe. This study aims to identify the main phenol compounds using a new HPLC-ESI+-MS/MS method, to evaluate some oxidative stress parameters and the hepatoprotective action of green dwarf coconut water, caffeic and ascorbic acids on the liver and serum of rats treated with ethanol. The results showed five polyphenols in the lyophilized coconut water spiked with standards: chlorogenic acid (0.18 µM), caffeic acid (1.1 µM), methyl caffeate (0.03 µM), quercetin (0.08 µM) and ferulic acid (0.02 µM) isomers. In the animals, the activity of the serum γ-glutamyltranspeptidase (γ-GT) was reduced to 1.8 I.U/L in the coconut water group, 3.6 I.U/L in the ascorbic acid group and 2.9 I.U/L in the caffeic acid groups, when compared with the ethanol group (5.1 I.U/L, p

Background Currently, cryoballoon ablation (CBA) has proven to be highly effective in achieving free from atrial fibrillation (AF), especially paroxysmal AF. However, the optimal freezing protocol for each patient to achieve successful pulmonary vein isolation by only CBA is still uncertain. The aim of this study was to evaluate the clinical implications of a reduction in the freezing duration ( Methods From November 2015 to August 2018, 286 consecutive paroxysmal AF patients undergoing CBA were enrolled. We compared 107 patients undergoing a tailor-made CBA procedure (Group A; August 2017-August 2018) to 179 patients with a standard CBA procedure (Group B; November 2015–July 2017). In Group A, the freezing duration was reduced to 150s when the temperature reached ≤−40°C within 40s. Furthermore, we reduced it to 120s when it reached ≤−50°C within 60s. In the other patients, the freezing time was 180s except for excessive freezing over −60°C and/or emergent situations while monitoring the esophageal temperature and for phrenic nerve injury as in Group B. Results The baseline clinical characteristics were similar between two groups. In Group A, 89 patients (83%) underwent CBA with a reduction in the freezing time. The rate of having reduction time in left inferior PV (LIPV) and right inferior PV (RIPV) was lower compared with left superior PV (LSPV) and right superior PV (RSPV) (respectively 17%, 29%, 56%, and 63.5%). However, for right inferior PV, in 31 patients having the reduced freezing time, none of them required touch-up ablation. Although the procedure time and frequency of touch-up ablation did not differ between the 2 groups, total freezing time for each PV was significantly shorter in Group A than Group B as shown in figure (LSPV: 164±28s vs. 216±67s; p The freezing time for each PV Conclusion The safety and efficacy of the new tailor-made CBA strategy were non-inferior to the standard procedure. This study showed that the unnecessary freezing time could be reduced in most of paroxysmal AF patients.

Background We previously reported that pulmonary capillary wedge pressure (PCWP) was noninvasively evaluated by 2D speckle tracking echocardiography (STE). Recently, novel software was introduced to examine volume and function of left ventricular and left atrium (LA) by 3D-STE automatically. Purpose We sought to compare the PCWP estimated by conventional 2D-STE (2D-ePCWP) and by novel 3D-STE (3D-ePCWP), and validate those values by cardiac catheterization. Methods Echocardiography and catheterization were performed in 29 patients (age 72±2) (7 ischemic heart disease, 2 hypertensive heart disease, 5 dilated cardiomyopathy, 12 valvular heart disease and 3 primary pulmonary hypertension).The ePCWP (mmHg) is noninvasively obtained as 10.8 − 12.4 x Log (left atrial active emptying function/minimum volume) as we previously reported. Echocardiography was performed just before the catheterization and we analyzed the 2D and 3D data by novel off-line software. 3D data was automatically analyzed and the border settings were fixed at default (ES60, ED30) (Figure). Results 2D-ePCWP and 3D-ePCWP had a good correlation with PCWP invasively obtained by catheterization (r=0.87 and 0.83, respectively, both p Conclusion This study demonstrated that PCWP might be noninvasively assessed by not only 2D-STE but also 3D-STE with reasonable accuracy and 3D-STE might have utility and value in the routine clinical practice.

