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Hybrid warfare has recently attracted scholarly attention. Despite its importance, hybrid warfare research remains underdeveloped, as it sometimes falls into the trap of ‘simplistic hypothesis testing’, which focuses on narrowly defined military factors while downplaying the fundamentals of international politics (e.g. balancing and diplomacy). This article fills this gap by constructing a new theoretical concept called ‘hybrid balancing’ by introducing the essence of hybrid warfare into classical realism, based on the scientific realism in the philosophy of science as a meta-theoretical foundation. ‘Hybrid balancing’ consists of three ideal types of balancing beyond the traditional hard one: political, economic and informational balancing. As a plausibility probe to show that the argument is sufficiently grounded in evidence to justify further research, I illustrate the new concept by examining China's hybrid warfare in the Indo-Pacific, an arena of geopolitical competition between China and the United States. The implications of the research are that it (1) shows the significance of ‘agency’ over ‘structure’ to solve the agent–structure debate, (2) develops a new theoretical concept explaining non-military aspects of balancing, (3) overcomes ‘simplistic hypothesis testing’, and (4) sheds new light on the Indo-Pacific, which had been overlooked in previous research around hybrid warfare.

Background The aim of this study was to compare the efficacy of drug-coated balloon (DCB) angioplasty with drug-eluting stent (DES) angioplasty in the treatment of de novo coronary artery lesions in dialysis patients. Method We retrospectively enrolled 400 consecutive dialysis patients with 464 coronary de novo lesions treated by DCB or DES from five participating institutions in Japan. The primary endpoint was target lesion revascularization (TLR) at 12 months. We performed serial coronary angiographic analysis. Results There were no significant differences in the rate of TLR between the groups in either crude or propensity score-matched analysis (DES 14.1% vs. DCB 14.7%, P = 0.864, DES 12.1% vs. 12.1%, P = 1.00). Target lesion thrombosis was not observed in the DCB group; however, stent thrombosis was observed in 7 patients (2.2%) in the DES group. The rate of binary restenosis was similar in both groups (DES, 20.9% vs. DCB, 22.8%; P = 0.749). The late lumen loss at follow-up was significantly greater in the DES group than in the DCB group (0.61 ± 0.76 mm vs 0.22 ± 0.48 mm; P Conclusion The efficacy of DCB angioplasty for de novo coronary artery lesions in dialysis patients was similar to that of DES angioplasty in the real world. Drug-coated balloon angioplasty can be an acceptable treatment for de novo coronary artery lesions in dialysis patients.

Purpose: (1) To evaluate the enhancement patterns of an ultrasmall superparamagnetic iron oxide contrast agent (USPIO-CA) compared with those of a gadolinium-based contrast agent (Gd-BCA). (2) To compare the histologic distribution of USPIO-related iron particles (USPIO-IPs) with the USPIO-enhancement area in the early vascular and in the cellular imaging phase (E- and L-phase, respectively) after intravenous CA administration., Methods:We performed USPIO-enhanced MRI of N-ethyl-N-nitrosourea (ENU)-induced endogenous rat glioma, including spin-echo (SE) T1-weighted images (T1WIs) and gradient-recalled-echo (GRE) T2-weighted images (T2WIs), before and at 3-6 h after USPIO-CA administration for E-phase images. For L-phase images, MRI was performed at 16-19 and 62-69 h after administration. Two observers determined the USPIO-enhancement area on E-phase images and Gd-enhancement areas. We compared the USPIO-enhancement size (USPIO-ES) and Gd-ES on SE T1WIs, and the hypo-intense USPIO-ES on GRE T2WIs and Gd-ES using the Wilcoxon signed-rank test. In addition, two raters visually evaluated the correspondence between the histologic distribution of USPIO-IPs and the USPIO-enhancement area on corresponding GRE T2WIs at each phase using a 3-rating scale., Results:Significantly smaller hyper-intense, hypo-intense and combined hyper-/hypo-intense areas were observed on USPIO-enhanced SE T1WIs compared with Gd-enhanced images (all P < 0.001). The hypo-intense USPIO-ES on GRE T2WIs was significantly smaller than the Gd-ES (P = 0.001). The distribution of USPIO-IPs on histopathological specimen and USPIO-enhancement on GRE T2WIs exhibited poor agreement in 5 of 9 tumors with enhancement from rats sacrificed early. The distribution of microglia containing USPIO-IPs corresponded with the pattern of USPIO-enhancement in the 2 tumors with late enhancement., Conclusion:The enhancement pattern and size of USPIO-CA in a rat glioma model were statistically different from those of Gd-BCA. Our histological data suggests that USPIO-enhanced MRI offers vascular bed imaging in E-phase and might depict the intra-tumoral distribution of immune effector cells in L-phase.

