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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.

In several studies, regional cerebral oxygen saturation (rSO2) has been measured in patients with postcardiac arrest syndrome (PCAS) to analyze the brain's metabolic status. However, the significance of rSO2 in PCAS patients remains unclear. In the present study, we investigated the relationship between rSO2 and physiological parameters. Comatose survivors of out-of-hospital PCAS with targeted temperature management (TTM) at 34°C for 24 hours were included. All patients were monitored for their rSO2 and additional parameters (arterial oxygen saturation [SaO2], hemoglobin [Hb], mean arterial pressure [MAP], arterial carbon dioxide pressure [PaCO2], and body temperature]) measured at the start of monitoring and 24 and 48 hours after return of spontaneous circulation (ROSC). Patients were divided into favorable and unfavorable groups, and the correlation between rSO2 and these physiological parameters was evaluated by multiple regression analysis. Forty-nine patients were included in the study, with 15 in the favorable group and 34 in the unfavorable group. There was no significant difference in the rSO2 value between the two groups at any time point. The multiple regression analysis of the favorable group revealed a moderate correlation between rSO2 and SaO2, Hb, and PaCO2 only at 24 hours (coefficients: 0.482, 0.422, and 0.531, respectively), whereas that of the unfavorable group revealed moderate correlations between rSO2 and Hb values at all time points, PaCO2 at 24 hours and MAP at 24 and 48 hours. rSO2 was moderately correlated to MAP in unfavorable patients. To optimize brain oxygen metabolic balance for PCAS patients with TTM measuring rSO2, we suggest total evaluation of each parameters of SaO2, Hb, MAP, and PaCO2.

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.

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, clinicians should be familiar with its management. 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 out of the 1,490 screened. All of these were simulation-based cross-over randomised controlled trials examining the quality of chest compressions. No data were available about the survival rates of mothers or fetuses/neonates. Meta-analyses indicated that resuscitation of pregnant women in the 27°–30° left-lateral tilt position lowered the quality of chest compressions, and the rates of correct compression depth and correct hand position decreased by 17% and 9%, respectively when compared with resuscitation in the supine position. Inexperienced clinicians faced difficulties in performing 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.

What is known and objective Favipiravir is a promising treatment candidate for managing coronavirus disease 2019 (COVID‐19). Warfarin has many drug interactions, but no interactions with favipiravir have been reported. Case summary Our patient was taking warfarin for deep vein thrombosis. The international normalized ratio (INR) was stable (1.65 to 2.0); however, it increased to 4.63 after administering favipiravir. The patient had no other factors justifying this change. What is new and conclusion Favipiravir and warfarin might have previously unidentified drug interactions that elevated the INR. Therefore, INR must be closely monitored when they are concomitantly administered in COVID‐19 patients., It is important to evaluate the drug–drug interactions between the limited antiviral drugs used in COVID‐19 and the drugs used to manage common comorbidities. We report a case of elevated anticoagulant action i.e., international normalized ratio (INR), when favipiravir and warfarin were used concomitantly in a patient with COVID‐19.

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 Conclusion: Perennial vitamin D insufficiency is prevalent in elderly Japanese patients with hip fractures.

The development of high-sensitive and economical strain sensors is crucial for precise and efficient measurement of ultra-small strain in industrial applications. This paper reports a microfabricated strain sensor based on aluminum nitride (AlN) combined with a metal-oxide-semiconductor field effect transistor (MOSFET). A high-quality AlN thin film works as a sensing element, which is connected electrically to the gate electrode of the MOSFET for the amplification of piezoelectric response of the AlN thin film. The pseudo gauge factor (GF) of the MOSFET is evaluated from the source-drain resistance change under the application of stress to the piezoelectric AlN thin film. A GF of as high as 1340 is obtained, which is seven times larger than the best GF demonstrated for the state-of-the-art silicon piezoresistive strain sensor. The exponential change of drain-source current with gate voltage in subthreshold region of the MOSFET offers a large enhancement of the sensitivity of such sensors. The developed strain sensor has various applications in strain and stress measurements in an ultra-small strain range.

