Adaptive Optics Microscopy with Wavefront Sensing Based on Neighbor Correlation.

Complex structures in living cells and tissues induce wavefront errors when light waves pass through them, and images observed with optical microscopes are undesirably blurred. This problem is especially serious for living plant cells because images are strikingly degraded even within a single cell. Adaptive optics (AO) is expected to be a solution to this problem by correcting such wavefront errors, thus enabling high-resolution imaging. In particular, scene-based AO involves wavefront sensing based on the image correlation between subapertures in a Shack-Hartmann wavefront sensor and thus does not require an intense point light source. However, the complex 3D structures of living cells often cause low correlation between subimages, leading to loss of accuracy in wavefront sensing. This paper proposes a novel method for scene-based sensing using only image correlations between adjacent subapertures. The method can minimize changes between subimages to be correlated and thus prevent inaccuracy in phase estimation. Using an artificial test target mimicking the optical properties of a layer of living plant cells, an imaging performance with a Strehl ratio of approximately 0.5 was confirmed. Upon observation of chloroplast autofluorescence inside living leaf cells of the moss Physcomitrium patens, recovered resolution images were successfully obtained even with complex biological structures. Under bright-field illumination, the proposed method outperformed the conventional method, demonstrating the future potential of this method for label- and damage-free AO microscopy. Several points for improvement in terms of the effect of AO correction are discussed.

Hydrogen inhalation attenuates lung contusion after blunt chest trauma in mice.

BACKGROUND: Lung contusion caused by blunt chest trauma evokes a severe inflammatory reaction in the pulmonary parenchyma that may be associated with acute respiratory distress syndrome. Although hydrogen gas has antioxidant and anti-inflammatory effects and is protective against multiple types of lung injury at safe concentrations, the effects of inhaled hydrogen gas on blunt lung injury have not been previously investigated. Therefore, using a mouse model, we tested the hypothesis that hydrogen inhalation after chest trauma would reduce pulmonary inflammation and acute lung injury associated with lung contusion. METHODS: Inbred male C57BL/6 mice were randomly divided into 3 groups: sham with air inhalation, lung contusion with air inhalation, and lung contusion with 1.3% hydrogen inhalation. Experimental lung contusion was induced using a highly reproducible and standardized apparatus. Immediately after induction of lung contusion, mice were placed in a chamber exposed to 1.3% hydrogen gas in the air. Histopathological analysis and real-time polymerase chain reaction in lung tissue and blood gas analysis were performed 6 hours after contusion. RESULTS: Histopathological examination of the lung tissue after contusion revealed perivascular/intra-alveolar hemorrhage, perivascular/interstitial leukocyte infiltration, and interstitial/intra-alveolar edema. These histological changes and the extent of lung contusion, as determined by computed tomography, were significantly mitigated by hydrogen inhalation. Hydrogen inhalation also significantly reduced inflammatory cytokine and chemokine mRNA levels and improved oxygenation. CONCLUSION: Hydrogen inhalation therapy significantly mitigated inflammatory responses associated with lung contusion in mice. Hydrogen inhalation therapy may be a supplemental therapeutic strategy for treating lung contusion.

Reduction of converging distance change in an aquatic display formed with aerial imaging by retro-reflection in conjugated optical structure.

This paper proposes an optical system for aquatic display that shows an image in water. The aquatic image is formed by utilizing aerial imaging by retro-reflection, which converges light by a retro-reflector and a beam splitter. Refraction on intersection between air and another material causes spherical aberration, which changes light-converging distance. In order to reduce the converging distance change, the light-source component is filled with water so that the optical system becomes conjugate including the medium. We analyzed converging of light in water by simulations. Furthermore, we have confirmed effectiveness of conjugated optical structure experimentally by use of a prototype.

Successfully treated case of severe hypothermia secondary to myxedema coma.

Background: Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. Case Presentation: A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. Conclusion: Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.

Luminal administration of biliverdin ameliorates ischemia-reperfusion injury following intestinal transplant in rats.

