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Through the progression of devices, the adaptation of carotid artery stenting (CAS) has been expanded according to the non-inferiority of CAS for carotid endarterectomy reported by several randomized control trials. To maintain favorable outcomes, identifying prognostic factors is essential for optimizing treatment indications and periprocedural management. This study focused on the prognostic factors of CAS using real-world data.This retrospective multicenter cohort study aimed to identify the prognostic factors after CAS using real-world data from the stroke registry of Yokohama (STrOke Registry of Yokohama; STORY) from January 1, 2018 to May 31, 2021. Patient characteristics, procedural factors, complications, and prognoses were collected using medical records.Data from 107 patients were enrolled in this study after excluding those with insufficient data (2 cases). The mean participant age was 74.9±8.2 years, and 66 patients (61.7%) were symptomatic. Symptomatic lesions were a significant prognostic factor in the overall analysis (p=0.003). A multivariate analysis showed that the estimated glomerular filtration rate (eGFR) (odds ratio: 1.11, p=0.003) and staged CAS (odds ratio: 38.9, p=0.04) were independent prognostic factors. The odds ratio and relative risk of mRS deterioration when eGFR was under 49 mL/min/1.73 mIn this real-world multicenter study, we established independent prognostic factors for CAS using high totality data. For patients with symptomatic lesions and low eGFR (≤49 mL/min/1.73 m

Background: Coronavirus disease 2019 (COVID-19) continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with COVID-19 symptoms are suspected of disease. Computed tomography (CT) in patients with suspected COVID-19 may be reasonable for triaging, and CT-first triage strategies have been proposed. However, clinical evaluation of a CT-first triage protocol is lacking. The aim of this study is to investigate the real-world efficacy and limitations of a CT-first triage strategy in patients with suspected COVID-19.Methods: This was a single-center cohort study evaluating outpatients with suspected COVID-19 who underwent a medical examination at Yokohama City University Hospital and who were prospectively registered between 9 February and 5 May 2020. We treated patients according to the CT-first triage protocol. CT findings were classified into five categories according to the COVID-19 Reporting and Data System (CO-RADS). With the CT-first triage protocol, patients with a suspicious clinical history, symptoms, or suspicious findings on chest CT were allocated to the COVID-19 suspected group. The primary outcome was efficacy of the CT-first triage protocol for outpatients with suspected COVID-19. We conducted additional analyses of the isolation time of outpatients with suspected COVID-19 and reached final diagnoses.Results: In total, 108 outpatients with suspected COVID-19 were examined at our hospital. Forty-eight patients (44.9%) were categorized as CO-RADS 1, 26 patients (24.3%) as CO-RADS 2, 14 patients (13.1%) as CO-RADS 3, 6 patients (5.6%) as CO-RADS 4, and 13 patients (12.1%) as CO-RADS 5. One patient was excluded because of pregnancy. Using the CT-first triage protocol, 48 (44.9%) patients were suspected of having COVID-19. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group not suspected of having COVID-19 were diagnosed with COVID-19 during follow up. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our CT-first triage protocol was acceptable for triaging outpatients with suspected COVID-19. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is limited.

