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Objectives The aim of this AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial subgroup analysis was to examine rivaroxaban monotherapy benefits and their relation to the time between stenting and enrollment among patients after coronary stenting. Background Of 2,215 patients with atrial fibrillation and stable coronary artery disease in the AFIRE trial, rivaroxaban monotherapy was noninferior to rivaroxaban plus antiplatelet therapy (combination therapy) in terms of efficacy and superior for safety endpoints. However, thrombotic risk after antiplatelet therapy cessation remained a concern among 1,444 patients who had undergone coronary stenting >1 year before enrollment. Methods The benefits of rivaroxaban monotherapy in coronary stenting subgroups were assessed for efficacy (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death of any cause), safety (major bleeding defined according to International Society on Thrombosis and Haemostasis criteria), ischemic endpoints, net adverse clinical event, and time between stenting and enrollment. Results Efficacy and safety endpoints for monotherapy were superior to combination therapy, with HRs of 0.70 for efficacy (95% CI: 0.50-0.98; P = 0.036) and 0.55 for safety (95% CI: 0.33-0.92; P = 0.019). For ischemic endpoints, the HR was 0.82 (95% CI: 0.58-1.15; P = 0.240). The HR became smaller with longer time between stenting and enrollment (efficacy, P for interaction = 0.158; safety, P = 0.097). Conclusions In patients with atrial fibrillation after coronary stenting, the benefits of rivaroxaban monotherapy for efficacy and safety endpoints were consistent with those in the whole AFIRE trial population. The benefits became apparent with longer time between stenting and enrollment. (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease Study [AFIRE]; UMIN000016612 , NCT02642419 )

Background Acute aortic dissection (AAD) is a life-threatening medical condition with high morbidity and mortality. The association between female sex and poorer outcomes following surgery for AAD type A has been reported; however, the sex-related differences in clinical features and in-hospital outcomes of AAD type B remain to be elucidated. Methods We studied a total of 1877 patients with AAD type B who were enrolled in the Tokyo Acute Aortic Super-network from January 2013 to December 2016. Clinical features and in-hospital outcomes were compared between sexes. Independent predictors of in-hospital mortality were assessed using a multivariable analysis. Results The mean age of the patients was 69±13 years and 549 (29%) were females. Female patients were older than males (74±13 years vs 67±13 years; p Conclusion In AAD type B, females were older and had altered consciousness level, IMH-type, and a less widespread dissection more frequently than males. The overall in-hospital mortality was higher in females; however, female sex was not associated with in-hospital mortality after multivariable adjustment. Funding Acknowledgement Type of funding source: None

Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP Funding Acknowledgement Type of funding source: None

Background Portal vein (PV) reconstruction is a crucial factor in successful living donor liver transplantation (LDLT). In LDLT using the right liver grafts with anatomic PV variations, we sometimes encounter dual PV anastomosis. In this study we describe PV variations of donor liver in detail as well as our experiences with PV reconstruction in right liver grafts with PV variations. Methods We performed LDLT in 149 recipients between 2002 and 2016. PV variations of donor liver were classified into 3 major anatomic patterns, and we retrospectively analyzed the procedure and postoperative complications of PV anastomosis. Results PV variations in donor livers were classified as type A (normal type) in 125 patients, type B (trifurcation type) in 7 (4.7%), and type C (caudal origin of the right posterior branch) in 17 (11.4%). Among 75 right liver grafts, 10 (13.3%) had anatomic PV variations. In 9 of 10 recipients, dual PV of the graft were anastomosed to dual PV branches of the recipient in direct end-to-end fashion. In the remaining recipient, the posterior portal branch of the graft was anastomosed to the recipient portal trunk through the interposed venous graft in end-to-end fashion and the anterior portal branch of the graft was anastomosed to the side wall of the interposed venous graft. These 10 recipients did not develop any postoperative complications associated with PV anastomosis, although 3 of the 149 recipients (2.0%) developed complications associated with PV anastomosis, such as thrombosis and necrosis. Conclusion Dual PV anastomosis of the right liver graft is safe and feasible in LDLT, even in anatomic PV variations.

In an attempt to increase the number of donor livers, there has been an increased use of marginal donor livers, such as steatotic (fatty) livers that increase susceptibility to ischemia and reperfusion injury (IRI). Inflammatory cell accumulation has a greater role in IRI in steatotic liver than in normal liver. Although the recombinant human soluble thrombomodulin (rhsTM) attracts attention as a new treatment for disseminated intravascular coagulation, the therapeutic efficacy of rhsTM in hepatic IRI remains uncertain, especially in fatty livers. We aimed to demonstrate the effect of rhsTM on hepatic IRI using well-established in vivo experimental models with steatotic liver. Methods C57/BL6 mice were divided into 2 groups: normal liver (NL) group and fatty liver (FL) group, in which the steatotic liver was induced by high-fat diet for 9 weeks. The mice in the NL and FL groups were premedicated with venous injection of rhsTM (TM) or saline (Control) as control groups. All 4 groups (NL-Control vs NL-TM, FL-Control vs FL-TM) were subjected to partial hepatic warm ischemia followed by reperfusion. Results rhsTM significantly attenuated liver injury in the FL group as well as the NL group, as evidenced by transaminase levels and histologic finding after hepatic IRI. rhsTM remarkably decreased the accumulation of inflammatory cells, such as macrophages and neutrophils, in both NL and FL tissue after IRI. Furthermore, rhsTM depressed mRNA and protein expressions of adhesion molecules such as intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 in both NL and FL groups after IRI. Conclusion Our results demonstrate that rhsTM has a protective effect on fatty liver as well as normal liver after hepatic IRI. They also suggest that rhsTM contributes to attenuation of leukocyte accumulation caused by depressing expressions of adhesion molecules that facilitate accumulation of leukocytes in liver tissue in hepatic IRI.

