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Abstract Background Intensive care unit‐acquired weakness (ICU‐AW) is a syndrome characterized by a long‐term muscle weakness often observed in sepsis‐surviving patients during the chronic phase. Although ICU‐AW is independently associated with increased mortality, effective therapies have yet to be established. Programmed death‐1 (PD‐1) inhibitors have attracted attention as potential treatments for reversing immune exhaustion in sepsis; however, its impact on ICU‐AW remains to be elucidated. Here, we study how PD‐1 deficiency affects sepsis‐induced skeletal muscle dysfunction in a preclinical sepsis model. Methods Chronic sepsis model was developed by treating wild‐type (WT) and PD‐1 knockout (KO) mice with caecal slurry, followed by resuscitation with antibiotics and saline. Mice were euthanized on days 15–17. Body weights, muscle weights, and limb muscle strengths were measured. Interleukin 13 (IL‐13) and PD‐1 expressions were examined by flow cytometry. Messenger RNA (mRNA) expressions of slow‐twitch muscles were measured by reverse transcription and quantitative polymerase chain reaction (RT‐qPCR). In an in vitro study, C2C12 myotubes were treated with lipopolysaccharide (LPS) and recombinant IL‐13 followed by gene expression measurements. Results WT septic mice exhibited decreased muscle weight (quadriceps, P

Background: Recent randomized control trials (JCOG0802 and CALGB140503) have shown sublobar resection to be noninferior to lobectomy for non–small cell lung cancer (NSCLC) ≤2.0 cm. We have previously proposed histologic criteria stratifying lung adenocarcinoma into indolent low malignant potential (LMP) and aggressive angioinvasive adenocarcinomas, resulting in better prognostication than provided by World Health Organization grade. Here we determine whether pathologic classification is reproducible and whether subsets of adenocarcinomas predict worse outcomes when treated by wedge resection compared to lobectomy. Methods: A retrospective cohort of 108 recipients of wedge resection and 187 recipients of lobectomy for stage I/0 lung adenocarcinomas ≤2.0 cm was assembled from 2 institutions. All tumors were classified by a single pathologist, and interobserver reproducibility was assessed in a subset (n = 92) by 5 pathologists. Results: Angioinvasive adenocarcinoma (21%-27% of cases) was associated with worse outcomes when treated with wedge resection compared to lobectomy (5-year recurrence-free survival, 57% vs 85% [P = .007]; 5-year disease-free survival [DSS], 70% vs 90% [P = .043]; 7-year overall survival, 37% vs 58% [P = .143]). Adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and LMP exhibited 100% 5-year DSS regardless of the surgical approach. Multivariable analysis showed that angioinvasion, tumor size, margin status, and extent of nodal sampling were significantly associated with recurrence but not with surgical procedure. There was substantial interobserver reproducibility among the pathologists for the diagnosis of angioinvasive adenocarcinoma (κ = 0.71) and the combined indolent AIS/MIA/LMP group (κ = 0.74). Conclusions: The majority (∼75%) of lung adenocarcinomas ≤2 cm are adequately managed with wedge resection; however, angioinvasive adenocarcinomas (∼25%) treated by wedge resection with suboptimal nodal sampling exhibit poor outcomes, with a 40% to 45% rate of recurrence within 5 years and 60% to 65% overall mortality at 7 years.

Abstract Background Severe hypocalcemia may lead to life-threatening arrhythmias. Denosumab is an effective treatment for osteoporosis that allows long intervals between doses. However, there is a risk of hypocalcemia in some patients. Due to the long half-life of denosumab, emergency physicians caring for patients presenting with symptoms of hypocalcemia may not be aware of the medication, and adverse effects may last longer. Case presentation A 55-year-old woman with a history of systemic lupus erythematosus (SLE) and anxiety disorder called for an ambulance for symptoms of hyperventilation and muscle cramps. After evaluation at the local hospital, she developed pulseless ventricular tachycardia and was resuscitated by defibrillation by the hospital staff. After conversion to sinus rhythm, she was transported to a tertiary center. Upon arrival, pulseless ventricular tachycardia occurred again, and veno-arterial extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) were implemented. Laboratory results showed severe hypocalcemia (corrected calcium level of 5.3 mg/dL) whereupon intravenous calcium supplementation was started. She had received the first dose of denosumab (60 mg) by subcutaneous injection 24 days prior to hospitalization. She was eventually weaned from ECMO and IABP support. Conclusion Cardiac arrest due to hypocalcemia is relatively rare but can be fatal. In the present case, hyperventilation may have acutely exacerbated pre-existing hypocalcemia, leading to ventricular tachycardia. The patient had a slightly decreased serum calcium level prior to denosumab. Close monitoring may be preferable after the primary dose of denosumab in selected patients. Emergency physicians caring for patients who may be suffering from symptoms/signs of hypocalcemia must be mindful of medications that have long half-lives and affect electrolyte balance when treating fatal arrhythmia due to hypocalcemia.

