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To enhance plant biomass production under low nitrogen conditions, we employed a method to artificially and temporarily accumulate the bacterial second messenger, guanosine tetraphosphate (ppGpp), to modify plastidial or mitochondrial metabolism. Specifically, we fused a chloroplast or mitochondrial transit-peptide to the N-terminus of the bacterial ppGpp synthase YjbM, which was conditionally expressed by an estrogen-inducible promoter in Arabidopsis. The resulting recombinant Arabidopsis plants exhibited estrogen-dependent ppGpp accumulation in chloroplasts or mitochondria and showed reduced fresh weight compared to wild type (WT) plants when grown on agar-solidified plates containing a certain amount of estrogen. This finding aligns with the previous study indicating that plastidial ppGpp levels can influence plant biomass production. When the recombinant plants were grown in the soil with estrogen and low nitrogen-containing water at specific time intervals, they exhibited greater fresh weight than WT plants. These results suggest that the conditional accumulation of ppGpp in not only chloroplasts, but also in mitochondria can lead to improved plant biomass production in soil with low nitrogen applications.

Abstract Microalgae are considered to be more useful and effective to use in biomass production than other photosynthesis organisms. However, microalgae need to be altered to acquire more desirable traits for the relevant purpose. Although neutron radiation is known to induce DNA mutations, there have been few studies on its application to microalgae, and the optimal relationship between irradiation intensity and mutation occurrence has not been established. In this study, using the unicellular red alga Cyanidioschyzon merolae as a model, we analyzed the relationship between the absorbed dose of two types of neutrons, high-energy (above 1 MeV) and thermal (around 25 meV) neutrons, and mutation occurrence while monitoring mutations in URA5.3 gene encoding UMP synthase. As a result, the highest mutational occurrence was observed when the cells were irradiated with 20 Gy of high-energy neutrons and 13 Gy of thermal neutrons. Using these optimal neutron irradiation conditions, we next attempted to improve the lipid accumulation of Euglena gracilis, which is a candidate strain for biofuel feedstock production. As a result, we obtained several strains with a maximum 1.3-fold increase in lipid accumulation compared with the wild-type. These results indicate that microalgae breeding by neutron irradiation is effective.

Abstract Background Local anaesthetic systemic toxicity (LAST) is a rare but life-threatening complication that can occur after local anaesthetic administration. Various clinical guidelines recommend an intravenous lipid emulsion as a treatment for local anaesthetic–induced cardiac arrest. However, its therapeutic application in pregnant patients has not yet been established. This scoping review aims to systematically identify and map the evidence on the efficacy and safety of intravenous lipid emulsion for treating LAST during pregnancy. Method We searched electronic databases (Medline, Embase and Cochrane Central Register Controlled Trials) and a clinical registry (lipidrescue.org) from inception to Sep 30, 2022. No restriction was placed on the year of publication or the language. We included any study design containing primary data on obstetric patients with signs and symptoms of LAST. Results After eliminating duplicates, we screened 8,370 titles and abstracts, retrieving 41 full-text articles. We identified 22 women who developed LAST during pregnancy and childbirth, all presented as case reports or series. The most frequent causes of LAST were drug overdose and intravascular migration of the epidural catheter followed by wrong-route drug errors (i.e. intravenous anaesthetic administration). Of the 15 women who received lipid emulsions, all survived and none sustained lasting neurological or cardiovascular damage related to LAST. No adverse events or side effects following intravenous lipid emulsion administration were reported in mothers or neonates. Five of the seven women who did not receive lipid emulsions survived; however, the other two died. Conclusion Studies on the efficacy and safety of lipids in pregnancy are scarce. Further studies with appropriate comparison groups are needed to provide more robust evidence. It will also be necessary to accumulate data—including adverse events—to enable clinicians to conduct risk–benefit analyses of lipids and to facilitate evidence-based decision-making for clinical practice.

Background: Acute pancreatitis (AP) severity is correlated with systemic infection incidence in the acute phase, and it is important to assess inflammation during the disease course and to recognize infection at an early stage. As in sepsis, inflammation in AP impairs tissue oxygen metabolism and disrupts microcirculation. We performed a vascular occlusion test (VOT) via near-infrared spectroscopy (NIRS), which noninvasively monitors local oxygen in peripheral tissues, to evaluate tissue oxygen metabolism and blood circulation during the acute AP phase. Methods: Tissue oxygen metabolism was measured via an NIRS probe attached to the thenar eminence at admission and 7 days after admission. The upper arm was wrapped with a sphygmomanometer cuff while avoiding brachial artery compression for 3 min. The minimum desaturation value was defined as the minimum tissue oxygen index (TOI), the maximum reactive hyperemia value after release was defined as the maximum TOI, and the difference was defined as the ∆TOI. The time from the minimum TOI to maximum TOI was defined as the TOI interval. Results: Fifteen healthy volunteers, 13 patients with AP, and 12 patients with sepsis were included. The TOI at baseline and ∆TOI (parameter describing tissue oxygen metabolism) decreased in a stepwise manner, and the TOI interval (measure of peripheral vasodilatory capacity) was protracted in a stepwise manner among the three groups. In a subgroup analysis, no significant differences in the NIRS-derived variables between patients with AP complicated by infection and those without infection were observed at admission; however, after 7 days, the groups significantly differed. Additionally, blood lactate concentrations were significantly correlated with the ∆TOI and TOI. Conclusions: Mild tissue oxygen metabolism impairment and tissue perfusion occurred in AP compared with sepsis, and changes similar to those in sepsis occur in AP complicated by infection. Further research is needed to evaluate whether these values can be applied to treating this group of patients.

