Metabolic acidemia due to saline absorption during transurethral and transcervical surgery: a report of 2 cases.

BACKGROUND: The development of endoscopic systems that include bipolar electrocautery has enabled the use of normal saline irrigation in transurethral or transcervical endoscopic surgery. However, excessive saline absorption can cause hyperchloremic metabolic acidosis. CASE PRESENTATION: Patient 1: A 76-year-old man was scheduled for transurethral resection of the prostate with saline irrigation. Approximately 140 min after the surgery, abdominal distension and cervical edema were observed. Abdominal ultrasound examination indicated a subhepatic hypoechoic lesion, which suggested extravasation of saline. Arterial blood gas analysis revealed hyperchloremic metabolic acidosis. The patient was extubated 2 h after the operation with no subsequent airway problems, and the electrolyte imbalance was gradually corrected. Patient 2: A 43-year-old woman was scheduled for transcervical resection of a uterine fibroid with saline irrigation. When the drape was removed after the operation was finished, notable upper extremity edema was observed. Arterial blood gas analysis revealed hyperchloremic metabolic acidosis. The patient's acidemia, electrolyte imbalance, and neck edema gradually resolved, and the patient was extubated 16 h after the operation without subsequent airway problems. CONCLUSIONS: Anesthesiologists should be aware of acidemia, cardiopulmonary complications, and airway obstruction caused by excessive saline absorption after saline irrigation in endoscopic surgery.

Laser frequency measurement in the short-wavelength region using an intermediate laser and a frequency noise cancellation method.

Optical frequency combs play a crucial role supporting optical frequency standards and cover a wide range of wavelengths (octaves). However, broadening the comb spectrum to the short-wavelength visible region (λ < 500 nm), where GaN-based blue diode lasers are available, is not an easy task. In this study, we propose a method for measuring the laser frequency in the short-wavelength region using an intermediate laser and a noise-canceling scheme. We demonstrate this method by measuring the frequency of a GaN-based laser at 399 nm and confirming that the frequency measurement is not affected by the frequency noise of the intermediate laser.

Inhaled nitric oxide improves post-cardiac arrest outcomes via guanylate cyclase-1 in bone marrow-derived cells.

RATIONALE: Nitric oxide (NO) exerts its biological effects primarily via activation of guanylate cyclase (GC) and production of cyclic guanosine monophosphate. Inhaled NO improves outcomes after cardiac arrest and cardiopulmonary resuscitation (CPR). However, mechanisms of the protective effects of breathing NO after cardiac arrest are incompletely understood. OBJECTIVE: To elucidate the mechanisms of beneficial effects of inhaled NO on outcomes after cardiac arrest. METHODS: Adult male C57BL/6J wild-type (WT) mice, GC-1 knockout mice, and chimeric WT mice with WT or GC-1 knockout bone marrow were subjected to 8 min of potassium-induced cardiac arrest to determine the role of GC-1 in bone marrow-derived cells. Mice breathed air or 40 parts per million NO for 23 h starting at 1 h after CPR. RESULTS: Breathing NO after CPR prevented hypercoagulability, cerebral microvascular occlusion, an increase in circulating polymorphonuclear neutrophils and neutrophil-to-lymphocyte ratio, and right ventricular dysfunction in WT mice, but not in GC-1 knockout mice, after cardiac arrest. The lack of GC-1 in bone marrow-derived cells diminished the beneficial effects of NO breathing after CPR. CONCLUSIONS: GC-dependent signaling in bone marrow-derived cells is essential for the beneficial effects of inhaled NO after cardiac arrest and CPR.

Iodine-stabilized laser at telecom wavelength using dual-pitch periodically poled lithium niobate waveguide.

We demonstrate the third harmonic generation of a 1542-nm laser using a dual-pitch periodically poled lithium niobate waveguide with a conversion efficiency of 66%/W2. The generated 514-nm light is used for saturation spectroscopy of molecular iodine and laser frequency stabilization. The achieved laser frequency stability is 1.1×10-12 at an average time of 1 s, which is approximately one order of magnitude better than the acetylene-stabilized laser at 1542 nm. Uncertainty evaluation and absolute frequency measurement are also performed. The developed frequency-stabilized laser can be used as a reliable frequency reference at the telecom wavelength for various applications including optical frequency combs and precision interferometric measurement.

Evaluation of laser frequency offset locking using an electrical delay line.

