Artificial intelligence-assisted ultrasound imaging in hemophilia: research, development, and evaluation of hemarthrosis and synovitis detection.

Background: Joint bleeding can lead to synovitis and arthropathy in people with hemophilia, reducing quality of life. Although early diagnosis is associated with improved therapeutic outcomes, diagnostic ultrasonography requires specialist experience. Artificial intelligence (AI) algorithms may support ultrasonography diagnoses. Objectives: This study will research, develop, and evaluate the diagnostic precision of an AI algorithm for detecting the presence or absence of hemarthrosis and synovitis in people with hemophilia. Methods: Elbow, knee, and ankle ultrasound images were obtained from people with hemophilia from January 2010 to March 2022. The images were used to train and test the AI models to estimate the presence/absence of hemarthrosis and synovitis. The primary endpoint was the area under the curve for the diagnostic precision to diagnose hemarthrosis and synovitis. Other endpoints were the rate of accuracy, precision, sensitivity, and specificity. Results: Out of 5649 images collected, 3435 were used for analysis. The area under the curve for hemarthrosis detection for the elbow, knee, and ankle joints was ≥0.87 and for synovitis, it was ≥0.90. The accuracy and precision for hemarthrosis detection were ≥0.74 and ≥0.67, respectively, and those for synovitis were ≥0.83 and ≥0.74, respectively. Analysis across people with hemophilia aged 10 to 60 years showed consistent results. Conclusion: AI models have the potential to aid diagnosis and enable earlier therapeutic interventions, helping people with hemophilia achieve healthy and active lives. Although AI models show potential in diagnosis, evidence is unclear on required control for abnormal findings. Long-term observation is crucial for assessing impact on joint health.

Magnetic and thermodynamic control of coordination network crystallization using a hexaazaphenalene-based ligand.

Assembly of coordination networks from Cd(II) and a multi-interactive hexaazaphenalene-based ligand was successfully modulated using magnetic fields and thermodynamic control. A relatively weak field of only 320 mT was able to perturb the orientational distribution of the ligand in solution nudging the reaction down a different path. The underlying mechanism involved alignment of the ligands along the field lines, which was supported by DFT calculations. This crystallization technique could be extended to the synthesis of other networks and facilitate a deeper exploration of the reaction landscapes.

Triple Isomerism in 3D Covalent Organic Frameworks.

Isomerism in covalent organic frameworks (COFs) has scarcely been known. Here, for the first time we show 3D COFs with three framework isomers or polymorphs constructed from the same building blocks. All isomers were obtained as large (>10 µm) crystals; although their crystal shapes were distinctly different, they showed identical FT-IR and solid-state NMR spectra. Our structural analyses revealed unprecedented triple isomerism in 3D COFs (noninterpenetrated dia, qtz, and 3-fold interpenetrated dia-c3 nets). Furthermore, this Communication reports the first known COF with qtz topology for which the structure determination was based on Rietveld analysis. We achieved triple framework isomerism by reticulating a tetrahedral building block with a flexible junction and a linear building block with PEO side chains and by varying solution compositions. Our energy calculations, along with the discovery of interisomer transition, revealed that the isomer with qtz topology was a kinetic isomer. Thus, this simple yet little-explored concept of reticulating only flexible building blocks is an effective pathway to significantly broaden the diversity of 3D COFs, which have been proposed for a myriad of applications.

Heparin-induced Thrombocytopenia with Anaphylactoid Reaction during Hemodialysis.

We herein report a 64-year-old man with heparin-induced thrombocytopenia accompanied by anaphylactoid reaction during hemodialysis. The patient was admitted to our hospital with acute myocardial infarction and developed acute kidney injury after percutaneous coronary intervention. When maintenance hemodialysis with heparin was initiated, the patient developed an anaphylactoid reaction with dyspnea, hypotension, nausea, and vomiting. Laboratory tests revealed thrombocytopenia. Immunoglobulin G antibodies to heparin-platelet factor 4 complexes were positive, and a functional assay showed heparin-independent platelet activation. These results provide a definitive diagnosis of heparin-induced thrombocytopenia. The onset timing supported a diagnosis of 'rapid-onset' heparin-induced thrombocytopenia.

Molecular Design of Organic Ionic Plastic Crystals Consisting of Tetracyanoborate with Ultralow Phase Transition Temperature.

