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Abstract Background Direct oral anticoagulants are the established drugs for treating pulmonary thromboembolism. The advantage of direct oral anticoagulants over conventional therapy for clot lysis and right ventricular unloading in the acute phase remains unclear. This study aimed to evaluate the effect of acute treatment with direct oral anticoagulants on clot dissolution and right ventricular unloading in intermediate high-risk pulmonary thromboembolism. Methods Thirty patients with intermediate high-risk pulmonary thromboembolism admitted between November 2012 and December 2018 were included; 21 and 9 were treated with direct oral anticoagulants and conventional therapy, respectively. We compared the efficacy of clot dissolution and right ventricular unloading for intermediate high-risk pulmonary thromboembolism between direct oral anticoagulant and conventional therapy in the acute phase. Efficacy was assessed by computed tomography obstruction index, right/left ventricular ratio, and brain natriuretic peptide levels between baseline and at discharge. Results Computed tomography obstruction index, right ventricular/left ventricular ratio, and brain natriuretic peptide levels were significantly lower at discharge than at admission in both groups. The rate of improvement in computed tomography obstruction index was significantly higher in the direct oral anticoagulant therapy group than in the conventional therapy group (64 ± 15% vs. 47 ± 16%; p = 0.01). There were no significant differences in the rate of improvement in right ventricular/ left ventricular ratio and brain natriuretic peptide levels between the two groups. Conclusions Compared with conventional therapy, direct oral anticoagulants significantly reduced pulmonary artery clot burden conventional therapy in the acute treatment of intermediate high-risk pulmonary thromboembolism.

Background: Limited data exists on upfront combination therapy for portopulmonary hypertension. We evaluated the clinical efficacy, long-term outcomes, and safety of upfront combination therapy in patients with portopulmonary hypertension. Methods: We performed a retrospective, single-center cohort study involving a final analysis of 33 consecutive patients diagnosed with portopulmonary hypertension who were taking pulmonary arterial hypertension-specific medication. We compared hemodynamic parameters, risk profiles, composite clinical worsening events, and safety between monotherapy (n = 23) and upfront combination therapy (n = 10). Results: Twenty-seven patients (82 %) were classified into the Child–Pugh A stage. The change ratios of pulmonary vascular resistance (−32 % vs. −57 %, P = 0.006) were significantly better with upfront combination therapy. Upfront combination therapy also showed significant improvement in risk profiles. Kaplan–Meier analysis showed that the composite event-free rate was significantly lower in patients who received upfront combination therapy than in those who received monotherapy (P = 0.016), although no statistical differences were observed in all-cause death. In the univariate Cox proportional hazards analysis, upfront combination therapy was a factor for decreasing composite clinical worsening outcomes (hazard ratio 0.190, 95 % confidence interval 0.042–0.854; P = 0.030). No significant hepatic impairments were observed over 2 years of follow-up in the upfront combination group. Conclusions: In patients with portopulmonary hypertension, upfront combination therapy significantly improved symptoms and short-term hemodynamics, and reduced long-term clinical worsening events without serious adverse effects. This study's findings suggest that patients with portopulmonary hypertension presenting with mild hepatic impairment benefit from upfront combination therapy.

Current research indicates the presence of highly skilled and motivated students with robust computational thinking backgrounds seeking opportunities to leverage their expertise in driving innovation and success in this era. These studies also reveal that students' computational thinking skills vary widely depending on educational resources, curriculum emphasis, and individual aptitude. Nonetheless, there is a growing recognition of the importance of fostering these skills, with efforts underway to integrate them more comprehensively into education systems worldwide, including in Indonesia and Japan, as representatives of developing and developed countries. Therefore, assessing the competency of computational thinking in these two countries would be intriguing. The descriptive qualitative research method was employed to delineate the computational thinking competencies of students in Indonesia and Japan. Student worksheets, specifically designed for this purpose, were utilized to gauge the development of these competencies during the learning process using the Scratch application. The results revealed that students employed various strategies in solving the given geometry problems. On the other hand, geometry is one of the mathematics topics that can identify students' computational thinking using this application. These findings were utilized to categorize students' computational thinking skills in the two countries and to identify potential obstacles students experienced in their efforts to enhance these skills. Nevertheless, these constraints offer significant insights into potential areas for future investigation and enhancement. Subsequent endeavors could prioritize conducting experiments by implementing specific learning approaches or methods that have demonstrated effectiveness in improving students' computational thinking skills. This study not only underscores the potential for expanding research on students' computational thinking skills but also provides an overview of the learning process, learning culture, and students' competence in solving geometry problems with tiered difficulty levels using their computational thinking skills.

Background Ring finger protein 213 (RNF213) p.Arg4810Lys is a susceptibility gene for moyamoya disease, peripheral pulmonary artery stenosis (PPS), and other vascular diseases and thrombosis. We investigated the prevalence and clinical characteristics of RNF213 variant carriers diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). Methods and Results We retrospectively analyzed the prevalence of the RNF213 p.Arg4810Lys variant in patients diagnosed with CTEPH (n=112) and PPS (n=10). Clinical and angiographic characteristics were evaluated between RNF213 variant carriers diagnosed with CTEPH and noncarriers with CTEPH and homozygous variant carriers with PPS. Eight heterozygous RNF213 p.Arg4810Lys variant carriers (7.1%) were identified among patients diagnosed with CTEPH, while 5 patients with PPS (50%) carried the homozygous variant. The clinical characteristics of heterozygous variant carriers with CTEPH were not remarkably different from those of noncarriers with CTEPH. All heterozygous variant carriers with CTEPH showed webs/bands lesions at the segmental/subsegmental level, with 75% showing distal tortuous vessels. None of the heterozygous variant carriers with CTEPH exhibited the string‐of‐beads pattern or elongated stenosis. Homozygous variant carriers with PPS showed the string‐of‐beads pattern, elongated stenosis, and distal tortuous vessels without webs/bands lesions. Conclusions A subset of patients diagnosed with CTEPH (7.1%) carried the heterozygous RNF213 p.Arg4810Lys variant. Clinical and angiographic characteristics of heterozygous variant carriers were not remarkably different from those of noncarriers of CTEPH. However, both heterozygous variant carriers with CTEPH and homozygous variant carriers with PPS showed tortuous vessels on angiography.