Frequency offset locking between two Nd:YAG lasers is performed using frequency locking with an electrical delay line. The relative frequency instability of the offset locking is measured to be 3.5×10-12 for an averaging time of 1 s, which is approximately 77 times smaller than that of the free-running case. The frequency instability of the frequency locking is compared to that of the phase locking between the two Nd:YAG lasers. Furthermore, a compact solid-state laser is frequency locked to an optical frequency comb with a frequency instability of 8.2×10-11 for an averaging time of 1 s, which is improved by approximately 20 times, with respect to the free-running case. The offset-locking scheme using a delay line is useful for various applications including a research on quantum optics, interferometric measurements, and experiments involving laser cooling, such as an optical lattice clock.

S-Nitrosylation of Calcium-Handling Proteins in Cardiac Adrenergic Signaling and Hypertrophy.

RATIONALE: The regulation of calcium (Ca(2+)) homeostasis by ß-adrenergic receptor (ßAR) activation provides the essential underpinnings of sympathetic regulation of myocardial function, as well as a basis for understanding molecular events that result in hypertrophic signaling and heart failure. Sympathetic stimulation of the ßAR not only induces protein phosphorylation but also activates nitric oxide-dependent signaling, which modulates cardiac contractility. Nonetheless, the role of nitric oxide in ßAR-dependent regulation of Ca(2+) handling has not yet been explicated fully. OBJECTIVE: To elucidate the role of protein S-nitrosylation, a major transducer of nitric oxide bioactivity, on ßAR-dependent alterations in cardiomyocyte Ca(2+) handling and hypertrophy. METHODS AND RESULTS: Using transgenic mice to titrate the levels of protein S-nitrosylation, we uncovered major roles for protein S-nitrosylation, in general, and for phospholamban and cardiac troponin C S-nitrosylation, in particular, in ßAR-dependent regulation of Ca(2+) homeostasis. Notably, S-nitrosylation of phospholamban consequent upon ßAR stimulation is necessary for the inhibitory pentamerization of phospholamban, which activates sarcoplasmic reticulum Ca(2+)-ATPase and increases cytosolic Ca(2+) transients. Coincident S-nitrosylation of cardiac troponin C decreases myocardial sensitivity to Ca(2+). During chronic adrenergic stimulation, global reductions in cellular S-nitrosylation mitigate hypertrophic signaling resulting from Ca(2+) overload. CONCLUSIONS: S-Nitrosylation operates in concert with phosphorylation to regulate many cardiac Ca(2+)-handling proteins, including phospholamban and cardiac troponin C, thereby playing an essential and previously unrecognized role in cardiac Ca(2+) homeostasis. Manipulation of the S-nitrosylation level may prove therapeutic in heart failure.

Mitochondria-targeted hydrogen sulfide donor AP39 improves neurological outcomes after cardiac arrest in mice.

AIMS: Mitochondria-targeted hydrogen sulfide donor AP39, [(10-oxo-10-(4-(3-thioxo-3H-1,2-dithiol-5yl)phenoxy)decyl) triphenylphosphonium bromide], exhibits cytoprotective effects against oxidative stress in vitro. We examined whether or not AP39 improves the neurological function and long term survival in mice subjected to cardiac arrest (CA) and cardiopulmonary resuscitation (CPR). METHODS: Adult C57BL/6 male mice were subjected to 8 min of CA and subsequent CPR. We examined the effects of AP39 (10, 100, 1000 nmol kg(-1)) or vehicle administered intravenously at 2 min before CPR (Experiment 1). Systemic oxidative stress levels, mitochondrial permeability transition, and histological brain injury were assessed. We also examined the effects of AP39 (10, 1000 nmol kg(-1)) or vehicle administered intravenously at 1 min after return of spontaneous circulation (ROSC) (Experiment 2). ROSC was defined as the return of sinus rhythm with a mean arterial pressure >40 mm Hg lasting at least 10 seconds. RESULTS: Vehicle treated mice subjected to CA/CPR had poor neurological function and 10-day survival rate (Experiment 1; 15%, Experiment 2; 23%). Administration of AP39 (100 and 1000 nmol kg(-1)) 2 min before CPR significantly improved the neurological function and 10-day survival rate (54% and 62%, respectively) after CA/CPR. Administration of AP39 before CPR attenuated mitochondrial permeability transition pore opening, reactive oxygen species generation, and neuronal degeneration after CA/CPR. Administration of AP39 1 min after ROSC at 10 nmol kg(-1), but not at 1000 nmol kg(-1), significantly improved the neurological function and 10-day survival rate (69%) after CA/CPR. CONCLUSION: The current results suggest that administration of mitochondria-targeted sulfide donor AP39 at the time of CPR or after ROSC improves the neurological function and long term survival rates after CA/CPR by maintaining mitochondrial integrity and reducing oxidative stress.