Background: Patients with circulatory failure have high mortality rates and require prompt assessment of microcirculation. Despite the improvement in hemodynamic parameters, microcirculatory dysfunction persists. We measured subcutaneous regional tissue oxygen saturation (rSO2) with near-infrared spectroscopy (NIRS), which can assess microcirculation in patients with circulatory failure. Methods: A finger-worn oximeter with NIRS measured rSO2 in the forehead, thenar eminence, thumb, and knees. First, the rSO2 was measured in healthy adult volunteers (n = 10). Circulatory failure was defined as a systolic blood pressure ≤ 90 mmHg and lactate ≥ 2 mmol/L. The study included 35 patients without circulatory failure and SOFA score of 0 at ICU admission and 38 patients with circulatory failure at ICU admission. Both groups included a single-center prospective study of patients who were transported to the ICU of the Nihon University Hospital. The rSO2 was measured only on ICU admission in the non-circulatory failure group and later in the circulatory failure group. Results: In the volunteer group, rSO2 at each site was approximately 58%. The rSO2 was significantly lower in the circulatory failure group than in the non-circulatory failure group (knee, p < 0.01). In the circulatory failure group, knee rSO2 showed a significant negative correlation with SOFA score (Day 0, ρ = −0.37, p = 0.02; Day 1, ρ = −0.53, p < 0.01; Day 2, ρ = −0.60, p < 0.01). Conclusions: Subcutaneous knee rSO2 was associated with SOFA score and was considered an indicator of microcirculatory dysfunction and organ damage.

Abstract Background Reactive thrombocytosis occurs secondary to systemic infections, inflammatory, and other conditions. The relationship between thrombocytosis and acute pancreatitis (AP) in inflammatory diseases is uncertain. This study aimed to evaluate the clinical significance of thrombocytosis in AP patients during hospitalization. Methods Subjects within 48 h of AP onset were consecutively enrolled over 6 years. Platelet counts of ≥ 450,000/µL were defined as thrombocytosis,

Objectives: Recent studies have reported that negative pressure wound therapy (NPWT) is useful for skin graft fixation. However, there is no reliable evidence of the optimal negative pressure strength during fixation. We verified the relationship between negative pressure strength and the engraftment rate retrospectively. Methods: This study included 130 patients who underwent skin graft fixation using NPWT. All cases were divided into full-thickness skin graft (FTSG) and split-thickness skin graft (STSG) groups and further classified into three subgroups based on negative pressure strength as follows: high-pressure (100 mmHg), moderate-pressure (75,

Bone-modifying agents (BMAs), with bone-resorptive inhibitory effects, such as zoledronic acid and denosumab, are widely used at higher doses for bone-related events caused by bone metastasis of malignant tumors. These drugs have been suggested to be associated with atypical femoral fractures (AFFs), and the relationship between BMAs and AFFs has attracted attention. To investigate the clinical features including bone union time of AFFs in patients administered BMA for bone metastasis, we conducted a retrospective multicenter study. Thirty AFFs from 19 patients were enrolled in this study. Thirteen patients had bilateral AFFs, and nineteen AFFs had prodromal symptoms. Eighteen AFFs underwent surgery after complete fracture, three failed to achieve bone union and required nonunion surgery, and 11 AFFs that achieved bone union had an average period until bone union of 16.2 months, which was much longer than that previously reported for ordinary AFFs. Seven patients discontinued the BMAs, but not due to AFFs. Stopping BMAs in patients with bone metastasis would make it difficult to secure their performance of activities of daily living, and AFF with BMA administration might require a longer time for union. Therefore, it would be important to prevent incomplete AFF from becoming complete AFF via prophylactic internal fixation.

