Multi-step prediction for influenza outbreak by an adjusted long short-term memory.

Influenza results in approximately 3-5 million annual cases of severe illness and 250 000-500 000 deaths. We urgently need an accurate multi-step-ahead time-series forecasting model to help hospitals to perform dynamical assignments of beds to influenza patients for the annually varied influenza season, and aid pharmaceutical companies to formulate a flexible plan of manufacturing vaccine for the yearly different influenza vaccine. In this study, we utilised four different multi-step prediction algorithms in the long short-term memory (LSTM). The result showed that implementing multiple single-output prediction in a six-layer LSTM structure achieved the best accuracy. The mean absolute percentage errors from two- to 13-step-ahead prediction for the US influenza-like illness rates were all <15%, averagely 12.930%. To the best of our knowledge, it is the first time that LSTM has been applied and refined to perform multi-step-ahead prediction for influenza outbreaks. Hopefully, this modelling methodology can be applied in other countries and therefore help prevent and control influenza worldwide.

Peripartum type B aortic dissection in patients with Marfan syndrome who underwent aortic root replacement: a case series study.

OBJECTIVE: To investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR). DESIGN: Retrospective case series study. SETTING: Tertiary perinatal care centre at a university hospital. POPULATION: Pregnant women fulfilling the revised Ghent nosology (2010) criteria for MFS who were managed at our institute. METHODS: The pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were reviewed retrospectively based on medical records. MAIN OUTCOME MEASURES: Obstetrical management and complication including the incidence of AD throughout the peripartum period. RESULTS: Among 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (five pregnancies) had received ARR before conception: three (60%) developed type B aortic dissection [AD(B)] during the peripartum period, compared with only one of 10 patients (12 pregnancies) without ARR (P < 0.05, Chi-square test). CONCLUSIONS: Our study results suggest that MFS patients after prophylactic ARR are still at high risk of AD(B) during the peripartum period. Careful pre-pregnancy counselling and multidisciplinary care throughout the peripartum period are essential for the management of MFS, even after surgical repair of an ascending aortic aneurysm. TWEETABLE ABSTRACT: MFS patients after prophylactic ARR are still at high risk of type B aortic dissection during the peripartum period.

Sub-100 W picosecond output from a phase-conjugate Nd:YVO4 bounce amplifier.

We demonstrated >80 W picosecond output at a pulse repetition frequency of 100 MHz from a dual Nd:YVO(4) amplifier laser system consisting of a phase-conjugate Nd:YVO(4) bounce amplifier combined with a second diode-side-pumped Nd:YVO(4) bounce amplifier. The output exhibited high quality spatial form with M(2) < 1.8 and a pulse duration (FWHM) of 9.2 ps. A peak power of >7.4 MW with an average power of 78.5 W was also achieved at a pulse repetition frequency of 1.0 MHz.

Cerebrovascular Accident Rate Is Different Between Centrifugal and Axial-Flow Pumps, but Survival and Driveline Infection Rates Are Similar.

OBJECTIVES: We analyzed the outcome of patients with implantable left ventricular assist devices (LVADs) at the University of Tokyo Hospital to compare those with centrifugal pumps (CE group: Duraheart and Evaheart) and those with axial-flow pumps (AX group: Heartmate II and Jarvik 2000). METHODS: A total of 68 patients who underwent implantation of LVADs (Duraheart: n = 15; Evaheart: n = 23; Heartmate II: n = 22; Jarvik 2000: n = 8) as a bridge to transplantation at our institution from May 2011 to April 2015 were retrospectively reviewed. All patients were followed through December 2015. RESULTS: The mean follow-up time of the CE group was 1.95 ± 0.92 year (total 74.1 patient-years) and that of the AX group was 1.56 ± 0.56 year (total 46.8 patient-years). Whether the patients underwent centrifugal or axial-flow pump implantations was not associated with survival or driveline infection according to log-rank test (1-year survival rate: 89% vs 100% [P = .221]; 1-year freedom rate: 40% vs 43% [P = .952]). The rates of freedom from cerebrovascular accident (CVA) at 1 year after LVAD implantation in the CE and AX groups were 70% and 96%, respectively (P < .001). The CE group showed a higher frequency of CVA (0.472 vs 0.021 event per patient-year). CONCLUSIONS: Our findings indicate that overall survival and driveline infection rates are similar between centrifugal and axial-flow pumps, but they suggest that patients with centrifugal pumps are more likely to develop CVAs than those with axial-flow pumps.