The impact of drug-coated balloon (DCB) on hemodialysis (HD) patients with coronary lesions remains unclear. This study aimed to compare outcomes after DCB treatment between HD and non-HD patients with de novo coronary lesions. A total of 235 consecutive patients who electively underwent DCB treatment for de novo coronary lesions were included (HD group: n = 100; non-HD group: n = 135). Angiographic follow-up was performed 6 months after the procedure. Patients were clinically followed up for 2 years. The incidence rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) were investigated. Diabetes and a history of coronary bypass grafting were more frequent in the HD group than in the non-HD group (69.0% vs. 50.7%, p = 0.007, and 24.0% vs 9.1%, p = 0.013, respectively). The reference diameter and pre-procedural diameter stenosis were greater in the HD group than in the non-HD group (2.49 mm vs. 2.24 mm, p = 0.007, and 65.9% vs. 59.6%, p = 0.015, respectively). Calcification was observed in 65.5% of all lesions, and rotational atherectomy was performed in 30.2% patients. The average diameter of the DCB was 2.51 mm (2.57 mm, HD group vs. 2.47 mm, non-HD group, p = 0.14). Although post-procedural diameter stenosis was similar between the groups, late lumen loss on follow-up angiography was larger in HD patients than in non-HD patients (0.27 mm vs. − 0.03 mm, p = 0.0009). The 2-year rates of freedom from TLR and MACE were lower in HD patients than in non-HD patients [79.3% vs. 91.7%, hazard ratio (HR) 2.76, 95% confidence interval (CI) 1.23–6.77, p = 0.014; and 61.6% vs. 89.4%, HR 4.60, 95% CI 2.30–10.2, p

OBJECTIVES To compare the long-term clinical outcomes after self-expandable bare nitinol stent (BNS) implantation between hemodialysis (HD) and non-HD patients with femoropopliteal (FP) disease. BACKGROUND Although a BNS has been commonly used in patients with FP disease, the long-term efficacy of BNSs in HD patients remains unknown. METHODS In total, 427 HD patients treated with a BNS for FP disease were enrolled, along with 157 non-HD patients as a control group. Over the following 5 years, the incidence of target lesion revascularization (TLR), major amputation and mortality was investigated. We also performed propensity-score matching analysis. RESULTS The 5-year TLR rate (45.2 vs. 32.5%, p = .013) and mortality rate (39.3 vs. 14.0%, p = .0002) were significantly higher in the HD group than in the non-HD group. The major amputation rate was comparable between the groups (7.2% in the HD group vs. 2.8% in the non-HD group, p = .16). In the propensity-score-matched cohort, the TLR rate, and mortality rate were remained higher in the HD group than in the non-HD group (48.9 vs. 34.1%, hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.30-3.49, p = .0024, and 47.9 vs. 12.0%, HR 3.38, 95% CI 1.86-6.56, p

We investigated the clinical impact of hemodialysis on long-term outcomes of bypass surgery in patients with peripheral artery disease. We evaluated 660 consecutive patients who underwent successful bypass surgery (392 hemodialysis and 268 non-hemodialysis). The endpoint was amputation-free survival (AFS). To minimize differences in clinical characteristics between the 2 groups, propensity score matching was performed. The AFS rates for 10-year follow-up were 39.3% and 67.7% in hemodialysis and non-hemodialysis patients [hazard ratio (HR) 2.21, 95% confidence interval (CI) 1.65–3.01, P < .0001]. Cumulative incidence of amputation was higher in the hemodialysis group than in the non-hemodialysis group [(19.4 vs 8.4%, HR 2.15, 95% CI 1.29–3.74, P = .0027). In a matched cohort (n = 210 each), AFS was still lower in the hemodialysis patients (53.1 vs 66.3%, HR 1.94, 95% CI 1.36–2.82, P = .0003). However, there was no significant difference in amputation rate between the groups (10.5 vs 10.6%, HR .97, 95% CI 0.49–1.87, P = .93). In a sub-analysis of patients with critical limb ischemia, similar results were obtained. The 10-year AFS was consistently lower in the hemodialysis group than in the non-hemodialysis group. However, the amputation rate was comparable between the groups when matched for the differences in clinical characteristics.

In this paper, a production and inventory system with state-dependent arrival rates is considered under a two-critical-number policy. If the number of products in the inventory reaches the value of...