Organic ionic plastic crystals (OIPCs) are a ductile soft material where the composing ions are in isotropic free rotation, while their positions are aligned in order. The rotational motion in its plastic phase promotes ion conduction by decreasing the activation energy. Here, we report novel OIPCs comprised of tetracyanoborate ([TCB]-) and various organic cations. In particular, the OIPC composed of [TCB]- and spiro-(1,1')-bipyrrolidinium ([spiropyr]+) cations can transform into its plastic phase at ultralow temperature (Tp = -55 °C) while maintaining a high melting point (Tm = 242 °C). Replacement of the cation with either tetraalkylammonium or phosphonium and comparing their phase behavior, the high Tm was attributed to the relatively small interionic distance between [spiropyr]+ and [TCB]-. At the same time, the low Tp was realized by the restricted vibrational mode of the spirostructure, allowing the initiation of isotropic rotational motion with less thermal energy input.

Composite formation of covalent organic framework crystals and sugar alcohols for exploring a new class of heat-storage materials.

We impregnated the sugar alcohols (SAs) erythritol and mannitol (Man) in >0.1 mm single crystals of a covalent organic framework, COF-300, to propose new solid-state heat storing materials. The fusion-freezing cycles of the Man-COF composite occur in a narrow range of 130-155 °C without large or random supercooling, which has been a crucial problem of SAs, indicating the significance of this materials concept. The Man-COF composite displayed two endothermic and two exothermic features in the heating/cooling cycles. We measured the heat transmission properties in detail, based on which we discuss and suggest a postulate on the phase change behaviour of Man in the pores of the COF.

Stable and low-threshold photon upconversion in nondegassed water by organic crystals.

Photon upconversion (UC) is a technology that converts lower-energy photons (longer wavelength light) into higher-energy photons (shorter wavelength light), the opposite of fluorescence. Thus, UC is expected to open a vast domain of photonic applications that are not otherwise possible. Recently, UC by triplet-triplet annihilation (TTA) between organic molecules has been studied because of its applicability to low-intensity light, although the majority of such studies have focused on liquid samples in the form of organic solvent solutions. To broaden the range of applications, solid-state UC materials have been an active area of research. We recently developed air-stable, high-performance molecular UC crystals that utilize a stable solid-solution phase of bicomponent organic crystals. This article begins with a brief overview of previous challenges in developing and improving solid-state TTA-UC materials. Then, we briefly review and explain the concept as well as advantages of our molecular solid-solution UC crystals. We applied these organic crystals for the first time to a water environment. We observed blue UC emission upon photoexcitation at 542 nm (green-yellow light) and then measured the excitation intensity dependence as well as the temporal stability of the UC emission in air-saturated water. In nondegassed water, these organic crystals were stable, functioned with a low excitation threshold intensity of a few milliwatts per square centimeter, and exhibited high photo-irradiation durability at least over 40 h; indicating that the developed organic crystals are also viable for aqueous conditions. Therefore, the organic crystals presented in this report are expected to extend the domain of UC-based photonic applications in practical water systems including in vivo diagnostic, clinical, and therapeutic applications.

ORIHIME study: real-world treatment patterns and clinical outcomes of 338 patients with acquired hemophilia A from a Japanese administrative database.

BACKGROUND: Acquired hemophilia A (AHA) is a rare disorder, and clinical practices for treating AHA have not been fully clarified in Japan. OBJECTIVES: This study aims to investigate the epidemiology of AHA and real-world treatment practices in Japan. PATIENTS/METHODS: This observational study was based on a health administrative database of hospitalized patients diagnosed with AHA who were treated with immunosuppressants. RESULTS: The study included 214 males and 124 females (mean age 75.7 years). The most frequently used bypassing agent was recombinant activated factor VII. The predominant choice of immunosuppressant for first-line treatment was steroid monotherapy. Median days from the index date to the start of rehabilitation was 65.0 for cardiovascular, 35.5 for respiratory and 23.0 for locomotor. The proportion of patients with an activities of daily living (ADL) score < 70 points was high at both first admission and final discharge (47.4% and 38.8%). The percentage of deaths during hospitalization was 18.6%. CONCLUSIONS: This study clarified the treatment patterns and clinical outcomes of AHA in a large population in Japan. This was the first study showing ADL score distribution and time to rehabilitation. Further investigation is needed to develop better clinical practices for treatment of AHA.

