Correction: Hayashi et al. More Tolerant Reconstructed Networks Using Self-Healing against Attacks in Saving Resource. Entropy 2021, 23, 102.

The authors wish to make the following correction to this paper [...].

More Tolerant Reconstructed Networks Using Self-Healing against Attacks in Saving Resource.

Complex network infrastructure systems for power supply, communication, and transportation support our economic and social activities; however, they are extremely vulnerable to frequently increasing large disasters or attacks. Thus, the reconstruction of a damaged network is more advisable than an empirically performed recovery of the original vulnerable one. To reconstruct a sustainable network, we focus on enhancing loops so that they are not trees, which is made possible by node removal. Although this optimization corresponds with an intractable combinatorial problem, we propose self-healing methods based on enhancing loops when applying an approximate calculation inspired by statistical physics. We show that both higher robustness and efficiency are obtained in our proposed methods by saving the resources of links and ports when compared to ones in conventional healing methods. Moreover, the reconstructed network can become more tolerant than the original when some damaged links are reusable or compensated for as an investment of resource. These results present the potential of network reconstruction using self-healing with adaptive capacity in terms of resilience.

Responsiveness of lumbosacral superficial dorsal horn neurons during the voiding reflex and functional loss of spinal urethral-responsive neurons in streptozotocin-induced diabetic rats.

AIMS: Sensory information from the lower urinary tract (LUT) is conveyed to the spinal cord to trigger and co-ordinate micturition. However, it is not fully understood how spinal dorsal horn neurons are excited during the voiding reflex. In this study, we developed an in vivo technique allowing recording of superficial dorsal horn (SDH) neurons concurrent with intravesical pressure (IVP) during the micturition cycle in both normal and diabetic rats. METHODS: Lumbosacral dorsal horn neuronal activity and IVP were recorded from urethane-anesthetized naive and streptozotocin (STZ)-induced diabetic rats. Saline was continuously perfused into the urinary bladder through a cannula to induce micturition. RESULTS: We classified SDH neurons into bladder- and urethral-responsive neurons, based on their responsiveness during the voiding reflex. Bladder-responsive SDH neurons responded to the rapid increase in IVP at the start of voiding. In contrast, urethral-responsive SDH neuronal firing increased at the peak IVP and their firing lasted during the voiding phase (the high-frequency oscillations). Urethral-responsive SDH neurons were more sensitive to capsaicin, received C afferent fiber inputs, and were rarely detected in STZ-diabetes rats. Administration of a cyclohexenoic long-chain fatty alcohol (TAC-302), which is reported to promote neurite outgrowth of peripheral nerves in STZ-diabetic rats, prevented the functional loss of spinal urethral response. CONCLUSIONS: Sensory information from the bladder and urethra is conveyed separately to different groups of SDH neurons. Functional loss of spinal urethral sensory information through unmyelinated C afferent fibers may contribute to diabetic bladder dysfunction.

Revealing the second harmonic generation in a femtosecond laser-driven cluster-based plasma by analyzing shapes of Ar XVII spectral lines.

We present experiments dealing with a femtosecond laser-driven cluster-based plasma, where by analyzing the nonlinear phenomenon of satellites of spectral lines of Ar XVII, we revealed the nonlinear phenomenon of the generation of the second harmonic of the laser frequency. For performing this analysis we developed new results in the theory of satellites of spectral lines. From such lineshape analysis we found, in particular, that the efficiency of converting the short (40 fs) intense (3x10¹8 W/cm²) incident laser light into the second harmonic was 2%. This result is in the excellent agreement with the 2-Dimensional Particle-In-Cell (2D PIC) simulation that we also performed. There is also an order of magnitude agreement between the thresholds for the SHG found from the line shape analysis and from the 2D PIC simulations.

[Preoperative Risk Factors; Hypertension and Arrhythmias].