To identify the risk factors for major adverse cardiovascular events (MACEs) in real-world practice for symptomatic peripheral artery disease in Japan.Data on Japanese patients (N = 880) from the Observational Prospective Multicenter Registry Study on Outcomes of Peripheral Arterial Disease Patients Treated by Angioplasty Therapy for Aortoiliac Artery who underwent de novo aortoiliac stent placement. The 3-year risk of incident MACEs was investigated.The median age of the patients was 72.6 years (range, 34-97 years), and 83.1% of the patients were men. The patients had the following conditions: smoking (35.6%), hypertension (94.1%), dyslipidemia (81.7%), diabetes (48.0%), renal failure on dialysis (12.6%), myocardial infarction (12.7%), stroke (15.8%), and chronic limb-threatening ischemia (7.1%). Femoropopliteal lesions were present in 38.8% of the limbs with aortoiliac lesions. The 3-year rate of freedom from MACEs was 89.1%. Baseline characteristics, such as age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions, were independently associated with the risk of incident MACEs. When the study population was stratified according to these risk factors, the rate of MACEs was highest in patients with at least 3 risk factors (32.9% at 3 years).The 3-year rate of freedom from MACEs was reported. Baseline characteristics, such as age, renal failure on dialysis, myocardial infarction, stroke, and femoropopliteal lesions, are independent risk factors for MACEs after aortoiliac stent placement.

To investigate the clinical outcomes after biodegradable-polymer (BP) and durable-polymer (DP) everolimus-eluting stent (EES) implantation in hemodialysis (HD) patients with coronary artery disease. We enrolled 221 consecutive HD patients successfully treated with EES implantation for coronary lesions. Over the following 2 years, we assessed the incidence of target lesion revascularization (TLR) and major adverse cardiac event (MACE), defined as the composite endpoint of TLR, all-cause mortality, or myocardial infarction. We performed a propensity-score matching analysis and collected follow-up coronary angiography data. There were 91 patients in the BP-EES group and 130 in the DP-EES group. Male sex and diabetes rates were significantly lower in the BP-EES group than in the DP-EES group. A debulking device was less frequently used in the BP-EES group than in the DP-EES group (7.6% vs. 21.5%, p = 0.006). TLR occurred in 38 patients, while stent thrombosis was observed in 3 patients; 19 patients died. TLR and MACE rates at 2 years were comparable between the two groups (19.2% in the BP-EES group vs. 20.4% in the DP-EES group, p = 0.73 and 26.9% vs. 34.2%, p = 0.93, respectively). In the propensity-score-matched cohort, TLR and MACE rates were similar between the two groups (19.2% in the BP-EES group vs. 18.1% in the DP-EES group, p = 0.69, and 26.9% vs. 30.2%, p = 0.66, respectively). Restenosis rates at follow-up angiography were similar between the two groups (p = 0.79). In hemodialysis patients, BP-EES and DP-EES showed similar 2-year clinical outcomes.

The impact of drug-coated balloon (DCB) on hemodialysis (HD) patients with coronary lesions remains unclear. This study aimed to compare outcomes after DCB treatment between HD and non-HD patients with de novo coronary lesions. A total of 235 consecutive patients who electively underwent DCB treatment for de novo coronary lesions were included (HD group: n = 100; non-HD group: n = 135). Angiographic follow-up was performed 6 months after the procedure. Patients were clinically followed up for 2 years. The incidence rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE) were investigated. Diabetes and a history of coronary bypass grafting were more frequent in the HD group than in the non-HD group (69.0% vs. 50.7%, p = 0.007, and 24.0% vs 9.1%, p = 0.013, respectively). The reference diameter and pre-procedural diameter stenosis were greater in the HD group than in the non-HD group (2.49 mm vs. 2.24 mm, p = 0.007, and 65.9% vs. 59.6%, p = 0.015, respectively). Calcification was observed in 65.5% of all lesions, and rotational atherectomy was performed in 30.2% patients. The average diameter of the DCB was 2.51 mm (2.57 mm, HD group vs. 2.47 mm, non-HD group, p = 0.14). Although post-procedural diameter stenosis was similar between the groups, late lumen loss on follow-up angiography was larger in HD patients than in non-HD patients (0.27 mm vs. - 0.03 mm, p = 0.0009). The 2-year rates of freedom from TLR and MACE were lower in HD patients than in non-HD patients [79.3% vs. 91.7%, hazard ratio (HR) 2.76, 95% confidence interval (CI) 1.23-6.77, p = 0.014; and 61.6% vs. 89.4%, HR 4.60, 95% CI 2.30-10.2, p 0.001, respectively]. In conclusion, the rates of TLR and MACE after DCB treatment were higher in HD patients than in non-HD patients.

