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Abstract Venus, lacking an intrinsic global dipole magnetic field, serves as a textbook example of an induced magnetosphere, formed by interplanetary magnetic fields (IMF) enveloping the planet. Yet, various aspects of its magnetospheric dynamics and planetary ion outflows are complex and not well understood. Here we analyze plasma and magnetic field data acquired during the fourth Venus flyby of the Parker Solar Probe (PSP) mission and show evidence for closed topology in the nightside and downstream portion of the Venus magnetosphere (i.e., the magnetotail). The formation of the closed topology involves magnetic reconnection—a process rarely observed at non-magnetized planets. In addition, our study provides an evidence linking the cold Venusian ion flow in the magnetotail directly to magnetic connectivity to the ionosphere, akin to observations at Mars. These findings not only help the understanding of the complex ion flow patterns at Venus but also suggest that magnetic topology is one piece of key information for resolving ion escape mechanisms and thus the atmospheric evolution across various planetary environments and exoplanets.

A preschool male patient with an extensive cardiac surgical history developed refractory chylothorax after a total cavopulmonary connection. Neither lymphoscintigraphy nor single-photon emission computed tomography (SPECT)/computed tomography could identify the lymphatic system leakage sites. Non-contrast heavy T2-weighted magnetic resonance lymphangiography (MRL) was performed to visualize the lymphatic system. Nevertheless, distinguishing lymphatic ducts from other watery structures of the patient remained difficult. Therefore, non-contrast MRL and SPECT images were fused. This hybrid diagnostic tool elucidated the pathophysiology of the prolonged chylothorax; pulmonary lymphatic perfusion syndrome and illustrated the anatomical connection of the thoracic duct and an abnormally dilated lymphatic network in the neck and left hilar regions. Subsequent intranodal lymphangiography with ethiodized oil confirmed these findings. SPECT/MRL may become an alternative modality for revealing the mechanism of prolonged chylothorax by visualizing the lymphatic system when dynamic contrast-enhanced magnetic resonance lymphangiography is unavailable.

Summary: Many studies have evaluated the economic feasibility of 100% renewable power systems using the optimization approach, but the mechanisms determining the results remain unclear, making this issue still debatable. This study presents a mathematical formulation of the mechanism that only the demand and power generation profiles determine the optimal capacities of generation and storage and their trade-off relationship. Furthermore, this study demonstrates the comprehensive quantification of the corresponding relationships among the factor cost of technologies, their optimal capacities, and total system cost. Based on these findings, the study also shows that hybrid systems comprising multiple renewable energy sources and different types of storage, including long-duration energy storage, are critical to reducing the total system cost by using actual profile data for multiple years and regions in Japan. This suggests that large-scale deployment of current-level power-to-gas technologies, such as water electrolysis, can contribute to the economics of 100% renewable power systems.

Abstract The left inferior phrenic vein (LIPV) is a major drainage vessel of gastric varices and serves as an important conduit in endovascular treatment for gastric varices. The narrowing of LIPV has been empirically demonstrated and sometimes hinders catheter insertion for the treatment of gastric varices. We herein investigated the morphology of narrowed LIPV in patients with portal hypertension. Venograms of LIPV on 25 patients with gastric varices (15 males; 10 females; age range, 45–79 years with a mean of 67 years) were retrospectively reviewed, the following four parameters were measured: the diameter of LIPV, the diameter of narrowed LIPV, the narrowing rate, and the distance to narrowed LIPV from the left renal vein. On all 25 venograms, a narrowing was detected just above the common trunk with the left adrenal vein. The diameter of LIPV was 9.0 ± 4.2 mm, the diameter of narrowed LIPV was 5.1 ± 2.3 mm, the narrowing rate was 40.6 ± 16.0%, and the distance to narrowed LIPV from the left renal vein was 20.0 ± 7.4 mm. This anatomical information about the narrowing of LIPV may contribute to the safe and efficacious treatment of gastric varices.