Isolated biliary leakage is difficult to manage, and afflicted patients often develop refractory fistula. The present case was a 43-year-old male donor whose wife developed acute fulminant liver failure. Computed tomography (CT) volumetry showed that the estimated remnant liver volume was only 394 mL (31%) if his right lobe would be harvested. Since remnant liver volume was marginal, our proposed cut line for the right hepatectomy was set in order to preserve branches of the middle hepatic vein draining segments 4b+8 and 5. Right hepatectomy was performed, but on postoperative day 14, the donor developed fever and right back pain, and enhanced CT showed a 6 cm intra-abdominal abscess at the site of cutting, and we diagnosed it as an isolated biliary fistula since the isolated segment 5/8 was receiving arterial blood supply and exhibiting regrowth. A transabdominal abscess drainage was performed, after which the patient lost 30 to 50 mL of bile juice per day in drainage until 2 months after the drainage procedure. Ethanol injection, acetic acid injection, and transarterial or portal embolization for the isolated liver were proposed, but these all were impossible to carry out because there were no accessible routes. Thus, re-abscess drainage with a 7-French drainage catheter was performed through the isolated liver on postoperative day 53, and the isolated functional liver was punctured to induce liver atrophy. After this drainage, the isolated liver started to shrink and bile output had been stopped. In conclusion, our punctured-liver drainage could be effective for the treatment of isolated biliary fistula, allowing physicians to avoid an invasive additional liver resection or other invasive percutaneous approach using chemical reagents.

Objective In patients with living donor liver transplantation (LDLT), late-onset complications sometimes develop because of long-term use of immunosuppressive drugs. One of the immunosuppressive drug-related complications is de novo malignancies resulting in reduced survival. Patients and Methods Among 153 patients undergoing LDLT, we retrospectively reviewed the medical records of 97 adult recipients (February 2002 to May 2017), who had been followed-up at our hospital for more than one year after LDLT. The median age was 52 years old (20–70) and the median observational period was 6.9 years (2.4–15.3). Results De novo malignancy after adult LDLT developed in 11.3% (11/97) of patients, including posttransplantation lymphoproliferative disorder (PTLD) (n = 4) (2 in the brain and 2 in abdominal lymph nodes), lung cancer (n = 1), pancreatic cancer (n = 1), gastric cancer (n = 1), laryngeal cancer (n = 1), lower gingival cancer (n = 1), bladder cancer (n = 1), and melanoma (n = 1). Age at cancer diagnosis ranged from 36 to 70 years old with an average age of 61 years. The interval from LDLT to cancer diagnosis was 8.3 years (3.9–12.2). Four patients (36.6%) including PTLD (n = 2), lung cancer (n = 1), and pancreatic cancer (n = 1) died of cancer and all of them were diagnosed with cancer within 10 years after LDLT. Six patients were diagnosed with cancer more than 10 years after LDLT and all of them survived after treatment of cancer. Conclusion De novo malignancy was found in 11.3% of LDLT patients, and more than half of this population subset developed tumors 10 years after LDLT. Long-term close follow-up should be performed by taking any kinds of de novo malignancy into consideration.

Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

Objectives Hepatic artery thrombosis (HAT) is a serious complication after living-donor liver transplantation (LDLT) leading to patient death in the absence of revascularization. With the recent advances in interventional radiology, interventional endovascular techniques have been used as alternative therapeutic options for HAT. This study evaluates the feasibility and clinical outcomes of endovascular treatment for HAT after LDLT. Methods The medical records of 120 patients who underwent adult-to-adult LDLT between February 2002 and February 2015 in our hospital were retrospectively reviewed to evaluate the frequency of HAT and outcomes of endovascular treatment. Results A total of nine patients (7.5%) developed HAT after LDLT, and the all patients underwent endovascular treatment. Overall technical success with endovascular treatment was achieved in 77.8% (7 of 9) of the patients. Intra-arterial thrombolysis was successful in one patient. Further intervention after intra-arterial thrombolysis was performed in the form of percutaneous transluminal angioplasty in six patients, and percutaneous transluminal angioplasty with stenting in two patients. Two patients with failure of revascularization by endovascular treatment were treated conservatively and developed hepatic arterial collaterals, and the both patients could avoid the graft failure. The overall survival rates did not differ significantly between the patients without HAT (n = 111) and those with HAT (n = 9) (1-, 3-, and 5-year overall survival rates of the patients without HAT vs. with HAT: 78.1%, 67.8%, and 65.3% vs. 66.7%, 66.7%, and 66.7%, respectively; P = .77). Conclusion Interventional endovascular treatment of HAT in LDLT is a feasible and reliable procedure in avoiding early graft failure with acceptable long-term patient outcome.

