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Purpose The present study analyzed the outcomes of our experience with abdominal aortic aneurysm (AAA) repair over 20 years using endovascular aortic repair (EVAR) with commercially available devices or open aortic repair (OAR) and reviewed our surgical strategy for AAA. Methods From 1999 to 2019, 1077 patients (659 OAR, 418 EVAR) underwent AAA repair. The OAR and EVAR groups were compared retrospectively, and a propensity matching analysis was performed. Results EVAR was first introduced in 2008. Our strategy was changed to an EVAR-first strategy in 2010. Beginning in 2018, this EVAR-first strategy was changed to an OAR-first strategy. After propensity matching, the overall survival in the OAR group was significantly better than that in the EVAR group at 10 years (p = 0.006). Two late deaths due to AAA rupture were identified in the EVAR group, although there were no significant differences between the OAR and EVAR groups with regard to the freedom from AAA-related death at 10 years. The rate of freedom from aortic events at 10 years was significantly higher in the OAR group than in the EVAR group (p Conclusion The rates of freedom from AAA-related death in both the OAR and EVAR groups were favorable, and the rate of freedom from aortic events was significantly lower in the EVAR group than in the OAR group. Close long-term follow-up after EVAR is mandatory.

Purpose To evaluate the efficacy of superselective transcatheter arterial embolization (TAE) for intractable postpartum hemorrhage (PPH) due to genital tract trauma (GTT) after vaginal delivery. Methods We evaluated 27 patients who underwent TAE for intractable PPH due to GTT after vaginal delivery at our institution between January 2008 and December 2020. Patients were divided into two groups according to TAE procedure; TAE performed as close as possible to the bleeding point, at least more peripherally than the second branch of the anterior division of the internal iliac artery, was defined as superselective TAE (S-TAE). TAE performed from the proximal segment of the internal iliac artery was defined as proximal TAE (P-TAE). Patient characteristics, pre-procedural contrast-enhanced computed tomography (CE-CT), procedure details, technical/clinical success, and complications were evaluated separately for the S-TAE and P-TAE groups. Results The combined technical/clinical success rate was 92%. No major procedure-related complications were seen (mean follow-up: 6.12 ± 3.93 days). The combined technical/clinical success rate of S-TAE was 100% and of P-TAE was 67% (p = 0.04). S-TAE was performed more frequently in patients with pre-procedural CE-CT (p = 0.01) and use of permanent embolic materials (p = 0.003). Conclusion S-TAE is safe and effective for intractable PPH due to GTT. Pre-procedural CE-CT may be useful for detecting the culprit artery and be helpful in performing S-TAE.

Purpose The purpose is to investigate the major and minor complications of the pancreas after transcatheter arterial embolization (TAE) using n-butyl-2-cyanoacrylate (NBCA) for bleeding from pancreatic arteries. Materials and methods Thirty-three patients who underwent TAE using NBCA for acute bleeding from pancreatic arteries and their parent arteries followed by contrast-enhanced computed tomography (CE-CT) were evaluated retrospectively. Complications and risk factors were assessed using Mann–Whitney U test or Fisher’s exact test for the univariate analysis. Patients’ characteristic, embolized artery, procedure details, and clinical outcomes were examined as possible risk factors. Results TAE was performed successfully in all patients. Minor pancreatic complications occurred in 10 patients (30%), including acute mild pancreatitis (n = 4) and focal lack of pancreatic parenchymal enhancement on CE-CT without pancreatitis (n = 6). No cases of major pancreatic complications, such as moderate/severe pancreatitis, were reported. Embolized artery was the only significant risk factor. The rate of complications per embolized artery were 15% (three out of 20 patients) in the arteries of the pancreatic head and 54% (seven out of 13 patients) in the arteries of pancreatic body and tail (p = 0.025). Conclusion TAE using NBCA for acute bleeding from pancreatic arteries is efficacious and safe. Mild pancreatic complications were observed more frequently in case of embolization of the pancreatic body and tail region than the pancreatic head.

Background Technological developments have led to an increased usage of external-body radiotherapy (RT) for the treatment of hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) may be required later in patients treated with RT because of the high recurrence rate and multinodular presentation of HCC. However, despite the risk of liver function impairment, the cumulative liver damage correlated with TACE following a hepatic RT has not been adequately assessed. Purpose To evaluate the feasibility of TACE following RT for HCC. Materials and methods Sixty-seven patients with HCC who underwent TACE after RT were retrospectively evaluated between 2012 and 2018. We assessed increases in Child–Turcotte–Pugh (CTP) by ≥2 points at 1 month, the incidence of major complications, survival duration, and short-term mortality within 6 months after TACE. Furthermore, we evaluated the predictive factors for liver function impairment and short-term mortality. Results Eight patients experienced a CTP increase ≥2 points at 1 month. There were no cases of liver abscesses or bilomas. Nine patients died within 6 months following TACE. The mean liver dose (MLD) was a significant predictor of liver function impairment at 1 month ( p = 0.042). Low liver functional reserve, distant metastasis ( p = 0.037), MLD ( p = 0.046), TACE type ( p = 0.025), and TACE within 3 months following RT ( p = 0.007) were significant predictors of short-term mortality. Conclusions Despite the feasibility of TACE following RT, clinicians should pay attention to impaired pretreatment liver function, following high dose RT, and the short duration between RT and TACE.