Objective Ascites in patients with decompensated cirrhosis can lead to abdominal distention and decrease quality of life. Tolvaptan, a vasopressin V2 receptor antagonist, is an effective agent in the treatment of ascites, whereas some patients are refractory to tolvaptan. The efficacy of transjugular intrahepatic portosystemic shunt (TIPS) for these patients is not known. In this study, we performed TIPS for tolvaptan-refractory cirrhotic patients and analysed its efficacy and safety in these patients.Design This retrospective analysis included patients with liver cirrhosis who received TIPS for ascites or hydrothorax refractory to tolvaptan therapy along with conventional diuretics between January 2015 and May 2018 at Tokai University Hospital. We evaluated the efficacy and safety of TIPS.Results This study included four patients. All patients presented with Child-Pugh class B liver cirrhosis and model for end-stage liver disease-sodium scores were 10/12/14/16. TIPS was generated successfully without any major complications in all patients. The body weight decreased by a mean of 4.7 (SD=1.0) kg and estimated glomerular filtration rate improved from a mean of 38.2 (SD=10.3) to 59.5 (SD=25.0) mL/min/1.73 m2 in a month after TIPS procedure.Conclusion TIPS is an effective potential treatment for ascites in patients with tolvaptan refractory condition. In appropriate patients who can tolerate TIPS, the treatment may lead towards renal function improvement.

Ion pickup by the solar wind is ubiquitous in space plasma. Because pickup ions are originally produced by ionization of an exospheric neutral atmosphere, their measurements contain information on the exospheric neutral abundance. Here we established a method to retrieve exospheric number densities, by analyzing the ion velocity distribution functions of pickup ions measured by the Mars Atmosphere and Volatile EvolutioN spacecraft. We successfully retrieved exospheric oxygen density distributions at altitudes ranging from 1000 to 10,000 km around Mars except for the vicinity of the bow shock. This method can be applied to other space missions to study the upper atmosphere of planets, moons, and other small bodies in our solar system, where pickup ions exist.

Rising global greenhouse gas emissions from the transport sector pose a major challenge to meeting the targets of the Paris Agreement. This raises questions of how technology, infrastructure and societal trends and policies can influence transport demand and thus also emissions, energy demand and service levels. Here, we review the literature on factors relevant to shifting total transport activity and mode shares, categorised into exogenous drivers, socio-behavioural, infrastructural and technological aspects. For each factor, we summarise current approaches to modelling and measuring the impact of each factor on transport systems, resulting in a proposed taxonomy to classify transport demand modelling approaches. We then comment on the suitability and sufficiency of existing modelling approaches for representing scenarios consistent with the Paris Agreement targets in models of the entire global energy system. Factors that affect transport demand are currently insufficiently represented in integrated assessment modelling approaches and thus emission reduction pathways. Improving the comprehension and representation of diverse factors that affect transport demand in global energy systems models, by incorporating features of complementary models with high resolution representations of transport, holds promise for generating well informed policy recommendations. Accordingly, policies could influence the development of the factors themselves and their potential role in mitigating climate change.

