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Hemoptysis is occasionally experienced in patients with hematological malignancies who have respiratory tract infection and severe thrombocytopenia. Thrombocytopenia due to hematological disease is one cause of hemoptysis. Chronic myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy characterized by both a myeloproliferative neoplasm and a myelodysplastic syndrome. This malignancy often infiltrates various extramedullary organs and has a poor prognosis. An 84-year-old Japanese man with CMML was suffered from hemoptysis and dyspnea. When he arrived at the emergency room, hemoptysis stopped. His white blood cell count was 866 × 109/L with 3.5% blast cells and 36.5% monocytes; hemoglobin was 6.7 g/dL; platelets count was 19 × 109/L; and C-reactive protein was 16.23 mg/dL. Chest X-ray examination revealed an invasion shadow near the mediastinum in the left upper lung field. Chest computed tomography revealed a tumorous lesion in the left upper lobe, which had progressed to the mediastinum and formed an infiltration shadow around it. He was administered the antibiotics and the hemostatic agents under hospitalization. He also received blood transfusion for anemia and thrombocytopenia. Rapid improvement in oxygenation was observed along with a rapid decrease in blood levels in the sputum. On the eighth days of hospitalization, however, the patient newly developed massive hemoptysis and died. Autopsy revealed rupture of a thoracic pseudoaneurysm due to infiltration of leukemia cells in the tunica media and lung. Clinicians should consider thoracic aortic aneurysms as a possible cause of hemoptysis even in cases with small hemoptysis. It should be noted that in CMML patients, direct infiltration of leukemia cells in the vascular wall can cause aneurysm formation.

Introduction Smoking is the leading cause of chronic obstructive pulmonary disease (COPD), and smoking cessation is the most effective treatment for patients with COPD. However, few studies have investigated the continuation/cessation of smoking and heated tobacco products (HTP) in patients with COPD. The objective of this study was to examine the characteristics of patients with COPD, those who are current smokers and those who switched from cigarettes to HTP, and to examine the reason for the continuation or cessation of smoking. Methods This multicenter, cross-sectional study included 411 outpatients with COPD. Data for this study were part of a study conducted for a comprehensive evaluation of the smoking status and clinical factors in patients with COPD and their families. Results Logistic regression analysis revealed that a younger age, longer duration of smoking, fewer daily cigarettes, and lower modified Medical Research Council (mMRC) dyspnea score, and a lower Simplified Nutritional Appetite Questionnaire (SNAQ) score for appetite, were characteristics of current smokers (age OR=0.94; duration of smoking OR=1.07; number of cigarettes per day OR=0.94; mMRC OR=0.68; SNAQ OR=0.83; p

The current chronic obstructive pulmonary disease (COPD) management aims to improve the patients' quality of life and healthy life expectancy; however, few studies have evaluated the level of satisfaction with the patients' current respiratory status in COPD patients and their families. This study aimed to examine the level of patient and family satisfaction with the patients' current respiratory status and to identify the clinical factors closely linked to dissatisfaction.This multicenter, cross-sectional study included 454 outpatients with COPD and 296 family members. Patients and families were allocated to the satisfied and dissatisfied groups based on their satisfaction with the patients' current respiratory status. Patients' health status, dyspnoea, appetite, respiratory function, and mood disorders were assessed.Among the participants of this study, 67% of patients and 60% of their families were dissatisfied with the patients' current respiratory status. The COPD assessment test (CAT) was the most sensitive marker of dissatisfaction compared to other clinical factors (p 0.01). The statistical cut-off value of CAT for predicting patient dissatisfaction was 11. CAT reflected patient dissatisfaction independent of age, sex, dyspnoea, appetite, mood disorders, body mass index, and respiratory function (odds ratio: CAT; 1.12 (1.07-1.19): p 0.01).Many patients and families are dissatisfied with the patients' respiratory status, and the patients' CAT score is useful to predict dissatisfaction. Our findings are consistent with the Global Initiative for Chronic Obstructive Lung Disease indicating that treatment should be enhanced in patients with a CAT score ≥10. Furthermore, treatment strategies targeting CAT may contribute to an improved patient satisfaction.