Background Preoperative prediction of thromboembolic complications using magnetic resonance imaging (MRI) in coronary arteries and carotid arteries has been established. However, the technique has not been applied in peripheral arteries. This study aimed to assess the relationship between thromboembolic complications during endovascular treatment (EVT) for iliac artery occlusion and signal intensity on MRI. Methods This single-institution study included 52 iliac artery occlusions in 51 patients (mean age, 70.4 years) who underwent successful EVT between January 2010 and March 2018. MRI using an inversion recovery-prepared, steady-state free precession technique was performed preoperatively. Thromboembolic complications were defined as distal embolization and in-stent protrusion greater than 25% of the stent cross-sectional area confirmed by angiography and intravascular ultrasonography, regardless of symptoms. The highest signal intensity of iliac artery occlusion divided by the signal intensity of adjacent iliopsoas muscle (target-to-muscle ratio, TMR) was measured on MR images. Multivariate analysis was performed to clarify the predictors of thromboembolic complications during EVT. Results Thromboembolic complications observed in 11 vessels (21.2%) from 11 patients comprised distal embolization (n = 4) and in-stent protrusion (n = 7). A TMR cutoff value > 2.57 had a sensitivity of 90.9%, specificity of 78.0%, positive predictive value of 52.6%, and negative predictive value of 97.0% for detecting thromboembolic complications during EVT. In the multivariate analysis, TMR >2.57 was the only independent factor associated with thromboembolic complications (odds ratio, 30.10; 95% confidence interval, 3.26–278.00; P = 0.003). Conclusions The presence of higher signal intensity in iliac artery occlusion on MRI is useful for predicting thromboembolic complications during EVT.

Detonation combustors are considered promising alternatives to conventional combustors because they offer high thermal efficiency and fast combustion. However, especially for the rotating detonation combustor, the theoretical propulsive performance has not been confirmed in experimental studies because the highly unsteady flow field hinders the measurements process. To understand the involved phenomena in more detail, a reflective shuttling detonation combustor (RSDC) with a rectangular combustion chamber was developed. The interior of the chamber can easily be visualized owing to its two-dimensional quality. Utilizing the RSDC, several combustion tests with gaseous ethylene and oxygen were conducted for different values of mass flow rates and equivalence ratios. Combustion modes from the tests were classified into four types based on the fast Fourier transform (FFT) analysis of the luminous intensity of the CH* self-luminescence images captured by a high-speed camera and a band pass filter. Simultaneously, the theoretical total pressure of a conventional isobaric combustor was compared to the static pressure measured at the bottom of the RSDC chamber. For the detonation modes, the ratio between experimentally measured static pressure and the theoretical pressure varied depending on the location in the chamber owing to the distribution of the time-averaged static pressure. Furthermore, the pressure ratio of the detonation modes was up to 18% lower than that of the deflagration mode potentially owing to the flow velocity induced by the detonation waves.

Decomposition reactions of NO molecules on gas-phase Rhn+ (n = 6–9) clusters were investigated by gas-phase thermal desorption spectrometry and density functional theory calculations. We found that NO adsorbs on the clusters, forming RhnNxOx+ at room temperature. Upon heating, NO desorption was observed below 800 K. Above 800 K, while for n = 7 and 8, each of Rh7N3O3+, Rh7N4O4+, and Rh8N3O3+ was found to release an N2 molecule, no N2 formation was clearly observed for Rh6,9NxOy+. We considered that both Rh7N3O3+ and Rh8N3O3+ have at least two dissociated NO molecules, while Rh6NxOx+ (x = 1–3) has one or less. Our computational results for Rh8N3O3+ suggested that the formation of an N–N bond in the Rh8N3O3+ structure must overcome an energy barrier of ∼2 eV, which is the highest among the suggested possible reaction pathways. These findings suggested that the size-dependent activity of NO decomposition is governed primarily by how NO molecules are adsorbed on Rhn+ clusters, i.e. whether two or more N atoms from dissociated NO molecules exist in the NO adsorbed clusters, and secondly, by the readiness of the N–N bond formation.

