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Background Coronary arterial aneurysms (CAAs) associated with Kawasaki disease (KD) significantly affect prognosis. However, the clinical course of CAAs and factors associated with CAA regression have not been well analyzed. Methods and Results The cohort of the Z‐Score 2nd Project Stage study, a multicenter, retrospective, cohort study involving 44 institutions in Japan including 1006 patients with KD, was examined. CAAs were classified by the z score of their internal diameter in the acute phase: small ( z z z ≥10). The lower limit of small CAA was based on the Japanese Ministry of Health, Labour and Welfare criteria. In the right coronary artery, the CAA regression rates 10 years after diagnosis were 95.5% for small, 83.2% for medium, and 36.3% for large. In the proximal left anterior descending artery, the regression rates 10 years after diagnosis were 95.3% for small, 80.1% for medium, and 28.8% for large. Cox regression analysis showed that diagnosis under the age of 1 year and onset of KD in 2010 to 2012 for the right coronary artery and the left anterior descending artery, and female for the right coronary artery were significantly associated with a high regression rate, whereas large CAAs for the right coronary artery and the left anterior descending artery were significantly associated with a low regression rate. Conclusions The current study, the largest Japanese study of its kind, found that small aneurysm, recent onset, and diagnosis under the age of 1 year predict regression, and that even giant aneurysms could regress. These data may contribute to long‐term management of coronary aneurysms. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000010606.

Objectives: To explore what the student participants learned and how they felt about the use of three educational settings, namely, face-to-face workshop setting, asynchronous and synchronous online learning environments and interactions with outpatients in a real-world clinical setting in a hybrid interprofessional education course. Methods: This qualitative study used semi-structured in-depth interviews with healthcare undergraduate student participants in a course comprising workshops in three educational settings. A total of 15 healthcare undergraduate students, which included four medical, three pharmacy, five nursing and three nutrition students, completed this IPE course. All students agreed to participate in the study. We conducted four focus groups selected using convenient sampling. Focus group transcripts were analysed using the 'Steps for Coding and Theorization' qualitative data analysis method. We investigated the students' perception through the experience of three educational settings in the hybrid interprofessional education course. Results: The students recognised that this course had three types of educational spaces, namely, real, semi-real and unreal. Then, the positive changes in the awareness of students are trained in recognition of the patient perspective, the recognition of the roles discharged by the other professions and the recognition of the functions of their own profession after experiencing the educational spaces designated for this course. Conclusions: The repeated experience of participants to real, semi-real and unreal educational spaces promoted changes over time in the students' awareness of interprofessional competencies with respect to patient-centred care and ameliorated their readiness to undertake interprofessional tasks.

Before the diagnosis of idiopathic pulmonary hemosiderosis (IPH), unexplained or puzzling anemia may precede and delay in the diagnosis of pediatric IPH is common. A 5.8 years old female child initiated with iron-refractory iron deficiency anemia-like iron deficiency and hemolytic anemia and at 6.8 years of age IPH was materialized, when the patient showed the triad signs of IPH with hemosiderin-laden alveolar macrophages in gastric aspirate. Although time to the diagnosis was previously reported to be ranged from 16 to 30 months, in our case it took 12 months from the initial anemia to IPH diagnosis.

The development of photovoltaics (PV)-powered vehicles are expected to contribute to reduce CO2 emission of vehicles and create a clean energy society. This paper presents the impact of high-efficiency solar cell modules on reduction in CO2 emission, charging cost reduction for electric vehicles, and reducing storage capacity of PV-powered electric vehicles. In this paper, the effects of solar cell module efficiency upon driving distance of PV-powered vehicles are also shown. Especially, the potential of Si tandem solar cells for PV-powered vehicle applications is discussed. This paper presents that the III-V/Si 3-junction solar cell modules with an efficiency of more than 37% have the potential of longer driving distance of 30 km/day average and more than 50 km/day on a clear day compared to an average 16 km/day driving by vehicles powered by 20% efficiency Si solar cell modules.

The potential benefit of heart rate reduction (HRR), independent of β-blockade, on right ventricular (RV) function in pulmonary hypertension (PH) remains undecided. We studied HRR effects on RV fib...