Generally speaking, hypertension and arrhythmias are risk factors affecting anesthetic management and postoperative prognosis. However, the most recent ACC/AHA clinical guideline does not require the preoperative strict control of arterial pressure for patients with hypertension, since there has been not any definite evidence demonstrating that the preoperative control improves postoperative cardiovascular prognosis. On the other hand, the guideline recommends that preoperative management of patients with arrhythmias should be done according to the guideline for each arrhythmia. However, the guideline does not definitely mention the type of arrhythmias in which we should give priority to treatment of the arrhythmias over anesthesia for an elective operation. Presumably, the paucity of clinical studies to address this issue limits the definite recommendations. In patients with serious arrhythmias, such as ventricular tachycardia and atrial fibrillation with thrombus in the left atrium, preoperative clinical conference including anesthesiologist surgeons and cardiologists should be performed to decide the treatment plan for the patient Antihypertensive and antiarrhythmic drugs are frequently given in patients with hypertension or arrhythmias. These medicines as a general rule should be given until the morning of the operation day, although we do not have definite clinical evidence to support the advantage of the continuing.

[Anesthetic Management of a Patient with Quasi-moyamoya Disease Undergoing Total Thyroidectomy for Graves' Disease].

Quasi-moyamoya disease defined as moyamoya disease combined with autoimmune diseases such as Graves' disease is rare. We report anesthetic management of a patient with quasi-moyamoya disease undergoing total thyroidectomy for Graves' disease resistant to medical therapy. This disease is characterized by the aggravation of cerebral ischemic symptoms with hyperthyroidism. We, therefore, applied steroid pulse therapy before the operation to induce temporal normalization of the thyroid function, and could perform safe anesthetic management of this patient with quasi-moyamoya disease.

Anti-modularization for both high robustness and efficiency including the optimal case.

Although robustness of connectivity and modular structures in networks have been attracted much attentions in complex networks, most researches have focused on those two features in Erdos-Renyi random graphs and Scale-Free networks whose degree distributions follow Poisson and power-law, respectively. This paper investigates the effect of modularity on robustness in a modular d-regular graphs. Our results reveal that high modularity reduces the robustness even from the optimal robustness of a random d-regular graph in the pure effect of degree distributions. Moreover, we find that a low modular d-regular graph exhibits small-world property that average path length is O(logN). These results indicate that low modularity on modular structures leads to coexistence of both high robustness and efficiency of paths.

Investigating stronger tolerant network against cascading failures in focusing on changing degree distributions.

Many real-world networks with Scale-Free structure are significantly vulnerable against both intentional attacks and catastrophic cascading failures. On the other hand, it has been shown that networks with narrower degree distributions have strong robustness of connectivity by enhancing loops. This paper numerically reveals that such networks are also tolerant against cascading failures. Our findings will be useful in designing stronger tolerant network infrastructures.

3D transesophageal echocardiographic visualization of the pulmonary artery catheter through the tricuspid valve and their position relative to the tricuspid valve leaflets.

BACKGROUND: The tricuspid valve is an atrioventricular valve consisting of three lobes. We used the 3D transesophageal echocardiography to visualize position of the pulmonary artery catheter at the tricuspid valve annulus and examined where the catheter passed through at the level of the tricuspid annulus. METHODS: In this prospective and observational study, we monitored the pressure wave on patients undergoing cardiac surgery with the catheter placement by monitoring the pressure waveform for 8 months. We measured the time required for the catheter to pass through the tricuspid and pulmonary valves, respectively. We acquired the 3D image of the tricuspid valve by transesophageal echocardiography and determined the position of the pulmonary artery catheter at the level of the tricuspid annulus. The data were analyzed by Kruskal-Wallis test followed by Mann-Whitney test with Holm multiple comparisons. P < 0.05 was considered significant. RESULTS: Of the 116 cases, the pulmonary artery catheter passed through the tricuspid valve between antero-posterior leaflets in 78 cases (67.2 %), between septal-posterior leaflets in 25 cases (21.6 %), and between antero-septal leaflets in 2 cases (1.7 %) and the center in 11 cases (9.5 %), respectively. The time required for the catheter to pass through the pulmonary valves was significantly different among the catheter positions at the level of the tricuspid annulus. CONCLUSION: The pulmonary artery catheter location at the level of the tricuspid annulus can be identified using 3D transesophageal echocardiography. The location of the catheter significantly affects the pulmonary artery catheter placement time.