Background Portal hypertension is a serious obstacle of partial orthotopic liver transplantation (POLT) with the use of small-for-size liver graft. Several therapeutic strategies including surgical innovations and pharmacological agents to reduce the portal hypertension have been developed. Splenectomy (SP) on POLT is one of surgical procedures to reduce portal pressure. We previously reported a dual cytoprotective mechanism of SP just before POLT, using small-for-size liver graft in a rat model. However, the best timing of SP during POLT has been unclear. We compared liver functions between SP just before and after POLT, using small-for-size rat liver grafts. Methods With the use of small-for-size liver grafts (20%) in rats previously reported, the rats were assigned to 2 groups: the pre-SP group (SP just before POLT) and the post-SP group (SP just after POLT). Liver tissues and blood were sampled at 6 and 24 hours after POLT for several liver function tests. Results The serum alanine aminotransferase levels at 24 hours after POLT were significantly decreased in the pre-SP group compared with the post-SP group (226 ± 78 vs 340 ± 71 IU/L). The infiltrations of neutrophil at 6 hours and ED-1–positive cells at 24 hours were significantly suppressed in the pre-SP group compared with the post-SP group. Serum hyaluronic acid levels, indicating attenuation of endothelial damage, were lower in the pre-SP group than in the post-SP group. Conclusions SP before POLT, which directly eliminates splenic inflammatory leukocytes, inhibits inflammatory leukocyte infiltration, which leads to impaired liver function as compared with SP after POLT.

Background Appropriate donor-recipient match has not been explored well in living-donor liver transplantation (LDLT) unlike deceased-donor liver transplantation. In this study, we evaluate the donor-recipient match using D-MELD (donor age × recipient Modified for End-stage Liver Disease [MELD] score) as a predictor of surgical outcomes in LDLT, paying attention to graft size and hepatitis C virus (HCV) status. Patient and Methods The 120 consecutive recipients who received adult-to-adult LDLT from March 2002 to December 2014 were divided into the two groups according to D-MELD score: D-MELD Results The 90-day mortality rate was significantly higher in the high-DM group than in low-DM group: 36.8% versus 14.9% ( P = .046). In the HCV-positive recipients, the 90-day mortality rate was significantly higher in high-DM group (n = 6) than in low-DM group (n = 37): 66.7% versus 13.5% ( P = .012), and the 3-year survival rate was significantly lower in high-DM group than in the low-DM group: 33.3% versus 56.8% ( P = .01). In the recipients with left graft, the 90-day mortality rate was significantly higher in the high-DM group (n = 8) than in the low-DM group (n = 41): 50% versus 14.6% ( P = .044), and total bilirubin level on postoperative day 14 was significantly higher in the high-DM group than in the low-DM group: 17.4 mg/dL versus 9.2 mg/dL ( P = .018). Conclusions It was clarified that D-MELD could predict early and long-term surgical outcomes in the recipients who were HCV-positive and who had smaller grafts.

Daikenchuto (DKT), a Japanese Kampo medicine, had been reported to increase small intestinal blood flow after liver resection. The aim of this study was to evaluate the effects of early enteral feeding of DKT on portal venous flow and early bowel movement after living donor liver transplantation (LDLT) in an attempt to clarify whether these effects on bowel motility can prevent bacterial and/or fungal translocation. Materials and Methods Our prospective study included the consecutive 16 LDLT recipients at Mie University Hospital between June 2006 and September 2009. Sixteen patients were divided into the 2 groups according to enteral feeding starting postoperative day (POD) 1: 8 patients in DKT (15 g/d) administration (DKT group, for 1 week) and 8 patients in tepid water administration (non-DKT group, for 1 week). Portal venous flow, portal venous pressure, presence of fungal infection (serum level of β-D-glucan and fungal polymerase chain reaction assay), time to first food intake, and time to first defecation were serially examined. Results Portal venous flow (mean [SD] velocity) was significantly increased in DKT group compared with non-DKT group: 47.5 (12.9) vs 31.8 (15.4) (P = .04) on POD 1, 46.8 (11.5) vs 28.8 (12.5) (P = .03) on POD 3, and 42.3 (17.2) vs 25.2 (9.0) (P = .05) on POD 5. However, mean (SD) portal venous pressures did not significantly change between the 2 groups. Between the 2 groups (DKT vs non-DKT), the day of first oral intake was not significantly different: 6.9 (2.5) vs 11.3 (8.7) (P = .061), but the mean (SD) day of first defecation was significantly shorter in the DKT group: 3.9 (1.1) vs 5.5 (2.6) (P = .02). Although fungal polymerase chain reaction assay was not significantly different between the 2 groups (4 vs 4 positive cases), the mean (SD) serum levels of β-D-glucan were significantly lower in the DKT group than in the non-DKT group: 9.0 (7.4) vs 18.4 (15.9) pg/mL (P = .04). Conclusion Early enteral feeding of DKT after LDLT increased portal vein blood flow without increasing portal vein pressure and stimulated early bowel movement, which in turn might prevent fungal translocation.