Abstract Heatstroke is a life-threatening event that affects people worldwide. Currently, there are no established tools to predict the outcomes of heatstroke. Although the Sequential Organ Failure Assessment (SOFA) score is a promising tool for judging the severity of critically ill patients. Therefore, in this study, we investigated whether the SOFA score could predict the outcome of patients hospitalized with severe heatstroke, including the classical and exertional types, by using data from a Japanese nationwide multicenter observational registry. We performed retrospective subanalyses of the Japanese Association for Acute Medicine heatstroke registry, 2019. Adults with a SOFA score ≥ 1 hospitalized for heatstroke were analyzed. We analyzed data for 225 patients. Univariate and multivariable analyses showed a significant difference in the SOFA score between non-survivors and survivors in classical and exertional heatstroke cases. The area under the receiver operating characteristic curve were 0.863 (classical) and 0.979 (exertional). The sensitivity and specificity of SOFA scores were 50.0% and 97.5% (classical), 66.7% and 97.5% (exertional), respectively, at a cutoff of 12.5, and 35.0% and 98.8% (classical), 33.3% and 100.0% (exertional), respectively, at a cutoff of 13.5. This study revealed that the SOFA score may predict mortality in patients with heatstroke and might be useful for assessing prognosis.

The Casimir effect is a quantum phenomenon induced by the zero-point energy of relativistic fields confined in a finite-size system. This effect for photon fields has been studied for a long time, while the realization of counterparts for fermion fields in Dirac/Weyl semimetals is an open question. We theoretically demonstrate the typical properties of the Casimir effect for relativistic electron fields in Dirac/Weyl semimetals and show the results from an effective Hamiltonian for realistic materials such as Cd3As2 and Na3Bi. We find an oscillation of the Casimir energy as a function of the thickness of the thin film, which stems from the existence of Dirac/Weyl nodes in momentum space. Experimentally, such an effect can be observed in thin films of semimetals, where the thickness dependence of thermodynamic quantities is affected by the Casimir energy.

The Casimir effect is a fundamental quantum phenomenon induced by the zero-point energy for a quantum field. It is well known for relativistic fields with a linear dispersion relation, while its existence or absence for nonrelativistic fields with a quadratic dispersion is an unsettled question. Here, we investigate the Casimir effects for various dispersion relations on the lattice. We find that Casimir effects for dispersions proportional to an even power of momentum are absent in a long distance but a remnant of the Casimir effect survives in a short distance. Such a remnant Casimir effect will be experimentally observed in materials with quantum fields on the lattice, such as thin films, narrow nanoribbons, and short nanowires. In terms of this effect, we also give a reinterpretation of the Casimir effect for massive fields.

Summary: Background: Inhaled molecular hydrogen gas (H2) has been shown to improve outcomes in animal models of cardiac arrest (CA). H2 inhalation is safe and feasible in patients after CA. We investigated whether inhaled H2 would improve outcomes after out-of-hospital CA (OHCA). Methods: HYBRID II is a prospective, multicentre, randomised, double-blind, placebo-controlled trial performed at 15 hospitals in Japan, between February 1, 2017, and September 30, 2021. Patients aged 20–80 years with coma following cardiogenic OHCA were randomly assigned (1:1) using blinded gas cylinders to receive supplementary oxygen with 2% H2 or oxygen (control) for 18 h. The primary outcome was the proportion of patients with a 90-day Cerebral Performance Category (CPC) of 1 or 2 assessed in a full-analysis set. Secondary outcomes included the 90-day score on a modified Rankin scale (mRS) and survival. HYBRID II was registered with the University Hospital Medical Information Network (registration number: UMIN000019820) and re-registered with the Japan Registry for Clinical Trials (registration number: jRCTs031180352). Findings: The trial was terminated prematurely because of the restrictions imposed on enrolment during the COVID-19 pandemic. Between February 1, 2017, and September 30, 2021, 429 patients were screened for eligibility, of whom 73 were randomly assigned to H2 (n = 39) or control (n = 34) groups. The primary outcome, i.e., a CPC of 1 or 2 at 90 days, was achieved in 22 (56%) and 13 (39%) patients in the H2 and control groups (relative risk compared with the control group, 0.72; 95% CI, 0.46–1.13; P = 0.15), respectively. Regarding the secondary outcomes, median mRS was 1 (IQR: 0–5) and 5 (1–6) in the H2 and control groups, respectively (P = 0.01). An mRS score of 0 was achieved in 18 (46%) and 7 (21%) patients in the H2 and control groups, respectively (P = 0.03). The 90-day survival rate was 85% (33/39) and 61% (20/33) in the H2 and control groups, respectively (P = 0.02). Interpretation: The increase in participants with good neurological outcomes following post-OHCA H2 inhalation in a selected population of patients was not statistically significant. However, the secondary outcomes suggest that H2 inhalation may increase 90-day survival without neurological deficits. Funding: Taiyo Nippon Sanso Corporation. Translation: For the Japanese translation of the abstract see Supplementary Materials section.