Background and objectives: Incidence rates of pulmonary nontuberculous mycobacterial (NTM) disease have been increasing, especially in the elderly population. Given the limited evidence regarding the safety and efficacy of NTM treatment, this study aimed to evaluate the same among elderly patients. Material and methods: Patients diagnosed with NTM disease at a tertiary hospital from January 2007 to December 2017 were enrolled and data were then retrospectively collected. Data of elderly patients who received antimycobacterial treatment were then analyzed. Results: A total of 161 patients satisfied the diagnostic criteria for NTM disease. There were 40 elderly patients who received treatments. Of the patients, 60% received the guideline oriented standard regimens. Single drug regimens were administered to 22.5% of patients. Only 55.0% of the patients were able to continue any treatment. Treatment-related discontinuation was observed in 44.4% of discontinued or changed patients. There were no significant differences in the characteristics of patients with or without adverse events. Patients who were able to continue the treatment for &gt, 12 months had a lower proportion of activities of daily living (ADL) disability (nine in 18, 50.0% vs. three in 22, 13.6%, p = 0.018) and heart disease (six in 18, 33.3% vs. 1/22, 4.6%, p = 0.033). Sputum culture conversion was achieved in 28 out of 40 (70.0%) elderly patients treated, and those who achieved sputum culture conversion had more standard regimens prescribed than those who failed sputum culture conversion (21 in 28, 75% vs. 3 in 12, 25%, p = 0.005). Conclusion: Age may not be an obstacle for receiving the benefits of the treatment of NTM disease with a precise evaluation of patient&rsquo, s comorbidities. Furthermore, elderly patients without heart disease and ADL disability may have better rate of continuing the NTM treatment. The current study suggested that selecting standard regimens to treat pulmonary NTM is important for elderly patients.

We report a case of severe acute respiratory syndrome coronavirus 2 and Legionella co-infection manifesting as pneumonia with gastrointestinal symptoms. The case highlights the importance of differential diagnosis during the COVID-19 pandemic, so we do not miss the opportunity to diagnose other treatable causes of disease with similar symptoms.

We developed and reported on a 3-D stacked CMOS image sensor (CIS) with a massive number of micro-bump interconnections placed at a narrow pitch between silicon substrates that pushes the envelope of CIS functions. The resistances of the interconnections were measured to be less than one hundredth of an ohm per bump with a test structure. There were, however, a small number of defective micro bumps with much higher impedance among the four million interconnections of the sensor. We developed a method for distinguishing defective interconnections from other defects and evaluated all interconnection resistances in a short amount of time with additional circuits in the CIS with reduced variable factors by using a modified current flow mode. This method makes it possible not only to identify defective interconnections but also to measure their impedances with less fluctuation.

Background: Elder population are susceptible to pulmonary non-tuberculous mycobacterial (PNTM) infection. Also, high age is a risk factor for progression and mortality of PNT, but the evidence related to PNTM treatment are still limited. Aims: The aim of this study was to evaluate the safety and efficacy of PNTM infection treatment among elder patients. Methods: We enrolled patients diagnosed with PNTM infection in a tertial hospital in Chiba, Japan, from January 2007 to December 2017. We retrospectively collected patient characteristics, administered treatments, symptoms, and radiographic findings from the medical records. Results: Hundred and sixty-one patients met the diagnostic criteria for PNTM infection, 75 patients were defined as elder group (age above 75) and 86 patients were in the younger group (age less than 75) In the elder group, 33 patients were treated for PNTM infection. On the other hand, 39 patients were treated in the younger group. Elder group tended to receive less medication for PNTM infection treatment. When comparing NTM treatment-related adverse events between elder and younger groups, no significant difference was observed (39.39% vs 23.08%, respectively). Also, the improvements of both radiological findings (elderly group 54.55% vs younger group 33.33%) and respiratory symptoms (elderly group 54.55% vs younger group 46.15 %) due to NTM treatment showed no significant differences between the two groups. Conclusions: The results of our study suggested that antibiotics therapy with less medication was tolerable and could be a reasonable option for elder patients with PNTM infection to control their symptoms.

We have developed a 3-D-stacked 16-Mpixel, 3.8- $\mu \text{m}$ pitch, and global shutter (GS) CMOS image sensor with a 2-Mpixel 10 000-frames/s high-speed image-capturing mode, with four million reliable microbump interconnections. This sensor consists of a photodiode (PD) substrate and an in-pixel storage node substrate. The four PDs in the unit pixel circuit on the top substrate share one microbump interconnection in 7.6- $\mu \text{m}$ pitch. Each signal of the PDs is transferred to the corresponding storage node on the bottom substrate via the interconnection to achieve a GS function. The ratio of the parasitic light sensitivity of an in-pixel storage node and the light sensitivity of a PD is −180 dB, which is the best record for a CMOS image sensor with 3.8- $\mu \text{m}$ pixels. The image sensor was fabricated with a wafer-on-wafer bonding process technology. We confirmed that the bonding process did not harm the pixel or the MOS transistor characteristics and required no extra area, which means no restrictions on the layout design of microbumps or circuits. No reliability problems were observed in either a heat cycle test or a high temperature and high humidity test.