Glycogen, the stored form of glucose, accumulates upon growth arrest in the presence of an excess carbon source in Escherichia coli and other bacteria. Chromatin immunoprecipitation screening for the binding site of a functionally unknown GntR family transcription factor, YegW, revealed that the yegTUV operon was a single target of the E. coli genome. Although none of the genes in the yegTUV operon have a clear function, a previous study suggested their involvement in the production of ADP-glucose (ADPG), a glycogen precursor. Various validation through in vivo and in vitro experiments showed that YegW is a single-target transcription factor that acts as a repressor of yegTUV, with an intracellular concentration of consistently approximately 10 molecules, and senses ADPG as an effector. Further analysis revealed that YegW repressed glycogen accumulation in response to increased glucose concentration, which was not accompanied by changes in the growth phase. In minimal glucose medium, yegW-deficient E. coli promoted glycogen accumulation, at the expense of poor cell proliferation. We concluded that YegW is a single-target transcription factor that senses ADPG and represses glycogen accumulation in response to the amount of glucose available to the cell. We propose renaming YegW to GgaR (repressor of glycogen accumulation).

Abstract Background The algorithm and protocol of the #7119 telephone triage in Tokyo, Japan, had been originally established and consists of three steps. In this study, we investigated the outcome of patients treated with physiological abnormality (ABCD approach: A, airway; B, breathing; C, circulation, and D, dysfunction of central nervous system) in step 2 during the #7119 telephone triage and clarified the meaning of evaluation of this approach. Methods We retrospectively reviewed data from the Tokyo Fire Department from January 2016 to December 2017. Almost all the patients triaged using the ABCD approach were transferred to the hospital by ambulance and assigned severity by a physician. We divided patients into groups with combinations of 15 patterns including A, B, C, D, AB, AC, AD, BC, BD, CD, ABC, ABD, ACD, BCD, and ABCD. We compared the proportion of severe cases in each group using a Fisher's exact test, followed by residual analysis. Results We analyzed 13,793 cases triaged using the ABCD approach. In this analysis, 31% of total cases were assessed as severe cases. Groupwise analysis showed that the proportion of severe cases was significantly higher in the AD, BC, CD, ABD, and ABCD groups, while it was significantly less in the C and AB groups than in the total cases. Conclusion At the #7119 telephone triage, we can pick up the severe cases by the ABCD approach. This may contribute to the prompt transportation of severe patients to hospitals by dispatching ambulance cars using the #7119 telephone triage methods.

Abstract Background Although rare, cardiac arrest during pregnancy is the leading cause of maternal death. Recently, its incidence has been increasing worldwide because more pregnant women have risk factors. The provision of early, high-quality cardiopulmonary resuscitation (CPR) plays a major role in the increased likelihood of survival; therefore, it is important for clinicians to know how to manage it. Due to the aortocaval compression caused by the gravid uterus, clinical guidelines often emphasise the importance of maternal positioning during CPR, but there has been little evidence regarding which position is most effective. Methods We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and OpenGrey (updated on April 3, 2021). We included clinical trials and observational studies with reported outcomes related to successful resuscitations. Results We included eight studies from the 1,490 screened. The eight studies were simulation-based, crossover trials that examine the quality of chest compressions. No data were available about the survival rates of mothers or foetuses/neonates. The meta-analyses showed that resuscitation of pregnant women in the 27°–30° left-lateral tilt position resulted in lower quality chest compressions. The difference is an 19% and 9% reduction in correct compression depth rate and correct hand position rate, respectively, compared with resuscitations in the supine position. Inexperienced clinicians find it difficult to perform chest compressions in the left-lateral tilt position. Conclusions Given that manual left uterine displacement allows the patient to remain supine, the resuscitation of women in the supine position using manual left uterine displacement should continue to be supported. Further research is needed to fill knowledge gaps regarding the effects of maternal positioning on clinical outcomes, such as survival rates following maternal cardiac arrest.

Abstract Background The concept that upper extremities can be used as an infusion route during cardiopulmonary resuscitation in pregnant women is a reasonable recommendation considering the characteristic circulation of pregnant women; however, this method is not based on scientific evidence. Objective of the review We conducted a scoping review to determine whether the infusion route should be established above the diaphragm during cardiopulmonary resuscitation in a pregnant woman. Discussion We included randomized controlled trials (RCTs) and non-RCTs on the infusion of fluids in pregnant women after 20 weeks of gestation requiring establishment of an infusion route due to cardiac arrest, massive bleeding, intra-abdominal bleeding, cesarean section, severe infection, or thrombosis. In total, 3150 articles from electronic database were extracted, respectively. After title and abstract review, 265 articles were extracted, and 116 articles were extracted by full-text screening, which were included in the final analysis. The 116 articles included 78 studies on infusion for pregnant women. The location of the intravenous infusion route could be confirmed in only 17 studies, all of which used the upper extremity to secure the venous route. Conclusion Pregnant women undergo significant physiological changes that differ from those of normal adults, because of pressure and drainage of the inferior vena cava and pelvic veins by the enlarged uterus. Therefore, despite a lack of evidence, it seems logical to secure the infusion route above the diaphragm when resuscitating a pregnant woman.