Abstract Background Nutcracker syndrome (NCS) is characterized by compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. While rare, NCS was reported to be accompanied by double inferior vena cava (IVC). We herein report a case of Noonan syndrome (NS) with double IVC who presented with macrohematuria and proteinuria. Case presentation The patient was a 23-year-old man, who had been diagnosed with NS due to RIT1 mutation, after showing foamy macrohematuria 3 weeks previously. A physical examination revealed low-set ears and a webbed neck. A urinalysis showed hematuria and proteinuria, and urinary sediments showed more than 100 isomorphic red blood cells per high-power field. His proteinuria and albuminuria concentrations were 7.1 and 4.5 g/g⋅Cr, respectively. Three-dimensional contrast-enhanced computed tomography (CT) showed double IVC and narrowing of the LRV after interflow of the left IVC. The aortomesenteric angle on a sagittal reconstruction of the CT image was 14.7°. Cystoscopy revealed a flow of macrohematuria from the left ureteral opening. On Doppler ultrasonography, there was scant evidence to raise the suspicion of the nutcracker phenomenon. Since severe albuminuria continued, a left kidney biopsy was performed. Light microscopy showed red blood cells in Bowman’s space and the tubular lumen. Electron microscopy revealed disruption of the glomerular basement membrane (GBM). Vulnerability of the GBM was suspected and a genetic analysis revealed a heterozygous mutation at c.4793 T > G (p.L1598R) in the COL4A3 gene. Screening for coagulation disorders revealed the factor VIII and von Willebrand factor (vWF) values were low, at 47.6 and 23%, respectively. A multimer analysis of vWF showed a normal multimer pattern and he was diagnosed with von Willebrand disease type 1. As the bleeding tendency was mild, replacement of factor VIII was not performed. His macrohematuria and proteinuria improved gradually without treatment, and his urinalysis results have been normal for more than 6 months. Conclusions The present case showed macrohematuria and proteinuria due to NCS in NS with double IVC and von Willebrand disease type 1. The macrohematuria and proteinuria originated from glomerular hemorrhage because of vulnerability of the GBM due to COL4A3 mutation.

Abstract Background Disseminated intravascular coagulation (DIC) is not a homogeneous condition, but rather includes heterogeneous conditions, and its pathophysiology and outcome vary considerably depending on the background. Although anticoagulant therapy is expected to be of benefit in the treatment of DIC, previous studies have suggested that the benefits are limited only to a specific subtype. Objects The purpose of this study was to identify the group that would benefit from combination therapy using thrombomodulin/antithrombin. Methods The data from 2,839 patients registered in the postmarketing surveillance of thrombomodulin were evaluated. The patients were divided into four groups depending on antithrombin and fibrinogen levels, and the additive effects of antithrombin on thrombomodulin were examined in the groups. Results The DIC score, Sequential Organ Failure Assessment score, and mortality were significantly higher in the DIC group with low-antithrombin/low-fibrinogen than in the DIC groups without either low antithrombin or low fibrinogen. The survival curve was significantly higher in DIC patients with combination therapy than in patients treated with thrombomodulin monotherapy, but this effect was seen only in patients with infection-based DIC. Conclusion DIC patients with low-antithrombin/low-fibrinogen risk poor outcomes, but they can be the target of combination therapy with antithrombin and thrombomodulin as long as the DIC is due to infection.

Abstract Background In patients with infectious diseases, disseminated intravascular coagulation (DIC) is often diagnosed without the fibrinogen value. The relationship between hypofibrinogenemia and outcomes of DIC in infectious diseases has thus remained unclear. Methods We analyzed 3204 patients who received with thrombomodulin alfa (TM-α) for DIC and suspected DIC. Hypofibrinogenemia was defined by a fibrinogen level

Abstract Background Although disseminated intravascular coagulation (DIC) is life-threatening, any organ failure associated with DIC resolution and outcomes have been unclear. Patients and methods A total of 2795 DIC patients (infection: 1990, hematological malignancy: 805) were analyzed in the post-marketing surveillance of thrombomodulin alpha (TM-α). The background factors of sequential organ failure assessment (SOFA) and antithrombin (AT) were investigated in DIC with infectious disease for their association with DIC resolution and outcome using κ statistics, indicating DIC resolution and survival or DIC non-resolution and non-survival. The same analyses were performed for total bilirubin, creatinine, lactate dehydrogenase, and underlying disease in DIC with hematological malignancy. Results In DIC with infectious disease, higher SOFA score severity was closely correlated with lower overall survival in both the DIC resolution and non-resolution groups, but AT activity was not. κ coefficients were 0.234, 0.295, and 0.311 for the SOFA score 0–6, 7–12, and 13–24 groups, respectively. In DIC with hematological malignancy, κ coefficients of total bilirubin were 0.251 and 0.434, and those of creatinine were 0.283 and 0.437 in the normal and abnormal groups, respectively, showing better concordance in the abnormal group than in the normal. Other factors had poor concordance. Conclusion In DIC with infectious disease, DIC resolution is an important therapeutic target in patients who have higher SOFA score severity. In DIC with hematological malignancy, DIC resolution is similarly important in patients with abnormality of bilirubin and/or creatinine. Trial registration The clinical characteristics and treatment outcomes of patients with DIC treated with TM-α between May 2008 and April 2010 were retrospectively analyzed by subgroup analysis of the post-marketing surveillance data.