The goal of this study was to evaluate whether pretransplant serum hyaluronic acid (HA) levels can predict outcomes after adult-to-adult living donor liver transplantation (LDLT).In study I, 21 patients who underwent LDLT (March 2002-February 2004) were divided into 2 groups: the H-I group (HA ≥500 ng/mL; n = 12) and the L-I group (HA 500 ng/mL; n = 9). The influence of pretransplantation HA levels on short-term surgical outcome was investigated. In study II, 77 LDLT patients (May 2004-December 2014) were also divided into 2 groups: the H-II group (HA ≥500 ng/mL; n = 40) and the L-II group (HA 500 ng/mL; n = 37). We compared long-term survival and investigated prognostic factors.In study I, HA levels significantly decreased after LDLT, and those in the H-I group were significantly higher compared with the L-I group at 1, 3, 5, and 7 days after LDLT. There were significant differences in postoperative peak total bilirubin levels (H-I vs L-I, 17.2 vs 6.2 mg/dL; P = .013), peak ascitic fluid volume (1327 vs 697 mL/d; P = .005), and the hepatocyte growth factor levels at 3 days after LDLT (1879 vs 1092 pg/mL; P = .03). In study II, the 1- and 5-year survival rates were significantly lower in the H-II group than in the L-II group (H-II vs L-II, 65.0% and 48.5% vs 86.5% and 80.8%; P = .004). In multivariate analysis, significant prognostic factors were preoperative HA ≥500 ng/mL (P = .004) and graft to recipient body weight ratio 0.8 (P = .042).Preoperative HA level can be a prognostic risk factor. Patients with high HA levels are vulnerable and should be carefully managed after LDLT.

Background It is difficult to reconstruct the portal vein (PV) using a long interpositional venous graft in living donor liver transplant (LDLT) patients with portal vein thrombosis (PVT), which involves the confluence of the superior mesenteric vein (SMV) and splenic vein (SV). We successfully performed LDLT for three patients with PVT using an interpositional vascular conduit passing posterior to the pancreas without a jump graft. Methods Three of 130 patients who underwent LDLT in our hospital between March 2002 and June 2011 required this technique. After indentifying the location of the SMV, SV and gastrocolic trunk, we ligated and cut the posterior superior pancreaticoduodenal vein and other short branches from the PV. The PV was drawn inferiorly to the pancreas and transected at the confluence of SMV and SV. The external iliac vein or internal jugular vein was sacrificed as a graft for anastomosis to the cut end of the SMV using 6-0 polypropylene running sutures. Then the venous graft was drawn superiorly to the pancreas by passing it posterior to the pancreas parenchyma for anastomosis to the liver graft PV. The interpositional vein was placed posterior to the pancreas where the PV used to be. Results All three patients displayed favorable postoperative courses with the Doppler ultrasound demonstrating good portal flow perioperatively. The postoperative portogram demonstrated patency of the vascular graft. Conclusion This method is easy and helpful to treat portal vein thrombosis, by providing the shortest route between the PV of the donor and the SMV of the recipient.

High-temperature joint materials are indispensable to realizing next-generation power modules with high-output performance. However, crack initiation resulting from stress concentration in semiconductor chips joined with high-temperature joint materials remains a critical problem in high-temperature operation. Therefore, clarifying the quantitative influence of joint materials on the stress generated in chips is essential. This study investigates the stress behavior of chips joined by Ni–Sn solid–liquid interdiffusion (SLID), which results in a high-temperature joint material likely to generate cracks after joining or when under thermal cycling. The results are compared with those fabricated using three types of solders, Pb–10%Sn, Sn–0.7%Cu, and Sn–10%Sb (mass %), which are conventional joint materials with different melting points and mechanical properties. Using Ni–Sn SLID results in the generation of high compressive stress (500 MPa) without stress relaxation after the joining process in contrast to the case of solders in which the compressive stresses are low (

The Edinburgh Postnatal Depression Scale has widespread use internationally with adult women, but few psychometric properties have been described for samples of adolescent mothers. The purpose of this paper is to validate the psychometric properties of the EPDS in a sample of adolescent mothers (n = 149) in a southern, urban area of the United States. Internal consistency reliability was .88. Principal components analysis supported a two factor structure accounting for 60% of variance. Results of item response theory analysis suggest that the EPDS and the Center for Epidemiologic Studies of Depression Scale have similar psychometric properties. This data can be used to provide evidence of construct validity of the EPDS. The study provides a foundation for further psychometric testing of the instrument.

We report a case of tubulointerstitial nephritis and uveitis (TINU syndrome) with full type Fanconi syndrome. A 32-year-old woman presented with fatigue, anorexia and weight loss. Laboratory findings showed anemia, polyclonal hypergammaglobulinemia and moderate renal dysfunction. Tubular function abnormalities were normoglycemic glucosuria, panaminoaciduria, phosphaturia and kaliuresis leading to hypokalemia. Renal tubular acidosis and hypouricemia were also evident. Serum antistreptolysin O titer was high. Ocular symptoms (bilateral anterior uveitis) emerged soon after admission. Renal biopsy showed diffuse tubulointerstitial infiltration by lymphocytes and plasma cells without granuloma. Treatment with systemic steroids was given and renal function, and ocular symptom returned to normal with 3 months. Although tubular abnormalities involving TINU syndrome has already been reported, the disease associated with full type Fanconi syndrome has rarely been seen, and systemic steroid may be beneficial in reducing the development of tubulointerstitial injury.

