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Tool steels have been commonly applied to die and mold parts because of the high strength and the high abrasive wear resistance obtained by the heat treatments. In order to achieve high machining rate, the heat-treated tool steels have recently finished with end mills coated by hard thin layers. The cutting force in milling of the tool steel should be controlled to improve the fatigue lives of die and mold, which are associated with not only the surface qualities but also the microstructure in the subsurface. This paper discusses the cutting process in milling of a cold work tool steel in terms of the cutting force and the residual stress in finished subsurface.

Background Understandings of subtypes of atypical atrioventricular nodal reentrant tachycardia (AVNRT) using variants of slow pathway (SP) are still growing. Inferolateral (inf-lat-) left atrial (LA) SP is a rare variant extending into an inf-lat-LA along the mitral annulus (MA). Purpose To characterize an unknown subtype of atypical fast-slow (F/S-) AVNRT using an inf-lat-LA-SP as a retrograde limb (inf-lat-LA-F/S-AVNRT). Methods This Japanese multicenter retrospective study enrolled 4 patients of inf-lat-LA-F/S-AVNRT that was characterized by the earliest site of atrial activation during tachycardia (EAA) between 3 and 6 o'clock along the MA. The diagnosis was made by an exclusion of AV reentrant tachycardia (AVRT) and atrial tachycardia (AT) according to the standard criteria and was confirmed by successful elimination of tachycardia and the inf-lat-LA-SP. Results Surface ECG during tachycardia revealed long RP appearance except one who had short RP due to a short conduction time across the inf-lat-LA-SP. During tachycardia, far-field LA activation preceding near-field activation of coronary sinus (CS) musculature was visible in the CS recording in 2. Retrograde conduction via the inf-lat-LA-SP with a decremental delay was consistently reproducible with ventricular stimulation in 2, 1 of whom had double atrial response, while it was always masked by the presence of a retrograde conduction via the fast pathway in 1 and a retrograde block at the lower common pathway in 1. An injection of a small dose of ATP transiently interrupted a retrograde conduction over the inf-lat-LA-SP, suggesting its ATP-sensitivity. Exclusion of AVRT was made by no resetting of tachycardia with left ventricular extrastimulus in 2 and VA dissociation during overdrive pacing of tachycardia in remaining 2. Exclusion of AT was made by V-A-V response after ventricular entrainment in 1 and termination without atrial capture by ventricular pacing in 2. Ablation of the right-sided SP was unsuccessful to eliminate the tachycardia, but ablation at or near the EAA by transseptal approach was successful to cure the tachycardia, associated with an elimination of a retrograde conduction over the inf-lat-LA-SP following a development of an accelerated junction rhythm in all. Low-frequency potentials preceding local atrial activation, consistent with a retrograde activation via the inf-lat-LA-SP were detected along the MA medial to the EAA in 1. Conclusions Differential diagnosis of tachycardia with the EAA in the inf-lat-LA and especially long RP appearance should include inf-lat-LA-F/S-AVNRT. Presumed arrhythmogenic substrate of the inf-lat-LA-SP seemed to be consistent with the remnant of embryogenic AV ring tissue in the electropharmacological and locational characteristics. Successful elimination of this AVNRT can be obtained by ablation of the inf-lat-LA-SP, but not of the right-sided SP. Funding Acknowledgement Type of funding sources: None.

Steel tubes with differential wall thickness are required to reduce the weight of automobiles. One of the forming processes of steel tubes with differential thickness is the ironing of the inner surface[1]. In the first process, the end of the steel tube is expanded. In the second process, the punch is pushed in and the inner surface of the steel tube is ironed. As a result, the steel tube with a wall thickness difference of 50% can be formed. In this report, the behaviour of the steel tube during forming and the possible forming condition were clarified using FEM (Finite Element Method) analysis. Abaqus/Explicit was used for FEM analysis, and analysis was performed using an axisymmetric model. As a result of the analysis, it was found that the friction coefficient difference Δμ needs more than the threshold in order to form the steel tube with differential thickness. If Δμ is larger than the threshold, the steel tube is fixed at the expansion part, and the steel tube with differential thickness can be formed. On the other hand, if Δμ is smaller than the threshold, the expansion part is slipping during forming and the steel tube with differential thickness cannot be formed. This result suggests that the effect of the friction coefficient can be evaluated quantitatively using FEM analysis.