Influence of model grid resolution on NO2 vertical column densities over East Asia.

UNLABELLED: NO2 vertical column densities (VCDs) over East Asia in June and December 2007 were simulated by the Community Multi-scale Air Quality (CMAQ) version 4.7.1 using an updated and more elaborate version of the Regional Emission Inventory in Asia (REAS) version 2. The modeling system could reasonably capture observed spatiotemporal changes of NO2 VCDs by satellite sensors, the Global Ozone Monitoring Experiment-2 (GOME-2), the Scanning Imaging Absorption Spectrometer for Atmospheric Cartography (SCIAMACHY), and the Ozone Monitoring Instrument (OMI), even at the coarsest horizontal resolution of 80 km. The CMAQ simulations were performed in a sequence of three horizontal resolutions (80 km, 40 km, and 20 km) for June and December 2007 to investigate the influence of changes of horizontal resolution on the obtained NO2 VCDs. CMAQ-simulated NO2 VCDs generally increased with improvements in resolution from 80 km to 40 km and then to 20 km. Increases in the CMAQ-simulated NO2 VCDs were greater for the change from 80 km to 40 km than for those from 40 km and 20 km, in which the increases of NO2 VCDs due to the improvement of horizontal resolution were approached convergence at the horizontal resolution of approximately 20 km. Conversely, no clear convergences in NO2 VCDs changes were found at near Tokyo and over the East China Sea. The biases of the NO2 VCDs simulated at a resolution of 20 km against the satellite retrievals were -36% near Beijing (CHN1) and -78% near Shanghai (CHN2) in summer; these errors were found to be comparable to the horizontal resolution-dependent errors, which were 18-25% at CHN1 and 44-58% at CHN2 from 80 km to 40 km. Conversely, the influence of changes of horizontal resolution in winter was relatively less compared to that in summer. IMPLICATIONS: NO2 VCDs over East Asia in June and December 2007 were simulated using CMAQ version 4.7.1 and REAS version 2. The modeling system could reasonably capture observed spatiotemporal changes of NO2 VCDs by satellite sensors. The CMAQ simulations were performed in a sequence of three horizontal resolutions, 80, 40, and 20 km, to investigate the influence of changes of horizontal resolution on the obtained NO2 VCDs. The results suggested that the influence of changes of horizontal resolution was larger in summer compared to that in winter. The magnitude of the influence was comparable to the biases of the NO2 VCDs simulated at a resolution of 20 km against the satellite retrievals.

Sensitivity analysis of source regions to PM2.5 concentration at Fukue Island, Japan.

UNLABELLED: The authors analyze the sensitivities of source regions in East Asia to PM2.5 (particulate matter with an aerodynamic diameter of < or = 2.5 microm) concentration at Fukue Island located in the western part of Japan by using a regional chemical transport model with emission sensitivity simulations for the year 2010. The temporal variations in PM2.5 concentration are generally reproduced, but the absolute concentration is underestimated by the model. Chemical composition of PM2.5 in the model is compared with filter sampling data in spring; simulated sulfate, ammonium, and elemental carbon are consistent with observations, but mass concentration of particulate organic matters is underestimated. The relative contribution from each source region shows the seasonal variation, especially in summer. The contribution from central north China (105 degrees E-124 degrees E, 34 degrees N-42 degrees N) accounts for 50-60% of PM2.5 at Fukue Island except in summer; it significantly decreases in summer (18%). Central south China (105 degrees E-123 degrees E, 26 degrees N-34 degrees N) has the relative contribution of 15-30%. The contribution from the Korean Peninsula is estimated at about 10% except in summer. The domestic contribution accounts for about 7% in spring and autumn and increases to 19% in summer. We also estimate the relative contribution to daily average concentration in high PM2.5 days (> 35 microg m(-3)). Central north China has a significant contribution of 60-70% except in summer. The relative contribution from central south China is estimated at 46% in summer and about 30% in the other seasons. The contributions from central north and south China on high PM2.5 days are generally larger than those of their seasonal mean contributions. The domestic contribution is smaller than the seasonal mean value in every season; it is less than 10% even in summer. These model results suggest that foreign anthropogenic sources have a substantial impact on attainment of the atmospheric environmental standard of Japan at Fukue Island. IMPLICATIONS: The contribution from several source regions in East Asia to PM2.5 concentration at Fukue Island, a remote island located in the western part of Japan and close to the Asian continent, is estimated using a three-dimensional chemical transport model. The model results suggest that PM2.5 that is attributed to foreign anthropogenic sources have a larger contribution than that of domestic pollution and have a substantial impact on attainment of the atmospheric environmental standard of Japan at Fukue Island.