Association of the Number of HLA-DR Mismatches With Early Post-transplant Acute Cellular Rejection Among Heart Transplantation Recipients: A Cohort Study in Japanese Population.

BACKGROUND: Although many risk factors are reported about graft rejection after heart transplantation (HTx), the effect of HLA mismatch (MM) still remains unknown, especially in the Japanese population. The aim of the present study was to investigate the influence of HLA MM on graft rejection among HTx recipients in Japan. METHODS: We retrospectively investigated the association of the number of HLA MM including class I (A, B) and class II (DR) (for each locus MM: 0 to 2, total MM: 0 to 6) and the incidence of moderate to severe acute cellular rejection (ACR) confirmed by endomyocardial biopsy (International Society for Heart and Lung Transplantation grade ≥ 3A/2R) within 1 year after HTx. RESULTS: Between 2007 and 2014, we had 49 HTx cases in our institute. After excluding those with insufficient data and positive donor-specific antigen, finally 35 patients were enrolled. Moderate to severe ACR was observed in 16 (45.7%) patients. The number of HLA-DR MM was significantly associated with the development of ACR (ACR+: 1.50 ± 0.63, ACR-: 1.11 ± 0.46, P = .029). From univariate analysis, DR MM = 2 was the only independent risk factor for ACR episodes (P = .017). The frequency of ACR within 1 year was significantly higher in those with DR MM = 2 (DR MM = 0 to 1: 0.3 ± 0.47, DR MM = 2: 1.17 ± 1.34 times, P = .007). CONCLUSIONS: The number of HLA-DR MMs was associated with the development and recurrence of ACR episodes among HTx recipients within 1 year after transplantation in Japanese population.

Power scaling of a pico-second Nd:YVO(4) master-oscillator power amplifier with a phase-conjugate mirror.

We investigated design issues for the power scaling of a pico-second Nd:YVO(4) master-oscillator power amplifier system with a photorefractive phase-conjugate mirror by using standard beam propagation analysis. We also demonstrated a 25 W diffraction-limited pico-second output. A corresponding extraction efficiency of 31 % was achieved.

Prostacyclin analog OP2507 prevents pulmonary arterial and airway constriction during lung preservation and reperfusion.

BACKGROUND: The effects of OP2507 on lung preservation with cold Euro-Collins solution and during the reperfusion period were evaluated. METHODS: For this study, canine lungs were flushed with a 10 micrograms/ml OP2507 solution (n = 7) or saline solution (control group, n = 7) (0.1 ml/kg body weight) and stored in the same solution. Pulmonary arterial pressure, pulmonary vascular resistance, airway pressure, respiratory capacity, and wet to dry weight ratio of the lungs were measured before and after 24 hours of cold preservation and after a 60-minute reperfusion period. RESULTS: Treatment with OP2507 significantly attenuated increases in pulmonary arterial pressure, pulmonary vascular resistance, and airway pressure after preservation and during the reperfusion period. Oxygen tension in outflow blood also was maintained with OP2507 treatment throughout the experimental period, whereas it was depressed during the reperfusion period in the control group. By electron microscopy, there was little evidence of vascular endothelial damage, such as cell swelling, detachment of endothelial cells from the lamina, and attenuation of the cytoplasm, in both groups. However, the tight junctions between cells were observed more clearly in the control group than in the OP2507 group, suggesting more cell membrane damage in the control group. CONCLUSIONS: Pretreatment with OP2507 prevented pulmonary artery and airway constriction after 12 hours of cold lung preservation and a decrease of oxygen tension in outflow blood during a 60-minute reperfusion period.