The water supply must be safe and sustainable. This requires a regulatory compliance, selection of an optimal water treatment process, timely response to water quality incidents as well as maintaining internal skills and knowledge among utility personnel to keep appropriate operational standards in the long run. Water supply services in Japan face various challenges, including a shrinking revenue base due to a declining population as well as a mass retirement of the baby-boomer generation. The Japan Water Research Center conducted questionnaire surveys and based on our findings developed the ‘knowledge transfer support system for water treatment technology’ for utilities to maintain internal skills and knowledge in the face of shrinking labour forces in the water sector. The system consists of three components: the database on water treatment technology, learning program on water treatment technology, and the assessment tool for knowledge transfer on water treatment technology.

Background Predicting the response of patients with ulcerative colitis (UC) to a molecular targeted drug before administration is an unmet need for optimizing individual patient care. We hypothesized that a new machine-learning approach could identify predictors of therapeutic efficacy that have not been reported as statistically significant factors using the conventional statistical approaches. As a proof-of-concept study, we explored predictors and a prediction model for the efficacy of vedolizumab (VDZ) for UC. Methods The clinical data at baseline (week 0) of 34 UC patients who started VDZ at Kyorin University Hospital was collected (Cohort 1; training cohort). The collected data contained 49 clinical features; patient background (e.g. sex, age, disease phenotype, etc.), treatment history, clinical/endoscopic activity, and blood examination items. Random forest (RF) was employed to investigate clinical features that affect steroid-free clinical remission (SFCR) with VDZ at week 22 in UC. A prediction model was developed using logistic regression based on the results of RF. The prediction ability of the prediction model was evaluated with the data of 35 patients who started VDZ at Toho University Sakura Medical Center (Cohort 2; extra-facility test cohort). The prediction ability of the VDZ prediction model for ustekinumab (UST) was examined using the data of 22 patients who started UST at Kyorin University Hospital (Cohort 3). Results RF computed the contribution of each clinical feature to achievement/no-achievement of SFCR at week 22. When the top 8 features (partial Mayo score, MCH, BMI, BUN, concomitant use of AZA, lymphocyte fraction, height, and CRP) were employed for logistic regression, the prediction accuracy of the prediction model was 100% and 68.6% for Cohorts 1 and 2, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in Cohort 2 were 92.3%, 54.5%, 54.5%, and 92.3%, respectively. Meanwhile, in Cohort 3 with UST, sensitivity, specificity, PPV and NPV were 70.0%, 45.5%, 53.4%, and 62.5%, respectively. Conclusion Our machine-learning approach detected clinical features at baseline that impact the achievement of SFCR at week 22 in patients who received VDZ for UC and developed a prediction model that appears to be useful to screen non-responders to VDZ. Given the low prediction ability in Cohort 3, our findings support the notion that a prediction model for each molecular targeted drug is needed for optimizing the drug selection for individual patients. This study provides the proof-of-concept that machine learning on clinical data could open a new era of personalized medicine for UC.

Issue Lifestyle modifications are essential for the prevention of lifestyle-related diseases such as hypertension, hyperlipidaemia, and type 2 diabetes. Healthcare providers in Japan are required to use information and communications technologies (ICT), such as health-related mobile applications (mHealth apps), in health guidance. Description of the Problem To understand the results of and issues in health guidance, two searches were conducted to identify the domains of health guidance provided using ICT. We searched the PubMed and Japan Medical Abstracts Society databases to identify articles published from 2000-2018. The first search identified frameworks of health guidance provided using ICT. The second search identified primary studies about using mHealth apps published between 2000 and 2018. The sample comprised 22 unique programs from 38 primary studies. The following research questions were explored: 1) What is the purpose of using the mHealth app? 2) Is there a significant difference in the effect of using the mHealth app instead of face-to-face communication? Results The mHealth app was used to enhance convenience and to improve or modify lifestyle. The latter included self-monitoring, typing health information, providing knowledge, sharing information, providing encouragement and praise, and correction of action plans. Some positive effects were observed, including compensating for insufficient information, enhancing self-management, and improving degrees of satisfaction of users. Only two programs did not report a significant difference in the effect of using the mHealth app as compared to face-to-face communication. Lessons This review showed that the frequency of typing information about diet and exercise appeared to be related to the prevention of primary lifestyle-related diseases and the improvement of self-management behaviour. Key messages Use of the mHealth app for providing health guidance might enhance continuous support for self-monitoring and self-management behaviour. Use the mHealth app for providing encouragement and praise might promote a smooth conversation, which in turn would facilitate appropriate self-management behaviour.