PROBLEM: Receiving adequate social support has been associated with positive outcomes for the postpartum adolescent and her baby. Therefore, social support is an important variable to include in research studies of postpartum adolescents. However, instruments developed for use in adults cannot be assumed to reliably and validly measure health-related concepts such as social support in adolescents (Rogler, 1999; Yarcheski, Mahon, & Yarcheski, 1992) without psychometric evaluation. PURPOSE: Therefore, the purpose of this study was to describe the reliability and validity of the Postpartum Support Questionnaire (PSQ) (Logsdon, 2002; Logsdon, Usui, Birkimer, McBride, 1996) with adolescents. METHOD: The PSQ was revised for use with adolescents, based upon focus groups with adolescents and professionals. Then, the PSQ was administered to a convenience sample of postpartum adolescents (N = 109) recruited from the Teenage Parent Program. FINDINGS: High internal consistency reliability was demonstrated for the total instrument and subscales. Factor analysis supported four factors, in line with the PSQ data with adults, with some indication for an additional adolescent factor. However, in adolescents material support and emotional support tend to load on the same factor. CONCLUSIONS: Social support may be defined differently in postpartum adolescents, but further research with a larger sample is needed to substantiate this finding. Instruments with psychometric data specific to adolescents should be chosen by researchers who study this group.

Research has focused on defining which types of family interactions promote development of anxiety. Control has emerged as an important construct in anxious families. Central to conceptualizing the relationship between family functioning, control beliefs, and anxiety is establishing a sequential relationship among these variable, which may entail mediating or moderating relationships, or relationships that change over the course of development. The current study investigated whether control acts as a moderator or a mediator between perceived family environment and anxiety in your adults. An undergraduate sample (N = 364) completed the family assessment device (FAD), anxiety control questionnaire (ACQ), Beck anxiety inventory (BAI), and a demographic questionnaire. Structural equation modeling (SEM) was used to test both moderating and mediating models. No moderating effects were found. Sense of control mediated the relation between aspects of family functioning and anxiety. Theoretical implications and suggestions for future research are discussed.

This paper intends to provide general information about the experiences of numerical relay operation under many different kinds of surges from switchyards in Japan. The main focus of this paper is to investigate the immunity of numerical relays against a switching surge with relatively high frequency in a gas-insulated substation that is considered to be severe for the relay's correct operation. It is concluded that the reliability of today's numerical relays in Japan against the switching surge is almost sufficient due to the effectiveness of the immunity test standard adopted and countermeasures against the switching surge in Japan.

Limited success has been achieved in identifying high-risk pregnant women via prenatal risk identification tools. The purposes of this study were to examine a risk assessment and nursing telephonic case management protocol used to identify high-risk mothers and infants, and to evaluate the costs and benefits of the protocol. This study involved a retrospective review of insurance data held by a large managed care organization (MCO). Analyzed data included information about current and past medical problems, and current lifestyle risk factors. Data analysis included frequencies, chi2, t tests, and logistic regression analysis. Pregnant MCO members experienced fewer high-risk conditions versus nonmembers. The overall pregnancy cost for a member was 1,818 dollars versus 4,587 dollars for a nonmember. Members experienced 2.5 times fewer babies hospitalized in the NICU, and significantly fewer mothers with high-risk conditions. The MCO program reduces costs and promotes better maternal and infant outcomes.

For many applications, it is very useful to know whether a matrix is an H-matrix or not. Recently, some iterative tests have been proposed for distinguishing H-matrix. In this paper, we propose a new method for being able to distinguish only a scalar times column vector. Numerical evidence for the effectiveness of the proposed algorithm is presented.

This paper describes a fully integrated single-chip CMOS mixed-signal system on a chip (SoC) for DVD RAM and ROM systems. It integrates a 32-b RISC CPU, formatter, servo digital signal processor (DSP), 16-Mb DRAM, error correction code (ECC), ATA interface, and partial-response-maximum-likelihood (PRML) read channel with 7-b interpolated parallel analog-to-digital converter (ADC). Increasing the bus bandwidth by using embedded DRAM, a hardware ECC engine, and four parallel digital finite-impulse response (FIR) filters contributes to the high playback speed of 16/spl times/. PR(3,4,4,3) architecture has been used in the read channel system for optical disc systems. The obtained wide tangential tilt margin of /spl plusmn/0.6/spl deg/ is due to the use of this PRML read channel technique. The interpolated parallel scheme has attained a high number of effective bits of 6.3 for 72-Mz input frequency at 432-MSample/s operation without any calibration technique, with low power consumption of 180 mW in a small core size of 1.05 mm/sup 2/. This SoC has been fabricated in 0.18-/spl mu/m 1PS3AL CMOS embedded DRAM technology. It contains 24 million transistors in a 144-mm/sup 2/ die and consumes 1.2 W at 432-MSample/s operation. This low power consumption allows the use of a low-cost plastic package. As a result, we can compose highly reliable DVD RAM and ROM systems with this SoC and some tiny components.

