[Long-term Outcomes of the Maze Procedure Omitting the Ablation Line to The Superior Vena Cava].

OBJECTIVE: In an effort to avoid postoperative sick sinus syndrome( SSS), we omit the ablation line to the superior vena cava( SVC) in the Cox-mazeⅢ lesion set. We report the long-term outcomes, including the freedom from SSS. METHODS: We studied 102 patients who underwent bi-atrial maze procedure for persistent atrial fibrillation (Af) from 2009 through 2023. Bipolar radio frequency ablation or cryoablation was used except for right-side atriotomy and right atriotomy. Cryoablation was used for atrioventricular annulus. The patient age was 68±9.4. Duration of Af was 3.4±6.5 years (unknown 9 cases). The amplitude of f-wave in V1 was 0.182±0.095 mV and it was<0.1 mV in 19 (18.6%). Diameter of the left atrium was 50±8.9 mm, and left atrial volume index was 89±37 ml/m2. Ninety-one (89.2%) patients underwent concomitant mitral valve surgery. RESULTS: Survival rate was 99% at 1 year and 96% at 5 years. Freedom from Af was 92% at 1 year and 88% at 5 years. Freedom from permanent pacemaker implantation (PPI) was 87% at 1 year and 83% at 5 years. CONCLUSIONS: Defibrillation rate and the incidence of PPI was comparable to those in previous reports after standard Cox-mazeⅢ. SSS after maze for persistent Af seem due to patient.

Clinical Features of Hypoxemia Due to Infection Under Home-Based Medication During the COVID-19 Pandemic Period.

BACKGROUND: Despite the growing demand for home-based medication during the COVID-19 pandemic period, there remains scarce evidence of hypoxemic infection in home-care settings. In this study, we investigated the clinical features of hypoxemic respiratory failure due to infection during the period under home-based medication (defined as 'home-care-acquired infection'). METHODS: This retrospective observational study enrolled patients with home-care-acquired infection, other than COVID-19, in two home-care clinics in Sapporo, Japan, between April 2020 and May 2021 (the early phase of the COVID-19 pandemic). The participants were divided into two groups according to whether they required additional home oxygen therapy, and were compared to assess the predictors of hypoxemic respiratory failure. Furthermore, the clinical features were compared with those in patients aged >60 years with COVID-19 who were admitted to Toyama University Hospital during the same period. RESULTS: A total of 107 patients with home-care-acquired infections were included in the study (median age, 82 years). Twenty-two patients required home oxygen therapy, and 85 did not. Thirty-day mortality rates were 32% and 8%. Among the patients in the hypoxemia group, none had desired a care-setting transition, following the advanced care planning. Multivariable logistic regression analysis showed that initial antibiotic treatment failure and malignant disease were independently associated with hypoxemic respiratory failure (odds ratio, 7.28 and 7.10; p=0.023 and p<0.005, respectively). In comparison with hypoxemia in the COVID-19 cohort, the lower incidence of febrile co-habitants and earlier onset of hypoxemia were significant in those due to home-care-acquired infection. CONCLUSION: This study demonstrated that hypoxemia due to home-care-acquired infection was characterized by distinct features, possibly different from those due to COVID-19 in the early pandemic period.

Patency of separate tube grafts for intercostal artery reconstruction: Size and length matter.

OBJECTIVES: Low patency is a major concern when using separate tube grafts for intercostal artery reconstruction. Our goal was to elucidate the optimal size and length of grafts from their patency and the computational fluid dynamics (CFD). METHODS: The patency, size and length of separate tube grafts were evaluated in 41 patients. Simulation of CFD was performed in a model derived from a patient with a patent 12-mm graft that was 15 mm long, with 2 simulation models with a smaller (8-mm) or longer (30-mm) graft. RESULTS: A total of 49 grafts were used for intercostal artery reconstruction. There was 1 in-hospital death and 2 spinal cord injuries. The patency rate, which could be evaluated in 46 grafts, was 63% (29/46). It was 71% (24/34) in thoracoabdominal aortic replacement and 42% (5/12) in descending aortic replacement. Among 14 patients in whom all grafts were occluded, no patients developed spinal cord injury. All grafts longer than 25 mm were occluded (n = 5). Eight- and 10-mm grafts showed better patency than 12-mm grafts in thoracoabdominal aortic replacement (P = 0.008) when grafts were shorter than 25 mm. Simulation of CFD revealed vortical flow within the 12-mm graft, which did not reach the intercostal orifice, whereas helical flow was maintained throughout the cardiac cycle within the 8-mm graft. CONCLUSIONS: Eight- and 10-mm grafts seemed better than 12-mm grafts, and grafts should be kept shorter than 25 mm. Simulation of CFD may shed light on the issue of the optimal intercostal artery reconstruction technique.

Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta.

Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.

18-Fluorodeoxyglucose positron emission tomography in the diagnosis of prosthetic aortic graft infection: the difference between open and endovascular repair.

OBJECTIVES: 18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has been reported as useful for diagnosing aortic graft infection. However, 18F-FDG uptake may depend upon various factors including open versus endovascular repair and time from surgery. We aimed to elucidate the factors influencing its uptake and the diagnostic value of 18F-FDG PET/CT after open and endovascular repair. METHODS: Hospital database of PET/CT (N = 14 490) and our departmental database were cross-checked to identify those who underwent 18F-FDG PET/CT after aortic repair. Patient's data were retrieved from the chart. Images were reviewed by 2 nuclear medicine specialists in consensus, and the presence of increased 18F-FDG uptake was recorded. The maximum standardized uptake value (SUV max) was measured. RESULTS: Among the 1112 patients who underwent aortic repair between 2011 and 2022, 71 patients were identified. Eighteen patients underwent 18F-FDG PET/CT for suspected graft infection and the remaining 53 patients for other purposes (malignancy, etc.). Fourteen patients were treated as aortic graft infection. They had significantly higher SUV max than those without graft infection [mean 8.64 (standard deviation 2.78) vs 3.40 (standard deviation 0.84); P < 0.01]. In the non-infected grafts, SUV max was higher early after open surgical repair, while it remained low after endovascular repair. CONCLUSIONS: After endovascular aortic repair, a constant cut-off value of 'SUV max = 4.5' seems appropriate for diagnosing graft infection, since it remains low and stable from the early postoperative period. After open surgical repair, it seems acceptable to have 'stepwise cut-off value' depending on the time from surgery.

HiVTac: A High-Speed Vision-Based Tactile Sensor for Precise and Real-Time Force Reconstruction with Fewer Markers.

Although they have been under development for years and are attracting a lot of attention, vision-based tactile sensors still have common defects-the use of such devices to infer the direction of external forces is poorly investigated, and the operating frequency is too low for them to be applied in practical scenarios. Moreover, discussion of the deformation of elastomers used in vision-based tactile sensors remains insufficient. This research focuses on analyzing the deformation of a thin elastic layer on a vision-based tactile sensor by establishing a simplified deformation model, which is cross-validated using the finite element method. Further, this model suggests a reduction in the number of markers required by a vision-based tactile sensor. In subsequent testing, a prototype HiVTac is fabricated, and it demonstrates superior accuracy to its vision-based tactile sensor counterparts in reconstructing an external force. The average error of inferring the direction of external force is 0.32∘, and the root mean squared error of inferring the magnitude of the external force is 0.0098 N. The prototype was capable of working at a sampling rate of 100 Hz and a processing frequency of 1.3 kHz, even on a general PC, allowing for real-time reconstructions of not only the direction but also the magnitude of an external force.

Real-Time Traffic Light Detection with Frequency Patterns Using a High-speed Camera.

LEDs are widely employed as traffic lights. Because most LED traffic lights are driven by alternative power, they blink at high frequencies, even at twice their frequencies. We propose a method to detect a traffic light from images captured by a high-speed camera that can recognize a blinking traffic light. This technique is robust under various illuminations because it can detect traffic lights by extracting information from the blinking pixels at a specific frequency. The method is composed of six modules, which includes a band-pass filter and a Kalman filter. All the modules run simultaneously to achieve real-time processing and can run at 500 fps for images with a resolution of 800 × 600. This technique was verified on an original dataset captured by a high-speed camera under different illumination conditions such as a sunset or night scene. The recall and accuracy justify the generalization of the proposed detection system. In particular, it can detect traffic lights with a different appearance without tuning parameters and without datasets having to be learned.

Validity and reliability of isometric knee extension muscle strength measurements using a belt-stabilized hand-held dynamometer: a comparison with the measurement using an isokinetic dynamometer in a sitting posture.