The photocatalytic bactericidal activity of titanium dioxide (TiO2) thin films has been extensively studied. In this study, we investigated the bactericidal activities of TiO2 nanotube (NT) thin films using Escherichia coli and Staphylococcus aureus cells as the model bacteria. Metallic titanium (Ti) thin films were anodized on a silicon (Si) wafer substrate to form TiO2 NT thin films. To evaluate the bactericidal activity of the TiO2 NT thin films, bacteria on the TiO2 NT thin films were irradiated with near-ultraviolet light (UV-A) at a wavelength of 365 nm. The bactericidal activity was estimated by the survival rate derived from the number of live cells, which form colonies on the cell culture medium. We demonstrated that the survival rate of the two types of bacteria investigated in this study was significantly reduced by UV light irradiation and that there was a difference in the temporal change in the survival rate between the two types of bacteria. Furthermore, we investigated the generation of reactive oxygen species (ROSs) by UV light irradiation of TiO2 NT thin films using electron spin resonance spectroscopy and fluorescence analysis. We found that the main ROS generated on the surface of the TiO2 NT film was the hydroxyl radical, OH•. In addition, the generation of ROSs increased with an increase in the UV irradiation time. We proposed a kinetic model that reproduces the dependence of bacterial viability on the UV light irradiation time by considering the temporal change in the amount of ROSs generated by UV light irradiation. A comparison of the calculated and experimental results revealed that the bactericidal effect consisted of the direct photolysis of bacteria and the photocatalysis via the generation of hydroxyl radicals, with the latter exhibiting a stronger bactericidal effect than the former.

歯周病と歯列不正は強い関連が認められており，双方の病態に大きな影響を与えている。長期間口腔内を健全な状態に保ち，種々の病態の再発を予防するためにも，歯周病に対する炎症のコントロールのみではなく，歯列不正の改善による適切な咬合の付与と安定化，力のコントロールが必須である。さらに，進行した歯周炎患者では，既存の歯列不正以外にも病的な歯の移動（Pathologic tooth migration：PTM）により咬合が不正となったり，二次性咬合性外傷が生じて歯周炎が進行する可能性もある。 今回，骨格性下顎前突症を伴う広汎型慢性歯周炎と診断した57歳の女性に対して，歯周基本治療後に下顎枝矢状分割術を伴う矯正治療を施行し，咬合状態を改善した後，保定治療中に歯周外科治療，補綴治療を行うことにより，歯周組織の改善と歯列，咬合の安定性が得られた症例を報告する。現在初診より13年が経過，歯周病安定期治療（Supportive periodontal therapy：SPT）へ移行してから6年経過しているが，良好に歯周組織と咬合の安定が維持されている。 骨格性下顎前突症を伴う慢性⻭周炎患者において，徹底的な炎症のコントロール下における下顎枝⽮状分割術を伴う矯正治療や補綴治療を含む包括治療を行う事で，歯周組織の長期安定を維持することができた症例を報告する。

Kawasaki Heavy Industries, Ltd. (KHI), Aachen University of Applied Sciences, and B&B-AGEMA GmbH have investigated the potential of low NOx micro-mix (MMX) hydrogen combustion and its application to an industrial gas turbine combustor. Engine demonstration tests of a MMX combustor for the M1A-17 gas turbine with a co-generation system were conducted in the hydrogen-fueled power generation plant in Kobe City, Japan. This paper presents the results of the commissioning test and the combined heat and power (CHP) supply demonstration. In the commissioning test, grid interconnection, loading tests and load cut-off tests were successfully conducted. All measurement results satisfied the Japanese environmental regulation values. Dust and soot as well as SOx were not detected. The NOx emissions were below 84 ppmv at 15 % O2. The noise level at the site boundary was below 60 dB. The vibration at the site boundary was below 45 dB. During the combined heat and power supply demonstration, heat and power were supplied to neighboring public facilities with the MMX combustion technology and 100 % hydrogen fuel. The electric power output reached 1800 kW at which the NOx emissions were 72 ppmv at 15 % O2, and 60 %RH. Combustion instabilities were not observed. The gas turbine efficiency was improved by about 1 % compared to a non-premixed type combustor with water injection as NOx reduction method. During a total equivalent operation time of 1040 hours, all combustor parts, the M1A-17 gas turbine as such, and the co-generation system were without any issues.

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Objective Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer-related deaths in Japan. Previous studies from other countries have reported venous thromboembolism prevalence rates of 12 to 36% in patients with pancreatic cancer. In this study, we aimed to determine the incidence of VTE in patients with PDAC in Japan and compare the characteristics of patients with and without VTE. Methods In this retrospective cohort study, clinicopathological characteristics of patients with and without concomitant VTE were compared. Patients Patients with PDAC treated at Fukui Prefectural Hospital, Japan from 2010 to 2019. Results The 1-year survival rate of all patients with pancreatic cancer was 40.7%. Among 432 patients with PDAC, 31 developed VTE. Seventeen (55%) patients received anticoagulant therapy. Compared with the non-VTE group, the VTE group had significantly more patients whose body mass index was >25 kg/m² ( p = .035) and had a significantly higher rate of chemotherapy ( p = .024). There was no significant difference in median survival time from PDAC diagnosis between the VTE and non-VTE groups. The 6-month mortality rate after VTE diagnosis was 54.8%. PDAC-related death was the most frequent cause of death, and thrombus-related death was not observed. Conclusion Several baseline characteristics differed between patients with and without VTE. The incidence of VTE in patients with PDAC is high. However, because the prognosis of PDAC itself remains quite poor, VTE may not have a significant effect on prognosis.