Identifying profiles of stroke patients benefitting from additional training: a latent class analysis approach.

OBJECTIVE: To identify profiles of stroke patient benefitting from additional training, using latent class analysis. DESIGN: Retrospective observational study. PATIENTS: Patients with stroke (n = 6,875) admitted to 42 recovery rehabilitation units in Japan between January 2005 and March 2016 who were registered in the Japan Association of Rehabilitation Database. METHODS: The main outcome measure was the difference in Functional Independence Measure (FIM) scores between admission and discharge (referred to as "gain"). The effect of additional training, categorized as usual care (no additional training), self-exercise, training with hospital staff, or both exercise (combining self-exercise and training with hospital staff), was assessed through multiple regression analyses of latent classes. RESULTS: Applying inclusion and exclusion criteria, 1185 patients were classified into 7 latent classes based on their admission characteristics (class size n = 82 (7%) to n = 226 (19%)). Patients with class 2 characteristics (right hemiparesis and modified dependence in the motor-FIM and cognitive-FIM) had positive FIM gain with additional training (95% confidence interval (95% CI) 0.49-3.29; p < 0.01). One-way analysis of variance revealed that training with hospital staff (95% CI 0.07-16.94; p < 0.05) and both exercises (95% CI 5.38-15.13; p < 0.01) led to a significantly higher mean FIM gain than after usual care. CONCLUSION: Additional training in patients with stroke with right hemiparesis and modified dependence in activities of daily living was shown to improve activities of daily living. Training with hospital staff combined with self-exercise is a promising rehabilitation strategy for these patients.

Detection of a Prethrombotic State in Patients with Hepatocellular Carcinoma, Using a Clot Waveform Analysis.

Background: Although hepatocellular carcinoma (HCC) is frequently associated with thrombosis, it is also associated with liver cirrhosis (LC) which causes hemostatic abnormalities. Therefore, hemostatic abnormalities in patients with HCC were examined using a clot waveform analysis (CWA). Methods: Hemostatic abnormalities in 88 samples from HCC patients, 48 samples from LC patients and 153 samples from patients with chronic liver diseases (CH) were examined using a CWA-activated partial thromboplastin time (APTT) and small amount of tissue factor induced FIX activation (sTF/FIXa) assay. Results: There were no significant differences in the peak time on CWA-APTT among HCC, LC, and CH, and the peak heights of CWA-APTT were significantly higher in HCC and CH than in HVs and LC. The peak heights of the CWA-sTF/FIXa were significantly higher in HCC than in LC. The peak times of the CWA-APTT were significantly longer in stages B, C, and D than in stage A or cases of response. In the receiver operating characteristic (ROC) curve, the fibrin formation height (FFH) of the CWA-APTT and CWA-sTF/FIXa showed the highest diagnostic ability for HCC and LC, respectively. Thrombosis was observed in 13 HCC patients, and arterial thrombosis and portal vein thrombosis were frequently associated with HCC without LC and HCC with LC, respectively. In ROC, the peak time×peak height of the first derivative on the CWA-sTF/FIXa showed the highest diagnostic ability for thrombosis. Conclusion: The CWA-APTT and CWA-sTF/FIXa can increase the evaluability of HCC including the association with LC and thrombotic complications.

Perineural Invasion Predicts Unfavorable Prognosis in Patients With Invasive Breast Cancer.