Development of highly-efficient photovoltaic (PV) modules and expanding its application fields are significant for the further development of PV technologies and realization of innovative green energy infrastructure based on PV. Especially, development of solar-powered vehicles as a new application is highly desired and very important for this end. This paper presents the impact of PV cell/module conversion efficiency on reduction in CO2 emission and increase in driving range of the electric based vehicles. Our studies show that the utilization of a highly-efficient (higher than 30%) PV module enables the solar-powered vehicle to drive 30 km/day without charging in the case of light weight cars with electric mileage of 17 km/kWh under solar irradiation of 3.7 kWh/m2/day, which means that the majority of the family cars in Japan can run only by the sunlight without supplying fossil fuels. Thus, it is essential to develop high-efficiency as well as low-cost solar cells and modules for automotive applications. The analytical results developed by the authors for conversion efficiency potential of various solar cells for choosing candidates of the PV modules for automotive applications are shown. Then we overview the conversion efficiency potential and recent progress of various Si tandem solar cells, such as III-V/Si, II-VI/Si, chalcopyrite/Si, and perovskite/Si tandem solar cells. The III-V/Si tandem solar cells are expected to have a high potential for various applications because of its high conversion efficiency of larger than 36% for dual-junction and 42% for triple-junction solar cells under 1-sun AM1.5 G illumination, lightweight and low-cost potentials. The analysis shows that III-V based multi-junction and Si based tandem solar cells are considered to be promising candidates for the automotive application. Finally, we report recent results for our 28.2% efficiency and Sharp’s 33% mechanically stacked InGaP/GaAs/Si triple-junction solar cell. In addition, new approaches which are suitable for automotive applications by using III-V triple-junction, and static low concentrator PV modules are also presented.

Development of high-efficiency solar cell modules and new application fields such as PV (Photovoltaics)-powered vehicles are significant for the further development of PV and the creation of new clean energy infrastructure based on PV. In this paper, analytical results for impact of high-efficiency solar cell modules on increasing driving distance, reducing CO 2 emission and saving charging cost of electric vehicles by PV-powered vehicles. Because the Si tandem solar cells are expected to have significant potential for PV-powered vehicle applications, potentials of high-efficiency and driving distance are also analyzed. The III-V/Si 3-junction solar cell modules have potential of driving distance of 30 km/day average and more than 50 km/day on a clear day.

Stretchable photovoltaics are emerging power sources for collapsible electronics, biomedical devices, and buildings and vehicles with curved surfaces. Development of stretchable photovoltaics are crucial to achieve rapid growth of the future photovoltaic market. However, owing to their rigidity, existing thin-film solar cells based predominantly on silicon, compound semiconductors, and perovskites are difficult to apply to 3D curved surfaces, which are potential real-world candidates. Herein, we present a stretchable micro-scale concentrator photovoltaic module with a geometrical concentration ratio of 3.5×. When perfectly fitted on a 3D curved surface with a sharp curvature, the prototype module achieves an outdoor power conversion efficiency of 15.4% and the daily generated electricity yield improves to a maximum of 190% relative to a non-concentration stretchable photovoltaic module. Thus, this module design enables high areal coverage on 3D curved surfaces, while generating a higher electricity yield in a limited installation area. The use of photovoltaic devices for energy harvesting in real-world applications requires that they are conformable to non-flat surfaces. Here, a micro-scale concentrator module shows 15.4% outdoor conversion efficiency and can stretch over curved 3D surfaces.

Right ventricular (RV) dysfunction determines mortality in patients with pulmonary arterial hypertension (PAH) and RV pressure loading. Experimental models commonly use Sugen hypoxia (SuHx)-induced PAH, monocrotaline (MCT)-induced PAH, or pulmonary artery banding (PAB). Because PAH models cannot interrogate RV effects or therapies independent of pulmonary vascular effects, we aimed to compare RV function and fibrosis in experimental PAB vs. PAH. Thirty rats were randomized to either sham controls, PAB, SuHx-, or MCT-induced PAH. RV pressures and function were assessed by high-fidelity pressure-tipped catheters and by echocardiography. RV myocyte hypertrophy, fibrosis, and capillary density were quantified from hematoxylin-eosin, picrosirius red-stained, and CD31-immunostained RV sections, respectively. RV pressures and the RV-to-left ventricular pressure ratio were significantly increased in all three groups to a similar degree (PAB 65 ± 17 mmHg, SuHx 72 ± 16 mmHg, and MCT 70 ± 12 mmHg) vs. controls (23 ± 2 mmHg, all