Background Left ventricular (LV) diastolic function is mainly composed of LV relaxation and LV stiffness. We reported that pulmonary capillary wedge pressure (ePCWP) and LV relaxation assessed by Tau (eTau) are noninvasively evaluated by speckle tracking echocardiography (STE). The minimum LV diastolic pressure (mLVP) was reported to have a strong correlation with Tau. Therefore, LV chamber stiffness (c-stiffness) may be assessed with the use of two LV diastolic pressure-volume coordinates: the mLVP and volume and the end-diastolic pressure (EDP) and volume. Purpose We sought to noninvasively assess LV stiffness using STE and validate the value by cardiac catheterization. Methods Echocardiography and catheterization were performed in 124 patients (age 72±8) (70 angina pectoris, 20 prior myocardial infarction, 19 hypertensive heart disease, 11 congestive heart failure and 4 paroxysmal atrial fibrillation). The ePCWP (mmHg) is noninvasively obtained as 10.8 − 12.4 × Log (left atrial active emptying function/minimum volume) and the eTau (ms) is obtained as isovolumic relaxation time/(ln 0.9 × systolic blood pressure − ln ePCWP) as previously reported. The mLVP (e-mLVP) was estimate using Tau. The estimated EDP (e-EDP) was calculated as 12.3 − 10.1 × Log (left atrial active emptying function / minimum volume). LV c-stiffness (mmHg/ml) was calculated as LV pressure change (from mLVP to EDP) obtained by catheterization divided by LV volume change during diastole which equals to stroke volume by echocardiography. Estimated c-stiffness (e-c-stiffness) was noninvasively obtained using e-mLVP and e-EDP. Furthermore, LV myocardial stiffness (m-stiffness) was calculated by LVED stress / LV longitudinal strain by STE, where LV stress (kdynes/cm2) was calculated as 0.334 × pressure × dimension / [thickness (1 + thickness/dimension)]. The estimated m-stiffness (e-m-stiffness) was calculated using e-EDP. Results The eTau and e-EDP estimated by STE had a good correlation with Tau and EDP invasively obtained by catheterization (r=0.75 and 0.63, respectively, both p Conclusion This study demonstrated that LV stiffness may be noninvasively assessed by STE with reasonable accuracy and may have utility and value in the routine clinical practice for the diagnosis and treatment in patients with diastolic dysfunction.

Background Left ventricular (LV) pressure-strain and pressure-volume (P-V) loop area reflect global myocardial work (MW) and stroke work (SW), but clinical use of these indexes is limited by the need of invasive pressure measurement. A noninvasive method to obtain LV pressure-strain loop area was recently introduced to examine MW by speckle tracking echocardiography (STE). Purpose We sought to evaluate the impact of preload change on MW and SW obtained using this novel method and to examine the utility to assess LV contractile performance by the SW and end-diastolic volume (EDV) relation (SW-VED) in patient with hemodialysis (HD). Methods LV pressure in a cardiac cycle was estimated using systolic blood pressure (SBP), LV minimum diastolic pressure (mDP) and end-diastolic pressure (EDP) in 20 HD patients (age 67±9)and 25 controls (age 67±9) by utilizing the profile of an empiric, normalized reference curve adjusted according to the duration of LV isovolumic and ejection phases as defined by timing of aortic and mitral valve events by echocardiography. Pulmonary capillary wedge pressure (ePCWP) is estimated as 10.8 – 12.4 × Log (left atrial active emptying function/minimum volume): KT index as previously reported. LVEDP were estimated as 12.3 – 10.1 × KT index. We examined the relation between LV pressure decline (Tau) and mDP by catheterization in 126 patients. Tau is estimated as isovolumic relaxation time/(ln 0.9 × systolic BP − ln ePCWP) as previously reported. SW was obtained by P-V loop area using the combination of pressure (SBP, mDP and EDP) and LV volume by 3D-STE. Echo parameters and BP were measured before and after HD and before and after leg up in controls. Results The mDP obtained by catheterization had a good correlation with Tau (Tau = 33.7 + 2.06 × mDP, r=0.70, p Conclusion LVSW noninvasively obtained by P-V loop area was increased in controls associated with increased preload and decreased in HD with decreased preload and SW-VED was deceased in HD. This novel and noninvasive method may be of potential utility to assess LV contractility and have a clinical interest and value to assess LV function.