Over the years the consumption of plastic products made of conventional polymers has produced a large amount of waste which has led to disposal problems worldwide. Among the alternatives to minimize these problems are reuse and recycling practices. Then, the recycling of plastic and the use of recycled materials to produce new materials reinforced with nanoparticles from natural resources can be an alternative to reduce inappropriate waste disposal. The objective of this study is to investigate the effects of the addition of clay and non-treated babassu fiber residues on the mechanical and morphological properties of composite based on recycled LDPE/EVA blend. Composite materials containing 1–3 wt% of babassu residues and 1 wt% of clay were prepared using a twin-screw extruder machine and flat die single extrusion process, in order to prepare hybrid composites sheets. The sheets prepared by recycled LDPE/EVA blend and its composites were characterized by tensile tests, XRD, and FE-SEM analysis and the correlation between properties was discussed.

Approximately 10–20% of patients with primary biliary cholangitis (PBC) progress to jaundice stage regardless of treatment with ursodeoxycholic acid and bezafibrate. In this study, we performed a GWAS and a replication study to identify genetic variants associated with jaundice-stage progression in PBC using a total of 1,375 patients (1,202 early-stage and 173 jaundice-stage) in a Japanese population. SNP rs13720, which is located in the 3′UTR of cathepsin Z (CTSZ), showed the strongest association (odds ratio [OR] = 2.15, P = 7.62 × 10−7) with progression to jaundice stage in GWAS. High-density association mapping at the CTSZ and negative elongation factor complex member C/D (NELFCD) loci, which are located within a strong linkage disequilibrium (LD) block, revealed that an intronic SNP of CTSZ, rs163800, was significantly associated with jaundice-stage progression (OR = 2.16, P = 8.57 × 10−8). In addition, eQTL analysis and in silico functional analysis indicated that genotypes of rs163800 or variants in strong LD with rs163800 influence expression levels of both NELFCD and CTSZ mRNA. The present novel findings will contribute to dissect the mechanism of PBC progression and also to facilitate the development of therapies for PBC patients who are resistant to current therapies.

Treatment of blood blister-like aneurysm (BBA) is a challenge due to its unfavourable morphology, small size and the friable neck of BBA. In the management of ruptured BBA, coil placement can be achieved by stent-assisted coil embolisation. We propose to incorporate a new technique using a steam-shaped microcatheter to improve safety. A 59-year-old woman was transferred to our hospital and diagnosed with subarachnoid haemorrhage (SAH) due to a ruptured BBA of the left internal carotid artery (ICA) at the C2 portion. For coil embolisation, we selected the aneurysm sac using a three-dimensional shaping technique and the jailing method. Post-embolisation angiography revealed complete occlusion of the aneurysmal sac. For safe treatment and stability of BBA, the shape of the catheter tip and the distal portion of the microcatheter are two important factors to consider. The proposed technique could help resolve the problem of catheter shaping in the treatment of BBA.

Mirogabalin, which is a novel ligand for the α₂δ subunit of voltage-gated calcium channels, is being developed for treating neuropathic pain including diabetic peripheral neuropathy and postherpetic neuralgia. Mirogabalin possesses unique α₂δ subunit binding characteristics and has potent and long-lasting analgesic effects in neuropathic pain models. In the present study, we investigated the effects of mirogabalin on N-type calcium channel currents of the rat dorsal root ganglion (DRG) culture neurons using the whole-cell patch clamp technique. Small or medium DRG neurons were isolated from Sprague-Dawley rats and were incubated for 20 to 24 h with mirogabalin or pregabalin. The DRG neurons were depolarised from a holding potential of -40 mV to +40 mV in steps of 10 mV for 220 ms, and elicited N-type calcium channel currents were recorded. The N-type calcium channel currents were verified by sensitivity to ω-conotoxin GVIA, a selective N-type calcium channel blocker. Mirogabalin inhibited the calcium channel currents of rat DRG neurons at 50 μM, and pregabalin inhibited them at 200 μM. Mirogabalin and pregabalin showed significant differences in the peak current densities at depolarisation to -20 and -10 mV when compared with that shown by the vehicle control. In conclusion, mirogabalin inhibits N-type calcium channel currents in rat DRG culture neurons. The potent and long-lasting analgesic effects of mirogabalin are thought to be associated with its potent and selective binding to α₂δ-1 subunits and following functional inhibition of calcium channel currents.