We developed a multiband imaging CMOS image sensor (CIS) with a multi-storied photodiode structure, which comprises two photodiode (PD) arrays that capture two different images, visible red, green, and blue (RGB) and near infrared (NIR) images at the same time. The sensor enables us to capture a wide variety of multiband images which is not limited to conventional visible RGB images taken with a Bayer filter or to invisible NIR images. Its wiring layers between two PD arrays can have an optically optimized effect by modifying its material and thickness on the bottom PD array. The incident light angle on the bottom PD depends on the thickness and structure of the wiring and bonding layer, and the structure can act as an optical filter. Its wide-range sensitivity and optimized optical filtering structure enable us to create the images of specific bands of light waves in addition to visible RGB images without designated pixels for IR among same pixel arrays without additional optical components. Our sensor will push the envelope of capturing a wide variety of multiband images.

We have developed a 3D stacked 16M-pixel, 3.8-μm pixel pitch, global-shutter CMOS image sensor with pixel level interconnections using four million micro bumps. The four photodiodes in the unit pixel circuit on the top substrate share one micro-bump interconnection at a 7.6-μm pitch. Each signal of the photodiodes is transferred to the corresponding storage node on the bottom substrate via the micro bump. This 3D architecture gives the image sensor not only a 16M-pixel global-shutter function but also a 2M-pixel 10K-fps high-speed image capturing mode with a burst of eight images. In this paper, we report on the improvement in the high-speed image capturing mode to operate at up to 100K fps by optimizing the timing for the higher-speed |image capturing with 2M-pixel resolution. In addition, we estimated the further potential of the 3D image sensor for high-speed image capturing to make the most of the 3D structure, which comprised one photodiode in the pixel unit circuit on the top substrate and electrically connected multiple storage nodes on the bottom substrate. This enables the image sensor to capture a burst of as many frames as the number of storage nodes in the pixel unit without sacrificing a photodiode and have better sensitivity with photodiodes fully occupying the chip surface with bigger photodiodes than when using conventional sensors. These results demonstrate that our 3D stacking technology pushes the envelope of capturing high-speed images with monolithic sensors.

Background There is no consensus regarding the initial intervention for primary spontaneous pneumothorax. We report the outcomes of outpatient treatment for primary spontaneous pneumothorax using a portable thoracic drainage device. Patients and Methods Between April 2007 and December 2011, 99 consecutive patients with a first episode of primary spontaneous pneumothorax were indicated for insertion of a portable thoracic drainage device. All patients were treated with a small-bore portable thoracic drainage device that consists of a flexible 9F silicone catheter with one-way valves and a small plastic chamber. Successful treatment was defined as when the pneumothorax was resolved after the insertion of a portable thoracic drainage device solely on an outpatient basis. Demographic data and treatment outcomes were obtained by a retrospective chart review. Results Ninety-seven patients (98%) with a first primary spontaneous pneumothorax were discharged from the emergency department after insertion of a portable thoracic drainage device. Ninety-three patients (94%) resolved with outpatient treatment. The median duration of portable thoracic drainage device insertion was 4 days (range, 0–33 days). The recurrence rate after treatment with a portable thoracic drainage device was 34% (32/93). There were two infections (2.0%), two instances of hemothoraces (2.0%), and one severe discomfort at the insertion site (1.0%). There were no cases of tension pneumothorax or reexpansion edema. Conclusion Outpatient treatment for primary spontaneous pneumothorax using a portable thoracic drainage device had a high success rate with few serious complications and an acceptable recurrence rate.

Our 3D stacked CMOS image sensor (CIS) has an ideal global shutter function with 16 million pixels and 4 million micro-bump interconnections placed at a 7.6-em pitch between two silicon substrates, achieving interconnections with very low resistance. We confirmed the reliability of our 3D stacked interconnection technology by conducting reliability tests, which included heat cycle tests and high temperature and high humidity tests. The interconnections in our image sensor are comprised of 4 million micro bumps per chip. No increase in the number of failed interconnections or in micro-bump interconnection resistance was observed. For the heat cycle tests, our CIS is designed to have two test modes to detect failed interconnections by scanning all 4 million micro-bump interconnections in a short period. In the high temperature and high humidity tests, we tested the reliability of the interconnections by using test element group (TEG) chips to monitor the resistance precisely. We evaluated the effects of wafer bonding and the micro bumps on a MOS transistor with the TEGs, comparing two types of structures, one with micro bumps and one without, located under an nMOS transistor, and no difference in Vth among them was observed. These results prove that our 3D technology is reliable enough to be applied to our products

We developed an efficient method for evaluating the 4 million micro-bump interconnection resistances of the 3D stacked 16-Mpixel CMOS image sensor by including vertical scanning and readout circuits and extra circuits in both of two substrates for a resistance testing mode, which enables us not only to find failed bumps but also to evaluate the resistances by scanning all micro bumps. We measured the resistances of the interconnections ranging from 50 to 500 kΩ with a resolution of 50kΩ.