Abstract Balloon pulmonary angioplasty (BPA) is beneficial for patients with chronic thromboembolic pulmonary disease (CTEPD) with pulmonary hypertension (PH). However, the clinical benefit of BPA for the patients with CTEPD without PH remains unknown. In this study, we aimed to evaluate the efficacy, safety, and long‐term outcomes of BPA in patients with CTEPD without PH. We retrospectively analyzed the data from 84 CTEPD patients with mean pulmonary artery pressure (mPAP)

We describe an autopsied case of systemic AA amyloidosis secondary to metastatic renal cell carcinoma presenting intractable diarrhea. Severe diarrhea was the major symptom for the diagnosis of AA amyloidosis. No renal symptoms which are common in AA amyloidosis secondary to renal cell carcinoma were shown because hemodialysis following bilateral nephrectomy had already been started 9 years before. Treatment against metastatic tumors as a solution of AA amyloidosis could not be performed because of bad performance status and the patient died 5 months after the diagnosis. Autopsy findings revealed that AA amyloid deposition was seen in multi-organs including the intestine. The metastatic tumors were histologically compatible as metastasis of renal cell carcinoma. There was no other cause of chronic inflammation such as inflammatory arthritis. We concluded that chronic inflammation provoked by the metastatic tumors of renal cell carcinoma was a major cause of systemic AA amyloidosis. Intestinal AA amyloidosis with malabsorption was the cause of death. Clinicians should keep it in mind that solid organ malignancy can be a cause of AA amyloidosis and renal cell carcinoma is the most common carcinomatous cause. This case is particularly instructive in that progression of amyloidosis may be missed in hemodialysis patients with anuria and that gastrointestinal symptoms can be the primary indicators of systemic amyloidosis. Endoscopic examination including biopsy is important for the diagnosis and early treatment of amyloidosis.

Free-space optical (FSO) communications can offer high-capacity transmission owing to the properties of the laser beams. However, performance degradation caused by atmospheric turbulence is an urgent issue. Recently, the application of polar codes, which can provide capacity-achieving error-correcting performance with low computational cost for decoding, to FSO communications has been studied. However, long-distance and real-field experiments have not been conducted in these studies. To the best of our knowledge, this study is the first to present the experimental results of polar-coded transmission over 7.8-km FSO links. Using experimental data, we investigated the performance of polar codes over atmospheric channels, including their superiority to regular low-density parity-check codes. We expect that our results will offer a path toward the application of polar codes in high-speed optical communication networks including satellites.

Abstract Introduction Under the current pandemic situation of the coronavirus disease 2019 (COVID‐19), we have newly developed a commercially available device named Endomask to prevent the diffusion of droplets from subjects undergoing esophagogastroduodenoscopy (EGD). Herein, we evaluate the efficacy and safety of the device, and also evaluate the stress of the device on the operators and the subjects of EGD. Methods The efficacy of the device was evaluated using an experimental model that simulated the environment of EGD. The safety of the device was evaluated clinically by means of measuring the oxygen saturation and the expiratory carbonic dioxide partial pressure of subjects with our device during EGD. The stress of the device on the operability of the endoscopists and the respiration of the subjects were evaluated using questionnaires. Results In the experiments with Endomask, the percentage of the area with simulated droplets was significantly reduced compared to that without our device (median, 0.24% vs. 6.96%, p = 0.009). The saturation of oxygen and the expiratory carbonic dioxide partial pressure of subjects with the device did not show significant change at any recording times. Neither the operators nor the subjects felt serious stress from examination with the device. Conclusions Endomask could remarkably and safely prevent the diffusion of droplets without serious stress. Endomask is expected to contribute to a reduction of the infectious risk of SARS‐CoV‐2 in endoscopy units during COVID‐19 pandemic.

Free-space optical (FSO) links offer a practical approach to realize quantum key distribution (QKD) in a global scale. However, when one wants to further extend the distance from the geostationary orbit to the ground, currently known QKD schemes cannot realize practical key rates mainly due to the diffraction losses of a laser beam. If the facts that the FSO links are highly directional and must be used in the line-of-sight (LoS) condition are taken into account, one may impose some physical restrictions on an eavesdropping model to explore longer-distance QKD. In this paper, we propose a novel FSO secret key agreement scheme, line-of-sight QKD (LoS-QKD), based on a quantum wiretap channel. In our model, an eavesdropper can tap only a limited fraction of the FSO signal beam but perform any physically allowable operations on the tapped signals. Fading effects which are significant in the FSO links are fully taken into account. We provide a security proof for the differential phase shift (DPS) keying scheme in terms of the metric which meets the composability. We investigate numerically the performances of LoS-QKD with DPS keying, including finite-length analysis, showing that our proposed scheme can realize high-speed and long-distance secret key agreement with information-theoretic security.