A gas separator which makes use of the molecular exchange flow of a Knudsen pump is fabricated. The Knudsen pump makes use of the thermal transpiration of rarefied gas in several sheets of porous membrane of 8 cm × 8 cm in size. The gas separator is desktop size, and it works near atmospheric pressure. The device continuously splits the feed gas flow into two flows of product gases at the total flow rate of 3 6 sccm. The difference of mole percentage between the product gases are around 1 % for neon isotope mixture and 50 % for helium-neon mixture. Present gas separator increases the mole fraction of trace gases in the feed mixture by about 4−5 times. The feasibility of the production of high purity gases by present method is also discussed.

To study the effects of the boundary layer on the deflagration to detonation transition (DDT) process, the mixture behind an incident shock wave was ignited using laser breakdown. Ignition timing was controlled so that the interaction of the resulting flame with a laminar or turbulent boundary layer could be examined. In the case of the interaction with a laminar boundary layer, wrinkling of the flame was observed after the flame reached the corner of the channel. On the other hand, interaction with the turbulent boundary layer distorted the flame front and increased the spreading rate of the flame followed by prompt DDT. The inner structure of the turbulent boundary layer plays an important role in the DDT process. The region that distorted the flame within the turbulent boundary layer was found to be the intermediate region $$0.01< y/\delta < 0.4$$ , where y is the distance from the wall and $$\delta $$ is the boundary layer thickness. The flame disturbance by the turbulent motions is followed by the flame interaction with the inner layer near the wall, which in turn generates a secondary-ignition kernel that produced a spherical accelerating flame, which ultimately led to the onset of detonation. After the flame reached the intermediate region, the time required for DDT was independent of the ignition position. The effect of the boundary layer on the propagating flame, thus, became relatively small after the accelerating flame was generated.

Background: Survivin and monoamine oxidase A (MAOA) levels are elevated in prostate cancer (PCa) compared to normal prostate glands. However, the relationship between survivin and MAOA in PCa is unclear. Methods: We examined MAOA expression in the prostate lobes of a conditional PTEN-deficient mouse model mirroring human PCa, with or without survivin knockout. We also silenced one gene at a time and examined the expression of the other. We further evaluated the combination of MAOA inhibitors and survivin suppressants on the growth, viability, migration and invasion of PCa cells. Results: Survivin and MAOA levels are both increased in clinical PCa tissues and significantly associated with patients' survival. Survivin depletion delayed MAOA increase during PCa progression, and silencing MAOA decreased survivin expression. The combination of MAOA inhibitors and the survivin suppressants (YM155 and SC144) showed significant synergy on the inhibition of PCa cell growth, migration and invasion with concomitant decrease in survivin and MMP-9 levels. Conclusions: There is a positive feedback loop between survivin and MAOA expression in PCa. Considering that survivin suppressants and MAOA inhibitors are currently available in clinical trials and clinical use, their synergistic effects in PCa support a rapid translation of this combination to clinical practice.

Objectives The techniques and outcomes of outflow reconstruction in living donor liver transplantation (LDLT) using cryopreserved homologous veins at the University of Tokyo Hospital are presented. Methods We performed 540 LDLTs from January 1996 to March 2015. Graft types included right liver graft (n = 262), left liver graft (n = 196), left lateral sector graft (n = 53), and posterior sector graft (n = 28). We routinely use cryopreserved homologous vein grafts for the hepatic vein reconstructions to secure the large outflow of the graft. In addition to the presentation of our techniques, the cases with symptomatic outflow obstruction and the treatments were also investigated. Results The 1-, 3-, and 5-year graft survival rates were 90.6%, 86.1%, and 83.5%, respectively. The incidence of severe complications (Clavien-Dindo grade IIIb and more) was 38%. The overall incidence of outflow obstruction requiring invasive treatment was 1.9% (10/540), including 3 left liver grafts (1.5%, 3/196) and 7 right liver grafts (2.7%, 7/262). Regarding the patency of the reconstructed veins, the left hepatic vein, middle hepatic vein, and right hepatic vein achieved nearly 100% patency. On the contrary, venous tributaries such as V5, V8, and inferior right hepatic vein were frequently occluded in the postoperative course. Conclusions Outflow reconstruction is a key for the successful LDLT. Cryopreserved homologous vein graft is useful for the promising hepatic vein reconstruction.