We investigate time evolution of S-wave charmonium populations under a time-dependent homogeneous magnetic field and evaluate survival probabilities of the low-lying charmonia to the goal of estimating the magnetic field strength at heavy-ion collisions. Our approach implements mixing between different spin eigenstates and transitions to radially excited states. We show that the survival probabilities can change even by an extremely short magnetic field. Furthermore, we find that the survival probabilities depend on the initial spin states. We propose the sum of the survival probabilities over spin partners as an observable insensitive to the initial states. We also find that the sum can be approximately given as a function of σB02 with a duration time σ and the maximum strength of the magnetic field B0.

Abstract Background The usefulness of the activated partial thromboplastin time (APTT) waveform has been reported in hemophilia, acquired hemophilia and monitoring for anticoagulants. Material and methods The APTT waveform was examined in patients suspected of having disseminated intravascular coagulation (DIC) to analyze its usefulness for the diagnosis of DIC or the prediction of the outcome or bleeding risk. Results DIC with fibrinogen

We find a novel phenomenon induced by the interplay between a strong magnetic field and finite orbital angular momenta in hadronic systems, which is analogous to the Paschen–Back effect observed in the field of atomic physics. This effect allows the wave functions to drastically deform. We discuss anisotropic decay from the deformation as a possibility to measure the strength of the magnetic field in high-energy heavy-ion collisions, which has not been measured experimentally. As an example we investigate charmonia with a finite orbital angular momentum in a strong magnetic field. We calculate the mass spectra and mixing ratios. To obtain anisotropic wave functions, we apply the cylindrical Gaussian expansion method. There we use different extension parameters for the parallel and transverse directions to the magnetic field.

Introduction: Systemic treatment with chemotherapy is warranted for patients with extensive-stage SCLC (ES-SCLC). The objective of this study was to determine whether racial and other healthcare disparities exist in receipt of chemotherapy for ES-SCLC. Methods: Utilizing the National Cancer Database, 148,961 patients diagnosed to have stage IV SCLC from 2004 to 2016 were identified. Adjusted ORs with 95% confidence intervals (95% CIs) were computed for receipt of chemotherapy using multivariate logistic regression modeling. Cox regression modeling was used to perform overall survival analysis, and adjusted hazard ratios were calculated. Results: A total of 82,592 patients were included, among which chemotherapy was not administered to 6557 (7.9%). Higher education, recent year of diagnosis, and treatment at more than one facility were associated with increased odds of receiving chemotherapy. Factors associated with a decreased likelihood of receiving chemotherapy were increasing age, race, nonprivate insurance, and comorbidities. On multivariate analysis, black patients had lower odds of receiving chemotherapy compared with white patients (adjusted OR, 0.85; 95% CI: 0.77–0.93, p = 0.0004). Furthermore, black patients had better survival compared with white patients (adjusted hazard ratio, 0.91; 95% CI: 0.89–0.94, p = 0.91). The 1-year survival (median survival) for black and white patients was 31.7% (8.3 mo) and 28.6% (8 mo), respectively. Conclusions: Black patients with ES-SCLC were less likely to receive chemotherapy, as were elderly, uninsured, and those with nonprivate insurance. Further studies are required to address underlying reasons for lack of chemotherapy receipt in black patients with ES-SCLC and guide appropriate interventions to mitigate disparities.

Aim Prothrombin complex concentrate (PCC) was recently approved for patients on warfarin therapy with international normalized ratios (INRs) exceeding 2 in Japan. However, rapid normalization of INR is necessary even in patients who do not meet the aforementioned criteria. We previously found that a fixed PCC dose of 500 IU is insufficient in some patients with INR elevation but is effective in patients with INR less than 2.5. On the basis of the results, we revised the protocol to administer a PCC dose of 500 IU to patients with INR less than 2.5 or 1,000 IU to patients with higher INRs. This study aimed to validate this revised protocol at an emergency department (ED) in Japan. Methods We retrospectively collected data for all patients who received PCC in accordance with the revised protocol at our ED between October 2014 and December 2017 (period B) and compared the findings with those in the previous period (January 2013 to September 2014, period A). Results In total, 15 and 11 patients received PCC without complications during periods A and B, respectively. All but one patient obeyed the protocol during period B. The average INRs at baseline and within 120 min after PCC infusion were 2.58 and 1.39, respectively, in period A (n = 9), versus 2.54 and 1.28, respectively, in period B (n = 8). Significantly more patients exhibited optimal responses (INR

We propose a definition of the Casimir energy for free lattice fermions. From this definition, we study the Casimir effects for the massless or massive naive fermion, Wilson fermion, and (Möbius) domain-wall fermion in 1+1 dimensional spacetime with the spatial periodic or antiperiodic boundary condition. For the naive fermion, we find an oscillatory behavior of the Casimir energy, which is caused by the difference between odd and even lattice sizes. For the Wilson fermion, in the small lattice size of N≥3, the Casimir energy agrees very well with that of the continuum theory, which suggests that we can control the discretization artifacts for the Casimir effect measured in lattice simulations. We also investigate the dependence on the parameters tunable in Möbius domain-wall fermions. Our findings will be observed both in condensed matter systems and in lattice simulations with a small size.