Abstract Background Patients with severe COVID-19 have disorders of the respiratory, cardiovascular, coagulation, skeletal muscle, and central nervous systems. These systemic failures may be associated with cytokine release syndrome, characterized by hyperpyrexia, thrombocytopenia, hyperferritinemia, and the elevation of other inflammatory markers. Rhabdomyolysis with high fever is a complication that is rarely found in COVID-19. The exact relations of these clinical conditions in patients with COVID-19 remain unknown. Case presentation We present the case of a 36-year-old man with severe COVID-19 complicated by rhabdomyolysis and high fever. After admission, his condition continued to deteriorate, with a high body temperature. On day 9, the patient had elevated creatine kinase and myoglobin levels consistent with rhabdomyolysis (26,046 U/L and 3668 ng/mL, respectively). In addition to viral therapy, he was immediately treated with hydration. However, the patient had persistent fever and elevated creatine kinase levels. The patient was diagnosed with malignant hyperthermia as a late complication of COVID-19, although he had no hereditary predisposition to malignant hyperthermia or neuroleptic malignant syndrome. The administration of dantrolene with muscle relaxation and anti-inflammatory function showed potential efficacy for rhabdomyolysis, high fever, and increased plasma inflammatory markers. Conclusions Malignant hyperthermia is triggered by not only anesthetic agents but also viral infections. A possible mechanism of malignant hyperthermia is hypersensitivity of calcium release from the sarcoplasmic reticulum. These include mutations in or the activation of the skeletal muscle ryanodine receptor calcium release channel. Dantrolene is a ryanodine receptor antagonist and is used as an anti-inflammatory agent. The administration of dantrolene showed potential efficacy for rhabdomyolysis, high body temperature due to inflammation, and increased inflammatory markers. The underlying mechanism of the association of rhabdomyolysis and high fever in COVID-19 might be similar to the pathogenesis of malignant hyperthermia.

Spacecraft use photovoltaics as power-generation systems. Although photovoltaics have advantages such as no requirement of fossil fuel or moving parts, a disadvantage is that generating power without sunlight is impossible. Spacecraft require new power-generation systems that do not depend on sunlight to make power generation possible in deep space where sunlight cannot reach. In this study, a thermoradiative (TR) system was investigated. The TR system generates power by thermal radiation from the TR cells to the surrounding environment. The possibility that the TR system would be most effective in spacecraft for which the surrounding temperature is 3 K was considered. Because the power generation of the TR system depends on the amount of radiation from the TR cells, the ideal state was simulated by assuming that the TR cell emits blackbody radiation to obtain the upper limit of the power generation. Furthermore, the effects of output voltage, cell bandgap, and TR cell temperature on the power generation were investigated numerically by using a HgCdTe photodiode, and the results were compared with those for blackbody radiation.

Abstract Background The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no significant improvement in neurological outcomes has been found among resuscitated patients using epinephrine, including trauma patients, the use of epinephrine is recommended in the Advanced Trauma Life Support protocol. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma. Methods This study is a post-hoc analysis of a prospective, multicentre, observational study on patients with OHCA between January 2012 and March 2013. We included adult patients with traumatic OHCA who were aged ≥15 years and excluded those with missing survival data. Patient data were divided into epinephrine or no-epinephrine groups based on the use of epinephrine during resuscitation at the hospital. Propensity scores were developed to estimate the probability of being assigned to the epinephrine group using multivariate logistic regression analyses adjusted for known survival predictors. The primary outcome was survival 7 days after injury, which was compared among the two groups after propensity score matching. Results Of the 1125 adults with traumatic OHCA during the study period, 1030 patients were included in this study. Among them, 822 (79.8%) were resuscitated using epinephrine, and 1.1% (9/822) in the epinephrine group and 5.3% (11/208) in the no-epinephrine group survived 7 days after injury. The use of epinephrine was significantly associated with decreased 7-day survival (odds ratio = 0.20; 95% CI = 0.08–0.48; P

Mass gatherings are events characterized by “the concentration of people at a specific location for a specific purpose over a set period of time that have the potential to strain the planning and response resources of the host country or community.” Previous reports showed that, as a result of the concentration of people in the limited area, injury and illness occurred due to several factors. The response plan should aim to provide timely medical care to the patients and to reduce the burden on emergency hospitals, and to maintain a daily emergency medical services system for residents of the local area. Although a mass gathering event will place a significant burden on the local health‐care system, it can provide the opportunity for long‐term benefits of public health‐care and improvement of daily medical service systems after the end of the event. The next Olympic and Paralympic Games will be held in Tokyo, during which mass gatherings will occur on a daily basis in the context of the coronavirus disease (COVID‐19) epidemic. The Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the Tokyo Olympic and Paralympic Games in 2020 (AC2020) was launched 2016, consisting of 28 academic societies in Japan, it has released statements based on assessments of medical risk and publishing guidelines and manuals on its website. This paper outlines the issues and countermeasures for emergency and disaster medical care related to the holding of this big event, focusing on the activities of the academic consortium.