As the important role of longitudinal shortening in ventricular function has been well recognized over the past decade, evaluation of longitudinal systolic function of the left ventricle has become a subject of growing interest. Tissue motion annular displacement of the mitral valve (TMAD) is a new parameter of longitudinal systolic function. Although some studies have reported that this new parameter correlates with left ventricular ejection fraction (LVEF) in adults, little is known about TMAD in normal children. In this work, we investigated 94 children with no history of cardiovascular disease. TMAD was measured in the apical four-chamber view using the two-dimensional speckle tracking technique. Three points for tracking were selected in a diastolic frame: the lateral mitral valve annulus, medial mitral valve annulus, and left ventricular apex. The value was expressed as the percentage of displacement of the midpoint of the mitral valve annulus, using software to correct for left ventricular length at end-diastole. Pearson’s coefficient was used to estimate the correlation between TMAD and left ventricular systolic function parameters including the biplane modified Simpson method-derived ejection fraction and global longitudinal strain (GLS). We also analyzed the correlation between TMAD and heart rate (HR), height, age, and body surface area (BSA). TMAD was found to correlate significantly with LVEF (r = 0.71, p

This research investigated the benefits of utilizing solar power as an energy source for future passenger vehicles and an innovative static concentrator photovoltaic module for practical automotive applications. Due to strict emissions standards, alternative energy sources must be found for vehicles in the future. It was estimated that replacing all passenger vehicles with hybrid vehicles (HVs) equipped with an 800 W rated-power solar module that generates an average output of 1.8 kW h/day would reduce CO2 emissions by 63% in Japan. To confirm the validity of this estimation, a test vehicle was created by installing a 6.8 m2 solar module onto a commercially available plug-in HV. An average power generation of 2.1 kW h/day was obtained by this solar module over 100 days under real-world conditions, which was larger than the power required to achieve the estimated CO2 emissions reduction. In addition, an innovative static low-concentrator with III–V cells was studied to help reduce the installation area of the solar module on the vehicles, which is essential for practical passenger vehicles. A new concentrator design method was proposed that can be easily integrated into a standard vehicle design procedure by utilizing numerical optimization in a CAD-friendly environment. Both design equations and a design example are discussed in this paper. The proposed lens design (asymmetric-aspheric type) can expand the acceptance incident angle of solar light and increase the annual energy yield of a solar panel, while maintaining the essential thin structure for automotive applications. In spite of the wide range of sun positions, this asymmetric-aspherical lens can maintaining stable illumination on the cell while suppressing the maximum spot intensity to 20×.

Background Development of right ventricular ( RV ) hypertension eventually contributes to RV and left ventricular ( LV ) myocardial fibrosis and dysfunction. The molecular mechanisms are not fully elucidated. Methods and Results Pulmonary artery banding was used to induce RV hypertension in rats in vivo. Then, we evaluated cardiac function and regional remodeling 6 weeks after pulmonary artery banding. To further elucidate mechanisms responsible for regional cardiac remodeling, we also mimicked RV hypertensive stress by cyclic mechanical stretching applied to confluent cultures of cardiac fibroblasts, isolated from the RV free wall, septal hinge points, and LV free wall. Echocardiography and catheter evaluation demonstrated that rats in the pulmonary artery banding group developed RV hypertension with leftward septal displacement, LV compression, and increased LV end‐diastolic pressures. Picrosirius red staining indicated that pulmonary artery banding induced marked RV fibrosis and dysfunction, with prominent fibrosis and elastin deposition at the septal hinge points but less LV fibrosis. These changes were associated with proportionally increased expressions of integrin‐β1 and profibrotic signaling proteins, including phosphorylated Smad2/3 and transforming growth factor‐β1. Moreover, mechanically stretched fibroblasts also expressed significantly increased levels of α‐smooth muscle actin, integrin‐β1, transforming growth factor‐β1, collagen I deposition, and wrinkle formation on gel assays, consistent with myofibroblast transformation. These changes were not observed in parallel cultures of mechanically stretched fibroblasts, preincubated with the integrin inhibitor ( BTT ‐3033). Conclusions Experimentally induced RV hypertension triggers regional RV , hinge‐point, and LV integrin β1‐dependent mechanotransduction signaling pathways that eventually trigger myocardial fibrosis via transforming growth factor‐β1 signaling. Reduced LV fibrosis and preserved global function, despite geometrical and pressure aberrations, suggest a possible elastin‐mediated protective mechanism at the septal hinge points.