We demonstrated multiband imaging with a multi-storied photodiode CMOS image sensor (CIS), which comprises two individually functioning layered devices that achieve optimized images in different substrates bonded by 3D technology. The sensor is able to capture a wide variety of multiband images, which is not limited to conventional visible RGB (Red Green Blue) images taken with a Bayer filter or to invisible infrared (IR) images, at the same time without any color or image degradation even with an extra IR light source. Its wide range sensitivity enables us to select the specific narrow band light wave with specific optical filter in addition to visible RGB images. This wide selection of specific wavelengths of light is useful for specific applications like medical systems to identify pathological lesions and also enables additional functions on the same sensor to make such systems smarter, smaller, and cheaper than the conventional combination of IR imaging sensors with RGB image ones. A wide selection of multiband images is also possible with our device by modifying the top semiconductor layer thickness or changing the characteristics of a color filter on the top substrate to cover a wide range of application needs.

Background This retrospective study examined gender differences in non-small cell lung cancer (NSCLC) by analyzing surgical cases at a single institution. Patients and Methods In this study, 735 NSCLC patients who underwent surgery from 1995 to 2010 were included. Clinical and pathological characteristics were retrieved by reviewing charts retrospectively, and variables between genders were compared. Results There were 489 males and 246 females in the study. The percentage of screening-detected lung cancers (83.7%), never smokers (82.9%), adenocarcinoma histology (90.7%), and pathological stage IA (42.7%) was higher in females than that in males (71.2, 8.2, 51.3, and 23.1%, respectively). Female patients had fewer cases of coronary artery disease (2.8%) and fewer pneumonectomy cases (2.0%) than the male patients (7.4 and 5.3%, respectively). The median follow-up period after surgery was 5.9 years. The overall survival rates at 5 years were 57.3% for males and 76.2% for females (p

A 16Mpixel 3D stacked CMOS image sensor with pixel level interconnections using 4,008,960 micro bumps at a 7.6μm pitch, which set no layout restriction and causes no harm to sensor characteristics, was developed to achieve both a 16Mpixel global-shutter mode with a −180dB PLS and 2Mpixel 10000fps high speed image capturing mode.

Background Validation of the clinical classification for lung cancer of the 7th edition of the TNM staging system among surgical cases has not been reported previously. Methods Data of 489 males and 246 females, with a mean age of 67.6 years, who underwent surgical resection for non-small-cell lung cancer were analyzed retrospectively. Results The 5-year survival rate of these patients was 72.2% for clinical stage IA ( n = 365), 58.4% for IB ( n = 158), 51.2% for IIA ( n = 77), 49.1% for IIB ( n = 42), 36.8% for IIIA ( n = 86), 80% for IIIB ( n = 5) and 50% for IV ( n = 2). The 5-year survival rate of patients was 100% for pathological stage 0 ( n = 2), 86.1% for IA ( n = 216), 73.8% for IB ( n = 173), 46.1% for IIA ( n = 97), 47.2% for IIB ( n = 69), 33.3% for IIIA ( n = 155), 33.3% for IIIB ( n = 3) and 30.9% for IV ( n = 20). Prognostic factors included female sex and 70 years of age or younger, as well as adenocarcinoma histology. Conclusions Deterioration in patient survival was indicated with the exception of stages IIIB and IV, each of which included only a small number of patients. Our study validated the current TNM staging system in surgical cases with regard to both clinical and pathological classifications.

A distortion-free stacked CMOS image sensor with high density micro-bump interconnections was developed. This sensor consists of a photodiode substrate and storage node substrate and was fabricated with a wafer-on-wafer stacking technology. More than 90,000 micro-bump interconnections at a pitch of 8.6 μm per chip convey the signals. A distortion-free image was successfully obtained with the developed sensor. A parasitic light sensitivity of -160 dB was achieved by means of a light shield that uses the three-dimensional structure. It was confirmed that the stacking process caused no harm to the CMOS image sensor characteristics. A connection yield of over 99.9 % and reliable connections for practical applications were achieved.