ObjectiveProtein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients.MethodsWe enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5–7.0 mg/L and T3:≥7.1 mg/L).ResultsKaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (pConclusionPreprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.

Background and Aims Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease with critical limb ischemia (CLI) even in patients on haemodialysis (HD) as well as general population, higher amputation and/or mortality rates still remains major clinical problems after bypass surgery in this population. In this 10-year follow-up study, we investigated the impact of HD on outcomes after surgical revascularization in patients with CLI. Method A total of 464 patients undergoing successfully elective bypass surgery were enrolled. We compared 304 HD patients with 335 limbs and 160 non-HD (NHD) patients with 183 limbs during 10 years follow-up period. Primary outcome was amputation-free survival (AFS) rate defined as freedom rate from composited endpoint with major amputation (limb amputation above ankle level) or all-cause mortality. To minimize the differences of clinical characteristics between the two groups, propensity score-matching with all baseline variables was performed. Results Prevalence of diabetes (55.6% vs. 33.8%), ulcer/gangrene (99.1% vs. 63.5%) and infra-popliteal artery disease (58.9% vs. 32.5%) were significantly higher in HD group compared to NHD group (p Conclusion The long-term AFS rate and survival rate were markedly lower in HD patients compared to NHD patients. However, the limb salvage rate was even between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcome. Pre-procedural inflammation status may also specifically affects the poor outcome in HD group.

Background and Aims Although lower extremity revascularization has been commonly performed in chronic haemodialysis (HD) patients with peripheral artery disease (PAD), poorer prognosis still remains major problems in such population. Recently, protein-energy wasting (PEW) or malnutrition have been considered to be strongly associated with chronic inflammation and advanced atherosclerosis in HD patients. We investigated the association of geriatric nutritional risk index (GNRI) as a surrogate marker of the PEW, C-reactive protein (CRP) and these joint role with prediction of amputation and/or mortality after lower extremity revascularization in chronic HD patients. Method We enrolled a total of 862 HD patients (age 67±10 years, diabetes 62.9%, critical limb ischemia 53.5%) who successfully underwent lower extremity revascularization (552 with endovascular therapy and 310 with bypass surgery). Patients were divided into tertiles according to GNRI levels; tertile 1 (T1): 96.6, and CRP levels; T1: 12.6mg/l, respectively. They were followed up for up to 8 years. Results During follow-up period (median: 43 months), 63 (7.3%) patients needed major amputation and 202 (23.4%) patients died. Kaplan-Meier analysis shows that amputation-free survival rates for 8 years were 47.5%, 51.6% and 66.5% in T1, T2 and T3 of GNRI, and were 65.8%, 58.7% and 33.2% in T1, T2 and T3 of CRP, respectively (p Conclusion Among HD patients undergoing lower extremity revascularization, those with pre-procedural declined GNRI and elevated CRP frequently experienced amputation and/or mortality, furthermore, combination of both variables could stratify the risk of amputation and/or mortality.

Electrochemical properties of mixed titanium‐niobium oxide TiNb2O7 (TNO) synthesized via vacuum annealing as high potential anode material for lithium‐ion batteries were investigated. Crystal structure, size, and morphology are nearly independent of the annealing atmosphere for starting materials but the color of vacuum‐annealed TNO (TNO‐V) is dark blue while white for the air‐annealed one (TNO‐A). X‐ray photoelectron spectroscopy analysis also indicated that Ti4+ and Nb5+ in TNO are partially reduced into Ti3+ and Nb4+ due to the introduction of oxygen vacancy. Electronic conductivity for TNO‐V was around 10−3 S cm−1 at room temperature and much higher than that for TNO‐A (=10−11 S cm−1). In electrochemical testing, both TNO‐A and TNO‐V electrodes showed reversible capacity of 260‐270 mAh g−1 at low current density of 0.5 mA cm−2, while at higher current density of 5.0 mA cm−2, TNO‐V electrode retained higher reversible capacity of 140 mAh g−1 than that for TNO‐A electrode (=80 mAh g−1). The enhancement of intrinsic electronic conductivity greatly contributes to improve the rate performance of TNO.