Background: The Coronavirus disease 2019 pandemic continues to spread worldwide. Because of the absence of reliable rapid diagnostic systems, patients with symptoms of Coronavirus disease 2019 are treated as suspected of the disease. Use of computed tomography findings in Coronavirus disease 2019 are expected to be a reasonable method for triaging patients, and computed tomography-first triage strategies have been proposed. However, clinical evaluation of a computed tomography-first triage protocol is lacking.The aim of this study is to investigate the real-world efficacy and limitations of a computed tomography-first triage strategy in patients with suspected Coronavirus disease 2019.Methods: This was a single-center cohort study evaluating outpatients with fever who received medical examination at Yokohama City University Hospital, prospectively registered between 9 February and 5 May 2020. We treated according to the computed tomography-first triage protocol. The primary outcome was efficacy of the computed tomography-first triage protocol for patients with fever in an outpatient clinic. Efficacy of the computed tomography-first triage protocol for outpatients with fever was evaluated using sensitivity, specificity, positive predictive value, and negative predictive value. We conducted additional analyses of the isolation time of feverish outpatients and final diagnoses.Results: In total, 108 consecutive outpatients with fever were examined at our hospital. Using the computed tomography-first triage protocol, 48 (44.9%) patients were classified as suspected Coronavirus disease 2019. Nine patients (18.8%) in this group were positive for severe acute respiratory syndrome coronavirus 2 using polymerase chain reaction; no patients in the group considered less likely to have Coronavirus disease 2019 tested positive for the virus. The sensitivity, specificity, positive predictive value, and negative predictive value of our computed tomography-first triage protocol for Coronavirus disease 2019 were 100%, 60.2%, 18.8%, and 100%, respectively. The protocol significantly shortened the duration of isolation for the not-suspected versus the suspected group (70.5 vs. 1037.0 minutes, P < .001). Conclusions: Our computed tomography-first triage protocol was acceptable for screening patients with suspected Coronavirus disease 2019. This protocol will be helpful for appropriate triage, especially in areas where polymerase chain reaction is inadequate.

Background Parent artery occlusion (PAO) is an effective treatment for hemorrhagic diseases associated with the internal carotid artery. There are several reports of long-term cerebral infarction or the formation of de novo cerebral aneurysms following PAO. Materials and methods We retrospectively reviewed these complications in 38 patients who underwent PAO for therapeutic treatment. We investigated perioperative cerebral infarctions, long-term cerebral infarctions, and de novo aneurysms. Results The mean age of the patients was 64.0 years, and 25 patients (65.8%) were female. The causative diseases were unruptured (n = 19; 50.0%) and ruptured (n = 8; 21.1%) aneurysms. PAO was performed after ischemic tolerance was assessed with balloon test occlusion (BTO), and BTO was performed in 34 patients, of whom 25 (73.5%) had ischemic tolerance. Twenty-six patients (68.4%) were treated with PAO alone, eight (23.5%) with low-flow bypass, and six (17.6%) with high-flow bypass. Perioperative complications occurred in five patients (13.2%): two of the 26 patients (7.7%) who underwent scheduled treatment and three of the 12 patients (25.0%) who underwent emergency treatment. One patient (2.6%) had long-term de novo aneurysm, and none developed cerebral infarction. Conclusions These results showed that the assessment of ischemic tolerance by performing BTO and appropriate revascularization in scheduled treatments are important to reduce perioperative and long-term cerebral infarctions. PAO must be performed with greater caution in emergency treatment.

We previously reported the efficacy of anti‐cancer therapy with hyperthermia using an alternating magnetic field (AMF) and a magnetic compound. In the course of the study, unexpectedly, we found that an AMF enhances the cytotoxicity of Compound C, an activated protein kinase (AMPK) inhibitor, although this compound is not magnetic. Therefore, we examined the cellular mechanism of AMF‐induced cytotoxicity of Compound C in cultured human glioblastoma (GB) cells. An AMF (280 kHz, 250 Arms) for 30 minutes significantly enhanced the cytotoxicity of Compound C and promoted apoptosis towards several human GB cell lines in vitro. The AMF also increased Compound C‐induced cell‐cycle arrest of GB cells at the G2 phase and, thus, inhibited cell proliferation. The AMF increased Compound C‐induced reactive oxygen species production. Furthermore, the AMF decreased ERK phosphorylation in the presence of Compound C and suppressed the protective autophagy induced by this compound. The application of an AMF in cancer chemotherapy may be a simple and promising method, which might reduce the doses of drugs used in future cancer treatment and, therefore, the associated side effects.

