Fat embolism syndrome: A severe case diagnosed early using dual-energy CT and saved with VA-ECMO and inhaled nitric oxide.

Diagnosing FES is difficult and time-consuming, and identify FES as an etiology of right ventricular volume overload for early diagnosis. Because FES is a reversible condition, even severe cases can bse treated if the patient survives the acute phase.

A case of cough syncope diagnosed by the Valsalva maneuver and cough induction test under invasive arterial pressure measurement.

Following the loss of consciousness during the Valsalva maneuver and cough induction test, real-time arterial pressure measurement could clarify the significant blood pressure decrease in a patient with cough syncope.

Daylights with high melanopsin stimulation appear reddish in fovea and greenish in periphery.

Melanopsin reportedly contributes to brightness and color appearance in photopic vision in addition to cone photoreceptor cells. However, the relationship between the contribution of melanopsin to color appearance and retinal location is unclear. Herein, we generated metameric daylights (5000 K/6500 K/8000 K) with different melanopsin stimulations while keeping the size and colorimetric values intact and measured the color appearance of the stimuli in the fovea and periphery. The experiment included eight participants with normal color vision. We found that with high melanopsin stimulation, the color appearance of the metameric daylight shifts to reddish at the fovea and greenish in the periphery. These results are the first to show that the color appearance of visual stimuli with high melanopsin stimulation can be completely different in the foveal and peripheral vision even when the spectral power distribution of visual stimuli in both visions is the same. Both colorimetric values and melanopsin stimulation must be considered when designing spectral power distributions for comfortable lighting and safe digital signage in photopic vision.

Pacemaker implantation for persistent sinus node dysfunction in a patient with COVID-19.

A 46-year-old woman was admitted with coronavirus disease-2019 infection. Symptomatic sinus bradycardia occurred, followed by congestive heart failure. Therapeutics such as isoproterenol, theophylline, and cilostazol could not safely improve her symptoms. She underwent pacemaker implantation 53 days after admission. Atrial pacing remained was at 60% after 6 months.

The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study.

BACKGROUND: The relationship between the timing of the first early recurrence and late recurrence after a single catheter ablation procedure for atrial fibrillation is controversial. METHODS: The Efficacy of Short-Term Use of Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation trial followed 2038 patients who underwent radiofrequency catheter ablation for atrial fibrillation. RESULTS: Of the patients, 907 (45%) had early recurrences within 90 days after the initial ablation. We divided these patients into two groups according to the timing of the first early recurrence episode, namely the ER1 group (early recurrence during the early phase; 0-30 days, n = 814) and ER2 group (early recurrence during the late phase; 31-90 days, n = 93). Three years after ablation, patients with early recurrences had a significantly lower event-free rate from late recurrences after a 90-day blanking period than patients without early recurrences (36.2% and 74.2%, respectively; log-rank, P < 0.0001). Three years after ablation, the event-free rate was significantly higher in the ER1 than the ER2 group (38.3% and 17.1%, respectively; log-rank, P < 0.0001). Moreover, the event-free rate at 3 years in the ER2 group was extremely low (5.6%) in patient with non-paroxysmal atrial fibrillation. CONCLUSION: Early recurrences were strongly associated with late recurrences, especially in patients with the first recurrence episode at >1 month within the blanking period after a single ablation procedure. Therefore, these patients should undergo close observation during follow-up, when they had especially with non-paroxysmal atrial fibrillation.

Incidence and Characteristics of Coronary Artery Spasms Related to Atrial Fibrillation Ablation Procedures　- Large-Scale Multicenter Analysis.