BACKGROUND: Intestinal grafts are susceptible to ischemia-reperfusion injury, resulting in the loss of mucosal barrier function and graft failure. Biliverdin is known to exert a variety of cytoprotective functions against oxidative tissue injury. Because the mucosal layer is the primary site of ischemia-reperfusion injury, mucosa-targeting strategies by luminal delivery of reagents might be beneficial. We tested whether intraluminal administration of biliverdin as an adjuvant to standard preservation solutions protected against ischemia-reperfusion injury. METHODS: Orthotopic syngeneic intestinal transplants were performed on Lewis rats after 6 hours of cold preservation. Saline containing biliverdin (10 µM) or without biliverdin was introduced into the lumen of the intestinal grafts immediately before cold preservation. RESULTS: Damage to the intestinal mucosa caused by ischemia-reperfusion injury resulted in severe morphological changes, including blunting of the villi and erosion, and led to significant loss of gut barrier function 3 hours after reperfusion. These changes to the mucosa were notably ameliorated by intraluminal administration of biliverdin. Biliverdin also effectively inhibited upregulation of messenger RNAs for interleukin-6, inducible nitric oxide synthase, and C-C motif chemokine 2. Additionally, biliverdin treatment prevented the loss of expression of claudin-1, a transmembrane, tight-junction barrier protein. The 14-day survival of recipients of biliverdin-treated grafts was significantly improved as compared with the recipients of saline-treated control grafts (83.3% vs 38.9%, P = .030). CONCLUSION: This study demonstrated that luminally delivered biliverdin provides beneficial effects during the transplant of rat small intestinal grafts and could be an attractive therapeutic option in organ transplantation.

The Impact of Medical Students Teaching Basic Life Support to Laypersons.

Basic life support (BLS) courses for laypersons, including cardiopulmonary resuscitation (CPR) training, is known to improve outcomes of out-of-hospital cardiac events. We asked medical students to provide BLS training for laypersons as a part of their emergency medicine education and evaluated the effects of training on the BLS skills of laypersons. We also used a questionnaire to determine whether the medical students who provided the BLS training were themselves more confident and motivated to perform BLS compared to students who did not provide BLS training. The proportions of laypersons who reported confidence in checking for a response, performing chest compressions, and automated external defibrillator (AED) use were significantly increased after the BLS training. The proportions of medical students who reported increased confidence/motivation in terms of understanding BLS, checking for a response, chest compression, use of AED, and willingness to perform BLS were significantly greater among medical students who provided BLS instructions compared to those who did not. BLS instruction by medical students was associated with an improvement in laypersons' CPR accuracy and confidence in responding to cardiac arrest. The results indicate that medical students could gain understanding, confidence, and motivation in regard to their BLS skills by teaching BLS to laypersons.

Luminal Administration of a Water-soluble Carbon Monoxide-releasing Molecule (CORM-3) Mitigates Ischemia/Reperfusion Injury in Rats Following Intestinal Transplantation.

BACKGROUND: The protective effects of carbon monoxide (CO) against ischemia/reperfusion (IR) injury during organ transplantation have been extensively investigated. Likewise, CO-releasing molecules (CORMs) are known to exert a variety of pharmacological activities via liberation of controlled amounts of CO in organs. Therefore, we hypothesized that intraluminal administration of water-soluble CORM-3 during cold storage of intestinal grafts would provide protective effects against IR injury. METHODS: Orthotopic syngeneic intestinal transplantation was performed in Lewis rats following 6 h of cold preservation in Ringer solution or University of Wisconsin solution. Saline containing CORM-3 (100 µmol/L) or its inactive counterpart (iCORM-3) was intraluminally introduced in the intestinal graft before cold preservation. RESULTS: Histopathological analysis of untreated and iCORM-3-treated grafts revealed a similar erosion and blunting of the intestinal villi. These changes in the mucosa structure were significantly attenuated by intraluminal administration of CORM-3. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h postreperfusion. CORM-3 significantly inhibited upregulation of proinflammatory mRNA levels, ameliorated intestinal morphological changes, and improved graft blood flow and mucosal barrier function. Additionally, CORM-3-treated grafts increased recipient survival rates. Pharmacological blockade of soluble guanylyl cyclase activity significantly reversed the protective effects conferred by CORM-3, indicating that CO partially mediates its therapeutic actions via soluble guanylyl cyclase activation. CONCLUSIONS: Our study demonstrates that luminally delivered CORM-3 provides beneficial effects in cold-stored rat small intestinal grafts and could be an attractive therapeutic application of CO in the clinical setting of organ preservation and transplantation.

Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study.

BACKGROUND: Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA. METHODS: A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival. RESULTS: Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36-70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22-41), and median transport time was 11 min (IQR 6-17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%. CONCLUSION: The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.

Short or Irregular Sleep Duration in Early Childhood Increases Risk of Injury for Primary School-Age Children: A Nationwide Longitudinal Birth Cohort in Japan.