Background It remains controversial whether coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) should be optimized to treat coronary artery disease in patients on chronic hemodialysis (HD). Recently, further refinement of drug-eluting stents, such as the everolimus-eluting stent (EES), has led to marked development in this field. We compared long-term clinical outcomes after CABG versus PCI with EES implantation in patients on chronic HD. Patients and methods We compared 138 patients undergoing CABG and 187 patients treated with EES implantation. The endpoint was major adverse cardiac events (MACE) as a composite outcome, including any revascularization, nonfatal myocardial infarction, or mortality. To reduce the selection bias for the two procedures, propensity score-matching was performed. Results During the follow-up period (43 months), 95 (29.2%) MACEs, including 43 (13.2%) revascularizations, 14 (4.3%) nonfatal myocardial infarctions, and 63 (19.4%) deaths, occurred. The freedom rate from MACE and mortality at 5 years were comparable between groups (69.7 vs. 66.7%, P=0.82 and 75.0 vs. 80.6%, P=0.10, respectively); however, those from revascularization at 5 years was higher in the CABG group than the EES group (89.4 vs. 81.0%, P=0.030). In propensity score-matched patients (n=92), the freedom rate from revascularization at 5 years was still higher in the CABG group than in the EES group (93.4 vs. 79.1%, P=0.013). Similarly, the freedom rates from MACE and mortality were comparable (70.0 vs. 66.3%, P=0.69 and 73.8 vs. 79.7%, P=0.30, respectively). Conclusion Even in the second-generation drug-eluting stent era, CABG is still superior for preventing revascularization in patients on chronic HD. However, PCI with EES implantation might not have disadvantages compared with CABG in terms of MACE.

Aim: To investigate the long-term clinical outcome of endovascular therapy (EVT) or bypass surgery in patients on hemodialysis (HD) with critical limb ischemia due to isolated infrapopliteal disease. Methods: We enrolled 254 consecutive HD patients successfully undergoing infrapopliteal revascularization by EVT (126 patients) and bypass surgery (128 patients). They were followed up for five years. Amputation-free survival (AFS) and incidence of any re-intervention were evaluated. A propensity score from all baseline variables was incorporated into Cox analysis. Results: In the EVT group, age was higher (p = 0.039), diabetes and coronary artery disease were more frequent (p = 0.004 and p = 0.0052, respectively), and tissue loss was more rarely observed (p < 0.0001) than in the bypass group. During the follow-up period, 21 major amputations and 64 deaths occurred. The propensity score-adjusted AFS rate at 5 years was comparable between groups (61.0% in EVT group vs. 55.1% in the bypass group, adjusted hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.52–1.42, p = 0.58). The adjusted survival rates were also similar between groups for amputation and all-cause mortality. However, freedom from any reintervention was markedly lower in the EVT than in the bypass group (48.6% vs. 84.6%, adjusted-HR, 3.56, 95% CI 1.95–6.75, p < 0.0001). Conclusions: The rate of AFS was broadly comparable between the two strategies, although compared with bypass surgery, EVT had much higher rates for re-intervention.

Objectives To investigate the efficacy of drug-coated balloon (DCB) for calcified coronary lesions. Background Calcified coronary lesions is associated with poor clinical outcomes after revascularization. Recently, DCB is emerging as an alternative strategy for de novo coronary lesions. However, reports describing the efficacy of DCB for calcified coronary lesions are limited. Methods A total of 81 patients (96 lesions) who electively underwent DCB treatment for de novo coronary lesions were enrolled: 46 patients (55 lesions) in the calcified group and 35 patients (41 lesions) in the non-calcified group. Angiographic follow-up data and clinical outcomes after the procedure were evaluated. Results The diameter of the DCB used was 2.5 ± 0.5 mm. No bail-out stenting was observed after DCB treatment. Rotational atherectomy was used in 82% of lesions in the calcified group. Follow-up angiography (median, 6.5 months after intervention) was performed for 59 patients (30 in the calcified group and 29 in the non-calcified group). Late lumen loss and rates of restenosis were comparable between the groups (0.03 mm in the calcified group vs -0.18 mm in the non-calcified group, P = 0.093 and 13.9% vs 3.03%, P = 0.095, respectively). The survival rates for target lesion revascularization free survival and major adverse cardiac events at 2 years were comparable between the groups (85.3% vs 93.4%, P = 0.64 and 81.4% vs 88.5%, P = 0.57, respectively). Conclusion Calcified coronary lesions might dilute the effect of DCB. However, clinical outcomes in the calcified group were similar to those in the non-calcified group.

