[Salvage from Extracorporeal Membrane Oxygenation due to Acute Deteriorated Heart Failure;Treatment Decision-tree Based on the Risk Factors].

BACKGROUND: Salvage rates for patients requiring extracorporeal membrane oxygenation (ECMO)due to acute cardiogenic shock remain poor due to difficulties in decision making on optical timing of ECMO removal or conversion to ventricular assist devices( VAD). METHOD: From 2005 to 2018, 37 patients supported with ECMO due to acute circulatory deterioration were referred to our department for implantation of VAD. Their outcomes were analyzed using multi-variate analysis to assess the risk factors of VAD implantation, and we adopted a new decision-tree to improve the outcomes. RESULTS: Four patients had severe cerebral complications and 2 patients suffered severe infection. Those 6 patients were withdrawn from VAD implantation. ECMO could be removed in 6 patients, but one of them underwent VAD implantation due to the intraaortic balloon pumping (IABP) -dependent circulatory condition. In total, 25 patients underwent VAD implantation. Four patients reached to heart transplantation. Six patients remain on VAD. VAD was explanted due to recovery in 2 patients. Statistically significant risk factors by multi-variate analysis on 2-year mortality were preoperative necessity of renal replacement (p=0.006) and T-Bil (p=0.051, >4.0 mg/dl). Two-year survival of patients without end-organ dysfunction was 83.3%.However, 2-year survival of patients with end-organ dysfunction was miserable (23.1%). Based on these findings, we applied to a new decision-tree with 4 steps from 2016;(1) rule out strokes and sepsis, (2) End-organ dysfunction should be treated before VAD implantation with proper management of mechanical circulatory support to recover end-organ dysfunction, (3) urgent conversion to VAD if there is no aortic valve opening, (4) conversion to VAD if cardiac functional recovery cannot be observed within 5 to 7 days. According to this decision-tree, 3 patients underwent VAD implantation after recovery from end-organ failure and survived in 2016. CONCLUSIONS: Our experiences of salvage from ECMO in patients with severely impaired cardiac function suggest that end-organ dysfunction( necessity of renal replacement and T-Bil>4.0 mg/dl) was a strong risk factor for mid-term mortality. Those patients should undergo VAD implantation after recovery from end-organ dysfunction.

Single-spin readout in a double quantum dot including a micromagnet.

We use photon-assisted tunneling (PAT) and an inhomogeneous Zeeman field to demonstrate spin-selective PAT readout with a double quantum dot. The inhomogeneous Zeeman field is generated by a proximal micromagnet, which provides different stray fields between the two dots, resulting in an energy difference between the interdot PAT of the up-spin state and that of the down-spin state. We apply various external magnetic fields to modify the relative filling weight between the up-spin and down-spin states and detect it by using a charge detection technique to probe the PAT induced charge delocalization in the double dot.

Surgical Repair of an Arch and Descending Aortic Aneurysm in a Child.

Pediatric thoracic aortic aneurysms are very rare, and almost all patients with such aneurysms have inflammatory or connective tissue diseases. This report describes a case involving 10-year-old girl who had an aortic arch and descending thoracic aortic aneurysm. Preoperative fluorine-18-fluorodeoxyglucose positron emission tomography combined with computed tomography showed an inflammatory lesion corresponding to the aneurysm's location. The ascending aorta, aortic arch, and descending thoracic aorta were replaced through median sternotomy and left thoracotomy with safe systemic and brain perfusion to avoid placing the anastomoses within the inflammatory lesion. The patient was discharged without complications, and an SMAD3 mutation was detected by postoperative mutational screening.

Microwave band on-chip coil technique for single electron spin resonance in a quantum dot.

Microwave band on-chip microcoils are developed for the application to single electron spin resonance measurement with a single quantum dot. Basic properties such as characteristic impedance and electromagnetic field distribution are examined for various coil designs by means of experiment and simulation. The combined setup operates relevantly in the experiment at dilution temperature. The frequency responses of the return loss and Coulomb blockade current are examined. Capacitive coupling between a coil and a quantum dot causes photon assisted tunneling, whose signal can greatly overlap the electron spin resonance signal. To suppress the photon assisted tunneling effect, a technique for compensating for the microwave electric field is developed. Good performance of this technique is confirmed from measurement of Coulomb blockade oscillations.

Purification and characterization of fibrinolytic alkaline protease from Fusarium sp. BLB.

Fusarium sp. BLB, which produces a strongly fibrinolytic enzyme, was isolated from plant leaf (Hibiscus). Fibrinolytic alkaline protease was purified from a culture filtrate of Fusarium sp. BLB by precipitation with (NH4)2(SO4) and column chromatography with CM-Toyopearl 650 M and Superdex 75. The purified enzyme was homogeneous on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). The molecular weight was 27,000 by SDS-PAGE. Maximum activity of protease was observed at pH 9.5 and 50 degrees C. Purified protease was active between pH 2.5 and 11.5 and was found to be stable up to 50 degrees C. The enzyme derived from Fusarium sp. BLB is useful for thrombolytic therapy because this enzyme showed pH resistance. The activity was inhibited by diisopropylfluorophosphate and phenylmethylsulfonyl fluoride. The N-terminal amino acid sequence of the enzyme showed a similarity to those of proteases from Fusarium sp., Streptomyces griseus, Bos taurus bovine, Katsuwo pelamis digestive tract, and Lumbricus rubellus.

Effect of valerian extract preparation (BIM) on the sleep-wake cycle in rats.

In the present study, we studied the effect of valerian extract preparation (BIM) containing valerian extract, golden root (Rhodiola rosea L.) extract and L-theanine (gamma-glutamylethylamide) on the sleep-wake cycle using sleep-disturbed model rats in comparison with that of valerian extract. A significant shortening in sleep latency was observed with valerian extract and the BIM at a dose of 1000 mg/kg. On the other hand, valerian extract and the BIM caused no significant effects on total times of wakefulness, non-rapid eye movement (non-REM) sleep and REM sleep. Valerian extract and the BIM at a dose of 1000 mg/kg also had no significant effect on delta activity. In conclusion, it became clear that the BIM could be useful as a herbal medicine having a sleep-inducing effect without causing an alteration of the sleep-wakefulness cycle.