To evaluate volume-outcome relationship in paediatric out-of-hospital cardiac arrest (OHCA).This post hoc analysis of the SOS-KANTO 2012 study included data of paediatric OHCA patients18 years old who were transported to the 53 emergency hospitals in the Kanto region of Japan between January 2012 and March 2013. Based on the paediatric OHCA case volume, the higher one-third of institutions (more than 10 paediatric OHCA cases during the study period) were defined as high-volume centres, the middle one-third institutions (6-10 cases) were defined as middle-volume centres and the lower one-third of institutions (less than 6 cases) were defined as low-volume centres. The primary outcome measurement was survival at 1 month after cardiac arrest. Multivariate logistic regression analysis for 1-month survival and paediatric OHCA case volume were performed after adjusting for multiple propensity scores. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups as patient demographics and prehospital factors.Among the eligible 282 children, 112, 82 and 88 patients were transported to the low-volume (36 institutions), middle-volume (11 institutions) and high-volume (6 institutions) centres, respectively. Transport to a high-volume centre was significantly associated with a better 1-month survival after adjusting for multiple propensity score (adjusted odds ratio, 2.55; 95% confidence interval, 1.05-6.17).There may be a relationship between institutional case volume and survival outcomes in paediatric OHCA.

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.

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.

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., This article describes medical problems, tasks, and topics at mass gathering events. It also introduces the current activities of the Academic Consortium on Emergency Medical Services and Disaster Medical Response Plan during the 2020 Tokyo Olympics (AC2020), consisting of 28 medical societies in Japan.

BACKGROUND Renal dysfunction is associated with increased cardiovascular-related mortality, but its impact on outcome of out-of-hospital cardiac arrest (OHCA) remains unclear. We assessed whether post-OHCA outcome correlated with renal function early after OHCA. Methods and Results: Of the 16,452 registered patients in the SOS-KANTO 2012 Study, 5,112 cardiogenic OHCA adults with creatinine measurement (mean age, 72 years; male, 64%) were examined. First-obtained creatinine was used to assess eGFR. Associations between eGFR groups, ≥60 (n=997), 45-59 (n=1,311), 30-44 (n=1,441), and

Herein, we report a pediatric case of acute paradoxical cerebral embolism complicated by serious acute pulmonary embolism that was caused by an extremely small patent foramen ovale (PFO). The patient had no medical history suggestive of any other reason. Paradoxical cerebral embolism may occur even with an extremely small PFO because of the increased right-side pressure of the heart and a resulting right-to-left shunt from the acute pulmonary embolism. Although pediatric cases of pulmonary embolism are rare, when diagnosed, clinicians should consider the risk of a concurrent paradoxical cerebral embolism resulting from a latent PFO. The possibility of PFO should be assessed extremely carefully in pediatric critical care by checking for a thrombogenesis tendency and the existence of deep vein thrombosis in the patient.

Many reports focus on the probability of intracranial hemorrhage as a complication after recombinant tissue plasminogen activator (rt-PA) therapy. However, thromboembolic complications are not well discussed. We experienced a case in which severe thromboembolic complications occurred in the right radial and right ulnar artery. Arterial fibrillation was observed in this case. If multiple thrombi exist in the atrium or ventricle, multiple small embolic particles may appear following thrombolytic therapy, and that may be a potential risk of secondary thromboembolic complications due to incomplete dissolution of thrombi. Transesophageal echocardiography is a standard method to detect intracardiac sources of emboli in the case of arterial fibrillation. Transesophageal echocardiography is, however, an invasive method for patients with ischemic stroke during rt-PA therapy. High resolution enhanced CT could be a useful tool and may be a reliable alternative to transthoracic echocardiography. Careful assessment of thromboembolic complications following rt-PA therapy in patients with arterial fibrillation is needed. In this case report and mini review, we would like to discuss about the accurate diagnostic methods to detect cardiac or undetermined embolic sources and provide expedited stroke care. These embolic sources may be more readily discovered during rt-PA therapy within the limited therapeutic time window.