BACKGROUND/AIM: Perineural invasion (PNI) is a poor prognostic factor in a variety of cancers. However, the frequency of PNI in invasive breast carcinoma varies among studies, and the prognostic significance of PNI remains unclear. Therefore, we aimed to explore the prognostic value of PNI in breast cancer patients. PATIENTS AND METHODS: The cohort included 191 consecutive female patients who underwent surgical resection of invasive carcinoma of no special type (NOS). The correlations between PNI and clinicopathological characteristics including prognosis were investigated. RESULTS: The frequency of PNI was 14.1% (27/191) and the PNI-positive status was significantly correlated with large pathological tumor size (p=0.005), lymph node metastasis (p=0.001), and lymphatic invasion (p=0.009). The log-rank test showed that PNI-positive patients had shorter distant metastasis-free survival (DMFS) (p=0.002) and disease-specific survival (DSS) (p<0.001). According to the multivariate analysis, PNI had a significant adverse effect on DMFS (p=0.037) and DSS (p=0.003). CONCLUSION: PNI could be used as an independent poor prognostic indicator in patients with invasive breast carcinoma.

Cost-effectiveness of occupational therapy for older adults: a protocol for an updated systematic review.

INTRODUCTION: The ageing populations in developed countries are a global concern, with increasing numbers of older adults facing physical, cognitive and psychological challenges, resulting in reduced quality of life and higher healthcare costs. Healthcare expenditure worldwide has been on the rise, especially among older adults, emphasising the importance of enabling independent living while reducing healthcare costs. Occupational therapy holds promising outcomes in promoting functional independence and enhancing the quality of life for older adults, but research on its cost-effectiveness remains limited. This systematic review aims to evaluate the recent evidence on the cost-effectiveness of occupational therapy interventions for older adults from a pragmatic perspective. METHODS AND ANALYSIS: This systematic review will cover full economic evaluations, including cost-effectiveness, cost-utility and cost-benefit analyses, by reviewing randomised and cluster randomised controlled trials. The participants will be aged over 65 years without disease or disability restrictions. Primary outcomes will be assessed using functional status and quality-of-life assessments. Studies published before July 2023 will be searched in PubMed, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, with no language restrictions. ETHICS AND DISSEMINATION: Ethical approval is not required for this literature-based systematic review. The study's findings will update the evaluation of occupational therapy's cost-effectiveness in older adults and will be made public by publishing them in scholarly journals. PROSPERO REGISTRATION NUMBER: CRD42023453558.

Predictive prognostic biomarkers in patients with COVID­19 infection.

The present study aimed to identify useful biomarkers to predict deterioration in patients with coronavirus disease 2019 (COVID­19). A total of 201 COVID­19 patients were classified according to their disease severity into non­severe (n=125) and severe (n=76) groups, and the behavior of laboratory biomarkers was examined according to the prognosis. Neutrophil count, aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase (LDH), C­reactive protein (CRP), sialylated carbohydrate antigen KL­6 (KL­6), procalcitonin (PCT), presepsin (PSP) and D­dimer levels were significantly higher, and lymphocyte count and platelet count were significantly lower in the non­severe group compared with the severe group. In the non­severe group, ROC analysis demonstrated that only four biomarkers, CRP, PSP, AST and LDH were useful for differentiating the prognosis between improvement and deterioration subgroups. No strong correlation was revealed for any of the markers. Multivariate analysis identified CRP as a significant prognostic factor in non­severe cases (odds ratio, 41.45; 95% confidence interval, 4.91­349.24; P<0.001). However, there were no blood biomarkers that could predict the outcome of patients in the severe group. Overall, several blood markers changed significantly according to disease severity in the course of COVID­19 infection. Among them, CRP, PSP, LDH and AST were the most reliable markers for predicting the patient's prognosis in non­severe COVID­19 cases.

Development of a new scale for the measurement of interprofessional collaboration among occupational therapists, physical therapists and speech-language therapists.

Background/Objective: The purpose of this study is to develop and validate an instrument to assess interprofessional collaboration by occupational therapists, physical therapists, and speech-language therapists. Methods: Item development consisted of a review of interprofessional collaboration and group interviews with occupational therapists, physical therapists, and speech-language therapists. The developed items were surveyed on a 4-point Likert scale among occupational therapists, physical therapists, and speech-language therapists. Ceiling effects, floor effects, and item-total correlation analysis for each item, as well as constructs, internal consistency, and cross-cultural validity of the scales were evaluated. Results: A total of 47 items were extracted for evaluation and 28 items with five factors ("team-oriented behavior," "exchange of opinions," "flexible response," "sharing the whole picture of the patient," and "coordination of support methods") were retained after the evaluation. The correlation coefficients of the five factors ranged from 0.48 to 0.72. The total score of each factor and the total score of all 28 items were compared for occupational therapists, physical therapists, and speech-language therapists, and the result showed that was no statistically significant difference between the total scores of all factors and the job titles. The Cronbach's alpha coefficients for the five factors are 0.842, 0.840, 0.805, 0.732, and 0.734 for the first, second, third, fourth, and fifth factors, respectively. Conclusions: The developed scale includes items aimed at facilitating patients' activities of daily living through interprofessional collaboration, and its content reflects the expertise of occupational therapists, physical therapists, and speech-language therapists.