The adsorption forms of NO and NO

Purpose To evaluate the mid-term outcomes of transarterial embolization (TAE) for type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR) and investigate the predictors of sac enlargement after embolization. Materials and Methods We conducted a retrospective analysis of 55 patients [48 men and 7 women, median age 79.0 (interquartile ranges 74-82) years] who underwent TAE for type II endoleak from 2010 to 2018. The aneurysmal sac enlargement, endoleaks, aneurysm-related adverse event rate, and reintervention rate were evaluated. Patients' characteristics and clinical factors were evaluated for their association with sac enlargement. Results Fifty-five patients underwent TAE with technical success and were subsequently followed for a median of 636 (interquartile ranges 446-1292) days. The freedom from sac enlargement rates at 1, 3, and 5 years was 73.2%, 32.0%, and 26.7%, respectively. After initial TAE, the recurrent type II, delayed type I, and occult type III endoleak were identified in 39 (71%), 5 (9%), and 3 (5%) patients, respectively. Although a patient had aorto-duodenal fistula, there was no aneurysm-related death. The freedom from reintervention rates was 84.6%, 35.7%, and 17.0%, respectively. In the multivariate analysis, sac diameter > 55 mm at initial TAE (hazard ratios, 3.23; 95% confidence intervals, 1.22-8.58; P < 0.05) was a significant predictor of sac enlargement. Conclusion TAE for type II endoleak was not effective in preventing sac enlargement, and reinterventions were required among the mid-term follow-up. The sac diameter > 55 mm at initial TAE was a significant predictor of sac enlargement.

Introduction: The underlying mechanism involved in the recurrence of hepatoma after hepatic arterial embolization (HAE) is not adequately examined. An immunosuppressive cytokine, transforming growth factor β1 (TGF-β1), can lead to tumor progression and is affected by hypoxia in various cancers. The study aimed to assess the effect of HAE on the expression of TGF-β1 in a rat hepatoma model. Methods: Sprague-Dawley rats bearing N1S1 hepatoma cells underwent HAE (HAE group, n = 5) or sham treatment (sham group, n = 4). The animals were euthanized at 48 h, and liver tissues were harvested. Immunohistochemistry (IHC) and quantitative polymerase chain reaction (qPCR) were performed to compare the expression of TGF-β1 and hypoxia-inducible factor 1α (HIF-1α) between the HAE and sham groups. In vitro experiments with the N1S1 cell line were also performed under normoxic (21% O2) or hypoxic (1% O2) conditions for 48 h, and the expression of TGF-β1 and HIF-1α was assessed with western blotting and enzyme-linked immunosorbent assay. Statistical data comparisons were performed by Student t test. Results: IHC showed that both the TGF-β1-positive and HIF-1α-positive tumor peripheral areas were larger in the HAE group (6.59 ± 2.49 and 10.26 ± 4.14%; p < 0.001, respectively) than in the sham group (0.34 ± 0.41 and 0.40 ± 0.84% respectively). Similarly, qPCR showed that the mRNA expression levels of TGF-β1 and HIF-1α were higher (1.95 ± 0.38-fold and 1.62 ± 0.37-fold; p < 0.001 and p = 0.002, respectively) in the HAE group than those in the sham group. TGF-β1 expression was suppressed when HIF-1α inhibitors were added (p = 0.001), and HIF-1α expression was upregulated when exogenous TGF-β1 was added (p = 0.033) in N1S1 cells. Conclusion: HAE enhanced local TGF-β1 expression in a rat hepatoma model. In vitro experiments suggest that HAE-induced hypoxic stress may trigger the interdependent expression of TGF-β1 and HIF-1α.

We studied the effects of mineral oil (MO) on the properties and structure of a spread monolayer of polar lipid constituents in meibum, by performing cyclic lateral compression-expansion experiments using a Langmuir trough. A meibum sample without nonpolar lipids (meibumΔnonpolar-lipid) was prepared by removing the nonpolar lipids from biological meibum extruded from rabbit eyelids and spread on a water surface for measuring the cyclic surface pressure (π)-film area (A) isotherms with in situ observation of the film morphology using a Brewster angle microscope. The meibumΔnonpolar-lipid formed a homogeneous fluid monolayer and underwent collapse upon compression. The π-A isotherm shifted to a smaller area upon repeating the compression-expansion cycles. These observations contrasted those obtained for meibum previously, which may have resulted from the absence of nonpolar lipids. The recovery of the film stability against the lateral compression-expansion cycles was analyzed by adding MO as a nonpolar compound to the film system. A spread film of 1:1 mixture (by weight) could recover the high reversibility of the π-A isotherms during the repeated compression and expansion processes.

