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Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated in the Japanese population. Methods: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The clinical characteristics and outcomes were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. Results: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10-26 days] and was longer in the HHS group (19.5 days) compared to the DKA groups (16 days). The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0% to 100%. The median ICU stay was 3 days for all groups. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. The most common complication was infection (18%), followed by pulmonary edema (2.7%), stroke (2.1%), ventricular arrhythmia (1.6%), and deep vein thrombosis (1%). Conclusions: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. Trial registration: This study is registered in the UMIN clinical trial registration system (UMIN000025393, Registered 23th December 2016)

Objectives We elucidate to investigate the prevalence of and factors associated with the use of physical restraints among critically ill or injured children in PICUs. Design This was a multicenter, longitudinal point prevalence study. Setting We included 26 PICUs in Japan. Patients Included children were 1 month to 10 years old. We screened all admitted patients in the PICUs on three study dates (in March, June, and September 2019). Intervention None. Measurements and main results We collected prevalence and demographic characteristics of critically ill or injured children with physical restraints, as well as details of physical restraints, including indications and treatments provided. A total of 398 children were screened in the participating PICUs on the three data collection dates. The prevalence of children with physical restraints was 53% (211/398). Wrist restraint bands were the most frequently used means (55%, 117/211) for potential contingent events. The adjusted odds of using physical restraint in patients 1-2 years old was 2.3 (95% CI, 1.3-4.0) compared with children less than 1 year old. When looking at the individual hospital effect, units without a prespecified practice policy for physical restraints management or those with more than 10 beds were more likely to use physical restraints. Conclusions The prevalence of physical restraints in critically ill or injured children was high, and significant variation was observed among PICUs. Our study findings suggested that patient age, unit size, and practice policy of physical restraint could be associated with more frequent use of physical restraints.

Objectives Zinc deficiency (Zn < 60 μg/dL) is known to play an important role for vascular calcification. However, little data is available regarding the association between zinc deficiency and aorta stiffness in dialysis patients. Thus, we studied the relationship between zinc deficiency and aorta stiffness in non-diabetic hemodialysis (HD) patients. Methods Of 150 patients receiving maintenance HD at our hospital, we included 79 non-diabetic HD patients (age: 70±11 years, 49 men) after excluding 71 diabetic HD patients. Zinc deficiency was defined as Zn Results The zinc deficiency group (ZD group) included 45 patients (57.0%). Compared to the zinc non-deficiency group (ZND group), patients with ZD group were significantly older, higher levels of CRP and hypoalbuminemia. Moreover, they had significantly higher levels of baPWV, and lower levels of ankle-brachial pressure index (ABI) (p Conclusion The study suggested that zinc deficiency may be an independent risk factor for aorta stiffness, even after adjusting for malnutrition and inflammation.

An AXEL sub-assembly and a 4-channel AXEL TOSA were designed and fabricated. The sub-assembly with a width of less than 0.65 mm was needed to make the width of TOSA applicable to QSFP-DD transceiver. On the other hand, the wire that connects between the terminator and the DC block capacitor must be 0.5 mm or longer to obtain 3-dB bandwidth of over 40 GHz which is enough for 50-Gbaud operation. To become that wire length 0.5 mm or more on the narrow sub-assembly, the AXEL chip was placed between the RF circuit board integrated with the terminator and the DC block capacitor. As a result, the AXEL sub-assembly with a width of only 0.65 mm and with a 3-dB bandwidth of more than 40 GHz was realized. Based on the designed sub-assembly, the 4-channel AXEL TOSA was fabricated. Size of the TOSA is only 18.2 × 6.2 × 5.4 mm (which is suitable for a QSFP-DD transceiver). Optical-modulation amplitudes (OMAs) of the fabricated TOSA exceed +4.7 dBm for all channels. 40-km SMF fiber-amplifier-less transmission of 4-channel × 100-Gbit/s/λ signals was successfully demonstrated by using the fabricated 4-channel AXEL TOSA, 4-channel APD ROSA, and a commercially available DSP. Loss budgets exceed 18 dB for all channels.