The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, >12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5-nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19-1.66, 7 h: aOR 1.10, 95% CI, 0.98-1.23, 8 h: aOR 1.13, 95% CI, 1.02-1.26, irregular: aOR 1.26, 95% CI 1.10-1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

Multicascade-linked synthetic-wavelength digital holography using a line-by-line spectral-shaped optical frequency comb.

Phase imaging without a phase wrapping ambiguity is required for wide-axial-range 3D imaging in the fields of surface topography measurement and biomedical imaging. Although multicascade-linked synthetic-wavelength digital holography (MCL-SW-DH) using an optical frequency synthesizer (OFS) is a promising method to meet this requirement, the slow switching of multiple optical wavelengths in the OFS prevents rapid imaging. In the work described in this article, a line-by-line spectral-shaped electro-optics-modulator-based optical frequency comb (EOM-OFC) is used as a light source in MCL-SW-DH to achieve rapid image acquisition. While MCL-SW-DH enables surface topography measurement with millimeter-order axial range and micrometer-order axial resolution, the line-by-line spectral-shaped EOM-OFC extracts a single narrow-linewidth OFC mode from the 10 GHz-spacing EOM-OFC at a center wavelength of 1545 nm within a spectral range of 30 nm at an interval of 500 ms. The effectiveness of the proposed MCL-SW-DH was highlighted by performing surface topography measurement with four step differences of sub-millimeter to millimeter size with an axial uncertainty of 2.08 µm in the image acquisition time of several seconds. The proposed MCL-SW-DH will be a powerful tool for 3D imaging with a wide axial range and high axial resolution.

Aerial image resolution measurement based on the slanted knife edge method.

Image resolution is one of the most important performance specifications of aerial display techniques. However, there is no standard method for evaluating the aerial image resolution. In this paper, we propose a method for measuring the modulation transfer function (MTF) of an aerial imaging system based on the slanted knife edge method. We hypothesize that aerial images have a different blur function from standard camera images. In order to explore this, we simulate blurred slanted knife edge images by convolving two types of blur functions. Furthermore, the MTF curves of the aerial image formed using different retro-reflectors are compared using the proposed method.

Triple-views aerial display to show different floating images for surrounding directions.

To realize a triple-views aerial image floating in the center of the passages that can be displayed in front of an user and passed through, we propose a novel display device using aerial imaging with retro-reflection with polarization. We confirmed that our device can form aerial images in the center of the intersection of three passages and can display different contents to users in each passage without using the material as screen.

Roadmap on 3D integral imaging: sensing, processing, and display.

This Roadmap article on three-dimensional integral imaging provides an overview of some of the research activities in the field of integral imaging. The article discusses various aspects of the field including sensing of 3D scenes, processing of captured information, and 3D display and visualization of information. The paper consists of a series of 15 sections from the experts presenting various aspects of the field on sensing, processing, displays, augmented reality, microscopy, object recognition, and other applications. Each section represents the vision of its author to describe the progress, potential, vision, and challenging issues in this field.

Luminal preloading with hydrogen-rich saline ameliorates ischemia-reperfusion injury following intestinal transplantation in rats.

Prolonged intestinal cold storage causes considerable mucosal breakdown, which could bolster bacterial translocation and cause life-threatening infection for the transplant recipient. The intestine has an intraluminal compartment, which could be a target for intervention, but has not yet been fully investigated. Hydrogen gas exerts organ protection and has used been recently in several clinical and basic research studies on topics including intestinal transplantation. In this study, we aimed to investigate the cytoprotective efficacy of intraluminally administered hydrogen-rich saline on cold IR injury in intestinal transplantation. Isogeneic intestinal transplantation with 6 hours of cold ischemia was performed on Lewis rats. Hydrogen-rich saline (H2 concentration at 5 ppm) or normal saline was intraluminally introduced immediately before preservation. Graft intestine was excised 3 hours after reperfusion and analyzed. Histopathological analysis of control grafts revealed blunting of the villi and erosion. These mucosal changes were notably attenuated by intraluminal hydrogen. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h post-reperfusion. However, this decline in permeability was critically prevented by hydrogen treatment. IR-induced upregulation of proinflammatory cytokine mRNAs such as IL-6 was mitigated by hydrogen treatment. Western blot revealed that hydrogen treatment regulated loss of the transmembrane protein ZO-1. Hydrogen-rich saline intraluminally administered in the graft intestine modulated IR injury to transplanted intestine in rats. Successful abrogation of intestinal IR injury with a novel strategy using intraluminal hydrogen may be easily clinically applicable and will compellingly improve patient care after transplantation.

