Search

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

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

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

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

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

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

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

Adenosquamous carcinoma (ASC) is a rare histological type of esophageal carcinoma. Esophagogastroduodenoscopy for the health checkup of a 71-year-old male revealed the presence of a slightly elevated lesion like a submucosal tumor at the lower part of the esophagus. The center of it was slightly depressed, and the depressed area was not stained by iodine. Magnifying endoscopy with narrow-band imaging revealed reticular pattern vessels in the depressed area, whereas no irregularity of the microvascular pattern of the surrounding area was evident. One of the biopsied specimens taken from the depressed area was diagnosed as squamous intraepithelial neoplasia, but a malignant tumor with submucosal invasion was suspected based on the findings of endoscopic ultrasonography. Endoscopic mucosal resection using a cap-fitted endoscope was performed, and the lesion was diagnosed as esophageal ASC histologically. Carcinomas that formed nested and ductal structures existed in the lamina propria and invaded to the submucosa. Almost all of them were covered by non-invasive intraepithelial neoplasia, whereas small erosion was seen in the central depressed area. The growing pattern of ASC was quite different from that of typical differentiated squamous cell carcinomas. When we do endoscopic examination for an esophageal lesion like submucosal tumor, we have to consider the possibility of an esophageal carcinoma that has a similar growing pattern. If reticular pattern vessels are seen with magnifying endoscopy, the existence of an invasive carcinoma is suspected, and additional endoscopic ultrasonography is recommended. Possible efforts to gain histological findings have to be made using bowling biopsy, endoscopic resection, and so on.

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

The effect of plasticizer content on the vibration absorbing properties for polyurethane elastomers was investigated. A natural frequency appeared on the frequency spectra at around 100 Hz. The natural frequency linearly decreased, and the transmissibility also decreased with the plasticizer content. Magnetic elastomers containing carbonyl iron particles with a dimeter of 7.0 mm also showed a natural frequency at ~260 Hz, and the natural frequency significantly decreased with the plasticizer content. The decrease in the transmissibility with the plasticizer content was larger than that for polyurethane elastomers. The natural frequency for magnetic elastomers increased by several ten Hz by a magnetic field of 60 mT although the transmissibility was independently of the plasticizer content. The effect of load on the natural frequency for these elastomers was also investigated, and it was found that the natural frequency is proportional to the storage modulus, G, with different two slopes depending on the mass of the system, m. The linear relation between the natural frequency and (G’/m)1/2 revealed that the observed vibration can be basically described by a simple harmonic oscillation.

Helicobacter pylori infection is the major cause for mucosa-associated lymphoid tissue (MALT) lymphoma and gastric cancers. On the other hand, gastric cancers are known to arise from gastric mucosal atrophy. We here report a case of signet ring cell gastric cancer that developed after radiation therapy for MALT lymphoma in H. pylori-uninfected patient whose stomach did not show gastric mucosal atrophy. A 58-year-old female was referred to our hospital for treatment of gastric MALT lymphoma. This patient was not infected with H. pylori, and upper gastrointestinal endoscopy revealed that she did not have gastric mucosal atrophy but had submucosal tumor-like MALT lymphoma lesion in the anterior wall of the upper gastric body. Since conventional eradication therapy was ineffective, her whole stomach was irradiated as a second-line therapy. The MALT lymphoma lesion turned into complete remission state after the therapy. The patient was followed every 6 months by upper gastrointestinal endoscopy for 4 years as complete remission until a newly developed decolorized depressed lesion was detected in the greater curvature of the proximal antrum, a completely different location from the MALT lymphoma lesion. A biopsy specimen from the lesion contained signet ring cell carcinoma, and she was successfully treated by endoscopic submucosal dissection. No signs of recurrence have been detected so far. The radiation therapy for MALT lymphoma might be associated with the occurrence of this signet ring cell gastric cancer, and since MALT lymphoma is indolent in nature, this case suggests that careful consideration is required when choosing the second-line therapy for MALT lymphoma patients.

The effect of a weak magnetic field on vibration transmissibility was investigated for magnetic elastomers with various volume fractions of magnetic particles. Polyurethane elastomers without magnetic particles exhibited a natural frequency at 53 Hz and were insensitive to a magnetic field of 60 mT. The natural frequency for magnetic elastomers with a volume fraction of 0.23 was 115 Hz at 0 mT, and increased to 134 Hz at 60 mT. The vibration transmissibility was independent of the magnetic field. A linear relation between the natural frequency and (G/m)1/2 was observed (G: storage modulus, m: mass), indicating that the observed vibration is basically described by a simple harmonic oscillation.

The long non-coding RNA HOTAIR has been reported to be a poor prognostic biomarker in a variety of malignant tumors. However, little is known about the association of HOTAIR with gastric cancer. We examined the expression of HOTAIR in 68 gastric cancer samples using quantitative real-time RT-PCR and analyzed its correlation with the clinical parameters. The functional role of HOTAIR was examined by generating human gastric cancer cell lines with increased or suppressed HOTAIR expression. The anchorage -independent growth was assessed by soft agar assay. The increased or suppressed HOTAIR expressing gastric cancer cells were injected into the tail vein or peritoneal cavity of immunodeficient mice to examine the effect of this molecule on metastasis and peritoneal dissemination. The expression of HOTAIR was significantly higher in cancer lesions than in adjacent non-cancerous tissues in human gastric cancers. In the diffuse type of gastric cancer, the High-HOTAIR group (HOTAIR/GAPDH > 1) showed significantly more venous invasion, frequent lymph node metastases and a lower overall survival rate compared to the Low-HOTAIR group (HOTAIR/GAPDH < 1). Colony formation on the soft agar was enhanced in a HOTAIR-dependent manner. HOTAIR-expressing MKN74 formed more liver metastasis compared to control when they were injected into the tail vein of mice. In addition, reduced expression of HOTAIR in KATO III suppressed peritoneal dissemination. These results suggest that HOTAIR plays a pivotal role in the development of gastric cancer.