Abstract Japan Aerospace Exploration Agency (JAXA) plans a Phobos sample return mission (MMX: Martian Moons eXploration). In this study, we review the related works on the past climate of Mars, its evolution, and the present climate and weather to describe the scientific goals and strategies of the MMX mission regarding the evolution of the Martian surface environment. The MMX spacecraft will retrieve and return a sample of Phobos regolith back to Earth in 2029. Mars ejecta are expected to be accumulated on the surface of Phobos without being much shocked. Samples from Phobos probably contain all types of Martian rock from sedimentary to igneous covering all geological eras if ejecta from Mars could be accumulated on the Phobos surface. Therefore, the history of the surface environment of Mars can be restored by analyzing the returned samples. Remote sensing of the Martian atmosphere and monitoring ions escaping to space while the spacecraft is orbiting Mars in the equatorial orbit are also planned. The camera with multi-wavelength filters and the infrared spectrometer onboard the spacecraft can monitor rapid transport processes of water vapor, dust, ice clouds, and other species, which could not be traced by the previous satellites on the sun-synchronous polar orbit. Such time-resolved pictures of the atmospheric phenomena should be an important clue to understand both the processes of water exchange between the surface/underground reservoirs and the atmosphere and the drivers of efficient material transport to the upper atmosphere. The mass spectrometer with unprecedented mass resolution can observe ions escaping to space and monitor the atmospheric escape which has made the past Mars to evolve towards the cold and dry surface environment we know today. Together with the above two instruments, it can potentially reveal what kinds of atmospheric events can transport tracers (e.g., H2O) upward and enhance the atmospheric escape. Graphical Abstract

Abstract How Epstein–Barr virus (EBV)‐positive diffuse large B‐cell lymphoma (DLBCL) occasionally occurs following chronic inflammation remains to be elucidated. The case of a 57‐year‐old man who developed pulmonary EBV‐positive DLBCL from underlying silicosis lesions is presented. Immunohistochemical examination of the resected silicosis lesions showed predominant helper T cells and M1/M2 macrophages, with a lack of B cells, regulatory T cells, and resident memory T cells. Two years later, EBV‐positive DLBCL emerged unexpectedly from the silicosis. The imbalance of the immune cells in the microenvironment, at least in part, may help explain how chronic inflammation contributes to EBV‐positive DLBCL.

Spin–orbit torques (SOTs) induced magnetization switching in a perpendicularly magnetized CoFeB film deposited on a Ti/in-plane magnetized Co2MnAl stack was investigated. Deterministic switching of the CoFeB magnetization was demonstrated by applying a current pulse to the stack in a direction parallel or antiparallel to the Co2MnAl magnetization. We found that the hysteresis loops of the anomalous Hall resistance for CoFeB under the constant current is shifted in the out-of-plane magnetic field axis direction depending on the directions of both the applied current and the magnetization of Co2MnAl. The shift amount exhibits an almost linear increase as the current magnitude increases. These results are consistent with the effects caused by SOTs originating from spin currents having an in-plane polarization orthogonal to the Co2MnAl magnetization.

Abstract Purpose To evaluate the clinical outcome of ultraselective transcatheter arterial embolization (TAE) with small-sized microcoils for acute lower gastrointestinal bleeding (LGIB). Materials and methods The subjects were 17 consecutive patients (mean age, 69 years) with LGIB who were treated with ultraselective TAE using small-sized microcoils between December 2013 and December 2019. Ultraselective TAE was defined as embolization of one or both of the long or short branches of the vasa recta. The etiologies of bleeding were colonic diverticulosis in 16 patients (94%) and malignancy in one patient (6%). The bleeding foci were in the ascending colon in 11 patients (65%), transverse colon in 2 patients (12%), and sigmoid colon in 4 patients (23%). A total of 18 branches (diameter: range 0.5–1.5 mm, mean 1.1 mm) of the vasa recta in 17 patients were embolized with small-sized microcoils (size range 1–3 mm, mean combined lengths of all microcoils 7.6 cm). The mean follow-up period was 19 months (range 1–80 months). The technical and clinical success rate, recurrent bleeding rate, major complications and long-term clinical outcomes were retrospectively evaluated. Results Technical and clinical success was achieved in all patients (17/17). The rates of early recurrent bleeding (within 30 days of TAE) and major complications were 0% (0/17). Recurrent bleeding occurred in one patient at 2 months after TAE, but was stopped with conservative treatment. There were no other bleeding episodes or complications in the follow-up period. Conclusion Ultraselective TAE with small-sized microcoils is a highly effective and safe treatment modality for LGIB.