Introduction. The Emergency Telephone Consultation Center in Tokyo (#7119) was the first telephone triage system in Japan and has operated since 2007. This study examined the revision of the #7119 protocol by referring the linked data to each code of the triage protocol. Methods. We selected candidates based on the medical codes targeted by the revision, linking data from the nurses’ decisions in triage and the patients’ condition severity when the ambulance arrived at the hospital, gathering data from June 1, 2016, to December 31, 2017. Then, several emergency physicians evaluated the cases and decided whether the code should be moved to the more or less urgent category or if new protocols and codes would be established. Results. In this revision, 371 codes were moved to the less urgent category, 35 codes were moved to the more urgent category, and 128 codes were newly established. In all, 59 red codes (transfer to the ambulance dispatcher) were reduced, while 254 orange codes (attendance at hospital within 1 hour) and yellow codes (within 6 hours) were moved to less urgent, and 12 yellow and green codes (within 24 hours) were moved to more urgent. Conclusion. We adjusted the triage codes for the revision by linking the call data with the case data. This revision should decrease the inappropriate use of ambulances and reduce the primary care workload. To achieve a more accurate revision, we need to refine the process of evaluating the validity of patients’ acuity over the telephone during triage.

Components smaller than the wavelength of electromagnetic waves are called meta-atoms. Thermal emission can be controlled by an artificial structure in which these meta-atoms are arranged on the surface. This artificial structure is called a metasurface, and its optical properties are determined by the materials and shapes of the meta-atoms. However, optical devices may require active control of thermal emission. In the present study, we theoretically and numerically analyze a wavelength-selective emitter using a graphene ribbon metasurface. The graphene ribbon metasurface consists of a graphene ribbon array, potassium bromide thin film, and silver substrate. The geometric parameters of the graphene metasurface are determined based on an equivalent circuit model that agrees well with the results of the electromagnetic field analysis (rigorous coupled-wave analysis). The proposed emitter causes impedance matching depending on the conductivity of the graphene ribbon in a very narrow wavelength range. The conductivity of graphene can be actively controlled by the gate voltage. Therefore, the proposed emitters may realize near-perfect emission with a high quality factor and active controllable switching for various wavelengths. In addition, the quality factor can be changed by adjusting the electron mobility of graphene. The proposed emitter can be used for optical devices such as thermophotovoltaic systems and biosensing.

Post-partum obstetric haemorrhage is a leading cause of mortality among Japanese women, generally treated with haemostatic measures followed by supplementary transfusion. Commonly used in the setting of severe trauma, massive transfusion protocols (MTPs), preparations of red blood cell concentrate (RBC) and fresh frozen plasma (FFP) with additional supplements, have proved effective in decreasing patient mortality following major obstetric bleeding events. Although promising, the optimal configuration of RBC and FFP utilized for obstetric bleeding needs to be verified. Here, we conducted a systematic literature review to define the optimal ratio of RBC to FFP for transfusion therapy during instances of obstetric bleeding. Our analysis extracted four retrospective, observational studies, all demonstrating that an FFP/RBC ratio of ≥1 was associated with improved patient outcomes following obstetric haemorrhage. We therefore conclude that, from the standpoint of haemostatic resuscitation, an FFP/RBC ratio of ≥1 is a necessary condition for optimal clinical management during MTP administration in the field of obstetrics. Hence, we further propose an optimized MTP strategy to be utilized in the setting of severe obstetric bleeding.

Abstract Background Ischemia/reperfusion injury (I/R) is an important pathophysiology of post-cardiac arrest syndrome (PCAS) against multiple organ dysfunction and mortality. The inflammatory response in PCAS causes systemic I/R. The purpose of this study was to demonstrate the pathophysiology of systemic I/R for secondary brain damage using the biomarkers high-mobility group box 1 (HMGB1), neuron-specific enolase (NSE), and interleukin-6 (IL-6). Methods This study was designed as a single-institution prospective observational study. Subjects were observed for 90 days, and neurological outcome was classified according to the Glasgow-Pittsburgh Cerebral Performance Categories Scale (CPC). Serum HMGB1, NSE, and IL-6 were evaluated for variability, correlation with each biomarker, or the Sequential Organ Function Assessment (SOFA) score and CPC at return of spontaneous circulation at 0, 24, 48, and 168 h. Results A total of 128 patients were enrolled in this study. Initial HMGB1 correlated with CPC (ρ = 0.27, p = 0.036) and SOFA score (ρ = 0.33, p