Burden of congenital hemophilia A requiring treatment in Japan: The HIKOBOSHI study.

Background: Treatment of congenital hemophilia A (HA) in Japan has greatly improved with the widespread adoption of prophylactic factor (F)VIII concentrates. However, it is unknown if this has translated into a real-world reduction in disease and treatment burden. Objectives: To describe HA disease burden in Japan based on information from two medical information databases, JMDC and Real World Data Co., Ltd. (RWD). Methods: Eligible individuals were diagnosed with congenital HA and prescribed FVIII concentrates, bypassing agents, or emicizumab. Treatment patterns and disease burden data were derived from health insurance claims and electronic medical records. Results: Data on 459 people with HA were retrospectively collected from 2005 to 2020 in the JMDC database (median [min, max] of 37 [2, 186] months of available records), and 229 people with HA from 1985 to 2020 in the RWD database (median [min, max] of 154 [0, 409] months of available records). Mean (standard deviation) ages at the time of the first record were 25.0 (16.8) years (JMDC) and 19.2 (20.3) years (RWD). In the JMDC database, mean monthly FVIII dose increased from 2201 IU in 2005 to 8239 IU in 2013 to 11,377 IU in 2019; HA-related drug costs increased accordingly. Mean (95% confidence interval) annual outpatient and out-of-hours visits decreased slightly between 2013 and 2019 (outpatient visits: from 22.9 [16.8-29.0] to 14.3 [12.6-16.1] per person; out-of-hours visits: from 1.3 [0.2-2.5] to 0.6 [0-1.4]). There was no change in mean number of hospitalizations. Conclusions: Challenges remain in HA, including treatment burden, outpatient visits, and hospitalizations.

Thermoelectrochemical Seebeck coefficient and viscosity of Co-complex electrolytes rationalized by the Einstein relation, Jones-Dole B coefficient, and quantum-chemical calculations.

The Seebeck coefficient (Se) and the viscosity of a redox electrolyte are the key characteristics of thermoelectrochemical cells that generate electric power from waste thermal energy. However, the recent upsurge of research in this field is seriously disconnected from the knowledge of solution chemistry explored in the previous century. Herein, we systematically investigate five redox couples of cobalt complexes containing different aromatic ligands and anions in γ-butyrolactone solvent to demonstrate how the Einstein relation of hydrodynamic theory and the Jones-Dole B coefficient obtained from viscosity measurements can be used to account for such electrolyte properties. In essence, we reveal that the outer-shell (solvent reorganization) and inner-shell (metal-ligand reorganization) contributions to the redox reaction entropy ΔSrc (∝Se) can be quantified by the analyses using the B-coefficients and quantum-chemical simulations, respectively, while the distinct regimes found in the viscosity and conductivity are well accounted for by the Einstein relation, despite its classical hydrodynamic origin.

Recent developments of sequence-based prediction of protein-protein interactions.

The identification of protein-protein interactions (PPIs) can lead to a better understanding of cellular functions and biological processes of proteins and contribute to the design of drugs to target disease-causing PPIs. In addition, targeting host-pathogen PPIs is useful for elucidating infection mechanisms. Although several experimental methods have been used to identify PPIs, these methods can yet to draw complete PPI networks. Hence, computational techniques are increasingly required for the prediction of potential PPIs, which have never been seen experimentally. Recent high-performance sequence-based methods have contributed to the construction of PPI networks and the elucidation of pathogenetic mechanisms in specific diseases. However, the usefulness of these methods depends on the quality and quantity of training data of PPIs. In this brief review, we introduce currently available PPI databases and recent sequence-based methods for predicting PPIs. Also, we discuss key issues in this field and present future perspectives of the sequence-based PPI predictions.

van der Waals solid solution crystals for highly efficient in-air photon upconversion under subsolar irradiance.

