Search

Abstract Aim To identify the most useful tissue perfusion parameter for initial resuscitation in sepsis/septic shock adults using a network meta‐analysis. Methods We searched major databases until December 2022 for randomized trials comparing four tissue perfusion parameters or against usual care. The primary outcome was short‐term mortality up to 90 days. The Confidence in Network Meta‐Analysis web application was used to assess the quality of evidence. Results Seventeen trials were identified. Lactate‐guided therapy (risk ratios, 0.59; 95% confidence intervals [0.45–0.76]; high certainty) and capillary refill time‐guided therapy (risk ratios, 0.53; 95% confidence intervals [0.33–0.86]; high certainty) were significantly associated with lower short‐term mortality compared with usual care, whereas central venous oxygen saturation‐guided therapy (risk ratio, 1.50; 95% confidence intervals [1.16–1.94]; moderate certainty) increased the risk of short‐term mortality compared with lactate‐guided therapy. Conclusions Lactate or capillary refill time‐guided initial resuscitation for sepsis/septic shock patients may decrease short‐term mortality. More research is essential to personalize and optimize treatment strategies for septic shock resuscitation.

Disseminated intravascular coagulation (DIC) is a systemic life-threatening process that can cause thrombosis and hemorrhage. Chronic DIC has been associated with aortic aneurysm/dissection. Aortic aneurysm/dissection should be included in the differential diagnosis of elderly patients with hemorrhagic diathesis due to DIC of uncertain etiology. Treatment depends on various factors, including the severity of underlying disease, extent of DIC, and patient comorbidities, as well as the ability of the patient to maintain activities of daily living once discharged from the hospital. This report describes the clinical characteristics of four elderly patients with chronic DIC associated with aortic aneurysm/dissection who were treated in our institution. We also offer the recommendations around most appropriate nonsurgical treatment of these patients.

A previously healthy 74-year-old Japanese female was hospitalized with fever and high C-reactive protein. She developed palatal herpangina-like aphthous ulcers, localized intestinal wall thickening, terminal ileum ulcers, and an erythematous acneiform rash; thus Behçet’s disease-like illness was suspected. Significant peripheral blood acute monocytosis developed during her hospitalization and acute monocytic leukemia (FAB M5b) with normal karyotype was diagnosed. By immunostaining, the infiltrating cells in the skin and the terminal ileum were identified as monocytic leukemic cells. This case exhibited a unique initial presentation of Behçet’s disease-like illness associated with acute monocytic leukemia.

Autonomous experiments for material synthesis have been developing with increasing speed. With the expanding search space for accessible materials, the efficient collection of prior knowledge, particularly synthesis conditions, before autonomous experiments is crucial in reducing the number of trials. In this study, we developed a workflow that systematically extracts synthesis conditions from scientific literature. We constructed a knowledge graph to test the simple hypothesis that significant correlations exist between the physical properties and synthesis conditions that appear nearby in a text. The performance of this scheme was demonstrated by extracting the appropriate thin-film synthesis conditions for conductive Nb-doped TiO2. The proposed methodology is expected to accelerate autonomous material synthesis experiments.

Compared to the optimization of a 1D synthesis parameter in materials synthesis, the optimization of multi-dimensional synthesis parameters is challenging for researchers. Bayesian optimization (BO) has shown high performance in optimizing high-dimensional synthesis parameters when appropriate hyperparameters are adopted. However, hyperparameter tuning for the kernel and acquisition functions used in BO is yet to be fully discussed by material researchers. In this study, we simulated materials synthesis under 2D and 3D synthesis conditions using artificial model functions with different process windows to investigate the effects of hyperparameters. The assumed parameters were temperature, oxygen partial pressure, and the sputtering power for thin-film deposition. Our findings indicate that estimating the process window and the range of physical property change based on the experience and knowledge of the materials researcher is crucial for tuning the hyperparameters of the kernel function. The simulations for high-dimensional search spaces case also indicate that the number of trials for optimization of synthesis conditions might reach several hundred or more. Therefore, the dimensionality and range of the search space must be limited based on the number of practical experiments, which is crucial for applying Bayesian optimization to materials synthesis. Our results facilitate fully automated and autonomous materials synthesis using BO and robotics for materials exploration in a high-dimensional search space.