Objective: In order to clarify indications for therapeutic hypothermia, we retrospectively examined patients resuscitated after Out-of-Hospital Cardiac Arrest (OHCA) who recorded an Auditory Brainstem Response (ABR) wave V according to the Utstein-style guidelines. Methods: Patients who recorded an ABR wave V immediately after resuscitation from OHCA were kept at 34 °C for 48 hours. The cohort was divided into two groups: A favorable neurological outcome group (F group: N=12) and an unfavorable neurological outcome group (U group: N=14). Favorable neurological outcome was defined as Pittsburgh Cerebral-Performance Scale (CPC) 1 or 2 and unfavorable as CPC 3-5. Data used to compare the groups included whether CA was witnessed, if a bystander initiated cardiopulmonary resuscitation, presence of cardiac etiology, initial cardiac rhythm and elapsed time from emergency call receipt until Return of Spontaneous Circulation (ROSC). Results: Elapsed time from receipt of the emergency call until ROSC was significantly shorter in the F group than in the U group. ROC curve analysis indicated that the cut-off duration was 28 minutes for a favorable neurological outcome. Conclusion: For OHCA patients with an ABR wave V, elapsed time from receipt of emergency call until ROSC may be an important parameter within the Utstein-style guidelines to determine the usefulness of therapeutic hypothermia.

Objectives Fatty acids (FAs) have various roles in pro-inflammatory and anti-inflammatory functions. Hypoalbuminemia is often observed in sepsis patients. An imbalance among these compounds formed from FAs caused by hypoalbuminemia may be related to increased mortality in sepsis patients. The purpose of this study was to investigate the correlations between serum albumin and FAs in sepsis and the outcome. Methods This study was an observational investigation. The clinical and laboratory data of sepsis patients were recorded and the Sequential Organ Failure Assessment (SOFA) score was calculated at admission. The serum arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and dihomo-gamma-linolenic acid (DHLA) levels were also measured as FAs. The body mass index (BMI) was used to determine the general nutrition status. Results Two hundred sepsis patients were enrolled during the study period. No significant correlations were observed between the BMI and the SOFA score or the serum albumin level at admission. The FA levels of the non-survivors were significantly lower, but there were no significant differences in the EPA/AA levels of the survivors and non-survivors. A low serum albumin level was closely related to low AA (p

Aim To describe the registry design of the Japanese Association for Acute Medicine - out-of-hospital cardiac arrest (JAAM-OHCA) Registry as well as its profile on hospital information, patient and emergency medical service characteristics, and in-hospital procedures and outcomes among patients with OHCA who were transported to the participating institutions. Methods The special committee aiming to improve the survival after OHCA by providing evidence-based therapeutic strategies and emergency medical systems from the JAAM has launched a multicenter, prospective registry that enrolled OHCA patients who were transported to critical care medical centers or hospitals with an emergency care department. The primary outcome was a favorable neurological status 1 month after OHCA. Results Between June 2014 and December 2015, a total of 12,024 eligible patients with OHCA were registered in 73 participating institutions. The mean age of the patients was 69.2 years, and 61.0% of them were male. The first documented shockable rhythm on arrival of emergency medical services was 9.0%. After hospital arrival, 9.4% underwent defibrillation, 68.9% tracheal intubation, 3.7% extracorporeal cardiopulmonary resuscitation, 3.0% intra-aortic balloon pumping, 6.4% coronary angiography, 3.0% percutaneous coronary intervention, 6.4% targeted temperature management, and 81.1% adrenaline administration. The proportion of cerebral performance category 1 or 2 at 1 month after OHCA was 3.9% among adult patients and 5.5% among pediatric patients. Conclusions The special committee of the JAAM launched the JAAM-OHCA Registry in June 2014 and continuously gathers data on OHCA patients. This registry can provide valuable information to establish appropriate therapeutic strategies for OHCA patients in the near future.

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.

Patients with post-cardiac arrest syndrome (PCAS) suffer from whole body ischemia/reperfusion injury similar to that experienced by newborn babies. Increased oxidative stress was confirmed in PCAS patients (n = 40) at the time of hospitalization by a significant increase in the percentage of the oxidized form of coenzyme Q10 in total coenzyme Q10 compared to age-matched healthy controls (n = 55). Tissue oxidative damage in patients was suggested by the significant increase in plasma levels of free fatty acids (FFA) and the significant decrease in polyunsaturated fatty acid contents in total FFA. A greater decrease in free cholesterol (FC) compared to cholesterol esters (CE) was observed. Therefore, the FC/CE ratio significantly increased, suggesting deficiency of lecithin-cholesterol acyltransferase secreted from the liver. Time course changes of the above parameters were compared among 6 groups of patients divided according to outcome severity. Rapid declines of FC and CE were observed in patients who died within a day, while levels remained unchanged in patients discharged in a week. These data suggest that liver function is one of the key factors determining the survival of patients. Interestingly, therapeutic hypothermia treatment enhanced the increment of plasma ratio of coenzyme Q10 to total cholesterol at the end of rewarming.

