Simple new clinical score to predict hepatocellular carcinoma after sustained viral response with direct-acting antivirals.

The time point of the most precise predictor of hepatocellular carcinoma (HCC) development after viral eradication with direct-acting antiviral (DAA) therapy is unclear. In this study we developed a scoring system that can accurately predict the occurrence of HCC using data from the optimal time point. A total of 1683 chronic hepatitis C patients without HCC who achieved sustained virological response (SVR) with DAA therapy were split into a training set (999 patients) and a validation set (684 patients). The most accurate predictive scoring system to estimate HCC incidence was developed using each of the factors at baseline, end of treatment, and SVR at 12 weeks (SVR12). Multivariate analysis identified diabetes, the fibrosis-4 (FIB-4) index, and the α-fetoprotein level as independent factors at SVR12 that contributed to HCC development. A prediction model was constructed with these factors that ranged from 0 to 6 points. No HCC was observed in the low-risk group. Five-year cumulative incidence rates of HCC were 1.9% in the intermediate-risk group and 15.3% in the high-risk group. The prediction model at SVR12 most accurately predicted HCC development compared with other time points. This simple scoring system combining factors at SVR12 can accurately evaluate HCC risk after DAA treatment.

Collective plasmonic resonances enhance the photoluminescence of rare-earth nanocrystal films processed by ultrafast annealing.

Herein, we demonstrate that rapid thermal annealing allows achieving close-to-one photoluminescence quantum yield while preserving the transparency of rare-earth nanocrystal films, which further enables their integration with nanophotonics. The combination with periodic arrays of aluminum nanodisks that support collective plasmonic resonances leads to enhanced directional emission.

Why does 2-(2-aminoethylamino)ethanol have superior CO2 separation performance to monoethanolamine? A computational study.

Our computational reaction analysis shows that 2-(2-aminoethylamino)ethanol (AEEA) has superior performance to monoethanolamine for CO2 separation, in terms of its ability to sorb CO2 by its primary amine and desorb CO2 by its secondary amine.

Role of a rapid response system and code status discussion as determinants of prognosis for critical inpatients: An observational study in a Japanese urban hospital.

ABSTRACT: Rapid response systems (RRS) have been introduced worldwide to reduce unpredicted in-hospital cardiac arrest (IHCA) and in-hospital mortality. The role of advance care planning (ACP) in the management of critical patients has not yet been fully determined in Japan.We retrospectively assessed the characteristics of all inpatients with unpredicted IHCA in our hospital between 2016 and 2018. Yearly changes in the number of RRS activations and the incidence of unpredicted IHCA with or without code status discussion were evaluated from 2014 to 2018. Hospital standardized mortality ratios were assessed from the data reported in the annual reports by the National Hospital Organization.A total of 81 patients (age: 70.9 ±â€Š13.3 years) suffered an unpredicted IHCA and had multiple background diseases, including heart disease (75.3%), chronic kidney disease (25.9%), and postoperative status (cardiovascular surgery, 18.5%). Most of the patients manifested non-shockable rhythms (69.1%); survival to hospital discharge rate was markedly lower than that with shockable rhythms (26.8% vs 72.0%, P < .001). The hospital standardized mortality ratios was maintained nearly constant at approximately 50.0% for 3 consecutive years. The number of cases of RRS activation markedly increased from 75 in 2014 to 274 patients in 2018; conversely, the number of unpredicted IHCA cases was reduced from 40 in 2014 to 18 in 2018 (P < .001). Considering the data obtained in 2014 and 2015 as references, the RRS led to a reduction in the relative risk of unpredicted IHCA from 2016 to 2018 (ie, 0.618, 95% confidence interval 0.453-0.843). The reduction in unpredicted IHCA was attributed partly to the increased number of patients who had discussed the code status, and a significant correlation was observed between these parameters (R2 = 0.992, P < .001). The reduction in the number of patients with end-stage disease, including congestive heart failure and chronic renal failure, paralleled the incidence of unpredicted IHCA.Both RRS and ACP reduced the incidence of unpredicted IHCA; RRS prevents progression to unpredicted IHCA, whereas ACP decreases the number of patients with no code status discussion and thus potentially reducing the patient subgroup progressing to an unpredicted IHCA.