BACKGROUND: Coronary artery spasms (CASs), which can cause angina attacks and sudden death, have been recently reported during catheter ablation. The aim of the present study was to report the incidence, characteristics, and prognosis of CASs related to atrial fibrillation (AF) ablation procedures.Methods and Results:The AF ablation records of 22,232 patients treated in 15 Japanese hospitals were reviewed. CASs associated with AF ablation occurred in 42 of 22,232 patients (0.19%). CASs occurred during ablation energy applications in 21 patients (50%). CASs also occurred before ablation in 9 patients (21%) and after ablation in 12 patients (29%). The initial change in the electrocardiogram was ST-segment elevation in the inferior leads in 33 patients (79%). Emergency coronary angiography revealed coronary artery stenosis and occlusions, which were relieved by nitrate administration. No air bubbles were observed. A comparison of the incidence of CASs during pulmonary vein isolation between the different ablation energy sources revealed a significantly higher incidence with cryoballoon ablation (11/3,288; 0.34%) than with radiofrequency catheter, hot balloon, or laser balloon ablation (8/18,596 [0.04%], 0/237 [0%], and 0/111 [0%], respectively; P<0.001). CASs most often occurred during ablation of the left superior pulmonary vein. All patients recovered without sequelae. CONCLUSIONS: CASs related to AF ablation are rare, but should be considered as a dangerous complication that can occur anytime during the periprocedural period.

Perfect appearance match between self-luminous and surface colors can be performed with isomeric spectra.

Surface color results from a reflected light bounced off a material, such as a paper. By contrast, self-luminous color results directly from an emitting light, such as a Liquid Crystal (LC) display. These are completely different mechanisms, and thus, surface color and self-luminous color cannot be matched even though both have identical tristimulus values. In fact, previous research has reported that metameric color matching fails among diverse media. However, the reason for this failure remains unclear. In the present study, we created isomeric color-matching pairs between self-luminous and surface colors by modulating the spectral distribution of the light for surface colors. Then, we experimentally verified whether such color matching can be performed. The results show that isomeric color matching between self-luminous and surface colors can be performed for all participants. However, metameric color matching fails for most participants, indicating that differences in the spectral distributions rather than the different color-generating mechanisms themselves are the reason for the color matching failure between different devices. We experimentally demonstrated that there is no essential problem in cross-media color matching by generating isomeric pairs. Our results can be considered to be of great significance not only for color science, but also for the color industry.

Effects of varying the standard deviation of the luminance on the appearance of food, flavour expectations, and taste/flavour perception.

What we taste is affected by what we see, and that includes the colour, opacity, and shape of the food we consume. We report two experiments designed to investigate how the standard deviation (SD) of the luminance distribution of food images influences the perceived visual texture and the taste/flavour experience by using the latest Augmented Reality (AR) technology. We developed a novel AR system capable of modifying the luminance distribution of foods in real-time using dynamic image processing for simulating actual eating situations. Importantly, this form of dynamic image manipulation does not change the colour on the food (which has been studied extensively previously). Instead, the approach outlined here was used to change the SD of the luminance distribution of the food while keeping the chromaticity, the average luminance, and the skewness constant. We investigated the effects of changing the luminance SD distribution of Baumkuchen (a German baked cake) and tomato ketchup on visual perception, flavour expectations, and the ensuing taste experience. Participants looked at a piece of Baumkuchen (Experiment 1) or a spoonful of tomato ketchup (Experiment 2) having different luminance distributions and evaluated the taste on sampling the food. Manipulating the SD of the luminance distribution affected not only the expected taste/flavour of the food (e.g. expected moistness, wateriness and deliciousness), but also the actual taste properties on sampling the food itself. The novel food modification method and system outlined here can therefore potentially be used to control the taste/flavour of different foods crossmodally by means of modifying their appearance properties (specifically the SD of the luminance distribution while keeping other aspects of image statistics constant), and can do so in real time, without the need for food markers.

XYZ color data on the visual degradation of vegetables.