Triplet-sensitized photon upconversion (UC) has been proposed for broad applications. However, the quest for superior solid materials has been challenged by the poor exciton transport often caused by low crystallinity, a small crystal domain, and aggregation of triplet sensitizers. Here, we demonstrate substantial advantages of the van der Waals solid solution concept to yield molecular crystals with extraordinary performance. A 0.001%-order porphyrin sensitizer is dissolved during recrystallization into the molecular crystals of a blue-fluorescent hydrocarbon annihilator, 9-(2-naphthyl)-10-[4-(1-naphthyl)phenyl]anthracene (ANNP), which contains bulky side groups. This attempt yields millimeter-sized, uniformly colored, transparent solid solution crystals, which resolves the long-standing problem of sensitizer aggregation. After annealing, the crystals exhibit unprecedented UC performance (UC quantum yield reaching 16% out of a maximum of 50% by definition; excitation intensity threshold of 0.175 sun; and high photostability of over 150 000 s) in air, which proves that this concept is highly effective in the quest for superior UC solid materials.

Kinetics of photon upconversion by triplet-triplet annihilation: a comprehensive tutorial.

This perspective article provides a comprehensive but organized tutorial introduction of the kinetics related to photon upconversion (UC) by triplet-triplet annihilation (TTA) (TTA-UC). The field of TTA-UC is multi-disciplinary and rapidly growing with the involvement of researchers from diverse backgrounds. TTA-UC consists of a series of tangled photophysical processes, so a solid understanding of the kinetic features and consequences is important to develop and evaluate materials for TTA-UC. This tutorial starts with an introduction of the standard model of TTA-UC along with the assumptions used in the model. The essential concept of the spin statistics for TTA and how this concept is related to the singlet branching ratio, which directly affects the efficiency of UC, are then explained through step-by-step analyses. Using these foundations, solutions for the steady-state behaviors are derived, featuring the universal curve that describes the excitation intensity dependence of the UC quantum yield for any sample type. Various useful functions for analyzing experimental data are also introduced and summarized. The transient behaviors of TTA-UC are then discussed along with their equations, and the usefulness for analyzing transient experimental data is explained using examples. In this article, self-consistent derivations and relevant references are provided for an easy understanding of the advanced discussion and analyses.

Ionic additive strategy to control nucleation and generate larger single crystals of 3D covalent organic frameworks.

To generate large single crystals of 3D covalent organic frameworks, the active use of ionic additives, which can greatly impact crystal size, is proposed. The crystal size ranking was found to be in accordance with the Hofmeister series and Gutmann donor number, providing a useful strategy to enhance crystal size and, consequently, generate COF-300 single crystals of >200 µm in size.

Renal intravascular large B-cell lymphoma predominantly localized in peritubular capillaries.

We report on a 70-year-old woman with intravascular large B-cell lymphoma, in whom the renal lesion was localized in the peritubular capillaries. The patient complained of fatigue, general malaise, and unsteadiness when walking. Laboratory tests showed anemia, increased C-reactive protein, and mild renal failure, with a serum creatinine level of 1.31 mg/dL and no remarkable proteinuria or hematuria. Renal biopsy showed intravascular large B-cell lymphoma. The large atypical cells were mainly accumulated within the peritubular capillaries and no large atypical cells were found in the glomeruli. Skin and bone marrow biopsies confirmed intravascular large B-cell lymphoma. Brain magnetic resonance imaging showed multiple small infarctions in the cerebral white matter. The patient was treated with dexamethasone, methotrexate, and cytarabine followed by CHOP (combined cyclophosphamide, doxorubicin, vincristine, and prednisone) and R-CHOP (CHOP with the recombinant anti-CD20 antibody rituximab), and her renal function improved soon after the start of chemotherapy.

Visible-to-ultraviolet (<340 nm) photon upconversion by triplet-triplet annihilation in solvents.

In this article, visible-to-ultraviolet photon upconversion (UV-UC) by triplet-triplet annihilation in the emission range shorter than 340 nm, which has not been explored well, is presented and the relevant physicochemical characteristics are elucidated. Investigations were carried out in several deaerated solvents using acridone and naphthalene derivatives as a sensitizer and emitter, respectively. Both upconversion quantum efficiency and sample photostability under continuous photoirradiation strongly depended on the solvent. The former dependence is governed by the solvent polarity, which affects the triplet energy level matching between the sensitizer and emitter because of the solvatochromism of the sensitizer. To elucidate the latter, first we investigated the photodegradation of samples without the emitter, which revealed that the sensitizer degradation rate is correlated with the difference between the frontier orbital energy levels of the sensitizer and solvent. Inclusion of the emitter effectively suppressed the degradation of the sensitizer, which is ascribed to fast quenching of the triplet sensitizer by the emitter and justifies the use of ketonic sensitizers for UV-UC in solvents. A theoretical model was developed to acquire insight into the observed temporal decays of the upconverted emission intensity under continuous photoirradiation. The theoretical curves generated by this model fitted the experimental decay curves well, which allowed the reaction rate between the emitter and solvent to be obtained. This rate was also correlated with the difference between the frontier orbital energy levels of the emitter and solvent. Finally, based on the acquired findings, general design guidelines for developing UV-UC samples were proposed.