IMPORTANCE: Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). OBJECTIVE: To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. MAIN OUTCOMES AND MEASURES: The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score

The objective of the present study was to investigate mechanisms of heart rate (HR) reduction on biventricular function and interactions in experimental pulmonary arterial hypertension (PAH). We compared cardiac cycle mechanics and interventricular interactions in 15 sham, 8 monocrotaline-PAH, 9 PAH + carvedilol, and 8 PAH + ivabradine rats. We used echocardiography to assess biventricular function, timing of cardiac cycle events, and septal position in PAH rats and related HR reduction effects on biventricular function measured by echocardiography and conductance catheter. HR was 302 beats/min in PAH + carvedilol rats and 303 beats/min in PAH + ivabradine rats versus 359 beats/min in PAH rats ( P < 0.01). Sham rats showed temporal alignment between right ventricular (RV) and left ventricular (LV) events, whereas PAH rats showed increased biventricular isovolumic contraction times (ICTs), delayed RV peak radial motion, and impaired early relaxation. Temporal malalignment was associated with decreased tricuspid and mitral diastolic annular peak velocities (3.7 vs. 6.4 and 3.4 vs. 5.3 cm/s, respectively, P < 0.001), delayed and shortened biventricular filling, and reduced early diastolic LV filling velocity (0.56 vs. 0.81 cm/s, P < 0.01). LV eccentricity index was increased at systole (2.0 vs. 1.2, P < 0.001), early diastole (2.1 vs. 1.1, P < 0.001), and end diastole (1.6 vs. 1.1, P < 0.001) in PAH versus sham rats. HR reduction with carvedilol and ivabradine shortened biventricular ICTs and the time to biventricular peak radial motion, improved RV relaxation, and increased early diastolic LV filling through reduced interventricular interaction and improved timing. These improvements corresponded with enhanced hemodynamics (increased cardiac output, RV contractility, and diastolic relaxation). In conclusion, HR reduction by carvedilol and ivabradine improves biventricular filling and hemodynamics in experimental PAH through realignment of RV-LV cardiac cycle events and improved interventricular interactions. NEW & NOTEWORTHY Carvedilol improves biventricular function in experimental pulmonary arterial hypertension, but the mechanisms of heart rate reduction versus β-blocker effect are inadequately defined. Here, we demonstrate that reducing heart rate using either carvedilol or ivabradine (hyperpolarization-activated current inhibitor without β-blocker effect) improves right ventricular filling and biventricular hemodynamics through the realignment of right ventricular-left ventricular cardiac cycle events and improved interventricular interactions.

This is the first reported non-electron-multiplying CMOS Image Sensor (CIS) photon-detector for replacing Photo Multiplier Tubes (PMT). 15jum pitch active sensor pixels with complete charge transfer and readout noise of 0.5 e-RMS are arrayed and their digital outputs are summed to detect micro light pulses. Successful proof of radiation counting is demonstrated.

Death and morbidity in pulmonary arterial hypertension (PAH) are often due to right ventricular (RV) failure and associated left ventricular (LV) dysfunction. We investigated regional myocardial remodeling and function as the basis for adverse ventricular‐ventricular interactions in experimental chronic RV pressure overload. Two distinct animal models were studied: A rabbit model of increased RV pressure‐load through progressive pulmonary artery banding A rat model of monocrotaline (MCT)‐induced pulmonary arterial hypertension (PAH). Regional myocardial function was assessed by speckle‐tracking strain echocardiography and ventricular pressures measured by catheterization before termination. Regional RV and LV myocardium was analyzed for collagen content, apoptosis and pro‐fibrotic signaling gene and protein expression. Although the RV developed more fibrosis than the LV; in both models the LV was substantially affected. In both ventricles, particularly the LV, fibrosis developed predominantly at the septal hinge‐point regions in association with decreased regional and global circumferential strain, reduced global RV and LV function and up‐regulation of regional transforming growth factor‐β1 (TGF β1) and apoptosis signaling. A group of PAH rats who received the TGF β blocker SB431542 showed improved RV function and reduced regional hinge‐point myocardial fibrosis. RV pressure‐loading and PAH lead to biventricular TGF β1 signaling, fibrosis and apoptosis, predominantly at the septal hinge‐point regions, in association with regional myocardial dysfunction. This suggests that altered geometry and wall stress lead to adverse RV‐LV interactions through the septal hinge‐points to induce LV fibrosis and dysfunction.