Febrile infection-related epilepsy syndrome (FIRES) is a disease of unknown etiology, characterized by refractory frequent focal seizures, which require prolonged intensive care. We successfully treated a boy with FIRES with anti-inflammatory and immunosuppressive therapy. This case suggests that an autoimmune mechanism may play a role in the development of FIRES

In our article to extend a 100 Gbit/s/λ fiber-amplifier-less optical link with a simple and cost-effective transmission system, we have fabricated an O-band wavelength range (1260–1360 nm) SOA assisted extended reach EADFB laser (AXEL) with a 300-μm-long DFB laser and 85-μm-long SOA. The length of the integrated electroabsorption modulator was set to 125 μm to obtain a section with low parasitic capacitance for high speed operation. The fabricated AXEL transmitter simultaneously achieved both the sufficient modulated light output of 8.9 dBm and an excellent quality eye diagram for a 53-Gbaud PAM4 signal with the TDECQ value of 1.52 dB. We investigated the effect of the integrated SOA on the AXEL's performance and found no significant degradation of the quality of the eye diagram or the bit error rate (BER) characteristics of the 53-Gbaud PAM4 back-to-back configuration, even when the AXEL achieved high modulated light output power. We were also able to extend the 53-Gbaud PAM4 fiber-amplifier-less optical link to 60 km by using the AXEL transmitter and APD receiver, and achieved error-free transmission assuming KP4-forward error collection (FEC). These results demonstrate that the enhanced modulated light output using the AXEL can successfully extend the 53-Gbaud PAM4 reach with a simple transmission setup.

This study focuses on the conditions for the implementation of the APP, in the form of a concession for the management of the sewerage business. Three uncertainties were identified as limiting factors for PPPs; a) level of service to ensure sustainability, aging of machinery and equipment; b) public spending on rain and the national government subsidy system; c) residents' perception of the water business and the provision of equitable services. The methodology includes case studies (cities of Hamamatsu, Osaka and Nara in Japan). It consists of two parts: a) analysis of relevant published materials and b) application of surveys and semi-structured interviews with municipal officials and, in the case of Osaka, an affiliated company established to operate the sewer business. RESUMEN: Este estudio se centra en las condiciones para la implementación de la APP, en forma de concesión para la gestión del negocio de alcantarillado. Se identificaron tres incertidumbres como factores limitantes para las APP; a) nivel de servicio para asegurar la sostenibilidad, deterioro de maquinaria y equipo; b) gasto público en lluvia y sistema de subsidios del gobierno nacional; c) percepción de los residentes sobre el negocio del agua y la provisión de servicios equitativos. La metodología incluye estudios de casos (ciudades de Hamamatsu, Osaka y Nara en Japón). Consta de dos partes: a) análisis de materiales publicados relevantes y b) aplicación de encuestas y entrevistas semiestructuradas con funcionarios municipales y, en el caso de Osaka, una empresa afiliada establecida para operar el negocio de alcantarillado. RÉSUMÉ: Cette étude se concentre sur les conditions de mise en œuvre du PPP, sous la forme d'une concession pour la gestion de l'entreprise d'assainissement. Trois incertitudes ont été identifiées comme des facteurs limitatifs pour les PPP ; a) niveau de service pour assurer la durabilité, détérioration des machines et des équipements ; b) dépenses publiques en pluie et système de subventions du gouvernement national ; c) perception par les résidents du commerce de l'eau et de la fourniture de services équitables. La méthodologie comprend des études de cas (villes de Hamamatsu, Osaka et Nara au Japon). Il se compose de deux parties : a) l'analyse des documents publiés pertinents et b) l'application d'enquêtes et d'entretiens semi-structurés avec des fonctionnaires municipaux et, dans le cas d'Osaka, une société affiliée établie pour gérer l'entreprise d'assainissement. RESUMO: Este estudo tem como foco as condições de implantação da APP, na forma de concessão para a gestão do negócio de esgotamento sanitário. Três incertezas foram identificadas como fatores limitantes para as PPPs; a) nível de serviço para garantir a sustentabilidade, deterioração de máquinas e equipamentos; b) gastos públicos em chuva e sistema de subsídios do governo nacional; c) A percepção dos residentes sobre o negócio da água e a prestação de serviços equitativos. A metodologia inclui estudos de caso (cidades de Hamamatsu, Osaka e Nara no Japão). Consiste em duas partes: a) análise de materiais publicados relevantes e b) aplicação de enquetes e entrevistas semiestruturadas com funcionários municipais e, no caso de Osaka, uma empresa afiliada estabelecida para operar o negócio da rede de esgotamento sanitário.