Validation of the Mitochondrial Delivery of Vitamin B1 to Enhance ATP Production Using SH-SY5Y Cells, a Model Neuroblast.

Large amounts of ATP are produced in mitochondria especially in the brain and heart, where energy consumption is high compared with other organs. Thus, a decrease in ATP production in such organs could be a cause of many diseases such as neurodegenerative diseases and heart disease. Based on thus assumption, increasing intracellular ATP production in such organs could be a therapeutic strategy. In this study, we report on the delivery of vitamin B1, a coenzyme that activates the tricarboxylic acid (TCA) cycle, to the inside of mitochondria. Since the TCA cycle is responsible for ATP production, we hypothesized delivering vitamin B1 to mitochondria would enhance ATP production. To accomplish this, we used a mitochondrial targeted liposome a "MITO-Porter" as the carrier. Using SH-SY5Y cells, a model neuroblast, cellular uptake and intracellular localization were analyzed using flow cytometry and confocal laser scanning microscopy. The optimized MITO-Porter containing encapsulated vitamin B1 (MITO-Porter (VB1)) was efficiently accumulated in mitochondria of SH-SY5Y cells. Further studies confirmed that the level of ATP production after the MITO-Porter (VB1) treatment was significantly increased as compared to a control group that was treated with naked vitamin B1. This study provides the potential for an innovative therapeutic strategy in which the TCA cycle is activated, thus enhancing ATP production.

Effectiveness of active occupational therapy in patients with acute stroke: A propensity score-weighted retrospective study.

Background and purpose: The effects of therapy and patient characteristics on rehabilitation outcomes in patients with acute stroke are unclear. We investigated the effects of intensive occupational therapy (OT) on patients with acute stroke. Methods: We performed a retrospective cohort study using the 2005-2016 Japan Rehabilitation Database, from which we identified patients with stroke (n = 10,270) who were admitted to acute care hospitals (n = 37). We defined active OT (AOT) and non-AOT as OT intervention times (total intervention time/length of hospital stay) longer or shorter than the daily physical therapy intervention time, respectively. The outcomes assessed were the Functional Independence Measure (FIM) and National Institutes of Health Stroke Scale (NIHSS) scores, duration of hospitalization, and rate of discharge. Propensity scores and inverse probability of treatment weighting analyses adjusted for patient characteristics were performed to investigate the effects of AOT on patient outcomes. Results: We enrolled 3,501 patients (1,938 and 1,563 patients in the AOT and non-AOT groups, respectively) in the study. After inverse probability of treatment weighting, the AOT group had a shorter length of hospitalization (95% confidence interval: -3.7, -1.3, p < 0.001), and the FIM (95% confidence interval: 2.0, 5.7, p < 0.001) and NIHSS (95% confidence interval; 0.3, 1.1, p < 0.001) scores improved significantly. Subgroup analysis showed that lower NHISS scores for aphasia, gaze, and neglect and lower overall NIHSS and FIM scores on admission led to a greater increase in FIM scores in the AOT group. Conclusions: AOT improved the limitations in performing activities of daily living (ADL) and physical function in patients with acute stroke and reduced the length of hospitalization. Additionally, subgroup analysis suggested that the increase in FIM score was greater in patients with severe limitations in performing ADLs and worse cognitive impairment, such as neglect, on admission.

Medical Costs and Readmissions After Intensive Poststroke Rehabilitation: Japanese Claims Data.