Vogt-Koyanagi-Harada (VKH) disease is an autoimmune disorder affecting melanocytes in the skin, eyes, inner ear, and meninges. The Epstein-Barr virus and cytomegalovirus (CMV) antigen have been hypothesized as possible triggering factors for the disease. Toll-like receptors (TLRs) play an important role in the induction of defense mechanisms of the innate and adaptive immune responses to microbial pathogens. Among TLRs, TLR9 recognizes unmethylated 2'-deoxyribo (cytidine-phosphate guanosine)(CpG) DNA motifs that are frequently present in viruses and plays a central role in the host defense against viral infection. The aim of this study was to investigate whether TLR9 polymorphisms were associated with VKH in a Japanese population.Ninety-four Japanese patients diagnosed with VKH and 125 healthy control subjects were recruited. Five single-nucleotide polymorphisms (SNPs: rs187084, rs5743836, rs352139, rs352140, rs5743845) in the TLR9 gene were genotyped, and allelic and phenotypic diversity was assessed between cases and control subjects.Strong linkage disequilibrium was observed among three SNPs (D'0.99), which were located in one haplotype block. Two SNPs (rs5743836 and rs5743845) were monopolymorphic in both cases and controls. No statistically significant association was observed for any of the SNPs between cases and controls.Three SNPs in the TLR9 gene were not significantly associated with susceptibility to VKH.

Silica coatings were fabricated on stainless steel substrates by electrophoretic deposition (EPD) of aqueous slurries. An cationic surfactant, polyethylenimine (PEI) was used for obtaining positively charged silica particles and coatings on the cathode in order to prevent the anode elution. In addition, in order to prevent formation of cracks in coatings on metal substrates after drying, polyvinyl alcohol (PVA) was added in slurries as a binder. Furthermore, we could obtain crack free coatings after drying by aqueous EPD assisted by sweeping flow.

Staphylococcus aureus surface protein G (SasG) is one of cell surface proteins with cell-wall sorting motif. The sasG mutant showed significantly reduced cell aggregation and biofilm formation. SasG is comprised of variable A domain and multiple tandem repeats of B domain, native-PAGE and in vitro formaldehyde cross-linking experiments revealed that the recombinant protein of the A domain showed homo-oligomerization as an octamer, but B domain did not. This study shows that SasG-A domain contributes to intercellular autoaggregation by homo-oligomerization, and that may facilitate the adherence to host-tissues in the infection of S. aureus.

Purpose To determine the main histological components that affect fractional anisotropy (FA) in postnatal development of the rat corpus callosum and compare FA values with histological changes evaluated quantitatively. Materials and Methods Diffusion tensor image (DTI) data of the rat (postnatal 1–10 weeks) corpus callosum were obtained with a 7.0 T MR scanner. Histological parameters were quantitatively assessed in toluidine blue-stained semithin sections. Simple and multiple linear regression analyses were performed to investigate relationships between FA values and histological variables. Results The mean FA value (mFA) increased significantly in the early growth stages, whereas the change became smaller after postnatal week 4. Simple regression analysis showed a high correlation between the area of myelin sheath and mFA (r = 0.856; P < 0.01). The area of extracellular space correlated negatively with mFA (r = −0.813; P < 0.01). In a forward stepwise analysis, the area of myelin sheath had the strongest influence on mFA (P < 0.001), followed by the number of unmyelinated axons (P = 0.113). Multiple linear regression analysis revealed that both parameters predicted mFA with a highly significant adjusted correlation coefficient (r2 adj. = 0.738, P < 0.001). Conclusion During the early development stage in the rat corpus callosum, the strongest contribution to FA value is the area of myelin sheath. J. Magn. Reson. Imaging 2008;28:847–854. © 2008 Wiley-Liss, Inc.

Staphylococcus aureus lipase (SAL) is known to possess broad substrate specificity for triacylglycerides. We found that a sub-minimum inhibitory concentration of farnesol (1000 mg L(-1)) inhibits this lipase activity on a Mueller-Hinton agar containing 1% Tween substrates. A quantitative lipase assay using p-nitrophenyl palmitate (pNPP) revealed that the inhibitory action of farnesol appears to be the result of the inhibition of lipase activity rather than of its secretion into the culture medium. The inhibition was observed in all the tested 8 methicillin-susceptible S. aureus and 31 methicillin-resistant S. aureus clinical isolates. Using homogeneous lipase purified by hydrophobic interaction chromatography, it was revealed that farnesol could competitively inhibit the lipase activity against the substrate pNPP.