OBJECTIVE The aim of this study was to assess the utility of 70-kilovoltage-peak (kVp) contrast-enhanced computed tomography (CECT) for visualization and identification of the right adrenal vein (RAV) in comparison with that of conventional 120-kVp CECT. METHODS This retrospective study included patients who underwent adrenal venous sampling with concurrent biphasic 120-kVp (120-kVp group, n = 43) or 70-kVp (70-kVp group, n = 47) CECT. Signal-to-noise ratios, contrast-to-noise ratios, longitudinal lengths, conspicuity scores, RAV detection rates, and size-specific dose estimates were compared between the 2 groups. RESULTS In comparison with the 120-kVp group, the 70-kVp group had significantly higher signal-to-noise and contrast-to-noise ratios (P < 0.001-P = 0.033), greater longitudinal lengths (P < 0.001-P = 0.002), superior conspicuity scores for the RAV (P < 0.001), higher RAV detection rates (P = 0.015-P = 0.033), and lower size-specific dose estimates (P < 0.001). CONCLUSIONS Seventy-kilovoltage-peak CECT has advantages over conventional 120-kVp CECT and is potentially useful for noninvasive assessment of the precise anatomy of the RAV.

The adsorption and thermal desorption of NO and NO2 molecules on gold cluster anions, Au4–, were experimentally observed using gas-phase thermal desorption spectrometry. Multiple collisions of NO molecules with Au4– at 300 K generated Au4(NO)k– (k = 1–3). The NO molecules desorbed from the clusters in a stepwise manner when the clusters were heated, and finally Au4– was regenerated above 600 K. For NO2, Au4N2O4– was found to be thermally unstable. Hence, two NO2 molecules were sequentially released from Au4N3O6–, when Au4N3O6– was heated at 500–800 K, forming Au4NO2–. A gold oxide cluster, Au4O2–, was produced as a result of the decomposition of NO2 to NO and O on Au4–, and the NO molecules were released above 900 K.

Purpose To evaluate the incidence of type II endoleak (EL-II) and aneurysm enlargement after endovascular aneurysm repair (EVAR) using the Endurant stent graft in patients with abdominal aortic aneurysm (AAA) with occluded inferior mesenteric artery (IMA). Materials and Methods Between 2012 and 2017, 103 patients who underwent EVAR using the Endurant stent graft for AAA with occluded IMA (50 patients with prophylactic embolized IMA and 53 with spontaneous occluded IMA) were retrospectively reviewed. The incidence of EL-II and aneurysm enlargement was evaluated. Predictive factors for persistent EL-II were evaluated based on patient characteristics, preprocedural anatomical characteristics, intraprocedural details, and postprocedural complications. Results Incidence rates of early EL-II and persistent EL-II were 6.8% (7/103 patients) and 4.9% (5/103 patients), respectively. Aneurysm enlargement was found in 10 patients (9.7%), including all 5 patients with persistent EL-II, 3 with de novo EL-II, and 2 with no EL-II. The rates of freedom from aneurysm enlargement at 1, 2, and 3 years were 98.7%, 97.0%, and 93.1% for the group without persistent EL-II, and 80.0%, 60.0%, and 20.0% for the group with persistent EL-II (p

We investigated the bactericidal activity of bulk nanobubbles (NBs) using E. coli, a model bacterium. Bulk NBs were produced by forcing gas through a porous alumina membrane with an ordered arrangement of nanoscale straight holes in contact with water. NBs with different gas contents, including CO2, O2, and N2, were generated and evaluated for their bactericidal effects. The survival rate of E. coli was significantly reduced in a suspension of CO2-containing NB (CO2-NB water). The N2-NB water demonstrated a small amount of bactericidal behavior, but its impact was not as significant as that of CO2-NB water. When E. coli was retained in O2-NB water, the survival rate was even higher than that in pure water (PW). We investigated the generation of reactive oxygen species (ROS) in NB suspensions by electron spin resonance spectroscopy. The main ROS generated in the NB water were hydroxyl radicals and OH·, and the production of ROS was the strongest in CO2-NB water, which was consistent with the results of the bactericidal effect measurements. We assumed that NB mediated by ROS would exhibit bactericidal behavior and proposed a kinetic model to explain the retention time variation of the survival rate. The results calculated based on the proposed model matched closely with the experimental results.

