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Long-gap esophageal atresia (EA) remains a challenging operative procedure. Several techniques have been reported to resolve the problem of distance between the proximal and distal esophagus. We report a thoracoscopic intraoperative esophageal close technique for long-gap EA. A female neonate was born at 39 weeks of gestation with long-gap EA (five vertebrae). The patient underwent thoracoscopic esophageal anastomosis after esophageal elongation. Careful dissection of the proximal and distal esophagus was performed; however, the distance between them was still long. Extra-thoracic traction sutures were placed at the upper esophagus. Then, a Neraton catheter was inserted trans-orally and the upper esophagus was pushed and opened. An internal traction suture was placed between the Neraton catheter and lower esophagus. The gap between the proximal and distal esophagus could be approximated by pulling the Neraton catheter. Esophageal anastomosis was performed successfully. Our thoracoscopic intraoperative esophageal close technique was simple and useful.

Aim: We present the study protocol of a multicenter, retrospective observational study that aims to investigate the efficacy of the actual treatment (the efficacy of conventional and Kampo medicines) of patients with mild to moderate or suspected coronavirus disease (COVID-19) Methods: This study is designed as a multicenter, retrospective observational study Outpatients and inpatients will be recruited from Japanese hospitals The inclusion criteria are as follows: having or suspected to have COVID-19, mild to moderate COVID-19, symptomatic, ≥20 years of age, male or female, able to communicate in Japanese, and treated with conventional and Kampo medicine The exclusion criteria are: unable to provide informed consent due to dementia, psychosis, or psychiatric symptoms, severe COVID-19, or determined unsuitable for this study The sample size is set at 1000, as this number of people can be treated at the collaborating medical institutions during the study period Results: The main outcome is the number of days without fever, with a body temperature of less than 37°C The secondary outcome is set at common cold-like symptoms other than fever (fatigue, cough, shortness of breath, sputum, diarrhea) and severity of illness and hospitalization up to 14 days after the visit Trial registration: The trial was registered in the University Hospital Medical Information Network (Reservation No UMIN000041301) on August 4, 2020 Conclusion: Our study will explore the contribution of conventional and Kampo medicine in the treatment of patients with mild and moderate COVID-19

形態: カラー図版あり, Physical characteristics: Original contains color illustrations, Accepted: 2019-01-12, 資料番号: PA1910029000

Background Air in the venous system may cause vascular air embolism, which is a potentially life-threatening event. The presence of air in venous system after basilar skull fracture is very rare. Case presentation A 77-year-old man fell from a truck bed and suffered head and neck trauma. On hospital arrival, his consciousness was clear and his vital signs were stable. His chief complaint was pain in the back of his head and neck. Head CT showed traumatic subarachnoid hemorrhage in the right frontal area and basilar skull fracture of the occipital bone. Whole body CT showed pneumocephalus and air in the jugular vein and right ventricle. The patient was placed in the supine position in a state of absolute rest to prevent vascular air embolism and was treated conservatively. On hospital day 3, CT was reperformed, revealing disappearance of air in the right ventricle and decreased air in the veins of the head and neck. On hospital day 4, the air in the veins disappeared completely on CT. He did not experience vascular air embolism after increasing of his activity level (e.g., raising his head on hospital day 3 and standing and walking alone on day 5). He was discharged 34 days after admission without sequelae. Conclusions Head trauma patients with basilar skull fracture might develop vascular air embolism if physicians fail to detect air in the venous system on hospital arrival. A high degree of suspicion regarding air in venous system or heart is required when patients present with such injuries.

