Comparison of long-term mortality in patients who underwent transcatheter aortic valve replacement with or without anti-atherosclerotic therapy.

Atherosclerosis is a risk factor for both aortic stenosis (AS) and coronary artery disease. This study aimed to investigate whether anti-atherosclerotic therapy (AT), defined as the simultaneous use of antiplatelet agents, statins, and renin aldosterone system inhibitors, had long-term clinical benefits for patients who underwent transcatheter aortic valve replacement (TAVR). Between October 2013 and May 2017, 2518 patients (31% men; median age, 85 years) who underwent TAVR in 14 Japanese centers were divided into two groups: patients who were prescribed anti-atherosclerotic therapy (AT, n = 567) and patients who were not (no AT, n = 1951). The median follow-up period for this cohort was 693 days (interquartile range, 389-870 days). Compared to no AT group, AT group was associated with significantly lower 2-year all-cause mortality (11.7% vs. 16.5%; log-rank p = 0.002) and 2-year cardiovascular mortality rates (3.5% vs. 6.0%; log-rank p = 0.017). In a propensity-matched cohort (n = 495 each; median follow-up, 710 days [IQR, 394 - 896 days]), patients in AT group had a lower prevalence of 2-year cardiovascular mortality (3.8% vs. 6.2%, log-rank p = 0.024) than that in the no AT group. In the multivariate stepwise regression analysis, AT was a significant predictor of cardiovascular mortality (hazard ratio 0.45; 95% confidence interval 0.25-0.80; p = 0.007). AT may improve survival in post-TAVR patients. Future studies are necessary to identify an optimal treatment regimen to improve long-term outcomes after TAVR.

Long-Term Clinical and Angiographic Outcomes After Implantation of New-Generation Drug-Eluting Stents for Patients on Maintenance Hemodialysis.

Prior research has revealed poorer clinical outcomes after drug-eluting stent (DES) implantation for hemodialysis patients. This study aims to investigate the long-term clinical and angiographic outcomes after new-generation DES implantation for hemodialysis patients.We retrospectively enrolled 91 consecutive patients (118 lesions) who underwent successful new-generation DES (everolimus-, zotarolimus-, and biolimus-eluting stents) implantation for the first time. We measured the serum calcium and phosphorus levels in the blood samples obtained just before hemodialysis. The follow-up period of clinical events was, at least, 1.5 years. In this study, major adverse cardiac and cerebrovascular events (MACCE) and clinically driven target lesion revascularization were reported in 36 (39.6%) and 11 (12.1%) patients, respectively. The prevalence of peripheral artery disease was significantly higher in the MACCE group (41.7% versus 14.5%, P = 0.006). The serum calcium level was significantly higher in the MACCE group (9.34 ± 0.92 mg/dL versus 8.77 ± 0.88 mg/dL; P = 0.004). The multivariate Cox proportional hazards model revealed that the serum calcium level (hazard ratio, 1.86; 95% confidence interval [CI]: 1.26-2.77; P = 0.002), suboptimal (over 55 mg2/dL2) calcium-phosphorus product (hazard ratio, 3.27; 95% CI: 1.41-7.61; P = 0.006) and the coexistence of peripheral artery disease (hazard ratio, 3.15; 95% CI: 1.49-6.65; P = 0.003) were independent predictors of MACCE.For hemodialysis patients, MACCE remains a frequent occurrence after new-generation DES implantation and is associated with calcium-phosphate metabolism and peripheral artery disease.

A Study about Perceptions of Kimono among College Students and Kimono Enthusiasts: Is It Difficult to Move in a Kimono?

Background: Kimono is being reevaluated for its sustainability aspects, such as having fewer offcuts in the production process due to its structural differences from Western-style clothes and its high reusability due to the adaptability to individuals' body shapes. On the other hand, once a common attire for daily wear in Japan, kimono has transitioned to being worn only on special events and the kimono-related industry has also shrunk. To stimulate demand for kimono, it is essential to familiarize younger generations with its potential as daily wear. Methods: A questionnaire survey on perceptions of kimono was conducted among two groups in Japan: 211 college students and 50 kimono enthusiasts. The questionnaire included demographic questions and psychometric scales, primarily focusing on their kimono experiences, challenges associated with wearing kimono, their perceptions of kimono and Western-style clothes, and their attitudes towards kimono. Results: The results revealed that a majority of students had worn kimono before, though they found it difficult to move while wearing it. In contrast, kimono enthusiasts evaluated it as easier to move, hard to become disheveled, and casual. They also rated the ease of wearing Western-style clothes lower compared to students, and this tendency intensified with the length of enthusiast experience. Furthermore, the findings indicated that enthusiasts regarded the kimono more as daily wear compared to students, while still deriving enjoyment from it as formal attire in special events. Conclusions: These results suggest that the cognition that Western-style clothes are easy to move and kimono is not may change with experiences. Therefore, providing opportunities for people in Japan to acquire how to wear kimono in comfortable ways possibly impacts their perceptions of kimono.