The frequency of severe antithrombin deficiency (SAD) was examined in the hematopoietic disorder-, infectious-, and basic-types of the disseminated intravascular coagulation (DIC). A posthoc analysis of 3008 DIC patients (infectious-type, 1794; hematological disorder-type, 813; and basic-type, 401) from post-marketing surveillance data of thrombomodulin alfa was performed. The clinical features of patients and outcomes were compared between patients with and without SAD, using an antithrombin cutoff value of 50%. Patients with SAD accounted for 40.4% of infectious-type DIC, 8.0% of hematopoietic disorder-type DIC, and 26.7% of basic-type DIC. There was no significant difference in thrombin–antithrombin complex levels between patients with and without SAD. The decreased fibrinogen level and differences in clinical features were significantly greater but the increases in fibrinolytic markers were significantly lower in patients with SAD than in those without. The 28-day survival rate was significantly lower in patients with SAD than in those without. Severe antithrombin deficiency was observed in all types of DIC, including hematopoietic disorders. Both hypofibrinolysis and hypercoagulability in patients with SAD may cause multiple organ failure and poor outcomes.

New-onset refractory status epilepticus (NORSE) is a rare neurological emergency condition with poor prognosis. A 30-year-old male suddenly had tonic-clonic convulsions seven days after a preceding fever and diarrhea. MRI showed a reversible splenial lesion, and he developed refractory multifocal and generalized seizures in spite of anticonvulsant medication. He was diagnosed with NORSE and received a combination treatment with immunotherapy and targeted temperature management (TTM), which effectively decreased his seizures. This case suggests that even for patients with reversible splenial lesions, NORSE should be considered, and that treatment with immunotherapy and TTM may be effective. Keywords: Status epilepticus, Immunotherapy, Targeted temperature management, Acute encephalopathy, Acute encephalitis

From the perspective of universal design, signs should be easy to understand for all users. In Japan, tourist information signs have become increasingly multilingual in recent years as the number of tourists from other countries has increased. However, it is not clear whether the current signs are comprehensible to both Japanese and non-Japanese speakers. In this study, field and questionnaire surveys on signs were conducted in Matsue City, a regional city in Japan, and the evaluations of Japanese and non-Japanese speakers were compared. In the field survey, a caption evaluation method was used to evaluate the visual environment, and in the questionnaire survey, the SD method was used to evaluate the signs obtained in the field survey. The results indicated that non-Japanese speakers were more likely to focus on signs, and signs with diagrams and maps were evaluated more positively. In addition, the evaluation structure of signs was found to consist of four elements: “Harmonicity”, “Clarity”, “Visibility”, and “Comprehensibility”. “Harmonicity” was indicated to be as important as “Clarity” and “Visibility”. These results suggest that the replacement of text with diagrams on signs contributes to the improvement of impressions and is particularly effective for non-Japanese speakers.

Abstract Introduction Both disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) cause microvascular thrombosis associated with thrombocytopenia, bleeding tendency and organ failure. Reports and discussion The frequency of DIC is higher than that of thrombotic thrombocytopenic purpura (TTP). Many patients with TMA are diagnosed with DIC, but only about 15% of DIC patients are diagnosed with TMA. Hyperfibrinolysis is observed in most patients with DIC, and microangiopathic hemolytic anemia is observed in most patients with TMA. Markedly decreased ADAMTS13 activity, the presence of Shiga-toxin-producing Escherichia coli (STEC) and abnormality of the complement system are useful for the diagnosis of TTP, STEC-hemolytic uremic syndrome (HUS)and atypical HUS, respectively. However, there are no specific biomarkers for the diagnosis of DIC. Conclusion Although DIC and TMA are similar appearances, all coagulation, fibrinolysis and platelet systems are activated in DIC, and only platelets are markedly activated in TMA.

Charmonium spectral functions in vector and pseudoscalar channels at finite temperature are investigated through the complex Borel sum rules and the maximum entropy method. Our approach enables us to extract the peaks corresponding to the excited charmonia, ψ′ and ηc′, as well as those of the ground states, J/ψ and ηc, which has never been achieved in usual QCD sum rule analyses. We show the spectral functions in vacuum and their thermal modification around the critical temperature, which leads to the almost simultaneous melting (or peak disappearance) of the ground and excited states.