Purpose To describe the relationship between postpartum support and depressive symptoms in a sample of African-American women of low socioeconomic status. Design Descriptive correlational design using a convenience sample. Method Fifty-seven African-American women at 4 to 6 weeks' postpartum were interviewed as they waited for their infant to receive a well-baby exam. Identification of amount and type of postpartum support received, as well as the importance of each type of support was measured using the Postpartum Support Questionnaire. Depressive symptoms were measured using the CES-D depression instrument. Results There was a high incidence of symptoms of depression, and depressive symptoms were associated with support being very important to the woman. Clinical implications Importance of support is a better predictor of outcomes than how much support a woman receives. Communication of need for support and establishing boundaries with family members are recommended.

Background and Purpose —Recent progress in noninvasive imaging techniques has resulted in increased detection of unruptured aneurysms. Although many neurosurgeons advocate surgical intervention for such unruptured aneurysms, the long-term results of surgery for unruptured aneurysms have not been carefully investigated. Methods —We analyzed 173 consecutive patients who had unruptured intracranial saccular aneurysm(s) detected by angiography that was performed for reasons other than subarachnoid hemorrhage (SAH). Of those, 115 cases were surgically treated and studied. All patients were followed up for either SAH, repeat treatment of aneurysms, or death. The median follow-up period was 8.8 years. Results —Four of the 115 patients suffered SAH either from a de novo aneurysm (2) or from regrowth of clipped aneurysm (1), or from regrowth after wrapping (1). Additionally, 1 patient also suffered SAH from an unstudied basilar aneurysm. One patient was incidentally found to have de novo aneurysm and underwent reoperation 14 years after the first operation. The cumulative risk for SAH for the 114 cases excluding the basilar aneurysm case was 1.4% in 10 years and 12.4% in 20 years. Conclusions —Although this study confirmed the long-term efficacy of clipping unruptured aneurysms, the risk of SAH was high compared with that in the general population, even after treatment. Considering the high mortality rate of SAH, long-term follow-up by angiography may be warranted for patients with surgically treated unruptured aneurysms.

Few techniques have been developed for deriving quantitative measures of activation patterns during ventricular fibrillation (VF). Such measures have many potential applications, for example, assessing the effects of time, drugs, or electrical interventions. We have developed a new framework for quantifying VF patterns as mapped from an array of approximately 500 unipolar electrodes. Individual activation wavefronts are isolated from one another using an algorithm that groups together adjacent active electrogram samples (dV/dt-0.5 V/sec). Contacts between wavefronts are detected: these include fractionations, in which a single wavefront breaks into multiple wavefronts, and collisions, in which multiple wavefronts coalesce to form a new wavefront. The timing and contact relationships between wavefronts are summarized as a directed graph. From this model of the VF episode, we derive several parameters: number of wavefronts, number of fractionations, number of collisions, mean wavefront size, mean area swept out, and mean duration. As an example of this analysis, we computed these parameters in six open-chest pigs at 5, 10, 15, and 20 sec after electrical induction of VF. The number of wavefronts and the number of collisions decreased, whereas the mean wavefront size and mean area swept out increased during this period. These results are consistent with previous studies showing a recovery of organization during the first minute of VF.

We have previously reported the cloning of a novel cytokine, IFN-gamma-inducing factor (IGIF), which shared some biologic activities with IL-12. In this study, we analyzed the effects of murine IGIF on the activation of T cells, and compared the effects with those of IL-12. IGIF alone had no effect on the activation of T cell lines or Th1 clones, while IGIF increased the IFN-gamma production by antigen-stimulated T cell lines, but had no effect on IL-4 or IL-10 production. As reported with IL-12, IGIF served as a costimulatory factor for Th1 clones stimulated with Ag on B cell APC, immobilized anti-CD3, Con A, or IL-2 to augment IFN-gamma production and to induce IL-2R alpha-chain expression and proliferation of the Th1 clones, whereas IGIF had little or no effect on the IL-4 production and proliferation of Th2 clones stimulated with anti-CD3 or Ag. However, IGIF synergized with IL-12 to further augment the IFN-gamma production of the Th1 clones. Even in the presence of saturated amounts of IL-12, IGIF still augmented the IFN-gamma production and proliferation and enhanced the IL-2R alpha-chain expression of the Th1 clones. In contrast with IL-12, IGIF induced IL-2 production by Ag- or anti-CD3-stimulated Th1 clones. These two findings indicate that IGIF and IL-12 are utilizing different signal transduction pathways. We also found that IGIF as well as IL-12 was endogenously released through interaction between Th1 cells and spleen cell APC in the presence of specific Ag, and that it regulated IFN-gamma production. These results further suggest that IGIF may act as an immunoregulatory factor in the immune response.