Few reports have characterized auditory processing in monaural listening, which is important for the understanding of auditory brain activity in subjects with hearing loss. We measure regional brain activity in response to monaural audition of 95 dB sound pressure level (SPL) monosyllables using functional magnetic resonance imaging (fMRI) in the 10 subjects with normal hearing and four subjects with unilateral deafness as controls for “cross-hearing”. Images were analyzed by statistical parametric mapping software. In subjects without hearing loss, the stimuli elicited cortical activation in the primary auditory and auditory association regions, particularly contralaterally where extent of activation was approximately 2.5 times the ipsilateral extent. All patients with profound unilateral deafness showed no statistically apparent response in the primary auditory and auditory association regions, ruling out an important influence from cross-hearing. We found fMRI to be a useful technique for analysis of auditory processing that should be applicable to patients with various hearing abnormalities.

To characterize brain activity in response to auditory stimuli during recovery from acute hearing loss, fMRI was performed at two time points in 11 patients with sudden deafness in the right ear, and 10 subjects with normal hearing. In the acute phase, right-ear auditory stimulation induced only a small response in the auditory cortex, limited to the left hemisphere. In the recovery phase, the auditory response was more extensive than in the acute phase. Stimulation of the left ear induced a more extensive response in the left than right hemisphere in both acute and recovery phases, which differed from the pattern in normal subjects. The changes in cortical activation patterns were seen within 1 week of sudden deafness. Thus, alteration of cortical response in deafness occurs earlier than suggested by previous reports.

We performed functional magnetic resonance imaging to identify the neural processing regions in the parieto-occipital cortices for human dynamic and static stereopsis. The subjects were ten ophthalmologists professionally trained to do microscopic surgery. Visual stimuli for dynamic or static stereopsis were performed with solid stereograms displayed in the image guides of a binocular visual stimulation device that we developed. The dorsal occipital portion and the superior parietal lobule (i.e. dorsal parieto-occipital portion) were activated not only in static stereopsis, but also in dynamic stereopsis. The activation showed a right hemispherical dominancy. On the other hand, the temporo-occipital junction (i.e. human MT (middle temporal area) / MST (medial superior temporal area) complex) was activated in dynamic stereopsis. This demonstrates that the dorsal parieto-occipital portion is a common neural processing region for dynamic and static stereopsis.

To investigate cross-projection of pure tone stimulation, optimal stimulation level and cross-talk effect, we examined the auditory processing of monaural pure-tone stimuli using functional magnetic resonance imaging (fMRI). We examined fMRI responses to monaural pure tones (1 kHz, 95 or 115 dB SPL) in 11 subjects with normal hearing and 4 patients with with profound unilateral deafness. Group analysis showed bilateral cortical activation in primary auditory and auditory association regions at 115 dB SPL. The activation was strong and mostly contralateral. At 95 dB SPl, only 2 of 11 subjects showed weak cortical activation. No activated area in the auditory cortex was observed in subjects with profound unilateral deafness in response to monaural stimulation of the deaf ear. The results supported the cross-projection of pure tone stimulation. Pure tone with 115 dB SPL was needed to obtain intense and stable activation without cross-talk using conventional boxcar model.

Diffusion-tensor MR imaging is a promising tool to evaluate white-matter integrity by quantitative and graphic maps including neural fiber tractogram. Current challenges afoot are to obtain higher quality diffusion-weighted MR images (high SNR, isotropic voxel, and high spatial resolution), to create a robust mathematical framework to process the data, to construct a user-friendly computer-based algorithm, to reveal determinants of diffusion process, and to establish analytical methodology.

Functional magnetic resonance imaging (fMRI) makes it possible to detect regions of neuronal activity in the brain. Moreover, this examination is quite non-invasive. Although fMRI is popularly employed in ophthalmology, it is sometimes impossible to give optimal visual stimulation to the subject because the space inside the MRI equipment is very small and has a strong magnetic field. Thus, there are strict limitations on visual stimulation devices. In order to resolve these problems, we developed a new binocular visual stimulation device for fMRI using image guides. This device consists of a pair of image guides, LCD projectors, C-mounted objective lenses, and eyepieces. The image guides and the eyepieces are diamagnetic. They can be attached to the surface or head coil unit of the MRI equipment without any magnetic influence on the fMRI signals. Since the images in both eyepieces are completely separated, binocular parallax stimulation can easily be given to a subject. This makes it possible to investiga...