Isolated lung perfusion with cisplatin in a rat lung solitary tumor nodule model.

BACKGROUND: The present study was conducted to evaluate the toxicity, pharmacokinetics and anti-tumor potency of isolated lung perfusion (ILP) with cisplatin in a visible lung tumor nodule model in rats. MATERIALS AND METHODS: A solitary tumor nodule was established by the injection of Methylcholanthrene-induced sarcoma cells into the left lung. Thirty rats were randomized to undergo ILP with either 0.1, 0.25, or 0.5 mg/mL cisplatin and buffered hespan (BHE), or with an intravenous injection of 1.0 or 2.5 mg cisplatin. RESULTS: The highest dose of cisplatin tolerated by the rats was 0.1 mg/mL for perfusion. A much higher platinum concentration in the tumor, of 6.67 +/- 1.64 vs. 2.51 +/- 0.60 micrograms/g tissue, but a significantly lower concentration in the serum and kidneys, was achieved by perfusion compared to that achieved by intravenous injection. A significantly lower tumor weight and 20% complete treatment response was achieved in rats given cisplatin than in those given BHE perfusion at 43.9 +/- 11.6 vs. 226.3 +/- 44.6 mg. CONCLUSION: ILP with cisplatin achieved superior results to intravenous injection according to the levels of toxicity and pharmacokinetic analysis, and it was effective against a visible tumor nodule model in rats.

Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord.

STUDY DESIGN: Magnetic resonance images of cervical compression myelopathy were retrospectively analyzed in comparison with surgical outcomes. OBJECTIVES: To investigate which magnetic resonance findings in patients with cervical compression myelopathy reflect the clinical symptoms and prognosis, and to determine the radiographic and clinical factors that correlate with the prognosis. SUMMARY OF BACKGROUND DATA: Signal intensity changes of the spinal cord on magnetic resonance imaging in chronic cervical myelopathy are thought to be indicative of the prognosis. However, the prognostic significance of signal intensity change remains controversial. METHODS: The participants in this study were 73 patients who underwent cervical expansive laminoplasty for cervical compression myelopathy. Their mean age was 64 years, and the mean postoperative follow-up period was 3.4 years. The pathologic conditions were cervical spondylotic myelopathy in 42 patients and ossification of the posterior longitudinal ligament in 31 patients. Magnetic resonance imaging (spin-echo sequence) was performed in all the patients. The transverse area of the spinal cord at the site of maximal compression was computed, and spinal cord signal intensity changes were evaluated before and after surgery. Three patterns of spinal cord signal intensity changes on T1-weighted sequences/T2-weighted sequences were detected as follows: normal/normal, normal/high-signal intensity changes, and low-signal/high-signal intensity changes. Surgical outcomes were compared among these three groups. The most useful combination of parameters for predicting prognosis was determined using a stepwise regression analysis. RESULTS: The findings showed 2 patients with normal/normal, 67 patients with normal/high-signal, and 4 patients with low-signal/high-signal change patterns before surgery. Regarding postoperative recovery, the preoperative low-signal/high-signal group was significantly inferior to the preoperative normal/high-signal group. There was no significant difference between the transverse area of the spinal cord at the site of maximal compression in the normal/high-signal group and the low-signal/high-signal group. A stepwise regression analysis showed that the best combination of surgical outcome predictors included age (correlation coefficient R = -0.348), preoperative signal pattern, and duration of symptoms (correlation coefficient R = -0.231). CONCLUSIONS: The low-signal intensity changes on T1-weighted sequences indicated a poor prognosis. The authors speculate that high-signal intensity changes on T2 weighted images include a broad spectrum of compressive myelomalacic pathologies and reflect a broad spectrum of spinal cord recuperative potentials. Predictors of surgical outcomes are preoperative signal intensity change pattern of the spinal cord on radiologic evaluations, age at the time of surgery, and chronicity of the disease.