A three-dimensional atom probe (3DAP) technique was used to observe the three-dimensional solute distribution around screw dislocations in neutron-irradiated modified 316 austenitic stainless steel. Si, Ni, and P were observed to get enriched around the cores of screw dislocations, while Fe, Cr, Mn, and Mo were depleted in the same areas. Si was segregated to a narrow region in the core for which, it was concluded that Si was trapped in the initial stage of segregation. Other enriched elements segregated to some edge features such as kinks and/or jogs formed as a result of Si trapping. The results suggest that solute–dislocation interaction of screw dislocations was similar to radiation-induced segregation, which is affected by the volume size factor of solute atoms.

100W C-band gallium nitride solid state power amplifier (GaN SSPA) was developed for satellite use. GaN SSPA has already been applied to various fields such as ground stations and radar systems. Mitsubishi Electric TOKKI Systems (MELOS) had succeeded in developing 150W S-band GaN SSPA and 70W C-band GaN SSPA for satellite use in the past. Based on these development results of the GaN SSPA, MELOS further developed a 100W C-Band GaN SSPA with power added efficiency (PAE) of 50%. In order to achieve higher power and efficiency, MELOS selected a new GaN device and optimized the matching circuit and improved the efficiency of electrical power conditioner (EPC). Furthermore, MELOS adopted MMICs in the RF Low Power Section and optimized the chassis to reduce size. Development result showed that, together with EPC, the GaN SSPA achieved an output power of 119.3W max with PAE of 53.4% max. The mass was 1.45 kg and environment tests at QT level proved that the GaN SSPA is applicable to space use. To the best of our knowledge, the GaN SSPA in this study achieves the highest PAE of C-band GaN SSPA ever reported over 100 W output power. MELOS will continue to pursue further its potential capabilities.

For the identification of susceptibility loci for primary biliary cirrhosis (PBC), a genome-wide association study (GWAS) was performed in 963 Japanese individuals (487 PBC cases and 476 healthy controls) and in a subsequent replication study that included 1,402 other Japanese individuals (787 cases and 615 controls). In addition to the most significant susceptibility region, human leukocyte antigen (HLA), we identified two significant susceptibility loci, TNFSF15 (rs4979462) and POU2AF1 (rs4938534) (combined odds ratio [OR] = 1.56, p = 2.84 × 10(-14) for rs4979462, and combined OR = 1.39, p = 2.38 × 10(-8) for rs4938534). Among 21 non-HLA susceptibility loci for PBC identified in GWASs of individuals of European descent, three loci (IL7R, IKZF3, and CD80) showed significant associations (combined p = 3.66 × 10(-8), 3.66 × 10(-9), and 3.04 × 10(-9), respectively) and STAT4 and NFKB1 loci showed suggestive association with PBC (combined p = 1.11 × 10(-6) and 1.42 × 10(-7), respectively) in the Japanese population. These observations indicated the existence of ethnic differences in genetic susceptibility loci to PBC and the importance of TNF signaling and B cell differentiation for the development of PBC in individuals of European descent and Japanese individuals.

A previous genome-wide association study (GWAS) performed in 963 Japanese individuals (487 primary biliary cholangitis [PBC] cases and 476 healthy controls) identified TNFSF15 (rs4979462) and POU2AF1 (rs4938534) as strong susceptibility loci for PBC. In this study, we performed GWAS in additional 1,923 Japanese individuals (894 PBC cases and 1,029 healthy controls), and combined the results with the previous data. This GWAS, together with a subsequent replication study in an independent set of 7,024 Japanese individuals (512 PBC cases and 6,512 healthy controls), identified PRKCB (rs7404928) as a novel susceptibility locus for PBC (odds ratio [OR] = 1.26, P = 4.13 × 10-9). Furthermore, a primary functional variant of PRKCB (rs35015313) was identified by genotype imputation using a phased panel of 1,070 Japanese individuals from a prospective, general population cohort study and subsequent in vitro functional analyses. These results may lead to improved understanding of the disease pathways involved in PBC, forming a basis for prevention of PBC and development of novel therapeutics.