The Casimir effect arises from the zero-point energy of particles in momentum space deformed by the existence of two parallel plates. For degrees of freedom on the lattice, its energy-momentum dispersion is determined so as to keep a periodicity within the Brillouin zone, so that its Casimir effect is modified. We study the properties of Casimir effect for lattice fermions, such as the naive fermion, Wilson fermion, and overlap fermion based on the Möbius domain-wall fermion formulation, in the 1+1-, 2+1-, and 3+1-dimensional space-time with the periodic or antiperiodic boundary condition. An oscillatory behavior of Casimir energy between odd and even lattice size is induced by the contribution of ultraviolet-momentum (doubler) modes, which realizes in the naive fermion, Wilson fermion in a negative mass, and overlap fermions with a large domain-wall height. Our findings can be experimentally observed in condensed matter systems such as topological insulators and also numerically measured in lattice simulations.

The presence of vomit, blood, or other foreign liquid materials in the upper airway is a major obstacle in difficult tracheal intubations (TIs) especially in prehospital care. However, the usefulness of video laryngoscopes (VLs) in these situations has not been investigated. The objective of this study was to compare the Airway Scope (AWS) and the Macintosh laryngoscope (ML) for their performance in TIs performed by emergency medical technicians (EMTs) using mannequin models with liquids in the airway. Rice gruel and mock blood were used to fill the upper airways of mannequins to create mock vomit and hematemesis models, respectively. TIs were performed by certified EMTs after visualizing the glottis using an AWS with an 18-Fr suction catheter and a ML with an 18-Fr suction catheter. TIs with AWS and ML were performed in random order in a comparative crossover trial. The TI success rate was evaluated based on the following: (a) the time taken from laryngoscope insertion into the oral cavity to glottis visualization, tracheal tube passage through the glottis, until the initiation of ventilation and (b) the subjective level of difficulty, which was assessed using a visual analog scale (VAS). TIs in vomiting and hematemesis scenarios were performed by 25 and 26 EMTs, respectively. The TI success rates for these scenarios were 100% with both AWS and ML. The median time required until successful ventilation was significantly shorter with AWS than with ML in both the vomiting (42 vs. 58 s) and hematemesis models (33 vs. 39 s), respectively. In the hematemesis scenarios, difficulty assessed using a VAS was lower with AWS than with ML (13 vs. 38 in median), respectively. Compared to the ML, the AWS was capable of faster and easier TIs, in a simulated model of liquid foreign material in the upper airway.

Spins of relativistic fermions are related to their orbital degrees of freedom. In order to quantify the effect of hybridization between relativistic and nonrelativistic degrees of freedom on spin-orbit coupling, we focus on the spin-orbital (SO) crossed susceptibility arising from spin-orbit coupling. The SO crossed susceptibility is defined as the response function of their spin polarization to the “orbital” magnetic field, namely, the effect of magnetic field on the orbital motion of particles as the vector potential. Once relativistic and nonrelativistic fermions are hybridized, their SO crossed susceptibility gets modified at the Fermi energy around the band hybridization point, leading to spin polarization of nonrelativistic fermions as well. These effects are enhanced under a dynamical magnetic field that violates thermal equilibrium, arising from the interband process permitted by the band hybridization. Its experimental realization is discussed for Dirac electrons in solids with slight breaking of crystalline symmetry or doping, and also for quark matter including dilute heavy quarks strongly hybridized with light quarks, arising in a relativistic heavy-ion collision process.

In human emotion estimation using an electroencephalogram (EEG) and heart rate variability (HRV), there are two main issues as far as we know. The first is that measurement devices for physiological signals are expensive and not easy to wear. The second is that unnecessary physiological indexes have not been removed, which is likely to decrease the accuracy of machine learning models. In this study, we used single-channel EEG sensor and photoplethysmography (PPG) sensor, which are inexpensive and easy to wear. We collected data from 25 participants (18 males and 7 females) and used a deep learning algorithm to construct an emotion classification model based on Arousal–Valence space using several feature combinations obtained from physiological indexes selected based on our criteria including our proposed feature selection methods. We then performed accuracy verification, applying a stratified 10-fold cross-validation method to the constructed models. The results showed that model accuracies are as high as 90% to 99% by applying the features selection methods we proposed, which suggests that a small number of physiological indexes, even from inexpensive sensors, can be used to construct an accurate emotion classification model if an appropriate feature selection method is applied. Our research results contribute to the improvement of an emotion classification model with a higher accuracy, less cost, and that is less time consuming, which has the potential to be further applied to various areas of applications.

We investigate two different types of relativistic Kondo effects, distinguished by heavy-impurity degrees of freedom, by focusing on the energy-momentum dispersion relations of the ground state with condensates composed of a light Dirac fermion and a nonrelativistic impurity fermion. Heavy-fermion degrees of freedom are introduced in terms of two types of heavy-fermion effective theories, in other words, two heavy-fermion limits for the heavy Dirac fermion, which are known as the heavy-quark effective theories (HQETs) in high-energy physics. While the first one includes only the heavy-particle component, the second one contains both the heavy-particle and heavy-antiparticle components, which are opposite in their parity. From these theories, we obtain two types of Kondo effects, in which the dispersions near the Fermi surface are very similar, but they differ in the structure at low momentum. We also classify the possible forms of condensates in the two limits. The two Kondo effects will be examined by experiments with Dirac/Weyl semimetals or quark matter, lattice simulations, and cold-atom simulations.