Summary This study aims to improve asphaltene-risk evaluation using long-term data. Temporal changes in asphaltene risks with gas injection were evaluated. In reservoirs under gas injection, the in-situ fluid component gradually changes by multiple contact with the injected gas. Those compositional changes affect asphaltene stability, causing difficulty in risk prediction using asphaltene models. This study aims to reduce the risk uncertainty depending on operational-condition changes. Periodic upgrading of asphaltene models is essential for understanding the time-dependent changes of asphaltene risks. In a previous study, the asphaltene risk was evaluated for an offshore oil field in 2008 using the cubic-plus-association equation-of-state (EOS) models and using all the available data at the time. Additional experimental data were subsequently collected for a gas-injection plan. An additional study was performed that incorporated and compared the data sets. According to the previous study recommendation, additional asphaltene laboratory studies were conducted using the newly collected samples. All the asphaltene-onset pressures (AOPs) detected in the new samples were higher than those found in the previous study. A large difference was observed between the past and recent AOPs in the lower reservoir even though the samples were collected from the same well. The asphaltene-precipitation risk increases considerably because the new study detected AOP at the reservoir temperature, whereas no AOPs were detected in the previous study. The difference may be attributed to saturation-pressure increase. Next, the numerical asphaltene models were revised; the re-evaluated asphaltene-risk estimations were higher in the lower reservoir and slightly higher in the upper reservoir than the past ones. The reference sample fluids were collected from two different wells with different asphaltene and methane (C1) contents. The reliability of the new asphaltene laboratory results was increased by applying multiple data interpretation. Thus, the difference between the past and recent results can be attributed to fluid alteration with time. On the basis of the analysis in this study, the risk rating was updated to slightly higher than in the previous evaluation, emphasizing the importance of regular monitoring of asphaltene risks. This study provides valuable findings of time-lapse evaluation of asphaltene-precipitation risks for a reservoir under gas injection. The evaluations currently conducted in the industry are snapshots of instantaneous risks. Through the entire field life, the risks have varied depending on the operating conditions. This study demonstrates that risk estimates can change in a unique field with identical work flow by analyzing data collected at different times. Finally, this study demonstrates the importance of time-dependent reservoir-fluid properties.

Early warning systems (EWS) have been proposed as a measure for controlling and preventing dengue fever outbreaks in countries where this infection is endemic. A vaccine is not available and has yet to reach the market due to the economic burden of development, introduction and safety concerns. Understanding how dengue spreads and identifying the risk factors will facilitate the development of a dengue EWS, for which a climate-based model is still needed. An analysis was conducted to examine emerging spatiotemporal hotspots of dengue fever at the township level in Taiwan, associated with climatic factors obtained from remotely sensed data in order to identify the risk factors. Machinelearning was applied to support the search for factors with a spatiotemporal correlation with dengue fever outbreaks. Three dengue fever hotspot categories were found in southwest Taiwan and shown to be spatiotemporally associated with five kinds of sea surface temperatures. Machine-learning, based on the deep AlexNet model trained by transfer learning, yielded an accuracy of 100% on an 8-fold cross-validation test dataset of longitudetime sea surface temperature images.

Laparoscopic gastrostomy tube placement has been increasingly adopted by pediatric surgeons. We herein report our experience with the performance of a laparoscopic-assisted Stamm-operation inside the minimal trocar site without the extension of the trocar site incision or mini-laparotomy. We present some technical modifications that facilitate suturing inside the minimal trocar site. A retrospective chart review was conducted of cases involving patients who underwent laparoscopic-assisted gastrostomy, using a simple extracorporeal method inside the trocar site from April 1998 to March 2018. One hundred five gastrostomy tubes were placed in a laparoscopic-assisted operation. All but two of the cases involved patients with neurological impairment. The mean age was 12.5 years; 28 cases were > 16 years of age. Seventy-five cases underwent gastrostomy during laparoscopic fundoplication. All gastrostomy procedures were completed without intraoperative difficulties; however, 8 cases, which involved a thick abdominal wall, required extension of the trocar site. No cases required conversion to open gastrostomy. No major complications were observed. Two patients developed continuous peristomal cellulitis after surgery, due to the mismatch of the site position and an unsuitable button device size. We demonstrated that laparoscopic gastrostomy with fully extracorporeal suturing within the trocar site is feasible and beneficial, especially for the most neurologically impaired pediatric cases. Technical modification, changing the order of the process, and suturing technique in the minimal space, made it easier to perform the procedures inside the minimal trocar hole.