Abstract Background The duration of cardiopulmonary resuscitation (CPR) is an important factor associated with the outcomes for an out-of-hospital cardiac arrest. However, the appropriate CPR duration remains unclear considering pre- and in-hospital settings. The present study aimed to evaluate the relationship between the CPR duration (including both the pre- and in-hospital duration) and neurologically favorable outcomes 1-month after cardiac arrest. Methods Data were utilized from a prospective multi-center cohort study of out-of-hospital cardiac arrest patients transported to 67 emergency hospitals between January 2012 and March 2013 in the Kanto area of Japan. A total of 3,353 patients with out-of-hospital cardiac arrest (age ≥18 years) who underwent CPR by emergency medical service personnel and achieved the return of spontaneous circulation in a pre- or in-hospital setting were analyzed. The primary outcome was a 1-month favorable neurological outcome. Logistic regression analysis was performed to estimate the influence of cardiopulmonary resuscitation duration. The CPR duration that achieved a cumulative proportion >99% of cases with a 1-month neurologically favorable outcome was determined. Results Of the 3,353 eligible cases, pre-hospital return of spontaneous circulation was obtained in 1,692 cases (50.5%). A total of 279 (8.3%) cases had a 1-month neurologically favorable outcome. The CPR duration was significantly and inversely associated with 1-month neurologically favorable outcomes with adjustment for pre- and in-hospital confounders (adjusted odds ratio: 0.911, per minute, 95% CI: 0.892–0.929, p 99%. Conclusions The CPR duration was independently and inversely associated with 1-month neurologically favorable outcomes after out-of-hospital cardiac arrest. The CPR duration required to achieve return of spontaneous circulation in >99% of out-of-hospital cardiac arrest patients with a 1-month favorable neurological outcome was 45 min, considering both pre- and in-hospital settings.

Background: Data of vitamin D sufficiency in Asian patients with osteoporotic fragility hip fractures are limited. This study aimed to obtain data from the Japanese population. Methods: Patients aged 60 years or older with hip fractures were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Levels were compared between patients receiving and not receiving treatment for osteoporosis, those with and without previous contralateral hip fractures, and those with femoral neck versus trochanteric fractures. Sex-based differences were also assessed. The serum levels in patients younger than 60 years with extremity fractures were assessed, and differences between elderly and younger patients were evaluated. The individual correlation between 25(OH)D levels and the ultraviolet (UV) index and age was analyzed in elderly patients with hip fractures. Results: The data of 360 patients (aged 84.7 ± 8.2 years), comprising 80 men and 280 women, were analyzed. The mean 25(OH)D level was 16.5 ± 7.2 ng/mL. The prevalence of vitamin D insufficiency (25(OH)D

Acetaminophen is absorbed rapidly after oral intake, and serum concentration peaks within 4 hours. The Rumack–Matthew (RM) nomogram is widely used to identify the potential risk of liver dysfunction. However, the RM nomogram was intended for use only when a single agent was ingested. We report the case of a patient with overdose ingestion of an over-the-counter combination cold medication that contained acetaminophen, where the patient’s serum concentration increased over time. Over-the-counter combination cold medications are designed to relieve cold symptoms. However, the possibility that other agents that were present in the drug may change gastrointestinal kinetics should also be considered. The risk of liver dysfunction cannot be accurately determined from a single serum acetaminophen concentration measurement. Because of the risk of a delayed increase in the serum acetaminophen concentration, monitoring for liver dysfunction and developing a treatment strategy that includes N-acetylcysteine are required. This case report is targeted to clinical physicians who treat patients with acetaminophen overdose resulting from ingestion of multiple agents, and it reviews points of consideration when using the RM nomogram in acute intoxication.