The newly developed Ihara's genetically epileptic rat (IGER) is thought to be a useful tool for studying epilepsy of the limbic type. Morphological changes in the hip-pocampus, which is one of the characteristic findings in the brains of patients with temporal lobe epilepsy, were presumed to occur also in IGER during the course of epileptic activities. We investigated chronological changes in volume of the IGER hippocampal formation using mag-netic resonance (MR) imaging. The experiment consisted of two protocols. First, MR imaging was performed for volumetric measurement of the cerebrum and the hippocampus in four male IGER, each at 2, 4, 6, 8, 10 and 12 months of age. After MR examination, the brains were subjected to histological and morphometric examinations. Second, changes in the hippocampal volume were traced chronologically in three IGER at the ages of 2, 4, 6, 8 and 10 months. Age-matched Wistar rats were used as controls. In IGER, the volume of the cerebrum, especially of the hippocampus, and the ratio of the hippocampal to the cerebral volume increased, in concert with the increase in seizure activities. Histological and morphometric invest-igations revealed that there was mild astrogliosis and marked microgliosis with hypertrophic change in the hippocampal formation with aging, but no loss of neurons was observed. Neither an increase in volume nor gliosis was found in the brains of control rats. The enlargement of the hippocampal formation in IGER brains was assumed to be partially due to gliosis of astrocyte and microglia with hypertrophy.

Medical terms consist of regular language or artificial words combined with adverbs of nouns to allow professional use. To examine the approaches taken to treat specific medical terms over the last 150 years, nine points were discussed: 1) development of medical dictionaries, 2) letters and characheristics, 3) expression of terms, 4) word formation, 5) approach to international information systems with a tree structure, 6) homonyms, 7) international compatibility of languages and terms, 8) new trends, 9) examples showing current features. As a result, four stages in the treatment of a medical term were proposed: 1) translation from foreign languages, 2) standardization of expression of terms, 3) participation in international communication systems, 4) comprehensive treatment of compatibility with different countries and academic fields.

Radiation-induced white matter injury has recently been evaluated by fractional anisotropy (FA) values using diffusion tensor image (DTI) data on magnetic resonance (MR) imaging. However, controversy remains as to which histological components affect anisotropy. FA values were compared with histological findings in rat irradiated brains. Forty Gy whole brain radiation was performed on 9 rats, with another 9 rats not subjected to irradiation prepared as the control group. DTI data for the corpus callosum were obtained using a 7.0 Tesla MR scanner at post radiation 18+2 to 48 +/- 2 weeks (p18w-p48w), and the mean FA value (mFA) was calculated. Histological parameters were assessed at p24w, p36w, and p48w in hematoxylin-eosin stained and immunohistochemically processed sections. Numbers of dilated vessels, hypertrophic glial fibrillary acidic protein (GFAP)-positive cells and Olig2-positive cells were quantitatively evaluated. Qualitative assessment of change in neurofilament (NF)-and myelin basic protein (MBP)-positive structures at each time point was also performed. The mFA decreased from p30w to p42w, significantly decreasing at p42w compared to the control group. However, It recovered to control levels at p48w. Histological examination showed that hypertrophic GFAP-positive cells and dilated vessels had increased at p48w. Olig2-positive cells decreased significantly at p48w compared to p24w and p36w (p0.05). Although NF-positive structures continued to decrease over time, MBP-positive structures recovered at p48w in agreement with the change in mFA. In the subacute/chronic stage, rat irradiated brain FA value in the corpus callosum appears to mainly reflect the change in myelin structure.

Local Nusselt number distributions for a square array of round air jets impinging on a flat surface and a concave surface were measured in high resolution by naphthalene sublimation techniques. Corresponding numerical simulations using a realizable k-e model were also conducted to investigate the heat transfer characteristics of the multiple jets and to clarify the complex flow structure. The experiments were conducted for Re = 5000, 10000, and 15000 at the non-dimensional nozzle to plate distance of 3.75. The Nusselt number for both flat and concave surfaces increased as Reynolds number increased from 5000 to 10000. Unexpectedly, experimental results showed the tendency of Nu to be saturated for Re = 15000, while showing a monotonic increase in numerical simulations. Most amount of wall jets from a central impinging jet formed large-scale recirculating flows, which surrounded free jet region of each jet, while some other wall jet were entrained by a small vortical structure near the target wall and merged into large-scale recirculating flow of the neighboring jets.Copyright © 2007 by ASME

We report a case of metastatic adenocarcinoma to the brain that appeared as a homogeneously hyperdense mass on CT. The lesion was initially diagnosed as an intracerebral hematoma. On serial CT scans, the high density lesion progressively enlarged. Pathology showed coagulation necrosis without hemorrhage or calcification. Analysis of the tumor revealed elevation of the protein content relative to the normal brain. We conclude that the high CT attenuation was due to the elevated protein content.