[Purpose] This study aimed to determine the validity and reliability of isometric knee extension muscle strength measurements using a belt-stabilized hand-held dynamometer compared to that using an isokinetic dynamometer with the participant in a sitting posture. [Participants and Methods] Forty-two university students participated. The isometric knee extension muscle strength was measured using a hand-held dynamometer and an isokinetic dynamometer. For both measurements, the participants were in the similar sitting posture. The sitting posture maintained trunk stability, with the hands on the bed, and the non-measurement-side toe touching the floor or table. The intra-class correlation coefficient and the relevance were verified. [Results] Intra-rater correlation coefficient (1, 1) of the two measurements was ≥0.75. A significant difference was found in the measurement value between males and females. No significant difference was found between the measurements value of the two devices. A significant positive correlation was found in the measurement value of two devices in the male participants. [Conclusion] When compared to the standard method of isometric knee extension muscle strength measurements using an isokinetic dynamometer with the participant in the sitting posture, measurements using the belt-stabilized hand-held dynamometer were considered valid and highly reliable in the male participants.

Correction: Motor planning error in Parkinson's disease and its clinical correlates.

[This corrects the article DOI: 10.1371/journal.pone.0202228.].

Isometric knee muscle strength measurement using a belt-stabilized hand-held dynamometer and an isokinetic dynamometer with and without trunk fixation: investigation of agreement of measurement values and factors influencing measurement.

[Purpose] The purpose of this study was to examine the agreement between the values obtained by using a hand-held dynamometer with a belt (belt-HHD) and an isokinetic dynamometer (IKD) for the measurement of isometric knee flexion and extension muscle strength. We also studied the factors influencing the measurement. [Participants and Methods] Overall, 26 healthy young adults (16 males, 10 females) participated in the study; the mean age was 21 years. Knee flexion and extension muscle strength were measured by three methods: 1) belt-HHD, 2) conventional IKD with the participant sitting on an attached chair (conv-IKD), and 3) modified IKD with the participant sitting on the same mat table as HHD (mod-IKD). [Results] In the measurement of knee extension, mod-IKD and conv-IKD showed a fixed bias and a proportional bias, conv-IKD and belt-HHD showed a fixed bias, and belt-HHD and mod-IKD showed a fixed bias. In the measurement knee flexion, conv-IKD and mod-IKD showed a proportional bias, belt-HHD and conv-IDK showed a fixed bias, and mod-IKD and belt-HHD showed a fixed bias. In each combination, the measured values were larger in the latter due to errors. However, the types and values of errors differed when analysis was conducted based on gender. [Conclusion] In order to increase the agreement between the values, it is necessary to revise the fixing method of the trunk, and the fixing method of the belt and the sensor pad in belt-HHD.

Correction to: Short-Term Symptomatic Relief in Gastroesophageal Reflux Disease: A Comparative Study of Esomeprazole and Vonoprazan.

The original version of the article unfortunately contained percentage errors in second and third paragraphs of GerdQ Score section. Below is the corrected version.

Short-Term Symptomatic Relief in Gastroesophageal Reflux Disease: A Comparative Study of Esomeprazole and Vonoprazan.

BACKGROUND AND AIM: Proton pump inhibitors and vonoprazan (a potassium-competitive acid blocker) are recommended as first-line treatments for gastroesophageal reflux disease (GERD). However, few reports have investigated the onset of action of these agents for GERD symptom relief. The present study compared the symptom relief of esomeprazole with that of vonoprazan via monitoring self-reported GERD symptoms after treatment initiation. METHODS: This was a prospective, multicenter, randomized, open-label, parallel group, comparative clinical study between esomeprazole (20 mg/day) and vonoprazan (20 mg/day) administered for 4 weeks to patients with GERD symptoms. Patients who had scores ≥ 8 on the Gastroesophageal Reflux Disease Questionnaire (GerdQ) were defined as having GERD and enrolled in this study. Sixty patients were randomly assigned to either the esomeprazole group (n = 30) or the vonoprazan group (n = 30). Treatment response rates in each drug group were evaluated according to the GerdQ. The Frequency Scale for the Symptoms of GERD (FSSG) scores from the 1st day after treatment initiation and the Global Overall Symptom (GOS) scale scores during treatment were also evaluated. RESULTS: At 4 weeks, the treatment response rates for symptom relief according to the GerdQ were 88.0% in the esomeprazole group and 81.8% in the vonoprazan group. The GOS scales, which reflect the impact of GERD symptoms, were similar for both groups. The FSSG scores decreased from the 1st to the 14th day in both groups. CONCLUSIONS: There were no substantial differences in the symptom relief between the two groups at any time point in this short-term study.