To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest.Ad hoc data analysis of a prospective, multicenter observational study.Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013.Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified.Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement.The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission.Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level.

Nano-structured arrays are engineered to meet the requirements of a variety of applications such as microfilters, sensors, and structural interface due to their unique mechanical characteristics, which cannot be achieved by conventional solid materials. However, it is hard to evaluate the elastic properties of nano-structured arrays owing to the discrete structure, sample size, and availability of suitable techniques. To facilitate this, we develop an advanced three-dimensional microscale vibration testing process. In the test, a specially designed three-dimensional microspecimen with tuned mass is excited by a piezoelectric actuator, and the resonance frequencies are detected by a laser device successfully. The anisotropic elastic moduli of nano-structured array composed of helical nano-springs are identified from a single spectrum. This array shows so strong characteristic anisotropy that the solid one hardly can attain. The microscale testing technique can be extended to other materials and mic...

The purpose of this study is to clarify the optical characteristics of a Tungsten–SiO 2 -based film-coupled metamaterial with a fishnet-shaped grating, and we aim to show that this structure could potentially be used as a solar selective absorber for a solar thermophotovoltaic system. The proposed film-coupled metamaterial absorber combined with a fishnet-shaped grating shows significant enhancement in its absorption in the visible spectral region compared with a flat Tungsten surface, and it keeps its spectral emission low in the infrared region, thereby reducing radiative heat loss. The underlying mechanisms of the proposed absorber are discussed through a 3D full-wave electromagnetic simulation, the results of which are compared with that of theoretical equations. Furthermore, its spectral absorption under oblique incident light at the transverse magnetic and transverse electric waves is scrutinized. The underlying absorption mechanisms and relations between each optical resonance are discussed in this paper and will prove to be fundamental not only in the design of solar selective absorbers but also in other wavelength-selective thermal radiation controlling devices.

Aim We compared the outcomes between patients who experienced out-of-hospital cardiac arrest at private residences and public locations to investigate whether patient and bystander characteristics can explain the poorer outcomes of out-of-hospital cardiac arrests at private residences. Methods Adult patients with intrinsic out-of-hospital cardiac arrest (n = 6,191, age ≥18 years) were selected from a prospectively collected Japanese database (January 2012 and March 2013). Patients were grouped according to arrest location into private-residence or control (e.g., public station or road, workplace, school, and other public locations) groups. The primary outcome was a favourable neurological outcome 1 month after out-of-hospital cardiac arrest. Results The arrest location and initial cardiac rhythm had interaction effects on the outcome. After adjusting for patient and bystander characteristics and relative to the control group, a significantly poorer 1-month neurological outcome was observed in the private-residence group if the initial cardiac rhythm was non-shockable (odds ratio: 0.36, 95% confidence interval: 0.24–0.54), while it was not significant if the initial cardiac rhythm was shockable (odds ratio: 1.16, 95% confidence interval: 0.74–1.84). Conclusions Patients with out-of-hospital cardiac arrest at private residences had poorer outcomes than those with out-of-hospital cardiac arrest at public locations, even after adjusting for patient and bystander characteristics, if the initial cardiac rhythm was non-shockable. Our results suggest that poorer patient and bystander characteristics do not completely explain the poorer outcomes of out-of-hospital cardiac arrests; there may be unknown mechanisms through which the location of cardiac arrest affect the outcomes.

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

In this study, a tungsten-SiO2-based metal&ndash, insulator&ndash, 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.

We propose a wavelength-selective emitter using nanoslit graphene metasurface. The nanoslit graphene metasurface consists of a graphene sheet, metallic slit, and dielectric layer for tailoring radiative properties. The utilization of rigorous electromagnetic simulation clarifies the mechanisms of thermal radiation. The proposed emitter shows high emissivity and a broad peak wavelength shift because of the electromagnetic resonances of graphene. This study may facilitate the initial design of wavelength-selective emitters using graphene metasurfaces.