This data article includes the visual stimuli used to model the freshness perception of four different vegetable textures, namely a cabbage, a carrot, a strawberry and a spinach. All four vegetables were optically measured during their degradation process in a humidity, temperature and light controlled environment. The visual data is in csv format for convenient usage. Each data point represents a pixel value using the hardware independent XYZ color space. The total size of the data can be related to an equivalent image of 1360 × 1024 resolution. Additionally, using the calibration data of an LCD-Display, the respective RGB color space images were derived from the XYZ data as an example. For interpretation and discussion, please see the original article entitled "Model of vegetable freshness perception using luminance cues" [1].

Hemodynamic responses related to intrinsically photosensitive retinal ganglion cells in migraine.

To clarify whether photoreception of intrinsically photosensitive retinal ganglion cells (ipRGCs) is related to migraine, we investigated the relationship between hemodynamic responses related to neural activity and visual stimulation of ipRGCs. It has been established that photoreception in ipRGCs is associated with photophobia in migraine. However, the relationship between visual stimulation of ipRGCs and hemodynamic responses in the visual cortex has not been clarified. Hemodynamic responses in the visual cortex were measured using functional near-infrared spectroscopy (fNIRS) as signals reflecting changes in oxygenated and deoxygenated hemoglobin concentrations. Different types of visual stimulation generated by a metamerism method were applied to the peripheral field of the eye of patients with migraine (N = 20) and healthy participants (N = 21). The stimulation intensity on the retina was controlled using an artificial pupil. In the primary visual cortex of patients with migraine, statistically significant changes in fNIRS signals dependent on visual stimulation intensity applied to ipRGCs were observed (p < 0.01), while no such changes were observed in healthy participants. These results reveal that visual stimulation of ipRGCs projecting to the primary visual cortex is involved in hemodynamic responses in patients with migraine, suggesting that ipRGCs, in addition to photometric values related to cones, are associated with migraine.

Spectral Image Processing for Museum Lighting Using CIE LED Illuminants.

This work presents a spectral color-imaging procedure for the detailed colorimetric study of real artworks under arbitrary illuminants. The results demonstrate this approach to be a powerful tool for art and heritage professionals when deciding which illumination to use in museums, or which conservation or restoration techniques best maintain the color appearance of the original piece under any illuminant. Spectral imaging technology overcomes the limitations of common area-based point-measurement devices such as spectrophotometers, allowing a local study either pixelwise or by selected areas. To our knowledge, this is the first study available that uses the proposed CIE (Commission Internationale de l'Éclairage) light-emitting diode (LED) illuminants in the context of art and heritage science, comparing them with the three main CIE illuminants A, D50, and D65. For this, the corresponding colors under D65 have been calculated using a chromatic adaptation transform analogous to the one in CIECAM02. For the sample studied, the CIE LED illuminants with the lowest average CIEDE2000 color differences from the standard CIE illuminants are LED-V1 for A and LED-V2 for D50 and D65, with 1.23, 1.07, and 1.57 units, respectively. The work studied is a Moorish epigraphic frieze of plasterwork with a tiled skirting from the Nasrid period (12th-15th centuries) exhibited in the Museum of the Alhambra (Granada, Spain).

One-year clinical outcomes of anticoagulation therapy among Japanese patients with atrial fibrillation: The Hyogo AF Network (HAF-NET) Registry.