BackgroundMechanical cardiopulmonary resuscitation (mCPR) for patients with out‐of‐hospital cardiac arrest attending the emergency department has become more widespread in Japan. The objective of this study is to determine the association between the mCPR in the emergency department and clinical outcomes. Methods and ResultsIn a prospective, multicenter, observational study, adult patients with out‐of‐hospital cardiac arrest with sustained circulatory arrest on hospital arrival were identified. The primary outcome was survival to hospital discharge. The secondary outcomes included a return of spontaneous circulation and successful hospital admission. Multivariate analyses adjusted for potential confounders and within‐institution clustering effects using a generalized estimation equation were used to analyze the association of the mCPR with outcomes. Between January 1, 2012 and March 31, 2013, 6537 patients with out‐of‐hospital cardiac arrest were eligible; this included 5619 patients (86.0%) in the manual CPR group and 918 patients (14.0%) in the mCPR group. Of those patients, 28.1% (1801/6419) showed return of spontaneous circulation in the emergency department, 20.4% (1175/5754) had hospital admission, 2.6% (168/6504) survived to hospital discharge, and 1.2% (75/6419) showed a favorable neurological outcome at 1 month after admission. Multivariate analyses revealed that mCPR was associated with a decreased likelihood of survival to hospital discharge (adjusted odds ratio, 0.40; 95% confidence interval, 0.20–0.78; P=0.005), return of spontaneous circulation (adjusted odds ratio, 0.71; 95% confidence interval, 0.53–0.94; P=0.018), and hospital admission (adjusted odds ratio, 0.57; 95% confidence interval, 0.40–0.80; P=0.001). ConclusionsAfter accounting for potential confounders, the mCPR in the emergency department was associated with decreased likelihoods of good clinical outcomes after adult nontraumatic out‐of‐hospital cardiac arrest. Further studies are needed to clarify circumstances in which mCPR may benefit these patients.

Purpose: Classification of femoral trochanteric fractures is usually based on plain X-ray findings using the Evans, Jensen, or AO/OTA classification. However, complications such as nonunion and cut out of the lag screw or blade are seen even in stable fracture. This may be due to the difficulty of exact diagnosis of fracture pattern in plain X-ray. Computed tomography (CT) may provide more information about the fracture pattern, but such data are scarce. In the present study, it was performed to propose a classification system for femoral trochanteric fractures using three-dimensional CT (3D-CT) and investigate the relationship between this classification and conventional plain X-ray classification. Methods: Using three-dimensional (3D)-CT, fractures were classified as two, three, or four parts using combinations of the head, greater trochanter, lesser trochanter, and shaft. We identified five subgroups of three-part fractures according to the fracture pattern involving the greater and lesser trochanters. In total, 239 femoral trochanteric fractures (45 men, 194 women; average age, 84.4 years) treated in four hospitals were classified using our 3D-CT classification. The relationship between this 3D-CT classification and the AO/OTA, Evans, and Jensen X-ray classifications was investigated. Results: In the 3D-CT classification, many fractures exhibited a large oblique fragment of the greater trochanter including the lesser trochanter. This fracture type was recognized as unstable in the 3D-CT classification but was often classified as stable in each X-ray classification. Conclusions: It is difficult to evaluate fracture patterns involving the greater trochanter, especially large oblique fragments including the lesser trochanter, using plain X-rays. The 3D-CT shows the fracture line very clearly, making it easy to classify the fracture pattern.

In this study, a tungsten-SiO2-based metal⁻insulator⁻metal-structured metasurface for the thermal emitter of the thermophotovoltaic system was designed and fabricated. The proposed emitter was fabricated by applying the photolithography method. The fabricated emitter has high emissivity in the visible to near-infrared region and shows excellent wavelength selectivity. This spectral emissivity tendency agreed well with the result calculated by the finite-difference time-domain method. Additionally, the underlying mechanism of its emission was scrutinized. Study of the fabrication process and theoretical mechanisms of the emission, clarified in this research, will be fundamental to design the wavelength-selective thermal emitter.

Heat transfer and fluid flow in a single-rib mounting channel were investigated by directly solving Navier-Stokes and energy equations. The flow and thermal fields were considered to be fully developed at the inlet of the channel, and the simulation was made for spatial advancement of turbulent heat transfer. The Reynolds number based on the friction velocity at the inlet and the channel half width was 150. The Prandtl number was 0.71. The budgets for turbulent heat fluxes and temperature variance at various sections were presented and were investigated, which would be useful for testing and developing turbulence models. Near a circular vortex in front of the rib, pressure diffusion terms made an important contribution. Remarkable production terms were generated near a reattachment point. Production and dissipation terms were not dominant in front of and above the rib, and a time scale ratio exceeded 2.0 in the region.

We explored the variable adult emergence in summer generations of a multivoltine sawfly [Arge nigrinodosa (Argidae)], larvae of which feed gregariously on the foliage of Rosa spp. (Rosaceae), and its ecological significance. The sawfly showed a trimodal adult emergence under long-day conditions in the laboratory. Following the first and largest cluster of emergence, a small tail of slightly delayed emergence was observed, which most likely was heritable. The third cluster of emergence after nonheritable partial diapause in prepupae seemed to match the synchronous emergence of a portion of adults in September under field conditions, probably a risk-spreading (i.e., bet-hedging) strategy to cope with food shortage during unpredictable periods of drought in summer.

Thermal radiation in a turbulent natural convection plays an important role in a wide area of engineering and nature. The purposes of this study are to investigate the effects of turbulent fluctuation on radiative heat transfer, and to evaluate radiative heat transfer models applied to turbulent natural convection. The present radiative heat transfer analysis of a turbulent natural convection using direct numerical simulation (DNS) provides a useful fundamental data for the complete coupling simulation in the future.