We investigate the benefits of utilizing solar power as an energy source for future automobiles. Since there are strict emission standards developed by governments, we must find an alternative energy source for the future automobiles. We show that replacing all passenger cars with hybrid vehicles equipped with a 800 W rated-power solar module would reduce greenhouse gas (GHG) emission by 63% in Japan. We obtained an average power generation of 2.1 kWh/day over 100 days by solar modules installed on a Prius under the real environment, which was larger than the required power to achieve the GHG emission reduction. We also investigate an innovative statistic low-concentrator with III-V cells in order to reduce installation area for the automobiles. We show that our proposed design (asymmetric-aspheric design) can expand the acceptance incident angle and increase the annual energy yield, while keeping thin structure, which is essential to automobile application.

We investigated the characteristics of GalnP solar cells grown directly on Ge substrates by molecular beam epitaxy (MBE). For comparison, GaAs solar cells were also grown on Ge substrates using similar initiation conditions. Compared to cells on GaAs, large degradation in open-circuit voltage (Voc) and short-circuit current density (Jsc) were observed in GaInP/Ge cells, while only small reductions were observed for GaAs/Ge. Transmission electron microscopy reveals an extremely high threading dislocation density (TDD) in the 109 cm−2 range in GaInP/Ge, four orders of magnitude larger than that of GaAs/Ge, despite the minimal lattice mismatch in both cells. GaInP/Ge initiation is far more challenging than GaAs/Ge initiation by MBE, and a homoepitaxial Ge layer will likely be necessary to obtain high-quality films.

Sildenafil is a strong pulmonary vasodilator that increases the intracellular cyclic guanosine monophosphate concentration through inhibition of phosphodiesterase-5. We assessed the benefit of oral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in paediatric patients.Sildenafil was administered at a starting dose of 0.5 mg kg(-1) following admission to the intensive care unit. With careful monitoring of haemodynamics, the dose was increased stepwise by 0.5 mg kg(-1) every 4-6 h up to a maximum of 2 mg kg(-1). After successful weaning from a ventilator and from other vasodilators, sildenafil was gradually discontinued over the next 5-7 days.A retrospective review of medical records showed an age distribution of1 month (n=26),or = 1-6 months (n=36),or = 6-12 months (n=19), 1-3 years (n=8), 4-9 years (n=9) and10 years (n=2) at the time of surgery. The surgeries were performed for ventricular septal defect closure (n=17), arterial switch (n=30), truncus arteriosus repair (n=10), complete atrioventricular septal defect repair (n=12), total anomalous venous drainage repair (n=9), and other open-heart surgery (n=22). The aforementioned concomitant inhaled nitrous oxide treatment was performed in 66 patients. Pulmonary arterial pressure decreased in 28, was unchanged in five and elevated in one patient out of the total of 34 cases for which data from continuous pressure monitoring were available. Bosentan was added in three cases with persistent symptoms due to pulmonary hypertension despite sildenafil treatment. After sildenafil administration, modest oxygen desaturation occurred in seven cases, but no 'rebound' pulmonary hypertension occurred. There were no significant adverse events during sildenafil treatment.Our results suggest that oral sildenafil is a safe and effective alternate for persistent pulmonary hypertension following congenital heart surgery in children.

Background In muscular dystrophy, cardiac function deteriorates with time and heart failure is one of the major causes of death. Although the combination of angiotensin-converting enzyme inhibitors (ACEI) and β-blockers improves cardiac function in adults, little is known about the efficacy of those drugs in patients with muscular dystrophy. Methods and Results The effect of the β-blocker, carvedilol, and/or ACEI on ventricular function in patients with muscular dystrophy was studied. Carvedilol and an ACEI were given to 13 patients (ACEI group; mean age 18 years, range 7-27 years), and an ACEI only to 15 patients (carvedilol group; mean age 15 years, range 8-29 years). Diagnoses included Duchenne muscular dystrophy (n=25), Fukuyama muscular dystrophy (n=2), and Emery-Dreifuss muscular dystrophy (n=1). Echocardiographic parameters of the left ventricle were measured during the 2-3 years of follow-up. In the carvedilol group, combination therapy of carvedilol and an ACEI for 2 years resulted in a significant increase in left ventricular fractional shortening (LVFS). In the ACEI group, there was no significant change in LVFS. Left ventricular end-diastolic dimension increased in the ACEI group, but not in the carvedilol group. Conclusion Carvedilol plus an ACEI improves left ventricular systolic function in patients with muscular dystrophy. (Circ J 2006; 70: 991 - 994)