Background Drug-eluting stent restenosis (DES-ISR) is associated with poorer outcomes than those of bare-metal stent restenosis after treatment with paclitaxel-coated balloon (PCB), and late restenosis after PCB angioplasty for DES-ISR is a residual problem. Excimer laser coronary angioplasty (ELCA) is thought to be advantageous for ISR treatment by removing neointima. However, whether the combination of ELCA and PCB angioplasty is more effective than the use of PCB only angioplasty in DES-ISR has not been studied so far. Purpose We evaluated the efficacy of ELCA and PCB combination therapy for DES-ISR at mid-and late-term after revascularization. Methods From January 2014 to March 2016, 166 DES-ISR lesions were treated with ELCA and no-ELCA prior to PCB. Two serial angiographic follow-ups were planned for the patients (at 6–12 and 18–24 months after procedure). Acute procedural and follow-up angiographic results were assessed by quantitative coronary angiography. ELCA and no-ELCA group included 74 lesions and 92 lesions, respectively. Results There was no significant difference between the two groups in the clinical characteristics except the prevalence of hemodialysis, the rate of first-generation DES (37.9% vs 36.8%, p=0.897), previous stent size (2.90±0.39 mm vs 2.77±0.39 mm, p=0.063), and reference vessel diameter (2.65±0.46 mm vs 2.60±0.65 mm, p=0.593). Early follow-up angiography was performed in 66 lesions (89.1%) of ELCA group, and was done in 76 lesions (82.6%) of no-ELCA group. In the ELCA group, percentage diameter stenosis (%DS) just after procedure and at 6–12 months later were significantly smaller than those of no-ELCA group. Besides, target lesion revascularization (TLR) rate at 6–12 months after procedure was tended to be lower in the ELCA group. Late follow-up angiography was performed for 93 lesions (81.6%) of the remaining 114 lesions (excluding TLR lesion), late restenosis was found 9 lesions (18.6%) in the ELCA group and 11 lesions (24.4%) in the no-ELCA group (p=0.504). Late luminal loss was similar in both groups (0.37±0.71 mm vs 0.24±0.82 mm, p=0.438), and %DS at 12–18 months after revascularization was not different between the two groups. Changes of %DS and TLR rate Conclusions %DS in the ELCA group was smaller at just after procedure and the advantage was kept even after 1-year. However, late restenosis and TLR at 2-year after revascularization for DES-ISR could not be reduced by ELCA and PCB combination therapy.

Introduction Left ventricular (LV) pressure-volume (P-V) loop area reflects stroke work (SW), but clinical use of this index is limited by the need of invasive pressure measurement. A noninvasive method to obtain LV pressure-strain loop was recently introduced to assess myocardial work (MW). The minimum LV diastolic pressure (mLVP) was reported to have a strong correlation with Tau and we reported that Tau was noninvasively evaluated by speckle tracking echocardiography (STE). Purpose We sought to evaluate the impact of preload change by leg lifts on LV SW noninvasively obtained by the novel method and to examine the utility to assess LV contractility by SW and end-diastolic (ED) volume relation (SW-VED). Methods Thirty six controls (age 71±10) and 30 patients with heart failure with reduced ejection fraction (EF) Results LVEF and longitudinal strain in HF before leg up by 3D-STE were lower compared to normal (LVEF; normal: 58±5 vs HF: 39±10*% and strain; −12±3 vs −8±3%*, *p Conclusion LV SW noninvasively obtained by P-V loop area was increased after leg up in both normal and HF but SW-VED in HF was smaller than normal, indicating reduced contractility in HF. This noninvasive method may be a new echocardiographic approach for quantification of LV SW and contractility.

Atomistic simulation based on lattice energy minimization was performed to study the defect process caused by europium in the NaCdPO4 structure. The calculations suggest that the most favorable intrinsic defect type is formed by cation anti-site defect, in which Na+ and Cd2+ ions exchange positions. The calculation also reveals that doping by Eu3+ on the Cd site is the most energetically favorable. Charge compensation by NaCdʼ anti-site defect is probable. Crystal field parameters are then calculated and used to obtain the 7F1 sublevels of the Eu3+, which we use to discuss the local symmetry of the Eu3+.

We report the atomistic simulation study of the Al3+-doping effects on the structural properties of LaCrO3 compound. We observed that Al3+-doping in the range of 0-80 wt% induced a decrease in the lattice parameters, unit cell volume, and Cr/Al-O and La-Cr/Al bond lengths. At the phase transition, around 60 wt% of Al3+-doping, and positive volume expansion was observed, which confirmed the orthorhombic (Pnma) to rhombohedral (R-3c) phase transition. The volume decompression amount was calculated to be about +0.50 A3 (+33.33%) per formula unit. The elastic constants of the unit cell expansion increased as Al3+-doping increased 80 wt%, and were estimated to be C11=C33, C12/C21=C23/C32, and C44=C66 for the orthorhombic and rhombohedral phases, respectively. However, these constant values match to those of the rhombohedral structure for further Al3+-doping. Thus, we concluded that increasing substitution of Cr3+ (0.615 A) by Al3+ (0.535 A) in the LaCrO3 lattice induces a decrease of distortions at (Cr/Al)O6 octahedra, indicating that a reduction of the chemical pressure caused the structural phase transition.