Comparison of Two Different Intensive Care Unit Systems for Severely Ill Children in Japan: Data from the JaRPAC Registry.

The importance of centralizing treatment services for severely ill children has been well established, but such entralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45; 95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29; 95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38; 95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72; 95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report.

Thyroid storm is a potentially fatal intensification of thyrotoxicosis normally marked by tachycardia, hyperthermia, impaired mental status, and severe agitation. It can be initiated by numerous causes. Failure to promptly diagnose the condition may lead to high mortality. Early diagnosis and treatment of thyroid storm are essential to prevent further life-threatening complications. A 10-year-old girl was admitted to our emergency center for intensive care. The patient presented tachypnea with stridor, paradoxical abdominal breathing, and "barking" cough. The patient was diagnosed as upper airway obstruction complicated by thyroid storm associated with influenza infection. Following immediate airway management, the patient was administered a short-acting beta-blocker, hydrocortisone, thiamazole, and saturated solution of potassium iodide was initiated. The patient was extubated on day 8 and transferred to a local hospital on day 11 without adverse complications. When examining patients with influenza infection, emergency doctors should be more attentive not to miss other critical diagnoses. The present case was initially diagnosed as croup due to influenza infection. Sharing our experience may help emergency physicians treat similar cases of pediatric airway compromise due to thyroid storm.

Optical image amplification in dual-comb microscopy.

Dual-comb microscopy (DCM), based on a combination of dual-comb spectroscopy (DCS) with two-dimensional spectral encoding (2D-SE), is a promising method for scan-less confocal laser microscopy giving an amplitude and phase image contrast with the confocality. However, signal loss in a 2D-SE optical system hampers increase in image acquisition rate due to decreased signal-to-noise ratio. In this article, we demonstrated optical image amplification in DCM with an erbium-doped fiber amplifier (EDFA). Combined use of the image-encoded DCS interferogram and the EDFA benefits from not only the batch amplification of amplitude and phase images but also significant rejection of amplified spontaneous emission (ASE) background. Effectiveness of the optical-image-amplified DCM is highlighted in the single-shot quantitative nanometer-order surface topography and the real-time movie of polystyrene beads dynamics under water convection. The proposed method will be a powerful tool for real-time observation of surface topography and fast dynamic phenomena.

Therapeutic strategies for ischemia reperfusion injury in emergency medicine.

Ischemia reperfusion (IR) injury occurs when blood supply, perfusion, and concomitant reoxygenation is restored to an organ or area following an initial poor blood supply after a critical time period. Ischemia reperfusion injury contributes to mortality and morbidity in many pathological conditions in emergency medicine clinical practice, including trauma, ischemic stroke, myocardial infarction, and post-cardiac arrest syndrome. The process of IR is multifactorial, and its pathogenesis involves several mechanisms. Reactive oxygen species are considered key molecules in reperfusion injury due to their potent oxidizing and reducing effects that directly damage cellular membranes by lipid peroxidation. In general, IR injury to an individual organ causes various pro-inflammatory mediators to be released, which could then induce inflammation in remote organs, thereby possibly advancing the dysfunction of multiple organs. In this review, we summarize IR injury in emergency medicine. Potential therapies include pharmacological treatment, ischemic preconditioning, and the use of medical gases or vitamin therapy, which could significantly help experts develop strategies to inhibit IR injury.

Visualization of internal structure and internal stress in visibly opaque objects using full-field phase-shifting terahertz digital holography.

We construct a full-field phase-shifting terahertz digital holography (PS-THz-DH) system by use of a THz quantum cascade laser and an uncooled, 2D micro-bolometer array. The PS-THz-DH enables us to separate the necessary diffraction-order image from unnecessary diffraction-order images without the need for spatial Fourier filtering, leading to suppress the decrease of spatial resolution. 3D shape of a visibly opaque object is visualized with a sub-millimeter lateral resolution and a sub-µm axial resolution. Also, the digital focusing of amplitude image enables the visualization of internal structure with the millimeter-order axial selectivity. Furthermore, the internal stress distribution of an externally compressed object is visualized from the phase image. The demonstrated results imply a possibility for non-destructive inspection of visibly opaque non-metal materials.

Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report.

INTRODUCTION: Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst. CASE PRESENTATION: A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management. CONCLUSION: Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.