The vertical activity concentration distributions of the radium isotopes, 226Ra and 228Ra, which are useful as radiotracers, were obtained for the first time in the western Subarctic Pacific Gyre (WSAG). It was possible to detect short-lived 228Ra present from the surface to 400 m depth by analyzing large seawater samples. Low 228Ra and high 226Ra activity concentrations in the surface layer in the WSAG were strongly influenced by upwelled deeper water with nutrients. The activity concentration distribution of 226Ra especially was in good agreement with the silicate concentration distribution, which was consistent with previous reported findings. These distributions were uniform from the surface to 100 m of the dichothermal layer due to vertical mixing in winter. 228Ra activity concentration decreased with water depth below the pycnocline and reached the undetectable level at 600 m which was within the oxygen minimum layer. Estimations of vertical fluxes of 228Ra and nitrate according to 228Ra decay indicated that the vertical transport by eddy diffusion was a minor process for the 228Ra and nitrate fluxes, and lateral transport mainly affected 228Ra in the intermediate warm water, that is, the mesothermal layer below the main pycnocline. Vertical mixing or submarine underground water and lateral transport to the WSAG could yield this 228Ra in the intermediate depth.

Anomalous retro-psoas artery is an extremely rare congenital anomaly of the iliac arteries reported in the English-language literature. Using contrast-enhanced computed tomography, we incidentally diagnosed an anomalous retro-psoas artery in a 60-year-old male patient with right renal cancer. Although anomalous retro-psoas artery is extremely rare and mostly asymptomatic, knowledge of it is needed to avoid severe vascular complications in the event of vascular intervention and surgery.

In this work, laser-heated electrospinning (LES) process using carbon dioxide laser was explored as an eco-friendly method for producing ultrafine fibers. To enhance the thinning of fibers and the formation of fiber structure, planar or equibiaxial stretching and subsequent annealing processes were applied to poly(ethylene terephthalate) (PET) fiber webs prepared by LES. The structure and properties of the obtained webs were investigated. Ultrafine fiber webs with an average diameter of approximately 1 μm and a coefficient of variation of 20–25% were obtained when the stretch ratios in the MD (machine direction) × TD (transverse direction) were 3 × 1 and 3 × 3 for the planar and equibiaxial stretching, respectively. In the wide-angle X-ray diffraction analysis of the web samples, preferential orientation of crystalline c-axis were confirmed along the MD for planar stretching and only along the web plane for equibiaxial stretching, which was in contrast to the stretching of film samples, where additional preferential orientation of benzene ring along the film plane proceeded. The results obtained suggest that PET fiber webs fabricated through LES and subsequent planar or biaxial stretching processes have potential for a wide variety of applications, such as packaging and battery separator materials.

Melt-electrospinning is an eco-friendly method for producing ultra-fine fibers without using any solvent. We prepared webs of poly(ethylene terephthalate) (PET) through melt-electrospinning using CO2 laser irradiation for heating. The PET webs comprised ultra-fine fibers of uniform diameter (average fiber diameter = 1.66 μm, coefficient of variation = 19%). The co-existence of fibers with high and low molecular orientation was confirmed through birefringence measurements. Although the level of high orientation corresponded to that of commercial highly oriented yarn, crystalline diffraction was not observed in the wide-angle X-ray diffraction (WAXD) analysis of the webs. The crystallinity of the webs was estimated using differential scanning calorimetry (DSC). The fibers with higher birefringence did not exhibit any cold crystallization peak. After annealing the web at 116 °C for 5 min, a further increase in the birefringence of the fibers with higher orientation was observed. The WAXD results revealed that the annealed webs showed crystalline diffraction peaks with the orientation of the c-axis along the fiber axis. In summary, the formation of fibers with a unique non-crystalline structure with extremely high orientation was confirmed.