OBJECTIVES: This study examined the association between intensive rehabilitation for subacute stroke patients and medical costs and readmission ratio during the year after discharge. DESIGN: This was a natural experiment study. SETTING AND PARTICIPANTS: We identified individuals with a diagnosis of cerebrovascular disorder (ICD-10: I60-I69 cerebrovascular disease) in an insurance claims database in Japan from January 2005 to December 2017. From the database, 980 patients who were admitted to a convalescent rehabilitation unit with stroke were identified. After excluding 575 patients, 405 were eligible for the study. METHODS: In Japan, from April 2011, a new policy was established that allows special costs to be added as rehabilitation time increases. This policy provides an additional medical fee for inpatients in a convalescent rehabilitation unit who receive more than 120 minutes of rehabilitation therapy. We defined high-intensity rehabilitation as transfer from hospitalization to a convalescent rehabilitation unit after April 2011. Outcomes were total direct medical costs and readmission ratio during the year after discharge from the convalescent rehabilitation unit. RESULTS: Daily rehabilitation time, total rehabilitation time, and total medical costs of the high-intensity rehabilitation group were significantly higher than those of the low-intensity rehabilitation group (P < .001, P < .001, P = .011, respectively). However, there was no significant difference in the medical costs during the year after discharge (P = .653) or in the readmission ratio (hazard ratio: 1.09, 95% confidence interval: 0.55-2.18, P = .804). CONCLUSIONS AND IMPLICATIONS: Intensive rehabilitation did not reduce medical costs or the readmission ratio during the first year after discharge. Future studies should consider the necessary rehabilitation intensity given the severity of the patient's condition, using large sample sizes.

Atmospheric response to high-resolution topographical and radiative forcings in a general circulation model of Venus: Time-mean structures of waves and variances.

Thermal tides, stationary waves, and general circulation are investigated using a T63 Venus general circulation model (GCM) with solar and thermal radiative transfer in the presence of high-resolution surface topography, based on time average analysis. The simulated wind and static stability are very similar to the observed ones (e.g., Horinouchi et al., 2018; Ando et al., 2020). The simulated thermal tides accelerate an equatorial superrotational flow with a speed of ~90 m s-1 around the cloud-heating maximum (~65 km). The zonal-flow acceleration rates of 0.2-0.5 m s-1 Earth day-1 are produced by both horizontal and vertical momentum fluxes at low latitudes. In the GCM simulation, strong solar heating above the cloud top (>69 km) and infrared heating around the cloud bottom (~50 km) modify the vertical structures of thermal tides and their vertical momentum fluxes, which accelerate zonal flow at 103 Pa (~75 km) and 104 Pa (~65 km) at the equator and around 103 Pa at high latitudes. Below and in the cloud layer, surface topography weakens the zonal-mean zonal flow over the Aphrodite Terra and Maxwell Montes, whereas it enhances the zonal flow in the southern polar region. The high-resolution topography produces stationary fine-scale bow structures at the cloud top and locally modifies the variances in the geographical coordinates (i.e., the activity of unsteady wave components). Over the high mountains, vertical spikes of the vertical wind variance are found, indicating penetrative plumes and gravity waves. Negative momentum flux is also locally enhanced at the cloud top over the equatorial high mountains. In the solar-fixed coordinate system, the variances (i.e., the activity of waves other than thermal tides) of flow are relatively higher on the nightside than on the dayside at the cloud top. Strong dependences of the eddy heat and momentum fluxes on local time are predominant. The local-time variation of the vertical eddy momentum flux is produced by both thermal tides and solar-related, small-scale gravity waves.

Improvement of saccharide yield from wood by simultaneous enzymatic delignification and saccharification using a ligninolytic enzyme and cellulase.

White-rot fungi are thought to hold promise for development of a delignification pretreatment process for wood biorefinery that is less energy-consuming than current processes. However, the reaction must take place over weeks and consumes non-neglectable amounts of saccharides. To establish a biological process for wood biorefinery would first require establishment of an enzymatic approach to delignification. Such an approach has the potential to lower costs and reduce saccharide loss. Here, we attempted enzymatic delignification reactions using manganese peroxidases (MnP), a lignin-degrading enzyme, under several reaction conditions. The delignification rate from beech wood meal (particle size <45 µm) of up to 11.0% in 48 h was reached in a MnP reaction supplemented with multiple co-oxidants, glucose, glucose oxidase (GOD) and commercial cellulase. An additional 48-h reaction using fresh MnP/co-oxidants increased the delignification rate to 14.2%. Simultaneous enzymatic delignification and saccharification, which occurs without a need for glucose supplementation, successfully improved the glucose yield to 160% of the reaction without MnP. Development of a more accurate imitation of the mechanisms of delignification that occurs in white-rot fungi has the potential to improve the monosaccharide yield resulting from simultaneous delignification and saccharification.