Update of the GRIP web service.

G protein-coupled receptors (GPCRs) can form homodimers, heterodimers, or higher-order molecular complexes (oligomers). The reports on the change of functions through the oligomerization have been accumulated. Inhibition of GPCR oligomerization without affecting the protomer's overall structure would clarify the oligomer-specific functions although inhibition experiments are costly and require accurate information about the interface location. Unfortunately, the number of experimentally determined interfaces is limited. The precise prediction of the oligomerization interfaces is, therefore, useful for inhibition experiments to examine the oligomer-specific functions, which would accelerate investigations of the GPCR signaling. However, interface prediction for GPCR oligomerization is difficult because different GPCR subtypes belonging to the same subfamily often use different structural regions as their interfaces. We previously developed a high-performance method to predict the interfaces for GPCR oligomerization, by identifying the conserved surfaces with the sequence and structure information. Then, the structural characteristic of a GPCR structure is regarded to be a thick-tube like conformation that is approximately perpendicular to the membrane plane. Our method had successfully predicted all of the interfaces available on that day. We had launched a web server for our interface prediction of GPCRs (GRIP). We have improved the previous version of GRIP server and enhanced its usability. First, we discarded the approximation of the GPCR structure as the thick-tube-like conformation. This improvement increased the number of structures for the prediction. Second, the FUGUE-based template recommendation service was introduced to facilitate the choice of an appropriate structure for the prediction. The new prediction server is available at http://grip.b.dendai.ac.jp/∼grip/.

Integration of thermo-electrochemical conversion into forced convection cooling.

Forced convection cooling is important in numerous technologies ranging from microprocessors in data centers to turbines and engines, and active cooling is essential in these situations. However, active transfer of heat or thermal energy under a large temperature difference promptly destroys the exergy, which is the free-energy component of the thermal energy. In this study, to partially recover presently lost exergy in such situations, thermo-electrochemical conversion is integrated into forced convection cooling. We design and fabricate a test cell in which an electrolyte liquid is forced through a channel formed between two parallel electrodes and the hot-side electrode simulates an object to be cooled. Our experimental investigations show that the narrower interelectrode channels afford higher cooling and power generation performances. The mass transfer resistance is the most dominant type of resistance for all the conditions tested and the charge transfer kinetics is found to be controlled by the electrolyte viscosity. The dependence of the generated power on the flow rate is caused by the change in the diffusion coefficient of redox species with temperature. As an evaluation measure for such forced-flow thermo-electrochemical cells, the gain (Λ)-defined as the ratio of the generated power to the hydrodynamic pumping work required to force the liquid through the cell-is introduced. Λ is above unity in a certain flow rate region. This demonstrates that such a system can generate more electric power than the hydrodynamic pump work required to drive the liquid through the cell.

Reconstitution of the embryonic kidney identifies a donor cell contribution to the renal vasculature upon transplantation.

The kidney possesses a highly organised vasculature that is required for its filtration function. While recent advances in stem cell biology have enabled the in vitro generation of kidney tissues, at least partially, recapitulation of the complicated vascular architecture remains a huge challenge. Herein we develop a method to reconstitute both the kidney and its vascular architecture in vitro, using dissociated and sorted mouse embryonic kidney cells. Upon transplantation, arteriolar networks were re-established that ran through the interstitial space between branching ureteric buds and eventually entered glomeruli. Using this system, we found that donor-derived endothelial cells significantly contributed to the arterioles and glomerular capillaries formed after transplantation. Unexpectedly, the near-complete depletion of canonical endothelial cells from the donor embryonic kidney suggested the existence of unidentified donor-derived endothelial precursors that were negative for canonical endothelial markers, but still contributed significantly to the vasculature in the transplants. Thus, our protocol will serve as a useful platform for identification of renal endothelial precursors and induction of these precursors from pluripotent stem cells.