Acceleration of rises in the level of rivers induced by rising air temperatures in a cold climate.

The effects of climate change on water discharge in rivers in cold climates were investigated. To quantify the impacts of air temperature rises on the promotion of snowmelt and associated acceleration of a rise in the level of a river, 10 rivers on Hokkaido, northwestern Japan were chosen. Available data of daily water discharge for more than half a century by the Ministry of Land, Infrastructure, Transport and Tourism (MLIT) were correlated with air temperatures observed at the 8 weather stations operated by the Japan Meteorological Agency (JMA). The analyses show that annual average air temperatures have risen at all 8 sites on Hokkaido for the period from 1954 to 2018. The trends for the 8 sites show a range from 0.119 °C/decade to 0.250 °C/decade with an average of 0.191 °C/decade. Annual snowfall has increased at Sutsu. The trend over the period from 1954 to 2018 was 45.2 cm/decade. Otherwise, annual snowfall has not changed significantly in the period (1954-2018). Accelerations of the rise in the level of the river induced by air temperature rises have been observed in the Teshio River, Ishikari River, Saru River, and Mu River. A delay in the rise in the level of the river caused by an increase in snowfall and the weak warming trend from January to April has been observed in the Shiribetsu River. Although air temperatures have risen year after year, a significant change in annual pattern of daily flow has not been observed in the Syokotsu River, Yubetsu River, Tokoro River, and Abashiri River located in eastern Hokkaido. This can be induced by the weak warming trends in April which may be due to the cold current of the sea of Okhotok.

[A case of amebic colitis that developed after corticosteroid therapy in which perforation occurred during metronidazole treatment].

Although amebiasis is usually asymptomatic, fulminant amebic colitis is associated with a high mortality rate. Here, we report the case of a patient with amebic colitis in which bowel perforation occurred despite treatment with metronidazole. A man in his 70s underwent steroid pulse therapy to treat serious acute hepatitis A. After corticosteroid therapy, he developed acute abdomen because of amebic colitis. We immediately administered metronidazole and his symptoms improved. After completing treatment, he developed colon perforation. Amebic colitis can progress to bowel perforation even after administering the appropriate medication, so this abdominal symptom requires careful attention.

Effects of clay in a sandy soil on saturated/unsaturated pore water flow and dissolved chloride transport from road salt applications.

Saturated/unsaturated pore water flow induced by rainwater infiltration in a soil column composed of a mixture of Toyoura sand and a small amount of clay (kaolin minerals) and the rinsing rate (mass transfer) of dissolved NaCl accumulated in the pore system from previous road salt application were investigated by experiments and simulations. Experiments were conducted with variable kaolin minerals mass contents (mixing ratios) in the soil columns. Measured saturated hydraulic conductivity (Ks) diminished with increased clay contents, i.e., Ks=0.00771, 0.00560, 0.00536, 0.00519, and 0.00314 cm s-1, for clay contents = 0.2, 0.5, 1, 2, and 5%, respectively. Experimental NaCl concentrations in the effluent from the bottom of the soil columns were about constant for times t ≈ 800, 1200, 1300, 1400, and 3400 s from the beginning of a rinsing experiment for the clay contents = 0.2, 0.5, 1, 2, and 5%, respectively. These NaCl concentrations then decreased with time quickly, and finally, approached zero. The presented model can reproduce experimental time variations of NaCl concentration in the effluent from the soil column reliably. Simulated salt mass left in the soil column with time also matches the experimental results for the clay contents = 0.2 and 0.5%. An inconsistency between simulated and experimental salt mass left in the soil columns becomes more significant as the clay content increases. These results suggest that the soil-water retention curve for the pure Toyoura sand can be applied to the soil column composed of kaolin minerals/Toyoura sand mixture when the clay content is small, i.e., less than 1%. Prediction of rinsing process becomes more difficult with increased clay content. However, the time required to remove saline water from the soil column to less than 1% of its initial value simulated by the model agrees closely with experimental results of 1000, 1500, 1700, 2100, and 5400 s, respectively.