Signalling pathways that mediate macrophage activation in disease are poorly understood. Here the authors show that inhibition of PARP9 and/or activation of PARP14 may attenuate macrophage-mediated vascular diseases, and also provide new insight into the development of effective therapies for other inflammatory disorders.

BackgroundWe previously reported that biofilms and innate immunity contribute to the pathogenesis of Kawasaki disease. Therefore, we aimed to assess the efficacy of clarithromycin, an antibiofilm agent, in patients with Kawasaki disease. Methods and ResultsWe conducted an open‐label, multicenter, randomized, phase 2 trial at 8 hospitals in Japan. Eligible patients included children aged between 4 months and 5 years who were enrolled between days 4 and 8 of illness. Participants were randomly allocated to receive either intravenous immunoglobulin (IVIG) or IVIG plus clarithromycin. The primary end point was the duration of fever after the initiation of IVIG treatment. Eighty‐one eligible patients were randomized. The duration of the fever did not differ between the 2 groups (mean±SD, 34.3±32.4 and 31.1±31.1 hours in the IVIG plus clarithromycin group and the IVIG group, respectively [P=0.66]). The relapse rate of patients in the IVIG plus clarithromycin group was significantly lower than that in the IVIG group (12.5% versus 30.8%, P=0.046). No serious adverse events occurred during the study period. In a post hoc analysis, the patients in the IVIG plus clarithromycin group required significantly shorter mean lengths of hospital stays than those in the IVIG group (8.9 days versus 10.3 days, P=0.049). ConclusionsAlthough IVIG plus clarithromycin therapy failed to shorten the duration of fever, it reduced the relapse rate and shortened the duration of hospitalization in patients with Kawasaki disease. Clinical Trial RegistrationURL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000015437.

To investigate sexual dimorphism and postnatal changes in skin collagen expression, mRNA levels of collagens and their regulatory factors in male and female skin were examined during the first 120 days of age by quantitative realtime PCR. Levels of mRNAs encoding extracellular matrices did not show any differences between male and female mice until day 15. Col1a1 and Col1a2 mRNAs noticeably increased at day 30 and remained at high levels until day 120 in male mice, while those in female mice remained at low levels during the period. Consistent with the mRNA expression, pepsin-soluble type I collagen contents in skin was very high in mature male as compared to female. Col3a1 mRNA in male mice also showed significantly high level at day 120 as compared to female. On the other hand, expression of mRNAs encoding TGF-ßs and their receptors did not show apparent sexual dimorphism although small significant differences were observed at some points. Castration at 60 days of age resulted in a significant decrease in type I collagen mRNA expression within 3 days, and noticeably decreased expression of all fibril collagen mRNAs examined within 14 days, while administration of testosterone tube maintained the mRNA expression at high levels. Despite the in vivo effect of testosterone, administration of physiological concentrations of testosterone did not affect fibril collagen mRNA expression in either human or mouse skin fibroblasts in vitro, suggesting that testosterone does not directly affect collagen expression in fibroblasts. In summary, present study demonstrated dynamic postnatal changes in expression of collagens and their regulatory factors, and suggest that testosterone and its effects on collagen expression are responsible for the skin sexual dimorphism but the effects of testosterone is not due to direct action on dermal fibroblasts.

The spinal cord of a 7-week-old female Wistar rat was hemi-transected at thoracic position 10 with a razor blade, and changes in glial cell line-derived neurotrophic factor (GDNF) protein and mRNA expression levels in the spinal cord were examined. GDNF protein and mRNA expression levels were evaluated by enzyme immunoassay and reverse transcription polymerase chain reaction, respectively. Although GDNF is distributed in the healthy spinal cord from 150 to 400 pg/g tissue in a regionally dependent manner, hemi-transection (left side) of the spinal cord caused a rapid increase in GDNF content in the ipsilateral rostral but not in the caudal part of the spinal cord. On the other hand, injury-induced GDNF mRNA was distributed limitedly in both rostral and caudal stumps. These observations suggest the possibility that increased GDNF in the rostral part is responsible for the accumulation of GDNF that may be constitutively transported from the rostral to caudal side within the spinal cord. Although such local increase of endogenous GDNF protein may not be sufficient for nerve regeneration and locomotor improvement, it may play a physiological role in supporting spinal neurons including motoneurons.