Motor planning error in Parkinson's disease and its clinical correlates.

This study aimed to investigate (a) motor planning difficulty by using a two-step test in Parkinson's disease (PD) compared with age-matched healthy subjects and (b) the relationship between motor planning difficulty and clinical factors. The two-step test was performed by 58 patients with PD with Hoehn & Yahr (H&Y) stage I-IV and 110 age-matched healthy older adult controls. In the two-step test, the participants estimated the two-step distance with maximum effort. Subsequently, they performed the actual two-step trial to measure the actual maximum distance. We calculated the accuracy of the estimation (estimated distance minus actual distance). In both groups, subjects who estimated >5 cm were defined as the overestimation group, and those who estimated <5 cm over- and underestimation were defined as the non-overestimation group. The overestimation group consisted of 17 healthy older adults (15.5%) and 23 patients with PD (39.7%). The number of patients with PD with overestimation was significantly more than that of healthy controls by Chi-squared test. H&Y stage and the Unified Parkinson's Disease Rating Scale (UPDRS) part II and III scores in overestimation group in PD patients were significantly higher than those in overestimation group in PD patients. Moreover, multiple regression using H&Y stage and UPDRS parts II and III as independent variables showed that the UPDRS part II score was the only related factor for the estimation error distance. Estimation error distance was significant correlated with UPDRS parts II and III. Patients with PD easily have higher rates of motor-related overestimation than age-matched healthy controls. In addition, UPDRS parts II and III expressed ability of activities of daily living and motor function as influences on motor-related overestimation. Particularly, multiple regression indicated that UPDRS part II directly showed the ability of daily living as an essential factor for overestimation.

Effects of trunk stability on isometric knee extension muscle strength measurement while sitting.

[Purpose] This study aimed to investigate the effect of trunk stability on isometric knee extension muscle strength measurement while sitting by performing simultaneous measurements with a handheld dynamometer (HHD) and an isokinetic dynamometer (IKD) in the same seated condition. [Subjects and Methods] The subjects were 30 healthy volunteers. Isometric knee extension muscle strength was simultaneously measured with a HHD and an IKD by using an IKD-specific chair. The measurement was performed twice. Measurement instrument variables and the number of measurements were examined by using the analysis of variance and correlation tests. [Results] The measurement instrument variables and the number of measurements were not significantly different. The correlation coefficients between the HHD and IKD measurements were ≥0.96. [Conclusion] Isometric knee extension muscle strength measurement using the HHD in the sitting position resulted in a lower value than that using the IKD, presumably because of the effect of trunk stability on the measurement. In the same seated posture with trunk stability, no significant difference in measurement values was observed between the HHD and IKD. The present findings suggest that trunk stability while seated during isometric knee extension muscle strength measurement influenced the HHD measurement.

Intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer for geriatric and stroke patients.

[Purpose] This study aimed to verify the appropriate number of measurements and the intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD) for geriatric and stroke patients. [Subjects and Methods] The subjects were 40 inpatients, who were divided into two groups: 20 stroke patients in the stroke group (SG), and 20 geriatric patients in the no-stroke group (N-SG). Measurements were performed three times using an HHD with a belt. The reliability was verified using Bland-Altman analysis and the intraclass correlation coefficient (ICC). [Results] ICC (1, 1) was >0.9. A systematic bias was not observed between the first and second measurement values except for the right side in N-SG. A systematic bias between the maximum value obtained during the first and second measurements and third measurement value was observed on the left side in N-SG, and on the non-paralyzed side in SG: the third measurement values were small in both cases. [Conclusion] Intrarater reliabilities were high for shoulder horizontal adductor strength measurements using an HHD with a belt for geriatric and stroke patients. Taking the systematic bias into consideration, these findings suggest that the required number of measurements is two.

Biomechanical evaluation of the rabbit tibia after implantation of porous hydroxyapatite/collagen in a rabbit model.

PURPOSE: Porous hydroxyapatite/collagen composite (HAp/Col) is an artificial bone substitute with excellent osteoconduction and sponge-like elasticity. However, the porosity of porous HAp/Col is as high as 95% and its mechanical strength is very poor. The aim of this study was to biomechanically analyze sites implanted with porous HAp/Col. METHODS: Rectangular cortical bone defects (3 × 8 mm) were made in the tibia of rabbits and filled with porous HAp/Col or porous ß-tricalcium phosphate or left vacant. The tibia was harvested at 4 or 12 weeks after surgery. The harvested specimens were analyzed using a micro-CT system, and the mechanical strength of the specimens was examined by torsion testing. RESULTS: Quantitative micro-CT analysis of the regenerated bone revealed that both bone substitutes equally facilitated bone regeneration. Biomechanical testing demonstrated that the torsional strength of HAp/Col-implanted sites was higher than that of the control (vs control: p = 0.030 and vs ß-TCP: p = 0.056). CONCLUSIONS: The results indicate that porous HAp/Col implantation is an effective strategy for recovery of the mechanical strength of bone defects.

Absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer.

[Purpose] The aim of this study was to verify the absolute reliability of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD). [Subjects and Methods] The subjects were 33 healthy college students. The measurements were made three times with the HHD fixed using a belt (BFHHD) or with the examiner's hand (conventional method; HFHHD). The absolute reliability of measurements was verified using Bland-Altman analysis, both in the all subjects group and a group of subjects showing measurements less than a fixed limit of 30 kgf. [Results] In the <30 kgf group, a systematic bias was not observed, and BFHHD values were greater than HFHHD values. BFHHD values in the all subjects group showed a systematic bias; the 3rd measurement value was less than the maximum value obtained during the 1st and 2nd measurements. [Conclusion] For obtaining an acceptable value during clinical measurements of horizontal adductor muscle strength, single measurements obtained using an HFHHD in the case of a <30 kgf group and the maximum value of two measurements obtained using a BFHHD are reliable.

Repair of osteochondral defects in a rabbit model using a porous hydroxyapatite collagen composite impregnated with bone morphogenetic protein-2.

Articular cartilage has a limited capacity for spontaneous repair, and an effective method to repair damaged articular cartilage has not yet been established. The purpose of this study was to evaluate the effect of transplantation of porous hydroxyapatite collagen (HAp/Col) impregnated with bone morphogenetic protein-2 (BMP-2). To evaluate the characteristics of porous HAp/Col as a drug delivery carrier of recombinant human BMP-2 (rhBMP-2), the rhBMP-2 adsorption capacity and release kinetics of porous HAp/Col were analyzed. Porous HAp/Col impregnated with different amounts of rhBMP-2 (0, 5, and 25 µg) was implanted into osteochondral defects generated in the patellar groove of Japanese white rabbits to evaluate the effect on osteochondral defect regeneration. At 3, 6, 12, and 24 weeks after operation, samples were harvested and subjected to micro-computed tomography analysis and histological evaluation of articular cartilage and subchondral bone repair. The adsorption capacity was 329.4 µg of rhBMP-2 per cm(3) of porous HAp/Col. Although 36% of rhBMP-2 was released within 24 h, more than 50% of the rhBMP-2 was retained in the porous HAp/Col through the course of the experiment. Defects treated with 5 µg of rhBMP-2 showed the most extensive subchondral bone repair and the highest histological regeneration score, and differences against the untreated defect group were significant. The histological regeneration score of defects treated with 25 µg of rhBMP-2 increased up to 6 weeks after implantation, but then decreased. Porous HAp/Col, therefore, is an appropriate carrier for rhBMP-2. Implantation of porous HAp/Col impregnated with rhBMP-2 is effective for rigid subchondral bone repair, which is important for the repair of the smooth articular surface.

Limits of the manipulative-fixed method for measurement of shoulder joint horizontal adduction muscle strength using a handheld dynamometer.

[Purpose] The aim of this study was to verify the limit of isometric muscle strength of shoulder joint horizontal adduction using handheld dynamometer (HHD) manipulated by hand (referred to as the manipulative-fixed method). [Subjects and Methods] The subjects were 33 healthy college students. The examiner was a healthy college student. Shoulder joint horizontal adductor muscle strength was measured using HHD with the subject in the supine position. The belt-fixed and manipulative-fixed methods were used to secure the HHD sensor unit. The limitations of the manipulative-fixed method were assessed by simple regression analysis, in which the participants were divided into 2 groups according to a branch point. The slope of the straight line of the graph was visualized. [Results] Single regression analysis of the <30 kgf group revealed significant results. The results of single regression of the >30 kgf group were not significant. [Conclusion] The manipulative-fixed method is simple to perform. However, there exists the possibility that the actual muscle strength is not measurable by this method. The measurement limit of the shoulder horizontal adduction strength with the manipulative-fixed method was 30 kgf in the case of the examiner in the present study. The fixed limit was also found to influence in the muscle strength of the upper limbs.