Oxygen uptake prediction in rivers and streams: A stochastic approach.

Dissolved oxygen fluctuations in a river over a short period of time were assumed to be caused by the microbial growth dynamics, and a stochastic model was built for oxygen uptake. As a case study, biochemical oxygen demand (BOD) was measured in water from the Ura River, Oita River, and Otozu River flowing through the urban district of Oita, Japan. Water samples were taken from each river and partitioned into BOD bottles. BOD was measured in five of these bottles on each of nine days. The experimental results show that the average daily BOD decreased exponentially as expressed by the Streeter-Phelps equation. A wide range of the measured five daily BOD-values was expressed by the difference between the maximum and minimum BOD-values on each day for each river. After the first few days the range became smaller. The proposed stochastic model describes the observed experimental fluctuation of BOD over time. Eighty to ninety percent of the experimental BOD plots are within the 80% probability range given by the model. The uncertainty of BOD prediction can be expressed by the error which is the non-dimensional ratio of the range to the median. Modeled and experimental results reveal that the error is about 0.5-1 (50-100% of expected value) after a few days. This suggests that the BOD predicted by deterministic water quality models can include uncertainty, i.e. the actual BOD can be a quarter or double of the simulated value, for the time scale of a few days. For a longer period, e.g. more than a week, the error can become even more significant.

Phototaxis of Propsilocerus akamusi (Diptera: Chironomidae) From a Shallow Eutrophic Lake in Response to Led Lamps.

A study on the attraction of adult Propsilocerus akamusi midges to different-colored light traps was carried out from October 21 to November 15, 2013. The 6 colored lights used in light-emitting diode (LED) lamps were white, green, red, blue, amber, and ultraviolet (UV). The UV lamp attracted the most P. akamusi, followed by green, white, blue, amber, and red. A white pulsed LED light attracted only half the number of midges as did a continuous-emission white LED light. The result indicated that manipulation of light color, considering that the red LED light and/or pulsed LED light are not as attractive as the other colors, may be appropriate for the development of an overall integrated strategy to control nuisance P. akamusi in the Lake Suwa area.

Non-linear effects on solute transfer between flowing water and a sediment bed.

A previously developed model of periodic pore water flow in space and time, and associated solute transport in a stream bed of fine sand is extended to coarse sand and fine gravel. The pore water flow immediately below the sediment/water interface becomes intermittently a non-Darcy flow. The periodic pressure and velocity fluctuations considered are induced by near-bed coherent turbulent motions in the stream flow; they penetrate from the sediment/water interface into the sediment pore system and are described by a wave number (χ) and a period (T) that are given as functions of the shear velocity (U(∗)) between the flowing water and the sediment bed. The stream bed has a flat surface without bed forms. The flow field in the sediment pore system is described by the continuity equation and a resistance law that includes both viscous (Darcy) and non-linear (inertial) effects. Simulation results show that non-linear (inertial) effects near the sediment/water interface increase flow resistance and reduce mean flow velocities. Compared to pure Darcy flow, non-linear (inertial) effects reduce solute exchange rates between overlying water and the sediment bed but only by a moderate amount (less than 50%). Turbulent coherent flow structures in the stream flow enhance solute transfer in the pore system of a stream bed compared to pure molecular diffusion, but by much less than standing surface waves or bed forms.

Survey of overactive bladder symptoms influencing bother before and after treatment with tamsulosin hydrochloride in Japanese patients with benign prostatic hyperplasia.