Lung volume reduction surgery for pulmonary emphysema using dynamic Xenon-133 and Tc-99m-MAA SPECT images.

The usefulness of Xe-133 and Tc-99m-MAA single photon emission computed tomography (SPECT) in identifying areas to be resected during video-assisted thoracoscopic lung reduction surgery for emphysema was examined. Twenty-nine patients with advanced emphysema were examined using Xe-133 and Tc-99m-MAA SPECT prior to and following surgery. For the Xe-133 dynamic SPECT, patients inhaled Xe-133 gas for 6 minutes. Equilibrium and subsequent washout SPECT images were acquired every 30 seconds for 6 to 7 minutes during spontaneous breathing. Ventilation was quantified by Xe-133 clearance time (T1/2) in addition to visual assessment. The patients underwent unilateral thoracoscopic volume reduction in the regions with abnormal Xe-133 retention and Tc-99m-MAA defect. All patients demonstrated marked, heterogeneous Xe-133 retention and Tc-99m-MAA defects preoperatively. The worst functioning areas were identified as nonventilated and noflow areas, or areas with air trapping and low perfusion. These changes were found even in patients with diffuse and symmetrical impairments on chest CT. After surgery, most of these "target areas" disappeared and pulmonary function tests demonstrated significant improvement. T1/2 correlated closely with the percent predicted FEV1 (%FEV) and 6-minute walk distance before and after surgery (p<0.0001). Xe-133 and Tc-99m-MAA SPECT imaging was useful in identifying "target areas" in the emphysematous lung. Directed unilateral thoracoscopic volume reduction based on these SPECT images is an effective treatment for emphysema.

Obstruction of the right ventricle outflow tract during right cardiac prolapse.

We observed cardiac prolapse following right pneumonectomy in which the patient experienced a 90 degree rotation of the heart and compression of right ventricular outflow tract from behind by the aorta, which led to an increase in right atrial pressure and a decrease of pulmonary artery pressure and cardiac output. Compression of the right ventricular outflow tract by the base of the aorta was observed as an additional shock inducing factor in right cardiac prolapse.

Terahertz-wave water concentration and distribution measurement in thin biotissue based on a novel sample preparation.

The measurement of water concentration and distribution in thin biotissues with terahertz (THz)-wave has been proposed. In this paper, a novel sample preparation approach was introduced to effectively preserve tissue freshness at room temperature. Excellent stability of this method was demonstrated by measuring the transmittance spectroscopy and imaging many times within a certain time. Moreover, the reliability of water volume concentration measurement with THz-wave was evaluated. Measurement results using THz-wave were in good agreement with volume concentration measurement results based on other quantitative methods. The results suggest that water concentration and distribution measurement in thin biotissues using THz-wave will be a potential modality for medical and biological diagnosis.

Semiconductor laser to single-mode fiber coupler.

Promising results of various coupling experiments between laser diodes and single-mode fibers to determine the optimum coupling method are reported. The cylindrical lens method is shown to be most efficient, with a coupling loss of 1.8 dB under optimum alignment conditions. More than -2 dB coupling efficiency is attained with a cylindrical lens whose radius is less than 8 microm. The laser to fiber coupling characteristics are estimated by Gaussian beam approximation. The optimum radius of a cylindrical lens, which gives maximum coupling efficiency, is derived by theoretical calculation, using the ray matrix method. The cylindrical lens alignment tolerance is also shown theoretically and experimentally.

Osseous lesions associated with anterior cruciate ligament injuries. Assessment by magnetic resonance imaging at various periods after injuries.