Aims Many experimental studies have reported that intra-arrest cooling during cardiac arrest is a promising treatment to mitigate brain injury. However, there is no clinically established method for cooling the brain during cardiac arrest. We hypothesized that, as blood flow in the lungs must be very slow during cardiopulmonary resuscitation, the blood could be cooled by ventilating the lungs with cooled oxygen like a radiator, and that this cooled blood would in turn cool the brain. The aim of this study was to develop equipment to cool oxygen for this purpose and to confirm its safety on a group of volunteers. Methods We developed new equipment that cools oxygen by running it through a vinyl chloride coil submerged in a bottle of water and frozen at −80°C. Using this equipment, seven volunteers were given oxygen by mask, and their blood pressure, heart rate, and peripheral saturation of oxygen were measured. The temperature in the mask was also measured. Results This equipment was able to decrease the temperature in the mask to −5°C at the Jackson Rees circuit for an oxygen flow of 10 L/min. Among the volunteer group, vital signs were unchanged and the temperature in the mask decreased from 30.1 ± 2.6°C (mean ± standard deviation) to 15.9 ± 9.6°C. No adverse effects were observed in the volunteers after experimentation. Conclusion We successfully developed new equipment to cool oxygen and established its safety in a volunteer study.

We numerically investigate a solar-selective absorber with tungsten core–shell nanoparticle arrays embedded in an SiO2 layer. The 3D full-wave finite-difference time-domain (FDTD) simulations are performed to investigate the geometric effects of different types of solar-selective absorbers. Consequently, broadband light absorption was achieved with either a tungsten nanoparticle array or a tungsten core–shell nanoparticle array because of the strong electric field enhancement in the gap between the core nanoparticles. The solar performance of the proposed structure is shown for high-efficiency solar light absorption. This study enhances understanding of the light absorption mechanism of metallic nanoparticle/dielectric composite and facilitates the design of high-efficiency solar-selective absorbers.

BACKGROUND Antiarrhythmic drugs (AAD) are often used for fatal ventricular arrhythmias during cardiopulmonary resuscitation (CPR). However, the efficacy of initial AAD administration during CPR in improving long-term prognosis remains unknown. This study retrospectively evaluated the effect of AAD administration during CPR on 1-month prognosis in the SOS-KANTO 2012 study population. METHODS AND RESULTS Of the 16,164 out-of-hospital cardiac arrest cases, 1350 shock-refractory patients were included: 747 patients not administered AAD and 603 patients administered AAD. Statistical adjustment for potential selection bias was performed using propensity score matching, yielding 1162 patients of whom 792 patients were matched (396 pairs). The primary outcome was 1-month survival. The secondary outcome was the proportion of patients with favorable neurological outcome at 1 month. Logistic regression with propensity scoring demonstrated an odds ratio (OR) for 1-month survival in the AAD group of 1.92 (P < 0.01), whereas the OR for favorable neurological outcome at 1 month was 1.44 (P = 0.26). CONCLUSIONS Significantly greater 1-month survival was observed in the AAD group compared with the non-AAD group. However, the effect of ADD on the likelihood of a favorable neurological outcome remains unclear. The findings of the present study may indicate a requirement for future randomized controlled trials evaluating the effect of ADD administration during CPR on long-term prognosis.

Neuro-critical care doctors should be familiar with the topics of sedation and analgesia for patients with acute brain injury (ABI) in the intensive care unit (ICU). Patients with elevated intracranial pressure (ICP) should be managed by intubation and mechanical ventilation with sedation of barbiturates, propofol, and midazolam. When propofol is used, special attention should be given to propofol infusion syndrome. To regulate sympathetic nerve activity and avoid hypertension, the rationale is to use opioids for ABI patients. Treatment with sedation interruption strategy should be avoided in all patients at risk for ICP elevation, who are undergoing TTM and treatment of refractory status epilepticus. Administration of ketamine has been associated with a reduction in the progress of spreading depression. Use of ketamine and dexmedetomidine for ABI patients may be optimized in selected cases.