Achalasia is a primary motility disorder with incomplete lower esophageal sphincter relaxation; it has an annual incidence of 0.11 cases per 100 000 children. Peroral endoscopic myotomy (POEM) is a new endoscopic treatment method for achalasia. Reports about POEM in pediatric patients are rare. We herein report the case of a 9-year-old female patient with achalasia who underwent POEM. The patient underwent endoscopic balloon dilatation because medication was not effective at a previous hospital; however, endoscopic balloon dilatation was not effective either. She then underwent successful POEM upon admission at our hospital. The patient was symptom-free at 2 years postoperatively with no signs of esophagitis in the absence of proton-pump inhibitor therapy.

To evaluate residual oil saturation by miscible flooding (Sorm), as a key parameter for evaluating CO2 miscible injection, a coreflooding experiment was conducted using a composite carbonate core through a prolonged testing period. It was indicated that compositional alteration by mixing of CO2 and oil continuously caused the complicated phenomena such as in-situ asphaltene deposition and gradual viscous oil production. In this paper, we show the observation of those critical phenomena during the prolonged coreflooding. Whereas 100% oil recovery is rarely obtained in actual miscible CO2 flooding, zero oil saturation is often predicted by use of the compositional simulator. Despite that CO2 injection pore volume (PV) is crucial to obtain Sorm, a popular assumption sets the CO2 injection PV ranging from 1.0 to 2.5 in many experiments. In this study, we increased CO2 injection PV up to 15. During tertiary mode CO2 flooding, compositions of effluent fluids were continuously analyzed. After the flood test, fluid saturations were measured in each plug core by the Dean-Stark method and asphaltene contents were measured with extracted oil. The tertiary CO2 flooding under miscible condition achieved high incremental recovery. The Sorm was obtained in core scale based on two different measurements: effluent analysis and Dean-Stark method described earlier. To validate the investigation, the Sorm was discussed from a viewpoint of pore throat size distribution (PTSD). In this analytical discussion, the predicted minimum pore diameter of CO2 penetrated pore space revealed consistent to the experimental Sorm. Three intriguing events were found during the coreflooding: (1) waxy crude production, (2) CO2 dry-out phenomena, and (3) in-situ asphaltene deposition. A compositional analysis of effluent fluids implies that the produced oil gradually became more paraffinic. After the mid-stage of coreflooding, steady decrease was observed for chloride and sodium ion concentrations in the effluent water. This decrease can be interpreted to be caused by dilution of formation brine as the result of CO2 dry-out phenomenon. The asphaltene contents remaining in plug cores showed an evidence of CO2-induced asphaltene precipitation. Due to the limited PV injection, usual coreflooding experiments cannot reproduce the findings described earlier. In this study, we clarified overall trends of those events through entire CO2 flooding. In this study, we demonstrated the importance of CO2 injection PV to obtain more reasonable residual oil saturation than those derived from usual experiments. Furthermore, relating behaviors were clearly observed as in-situ asphaltene deposition and waxy crude oil production by the prolonged CO2 miscible coreflooding. These observations should provide a useful insight for a robust operation during entire CO2 EOR application through further risk evaluation of not only asphaltene but also paraffin.