This paper presents a visualization methodology, in the form of a multi-dimensional techno-economic assessment diagram, to comprehensively illustrate the relationship between assumptions (sets of input parameters) and results (corresponding output variables). This methodology is applied to analyze the lifecycle costs and CO2 emissions of hybrid vehicles (HVs) and electric vehicles (EVs). This paper then develops an eight-dimensional interactive diagram showing the relative advantages of HVs or EVs in the input space consisting of the following parameters: HV fuel efficiency; EV energy efficiency, total mileage travelled gasoline price, electricity price, battery price, gasoline CO2 intensity, and electricity CO2 intensity. This methodology provides a map illustrating the comprehensive relationship between the inputs and outputs in the model used, where specific scenarios (specific sets of inputs and their outputs) are represented by points plotted on the map. This methodology can be used in systematic comparisons of electric vehicles and related uncertainty analyses.

Leaf tissues of plants usually contain several types of idioblasts, defined as specialized cells whose shape and contents differ from the surrounding homogeneous cells. The spatial patterning of idioblasts, particularly of trichomes and guard cells, across the leaf epidermis has received considerable attention as it offers a useful biological model for studying the intercellular regulation of cell fate and patterning. Excretory idioblasts in the leaves of the aquatic monocotyledonous plant Egeria densa produced light blue autofluorescence when irradiated with ultraviolet light. The use of epifluorescence microscopy to detect this autofluorescence provided a simple and convenient method for detecting excretory idioblasts and allowed tracking of those cells across the leaf surfaces, enabling quantitative measurement of the clustering and spacing patterns of idioblasts at the whole leaf level. Occurrence of idioblasts was coordinated along the proximal-distal, medial-lateral, and adaxial-abaxial axes, producing a recognizable consensus spatial pattern of idioblast formation among fully expanded leaves. Idioblast clusters, which comprised up to nine cells aligned along the proximal-distal axis, showed no positional bias or regularity in idioblast-forming areas when compared with singlet idioblasts. Up to 75% of idioblasts existed as clusters on every leaf side examined. The idioblast-forming areas varied between leaves, implying phenotypic plasticity. Furthermore, in young expanding leaves, autofluorescence was occasionally detected in a single giant vesicle or else in one or more small vesicles, which eventually grew to occupy a large portion of the idioblast volume as a central vacuole. Differentiation of vacuoles by accumulating the fluorescence substance might be an integral part of idioblast differentiation. Red autofluorescence from chloroplasts was not detected in idioblasts of young expanding leaves, suggesting idioblast differentiation involves an arrest in chloroplast development at a very early stage, rather than transdifferentiation of chloroplast-containing epidermal cells.

Protease-activated receptor 2 (PAR2) belongs to the PAR family (PAR1 to PAR4), which is activated by serine proteases (trypsin, tryptase, etc.). In this study, we evaluated the role of PAR2 in allergic inflammation of airways using PAR2-deficient (PAR2−/−) mice. In wild-type mice, infiltration of eosinophils and high eotaxin content were found in bronchoalveolar lavage fluid (BALF) after ovalbumin (OA) sensitization and following challenge. In contrast, both OA-induced infiltration of eosinophils and increase of eotaxin content were abrogated in BALF from PAR2−/− mice. The activation of PAR2 might be essential in the production of eotaxin and consequential allergic inflammation in airways. Keywords:: protease-activated receptor 2, eosinophil, eotaxin