Materials exploration requires the optimization of a multidimensional space including the chemical composition and synthesis parameters such as temperature and pressure. Bayesian optimization has attracted attention as a method for efficient multidimensional optimization. Appropriate choices of the acquisition function and initial values of the hyperparameters of the kernel functions are essential for the Bayesian optimization of synthesis conditions in a small number of experiments. However, to date, there has been little discussion on how to tune Bayesian optimization for materials exploration, and no guidelines have been provided for materials scientists. In this study, we investigated the optimum initial values of the hyperparameters in Bayesian optimization using one-dimensional model functions that mimic actual materials syntheses. The optimal lengthscale and variance for different process windows of materials synthesis were investigated. It was shown that the use of an appropriate acquisition function and suitable initial values of the hyperparameters of the kernel functions enable the optimization of synthesis conditions in a small number of trials. These results provide insight for enabling fully automated and autonomous materials synthesis using Bayesian optimization and robotics for materials exploration.

Background: Hemolytic features in patients with pernicious anemia have not been emphasized. Methods: Seven Japanese patients at 60 - 88 years of age with vitamin B12 deficiency-related hemolytic anemia were assessed. Results: Serum vitamin B12 levels in these cases were 46 - 89 pg/mL (normal reference range: 233 - 914 pg/mL). Clinically, the patients presented with thrombotic microangiopathy (TMA)-like hemolytic features (including macrocytic anemia, schistocytes on blood smears, high serum lactate dehydrogenase, hyperbilirubinemia, and low serum haptoglobin). Six cases had type A gastritis (assessed by esophagogastroduodenoscopy with hypergastrinemia) with additional laboratory data of high plasma homocysteine levels and anti-intrinsic factor/anti-parietal cell antibodies. One case was in post-gastrectomy condition. Following treatment with vitamin B12, anemia resolved within 4 weeks in five of the seven cases except for two cases of delayed response. Conclusions: In elderly patients exhibiting hemolytic features in association with macrocytic anemia, vitamin B12 deficiency should be considered in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Abstract Background Ileus is quite a common disease, but is associated with various causes. As far as we know, there have only been one case of ileus due to inverted bladder diverticulum, which is extremely rare. Case presentation The patient was a 53-year-old male. He made an emergency visit to our hospital with a chief complaint of left lower quadrant pain. He underwent right inguinal hernia surgery at 2 years of age with no history of laparotomy. An abdominal enhanced CT revealed inversion of the bladder left side wall where part of enlarged small intestine was found. Ascites were also found between the incarcerated small intestine and the bladder, leading to a diagnosis of strangulation ileus due to internal hernia and subsequent emergency surgery. A laparotomy revealed incarceration of the small intestine in the bladder left wall as a Richter type. The incarceration was rigid. We believed it would be difficult to pull out by extraction. Therefore, we inserted a Nelaton catheter between the incarcerated small intestine and the bladder and carried out the water pressure method to release the ileus. We did not perform an enterectomy since no manifest necrosis or perforation of the small intestine was found. The inverted bladder wall was a partial depression. We interpreted it to be a bladder diverticulum. We made a suture for occlusion with the bladder diverticulum inverted. Ileus arising from inverted bladder diverticulum is a very rare disease state. We hereinafter report on this case along with bibliographical considerations. Conclusions We experienced a case of small intestine ileus due to inverted bladder diverticulum, which is very rare. In terms of preservation of the bowel, we believed the water pressure method to release the ileus was useful.