BACKGROUND: Although anticoagulation therapy could reduce the risk of strokes in patients with atrial fibrillation (AF), large-scale investigations in the direct oral anticoagulant (DOAC) and AF catheter ablation (CA) era are lacking. METHODS: This study was designed as a prospective, multicenter, observational study and a total of 2113 patients from 22 institutions were enrolled in the Hyogo area. RESULTS: The mean age and CHADS2 score were 70.1 ± 10.8 years old and 1.5 ± 1.1, respectively. The follow-up period was 355 ± 43 days. CA was performed in 614 (29%) and DOACs were prescribed in 1118 (53%) patients. Ischemic strokes/systemic embolisms (SEs) and major bleeding occurred in 13 (0.6%) and 17 (0.8%) patients, respectively. New onset dementia, hospitalizations for cardiac events, and all-cause death occurred in eight (0.4%), 60 (2.8%), and 29 (1.4%) patients, respectively. A multivariate analysis demonstrated that persistent AF and the body weight (BW) were associated with ischemic strokes/SEs and major bleeding, respectively (persistent AF: hazard ratio, 9.57; 95%CI, 1.2-74.0; P = .03; BW: hazard ratio, 0.94; 95%CI, 0.90-0.99; P = .02). AFCA history was associated with the cardiac events (hazard ratio, 0.44; 95%CI, 0.20-0.99; P = .04). Age was associated with new onset dementia (hazard ratio, 1.1; 95%CI, 1.0-1.2; P = .03). CONCLUSIONS: In the DOAC and CA era, the incidence of ischemic strokes/SEs, major bleeding and cardiac events could be dramatically reduced in patients with AF. However, some unsolved issues of AF management still remain especially in elderly patients with persistent AF and a low BW.

Infant Can Visually Differentiate the Fresh and Degraded Foods: Evidence From Fresh Cabbage Preference.

Perceiving and judging food quality is indispensable in daily life. The present study examined this ability's development in infants during the early postnatal months. We tested if infants aged 5-8 months can discriminate different degree of freshness in cabbage, strawberry, carrot, and spinach. In Experiment 1, images of fresh and degraded vegetables were presented side by side; infants aged 7-8 months significantly preferred fresh over degraded cabbage images. In Experiments 2 and 3, infants aged 7-8 months maintained their preference when the images were achromatic, but no longer preferred the fresh cabbage images when pixels in those images were randomized. Given these results, we suggest that the ability to discriminate different degrees of freshness, at least for cabbage, develops at approximately 7-8 months of age, which is the time probably prior to taste learning.

A quantitative analysis of the contribution of melanopsin to brightness perception.

In the retina, intrinsically photosensitive retinal ganglion cells (ipRGCs) which express photopigment melanopsin have been identified as photoreceptors which differ from cones and rods. It has been established that such melanopsin-expressing RGCs are involved in the circadian photo-entrainment and pupillary light reflexes. An additional projection from ipRGCs to the lateral geniculate nucleus has been identified, which indicates the association of ipRGCs with visual perception induced by the image-forming pathway. Reportedly, ipRGCs modulate brightness perception but quantitative analysis of brightness perception involving melanopsin and cones-based signals has not been elucidated. We conducted brightness perception experiments that involved melanopsin using a novel projector with six primary colors and formulated the results for melanopsin and cone stimuli. The white visual stimuli (5 degrees in size) that we used had a single xy-chromaticity values but melanopsin stimuli were modulated by designing different spectral distributions. Perceived brightness was measured using a magnitude estimation method at several luminance levels in the near periphery (7 degrees). Additionally, pupil diameter was measured for estimating the intensity of visual stimuli on the retina. The results showed that the perceived brightness of a white visual stimulus with different spectral distributions can be described by a summation of the nearly linear melanopsin response and the non-linear cone response with weighted coefficients, and the contribution ratio of melanopsin in brightness perception increased to 50% and more with increasing visual stimulus. These suggest that melanopsin signals play a crucial role in the estimation of the absolute intensity of the light environment by obtaining absolute brightness information even when cones are adapted by light.

A Decision Tree-Based Survival Analysis of Patients with a History of Inappropriate Implantable Cardioverter-Defibrillator Therapy.