A high-performance Ni-CeO2/Ni/Ni-Y2O3·ZrO2 three-layer anode for direct iso-octane feeding of solid oxide fuel cells.

Solid oxide fuel cells (SOFCs) directly fed with iso-octane are expected to be power sources for mobile devices and automobiles. However, the conventional anode catalysts nickel (Ni) or cerium oxide (CeO2) used for direct feeding of iso-octane do not suppress carbon deposition or generate high power. In this study, we investigated the Ni-CeO2/Ni/Ni-yttria-stabilized-zirconia (YSZ) three-layer anode to establish the suppression of carbon deposition and high-power generation in the SOFC. The anode consists of a Ni-CeO2 catalyst layer as the top layer, an Ni catalyst layer as the second layer, and a Ni-YSZ catalyst layer as the third layer on top of the electrolyte. The concept of the three-layer anode is as follows: fuel reforming occurs in the Ni-CeO2 layer, the reformed H2 or CO is electrochemically oxidized in the Ni-YSZ catalyst layer, and the Ni catalyst middle layer prevents the reaction between YSZ and CeO2. Scanning electron microscopy and electrochemical characterization confirmed carbon deposition suppression and improved power generation. The anode showed no carbon deposition and generated high-power, 600 mA cm-2 and 150 mW cm-2, at 950°C and a steam/carbon ratio of 3.0. Additionally, we discuss the fuel reforming reactions on the three-layer electrode by the results of exhaust gas analysis.

Optimization of pump spectra for gain-flattened photonic crystal fiber Raman amplifiers operating in C-band.

This paper focuses on the optimization of pump spectra to achieve low Raman gain ripples over C-band in ultra-low loss photonic crystal fiber (PCF) and dispersion compensating PCFs (DCPCFs). Genetic algorithm (GA), a multivariate stochastic optimization algorithm, is applied to optimize the pump powers and the wavelengths for the aforesaid fiber designs. In addition, the GA integrated with full-vectorial finite element method with curvilinear edge/nodal elements is used to optimize the structural parameters of DCPCF. The optimized DCPCF provides broadband dispersion compensation over C-band with low negative dispersion coefficient of -530 ps/nm/km at 1550 nm, which is five times larger than the conventional dispersion compensating fibers with nearly equal effective mode area (21.7 mum(2)). A peak gain of 8.4 dB with +/-0.21 dB gain ripple is achieved for a 2.73 km long DCPCF module when three optimized pumps are used in the backward direction. The lowest gain ripple of +/-0.36 dB is attained for a 10 km long ultra-low loss PCF with three backward pumps. Sensitivity analysis has been performed and it is found that within the experimental fabrication tolerances of +/-2%, the absolute magnitude of dispersion may vary by +/-16%, while the Raman gain may change by +/-7%. Through tolerance study, it is examined that the ring core's hole-size is more sensitive to the structural deformations.

Chronic myoclonia of subcortical origin with antiglutamate receptor antibodies.

We report a 10-year-old girl with chronic nonprogressive continuous myoclonia with mild muscle weakness and dissociated sensory impairment of the ipsilateral side of myoclonic jerks. Irregular myoclonic jerks continuously appeared in the right upper limb. The jerk-locked back averaging of electroencephalographic activity failed to show any activity preceded by the muscle contraction. Magnetic resonance imaging of the brain and cervical spine revealed no abnormal findings. Single photon emission computed tomography showed an increased blood perfusion in the left thalamus. (18)F-deoxyglucose-positron emission tomography (PET) also showed a slight high density in the posterior region of the left thalamus. Antiglutamate receptor epsilon2 and delta2 antibodies were detected in the serum and cerebrospinal fluid. The patient's symptoms have now been stable with clonazepam treatment for 2 years. The left thalamus was suspected to have been the region at least partly responsible for the patient's symptoms.

Spontaneous Rotation of Nonlinear Pattern Formed by Aqueous Colloidal Suspension between ITO Electrodes during Electrolysis Perpendicular to Gravity.

A colloidal fluid is found to rotate spontaneously during electrolysis when gravity acts perpendicular to the direction of an applied electric field. An aqueous dispersion containing charged colloidal particles is placed inside an O-ring sandwiched between two parallel ITO electrodes. A clip is used to hold the assembly together to prevent the liquid from leaking out. The assembly is positioned such that the electrodes stand vertically, i.e., the electric field during electrolysis points perpendicular to gravity. When a direct-current voltage is applied to initiate the electrolysis of water, a nonlinear colloidal pattern is formed by electroconvective flow. Moreover, the entire fluid rotates spontaneously about the O-ring center with a constant angular velocity. The rotational dynamics are governed by how strong and where the assembly is clipped relative to the gravitational direction. A new phenomenological relationship between the angular velocity, compression vector, and gravity is derived. Coupling of an electrochemical reduction reaction of the ITO film with electroconvection during electrolysis is proposed as a mechanism for the rotational motion.