Narrative is a universal form of human information and communication. The generative cognition of narrative will be a core element of a human-like and human-friendly autonomous agent. In the field of artificial intelligence (AI), the knowledge aspect of narrative, including script knowledge and episodic memory, has been studied from a functional perspective. However, this knowledge aspect is rooted in the close relationship between a narrative and how the human mind organizes subjective experiences into a mental representation. We use the term “story” to refer to the uniform mental representation of a piece of a subjective world containing individual meaning and a rich temporal extent. For example, stories include the following types of mental object: an episodic memory, an autobiographical memory, the contextual structure of a current situation, a prospective memory, a planned or imagined future, and a fictional or virtual story. Although narrative cognition is a very complex problem for AI, a cognitive mechanism for dynamically generating mental stories through interacting with external environments is necessary for the ultimate autonomous agent. Considering this long-term goal, in this paper, we provide a structural overview of a subjective world formed by stories as experiences of an agent. In particular, the following structural aspects of mental stories are described: a story-based context of a current situation, association of past, future, and fictional stories, association of others’ mental stories, and the distinction between factual and fictitious stories.

The authors propose the design of a Socially Open Narrative Generation System (SONGS) that co-creates a collection of diverse narratives from a narrative generation program and people. This is a challenge of the social application of narrative generation technology used for vitalizing the social activity of producing and sharing narratives. The key idea is to connect and unify individual narrative productions by many agents, including a computer program and many humans, via a collection of narratives produced and accumulated by these agents. At the same time, SONGS is the practice of a computational approach to narratology as a model for the social process of narrative production. This chapter describes the key concepts and mechanism design of SONGS with several experimental programs.

The authors propose the conceptual design of a co-creative narrative generation system that co-creates a collection of diverse narratives from a narrative generation program and people. The long-term goal of this study is to vitalize humans' narrative creation by developing generative narrative technology. The key idea is to connect and unify individual narrative productions by many agents, including one or more computer programs and humans, via a collection of narratives produced and accumulated by these agents. Simultaneously, a co-creative narrative generation system is the practice of a computational approach to narratology as a model for the social system of narrative production. This chapter describes the basic concepts of the co-creative narrative generation system.

In this chapter, the author develops a computational model of the narrative ability for artificial agents. To illustrate an overview of this study, the author addresses an architectural and conceptual systematization of the narrative ability. The proposed model consists of two essential elements: the “mental world” as the internal representation of the world that is formed from many stories, and the mechanism of “narrating” as the act of expressing part of the mental world. In this chapter, the basic concepts and system frameworks of the narrative ability, mental world, and narrating are presented.

Lately, automatic content generation has been receiving increasing attention, and studies pertaining to narrative generation systems have great scope of application in this field. A fundamental issue in designing applications of narrative generation technology is developing a connection between a narrative generation program and people. In this paper, we propose a visual interface for providing various computer-generated narratives to the user. The narrative generation program was also developed by us previously. The interface is used to arrange and visualize narratives into a two-dimensional space on the basis of their structural features. Users will be able to explore and browse narratives by using the visualized objects based on their own values or objectives. We have shown several visualization examples to help in discussing the availability of the interface. In addition, we have presented a new line of research, brought to light by this proposal—the vision of a co-creative connection between narrative generation systems and people, in particular.

Shortage of autologous blood vessel sources and disadvantages of synthetic grafts have increased interest in the development of tissue-engineered vascular grafts. However, tunica media, which comprises layered elastic laminae, largely determines arterial elasticity, and is difficult to synthesize. Here, we describe a method for fabrication of arterial grafts with elastic layer structure from cultured human vascular SMCs by periodic exposure to extremely high hydrostatic pressure (HP) during repeated cell seeding. Repeated slow cycles (0.002 Hz) between 110 and 180 kPa increased stress-fiber polymerization and fibronectin fibrillogenesis on SMCs, which is required for elastic fiber formation. To fabricate arterial grafts, seeding of rat vascular SMCs and exposure to the periodic HP were repeated alternatively ten times. The obtained medial grafts were highly elastic and tensile rupture strength was 1451 ± 159 mmHg, in which elastic fibers were abundantly formed. The patch medial grafts were sutured at the rat aorta and found to be completely patent and endothelialized after 2.5 months, although tubular medial constructs implanted in rats as interpositional aortic grafts withstood arterial blood pressure only in early acute phase. This novel organized self-assembly method would enable mass production of scaffold-free arterial grafts in vitro and have potential therapeutic applications for cardiovascular diseases.