The specific history of collisionless drift waves is marked by focusing upon current-driven, shear-modified, and electron-temperature-gradient modes. Studies of current-driven collisionless drift waves started in 1977 using the Innsbruck Q machine and was continued over 30 years until 2009 with topics such as plasma heating by drift waves in fusion-oriented confinement and space/astrophysical plasmas. Superposition of perpendicular flow velocity shear on parallel shear intensively modifies the drift wave characteristics through the variation of its azimuthal structure, where the parallel-shear driven instability is suppressed for strong perpendicular shears, while hybrid-ion velocity shear cause unexpected stabilization of the parallel-shear-modified drift wave. An electron temperature gradient can be formed easily by control of thermionic electron superimposed on ECR plasma, and is found to excite low-frequency fluctuation in the range of drift waves (© 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Introduction: The effects of Streptococcus salivarius on the competence-stimulating peptide (CSP)-dependent biofilm formation by Streptococcus mutans were investigated. Methods: Biofilms were grown on 96-well microtiter plates coated with salivary components in tryptic soy broth without dextrose supplemented with 0.25% sucrose. Biofilm formations were stained using safranin and quantification of stained biofilms was performed by measuring absorbance at 492 nm. Results: S. mutans formed substantial biofilms, whereas biofilms of S. salivarius were formed poorly in the medium conditions used. Furthermore, in combination cultures, S. salivarius strongly inhibited biofilm formation when cultured with S. mutans. This inhibition occurred in the early phase of biofilm formation and was dependent on inactivation of the CSP of S. mutans, which is associated with competence, biofilm formation, and antimicrobial activity of the bacterium, and is induced by expression of the comC gene. Comparisons between the S. mutans clinical strains FSC-3 and FSC-3ΔglrA in separate dual-species cultures with S. salivarius indicated that the presence of the bacitracin transport ATP-binding protein gene glrA caused susceptibility to inhibition of S. mutans biofilm formation by S. salivarius, and was also associated with the regulation of CSP production by com gene-dependent quorum sensing systems. Conclusion: It is considered that regulation of CSP by glrA in S. mutans and CSP inactivation by S. salivarius are important functions for cell-to-cell communication between biofilm bacteria and oral streptococci such as S. salivarius. Our results provide useful information for understanding the ecosystem of oral streptococcal biofilms, as well as the competition between and coexistence of multiple species in the oral cavity.

A transition of the drift wave instability driven by the parallel ion flow velocity shears is observed by controlling the ion density ratio in hybrid ion plasmas. Furthermore, an anomalous decrease in the fluctuation an amplitude is observed in the transition process, which is considered to be caused by enhancement of an ion Landau damping effect due to mixing of two unequal-mass ion species.

Group B Streptococci (GBS) is a leading cause of sepsis and meningitis in neonates and immunocompromised adults in western countries. GBS do not bind to fibronectin (Fn) in solution, but will bind to Fn adsorbed onto a solid surface. The reason for the specificity of this binding is unknown. Single molecule force spectroscopy was used to test the hypothesis that GBS, through streptococcal C5a peptidase (ScpB) molecules present on the surface of the bacteria, binds to a motif created by the juxtaposition of multiple adjacent Fn molecules. Atomic force microscopy (AFM) topographical images of adsorbed Fn deposited from various Fn coating concentrations were used to determine the Fn surface concentration. ScpB was tethered to an AFM tip with all surface modifications characterized by X-ray photoelectron spectroscopy and time-of-flight secondary ion mass spectrometry. At the lowest Fn coverages the probability of observing a ScpB-Fn binding event increased linearly with Fn surface coverage. As an Fn monolayer was reached the probability of a ScpB-Fn binding event occurring increased markedly ( approximately 50 fold), with a concomitant increase in the rupture force from 17 pN to 33 pN. These results are consistent with the hypothesis that ScpB binds to a motif created by the juxtaposition of multiple Fn molecules.