The spectral characteristics of the diffuse galactic mid- and far infrared emission at λ = 10 – 60 μm are investigated using the IRTS and IRAS data. We estimate the grain temperature, total far-infrared intensity ( FIR ) and radiation density from the emission of the large grains at λ > 100 μm, assuming that the spectrum has a single temperature Planck function with a λ −2 emissivity law. We found that the spectral energy distribution of the diffuse galactic emission at wavelengths from 10 μm to 1 mm changed as a function of the dust temperature. In addition, we found clear correlation for the intensity of emissions at 12, 25, and 60 μm. The 12 μm intensity is proportional to FIR , and the ratios of the 25 and 60 μm intensities to FIR are proportional to the strength of the interstellar radiation field. These correlations are consistent with those found in the data of seven H II regions with various physical conditions. This suggests that the emitters of the emission at 12–60 μm are well mixed with large grains radiating at wavelength greater than 100 μm and implies that the ratio of the mass of these emitters to the mass of the large grains is constant in interstellar space. We conclude that the 12 μm emission is largely due to unidentified infrared features and that the 25 and 60 μm emission arises from very small grains transiently heated by multiple-photon

Accepted: 2001-10-30, 資料番号: SA1001334000

Left ventricular (LV) function influences outcomes in right ventricular (RV) failure. Carvedilol reduces mortality in LV failure and improves RV function in experimental pulmonary arterial hypertension (PAH). However, its impact on ventricular-ventricular interactions and LV function in RV afterload is unknown. We investigated effects of carvedilol on biventricular fibrosis and function in a rat model of persistent PAH. Rats were randomized into three groups: Sham controls, PAH, and PAH + carvedilol. Severe PAH was induced by 60 mg/kg subcutaneous monocrotaline. In the treatment group, oral carvedilol (15 mg/kg/day) was started 2 weeks after monocrotaline injection and continued for 3 weeks until the terminal experiment. Echocardiography and exercise performance were performed at baseline and repeated at the terminal experiment with hemodynamic measurements. LV and RV myocardium were analyzed for hypertrophy, fibrosis, and molecular signaling by protein and mRNA analysis. PAH and PAH + carvedilol rats experienced severely elevated pulmonary arterial pressures and RV hypertrophy. Despite similar RV systolic pressures, carvedilol reduced biventricular collagen content (RV fibrosis area; 13.4 ± 6.5 vs. 5.5 ± 2.7 %, p

Right ventricular (RV) function is an important determinant of mortality in patients with idiopathic pulmonary arterial hypertension (iPAH). The aim of this study was to serially evaluate global and regional RV two-dimensional strain and their relation to transplantation-free survival in children with iPAH.RV regional and global longitudinal strain was retrospectively assessed in children with iPAH. Serial echocardiograms at 3 to 6 months from presentation and then at yearly intervals were analyzed. Results were compared with those from controls and between iPAH survivors (group 1) and those who died or needed transplantation (group 2). Survival stratified by RV global longitudinal strain at presentation was analyzed.Seventeen patients with iPAH (mean age, 8.4 ± 4.8 years; seven male patients), of whom 11 were alive (group 1) and six had died or undergone transplantation (group 2), and 17 age-matched controls were studied. The median follow-up period was 1.5 years (range, 0.04-7.8 years). RV global longitudinal strain was significantly reduced in patients with iPAH compared with controls (-13.5 ± 5.9% vs -24.4 ± 3.9%, P .001) and in group 2 compared with group 1 at presentation (-9 ± 2.8% vs -16 ± 5.7%, P .05) and throughout follow-up. During follow-up, RV global and regional longitudinal strain worsened in group 2, especially in RV apical segments (-6.3 ± 5% vs -1.9 ± 1.6% at presentation compared with the last echocardiographic assessment in group 2, P .05), but was unchanged in group 1. RV global longitudinal strain-14% predicted transplantation-free survival with 100% sensitivity and 54.5% specificity.RV strain imaging may be useful for serial follow-up and prognostication in children with iPAH.