Melanoma has an extremely poor prognosis due to its rapidly progressive and highly metastatic nature. Several therapeutic drugs have recently become available, but are effective only against melanoma with specific BRAF gene mutation. Thus, there is a need to identify other target molecules. We show here that Transient receptor potential, canonical 3 (TRPC3) is widely expressed in human melanoma. We found that pharmacological inhibition of TRPC3 with a pyrazole compound, Pyr3, decreased melanoma cell proliferation and migration. Similar inhibition was observed when the TRPC3 gene was silenced with short-hairpin RNA (shRNA). Pyr3 induced dephosphorylation of signal transducer and activator of transcription (STAT) 5 and Akt. Administration of Pyr3 (0.05 mg/kg) to mice implanted with human melanoma cells (C8161) significantly inhibited tumor growth. Our findings indicate that TRPC3 plays an important role in melanoma growth, and may be a novel target for treating melanoma in patients.

我々は, 歯周炎により歯の移動と挺出が引き起こされること, 歯周基本治療後に患者の不安傾向が減少することを明らかにした。これらから「歯周炎による歯の移動と挺出がまず始めに引き起こされ, その後, 早期接触が生じる」という仮説を立てた。本研究の目的は, 早期接触が唾液中ストレスマーカーに与える影響を評価することであった。本研究の被験者は19歳から28歳までの健常者22名(男性15名, 女性7名)であった。実験的に早期接触を付与するために1mm厚のポリエステルレジン製プレート装置を作製し, 被験者の下顎右側第一大臼歯に装着させた。また, 不安傾向を評価するために, 全ての被験者にState-TraitAnxietyInventory(STAI)を記入させた。実験的早期接触が咬合力, 咬合接触面積に与える影響は, Dental Prescale®システムにより評価した。早期接触付与前後のパラフィン咀嚼時の全唾液を採取し, 唾液中のクロモグラニンA濃度, コルチゾール濃度, アミラーゼ活性を測定した。咬合力及び咬合接触面積については早期接触付与前後で有意差を認めた。しかし, 唾液中コルチゾール, クロモグラニンA濃度については有意差を認めなかった。唾液アミラーゼ活性は, 早期接触付与後で有意に増加していた。これらの結果から, 実験的な早期接触によりストレス反応が引き起こされる可能性が示唆された。日本歯周病学会会誌(日歯周誌)53(2) : 113-124, 2011.

We previously reported that μ-oxo N,N’-bis(salicylidene)ethylenediamine iron [Fe(Salen)], a magnetic organic compound, has direct anti-tumor activity, and generates heat in an alternating magnetic field (AMF). We showed that Fe(Salen) nanoparticles are useful for combined hyperthermia-chemotherapy of tongue cancer. Here, we have examined the effect of Fe(Salen) on human glioblastoma (GB). Fe(Salen) showed in vitro anti-tumor activity towards several human GB cell lines. It inhibited cell proliferation, and its apoptosis-inducing activity was greater than that of clinically used drugs. Fe(Salen) also showed in vivo anti-tumor activity in the mouse brain. We evaluated the drug distribution and systemic side effects of intracerebrally injected Fe(Salen) nanoparticles in rats. Further, to examine whether hyperthermia, which was induced by exposing Fe(Salen) nanoparticles to AMF, enhanced the intrinsic anti-tumor effect of Fe(Salen), we used a mouse model grafted with U251 cells on the left leg. Fe(Salen), BCNU, or normal saline was injected into the tumor in the presence or absence of AMF exposure. The combination of Fe(Salen) injection and AMF exposure showed a greater anti-tumor effect than did either Fe(Salen) or BCNU alone. Our results indicate that hyperthermia and chemotherapy with single-drug nanoparticles could be done for GB treatment.