Epidemiologic studies have revealed that consuming green tea or coffee reduces diabetes risk. We evaluated the effects of the combined consumption of green tea catechins and coffee chlorogenic acids (GTC+CCA) on postprandial glucose, the insulin incretin response, and insulin sensitivity. Eleven healthy men were recruited for this randomized, double-blinded, placebo-controlled crossover trial. The participants consumed a GTC+CCA-enriched beverage (620 mg GTC, 373 mg CCA, and 119 mg caffeine/day) for three weeks; the placebo beverages (PLA) contained no GTC or CCA (PLA: 0 mg GTC, 0 mg CCA, and 119 mg caffeine/day). Postprandial glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) responses were measured at baseline and after treatments. GTC+CCA consumption for three weeks showed a significant treatment-by-time interaction on glucose changes after the ingestion of high-fat and high-carbohydrate meals, however, it did not affect fasting glucose levels. Insulin sensitivity was enhanced by GCT+CCA compared with PLA. GTC+CCA consumption resulted in a significant increase in postprandial GLP-1 and a decrease in GIP compared to PLA. Consuming a combination of GTC and CCA for three weeks significantly improved postprandial glycemic control, GLP-1 response, and postprandial insulin sensitivity in healthy individuals and may be effective in preventing diabetes.

Future materials-science research will involve autonomous synthesis and characterization, requiring an approach that combines machine learning, robotics, and big data. In this paper, we highlight our recent experiments in autonomous synthesis and resistance minimization of Nb-doped TiO2 thin films. Combining Bayesian optimization with robotics, these experiments illustrate how the required speed and volume of future big-data collection in materials science will be achieved and demonstrate the tremendous potential of this combined approach. We briefly discuss the outlook and significance of these results and advances.

Abstract Background To determine whether prebiopsy multiparametric magnetic resonance imaging (mpMRI) with subsequent systematic plus targeted biopsies for suspicious lesions improve prostate cancer detection compared with standard non-targeting systematic biopsies without mpMRI in biopsy-naïve patients. Methods Patients who underwent their first prostate biopsy due to suspicion of prostate cancer were analyzed retrospectively to compare the biopsy outcomes between patients who received prebiopsy mpMRI (215 patients) and those who did not (281 patients). mpMRI was performed to determine pre-biopsy likelihood of the presence of prostate cancer using a three-point scale (1 = low level of suspicion, 2 = equivocal, and 3 = high level of suspicion). Systematic biopsies were performed in both groups. Targeted biopsies were added for a high level of suspicious lesions on mpMRI. All biopsies were performed by transperineal biopsy technique. After biopsy, Prostate Imaging Reporting and Data System ver. 2 (PIRADS-2) scoring was performed to describe the mpMRI findings and predictive value of PIRADS-2 was evaluated. Results The detection rate of total and clinically significant prostate cancer was significantly higher in patients who received prebiopsy mpMRI than in those who did not (55.3 and 46.0% vs. 42.0 and 35.2%, respectively; p = 0.004 and p = 0.016). The clinically insignificant prostate cancer detection rate was similar between the two groups (9.3% vs. 6.8%; p = 0.32). Of 86 patients who underwent systematic plus targeted biopsy in the MRI cohort and were diagnosed with prostate cancer, seven patients were detected by addition of targeted biopsy whereas 29 patients were missed by targeted biopsy but detected by systematic biopsy. There was a correlation between the PIRADS-2 and prostate cancer detection rate, and a receiver-operator curve analysis yielded an area under the curve of 0.801 (p

Here, we report on the design and performance of a silicon photonic micro-transceiver required to operate in 5G and 6G environments at high ambient temperatures above 105 °C. The four-channel “IOCore” micro-transceiver incorporates a 1310 nm quantum dot laser system and operates at a data rate of 25 Gbps and higher. The 5 × 5 mm micro-transceiver chip benefits from a multimode coupling interface for low-cost assembly and robust connectivity at high temperatures as well as an optical redundancy scheme, which increases reliability by over an order of magnitude.