The objective of this paper is to overcome the asphaltene risk evaluation usually conducted snapshot basis. We evaluate the temporal change in the asphaltene risks as gas injection proceeds. In reservoirs under gas injection, in-situ fluid component gradually changes by multiple contacting with the injection gas. Those compositional changes affect asphaltene stability and bring difficulty into the risk predictions by asphaltene models. This study aims to reduce the risk uncertainty depending on operational condition changes. Periodical upgrading of asphaltene model is essential for understanding the time-depending changes of asphaltene risks. In the previous study (Yonebayashi et al. 2011), the asphaltene risk was evaluated for an offshore oil field in the Arabian Gulf in 2008 by use of cubic-plus-association equation of state (CPA-EoS) models on the basis of all available date at the time. After the previous study, additional experimental data was accumulated forthe future gas injection plan. Then, the update study was performed by incorporating those newly collected data. Subsequently, both findings in the past and the present were compared with each other. According to the previous study recommendation, additional asphaltene laboratory studies were conducted on the basis of newly collected samples. All Asphaltene On-set Pressure (AOP) detected from the new samples were higher than those of the previous study. Especially, a large difference was observed from the past/present results of the lower reservoir's AOPs even though samples collected from the identical well. Asphaltene precipitation risk was observed to increase largely because the new AOP was detected at the reservoir temperature while no AOPs detected in the previous study. The difference might be occurred by saturation pressure increase. Then, the numerical asphaltene models were revised, and accordingly, the asphaltene risk estimation were updated higher in the lower reservoir. For the upper reservoir, the past/present AOPs were slightly changed to become higher. The reference sample fluids were collected from two different wells showing minor difference of asphaltene contents. Those variations might be caused by geological heterogeneity that could affect on fluid maturity. Then, the risk rating was updated to be slight higher, too. In this paper, through the comparison between the previous and current studies, it was pointed out the importance of regular monitoring asphaltene risks. This study provides the valuable findings of time-lapse evaluation of asphaltene precipitation risks for reservoir under gas injection. The evaluations currently conducted in the industry are snapshots of instantaneous risks. Through entire field life, the risks have varied depending on operating conditions. This study argued the risk-change in the unique field by the identical workflow but using each representative data collected at different times. Finally, this study demonstrated the importance of time-depending fluid dynamics.

This report presents the case of a 6-day-old male with cystic biliary atresia (CBA), and the cyst was detected antenatally. Antenatal ultrasonography suggested the possibility of CBA or a choledochal cyst at 16 weeks' gestation. However, the cyst disappeared during the later gestational period. The cyst was detected again by preoperative imaging. Surgical cholangiography at 30 days of age confirmed CBA, but the common hepatic duct (CHD) was extremely narrow. The histopathological findings revealed the partial obstruction of CHD. These findings suggest that correctable CBA (I cyst) may change into uncorrectable CBA (IIId).

This report describes the case of an ileal perforation secondary to clamping of the exomphalos minor in 3-day-old girl. Eighteen accidental clamping or cutting cases were found in the published work. It is thought that this defect resulted from either the clamping, ligation or cutting of the bowel in a small unrecognized omphalocele. These complications are extremely rare, but should be held in mind when performing an umbilical ligation.

A previous study documented the effects of maternal corticosteroid treatment on structural growth and functional development in fetal lungs associated with pathogenic conditions such as oligohydramnios using immunohistochemical and morphometric analyses. The purpose of the present study was to examine the effect of maternal dexamethasone treatment the expression of lamellar body in type II pneumocytes of the fetal rabbit lungs with hypoplasia induced by oligohydramnios using electron microscopy. Using an amniotic shunting rabbit model, pregnant rabbits were injected intravenously with either 0.1 ml of saline or 0.25 mg/kg/day of dexamethasone in 0.1 ml of saline 48 and 24 h before the delivery of fetuses, at day 30 of gestation. The number of lamellar bodies per type II pneumocyte was counted in each group using electron micrographs. The number of lamellar bodies per type II pneumocyte in the lungs of the shunted group that received saline was consistently and significantly less than that of the other three groups (5.49 +/- 2.07 vs. 7.34 +/- 2.27: shunted group that received dexamethasone, 7.58 +/- 2.08: non-shunted group that received saline, 7.79 +/- 1.90: non-shunted group that received dexamethasone; P < 0.01). These results suggest that maternal dexamethasone treatment accelerates the maturation of the surfactant system, especially the expression of lamellar bodies in type II pneumocytes, even in hypoplastic lungs induced by oligohydramnios.