Kawasaki Heavy Industries, LTD. (KHI) has research and development projects for a future hydrogen society. These projects comprise the complete hydrogen cycle, including the production of hydrogen gas, the refinement and liquefaction for transportation and storage, and finally the utilization in a gas turbine for electricity and heat supply. Within the development of the hydrogen gas turbine, the key technology is stable and low NOx hydrogen combustion, namely the Dry Low NOx (DLN) hydrogen combustion. KHI, Aachen University of Applied Science, and B&B-AGEMA have investigated the possibility of low NOx micro-mix hydrogen combustion and its application to an industrial gas turbine combustor. From 2014 to 2018, KHI developed a DLN hydrogen combustor for a 2MW class industrial gas turbine with the micro-mix technology. Thereby, the ignition performance, the flame stability for equivalent rotational speed, and higher load conditions were investigated. NOx emission values were kept about half of the Air Pollution Control Law in Japan: 84ppm (O2-15%). Hereby, the elementary combustor development was completed. From May 2020, KHI started the engine demonstration operation by using an M1A-17 gas turbine with a co-generation system located in the hydrogen-fueled power generation plant in Kobe City, Japan. During the first engine demonstration tests, adjustments of engine starting and load control with fuel staging were investigated. On 21st May, the electrical power output reached 1,635 kW, which corresponds to 100% load (ambient temperature 20 °C), and thereby NOx emissions of 65 ppm (O2-15, 60 RH%) were verified. Here, for the first time, a DLN hydrogen-fueled gas turbine successfully generated power and heat.

Purpose: To evaluate the clinical utility of the Gore Excluder iliac branch endoprosthesis (IBE) for Japanese patients with aortoiliac aneurysms. Materials and Methods: This was a multicenter retrospective cohort study (J-Preserve Registry). Patients undergoing endovascular aortic repair using the Gore Excluder IBE for aortoiliac aneurysms between August 2017 and June 2020 were enrolled. Data pertaining to the baseline and anatomical characteristics, technical details, and clinical outcomes were collected from each institution. The primary endpoints were technical success, IBE-related complications, and reinterventions. Secondary endpoints were mortality, aneurysm size change, and reintervention during follow-up. Technical success was defined as accurate deployment of the IBE without type Ib, Ic, or III endoleaks on the IBE sides on completion angiography. A change in aneurysm size of 5 mm or more was taken to be a significant change. Results: We included 141 patients with 151 IBE implantations. Sixty-five IBE implantations (43.0%) had at least one instruction for use violation. Twenty-two patients (15.6%) required internal iliac artery (IIA) embolization for external iliac artery extension on the contralateral side. Of 151 IBE implantations, 19 exhibited IIA branch landing zones due to IIA aneurysms. Mean maximum and proximal common iliac artery (CIA) diameters were 32.9±9.9 mm and 20.5±6.9 mm, respectively. The mean CIA length was 59.1±17.1 mm. The IIA landing diameter and length were 9.0±2.3 mm and 33.8±14.6 mm. The overall technical success rate was 96.7%. There were no significant differences in IBE-related complications (2.3% vs 5.3%, p=0.86) or IBE-related reinterventions (1.5% vs 5.3%, p=0.33) between the IIA trunk and IIA branch landing groups. The mean follow-up period was 635±341 days. The all-cause mortality rate was 5.0%. There were no aneurysm-related deaths or ruptures during the follow-up. Most patients (95.7%) had sac stability or shrinkage. Conclusion: The Gore Excluder IBE was safe and effective for Japanese patients in the midterm. Extending the IIA device into the distal branches of the IIA was acceptable, which may permit extending indications for endovascular aortic aneurysm repair of aortoiliac aneurysms to more complex lesions. Clinical Impact This study suggests clinical benefits of the Gore Excluder IBE for Japanese patients, despite 43% of the IBE implantations having at least one IFU violation.

Carbon dioxide (CO2) treatment is reported to have an antitumor effect owing to the improvement in intratumoral hypoxia. Previous studies were based on histological analysis alone. In the present study, the improvement in intratumoral hypoxia by percutaneous CO2 treatment in vivo was determined using 18F-fluoromisonidazole positron emission tomography-computed tomography (18F-FMISO PET-CT) images. Twelve Japanese nude mice underwent implantation of LM8 tumor cells in the dorsal subcutaneous area 2 weeks before percutaneous CO2 treatment and 18F-FMISO PET-CT scans. Immediately after intravenous injection of 18F-FMISO, CO2 and room air were administered transcutaneously in the CO2-treated group (n=6) and a control group (n=6), respectively; each treatment was performed for 10 minutes. PET-CT was performed 2 h after administration of 18F-FMISO. 18F-FMISO tumor uptake was quantitatively evaluated using the maximum standardized uptake value (SUVmax), tumor-to-liver ratio (TLR), tumor-to-muscle ratio (TMR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Mean ± standard error of the mean (SEM) of the tumor volume was not significantly different between the two groups (CO2-treated group, 1.178±0.450 cm3; control group, 1.368±0.295 cm3; P=0.485). Mean ± SEM of SUVmax, TLR, MTV (cm3) and TLG were significantly lower in the CO2-treated group compared with the control group (0.880±0.095 vs. 1.253±0.071, P=0.015; 1.063±0.147361 vs. 1.455±0.078, P=0.041; 0.353±0.139 vs. 1.569±0.438, P=0.015; 0.182±0.070 vs. 1.028±0.338, P=0.015), respectively. TMR was not significantly different between the two groups (4.520±0.503 vs. 5.504±0.310; P=0.240). In conclusion, 18F-FMISO PET revealed that percutaneous CO2 treatment improved intratumoral hypoxia in vivo. This technique enables assessment of the therapeutic effect in CO2 treatment by imaging, and may contribute to its clinical application.