The local symmetry of the Eu3+ was obtained through atomistic simulation and crystal field models applied to lanthanides. Structural properties such as lattice parameters and unit cell volume were reproduced using a set of empirical interatomic potentials with good accuracy. The LiF Anti-Schottky intrinsic defect was most favourable energetically. The solution energy obtained by bound extrinsic defects showed that the Eu3+ prefers the Li+ site compensated by lithium vacancy. Spectroscopic calculations revealed that the europium occupies a luminescent site with distorted inversion centre. A slightly distorted D4h symmetry is most favourable with the charge factors: g1 = 0.629, g2 = 0.738, g3 = 0.627 and g4 = 0.625, which reproduced satisfactorily the 7F1 manifold splitting and the 7F1, 7F2 and 5D1 energy sublevels.

The CaSO 4 : Eu 3 + has been prepared by the slow evaporation route with different concentrations of the luminescent ion, characterized by XRD and emission spectra techniques and studied by atomistic simulation and crystal field theory. The lattice parameters were obtained with a new set of potentials which is proving to be more appropriate to simulate the lattice parameters and the local Eu 3 + luminescent site than those published elsewhere. The Simple Overlap Model (SOM) was applied in the frame of the Method of Equivalent Nearest Neighbours (MENN) in order to predict the charge factors devoted do the Eu–O bond and the 7 F 1 energy sub-levels through the crystal field parameters. The central ion charge ( g Eu ) was predicted by the Batista–Longo Improved Model (BLIM). Our calculations indicated that the Eu 3 + prefers the Ca 2 + site compensated by calcium vacancy or interstitial oxygen. Using the four simulated structures the 7 F 1 Stark levels were satisfactory reproduced. Thus, based on the simulations and the number of lines exhibited in the emission spectra, one has a strong indication that the Eu ion occupies a distorted local symmetry which is a combination of the D 2 and C 2 v point groups.

Diffusion welding of metallic materials requires contact of clean surfaces by removing surface films. However, there is microscopic unevenness on the surfaces and they are covered with oxide layers, absorbed gas layers, contaminating substance layers, etc. Welding is prevented by this unevenness and by these surface films and it is the stability of the surface films, in particular, which affects welding. Aluminium is regarded as a particularly difficult material for diffusion welding since it has a highly stable strong oxide film. Hence, to weld aluminium, it is necessary to remove this stable film so that welding can be performed. This article describes will describe the result of the investigation into the effect of twist angle, welding pressure and temperature, film thickness and surface roughness on the joint strength of the material.

Hicks and Dresselhaus predicted that quantum well and nanowire thermoelectric materials could show a meaningful enhancement of the heat-to-electricity conversion efficiency compared to their bulk counterparts. The unique transport properties of bismuth, specifically the low effective mass, high mobility, and large Bohr radius of its charge carriers, enabled the study of size-quantization effects in Bi nanowires following those theoretical predictions. In this review, the band structure of Bi and Bi

We performed a detailed analysis of elemental abundances, dust features, and polycyclic aromatic hydrocarbons (PAHs) in the C-rich planetary nebula (PN) Wray16-423 in the Sagittarius dwarf spheroidal galaxy, based on a unique dataset taken from the Subaru/HDS, MPG/ESO FEROS, HST/WFPC2, and Spitzer/IRS. We performed the first measurements of Kr, Fe, and recombination O abundance in this PN. The extremely small [Fe/H] implies that most Fe atoms are in the solid phase, considering into account the abundance of [Ar/H]. The Spitzer/IRS spectrum displays broad 16-24 um and 30 um features, as well as PAH bands at 6-9 um and 10-14 um. The unidentified broad 16-24 um feature may not be related to iron sulfide (FeS), amorphous silicate, or PAHs. Using the spectral energy distribution model, we derived the luminosity and effective temperature of the central star, and the gas and dust masses. The observed elemental abundances and derived gas mass are in good agreement with asymptotic giant branch nucleosynthesis models for an initial mass of 1.90 Msun and a metallicity of Z=0.004. We infer that respectively about 80 %, 50 %, and 90 % of the Mg, S, and Fe atoms are in the solid phase. We also assessed the maximum possible magnesium sulfide (MgS) and iron-rich sulfide (Fe50S) masses and tested whether these species can produce the band flux of the observed 30 um feature. Depending on what fraction of the sulfur is in sulfide molecules such as CS, we conclude that MgS and Fe50S could be possible carriers of the 30 um feature in this PN., Comment: 25 pages, 17 figures, 16 tables, Accepted for publication by MNRAS