Heat transfer and fluid flow in a single-rib mounting channel were investigated by directly solving Navier-Stokes and energy equations. Flow and thermal fields were considered to be fully developed at the inlet of the channel, and the simulation was made for spatial advancement of turbulent heat transfer. Keeping the frictional Reynolds number, Reτ0, at 150, the rib height ratio was changed in four steps from H/δ = 0.05 to H/δ = 0.4. Computational results were confirmed to be nearly independent of grid meshes. In addition, numerical accuracy was confirmed through close agreement between computed mean pressure and the experiment by Yao et al. (1995). The numerical results revealed that the highest value of the mean Nusslet number was as large as 1.3 times the smooth surface consuming the same pumping power, and the local enhancement of heat transfer was correlated with the turbulence increase near the rib front and the reattachment point. According to the Reynolds stress budgets for H/δ = 0.2, there were mechanisms to induce powerful fluctuations: (1) Streamwise fluctuation was increased through production by flow deceleration in the upstream of the rib; (2) Redistribution to wall-normal and spanwise fluctuations was fortified by the fluid splattering to the rib front. Therefore, excellent performance of heat transfer was concluded to occur due to flow structures, which induce the strong disturbance near the rib front triggering smooth transition of the separated shear layer.

The objective of this study is to develop a new simulator for laser therapy. In order to minimize undesired effects on the laser therapy, it is important to precisely predict for heat and photon transport inside a biological tissue. In the present study, the photon transport is solved with the Radiation Element Method by Ray Emission Model (REM2), and then coupled with bioheat transfer equation. The dimensionless results become valuable guidance for developing a laser therapy system.

We propose a decentralized algorithm to calculate the control signals for lights in wireless sensor/actuator networks. This algorithm uses an appropriate step size in the iterative process used for quickly computing the control signals. We demonstrate the accuracy and efficiency of this approach compared with the penalty method by using Mote-based mesh sensor networks. The estimation error of the new approach is one-eighth as large as that of the penalty method with one-fifth of its computation time. In addition, we describe our sensor/actuator node for distributed lighting control based on the decentralized algorithm and demonstrate its practical efficacy.

This study presents an optimization methodology for finding the heaters setting that produce a desired heat flux and temperature distribution over a region of the enclosure surface, called the design surface. Radiation element method by ray emission model (REM2) was used to calculate the radiative heat flux on the design surface, which enable us to handle reflecting surfaces. Micro-genetic algorithm was used to minimize an objective function, which was expressed by the sum of square error between estimated and desired heat fluxes on the design surface. The novel features of this methodology were demonstrated by finding the optimal heaters setting of a three dimensional enclosure for three aspect ratio. The effects of refractory properties have been studied as well.

Chylomicron remnants have been suggested to be involved in the development of atherosclerosis. To investigate the mechanisms of chylomicron remnant-induced atherosclerosis, we prepared cholesterol (Chol)-containing emulsion particles as models for chylomicron remnants. Chol markedly increased the apolipoprotein E (apoE) binding maximum of emulsions without changing the binding affinity and thereby promoted emulsion uptake by J774 macrophages. Fluorescence measurements showed that Chol increased acyl chain order and head group hydration of the surface phospholipid (PL) layer of emulsions. The binding maximum of apoE was closely correlated with the hydration and the increase in the PL head group separation at the emulsion surface. From experiments using inhibitors for lipoprotein receptors, heparan sulfate proteoglycans and low density lipoprotein receptor-related protein were found to be the major contributors to the uptake of Chol-containing emulsions. Trypan blue dye exclusion revealed that the uptake of Chol-containing emulsions induced cytotoxicity to J774 macrophages.This study proposes a mechanism of atherosclerosis induced by chylomicron remnants.

A Morel-Lavallee lesion (MLL) involves posttraumatic fluid collection around the greater trochanter. Many cases of MLL are missed at the initial evaluation, and the treatment of MLL is not well established. We present two cases in which MLL was missed at the initial evaluation. Case 1. A 65-year-old man was run over by a parade float. There was subcutaneous hematoma around the left greater trochanter, and no fracture was found. We diagnosed this injury as MLL on the 7th day after the trauma. Although we performed percutaneous drainage, the injured area was infected. Case 2. A 57-year-old man was hit by a train in a factory. There was an iliac wing fracture, but an MLL was not initially recognized. On the 6th day after the trauma, when performing open reduction and internal fixation for the iliac fracture, we recognized the lesion and performed percutaneous drainage simultaneously. This lesion also became infected. In these two cases, the wounds finally healed after a long duration of treatment. We suggest that it is important to keep this injury in mind and debride the lesion early and completely in the treatment course.