Conventional CMOS image sensors widely used in products currently on the market are mainly equipped with a rolling exposure function. This rolling exposure causes so-called “Jell-o effect” distortion when capturing a moving target. CMOS image sensors with a global-shutter function are one of the solutions to avoid this distortion. An in-pixel storage node is required to create a global-shutter CMOS image sensor. A floating diffusion and an additional capacitor can be used as an in-pixel storage node [1,2]. The light sensitivity of the in-pixel storage node is specified by the parasitic light sensitivity (PLS), which is the ratio of the light sensitivity of an in-pixel storage node and the light sensitivity of a photodiode. The PLS should be small enough so that the in-pixel storage is not light-sensitive. Artifacts are captured in an image from bright moving objects during read-out if the PLS is not small enough. The PLS of reported global-shutter CMOS image sensors is around -100dB. That would be small enough to use those image sensors in fields where the light source can be controlled. However, for DSC usage, users can easily encounter scenes with bright objects (e.g. sunlight or car headlights). Even if the in-pixel storage node is light-shielded, it is difficult to perfectly protect the in-pixel storage node from photo-generated carriers, as long as the in-pixel storage node and a photodiode are on the same silicon substrate. Meanwhile, 3D stacking technologies have been introduced for image sensors to give them more functionality and improved performance [3,4]. The reported minimum interconnection pitches for image sensors are over 20μm. These technologies do not fit the smaller pixel pitches of the image sensors in recent DSCs. In this paper, we report a rolling-shutter distortion-free 3D stacked image sensor with an in-pixel storage node of -160dB parasitic light sensitivity. The image sensor virtually achieves a global-shutter function using a 4-times frame-shutter operation. The image sensor has 2 semiconductor substrates, where 1 substrate has a backside-illuminated photodiode array and the other a storage-node array. The image sensor achieves a PLS level of -160dB. The image sensor has 8.6μm pitched interconnections, and an interconnection yield of over 99.9% is achieved.

The photophysical properties of C70 excited states were investigated by some time-resolved spectroscopic techniques. The absorption bands of singlet excited state (1C70*) and triplet excited state (3C70*) in the visible region were observed by time-resolved absorption spectroscopy using a streak camera. The intersystem crossing rate constant kisc from 1C70* to 3C70* was determined to be 1.25 × 109 s-1 by the analysis of the absorption−time profiles considering the overlap of the decay of 1C70* and the growth of 3C70*, where the curve fitting was carried out by using the decay rate constant of 1C70* (1.61 × 109 s-1) determined by the picosecond time-resolved emission spectroscopy. The picosecond time-resolved near-IR spectra of 3C70* were obtained by the pump−probe technique, using a probe beam based on the broad-band optical parametric generation (OPG) of a β-barium borate (BBO) crystal pumped by 532-nm laser pulse. The lowest transition band of the T−T absorption of 3C70* was found in the near-IR region ...

Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula. (J Vasc Surg 2001;33:1280-2.)

胸部X線上で結節性陰影および両側肺門リンパ節腫脹を呈し, 鋭匙細胞診所見からサルコイドーシス (以下, サ症) がつよく示唆され, ほかの検査所見から確診しえた症例を報告する.症例は55歳女性.検診にて胸部異常陰影を指摘され旭中央病院受診.両肺に多発性異常陰影があり, 鋭匙細胞診・経気管支肺生検 (以下TBLB) を行った.鋭匙細胞診では, 類上皮細胞の集塊が多数観察され, 多核巨細胞もわずかながらみられた.壊死背景をまったく欠き, 異物・真菌などもみられなかったことから, 細胞診の段階でサ症をつよく疑った.TBLBで気管支壁内に非乾酪壊死性類上皮細胞性肉芽種がみられた.以上の所見およびほかの検査所見からサ症と確診した.剥離細胞診はサ症の診断にほぼ無力であるが, 直接採取法による細胞診は結節性病変をともなうサ症診断に有力な手段になりうることが確認された.

Surface activation of TiO2 mesopores in contact with aqueous electrolytes was conducted by hydrophilic conversion and reaction of chemical adsorbents. Water-based dye-sensitized solar cell was fabr...

All plastics photo-exchargeable battery is made of storage layer and photocatalyst layer in the organic substance. We attempt to improve that the replenishment of the electron to the photocatalyst layer is easy to be carried out by using the anion exchange filter. When the light was illuminated, there is a term to which the storage quantity shows the maximum value by adjusting the film thickness of storage layer and photocatalyst layer.

Picosecond time-resolved absorption spectra of C60 singlet and triplet excited states are observed in the near-IR region in the region 700–1300 nm by the pump-probe technique using a probe beam based on broad-band optical parametric generation (OPG) in β-barium borate (BBO) pumped by a picosecond laser pulse at 532 nm and using an InGaAs multichannel detector.