This study sought to confirm if thoracic endovascular aortic repair (TEVAR) was an appropriate therapeutic strategy for blunt thoracic aortic injury (BTAI). Between 3/2005 and 12/2020, 104 patients with BTAI were brought to our hospital. The severity of each trauma case was evaluated using the Injury Severity Score (ISS); aortic injuries were classified as type I to IV according to Society for Vascular Surgery guidelines. Initial treatment was categorized into four groups: nonoperative management (NOM), open aortic repair (OAR), TEVAR, or emergency room thoracotomy/cardiopulmonary resuscitation (ERT/CPR). The patients’ mean age and ISS were 56.7 ± 20.9 years and 48.3 ± 20.4, respectively. Type III or IV aortic injury were diagnosed in 82 patients. The breakdown of initial treatments was as follows: NOM for 28 patients, OAR for four, TEVAR for 47, and ERT/CPR for 25. The overall early mortality rate was 32.7%. Logistic regression analysis confirmed ISS > 50 and shock on admission as risk factors for early mortality. The cumulative survival rate of all patients was 61.2% at 5 years after treatment. After initial treatment, eight patients receiving TEVAR required OAR. The cumulative rate of freedom from reintervention using TEVAR at 5 years was higher in approved devices than in custom-made devices (96.0 vs. 56.3%, p = 0.011). Using TEVAR as an initial treatment for patients with BTAI is a reasonable approach. Patients with severe multiple traumas and shock on admission had poor early outcomes, and those treated with custom-made devices required significant rates of reintervention.

Lung cancer is the leading cause of death from cancer in Japan. Studies in other countries have reported a venous thromboembolism (VTE) rate of 4%–20% in cancer patients. In this study, we aimed to determine the incidence of VTE in lung cancer patients in Japan and compared the characteristics of patients with and without VTE. In this retrospective cohort study, the clinicopathological characteristics of study patients with and without concomitant VTE were compared. Patients with lung cancer treated at Fukui Prefectural Hospital, Japan from 2008 to 2017. Of the 1471 patients with lung cancer studied, 28 developed VTE. Five patients developed pulmonary thromboembolism (PTE) alone, 9 PTE with concomitant deep vein thrombosis, and 14 deep vein thrombosis alone. Compared with patients in the non-VTE group, the VTE group was significantly younger (mean value ± SD 66.3 ± 10.1 vs. 73.0 ± 10.6 years, p = 0.001), contained significantly more patients with stage IIIb–IV disease (p = 0.002), and had a significantly higher rate of chemotherapy (p < 0.001) and radiation therapy (p = 0.007). There was no significant difference in median survival time from lung cancer diagnosis between the VTE and non-VTE groups. The 1-year mortality rate after VTE diagnosis was 60.7%. Lung cancer was the most frequent cause of death, followed by infection and VTE. Several baseline characteristics differed between patients with and without VTE. The prognosis may worsen after development of VTE, suggesting that lung cancer patients should be carefully monitored for it.

To assess the safety and efficacy of transarterial embolization (TAE) and to evaluate the utility of contrast-enhanced computed tomography (CE-CT) for life-threatening spontaneous retroperitoneal hemorrhage (SRH). Nineteen patients underwent TAE following CE-CT for life-threatening SRH. CE-CT and angiographic findings, technical successes, and clinical successes were evaluated. The diagnostic performance of CE-CT for the detection of active bleeding arteries was also assessed by two independent readers. Active extravasation of contrast material was accurately observed in 78.9‒84.2% of the patients on CE-CT. Angiograms revealed active extravasation in 37 arteries of 15 patients (78.9%), and 4 patients showed no sign of active bleeding. Sensitivity, positive predictive value, and accuracy rate of CE-CT for the detection of active bleeding vessels was 59.5%, 62.9‒71.0% and 55.6‒60.0% respectively. The successful embolization of 48 intended arteries was achieved in all the patients, including empirical TAE in four patients. Hemodynamic stabilization was achieved in 17 patients (89.5%) with a significant decrease in transfusion (p

Modification of Rh chemical activity for decomposition of NO by alloying with Ta was studied by vibrational spectroscopy of gas-phase clusters, where one single Rh atom was substituted by Ta, with NO adsorbed. While NO adsorbs molecularly on pure Rh clusters, it was found to adsorb dissociatively on RhnTa+ (n = 2–8) with the O bound to the Ta on-top site. A reaction path for NO decomposition obtained by density functional theory calculations for octahedral Rh5Ta+ and Rh6+ suggests that the Ta oxygen affinity strongly reduces the energy barrier right before bond cleavage, facilitating NO dissociation. The trend is consistent with the Bell–Evans–Polanyi principle. The addition of other less oxophilic dopant atoms could plausibly enhance catalytic reactivity of Rh.