Nivolumab-Induced Myocarditis Concomitant with Myasthenia Gravis.

We report a 69-year-old female patient with advanced lung cancer who developed myocarditis concomitant with myasthenia gravis (MG), also known as "Herzmyasthenie," after 3 cycles of nivolumab administration. Her initial symptoms were general malaise and double vision. However, her myocarditis deteriorated rapidly the following day, necessitating a temporary pacemaker and noninvasive positive pressure ventilation in the intensive care unit. Immunohistochemical examination of a myocardial biopsy suggested an immune response on the basis of HLA associations. The patient also developed impaired adduction of her left eye and elevated serum levels of acetylcholine receptor antibody, suggesting the onset of MG. Her condition gradually improved after immediate methylprednisolone pulse therapy. This case of nivolumab-induced "Herzmyasthenie" highlights the need to be aware that fulminant myocarditis might occur at the same time as MG during treatment with anti-programmed cell death-1 monoclonal antibodies.

Increased IL-1beta production from dsRNA-stimulated leukocytes in febrile seizures.

This study examined the possibility that children with and without a history of febrile seizures might mount different immune responses to double-stranded ribonucleic acid, which is a common viral factor that induces host cell immune responses, and is recognized by Toll-like receptor 3. The production of interleukin-1beta and interferon-alpha from double-stranded ribonucleic acid-stimulated leukocytes was examined in 27 children (age 3.6+/-0.3 years) with a history of febrile seizures and in 18 children (age 3.4+/-0.2 years) without a history of febrile seizures. Significantly (P=0.0007) increased interleukin-1beta production was observed in children with a history of febrile seizures, compared with control subjects. When patients with a single prior episode of febrile seizures (n=9) and those with multiple prior episodes of febrile seizures (n=18) were compared, a significant difference in interleukin-1beta production was not observed. Genotyping of interleukin-1beta(-511), Toll-like receptor 3, Toll-IL-1 receptor domain-containing adapter inducing interferon-beta, and interleukin-1 receptor antagonist polymorphisms revealed no significant differences in allelic distribution among febrile seizure patients and control subjects. Interleukin-1beta production was not significantly influenced by genotype. Viral infection results in increased interleukin-1beta production in febrile seizure patients, and this may play a role in febrile seizures.

A novel support system for patient immobilization and transportation for daily computed tomographic localization of target prior to radiation therapy.

PURPOSE: To develop a method for quick and smooth transportation of patients from a computed tomography (CT) table to a linear accelerator (linac) table for confirming tumor center before radiation therapy. MATERIALS AND METHODS: We developed a system using a subtable for patient immobilization that is transported via a customized stretcher. The patient lies on the subtable and is immobilized by a vacuum cushion and thermoplastic body cast. The subtable stretcher is used to carry the subtable from the CT table to the linac table. During transportation, the subtable is kept flat and shock to the subtable is carefully avoided. Between August 2001 and September 2002, a total of 9 patients with solitary upper lung tumors (superior to carina) were treated using this system. RESULTS: Intrafractional tumor motion along the x (left-right), y (anterior-posterior), and z axis (superior-inferior) ranged from -2 mm to 2 mm, -2 mm to 2 mm, and -5 mm to 3 mm, respectively. The standard deviation of intrafractional tumor motion along the x, y, and z axis ranged from 0.5 mm to 1.5 mm, 0 mm to 1.7 mm, and 0.6 mm to 3.5 mm, respectively. Interfractional setup errors along the x, y, and z axis ranged from -5 mm to 4 mm, -6 mm to 8 mm, and -6 mm to 6 mm, respectively, and we could reduce interfractional setup errors in the majority of treatment sessions. CONCLUSIONS: We developed a system that allows patients to be immobilized and transported to verify tumor location on a daily basis. This system is highly useful for reducing setup errors.

Response of Holstein cows with milk fever to first treatment using two calcium regimens: a retrospective clinical study.

The responses of 64 Holstein cows with milk fever to first treatment with 500 ml of either of 2 intravenous calcium (Ca) solutions, one containing Ca alone (group A, n = 32) or 1 containing Ca, phosphate and magnesium (group B, n = 32), were evaluated by selected clinical signs and serum biochemical data. Based on the cow's ability to stand, treatment response was categorized into "immediate response" (stood after single treatment), "delayed response" (stood after repeated treatments) and "non-response" (slaughtered despite repeated treatments). No significant differences among the response categories were found between the two groups, suggesting that the solution containing Ca borogluconate alone was sufficient for the first treatment of milk fever.