Case A 74‐year‐old woman underwent computed tomography‐guided transthoracic needle biopsy of a small lung mass. Immediately after the procedure, she lost consciousness. After resuscitation, her brain computed tomography scan confirmed a cerebral air embolism. Outcome As hyperbaric oxygenation was unavailable, she received controlled normothermia for neuroprotection. No cerebral symptoms were observed following treatment. Conclusion Air embolisms are rare, but fatal, complications of computed tomography‐guided transthoracic needle biopsy. Therefore, clinicians should be familiar with early diagnosis and prompt treatment. Preventing hyperthermia might be effective for treating hypoxic brain injury caused by cerebral air embolisms.

We propose a novel mechanism of the Kondo effect driven by a chirality imbalance (or chiral chemical potential) of relativistic light fermions. This effect is realized by the mixing between a right- or left-handed fermion and a heavy impurity in the chirality imbalanced matter even at zero density. This is different from the usual Kondo effect induced by finite density. We derive the Kondo effect from both a perturbative calculation and a mean-field approach. We also discuss the temperature dependence of the Kondo effect. The Kondo effect at nonzero chiral chemical potential can be tested by future lattice simulations.

The quantum chromodynamics (QCD) Kondo effect is a quantum phenomenon in which heavy quarks (c,b) exist as impurity particles in quark matter composed of light quarks (u,d,s) at extremely high density. This is analogous to the famous Kondo effect in condensed matter physics. In the present paper, we show theoretically the existence of the “QCD Kondo excitons,” i.e., the bound states of light quarks and heavy quarks, as the lowest-excitation modes above the ground state of the quark matter governed by the QCD Kondo effect. These are neutral for color and electric charges, similarly to the Kondo excitons in condensed matter, and they are a new type of quasiparticles absent in the normal phase of quark matter. The QCD Kondo excitons have various masses and quantum numbers, i.e., flavors and spin parities (scalar, pseudoscalar, vector, and axial vector). The QCD Kondo excitons lead to the emergence of the neutral currents in transport phenomena, which are measurable in lattice QCD simulations. The study of the QCD Kondo excitons will provide us with understanding of new universal properties shared by quark matter and condensed matter.

Membrane trafficking of integrins plays a pivotal role in cell proliferation and migration. How endocytosed integrins are targeted either for recycling or lysosomal delivery is not fully understood. Here, we show that fibronectin (FN) binding to α5β1 integrin triggers ubiquitination and internalization of the receptor complex. Acidification facilitates FN dissociation from integrin α5β1 in vitro and in early endosomes, promoting receptor complex deubiquitination by the USP9x and recycling to the cell surface. Depending on residual ligand occupancy of receptors, some α5β1 integrins remain ubiquitinated and are captured by ESCRT-0/I, containing histidine domain-containing protein tyrosine phosphatase (HD-PTP) and ubiquitin-associated protein 1 (UBAP1), and are directed for lysosomal proteolysis, limiting receptor downstream signaling and cell migration. Thus, HD-PTP or UBAP1 depletion confers a pro-invasive phenotype. Thus, pH-dependent FN-integrin dissociation and deubiquitination of the activated integrin α5β1 are required for receptor resensitization and cell migration, representing potential targets to modulate tumor invasiveness.

Leuconostoc species are vancomycin-resistant Gram-positive cocci. Infections due to Leuconostoc species have been reported in various immunocompromised patients, but little is known about such infection in patients with hematologic malignancies. We report a case of Leuconostoc infection in a 44-year-old woman with acute lymphoblastic leukemia. The patient developed a high fever despite antimicrobial therapy with doripenem after induction chemotherapy. After an isolate from blood cultures was identified as L. pseudomesenteroides, we changed the antibiotics to piperacillin-tazobactam and gentamicin, after which the patient recovered from the infection. Physicians should be aware of Leuconostoc species as causative pathogen if they encounter Gram-positive cocci bacteremia resistant to standard antibiotics such as vancomycin and teicoplanin, especially in patients with hematologic malignancies.

Semaphorin family proteins act on cells to mediate both repulsive and attractive guidance via binding to plexin family receptors, thereby playing fundamental roles in the morphogenesis and homeostasis of various tissues. Although semaphorin-plexin signaling is implicated in various diseases and is thus a target of intensive research, our mechanistic understanding of how semaphorins activate plexins on the cell surface is limited. Here, we describe unique anti-plexin-A1 antibodies that can induce a collapsed morphology in mouse dendritic cells as efficiently as the semaphorin 3A (Sema3A) ligand. Precise epitope analysis indicates that these "semaphorin-mimicking" antibodies dimerize cell-surface plexin-A1 by binding to the N-terminal sema domain of the plexin at sites away from the interface used by the Sema3A ligand. Structural analysis of plexin-A1 fragments using negative stain electron microscopy further revealed that this agonistic capacity is closely linked to the location and orientation of antibody binding. In addition, the full-length plexin-A1 ectodomain exhibited a highly curved "C" shape, reinforcing the very unusual dimeric receptor conformation of this protein at the cell surface when engaged with Sema3A or agonistic antibodies.