We computationally designed an ultranarrow-band wavelength-selective thermal radiator via a materials informatics method alternating between Bayesian optimization and thermal electromagnetic field calculation. For a given target infrared wavelength, the optimal structure was efficiently identified from over 8 billion candidates of multilayers consisting of multiple components (Si, Ge, and SiO2). The resulting optimized structure is an aperiodic multilayered metamaterial exhibiting high and sharp emissivity with a Q-factor of 273. The designed metamaterials were then fabricated, and reasonable experimental realization of the optimal performance was achieved with a Q-factor of 188, which is significantly higher than those of structures empirically designed and fabricated in the past. This is the first demonstration of the experimental realization of metamaterials designed by Bayesian optimization. The results facilitate the machine-learning-based design of metamaterials and advance our understanding of the narrow-band thermal emission mechanism of aperiodic multilayered metamaterials., Ultranarrow-band wavelength-selective thermal radiators were designed by coupling electromagnetic calculation and Bayesian optimization, fabricated, and measured to exhibit top performance.

The outcomes of patients with non-shockable out-of-hospital cardiac arrest (non-shockable OHCA) are poorer than those of patients with shockable out-of-hospital cardiac arrest (shockable OHCA). In this retrospective study, we selected patients from the SOS-KANTO 2012 study with non-shockable OHCA that developed after emergency medical service (EMS) arrival and analyzed the effect of therapeutic hypothermia (TH) on non-shockable OHCA patients. Of 16,452 patients who have definitive data on the 3-month outcome in the SOS-KANTO 2012 study, we selected 241 patients who met the following criteria: age ≥ 18 years, normal spontaneous respiration or palpable pulse upon emergency medical services arrival, no ventricular fibrillation or pulseless ventricular tachycardia before hospital arrival, and achievement of spontaneous circulation without cardiopulmonary bypass. Patients were divided into two groups based on the presence or absence of TH and were analyzed. Of the 241 patients, 49 underwent TH. Univariate analysis showed that the 1-/3-month survival rates and favorable 3-month cerebral function outcome rates in the TH group were significantly better than the non-TH group (46% vs 19%, respectively, P

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.

Objective This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms. Methods This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes. Results Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96–0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92–0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival. Conclusions While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed.

Due to the interference effect, the reflectance and transmittance of an arbitrary linearly polarized wave cannot be fully described by the reflectance and transmittance of transverse electric and transverse magnetic waves. In this work, the polarization dependence of reflectance and transmittance for anisotropic metamaterials is examined. The explicit mathematical relationship between the Fresnel coefficients and the reflectance (or transmittance) for a given polarization angle is derived. A method is presented that can be used to obtain the reflectance (or transmittance) for any polarization angle from three other polarizations. Several different anisotropic metamaterials are numerically investigated with the finite-difference time-domain technique to elucidate the polarization dependence of reflectance or transmittance. The reflectance and transmittance obtained from the three-polarization-angle method are in agreement with those from the rigorous numerical simulation.

This work deals with the spectral radiative properties of metamaterials made of a 2D metallic pattern on a dielectric thin film that separates the top periodic structure from a metal ground plane. Two distinct patterns are considered: one consists of disconnected double-rectangle gold pattern and the other is made of L-shape pattern. Both structures exhibit dual-band emission or absorption peaks in the infrared region. Unlike the disconnected rectangular pattern for which the normal emittance is independent of the polarization angle, the L-shape structure shows strong polarization dependent due to near-field coupling. The electromagnetic fields at the resonant frequencies are analyzed using the finite-difference time-domain technique to elucidate the physical mechanisms accounting for the different behaviors. For both structures, the resonance mechanisms can be explained by magnetic polaritons. Inductor–capacitor circuit models are developed to quantitatively predict the resonance frequencies. This work helps the understanding of polarization dependence in metamaterials and may facilitate their applications in biosensing and infrared spectroscopic system.

Background Mechanical 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 Results In 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). Conclusions After 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.

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

The introduction of International Organization for Standardization (ISO) standard 26262 “Road vehicles — Functional safety” in 2011 provided a state-of-the-art methodology for achieving functional safety in automotive electrical and/or electronic (E/E) systems. The standard defines the probabilistic metric for random hardware failures (PMHF) as the average probability of a violation of a safety goal associated with a failure over a vehicle's lifetime and architecture metrics. Although a PMHF formula is provided, the explanation of the standard is insufficient. In this paper, we propose a method to calculate the PMHF and expand the application to redundant subsystems that are not adequately described in the standard.

[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.