In pediatric teaching hospitals, medical decisions are traditionally made by the attending and resident physicians during rounds that do not include parents. This structure limits the ability of the medical team to provide "family-centered care" and the attending physician to model communication skills. The authors thus set out to identify how parents responded to participation in interdisciplinary teaching rounds conducted in a large tertiary care children's teaching hospital.A qualitative descriptive study was conducted using data from semistructured interviews of parents who had participated in rounds on the inpatient medical unit of a large academic children's hospital. From December 2004 to April 2005, 18 parents were interviewed after their participation in rounds. Questions assessed their experiences, expectations, preferred communication styles, and suggestions for improvement. Transcripts of the interviews were analyzed using qualitative content analysis.Being able to communicate, understand the plan, and participate with the team in decision making about their child's care were the most frequently cited outcomes of importance to parents. All 18 participants described the overall experience as positive, and 17 of 18 described themselves as "comfortable" with inclusion in rounds. Use of lay terminology and inclusion of nurses in rounds were preferred.Including parents on ward rounds at a teaching hospital was viewed positively by parents. Specific themes of particular importance to parents were identified. Further study is needed to assess the impact of inclusion of parents on rounds on patient outcomes and the resident experience.

The question of whether donor age negatively impacts recipient outcome in adult-to-adult living donor liver transplantation (LDLT) is rarely discussed. The aim of this study was to evaluate the impact of older donor age (50 years or older) on recipient outcomes in adult-to-adult LDLT.LDLT data were retrospectively evaluated from our 299 LDLT cases in 297 recipients, which were divided into 2 groups: a younger group (group Y, donor age50, n=237) and an older group (Group O, donor ageor=50, n=62). Clinical parameters of both recipients and donors were comparable between groups.There was no difference between the groups in patient survival or postoperative complications of either donors or recipients. In recipients, graft regeneration was significantly impaired in Group O. Graft function, including protein synthesis and cholestasis, was comparable between the 2 groups.Although the regeneration capacity of aged grafts was impaired, the function of grafts from older donors was comparable to that of those from younger donors. There was no difference in the clinical outcomes between the groups.

Understanding the interactions of adsorbed fibronectin (Fn) with other biomolecules is important for many biomedical applications. Fn is found in almost all body fluids, in the extracellular matrix, and plays a fundamental role in many biological processes. This study found that the structure (conformation, orientation) and reactivity of Fn adsorbed onto mica is dependent on the Fn surface concentration. Atomic force microscopy and x-ray photoelectron spectroscopy were used to determine the surface coverage of adsorbed Fn from isolated molecules at low surface coverage to full monolayers at high surface coverage. Both methods showed that the thickness of Fn film continued to increase after the mica surface was completely covered, consistent with Fn adsorbed in a more upright conformation at the highest surface-Fn concentrations. Time-of-flight secondary ion mass spectrometry showed that relative intensities of both sulfur-containing (cystine, methionine) and hydrophobic (glycine, leucine/isoleucine) amino acids varied with changing Fn surface coverage, indicating that the conformation of adsorbed Fn depended on surface coverage. Single-molecule force spectroscopy with collagen-related peptides immobilized onto the atomic force microscope tip showed that the specific interaction force between the peptide and Fn increases with increasing Fn surface coverage.

This paper proposes and demonstrates a numerical simulation method suitable to analyze the local damage and dynamic response of the structures composed of the reinforced concrete (RC) and/or the geological materials subjected to extremely severe loading by the energetic material like high explosives (HE). After the description of the numerical simulation method, the former part of this work attests that the present method has an enough accuracy to simulate the dynamic behavior of the RC structures subjected to the impulsive loading, through comparison of numerical analysis results with those of reference experiments. In the latter part of this work, a three-dimensional numerical simulation is performed by using the same analysis code as applied in the former part, but for much more complicated physical system. Through the discussion on the numerical simulation results the effectiveness of the present method is demonstrated from the viewpoint of the explosion safety and the structural integrity evaluation.

A 3.5-month-old papillon puppy was brought to our clinic with chief complaints of progressive quadriparesis, ataxia and head tremor. Lesions in the cerebellum, brainstem and spinal cord were suspected on the basis of a neurological examination. No abnormality was found in a clinicopathological examination or on magnetic resonance imaging. On the basis of these results differential diagnoses including an inflammatory disease, a degenerative condition or a storage disorder were considered. Subsequently, the signs progressed and glossoplegia and dysphagia developed at six months of age. At a second magnetic resonance imaging, severe atrophy of the entire brain was found. After these examinations, the puppy was euthanased and histopathologically diagnosed with neuroaxonal dystrophy. Because magnetic resonance imaging detected abnormal features that were characteristic of neuroaxonal dystrophy in this case, we speculate that magnetic resonance imaging can assist in the pre-mortem diagnosis of this disease.