Ventilator-associated conditions (VACs), for which new surveillance definitions and methods were issued by the Center for Disease Control and Prevention (CDC), are respiratory complications occurring in conjunction with the use of invasive mechanical ventilation and are related to adverse outcomes in critically ill patients. However, to date, risk factors for VACs have not been adequately established, leading to a need for developing a better understanding of the risks. The objective of this study was to explore care-related risk factors as a process indicator and provide valuable information pertaining to VAC preventive measures.This retrospective, single-center, cohort study was conducted in the intensive-care unit (ICU) of a university hospital in Japan. Patient data were automatically sampled using a computerized medical records system and retrospectively analyzed. Management and care-related, but not host-related, factors were exhaustively analyzed using multivariate analysis for risks of VACs. VAC correlation to mortality was also investigated.Of the 3122 patients admitted in the ICU, 303 ventilated patients meeting CDC-specified eligibility criteria were included in the analysis. Thirty-seven VACs (12.2%) were found with a corresponding rate of 12.1 per 1000 ventilator days. Multivariate analysis revealed four variables related to patient care as risk factors for VACs: absence of intensivist participation in management of ventilated patients [adjusted HR (AHR): 7.325, P < 0.001)], using relatively higher driving pressure (AHR: 1.216, P < 0.001), development of edema (AHR: 2.145, P = 0.037), and a larger body weight increase (AHR: 0.058, P = 0.005). Furthermore, this research confirmed mortality differences in patients with VACs and statistically derived risks compared with those without VACs (HR: 2.623, P = 0.008).Four risk factors related to patient care were clearly identified to be the key factors for VAC preventive measures.

Recent studies have shown that monocytes possess pluripotent plasticity. We previously reported that monocytes could differentiate into hepatic stellate cells. Although stellate cells are also present in the pancreas, their origin remains unclear. An accumulation of enhanced green fluorescent protein (EGFP)(+)CD45(-) cells was observed in the pancreases and livers of chimeric mice, which were transplanted with a single hematopoietic stem cell isolated from EGFP-transgenic mice and treated with carbon tetrachloride (CCl4). Because the vast majority of EGFP(+)CD45(-) cells in the pancreas expressed stellate cell-associated antigens such as vimentin, desmin, glial fibrillary acidic protein, procollagen-I, and α-smooth muscle actin, they were characterized as pancreatic stellate cells (PaSCs). EGFP(+) PaSCs were also observed in CCl4-treated mice adoptively transferred with monocytes but not with other cell lineages isolated from EGFP-transgenic mice. The expression of monocyte chemoattractant protein-1 (MCP-1) and angiotensin II (Ang II) increased in the pancreas of CCl4-treated mice and their respective receptors, C-C chemokine receptor 2 (CCR2) and Ang II type 1 receptor (AT1R), were expressed on Ly6C(high) monocytes isolated from EGFP-transgenic mice. We examined the effect of an AT1R antagonist, irbesartan, which is also a CCR2 antagonist, on the migration of monocytes into the pancreas. Monocytes migrated toward MCP-1 but not Ang II in vitro. Irbesartan inhibited not only their in vitro chemotaxis but also in vivo migration of adoptively transferred monocytes from peripheral blood into the pancreas. Irbesartan treatment significantly reduced the numbers of EGFP(+)F4/80(+)CCR2(+) monocytic cells and EGFP(+) PaSCs in the pancreas of CCl4-treated chimeric mice receiving EGFP(+) bone marrow cells. A specific CCR2 antagonist RS504393 inhibited the occurrence of EGFP(+) PaSCs in injured mice. We propose that CCR2(+) monocytes migrate into the pancreas possibly via the MCP-1/CCR2 pathway and give rise to PaSCs.

Tumor biomarkers provide a quantitative tool for following tumor progression and response to therapy. However, investigations of clinically useful tumor biomarkers are time-consuming, costly, and limited by patient and tumor heterogeneity. In addition, assessment of biomarkers as indicators of therapy response is confounded by the concomitant use of multiple therapeutic interventions. Herein we report our use of a clinically relevant orthotopic animal model of malignant pleural mesothelioma for investigating tumor biomarkers. Utilizing multi-modality imaging with correlative histopathology, we demonstrate the utility and accuracy of the mouse model in investigating tumor biomarkers--serum soluble mesothelin-related peptide (SMRP) and osteopontin (OPN). This model revealed percentage change in SMRP level to be an accurate biomarker of tumor progression and therapeutic response--a finding consistent with recent clinical studies. This in vivo platform demonstrates the advantages of a validated mouse model for the timely and cost-effective acceleration of human biomarker translational research.