OBJECTIVE: To evaluate the relation between bother and overactive bladder (OAB) symptoms in patients with benign prostatic hyperplasia (BPH) patients using questionnaires: the BPH Impact Index (BII) and the OAB symptom score (OABSS). Annoyance from BPH usually provides the basis for a patient's decision to seek medical treatment. However, a study investigating the bother caused by OAB symptoms in patients with BPH and OAB has not been fully conducted. METHODS: The present study included 100 male patients who were diagnosed with BPH and OAB according to questionnaire criteria. All patients were instructed to take tamsulosin for 28 days. The relation between the BII and OABSS was assessed to determine the factors influencing OAB symptoms on the BII before and after treatment. RESULTS: The BII correlated positively with the OABSS, and multivariate analysis showed that the subscore of urgency was the only independent factor influencing the BII. Even after treatment, lower urinary tract symptoms were diagnosed as OAB using the OABSS criteria in 45 (45.0%) of the 100 patients. In these patients, the BII still correlated positively with the OABSS. However, multivariate analysis showed that the subscore of urgency incontinence, not urgency, was the only independent factor influencing the BII, although the subscore of urgency incontinence was significantly decreased with tamsulosin treatment. CONCLUSION: The degree of bother correlated with the degree of OAB symptoms in patients with BPH and OAB at baseline and after treatment with tamsulosin. The OAB symptom causing the bother was altered by treatment with tamsulosin in these patients.

Oxygen consumption by a sediment bed for stagnant water: comparison to SOD with fluid flow.

A model of sedimentary oxygen demand (SOD) for stagnant water in a lake or a reservoir is presented. For the purposes of this paper, stagnant water is defined as the bottom layer of stratified water columns in relatively unproductive systems that are underlain by silt and sand-dominated sediments with low-organic carbon (C) and nitrogen (N). The modeling results are compared to those with fluid flow to investigate how flow over the sediment surface raises SOD compared to stagnant water, depending on flow velocity and biochemical activity in the sediment. SOD is found to be substantially limited by oxygen transfer in the water column when water is stagnant. When flow over the sediment surface is present, SOD becomes larger than that for stagnant water, depending on flow velocity and the biochemical oxygen uptake rate in the sediment. Flow over the sediment surface causes an insignificant raise in SOD when the biochemical oxygen uptake rate is small. The difference between SOD with fluid flow and SOD for stagnant water becomes significant as the biochemical oxygen uptake rate becomes larger, i.e. SOD is 10-100 times larger when flow over the sediment surface is present.

Sedimentary microbial oxygen demand for laminar flow over a sediment bed of finite length.

Dead organic material accumulated on the bed of a lake, reservoir or wetland often provides the substrate for substantial microbial activity as well as chemical processes that withdraw dissolved oxygen (DO) from the water column. A model to estimate the actual DO profile and the "sedimentary oxygen demand (SOD)" must specify the rate of microbial or chemical activity in the sediment as well as the diffusive supply of DO from the water column through the diffusive boundary layer into the sediment. Most previous experimental and field studies have considered this problem with the assumptions that the diffusive boundary layer is (a) turbulent and (b) fully developed. These assumptions require that (a) the flow velocity above the sediment bed is fast enough to produce turbulent mixing in the boundary layer, and (b) the sediment bed is long. In this paper a model for laminar flow and SOD over a sediment bed of finite length is presented and the results are compared with those for turbulent flow. Laminar flow near a sediment bed is encountered in quiescent water bodies such as lakes, reservoirs, river backwaters, wetlands and ponds under calm wind conditions. The diffusive oxygen transfer through the laminar diffusive boundary layer above the sediment surface can restrict the microbial or chemical oxygen uptake inside the sediment significantly. The developing laminar diffusive boundary layer above the sediment/water interface is modeled based on the analogy with heat transfer, and DO uptake inside the sediment is modeled by Michaelis-Menten microbial growth kinetics. The model predicts that the rate of SOD at the beginning of the reactive sediment bed is solely dependent on microbial density in the sediment regardless of flow velocity and type. The rate of SOD, and the DO penetration depth into the sediment decrease in stream-wise direction over the length of the sediment bed, as the diffusive boundary layer above the sediment/water interface thickens. With increasing length of the sediment bed both SOD rate and DO penetration depth into the sediment tend towards zero if the flow is laminar, but tend towards a finite value if the flow is turbulent. That value can be determined as a function of both flow velocity and microbial density. The effect of the developing laminar boundary layer on SOD is strongest at the very lowest flow velocity and/or highest microbial density inside the sediment. Under quiescent conditions, the effective SOD exerted by a reactive sediment bed of a lake or wetland approaches zero, i.e. no or very little oxygen demand is exerted on the overlying water column, except at the leading edge.