Frequent association of autism spectrum disorder in patients with childhood onset epilepsy.

Autism spectrum disorder (ASD) has a close relationship with epilepsy. This study retrospectively examined patients with epilepsy associated with ASD. Among the 519 patients with epilepsy, 79 patients (15.2%) had ASD. Sixty-two patients had idiopathic ASD and 17 had secondary ASD. The epilepsy patients with idiopathic ASD were retrospectively analyzed. There were 47 males and 15 females, ranging from 2 to 43 years of age (median 11 years). The most frequent age at the onset of seizures was 4 years, and 85% occurred before 10. ASD was detected after the onset of epilepsy in 29 cases (46.8%), and eight of them had been overlooked for more than five years. Most of these were high-functioning ASD cases. The most frequent type of seizure was a complex partial seizure (CPS; 68%). Paroxysmal activities on EEG were localized in the frontal area in about half of the cases. Multiple anti-epileptic drugs were used in 33.8% cases (two in 17.7%, three in 16.1%), and 67.3% of the patients were seizure-free for more than two years. An amelioration of the autistic symptoms occurred after epilepsy treatment in five cases (8%). CPS with frontal paroxysms occurring from one to nine years of age seems to be characteristic of epilepsy associated with ASD.

Febrile seizures: characterization of double-stranded RNA-induced gene expression.

An association has long been suspected between febrile seizures and interleukin-1beta, the most potent endogenous pyrogen. Interleukin-1beta production increases after double-stranded RNA stimulation in leukocytes of febrile seizure patients. To elucidate the genetics of the immune response, the gene expression pattern after double-stranded RNA stimulation was investigated using DNA microarray. Compared with the control group, expression of the genes ACCN4 (sodium channel), KCNC3 (potassium channel), GABRE (gamma-aminobutyric acid receptor epsilon subunit), RIPK2 (receptor interacting protein kinase-2), TLR4 (toll-like receptor-4), IL26 (interleukin-26), and TNF (tumor necrosis factor), and CASP1 (caspase-1) was increased in the febrile seizure group (P < 0.01). Because RIPK2 and CASP1 are associated with interleukin-1beta production, increased expression might cause increased interleukin-1beta production in the febrile seizure patients. The induced expression of several ion channel genes by double-stranded RNA may affect neuronal excitability which leads to seizure susceptibility during infection.

Construction of a remote radiotherapy planning system.

BACKGROUND: We constructed a remote radiotherapy planning system, and we examined the usefulness of and faults in our system in this study. METHODS: Two identical radiotherapy planning systems, one installed at our institution and the other installed at an affiliated hospital, were used for radiotherapy planning. The two systems were connected by a wide area network (WAN), using a leased line. Beam data for the linear accelerator at the affiliated hospital were installed in the two systems. During the period from December 2001 to December 2002, 43 remote radiotherapy plans were made using this system. RESULTS: Data were transmitted using a file transfer protocol (FTP) software program. The 43 radiotherapy plans examined in this study consisted of 13 ordinary radiotherapy plans, 28 radiotherapy plans sent to provide assistance for medical residents, and 2 radiotherapy plans for emergency cases. There were ten minor planning changes made in radiotherapy plans sent to provide assistance for medical residents. CONCLUSION: Our remote radiotherapy planning system based on WAN using a leased line is useful for remote radiotherapy, with advantages for both radiation oncologists and medical residents.

Differentiating between bacterial and viral infection by measuring both C-reactive protein and 2'-5'-oligoadenylate synthetase as inflammatory markers.

This study aimed to find a method to distinguish between bacterial and viral infection by measuring inflammatory markers in the early phase of the illness. We examined the activity of acute phase proteins, including C-reactive protein (CRP), serum amyloid A (SAA), and 2'-5'-oligoadenylate synthetase (2-5A synthetase), in sera obtained from children with bacterial and viral infections that were diagnosed by isolation of the pathogen or by positive serology. Increases in levels of CRP and SAA generally paralleled each other. In the acute stage of bacterial infections, CRP levels were moderately or highly increased and 2-5A synthetase levels were normal, whereas in viral infections, CRP levels were normal or slightly increased and 2-5A synthetase levels were increased. To better distinguish between bacterial and viral infection we used the ratio of CRP (mg/l) to 2-5A synthetase (pmol/dl) x10 as the differential index. The values for this index in bacterial infections ranged from 3.9 to 50, and were higher than the values in viral infections, which ranged from 0 to 0.9. We propose that the measurement of both CRP and 2-5A synthetase during the acute phase of illness (within 5 days of onset) is of value to determine whether the infection is caused by a bacteria or virus.