Background— Right ventricular diastolic dysfunction influences outcomes in pulmonary arterial hypertension (PAH), but echocardiographic parameters have not been investigated in relation to invasive reference standards in pediatric PAH. We investigated echocardiographic parameters of right ventricular diastolic function in children with PAH in relation to simultaneously measured invasive reference measures. Methods and Results— We prospectively recruited children undergoing a clinically indicated cardiac catheterization for evaluation of PAH and pulmonary vasoreactivity testing. Echocardiography was performed simultaneously with invasive reference measurements by high-fidelity micromanometer catheter. For analysis, patients were divided into shunt and nonshunt groups. Sixteen children were studied. In the group as a whole, significant correlations were found among τ and tricuspid deceleration time, E′ , E/E′ , Time E – E ′ , A wave velocity, and global early and late diastolic strain rate. d p /d t minimum correlated significantly with late diastolic tricuspid annular velocity ( A′ ), tissue Doppler imaging–derived systolic:diastolic duration ratio, and global late diastolic strain rate. End-diastolic pressure correlated significantly with tissue Doppler imaging–derived systolic:diastolic duration ratio. On multivariate analysis, tricuspid deceleration time, Time E – E ′ , and global early diastolic strain rate were independent predictors of τ, whereas tissue Doppler imaging–derived systolic:diastolic duration ratio was an independent predictor of d p /d t minimum. In general, correlations between echocardiographic and invasive parameters were better in the shunt group than in the nonshunt group. Conclusions— Echocardiography correlates with invasive reference measures of right ventricular diastolic function in children with PAH, although it does not differentiate between early versus late diastolic abnormalities. Newer echocardiographic techniques may have added value to assess right ventricular diastolic dysfunction in this population.

Using the Mid-Infrared Spectrometer on board the Infrared Telescope in Space and the low-resolution grating spectrometer (PHT-S) on board the Infrared Space Observatory, we obtained 820 mid-infrared (5 to 12 $\mu$m) spectra of the diffuse interstellar medium (DIM) in the Galactic center, W51, and Carina Nebula regions. These spectra indicate that the emission is dominated by the unidentified infrared (UIR) emission bands at 6.2, 7.7, 8.6, and 11.2 $\mu$m. The relative band intensities (6.2/7.7 $\mu$m, 8.6/7.7 $\mu$m, and 11.2/7.7 $\mu$m) were derived from these spectra, and no systematic variation in these ratios was found in our observed regions, in spite of the fact that the incident radiation intensity differs by a factor of 1500. Comparing our results with the polycyclic aromatic hydrocarbons (PAHs) model for the UIR band carriers, PAHs in the DIM have no systematic variation in their size distribution, their degree of dehydrogenation is independent of the strength of UV radiation field, and they are mostly ionized. The latter finding is incompatible with past theoretical studies, in which a large fraction of neutral PAHs is predicted in this kind of environment. A plausible resolution of this discrepancy is that the recombination coefficients for electron and large PAH positive ion are by at least an order of magnitude less than those adopted in past theoretical studies. Because of the very low population of neutral state molecules, photoelectric emission from interstellar PAHs is probably not the dominant source of heating of the diffuse interstellar gas. The present results imply constant physical and chemical properties of the carriers of the UIR emission bands in the DIM., Comment: 13 pages, 6 figures. Accepted for publication in ApJ

Background Matrix metalloproteinase (MMP)-9 is thought to be involved in coronary artery aneurysms (CAAs) in patients with Kawasaki disease (KD); however, MMP-9 inhibitors are not used clinically. This study investigated whether the angiotensin-converting enzyme (ACE) inhibitor captopril could inhibit serum MMP-9 activity using serum from KD patients in an in vitro experiment. Methods In 7 KD patients, serum MMP-9 activity was measured using the MMP-9 assay kit 3 times: before and after intravenous immunoglobulin (IVIG) treatment, and during the convalescent phase. The effect of captopril on MMP-9 activity was also assessed using serum obtained before IVIG treatment. Results Serum MMP-9 activity was significantly higher during the pre-treatment phase than during the post-treatment and convalescent phases. MMP-9 activity during the pre-treatment phase was dose-dependently inhibited by captopril, and the IC50 for MMP-9 was 500 nM. The potency of captopril for MMP-9 inhibition was comparable to that for ACE inhibition. Conclusion ACE inhibitor may be effective for preventing CAA formation in KD patients, especially IVIG non-responders.

We have developed a new 50-cm infrared balloon-borne telescope. The first flight of this telescope system is scheduled for September 1998. We used an offset paraboloidal mirror and used its primary focus to reduce the amount of background emission from the telescope itself in order to perform photometric observation with high sensitivity. The structure of the telescope is made of carbon fiber reinforced plastics (CFRP) to reduce its weight and make the optics free from thermal contraction due to low temperatures during observational flights to retain good focusing of the optics. For the detector, we use our newly developed 4 × 8 stressed Ge:Ga array in order to perform 150–180 μm photometry. The detector is installed in a cryostat and cooled by liquid He down to 2 K. The large format of the detector raises the observational efficiency enabling us to survey a wide area of the sky (up to 10° × 10°) with a high spatial resolution of 1.5′ in one observational flight. In the first flight, we plan to survey the Orion region, W51, etc. and to map some external galaxies.