Diffusive boundary layer development above a sediment-water interface.

A model to estimate the entry length to a fully developed diffusive boundary layer above a sediment bed, such as those found in lakes, reservoirs, rivers, and estuaries, is presented. The model is used to determine how the length of a sediment bed in mass-transfer experiments influences the measured vertical diffusive flux at the sediment-water interface. A nondimensional local mass flux is introduced in the form of a Sherwood number (Sh) and expressed as a function of both the distance from the leading edge of the sediment bed (x) and the Schmidt number (Sc). Similarly, a mean Sherwood number (Sh(ave)) for a sediment bed of length (L) is introduced. The diffusive boundary layer grows with distance, and its thickness depends on the Schmidt number (i.e., the diffusive boundary layer gets thicker and develops more quickly as the Schmidt number decreases). For Schmidt numbers greater than or equal to 100, the diffusive boundary layer begins to develop slowly but is fully developed when the nondimensional horizontal coordinate (x+) is approximately 1000. The Sherwood number is largest (i.e., infinity) near the leading edge of the sediment bed (i.e., at x = 0), decreases as the distance from the bed increases, and, finally, approaches a constant value for a fully developed diffusive boundary layer (Sh(infinity)). In this paper, the distance to a fully developed diffusive boundary layer (L99) and the required length of a sediment bed are related explicitly to Sc, sheer velocity (U*), and the relative errors of local or average Sherwood numbers (Sh or Sh(ave), respectively) against the Sherwood number for the fully developed diffusive boundary layer (Sh(infinity)). The lengths L99 and L decrease as the Schmidt number increases and become independent of the Schmidt number when Sc is greater than 1000. A longer sediment bed is needed when the shear velocity or the Schmidt number is small (e.g., L99 and L approximately 1.0 m and 8.0 m, respectively, for Sc = 500, U* = 0.1 cm/s, and a 3% acceptable error). Experimental studies may not be able to meet these requirements and an adjustment of measured mass-transfer rates at a sediment-water interface may be necessary. The magnitude of that adjustment is up to 50%. Its dependence on the Schmidt number, shear velocity, and bed length is given in this paper.

Unsteady diffusional mass transfer at the sediment/water interface: Theory and significance for SOD measurement.

Dissolved oxygen uptake at a sediment/water interface (SOD) is controlled by mass transport and/or biochemical reactions in two adjacent boundary layers: the diffusive boundary layer delta(D) in the water and the penetration depth delta in the sediment. Either one of those boundary layers or both can be controlling. The transition from sediment control to water control is a function of shear velocity at the sediment/water interface (U(*)) and biochemical activity rate (micro(0)) in the sediment. A model was developed for the unsteady response of SOD and DO profiles near the sediment/water interface. Michaelis-Menten kinetics were used initially, but zero order kinetics work just as well when the half saturation coefficient K(O(2)) is small as was suggested by field data. Beginning with zero DO in the sediments the times required to reach steady state DO profiles and SOD was on the order of minutes to hours, faster where biochemical activity is strong. The values of SOD estimated by the model were compared with experimental data to verify the reliability of the model. The model can reproduce observed penetration depths and diffusive boundary layer thickness. Values of SOD estimated by the model were of same magnitude as observed data. The unsteady DO uptake model can be used to provide guidance for field measurements of SOD. Placing a chamber (with a stirrer) into the sediments disturbs the DO equilibrium at the sediment/water interface. A new equilibrium will be reached within a time that can be measured in terms of cumulative DO consumption in the chamber (SOD exerted). Upper bounds for (SOD exerted) are larger when biochemical activity in the sediments is smaller. Values of SOD exerted are less than 0.1gm(-2) when micro(0) is less than 50mgl(-1)d(-1) and U(*)>0.1cm/s. In other words, steady state conditions are easier to reach for high SOD values. Actual times required to reach steady state can be from minutes to hours. If flow conditions in the chamber and at the natural sediment/water interface are much different, measured SOD values have to be adjusted. A procedure for the adjustments, which can be substantial, has been developed.