The Dual-frequency Precipitation Radar (DPR) on the Global Precipitation Measurement (GPM) core satellite was developed by Japan Aerospace Exploration Agency (JAXA) and National Institute of Information and Communications Technology (NICT). The GPM is a follow-on mission of the Tropical Rainfall Measuring Mission (TRMM). The objectives of the GPM mission are to observe global precipitation more frequently and accurately than TRMM. The frequent precipitation measurement about every three hours will be achieved by some constellation satellites with microwave radiometers (MWRs) or microwave sounders (MWSs), which will be developed by various countries. The accurate measurement of precipitation in mid-high latitudes will be achieved by the DPR. The GPM core satellite is a joint product of National Aeronautics and Space Administration (NASA), JAXA and NICT. NASA developed the satellite bus and the GPM Microwave Imager (GMI), and JAXA and NICT developed the DPR. JAXA and NICT developed the DPR through procurement. The contract for DPR was awarded to NEC TOSHIBA Space Systems, Ltd. The configuration of precipitation measurement using active radar and a passive radiometer is similar to TRMM. The major difference is that DPR is used in GPM instead of the precipitation radar (PR) in TRMM. The inclination of the core satellite is 65 degrees, and the flight altitude is about 407 km. The non-sun-synchronous circular orbit is necessary for measuring the diurnal change of rainfall similarly to TRMM. The DPR consists of two radars, which are Ku-band (13.6 GHz) precipitation radar (KuPR) and Ka-band (35.5 GHz) precipitation radar (KaPR). Both KuPR and KaPR have almost the same design as TRMM PR. The DPR system design and performance were verified through the development test and the proto flight test. DPR had handed over to NASA and integration of the DPR to the GPM core spacecraft had completed in May 2012. GPM core spacecraft satellite system test had completed in November 2013. The result of the satellite system test concerning to the DPR satisfied system requirements. GPM core observatory was shipped to Tanegashima Space Center, JAPAN and Launch Site Operations had started on November 2013 and GPM core observatory was launched at 18:37:00 (UT) on February 27, 2014 successfully. DPR orbital check out was completed in May 2014. The orbital check out and the initial calibration and validation operation result of DPR is reported.

Onboard calibration method of the Dual-frequency Precipitation Radar (DPR) installed on the Global Precipitation Measurement (GPM) core observatory, launched in February 2014, is described. The orbital check out status of DPR will be reported.

Snow samples collected over sea ice near Syowa Station were analyzed for ionic constituents to understand sulfate depletion in sea salt aerosol particles, which have often been observed in winter in the coastal region of Antarctica. Ratios of Cl/Na^+ in snow were higher than that in sea water, whereas SO_4^/Na^+ ratios were lower in snow samples. The degree of SO_4^2 depletion relative to the sea water composition increased with increase in Na^+ concentration. From comparison with a simple chemical mass balance model using the SO_4^/Na^+ ratios in the samples, depletion of SO_4^ in snow is considered to be largely attributed to the fractionation of sulfate by forming Mirabilite (Na_2SO_4・10H_2O) during sea ice growth. The Br/Na^+ ratios of the snow predicted from the fractionation model differ significantly from the observed values : positive deviations were found in dark early July and negative deviations were seen in September. This could have resulted from Br_2 release from the snow after local sunrise. In winter aerosols collected at Syowa Station, depletion of SO_4^ was also found. Based on statistics of meteorological data at Syowa Station, as appropriate conditions of meteorological and salt concentrations in drifting snow particle were fulfilled, the depletion of SO_4^2 in aerosol particles in winter can be explained by sublimation of salted drifting snow particles from the sea ice area.

The Dual-frequency Precipitation Radar (DPR) on the Global Precipitation Measurement (GPM) core observatory is developed by Japan Aerospace Exploration Agency (JAXA) and National Institute of Information and Communications Technology (NICT). GPM objective is to observe global precipitation more frequently and accurately. GPM contributes to climate and water cycle change studies, flood prediction and numerical weather forecast. GPM consists of GPM core observatory and constellation satellites carrying microwave radiometers (MWRs) and/or sounders (MWSs). The frequent measurement will be achieved by constellation satellites, and the accurate measurement will be achieved by DPR with high sensitivity and dual frequency capability. GPM core observatory is jointly developed by National Aeronautics and Space Administration (NASA) and JAXA. NASA is developing the satellite bus and GPM microwave radiometer (GMI), and JAXA is developing DPR. GPM algorithms for data processing are developed jointly. The DPR consists of Ku-band (13.6 GHz) radar suitable for heavy rainfall in the tropical region, and Ka-band (35.55 GHz) radar suitable for light rainfall in higher latitude region. Drop size distribution information will be derived which contributes to the improvement of rainfall estimate accuracy. DPR will also play a key role to improve rainfall estimation accuracy of constellation satellites. DPR proto-flight test at JAXA Tsukuba space center is finished and it is delivered to NASA for integration to the GPM observatory. In this paper, DPR PFT test result at Tsukuba space center, DPR status in the GPM observatory environmental test, and DPR on-orbit calibration plan will be presented.