In deceased-donor liver transplantation settings, post-transplantation acute renal failure with the induction of renal replacement therapy (RRT) is known to have negative effects on graft and patient survivals. However, the impact of RRT in living-donor liver transplantation (LDLT) has not been well investigated. The aim of this study was to elucidate risk factors requiring RRT and prognostic factors after its induction.Clinical data on the consecutive 113 adult patients who underwent LDLT from March 2002 to May 2013 were retrospectively reviewed. They were divided into 2 groups: RRT (n = 33) and Non-RRT (n = 80). The primary reasons for receiving RRT were hepatorenal syndrome (n = 17), sepsis (n = 12), and renal hypoperfusion (n = 4).Although there were no significant differences in age or sex, the Model for End-Stage Liver Disease (MELD) score was significantly higher in the RRT group than in the Non-RRT group (23 ± 13 vs 16 ± 7; P = .002). The graft-recipient weight ratio (GRWR) was significantly lower in the RRT group (0.86 ± 0.3 vs 0.99 ± 0.2; P = .025). The 1- and 5-year patient survival rates were significantly higher in the Non-RRT group than in the RRT group (respectively, 91.3% and 84.3% vs 42.9% and 25.5%; P .001). In multivariate analysis, independent risk factors for receiving RRT were MELD score20 (P = .044) and GRWR 0.7 (P = .039). In the RRT group, donor age50 years (P = .042) and preoperative serum creatinine level1.5 mg/dL (P = .049) were significant prognostic risk factors.In adult LDLT patients, the induction of RRT after LDLT was a negative predictor of survival. In addition to the preoperative recipient's condition, donor factors including graft size and donor age influenced prognosis after the induction of RRT.

Background Biliary complications remain the leading cause of postoperative complications after living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy. The aim of this study was to analyze the causes of these complications. Methods One hundred eight patients who underwent LDLT with duct-to-duct biliary reconstruction at Mie University Hospital were enrolled in this study. The mean follow-up time was 58.4 months (range, 3–132). The most recent 18 donors underwent indocyanine green (ICG) fluorescence cholangiography for donor hepatectomy. The development of biliary complications was retrospectively analyzed. Biliary complications were defined as needing endoscopic or radiologic treatment. Results Biliary leakages and strictures occurred in 6 (5.6%) and 15 (13.9%) of the recipients, respectively, and 3 donors (2.7%) experienced biliary leakage. However, since the introduction of ICG fluorescence cholangiography, we have not encountered any biliary complications in either donors or recipients. Biliary leakage was an independent risk factor for the development of biliary stricture (P = .013). Twelve (80%) of the 15 recipients with biliary stricture had successful nonoperative endoscopic or radiologic management, and 3 patients underwent surgical repair with hepaticojejunosotomy. Conclusions Biliary leakage was an independent factor for biliary stricture. ICG fluorescence cholangiography might be helpful to reduce biliary complications after LDLT in both donors and recipients.

In this paper, some motor control methods by using a behavior model which is created by the FEA results are proposed. A real time simulator with the behavior model is worked with the real time motor control, especially the torque ripple control and the current sensorless control are performed and verified by the experiments.

Wide bandgap ternary Zn 1-x Hg x Se (x = 0-0.14) and quaternary Zn 1-x Hg x S y Se 1-y (x = 0-0.03, y = 0-0.4) alloy layers have been grown on GaAs substrates by molecular beam epitaxy (MBE), and characterized by optical reflectance, absorption and photoluminescence. The layers show strong photoluminescence composed of a single emission band whose peak energy decreases rapidly with increasing Hg content x. For the Zn 1-x Hg x S y Se 1-y layers with small x and y, the origin of the emission band can be explained in terms of excitonic transitions. As to the layers with large x and y, however, a large discrepancy is found between the fundamental absorption edge and the emission band. This behavior is discussed in terms of localized tail states induced by the microscopic compositional fluctuation of the alloy layers.

Support has been found to be related to perinatal health, resulting in the development of the Postpartum Support Questionnaire based on the four categories of support (informational, material, emotional and comparison) identified by House (1981) and Cronenwett (1985). Data from four studies (N=207) provided evidence of the psychometric properties of the instrument. Internal consistency reliability was demonstrated (alpha = .90 to .94 for total instrument). Test-retest reliability ranged from .69 to .79 for total scores and .30 to .79 for categories of support. Measures of concurrent validity with the Personal Resource Questionnaire 85 were .42 and .48 at 6 and 8 weeks postpartum. Confirmatory factor analysis using LISREL 7 supported the four categories of support, but the use of these factors separately remains to be demonstrated.

Deuterated polysiloxane with high transparency and high thermal stability was newly synthesized for use as optical waveguide material. Single-mode channel waveguides using the polymer were fabricated by conventional photolithography and dry etching. The propagation loss of the channel waveguides was measured and found to be 0.17 dB/cm at 1.31 /spl mu/m and 0.43 dB/cm at 1.55 /spl mu/m. The thermal and environmental stability of the waveguides was demonstrated by the fact that the propagation loss remained unchanged after tests at 200/spl deg/C for 30 min, at 120/spl deg/C for 1000 h, and at 75/spl deg/C and 90% RH for 1000 h.