In this study, we compared cancer patients preference for computerised (tablet/web-based) surveys versus paper. We also assessed whether the understanding of a cancer-related topic, pharmacogenomics is affected by the survey format, and examined differences in demographic and medical characteristics which may affect patient preference and understanding. Three hundred and four cancer patients completed a tablet-administered survey and another 153 patients completed a paper-based survey. Patients who participated in the tablet survey were questioned regarding their preference for survey format administration (paper, tablet and web-based). Understanding was assessed with a ‘direct’ method, by asking patients to assess their understanding of genetic testing, and with a ‘composite’ score. Patients preferred administration with tablet (71%) compared with web-based (12%) and paper (17%). Patients

Intravascular polarimetry with polarization sensitive optical frequency domain imaging (PS-OFDI) measures polarization properties of the vessel wall and offers characterization of coronary atherosclerotic lesions beyond the cross-sectional image of arterial microstructure available to conventional OFDI. A previous study of intravascular polarimetry in cadaveric human coronary arteries found that tissue birefringence and depolarization provide valuable insight into key features of atherosclerotic plaques. In addition to various tissue components, catheter and sample motion can also influence the polarization of near infrared light as used by PS-OFDI. This paper aimed to evaluate the robustness and repeatability of imaging tissue birefringence and depolarization in a clinical setting. 30 patients scheduled for percutaneous coronary intervention at the Erasmus Medical Center underwent repeated PS-OFDI pullback imaging, using commercial imaging catheters in combination with a custom-built PS-OFDI console. We identified 274 matching cross sections among the repeat pullbacks to evaluate the reproducibility of the conventional backscatter intensity, the birefringence, and the depolarization signals at each spatial location across the vessel wall. Bland-Altman analysis revealed best agreement for the birefringence measurements, followed by backscatter intensity, and depolarization, when limiting the analysis to areas of meaningful birefringence. Pearson correlation analysis confirmed highest correlation for birefringence (0.86), preceding backscatter intensity (0.83), and depolarization (0.78). Our results demonstrate that intravascular polarimetry generates robust maps of tissue birefringence and depolarization in a clinical setting. This outcome motivates the use of intravascular polarimetry for future clinical studies that investigate polarization properties of arterial atherosclerosis. © 1982-2012 IEEE.

A 41-year-old Japanese female was admitted to our hospital with a history of right abducens nerve palsy, right gaze diplopia, right eye pain and double vision. Thyroid function, thyroid autoantibody levels, and tests for other pathologies were normal. Orbital contrast-enhanced short-TI Inversion Recovery-magnetic resonance imaging before treatment showed contrast-enhanced, severe lateral rectus and rectus superior muscle swelling in the right eye. We therefore diagnosed this patient as orbital myositis. Intravenous glucocorticoid pulse therapy with methylprednisolone (mPSL) was initiated. After prescribing a daily dose of 1,000 mg of mPSL three times a week, all symptoms, including physical abnormalities, disappeared. The patient was discharged on day 14 after hospitalization and was prescribed oral PSL (30 mg/day). This report indicates that early and initial adequate treatment with a high dose of mPSL is very effective for orbital myositis treatment. However, the possibility of recurrences must be always considered at subsequent follow-up. Case Study Tetsuka et al.; BJMMR, 8(4): 362-366, 2015; Article no.BJMMR.2015.460 363