As a novel detonation combustor that differs from a pulse and a rotating detonation engine, a reflective shuttling detonation combustor (RSDC), in which detonation waves shuttle repeatedly, was proposed. In a fan-shaped two-dimensional combustor, detonation waves propagate, repeating attenuation and re-ignition by a shock reflection at the side wall. In the demonstration experiment, chemiluminescence visualization and pressure measurement with ethylene–oxygen mixture were conducted at the same time. As the result, a single shuttling wave coupled with pressure rise was observed in the combustor. The tangential velocity of the wave was 1526 ± 12 m/s and approximately 60% of the estimated Chapman–Jouguet velocity of 2513 m/s. The ratio of pressure in front of the wave to one behind the primary wave or the reflected wave was in good agreement with one-dimensional shock theory, and it was suggested that the rapid reaction behind the reflected shock wave sustained the continuous propagation of the shock wave., ファイル公開：2021-01-01

Background Management of abdominal branches associated with Stanford type B aortic dissection is controversial without definite criteria for therapy after thoracic endovascular aortic repair (TEVAR). This is in part due to lack of data on natural history related to branch vessels and their relationship with the dissection flap, true lumen, and false lumen. Purpose To investigate the natural history of abdominal branches after TEVAR for type B aortic dissection and the relationship between renal artery anatomy and renal volume as a surrogate measure of perfusion. Materials and Methods This study included patients who underwent TEVAR for complicated type B dissection from January 2012 to March 2017 at 20 centers. Abdominal aortic branches were classified with following features: patency, branch vessel origin, and presence of extension of the aortic dissection into a branch (pattern 1, supplied by the true lumen without branch dissection; pattern 2, supplied by the true lumen with branch dissection, etc). The branch artery patterns before TEVAR were compared with those of the last follow-up CT (mean interval, 19.7 months) for spontaneous healing. Patients with one kidney supplied by pattern 1 and the other kidney by a different pattern were identified, and kidney volumes over the course were compared by using a simple linear regression model. Results Two hundred nine patients (mean age ± standard deviation, 66 years ± 13; 165 men and 44 women; median follow-up, 18 months) were included. Four hundred fifty-nine abdominal branches at the last follow-up were evaluable. Spontaneous healing of the dissected branch occurred in 63% (64 of 102) of pattern 2 branches. Regarding the other patterns, 6.5% (six of 93) of branches achieved spontaneous healing. In 79 patients, renal volumes decreased in kidneys with pattern 2 branches with more than 50% stenosis and branches supplied by the aortic false lumen (patterns 3 and 4) compared with contralateral kidneys supplied by pattern 1 (pattern 2 vs pattern 1: -16% ± 16 vs 0.10% ± 11, P = .002; patterns 3 and 4 vs pattern 1: -13% ± 14 vs 8.5% ± 14, P = .004). Conclusion Spontaneous healing occurs more frequently in dissected branches arising from the true lumen than in other branch patterns. Renal artery branches supplied by the aortic false lumen or a persistently dissected artery with greater than 50% stenosis are associated with significantly greater kidney volume loss. © RSNA, 2019 Online supplemental material is available for this article.

To evaluate the advantages of intraprocedural CT during adrenal venous sampling (AVS) to confirm accurate catheterization of the right adrenal vein (RAV). This single-institution study included 106 patients (mean age 52.4 years; range 28–74 years) with primary aldosteronism who performed contrast-enhanced CT (CECT) before AVS following AVS between January 2011 and March 2018. After catheterization of the RAV under fluoroscopic guidance, unenhanced CT images were obtained to confirm catheter position on unified CT angiography system. Catheter repositioning was performed when the catheter was inaccurately positioned. Venography findings were classified into two groups: (1) presumably cannulated in the RAV (presumed RAV group) and (2) obscured visualization of the RAV because of collateral vessels (obscured RAV group). Success rates of AVS were compared using Fisher’s exact test. The overall success of AVS was achieved in 104 patients (98.1%). Catheter was deviated into the IVC during intraprocedural CT in four patients. Fourteen patients (14.0%) required catheter repositioning by intraprocedural CT images, and accurate catheterization in the RAV was eventually accomplished. The success rate of AVS was significantly higher in the presumed RAV group (90.1% [73/81]) than that in the obscured RAV group (68.4% [13/19]) (p = 0.024). If intraprocedural CT was not acquired during AVS, the success rate of AVS would have been significantly lower (84.9% [90/106]) compared with that use of intraprocedural CT (98.1% [104/106]) (p