We report the pulsed laser deposition (PLD) of anatase TiO2, LaAlO3, and La0.7Ca0.3MnO3 epitaxial thin films by a fifth-harmonic Nd:Y3Al5O12 (Nd:YAG) laser. High-quality anatase Ti0.996Nb0.004O2 epitaxial thin films were deposited and showed transparent conducting properties, with a maximum mobility of 94 cm2V−1s−1 at 80 K. These results are consistent with those obtained for films deposited by excimer lasers. Furthermore, we report the deposition of droplet-free flat LaAlO3 and La0.7Ca0.3MnO3 films. The latter films exhibited an insulator-to-metal transition at ∼240 K, accompanied by a large magnetoresistive effect, in agreement with previous studies using excimer lasers. These results indicate that the fifth harmonic of a Nd:YAG laser may be a potential alternative to excimer lasers for PLD.

Chlorogenic acids (CGAs) reduce blood pressure and body fat, and enhance fat metabolism. In roasted coffee, CGAs exist together with the oxidant component hydroxyhydroquinone (HHQ). HHQ counteracts the antihypertensive effects of CGA, but its effects on CGA-induced fat oxidation (FOX) are unknown. Here we assessed the effects of CGA-enriched and HHQ-reduced coffee on FOX. Fifteen healthy male volunteers (age: 38 ± 8 years (mean ± SD); BMI: 22.4 ± 1.5 kg/m2) participated in this crossover study. Subjects consumed the test beverage (coffee) containing the same amount of CGA with HHQ (CGA-HHQ(+)) or without HHQ (CGA-HHQ(−)) for four weeks. Postprandial FOX and the ratio of the biological antioxidant potential (BAP) to the derivatives of reactive oxygen metabolites (d-ROMs) as an indicator of oxidative stress were assessed. After the four-week intervention, postprandial FOX and the postprandial BAP/d-ROMs ratio were significantly higher in the CGA-HHQ(−) group compared with the CGA-HHQ(+) group (4 ± 23 mg/min, group effect: p = 0.040; 0.27 ± 0.74, group effect: p = 0.007, respectively). In conclusion, reducing the amount of HHQ facilitated the postprandial FOX effects of CGA in coffee. Our findings also suggest that the mechanism underlying the inhibition of FOX by HHQ is related to postprandial oxidative stress.

The patient was a 74-year-old man suffering from tuberculotic chronic pyothorax. He had hematemesis in January 2006. Hb was 6.1 g/dl. A type 2 tumor 3 cm in diameter was found in the vaulted region on the greater curvature side. It was diagnosed as a malignant lymphoma. WBC and differential count were normal, and the patient tested negative for HTVL-1 antibody. sIL2-R was elevated to 1,500 U/ml. The superficial lymph nodes were not palpable. CT examination was not remarkable for the liver and spleen. There was no generalized lymph node enlargement. Based on these findings, a diagnosis of malignant lymphoma of gastric origin was made. As the patient had respiratory disorders, too, wedge-shaped gastrectomy was performed to inhibit invasion. Pathological examination revealed CD3 positive large atypical lymphocytes diffusely, EBV positive, HP negative. As a result, a diagnosis of non-Hodgkin T-cell lymphoma was made. The tumor did not return for 1 year and 8 months after surgery, but the patient died of sudden aggravation of respiratory disorders in September 2007. Pathological anatomy was performed. The gastric remnant was left with lymphoma, and the bone marrow and systemic lymph nodes were negative for a malignant lymphoma. The possibility of stomach metastasis from the preoperative pyothorax-related malignant lymphoma was considered, but was ruled out because the lungs were devoid of a malignant lymphoma. We report a case of an extremely rare malignant T-cell lymphoma of gastric origin.

Treatment for haemangioma of the spinal cord often results in extensive bony resection that necessitates fusion and/or instrumentation. We report on a 75-year-old man who presented with neuropathic pain and muscle weakness of both lower limbs, secondary to an epidural haemangioma at T11–T12, extending laterally into the neuroforamen. The tumour was resected within the neuroforamen after a partial laminectomy and limited medial foraminotomy at T11–T12, without disruption of the osseous continuity of the pars interarticularis, avoiding spinal stabilisation surgery.