Mizoribine (MZR), a purine nucleoside antibiotic, is an effective immunosuppressive agent that prevents rejection reactions after kidney transplantation in humans. The present study was performed to examine the effect of MZR on nephrosis produced in rats given puromycin aminonucleoside (PAN). Urinary protein excretion in rats injected with PAN and MZR (PAN + MZR rats) was shown to be reduced significantly in comparison with rats given only PAN (PAN rats). Although mild hypoproteinemia persisted during the experimental period in PAN + MZR rats, no loss of body weight or state of malnutrition was observed. The reduction of serum IgG and C3 was reversed by administration of MZR. Polyethyleinamine (PEI) staining of renal sections showed increased numbers of anionic sites in PAN + MZR rats in comparison with PAN rats, suggesting that MZR improved the permselectivity of the glomerular basement membrane (GBM). Moreover, the production of thromboxane B2 (TxB2) was significantly inhibited in PAN + MZR rats compared with PAN rats. No serious adverse effects of MZR were observed after a large dose of the agent. It is possible that restoration of the charge barrier of the GBM damaged by PAN, or reduction of TxB2 production by the glomeruli may underlie the reduction of protein excretion induced by administration of MZR.

Under atmospheric pressure, methanol was produced from CO2−H2 over Pd/ZnO and from CO−H2 over Pd/MgO catalyst. Similar support effects were observed over Cu catalysts.

Epitaxial layers of wide-bandgap Zn 1− x Hg x Se ( x = 0–0.14) alloys on GaAs substrates have been successfully grown by gas-source molecular beam epitaxy using elemental Zn and Hg, and H 2 Se gas. From the photoluminescence measurements at room temperature and 35 K, we find that luminescence spectra of the Zn 1− x Hg x Se layers are dominated by broad near-band-edge emission bands, whose emission peak shifts rapidly toward lower energies with increasing Hg content. The spectral width of emission bands is discussed in terms of microscopic compositional fluctuation in the alloy layers.

The junctional epithelium provides the front-line defense against periodontal bacterial infection. The migration of neutrophils into the junctional epithelium might represent a protective reaction against bacterial infections. However, neutrophils penetrate into the junctional epithelium even under sterile conditions. In this study, we analyzed and compared the number of neutrophils and the cytokine expression related to neutrophil migration in the junctional epithelium in conventional and germ-free mice. Germ-free and conventional ICR mice were used at 12 wk of age. Frozen sections were used for the detection of Gr-1, macrophage inflammatory protein-2 (MIP-2/CXCL2) and proliferating cell nuclear antigen-positive cells in the two groups of mice. Laser capture microdissection and RT-PCR analysis were used to evaluate the expression of keratinocyte-derived chemokine (KC/CXCL1), MIP-2, interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) mRNAs in the two groups of mice. Morphometric examination indicated an increase in the area of the junctional epithelium upon bacterial infection. Immunohistochemical studies also detected an increased number of neutrophils in the junctional epithelium upon bacterial infection. Higher up-regulation of KC and MIP-2 were detected in the junctional epithelium of conventional mice than in germ-free mice, whereas the expression of Il-1β and Tnfα mRNAs was not affected. Junctional epithelium cells constitutively expressed several types of chemokines and cytokines and the expression of chemokines was augmented by bacterial infection. Therefore, the constitutive expression of cytokines in junctional epithelium might be related to the morphological and functional homeostasis of the junctional epithelium in addition to the defense against the bacterial infection.

SUMMARYIRBP is a glycolipoprotein with a four-fold partially homologous repeat structure approximately 300 residues in length, and is one of the retinal antigens capable of inducing experimental autoimmune uveoretinitis (EAU) in susceptible animals by their active immunization. The most immunopathogenic peptide of bovine IRBP for FAU in Lewis rats is reported to be the sequence 1169–1191 (PTARSVGAADGSSWEGVGVVPDV) with two immunogenic motifs common to T cell epitopes (underlined). The uveitogenic site of peptide 1169–1191 was localized at the carboxyl terminus (peptide 1182 1191) and not al the amino acid terminus (peptide 1169–1182). Repeat peptides of sequenee 11 79–1191 containing the four homologous residues (1182W. 1186G. 1187V and 1189P). that is the peptides 271–283, 579 591 and 880892. all elicited EAU. Peptide 579–591 could not stimulate proliferation of lymphocytes from rats immunized with IRBP, but had the capacity to adoptively transfer EAU. The roie of the homologous residues was examined using analogues of the uveitogenic peptide 1182–1194. in which each homologous residue was substituted by giycine (G) or leucine (L) (1182W→G, 1186G→L, 1187V→G, and 1189 P→G). One analogue (1186G →L) strongly diminished the ability to induce FAU. while the other three analogues completely abolished the ability, indicating that these homologous residues were essential for the induction of FAU. In addition, the uveitogenic peptides tested in this study were found not to contain the major epitope for antibody production.

This paper reviews a new packaging technique for laser diode (LD) arrays. This technique uses a new film carrier which has high-density inner leads and fanned-out microstrip line patterns on polyimide film. The film carrier is used to connect the LD array to peripheral circuits, such as LD drivers. There is less mutual inductance between lines on the film carrier than with the conventionally used airing structure which comprises bonding wire and an alumina (Al/sub 2/O/sub 3/) circuit board. This structure can reduce the electrical crosstalk between channels on the LD array with high-density interconnection. A 4-channel LD array sub-module is fabricated employing the above technique, and demonstrated. The module has good frequency characteristics over a bandwidth of 2.3 GHz. The electrical crosstalk between adjacent LDs is less than -30 dB at 1 GHz. This value is about 10 dB lower than with the conventional wiring structure. >