With FDTD (finite-difference time-domain) calculations we study the acoustic waves propagating in a semi-infinite, two-dimensional (2D) periodic elastic structure, i.e., a 2D phononic crystal, with a flat surface together with a line defect. Specifically we search for the acoustic modes localized near the surface and at the same time confined inside the straight line defect, i.e., the surface guided waves. The surface assumed is perpendicular to the axis of circular cylinders (steel) embedded periodically in a background material (polymer). These surface guided waves found are unstable in general due to the interaction with bulk acoustic waves but can propagate the distances over several hundreds of lattice constants for a certain range of frequencies.

Background Differentiating between acute cellular rejection (ACR) and recurrent hepatitis C virus after liver transplantation in hepatitis C virus–positive patients is difficult, but vital for preventing graft loss. Methods The blood eosinophil counts 3 days before or on the day of biopsy were retrospectively reviewed to evaluate their value for predicting ACR in 91 biopsy samples from 45 patients. Results Eosinophil counts on the day of biopsy were significantly higher in the ACR group (n = 20) than in the non-ACR (n = 71) group, although the difference was negligible 3 days before the biopsy. A relative eosinophil count of 2% or an absolute eosinophil count of 200 cells/mm 3 predicted ACR with a specificity of 94% or 96%, respectively. Conclusions Blood eosinophil count on the day of biopsy can be helpful in the diagnosis of ACR in patients who underwent living donor liver transplantation for hepatitis C virus–related cirrhosis.

Aims: To investigate structure of the hot object in the symbiotic prototype Z And during its major 2000-03 active phase. Methods: Analysis of the far ultraviolet, optical low- and high-resolution spectroscopy and UBVR photometry. Reconstruction of the spectral energy distribution (SED) during the outburst. The Raman scattering process. Results: At the initial stages of the outburst the hot object was characterized by the two-temperature spectrum (a warm stellar radiation and a strong nebular emission) with signatures of a mass-outflow at moderate (100-200 km/s) and very high (1000-2000 km/s) velocities. The corresponding structure of the hot object consists of an optically thick, slowly-expanding disk-like material encompassing the accretor at the orbital plane and a fast optically thin wind over the remainder of the star. A striking similarity of [FeVII]6087 and Raman 6825 profiles at/after the dilution of the disk suggested their origin within the interaction zone where the winds from the binary components collide., 18 pages (printed format), 9 figures, 4 tables, 2 appendices; accepted for publication in A&A (02/03/2006)

This paper introduces a novel silicon-on-insulator (SOI) lateral radio-frequency (RF) bipolar transistor. The fabrication process relies on polysilicon side-wall-spacer (PSWS) to self-align the base contact to the intrinsic base. The self-aligned base and emitter regions greatly reduce the parasitic components. In this unique design, the critical dimensions are not limited by lithography resolution. With the control of the SOI film thickness or SWS width, the device can be optimized for higher speed, gain, breakdown, or current drive capability. Furthermore, with no additional mask, both common-emitter and common-collector layout configurations can be realized, providing more flexibility to the circuit design and more compact layout. The experimental f/sub T//f/sub max/ of the high-speed device are 17/28 GHz, the second fastest reported f/sub T/ for lateral bipolar junction transistors (LBJT) so far. As for the high-voltage device, the measured f/sub T//f/sub max/ of 12/30 GHz and BV/sub CEO/ of over 25 V produces a Johnsons product well above 300 GHz /spl middot/V. This figure is currently the closest reported data to the Johnsons limit for lateral BJTs. This technology can easily be integrated with CMOS on SOI. Therefore, it is feasible to build fully complimentary bipolar and MOS transistors on a single SOI substrate to form a true complementary-BiCMOS process. This silicon-based lateral SOI-BJT technology is a promising candidate for realizing future RF SoC applications.

Efficient allelic exchange mutagenesis in group B streptococci (GBS) has been hampered by the lack of a counterselectable marker system. Growth inhibition of GBS by the glutamine analog gamma-glutamyl hydrazide requires glnQ . We have used this phenomenon to create a counterselectable marker system for efficient selection of allelic exchange mutants in GBS.