We have developed a 4 × 8 array of stressed Ge:Ga detectors. This array detector has a high density format ofentrance pupils so that we can minimize the size of the cameraoptics. The cutoff wavelength of the detector is about 170 μm, and the detector's NEP is better than 1016 WHz-1/2. We are going apply this array detector toballoon-borne astronomical observations. Furthermore, we aredeveloping this detector into a 5 × 15 array detector that will be placed onboard the IRIS satellite to be launched in 2003.

Double-tremie work was applied to mitigate some effects caused by dumping dredged materials. Field investigations were carried out in order to clarify its efficiency, which can reduce the discharge of suspended solids by circulating water body in it. It is found that natural circulation did not occur under an intermittent dumping condition, but an additional compulsory circulation by aeration could keep suspended solids in the tremie at a higher level and reduce the discharge to the surrounding water.

We report a case of an 8-year-old girl with fulminant myocarditis successfully treated with percutaneous cardiopulmonary support (PCPS). She was first taken to our hospital for treatment of suspected infective enterocolitis since her main symptoms were fever, vomiting and diarrhea. On day 2 after admission, her ECG showed wide QRS and echocardiography demonstrated severe hypokinesis. She was transferred to the ICU with suspected acute myocarditis. On admission to the ICU, circulatory collapse was not detected. ECG showed severe bradycardia and ventricular fibrillation after intubation. Cardiopulmonary resuscitation was performed immediately for 50 minutes prior to initiation of PCPS. She was treated intensively with catecholamines, plasma exchange, continuous hemodiafiltration, high-dose gamma-globulin, and high dose methylprednisolone. Hypothermia therapy was also performed. She was weaned from PCPS on day 6 after initiation of PCPS. The patient was finally discharged from the hospital without any neurological complications on day 68 after weaning from PCPS. The proportion of patients in whom cardiopulmonary resuscitation was performed or having ventricular tachycardia or fibrillation were higher in non-survivors than in survivors.

Accepted: 1996-11-07, 資料番号: SA1001319000

Accepted: 1996-10-22, 資料番号: SA1001320000

The far-infrared line mapper (FILM) is a far-infrared spectrometer and in one of four focal plane instruments of the infrared telescope in space (IRTS), FILM was designed for wide area intensity mapping of far-infrared emission from interstellar gas and dust in the galaxy. The targets are the [CII] 158 micrometer line of the ionized carbon, the [OI] 63 micrometer line of the oxygen atom, and the continuum emission at 155 and 160 micrometer from the interstellar dust grain. A cylindrically concave varied line-space grating and a linear array of stressed Ge:Ga were successfully developed and allowed us to make a compact spectrometer compatible to severe limitations of the small cryogenic telescope. The IRTS, onboard the space flyer unit (SFU), was launched by a HII rocket on March 18, 1995 and was recovered by a STS on January 13, 1996. The FILM worked very well during four weeks allocated for the IRTS observation and produced a lot of valuable data. The sensitivity and the spatial resolution for the [CII] line are an order of magnitude better than the previous work.

Accepted: 1996-08-27, 資料番号: SA1001321000

Recently, many cases of children presenting reversible splenial lesions during febrile illness (RESLEF) have been reported; however, their overall clinico-radiological features are unclear. To describe the clinico-radiological features, we retrospectively reviewed the etiology (pathogen), clinical course, laboratory data, magnetic resonance imaging and electroencephalography (EEG) findings, therapy, and prognosis of 23 episodes in 22 children (1 child recurred) who presented neurological symptoms, with RESLEF. The etiologies (pathogens) varied. Seizure occurred in 7 episodes, disturbance of consciousness (DC) in 13, and delirious behavior in 18. Serum sodium levels

We report a successful arterial switch operation for complete transposition of great arteries with atrial and visceral situs inversus totalis and mirror image dextrocardia in a 12-day-old infant girl. The aorta was located left side-by-side to the pulmonary trunk with a single coronary artery (mirror image of 1RLCx). After French maneuver, the posterior circumference of the neo-aorta was reconstructed. Then the coronary button was transplanted into the neo-aorta with a trap door technique carefully avoiding any twist and over-stretch. The neo-pulmonary trunk was reconstructed with an autologous pericardial patch and sutured to the longitudinal incision made into the left central pulmonary artery. The baby was discharged from hospital and has been doing well without any morbidity relating myocardial ischemia.