Efonidipine hydrochloride ethanolate (NZ-105) is a novel 1,4-dihydropyridine derivative and Ca antagonist. Its chemical structure is distinctive, being a solvate composed of an equimolar adduct of ethanol and efonidipine hydrochloride, and it represents one of a few cases of solvates marketed as a pharmaceutical drug. The research presented in this paper used methods to assess its solid-state properties and included thermal analysis (thermogravimetry-differential thermal analysis, TG-DTA), Fourier transform infrared spectroscopy (FT/IR), evolved gas analysis-mass spectrometry (EGA-MS), environmental (low-vacuum) scanning electron microscopy (E-SEM), variable temperature powder X-ray diffraction, and single-crystal X-ray structure analysis, in order to clarify the thermal behavior of the hydrogen chloride and ethanol adducts of efonidipine in the study of the thermal stability of efonidipine hydrochloride ethanolate. Upon heating, efonidipine hydrochloride ethanolate first released ethanol and subsequently formed a decomposition product with the elimination of chloride ions. X-ray diffraction patterns and particulate forms were markedly altered after the release of ethanol, which suggested the interaction of ethanol molecules with chloride ions and efonidipine molecules within the crystal structure. Vastly different from efonidipine, the crystal structure of efonidipine hydrochloride ethanolate arranges the chloride ion within a basket-type conformation formed by the bulky diphenyl and phosphate groups. This distinctive crystal structure was thought to suppress the elimination of chloride ions and contribute significantly to the improved thermal stability of the compound.

Laser induced breakdown spectroscopy (LIBS) based on femtosecond laser pulses has widely been used for analyzing chemical elements in samples. In this research, we achieved the double-pulse operation with a two-polarizer configuration, and the signal enhancement factor of 4–15 was observed as compared with the single pulse LIBS scheme. It is found that with the change in interpulse delay time between 0 and 150 ps, the laser-fluence dependence of the LIBS signal enhancement can be classified into three types that are characterized by the different behavior of linear and quadratic intensity increase, followed by the intensity saturation. Such different responses are presumably ascribable to the mechanisms of electron-ion relaxation and plasma reheating. Also, different behavior is seen for the signal enhancement with different laser intensity and beam diameter while the laser fluence is kept constant. This indicates that generally, the use of a larger beam diameter is recommended for increasing the signal enhancement factor.

Objectives To achieve ideal functional and aesthetic requirements, ridge augmentation is often required before dental implant placement. Bone augmentation (especially vertical), which normally consists of complex and invasive surgeries, still remains challenge. This study seeks to investigate the feasibility of an injectable in situ gel-forming system containing strontium hydroxyapatite (SrHA) and alginate for minimally invasive bone augmentation in a rat calvarial model. Material and methods SrHA–alginate solution was prepared by mixing SrHA powder with alginate solution (20 mg/mL) to the final concentration of 0.5% (w/v). Each animal received a 200-μL single subperiosteal injection of either SrHA–alginate solution or alginate solution. The new bone formation was assessed at 0, 4, and 8 weeks histologically and radiologically. Results The SrHA–alginate solution materials could form solid gel once injected. As such, no sutures were required to close the injection site. Significantly greater amount of new bone formation was observed in the SrHA–alginate group compared with the alginate group both by micro-CT and by histological section. The newly formed bone in the SrHA–alginate group originated both from the underlying original bone and from the elevated periosteum. A 2.3-fold increase of the vertical bone height was observed in the SrHA–alginate group compared with 1.3-fold increase in the alginate group. Conclusions Rat calvarial bone augmentation was achieved by a single subperiosteal injection of SrHA–alginate solution without any administration of stem cells or growth factors. The in situ gel-forming material may hold potential therapeutic benefits for local bone augmentation in a minimally invasive manner.

ObjectivesBecause posterior cruciate ligament (PCL) resection makes flexion gaps wider in total knee replacement (TKR), preserving or sacrificing a PCL affects the gap equivalence; however, there are no criteria for the PCL resection that consider gap situations of each knee. This study aims to investigate gap characteristics of knees and to consider the criteria for PCL resection.MethodsThe extension and flexion gaps were measured, first with the PCL preserved and subsequently with the PCL removed (in cases in which posterior substitute components were selected). The PCL preservation or sacrifice was solely determined by the gap measurement results, without considering other functions of the PCL such as ‘roll back.’ResultsWide variations were observed in the extension and flexion gaps. The flexion gaps were significantly larger than the extension gaps. Cases with 18 mm or more flexion gap and with larger flexion than extension gap were implanted with cruciate retaining component. A posterior substitute component was implanted with the other cases.ConclusionsIn order to make adequate gaps, it is important to decide whether to preserve the PCL based on the intra-operative gap measurements made with the PCL intact. Cite this article: Bone Joint Res 2014;3:95–100.