[Sugammadex reversal after extubation under muscle relaxation to prevent cough reflex in a patient with intractable spontaneous pneumothorax].

A 40-year-old man (168 cm tall and weighing 71 kg) with intractable pneumothorax was operated for resection of a bulla in the left lung. After insertion of epidural catheter via T 5-6 interspace, general anesthesia was induced and maintained with propofol, remifentanil and rocuronium. The duration of surgery was 1h 48 min and rocuronium given during surgery was 110 mg. After completion of surgery, the double-lumen tube was replaced with laryngeal mask airway to prevent cough reflex. However, infusion of sugammadex 200 mg induced mild cough reflex, resulting in air leakage from thoracic drainage. Because air leakage still continued after extubation, reoperation must be done and re-intubation was required. Since rocuronium 50 mg did not provide satisfactory muscle relaxation measured by train of four, additional dose of rocuronium 40 mg was administered and re-intubation was successfully performed without cough reflex. Reoperation lasted for 43 minutes and rocuronium infused was 100 mg. Nasal airway was inserted to prevent airway obstruction by the tongue and extubation was performed under muscle relaxation with infusion of rocuronium 10 mg. And then, immediate administration of sugammadex 400 mg could elicit spontaneous respiration without cough reflex.

Selective estrogen receptor modulators and deep venous thrombosis after an emergent operation in senior women.

BACKGROUND: Selective estrogen receptor modulators (SERMs), clinically applied to osteoporosis, may have potential risk of deep venous thrombosis (DVT) and discontinuation of SERMs may be required before surgery. However, we cannot discontinue SERMs for a certain duration, when patients undergo an emergent operation. CASE PRESENTATION: We reported two aged patients undergoing an emergent orthopedic surgery for lower extremities while taking SERMs for osteoporosis before the operation. DVT was newly developed in one patient and worsened in the other patient after the operation. We found eight aged patients underwent the same operation while taking SERMs for recent 3 years, including the two cases and DVT did not occur in the other six patients. Thus, the incidence of DVT in our patient population was 25%. CONCLUSION: We showed that DVT developed or worsened after operation in two patients taking SERMs before operation. Ultrasound examination after operation may be recommended in these population. (149 words).

Adding links on minimum degree and longest distance strategies for improving network robustness and efficiency.

Many real-world networks characterized by power-law degree distributions are extremely vulnerable against malicious attacks. Therefore, it is important to obtain effective methods for strengthening the robustness of the existing networks. Previous studies have been discussed some link addition methods for improving the robustness. In particular, two effective strategies for selecting nodes to add links have been proposed: the minimum degree and longest distance strategies. However, it is unclear whether the effects of these strategies on the robustness are independent or not. In this paper, we investigate the contributions of these strategies to improving the robustness by adding links in distinguishing the effects of degrees and distances as much as possible. Through numerical simulation, we find that the robustness is effectively improved by adding links on the minimum degree strategy for both synthetic trees and real networks. As an exception, only when the number of added links is small, the longest distance strategy is the best. Conversely, the robustness is only slightly improved by adding links on the shortest distance strategy in many cases, even combined with the minimum degree strategy. Therefore, enhancing global loops is essential for improving the robustness rather than local loops.

Practical counting of substitutive paths on a planar infrastructure network.