Dust storms and the atmospheric waves can play a significant role in the dynamics in the upper neutral atmosphere of Mars. Recent observations found that a periodic variation of neutral H and O exists in the upper atmosphere, which is likely associated with atmospheric waves that occurred during the regional dust storm on 4 September 2016. However, such periodic variations accompanying the dust storm are far from understood in terms of the Martian ionized particles (i.e., ionosphere). Here we investigated the periodic variation of the ion density in the Martian ionosphere during the regional dust storm in September 2016 based on the MAVEN/STATIC observations. Assuming a simple Chapman layer model, we implemented numerical fitting for the ion density altitude profile to retrieve the peak ion densities in the Martian ionosphere. We then applied periodogram analysis to these peak ion densities in order to identify the peak periodicities together with their confidence levels. We identified several distinct peak periodicities with a scale from ~1 day up to ~20 days. The peak periodicities around 6-9 days are comparable to those seen in the Martian neutral atmosphere. In addition, the other peak periodicities likely correspond to the periodic crossings of the local crustal fields and periodic variation of the upstream solar wind, indicating a strong regional coupling between the lower atmosphere and the upstream solar wind. [ABSTRACT FROM AUTHOR]

Objective: Magnetic resonance thoracic ductography (MRTD), concomitant with blood vessel imaging, provides useful anatomical information. The purpose of this study was to assess the visibility of the thoracic duct and blood vessels simultaneously by MRTD using balanced turbo-field-echo (bTFE) and turbo spin-echo (TSE). Methods: MRTDs concomitant with blood vessel imaging on bTFE and TSE were obtained for 10 healthy volunteers with a 1.5T-magnetic resonance unit. Visibility of the thoracic duct, blood vessels in the thoracic region; motion artifacts; and overall image quality were scored by two radiologists using three-to-five-point scales; those were compared between bTFE and TSE. Results: The thoracic duct was generally well-visualized on MRTD sequences. The upper part of the thoracic duct was better visualized on TSE than on bTFE (p < 0.05). The blood vessels were well visualized on bTFE and TSE; the bilateral subclavian arteries and the right subclavian veins were better visualized on TSE than on bTFE (all p < 0.05). Motion artifacts and overall image quality were better on TSE than on bTFE (p = 0.0039 and 0.0020, respectively). Conclusion: MRTD concomitant with blood vessel imaging on TSE has better visibility of the thoracic duct and blood vessels than bTFE. [ABSTRACT FROM AUTHOR]

Abstract Background Lower extremity artery disease is increasingly prevalent, and complex lesions such as calcified chronic total occlusions pose significant challenges during endovascular therapy. The needle rendezvous technique, which involves puncturing a needle toward the guidewire within the lesion or lumen and advancing the guidewire into the needle lumen to achieve guidewire externalization, offers a potential solution. If device passage remains challenging, the Rendezvous-PIERCE technique can be subsequently employed by advancing the needle over the externalized guidewire to modify the lesion directly. This study aimed to evaluate the procedural outcomes of needle rendezvous in infrainguinal arterial occlusive lesions. Methods This single-center, retrospective, single-arm study included patients treated with needle rendezvous between August 2020 and March 2024. The primary outcome was technical success rate, defined as the device passage following guidewire externalization using needle rendezvous. Secondary outcomes included the rates of procedural success, complications, and 30-day clinical-driven target lesion revascularization (CDTLR). Results Twenty-five patients (25 limbs) with 52% on hemodialysis and 80% having chronic limb-threatening ischemia in 52% and 80% were enrolled. All cases involved bilateral calcified occlusions, and 72% targeted the infrapopliteal artery segment. The average needle rendezvous time was 3.7 ± 2.0 min. Rendezvous-PIERCE was performed in 28% of cases. All cases achieved 100% technical and procedural success, with no procedure-related complications. The 30-day CDTLR rate was 8%, limited to below-the-knee lesions. Conclusions Needle rendezvous is a safe and effective technique for treating complex infrainguinal arterial occlusions, providing a viable alternative when conventional methods fail.