Implantable cardioverter-defibrillators (ICDs) improve survival in patients who are at risk of sudden death. However, inappropriate therapy is commonly given to ICD recipients, and this situation may be associated with an increased risk of death. This study aimed to construct a risk stratification scheme by using decision tree analysis in patients who received inappropriate ICD therapy.Mortality was calculated from a retrospective data analysis of a multicenter cohort involving 417 ICD recipients. Inappropriate therapy was defined as therapy for nonventricular arrhythmias, including sinus tachycardia, supraventricular tachycardia, atrial fibrillation/flutter, oversensing, and lead failure. Inappropriate therapy included antitachycardia pacing, cardioversion, and defibrillation. The prognostic factors were identified by a Cox proportional hazards regression analysis, and we constructed a decision tree.During an average follow-up of 5.2 years, 48 patients (12%) had all-cause death. A multivariate Cox hazard model revealed that the age (hazard ratio [HR] 1.06, P < 0.001), ln B-type natriuretic peptide (BNP) (HR 1.47, P = 0.02), nonsinus rhythm at implantation (HR 2.70, P < 0.05), and inappropriate therapy occurring during sedentary/awake conditions (HR 3.51, P = 0.001) correlated with an increased risk of mortality. An inappropriate therapy due to abnormal sensing (HR 0.16, P = 0.04) decreased the risk of mortality. Furthermore, a decision tree analysis stratified the patients well by using 4 covariates: BNP, activity at the time of inappropriate therapy, mechanism of inappropriate therapy, and baseline rhythm at ICD implantation (log-rank test, P < 0.0001).We identified the predictors of mortality in inappropriate ICD therapy recipients and constructed a risk stratification scheme by using decision tree analysis.

Efficacy of Endocardial Ablation of Drug-Resistant Ventricular Fibrillation in Brugada Syndrome: Long-Term Outcome.

Background Both endocardial trigger elimination and epicardial substrate modification are effective in treating ventricular fibrillation (VF) in Brugada syndrome. However, the primary approach and the characteristics of patients who respond to endocardial ablation remain unknown. Methods Among 123 symptomatic Brugada syndrome patients (VF, 63%; syncope, 37%), ablation was performed in 21 VF/electrical storm patients, the majority of whom were resistant to antiarrhythmic drugs. Results Careful endocardial mapping revealed that 81% of the patients had no specific findings, whereas 19% of the patients, who experienced the most frequent VF episodes with notching of the QRS in lead V1, had delayed low-voltage fractionated endocardial electrograms. Ablation of VF triggers followed by endocardial substrate modification was performed in the right ventricular outflow tract in 85% of the cases and in the right ventricle in 15%. VF triggers could not be completely eliminated in 1 patient and VF became noninducible in 14 (88%) patients among 16 patients who underwent VF induction with normalization of Brugada-type ECG in 3. During follow-up (56.14±36.95 months), VF recurrence was observed in 7 patients. Importantly, all patients who had nothing of QRS in lead V1 did not respond to endocardial ablation despite presence of VF-triggering ectopic beats during ablation. Conclusions With careful documentation of VF-triggering ectopic beats and detailed endocardial mapping, endocardial VF trigger elimination followed by endocardial substrate modification has an excellent long-term outcome, whereas presence of QRS notching in lead V1 was associated with high VF recurrence suggesting epicardial substrate ablation as effective initial approach.

Trans-aortic pulmonary vein isolation using magnetic navigation system for paroxysmal atrial fibrillation in a patient with dextrocardia, situs inversus, and inferior vena cava continuity with azygos vein.

A 51-year-old male with dextrocardia and situs inversus underwent catheter ablation for paroxysmal atrial fibrillation. Because the procedure through the trans-septal approach was impossible due to the inferior vena cava continuity with azygos vein, we performed pulmonary vein isolation using magnetic navigation system through the retrograde trans-aortic approach. Superior and inferior left-sided and superior right-sided pulmonary veins could be isolated which was confirmed by the ablation catheter. The patient was free from atrial fibrillation episode at the 12 months follow-up except only one palpitation episode lasting nearly 12 hours at 9 months after the ablation.

Inappropriate implantable cardioverter defibrillator shocks-incidence, effect, and implications for driver licensing.

PURPOSE: Patients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions. METHODS: Inappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold. RESULTS: Of the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 ± 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 ± 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively. CONCLUSIONS: We found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits.