Improving Visualization of In-stent Lumen Using Prototype Photon-counting Detector Computed Tomography with High-resolution Plaque Kernel.

The study aimed to compare the performance of photon-counting detector computed tomography (PCD CT) with high-resolution (HR)-plaque kernel with that of the energy-integrating detector CT (EID CT) in terms of the visualization of the lumen size and the in-stent stenotic portion at different coronary vessel angles. The lumen sizes in PCD CT and EID CT images were 2.13 and 1.80 mm at 0°, 2.20 and 1.77 mm at 45°, and 2.27 mm and 1.67 mm at 90°, respectively. The lumen sizes in PCD CT with HR-plaque kernel were wider than those in EID CT. The mean degree of the in-stent stenotic portion at 50% was 69.7% for PCD CT and 90.4% for EID CT. PCD CT images with HR-plaque kernel enable improved visualization of lumen size and accurate measurements of the in-stent stenotic portion compared to conventional EID CT images regardless of the stent direction.

Splenic injury caused by cardiopulmonary resuscitation in a full stomach with hematoma after hemorrhagic shock due to bleeding duodenal ulcer: A case report.

Background: Cardiopulmonary resuscitation is essential for cardiopulmonary arrest, but complications from chest compressions warrant monitoring. Although rib and sternal fractures are common, abdominal injuries are rare, and splenic injuries are much rarer. Case Presentation: A 74-year-old man was admitted to the emergency room with a hemorrhagic duodenal ulcer. During hospitalization, the patient went into cardiopulmonary arrest due to hemorrhagic shock. Spontaneous circulation returned after 7 min of cardiopulmonary resuscitation. He underwent transcatheter arterial embolization to stop the bleeding from the duodenal ulcer. The next day, a close examination of the patient's progressive anemia revealed splenic injury; transcatheter arterial embolization was performed to save his life. Conclusion: It is important to consider the complication of splenic injury in patients with cardiopulmonary arrest who have undergone appropriate cardiopulmonary resuscitation. A possible mechanism-especially in patients with a full stomach-is the squeezing of the spleen by the diaphragm, abdominal wall, and stomach.

How does error correction occur during lexical learning?

We examined two theories of the mechanisms that enable error correction via corrective feedback. One theory focuses on enhancing the encoding of corrective feedback (corrective feedback-encoding facilitation account). The other is the recursive reminding theory, which considers memory integration between an initial event with error generation and a subsequent event involving correct answer feedback. The Japanese idiom pronunciation task was used in two experiments, in which it was manipulated whether the generated errors were visually presented, as well as corrective feedback. In an immediate retest after a five-minute retention interval, participants recalled their errors in the initial test and their correct answers. In addition, error trials fell into three ordinal confidence categories (low, medium, and high). First, a typical hypercorrection was replicated in which higher-confidence errors are more likely to be corrected. However, this was not observed when errors from the initial test were not recalled in the final test, which does not align with the corrective feedback-encoding facilitation account. The second issue was whether additional experience with the generated errors would enhance the error correction. Given the recursive reminding theory, the additional experience of errors should reinforce the mutual dependence between an error and the correct answer provided by feedback, improving cued recall performance later. This prediction is supported. The present findings suggest that the recursive reminding theory can explain the benefits of generating errors when learning through corrective feedback and can also be expanded to understand the hypercorrection effect.

Segmental arterial mediolysis with a ruptured visceral artery on two consecutive days.

Background: We describe a case of segmental arterial mediolysis in which a vessel ruptured on two consecutive days. Case Presentation: A 69-year-old man presented with sudden-onset abdominal pain. Computed tomography showed a hematoma in the gastric wall. The patient was discharged after the pain was relieved but returned 8 h later with abdominal pain and shock. Repeated computed tomography revealed a massive intra-abdominal hemorrhage without previous aneurysm formation. Emergency angiography and coil embolization were successfully carried out. Segmental arterial mediolysis was diagnosed after irregular vasodilated lesions were observed in multiple arteries. Conclusion: This case suggests that accurately predicting the next vessel rupture is difficult. For patients experiencing intra-abdominal bleeding with segmental arterial mediolysis, we suggest treating only ruptured aneurysms and closely following-up unruptured aneurysms.

Combined X-ray Reflectivity and Infrared Study of the Effect of Hydrogen Bonding of the OH Group on the Relaxation Behavior in Ultrathin Polyvinylphenol Films on SiO2.

Utilizing X-ray reflectivity and infrared reflection absorption spectroscopy (IR-RAS), we have investigated the thermal expansion and contraction of ultrathin polyvinylphenol (PVPh) films supported on a silicon (100) substrate capped with an amorphous SiO2 layer. Despite being known to form strong interactions with the SiO2 surface, the thin PVPh films showed a reduction in the glass-transition point Tg, similar to the behavior of polystyrene thin films deposited on SiO2. We explored the relationship between thermal expansivity and film thickness using well-annealed films and found that it decreases with film thickness in the range below twice the radius of gyration of a polymer chain (2Rg) in the glassy state. Thickness expansion in the glassy state and contraction in thickness at temperatures higher than Tg bulk (melt state) showed the presence of two competing relaxation processes. The reported negative thermal expansion in PVPh thin films, which was discovered to be one of the inherent properties, may have been caused by the fast relaxations that take place at the free polymer surface. IR-RAS was utilized to investigate the effect of thickness on hydrogen bonding in PVPh, and it was confirmed that with decreasing thickness, hydrogen bonding becomes weak, and the number of free OH groups increases. Therefore, thinner PVPh samples exhibit lower Tgs as an effect of easier molecular motions.

Amatoxin poisoning caused by Galerina sulciceps, a species with no prior record of identification in Japan: a case report.

A 60-year-old man presented with acute gastroenteritis, hypovolemic shock, acute renal failure (BUN/Cr, 56.7/4.24 mg/dl), and aspiration pneumonia. The previous day, he ingested 30 caps of mushrooms of an unknown species. The patient was treated with a massive intravenous infusion, renal replacement therapy, and antimicrobial agents. Late-onset mild liver injury peaked on day 11 (AST/ALT, 62/67 IU/l). Acute renal failure improved once before worsening, with the worst symptoms on day 19 (BUN/Cr, 99/6.61 mg/dl). Thereafter, the patient showed gradual improvement, and renal replacement therapy was discontinued on day 23. His general condition improved fully and he was transferred to another hospital for rehabilitation on day 47. The mushrooms were later identified as Galerina sulciceps by the Basic Local Alignment Search Tool, and toxicologic analysis using liquid chromatography-tandem mass spectrometry revealed an average of 85 ppm α-amanitin and 330 ppm ß-amanitin in the tissue of the mushrooms brought in by the patient's family. Galerina sulciceps is distributed mainly in tropical and subtropical regions of Southeast Asia and had never been identified before in Japan. The heat of fermentation generated by the thick layer of wood chips on the ground or global warming may have contributed to its growth in Japan. Interestingly, our patient did not have liver dysfunction, which is one main and typical amatoxin poisoning symptom. Variation in clinical presentation may be attributed to the different ratios of α-amanitin to ß-amanitin in different mushroom species.

An introduction to photon-counting detector CT (PCD CT) for radiologists.

The basic performance of photon-counting detector computed tomography (PCD CT) is superior to conventional CT (energy-integrating detector CT: EID CT) because its spatial- and contrast resolution of soft tissues is higher, and artifacts are reduced. Because the X-ray photon energy separation is better with PCD CT than conventional EID-based dual-energy CT, it has the potential to improve virtual monochromatic- and virtual non-contrast images, material decomposition including quantification of the iodine distribution, and K-edge imaging. Therefore, its clinical applicability may be increased. Although the image quality of PCD CT scans is superior to that of EID CT currently, further improvement may be possible. The introduction of iterative image reconstruction and reconstruction with deep convolutional neural networks will be useful.

Effects of shorter activated coagulation time on hemorrhage during venoarterial extracorporeal membrane oxygenation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used for decades, but optimal anticoagulation control remains unknown. This study aimed to compare shorter target activated coagulation time (ACT) criteria with the usual target ACT criteria in terms of complications. METHODS: We retrospectively identified patients who received ECMO between 1 January 2013 and 31 December 2018 in an acute tertiary care hospital. Patients were divided into two groups: (I) those whose target ACT was 160-180 sec and (II) those whose target ACT was 180-220 sec. Cox proportional hazard models and Fine-Gray models adjusted for propensity score to account for the competing risk of death were used to compare the incidence of hemorrhage during ECMO between the groups. RESULTS: We identified 74 patients, 25 of whom were managed with target ACT 160-180 sec, and 49 of whom were managed with target ACT 180-220 sec. In crude analysis, the proportions of patients with hemorrhage in the under 180-sec group were significantly more than those in the over 180-sec group [60.0% (15/25) vs. 28.6% (14/49), p = 0.009]. Shorter target ACT was not associated with hemorrhage during ECMO in either Cox regression (hazard ratio, 1.67; 95% confidence interval, 0.59-4.80; p = 0.336) or Fine-Gray model (hazard ratio, 1.58; 95% confidence interval, 0.64-3.91; p = 0.324). CONCLUSIONS: The shorter ACT target was not associated with improved hemorrhage and inappropriate coagulation than the usual target ACT criteria. This study is the first to compare the ACT target of patients with ECMO.

Short-Chain Mono-Alkyl ß-D-Glucoside Crystals-Do They Form a Cubic Crystal Structure?

Three-dimensional liquid crystal (LC) phases, cubic LC phases, have been extensively studied as fascinating molecular assembled systems formed by amphiphilic compounds. However, similar structures have only been seen in rare instances in lipid crystal states in glycolipid crystal studies. In this study, we prepared short-chain n-alkyl ß-D-glucosides (CnG) with an alkyl chain length n ranging from 4 to 6 and investigated their crystal structures. First, differential thermal analysis (DTA) and thermogravimetric analysis (TG) measurements showed the formation of hydrated crystals for C4G and C5G, respectively. Second, the crystal structures of CnG (n = 4, 5, 6) in both anhydrous and hydrated states were examined using a temperature-controlled powder X-ray diffraction (PXRD) measurement. Both hydrate and anhydrous crystals of C4G and C5G with critical packing parameters (CPPs) less than 0.33 formed cubic crystal phases. Bilayer lengths, calculated from the main diffraction peaks in each PXRD profile, depended on crystalline moisture for C5G, but no significant change was confirmed for C4G, indicating that the properties of each hydrophilic layer differ. However, C6G with a CPP of 0.42 formed a crystal structure with a modulated lamellar structure similar to C7G and C8G with similar CPP values. Thus, a glycolipid motif concept with a cubic crystal structure was demonstrated.

Physical properties of lactic acid bacteria influence the level of protection against influenza infection in mice.

We evaluated whether the water dispersibility of lactic acid bacteria (Enterococcus faecalis KH2) affects their efficacy. When cultured lactic acid bacteria are washed, heat-killed, and powdered, adhesion occurs between results in aggregation (non-treated lactic acid bacteria, n-LAB). However, dispersed lactic acid bacteria (d-LAB) with a lower number of aggregates can be prepared by treating them with a high-pressure homogenizer and adding an excipient during powdering. Mice were administered n-LAB or d-LAB Peyer's patches in the small intestine were observed. Following n-LAB administration, a high amount of aggregated bacteria drifting in the intestinal mucosa was observed; meanwhile, d-LAB reached the Peyer's patches and was absorbed into them. Evaluation in a mouse influenza virus infection model showed that d-LAB was more effective than n-LAB in the influenza yield of bronchoalveolar lavage fluids on day 3 post-infection and neutralizing antibody titers of sera and influenza virus-specific immunoglobulin A in the feces on day 14 post-infection. Therefore, the physical properties of lactic acid bacteria affect their efficacy; controlling their water dispersibility can improve their effectiveness.

Safety and efficacy of cold-water immersion in the treatment of older patients with heat stroke: a case series.

BACKGROUND: Heat stroke treatment focuses on rapid cooling because symptom severity correlates with the duration of hyperthermia (i.e., time during which the core body temperature is sustained above the critical threshold). Several reports have revealed that cold-water immersion is a safe and appropriate therapy for exertional heat stroke in young, otherwise healthy patients. However, few reports have assessed cold-water immersion in older patients. We document three cases of cold-water immersion in older heat stroke patients and evaluate its safety and efficacy. CASE PRESENTATION: Three older patients with severe heat stroke were treated with cold-water immersion. Core body temperatures decreased rapidly, and no complications occurred during the treatment. CONCLUSION: Cold-water immersion can achieve rapid cooling and is effective in treating heat stroke. With special precautions, it can be performed safely for older patients. Further investigation is warranted to establish appropriate cooling methods in older adults.

Unveiling the Uniqueness of Crystal Structure and Crystalline Phase Behavior of Anhydrous Octyl ß-D-Glucoside Using Aligned Assembly on a Surface.

Although the anomalous low crystallinity of octyl ß-D-glucoside (ß-OGlu) was first proposed more than 30 years ago, many fundamental aspects of its crystal structure and of the crystalline phase behavior of the pure substance have remained uncertain. In this paper, we employ grazing-incidence wide-angle X-ray-diffraction measurements using a two-dimensional detector (2D-GI-WAXD) and perpendicularly aligned crystalline films to demonstrate that ß-OGlu forms crystal structures consisting of an intermediate phase-like a ripple phase with two large crystal-lattice constants, a and c, comparable to the lengths of its bilayer structures. Furthermore, solid-to-solid phase transitions accompanied by latent heat confirm the existence of a solid-solution-like phase consisting of a crystalline and a liquid-crystal (LC) phase, which persists over a 20 °C temperature range, in a single-component system. In addition, the system forms a superlattice, accompanied by a change in packing of the component sugars in the partial-melting state; this shift is different from the gel-crystal transition observed for a typical lipid system. These facts indicate that even in the crystalline phase formed from a single component, each individual ß-OGlu molecule in a single-component phase plays a versatile role in the crystallisation and melting processes. These findings must somewhat explain the specific co-assembling features with proteins of ß-OGlu, which has long been used empirically in biochemistry.

Tissue-adhesive wirelessly powered optoelectronic device for metronomic photodynamic cancer therapy.

Metronomic (that is, low-dose and long-term) photodynamic therapy (mPDT) for treating internal lesions requires the stable fixation of optical devices to internal tissue surfaces to enable continuous, local light delivery. Surgical suturing-the standard choice for device fixation-can be unsuitable in the presence of surrounding major nerves and blood vessels, as well as for organs or tissues that are fragile, change their shape or actively move. Here, we show that an implantable and wirelessly powered mPDT device consisting of near-field-communication-based light-emitting-diode chips and bioadhesive and stretchable polydopamine-modified poly(dimethylsiloxane) nanosheets can be stably fixed onto the inner surface of animal tissue. When implanted subcutaneously in mice with intradermally transplanted tumours, the device led to significant antitumour effects by irradiating for 10 d at approximately 1,000-fold lower intensity than conventional PDT approaches. The mPDT device might facilitate treatment strategies for hard-to-detect microtumours and deeply located lesions that are hard to reach with standard phototherapy.

Physicochemical characterization of 6-O-acyl trehalose fatty acid monoesters in desiccated system.

The understanding of the basic physicochemical properties of trehalose lipid is indispensable to extending their availability. In this study, the hydrate crystal (Cr), the liquid crystalline (LC) phase and the glassy state formations of 6-O-acyl trehalose fatty acid monoester (TREn) were examined under in a desiccated system. TREn (n = 10, 12, 14, 16) formed monohydrate Cr and showed the hydrate Cr-glassy fluid lamellar LC (Lα) phase transition via dehydration in the heating process. Here, Lα phase for TRE10 and TRE12 was kinetically formed by the dehydration below the glass transition temperature (Tg). On the dehydration temperature (Tdeh), Tgs, and heat capacity changes (ΔCps) at these Tgs, no distinct effects by the difference of the acyl chain length were recognized, possibly because the core structure of containing sugar hydrate Cr or sugar moieties should be similar regardless of the acyl chain length. Besides, TRE10 having a relatively high hydrophilic/hydrophobic balance (HLB) afforded to form the cubic LC (Q) phase and the corresponding glassy phase, while TRE14 and TRE16 having low HLB afforded the Lα phase as well as the corresponding glassy phases above Tg. TRE12 having middle HLB afforded both LCs and the corresponding glassy phase by controlling the kinetics of LC-LC phase transition between Lα and Q phases. Furthermore, the anomalous reversible phase transition during both the heating and cooling processes was also ascertained in the glassy phase for TRE16, which was considered the phase transition between glassy Lα and glassy lamellar gel (Lß) phase. It greatly empathizes the two-dimensional trehalose glass layer and fluid hydrocarbon chains in the TREn glassy phase. Thus, in this study, it was demonstrated that TREn as the simplest trehalose lipid exhibited the glassy formation performance as well as the hydrate Cr formation, which showed less chain length dependence, together with the LC formation and the phase transition between glassy Lα and glassy Lß phase, which depended on chain length greatly.

Effect of Freeze-Thaw Treatment on the Precipitation of Octyl ß-D-Galactoside Hemihydrate Crystal from the Aqueous Solution.

Cryogenic treatment, like the freeze-thaw process, has been reported to be effective in modifying the physicochemical properties of polymeric hydrogels. However, not much attention has been paid to this process in terms of the precipitation of surfactant-water systems. In this study, two effective cryogenic methodologies were successfully reported to alter the physicochemical properties of a precipitate of an octyl ß-D-galactoside (Oct-Gal)-water system. First, hyperrapid cooling (i.e., cooling at 30°C/min) was found to be an effective type of cryogenic treatment: the phase transition temperature (TK) and enthalpy at the phase transition (∆HK) between the crystal-dispersed phase and the sol (micelle) phase significantly decreased. In addition, cryogenic treatment in the presence of electrolytes, such as NaCl, NaBr, and CsCl, was effective even in the absence of the hyperrapid cooling condition. The hyperrapid cooling or the addition of certain electrolytes was considered to prevent the precipitation of the Oct-Gal hemihydrate crystals prior to the complete freezing of ice and the electrolyte/ice eutectic. Hence, the size of the aggregated crystals prepared by the above-mentioned effective cryogenic treatments seemed to be decreased compared with that of the normal precipitated crystals, thereby changing TK and ∆HK. Thus, two basic methodologies for the modification of the physicochemical properties of the crystal-dispersed phase of surfactant-water systems are discussed.

Development of Ca2+-release mechanisms during oocyte maturation of the starfish Asterina pectinifera.

An important step for successful fertilization and further development is the increase in intracellular Ca2+ in the activated oocyte. It has been known that starfish oocytes become increasingly sensitive to inositol 1,4,5-trisphosphate (IP3) during meiotic maturation to exhibit highly efficient IP3-induced Ca2+ release (IICR) by the time of germinal vesicle breakdown (GVBD). However, we noted that the peak level of intracellular Ca2+ increase after insemination is already high in the maturing oocytes before GVBD. Using maturing oocytes before GVBD, we investigated Ca2+ release mechanisms other than IICR. We report here that Ca2+-release mechanisms dependent on nicotinic acid adenine dinucleotide phosphate (NAADP) and nicotinamide adenine dinucleotide (NADP), the precursor of NAADP, became functional prior to the development of IICR mechanisms. As with IP3, but unlike NAADP, the Ca2+ stores responsive to NADP are sensitized during the meiotic maturation induced by 1-methyladenine (1-MA). This suggests that the process may represent a physiological response to the maturation hormone. NADP-dependent Ca2+ release in immature oocytes, however, did not induce oocyte maturation by itself, but was enhanced by the conditions mimicking the increases of intracellular Ca2+ and pH that take place in the maturing oocytes of starfish.

Structural Insights into Solid-to-Solid Phase Transition and Modulated Crystal Formation in Octyl-ß-d-Galactoside Crystals.

Despite the significance of synthetic monotailed ß-linked galactolipids, for a detailed understanding of natural galactolipids, many aspects of these ß-linked galactolipids' crystal structures such as temperature-dependence and hydration characteristics remain inadequately understood. In this manuscript, we demonstrated detailed insight of crystal characteristics of one of the simplest monotailed galactolipids, octyl-ß-d-galactoside (MOß-Gal), using thermal analyses, Fourier-transform infrared spectroscopy (FTIR), powder X-ray diffraction (PXRD) measurements and grazing-incidence wide-angle X-ray diffraction (GI-WAXD) analysis. As a result, it was revealed that the MOß-Gal anhydrous crystal showed a continuous structural change from the high-symmetry structure to low-symmetry crystal lattice via the strengthened hydrogen bonding interaction as the temperature decreased. In addition, the hemihydrate crystal was found to be in the modulated "ribbon phase". These insights strongly suggest that ß-linked galactolipids possess intrinsic characteristics necessary to form a modulated structure even in the crystal state and demonstrate the importance of the presence of tiny amounts of water as cushioning media for preventing order parameter evolution.

Oligosaccharide-based Surfactant/Citric Acid Buffer System Stabilizes Lactate Dehydrogenase during Freeze-drying and Storage without the Addition of Natural Sugar.

Experiments were conducted to assess the maintenance effects of oligosaccharide-based surfactants on the enzymatic activity of a model protein, lactate dehydrogenase (LDH), during freeze-drying and room temperature storage using the citric acid buffer system. Oligosaccharide-based surfactants, which exhibit a high glass transition temperature (Tg), promoted the eminent retention of enzymatic activity during these protocols, whereas monosaccharide-based surfactants with a low Tg displayed poor performance at high concentration, albeit much better than that of Tween 80 at middle concentration. The increase in the alkyl chain length did not exert positive effects as observed for the maintenance effect during freeze-thawing, but an amphiphilic nature and a glass forming ability were crucial for the effective stabilization at a low excipient concentration during freeze-drying. Even a low oligosaccharide-based surfactant content (0.1 mg mL(-1)) could maintain LDH activity during freeze-drying, but a high surfactant content (1.0 mg mL(-1)) was required to prevent buffer precipitation and retain high LDH activity on storage. Regarding storage, glass formation restricted molecular mobility in the lyophilized matrix, and LDH activity was effectively retained. The present results describe a strategy based on the glass-forming ability of surfactant-type excipients that affords a natural sugar-free formulation or an alternative use for polysorbate-type surfactants.

Prevalence of Type A Acute Aortic Dissection in Patients With Out-Of-Hospital Cardiopulmonary Arrest.

Postmortem computed tomography (PMCT) has been recently reported to be useful for detecting causes of death in the emergency department. In this study, the incidence and causes of death of type A acute aortic dissection (AAD) were investigated in patients who experienced out-of-hospital cardiopulmonary arrest (OHCPA) using PMCT. PMCT or enhanced computed tomography was performed in 311 of 528 consecutive patients experiencing OHCPA. A total of 23 (7%) of 311 patients were diagnosed with type A AAD based on clinical courses and CT findings. Eighteen consecutive patients who did not experience OHCPA were diagnosed with type A AAD during the same period. Pre-hospital death was observed in 21 (51%) of 41 patients with type A AAD. Bloody pericardial effusion was observed more frequently in patients who experienced OHCPA with type A AAD than in those who did not experience OHCPA with type A AAD (91% vs 28%, respectively; p <0.05). In conclusion, the incidence of type A AAD was common (7%) in patients who experienced OHCPA, with a high rate of pre-hospital death. Aortic rupture to the intrapericardial space was considered the major cause of death in patients who experienced OHCPA with type A AAD.

Catalytic Enantioselective Synthesis of N-C Axially Chiral Phenanthridin-6-one Derivatives.

N-C axially chiral phenanthridin-6-one derivatives bearing various ortho-substituted phenyl groups on the nitrogen atom were enantioselectively prepared through (R)-DTBM-SEGPHOS-Pd(OAc)2-catalyzed intramolecular Buchwald-Hartwig amination. The enantioselectivity strongly depended on solvents, bases, and reaction temperature as well as on the bulkiness of ortho-substituents.