When there are many non-intersecting paths between two vertices on a network, the connectivity is fault-tolerant. Because of no common vertices on these paths, they can be emergently used in avoiding destroyed parts on the usual paths by any disasters or attacks. It gives a tolerance index whether the combination of non-intersecting paths is many or few. However, to enumerate such paths is an intractable combinatorial problem, no practical algorithm has been known. On the other hand, many socio-technological infrastructure networks are embedded on the surface of Earth. Thus, as an approximate solution, we extendedly apply the counting method based on a path matrix with our proposed mapping to directed acyclic graphs from a planar network according to each pair of source and terminal vertices. The tendency of many or few combinations of the paths is clearly investigated through computer simulations for realistic networks. This approach will be useful for evaluating the existence of substitutive paths to improve the tolerance in risk management.

Postoperative delirium does not affect cardiopulmonary exercise testing in aged patients undergoing cardiac valve surgery.

BACKGROUND: The effect of delirium on cardiopulmonary exercise testing (CPX) is unknown. This retrospective study was to examine the effect of delirium on CPX at discharge in aged patients undergoing cardiac surgery. METHODS: This study included seventy patients aged 70 or older undergoing cardiac valve surgery, who entered our ICU and were discharged from our hospital between June 2016 and July 2018. All patients received active exercise by our rehabilitation team from the first postoperative day and were performed a CPX on a cycle ergometer before discharge. The anaerobic threshold oxygen uptake and the slope of the relationship between carbon dioxide output and minute ventilation were examined. We obtained the patient's data, including patient's characteristics, cardiac function, anesthesia data, laboratory data, ICU data, and length of ICU and hospital stay. Data were analyzed by unpaired t test or Fisher's exact test. P < 0.05 was considered statistically significant. RESULTS: Of the 70 patients, 21 patients experienced delirium during ICU stay. The delirium group needed longer administration of sedatives and longer ICU stay and showed higher CRP value and lower renal function but similar cardiopulmonary function before discharge from our hospital compared with the non-delirium group. CONCLUSIONS: Patients with a history of delirium during ICU showed higher CRP value and lower renal function before discharge, but the CPX values at discharge were not significantly affected by delirium.

Two cases of hemodynamic improvement by modulation of atrioventricular delay in cardiac operations.

BACKGROUND: Symptomatic sick sinus syndrome is one of the indications for pacemaker implantation, and we have to consider to program the pacemaker to an asynchronous pacing mode during an operation. CASE PRESENTATION: We reported two cases with a pacemaker implanted for sick sinus syndrome undergoing cardiac operation. We changed programming of the pacemaker to an asynchronous pacing mode (DOO) and modulated the programmed atrioventricular delay to avoid ventricular pacing, resulting in better hemodynamic condition. Although we observed premature ventricular contraction, no lethal arrhythmias induced by the R-on-T phenomenon were noted. CONCLUSION: Programming of the pacemaker to an asynchronous pacing mode and modulation of the programmed atrioventricular delay to avoid ventricular pacing may be an option for pacemaker management during an operation.

Total arch and descending thoracic aortic replacement for massive hemoptysis requiring CPR caused by intrapulmonary penetration of chronic dissecting aortic aneurysm: a case report.

BACKGROUND: Intrapulmonary penetration of the thoracic aorta is a rare, life-threatening complication of a chronic dissecting aortic aneurysm. It causes massive hemoptysis requiring prompt intervention to prevent fatal airway bleeding. A surgical approach that enables diverse surgical maneuvers and intraoperative organ protection is crucial. CASE PRESENTATION: A 62-year-old man, who underwent graft replacement of the ascending aorta for an acute type A aortic dissection 20 months before, developed massive hemoptysis and cardiac arrest. The hemoptysis was secondary to an aortopulmonary fistula from a rapidly expanding dissecting aortic aneurysm. However, a successful return of spontaneous circulation was achieved with cardiopulmonary resuscitation, including establishment of veno-arterial extracorporeal membrane oxygenation. The patient successfully underwent a total arch and descending thoracic aortic replacement. This was achieved by a median sternotomy combined with a left thoracotomy using a straight incision with a rib-cross (SIRC) approach. The patient was uneventfully discharged and remained well for the following 2 years. CONCLUSIONS: When performing a surgical graft replacement for an aortopulmonary fistula with a thoracic aortic aneurysm, the surgical approach chosen is critical. A surgical procedure using a median sternotomy combined with a left thoracotomy and a SIRC approach can be an effective therapeutic option.