This study investigated the effect of adjuvant sublingual immunotherapy (SLIT) on inhaled corticosteroid (ICS) dose in patients with pollinosis-associated asthma.We retrospectively evaluated patients with cedar pollinosis-associated asthma who initiated pharmacotherapy with or without adjuvant SLIT therapy from December 2014 to December 2016 and who continued treatment for 3 years. Changes in ICS dose (fluticasone propionate or its equivalent), antihistamine use, leukotriene antagonist use and intranasal corticosteroid (INCS) use over the 3-year period were compared.The study included 36 and 35 patients in the add-on SLIT and standard treatment groups, respectively. At 3 years, the add-on SLIT group showed a significant decline in ICS dose (p = 0.024). Although leukotriene antagonist use and INCS use did not differ between the two groups, the percentage of patients using antihistamines at 3 years was significantly lower in the add-on SLIT group than in the standard treatment group (p = 0.009); one in three patients on adjuvant SLIT therapy was able to discontinue ICS treatment. Patients who discontinued ICS treatment were younger (44.6±13.3 years vs. 55.0±14.1 years, p = 0.042), had a higher FEVThe addition of SLIT to standard pharmacotherapy resulted in a significant reduction in ICS dose at 3 years.

FeSe is a unique high-$$T_c$$ T c iron-based superconductor in which nematicity, superconductivity, and magnetism are entangled with each other in the P-T phase diagram. We performed $$^{77}$$ 77 Se-nuclear magnetic resonance measurements under pressures of up to 3.9 GPa on 12% S-substituted FeSe, in which the complex overlap between the nematicity and magnetism are resolved. A pressure-induced Lifshitz transition was observed at 1.0 GPa as an anomaly of the density of states and as double superconducting (SC) domes accompanied by different types of antiferromagnetic (AF) fluctuations. The low-$$T_{\mathrm{c}}$$ T c SC dome below 1 GPa is accompanied by strong AF fluctuations, whereas the high-$$T_{\mathrm{c}}$$ T c SC dome develops above 1 GPa, where AF fluctuations are fairly weak. These results suggest the importance of the $$d_{xy}$$ d xy orbital and its intra-orbital coupling for the high-$$T_{\mathrm{c}}$$ T c superconductivity.

Aim More than 90% of pediatric solid organ abdominal injuries are treated non-operatively. It remains difficult to decide who should graduate to surgical management, more so if adult physicians must make these decisions on pediatric patients. The purpose of this study was to examine outcomes of all pediatric abdominal trauma cases in a single center, focusing on the decision-making algorithm for operative or non-operative treatment by pediatric and adult physicians. Methods We undertook a retrospective review of a pediatric trauma database from April 2006 to March 2016. Groups were divided into operative and non-operative, single or multi-organ injury, and adult or pediatric physician. Operative treatments included laparotomy or interventional radiology procedures. Primary outcome was survival within 30 days. Results There were 53 abdominal trauma cases; among them, 48 (90.6%) survived and 5 (9.4%) died within 30 days. The probability of survival for mortalities was less than 11%. Forty-two cases were treated non-operatively and 11 operatively. Injury Severity Score was higher in operative group (17 [9, 41]/9 [4, 16.3]). Adult physicians saw 33 patients including seven operative, whereas pediatric physicians saw 20 including four operative cases. There was no statistical difference for the management decision between adult and pediatric physicians. Conclusion Our decisions for intervention were within acceptable rates. Adult physicians did not tend to operate more, but there were cases that did not fit the criteria of the algorithm. Further investigation is needed to look at which factors should be focused on to determine whether or not operative treatments are indicated.