In 56 patients with anterior cruciate ligament (ACL) rupture, we retrospectively examined osseous lesions secondary to the rupture using magnetic resonance imaging (MRI). Depending on the time from their ligamentous injury to the performance of MRI, the patients were divided into three groups: the acute group (less than 1 month, n = 20), the subacute group (between 1 and 12 months, n = 16), and the chronic group (12 months or more, n = 20). Occult osseous lesions which were not detected by roentgenography were revealed by MRI in 14 patients in the acute group (70.0%), 5 in the subacute group (31.3%), and 1 in the chronic group (5%). The detection rate of osseous lesions by MRI was significantly higher in the acute group than in the other groups (P < 0.001). Osseous lesions were always detected in the same locations of the lateral compartment of the knee joint. When examined by arthroscopy, these lesions were often found to be accompanied by articular cartilage injuries. In the acute group, osseous lesions were visible in the high signal intensity area of T2-weighted images and in the low signal intensity area of proton density images. They were interpreted as representing hemorrhage and edema within the bone marrow. In the subacute and chronic groups, the osseous lesions were smaller, and their signal intensity on T2-weighted images was lower than that in the acute group, probably reflecting the ongoing resorption of the hemorrhage and healing of the lesions. These results suggest that osseous lesions develop following injury to the ACL.

Quantitative evaluation of gait pattern in patients with osteoarthrosis of the knee before and after total knee arthroplasty. Gait analysis using a pressure measuring system.

Using a pressure measuring system, we quantitatively evaluated gait pattern in patients with osteoarthrosis (OA) of the knee before and after total knee arthroplasty (TKA). In the OA group, the stance time was longer, and the average vertical component of the floor reaction force (AVF) was lower than the values in normal age-matched subjects. These gait parameters correlated with the clinical score. These results suggest that changes in the gait parameters reflect gait patterns that reduce load on the knee. The center of pressure (COP) under the foot was correlated with the axial alignment of the lower limb in the mid-stance phase. In the TKA group, the clinical scores and gait parameters were improved 12 months after surgery compared with the preoperative values. The COP in the mid-stance phase moved inward after the TKA. However, in patients examined more than 2 years after a TKA, stance time and AVF did not reach normal levels, despite the patients' good clinical scores. These findings indicate that the gait pattern before surgery continues although pain on walking is reduced early after a TKA. Gait evaluation with a simple pressure measuring system revealed the changes in gait that are difficult to define by subjective clinical assessment.

Knee deformities in multiple hereditary exostoses. A longitudinal radiographic study.

For a mean period of 7.8 years, the morphology of knee deformity and its annual changes in 8 patients (16 knees; mean age at the initial examination, 8.4 years) with multiple hereditary exostoses were evaluated radiographically. Knee deformity developed during the growth spurt period. Genu valgum with a femorotibial angle that decreased more than 2 standard deviations from the mean of age-matched normal children was observed in 6 of the 16 knees. In 3 of these 6 knees, recurrent dislocation of the patella was observed. Angulation of the femur varied among the knees, but the tibia showed valgus angulation in the proximal metaphysis in all knees. Thus, knee deformity in patients with multiple hereditary exostoses was primarily genu valgum caused by valgus angulation of the tibia.

Radiological pathogenesis of cervical myelopathy in 60 consecutive patients with cervical ossification of the posterior longitudinal ligament.

STUDY DESIGN: The radiological pathogenetic factors for cervical myelopathy in 60 consecutive patients with cervical ossification of the posterior longitudinal ligament (OPLL) were investigated retrospectively. OBJECTIVE: To clarify which patients with OPLL will develop cervical myelopathy. METHODS: Sixty consecutive patients with OPLL were radiologically assessed comparing the myelopathic patient group (M group, n=41) and the mild or non-myelopathic patient group (non-M group, n=19). RESULTS: The narrowing ratio of the spinal canal in the M group (47.1%) was significantly greater (P=0.026) than that in the non-M group (38.3%). The two groups showed a significant difference (P=0.0016) with regard to the Pavlov ratio (M group, 0.73; non-M group, 0.84). The total range of motion of the cervical spine did not differ between the two groups but the per cent range of motion was significantly greater (P=0.037) in the M group than in the non-M group. CONCLUSION: This study suggests that factors important in the onset or aggravation of myelopathy are factors related to pathological compression by OPLL, cervical soft disc herniation, developmentally narrow spinal canal, and local or non-proportional hypermobility.