Efficient generation of Xe K-shell x rays by high-contrast interaction with submicrometer clusters.

The interaction between a 25 TW laser and Xe clusters at a peak intensity of 1 × 10¹9 W/cm² has been investigated. Xe K-shell x rays, whose energies are approximately 30 keV, were clearly observed with a hard x-ray CCD at 3.4 MPa. Moreover, we studied the yield of the Xe K-shell x rays by changing the pulse duration of the laser at a constant laser energy and found that the pulse duration of 40 fs is better than that of 300 fs for generating Xe K-shell x rays.

Effect of olprinone, a phosphodiesterase III inhibitor, on balance of cerebral oxygen supply and demand during cardiopulmonary bypass.

Neuropsychological dysfunction with cardiopulmonary bypass (CPB) may be facilitated by inadequate cerebral oxygen balance during CPB. Olprinone, a phosphodiesterase III inhibitor, augments cerebral blood flow by a direct vasodilator effect on cerebral arteries. We conducted the present randomized study in patients undergoing cardiac surgery with CPB to investigate whether olprinone improved the balance of cerebral oxygen supply and demand during the rewarming period of CPB. After anesthesia, a 5.5 F fiberoptic oximeter catheter was inserted into the right jugular bulb retrogradely for monitoring the jugular venous oxyhemoglobin saturation (SjO2), and a probe of transcranial near-infrared spectroscopy was placed over the forehead for monitoring the bilateral regional cerebral oxygen saturation (rSO2). Patients were randomly assigned to 3 groups, and olprinone was administered at 0, 0.2, or 0.4 µg·kg(-1)·min(-1) after establishment of hypothermic CPB. Olprinone significantly prevented the reduction of the SjO2 at 5 and 10 minutes after the start of rewarming, although it did not alter rSO2. Furthermore, there was a minor reduction of the bilateral rSO2 at low doses of olprinone (0.2 µg·kg(-1)·min(-1)). We conclude that olprinone prevents the decrease of the SjO2 at the rewarming period and improves the balance of cerebral oxygen supply and demand during the rewarming period of CPB. In addition, a future extended study may be required to elucidate the effect of low dose of olprinone.

Anesthetic management of a patient with severe aortic regurgitation undergoing reoperation for ascending aorta false aneurysm using hypothermia: prevention of ventricular fibrillation by nifekalant.

BACKGROUND: To prevent cardiac collapse and to protect cerebral function, hypothermic cardiopulmonary bypass is established before resternotomy. However, ventricular fibrillation under hypothermia facilitates left ventricular distension, which causes irreversible myocardial damage when the patient has aortic regurgitation. We report a case of successful management in preventing ventricular fibrillation under hypothermia by using nifekalant. CASE PRESENTATION: A 56-year-old male, who had been performed a David operation, was scheduled for a Bentall operation for a pseudo aortic aneurysm with severe aortic regurgitation. After inducing anesthesia, we administered intravenous nifekalant and a vent tube was inserted into the left ventricle under one-lung ventilation. Extracorporeal circulation was established and resternotomy started after cooling to 27 °C. Although severe bradycardia and QT prolongation were observed, ventricular fibrillation did not occur until aortic cross-clamping. CONCLUSION: Combining maintaining cerebral perfusion and avoiding left ventricle distension during hypothermia was successfully managed with nifekalant in our redo cardiac patient with aortic regurgitation.