The Dual-frequency Precipitation Radar (DPR) on the Global Precipitation Measurement (GPM) core spacecraft is being developed by Japan Aerospace Exploration Agency (JAXA) and National Institute of Information and Communications Technology (NICT). The GPM is a follow-on mission of the Tropical Rainfall Measuring Mission (TRMM). The objectives of the GPM mission are to observe global precipitation more frequently and accurately than TRMM. The frequent precipitation measurement about every three hours will be achieved by some constellation satellites with microwave radiometers (MWRs) or microwave sounders (MWSs), which will be developed by various countries. The accurate measurement of precipitation in mid-high latitudes will be achieved by the DPR. The GPM core satellite is a joint product of National Aeronautics and Space Administration (NASA), JAXA and NICT. NASA is developing the satellite bus and the GPM microwave radiometer (GMI), and JAXA and NICT are developing the DPR. JAXA and NICT are developing the DPR through procurement. The contractor for DPR is NEC TOSHIBA Space Systems, Ltd. The configuration of precipitation measurement using an active radar and a passive radiometer is similar to TRMM. The major difference is that DPR is used in GPM instead of the precipitation radar (PR) in TRMM. The inclination of the core spacecraft is 65 degrees, and the flight altitude is about 407 km. The non-sun-synchronous circular orbit is necessary for measuring the diurnal change of rainfall similarly to TRMM. The DPR consists of two radars, which are Ku-band (13.6 GHz) precipitation radar (KuPR) and Ka-band (35.55 GHz) precipitation radar (KaPR). According to the different detectable dynamic ranges, The KaPR will detect snow and light rain, and the KuPR will detect heavy rain. In an effective dynamic range in both KuPR and KaPR, drop size distribution information and more accurate rainfall estimates will be provided by a dual-frequency algorithm. The proto-flight test for DPR have finished in February 2012 and DPR integration on GPM core spacecraft was successfully completed in May 2012. The status of proto-flight model of DPR will be presented.

Objective Wound dehiscence caused by surgical site infection (SSI) presents a complicated problem. Negative pressure wound therapy (NPWT) was developed to treat wound dehiscence. Nutritional treatment using arginine has also been recently shown to be effective for the treatment of pressure ulcers. Therefore, wound complications due to SSI were treated using NPWT combined with nutritional therapy with an arginine-rich supplement (ARS). Methods Six pediatric patients with wound dehiscence due to SSI received this combined therapy. Results The average age of the patients was 12.2 mo. The operations that these patients underwent included laryngotracheal separation, radical operation for spinal bifida, gastrostomy, colostomy, anorectoplasty, and tumor extirpation. A local wound infection induced wound dehiscence in all patients. Therefore, NPWT was introduced with an enteral administration of ARS. All wounds completely healed within 1 mo after the introduction of this combined therapy without any other complications from the NPWT or ARS. A follow-up study at 6 mo after this therapy was completed showed no complications associated with the wounds. Conclusion This combination therapy using NPWT and ARS administration was effective in inducing early healing of infected wound complications after surgery.

Aim: The present study was carried out using electron microscopy to evaluate the expression of lamellar bodies in type II pneumocytes of fetal rabbit lungs with hypoplasia induced by oligohydramnios. Methods: Using an amniotic shunting rabbit model, the lungs obtained from 32 fetuses, including 16 experimental fetuses (shunting group) and 16 control fetuses (control group), were used for electron microscopic studies. At least 250 type II pneumocytes per fetus were photographed. The number of lamellar bodies per type II pneumocyte was counted. Results: The number of lamellar bodies per type II pneumocyte of the shunting group was consistently and significantly less than that of the control group (5.49 ± 2.07 vs 7.58 ± 2.08; P