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A 55-year-old woman was suspected of having hilar lymph node enlargement on a routine examination of the chest computed tomography( CT) scan at our hospital. On further examination, thoracic contrast CT and bronchial arteriography showed prominent dilation and meandering of the right bronchial artery with an aneurysm which formed a fistula to the pulmonary artery A7 at its distal end. Diagnosed as racemose hemangioma of bronchial artery with pulmonary artery fistula, we performed a surgical resection by open thoracotomy on the second day following bronchial artery embolization( BAE). No recurrence was observed in the five years of follow-up period after surgery. Therefore, surgical resection for asymptomatic racemose hemangioma of bronchial artery with bronchial artery-pulmonary artery fistula can be considered an effective method for the long-term prevention of bleeding.

The AMBITION study (NCT01178073) provided the first long-term clinical evidence for initial combination therapy with ambrisentan and tadalafil in patients with pulmonary arterial hypertension (PAH). Nevertheless, predictors of treatment response were not assessed.To identify predictors for response to initial combination therapy, we examined data from 302 patients with PAH (World Health Organization Functional Class II or III) who received initial combination therapy from the modified intention-to-treat population of the AMBITION study (n = 605). A responder was defined as not having undergone a clinical failure event. Univariate and multivariate analyses were performed. Multivariate logistic regression with interactive backward selection was used to assess the independent association of potential predictors with response.Treatment responders were younger, more often female, and less likely to have comorbidities or a requirement for oxygen therapy, compared with nonresponders. At multivariate analysis, female sex (odds ratio [OR] 2.67; 95% confidence interval [CI] 1.29, 5.52; P = 0.0081), longer 6-minute walk distance (OR 1.01; 95% CI 1.00, 1.01; P = 0.0039), lower baseline log N-terminal-prohormone of brain natriuretic peptide (OR 0.70; 95% CI 0.52, 0.94; P = 0.0190), and aldosterone antagonist use (OR 2.54; 95% CI 1.03, 6.26; P = 0.0436) independently predicted response to initial combination therapy.Besides demographic factors, the absence of comorbidities and less severe disease state, and the use of aldosterone antagonist therapy identified patients with PAH most likely to respond to initial combination therapy with ambrisentan and tadalafil. Further study to evaluate the role of aldosterone antagonist therapy in PAH is warranted.

Background: This retrospective study was conducted to evaluate the safety and efficacy of ambrisentan combination therapy with phosphodiesterase type 5 (PDE5) inhibitors in Japanese patients with pulmonary arterial hypertension (PAH). Methods and Results: PAH patients who received ambrisentan for the first time in combination with a PDE5 inhibitor between January 2013 and the end of August 2015 were included in this study. Adverse drug reaction (ADR) safety analysis, as well as the efficacy analysis focusing on changes in clinical parameters, were investigated for overall cases and cases stratified by patient background. Forty-eight consecutive patients (n=21, 43.8% with idiopathic PAH; male/female, 18/30; average age, 43.3±17.4 years; World Health Organization functional class III/IV, n=22, 45.8%) who were treated with ambrisentan and a PDE5 inhibitor in Japan underwent the safety analysis. A total of 14 ADR occurred in 10 patients (20.8%). ADR included headache (8.3%), face edema (4.2%), angina pectoris (2.1%), hyperemia (2.1%), dyspnea (2.1%), pulmonary hypertension (i.e., worsening of PAH, 2.1%), nausea (2.1%), hepatic function abnormal (2.1%), edema (2.1%), and sudden death (2.1%). On analysis of hemodynamics parameters, there was a significant improvement in the mean pulmonary arterial pressure (-13.5 mmHg, P=0.0001) and pulmonary vascular resistance (-563.53 dyn·s·cm-5, P=0.0033). Conclusions: Ambrisentan combination therapy is safe and effective in hemodynamics improvement.

We present the case of a giant bronchogenic cyst (BC) that appeared just within the right diaphragm. A 51‐year‐old man was referred to our hospital with a chief complaint of pain from the lumbar area to the right shoulder. Computed tomography images showed a cystic mass measuring 18.0 × 17.5 × 12.8 cm in the right thoracic cavity. Right posterolateral thoracotomy from the eighth intercostal space was performed, and the cyst wall and diaphragm were resected together. The defect of the diaphragm was repaired using a 2‐mm‐thick Gore‐Tex™ expanded polytetrafluoroethylene patch. It is embryologically rare for a giant BC to develop within the right diaphragm. As BCs may be associated with malignant tumours or infection, complete resection of the cyst wall is required. Literature review revealed no consensus on the best surgical procedure. Therefore, it is important to consider the appropriate surgical procedure for each case., We present an exceedingly rare case of a giant bronchogenic cyst that had developed within the right diaphragm. The cyst was successfully surgically resected.

We revisit supersymmetric nonlinear sigma models on the target manifold $CP^{N-1}$ and $SO(N)/SO(N-2)\times U(1)$ in four dimensions. These models are formulated as gauged linear models, but it is indicated that the Wess-Zumino term should be added to the linear model since the hidden local symmetry is anomalous. Applying a procedure used for quantization of anomalous gauge theories to the nonlinear models, we determine the form of the Wess-Zumino term, by which a global symmetry in the linear model becomes smaller in the action than the conventional one. Moreover, we analyze the resulting linear model in the $1/N$ leading order. Consequently, we find that the model has a critical coupling constant similar to bosonic models. In the weak coupling regime, the $U(1)$ local symmetry is broken but supersymmetry is never broken. In contrast to the bosonic case, it is impossible to find stable vacua in the strong coupling regime as far as in the $1/N$ leading order. These results are straightforwardly generalized to the case of the hermitian symmetric space., Comment: 1+22 pages, 2 figures; v2: a subsection, footnotes and a reference added; v3: references and comments added for section 1, published version

A 50's-year-old woman was pointed out an abnormal shadow in the right lung field on chest X-ray. Chest computed tomography revealed a nodule in the upper lobe of the right lung. No specific finding was shown by bronchoscopy. A thoracoscopic operation was performed. Wedge resection was performed using automatic suturing devices. Intraoperative pathology revealed the lesion to be necrotizing granuloma, and the operation was finished without resection of the residual upper lobe. After surgery, the upper right lung field shadow and intrathoracic hematoma were observed, and reoperation was performed. The residual upper lobe was highly congested with bleeding from the stump, requiring lobectomy. It was possibly caused by a deep cut of the lung parenchyma with automatic suturing devices at lung wedge resection, resulting in obstruction of the drainage vein.

ObjectivesTo evaluate initial combination therapy with ambrisentan plus tadalafil (COMB) compared with monotherapy of either agent (MONO), and the utility of baseline characteristics and risk stratification in predicting outcomes, in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) and the systemic sclerosis (SSc)–pulmonary arterial hypertension (PAH) subpopulation.MethodsThis post hoc analysis of the Ambrisentan and Tadalafil in Patients with Pulmonary Arterial Hypertension (AMBITION) study included patients with CTD-PAH from the modified intention-to-treat population. Time to clinical failure (TtCF) was assessed by baseline characteristics, treatment assignment and risk group (low, intermediate and high) at baseline and week 16. TtCF was compared between groups using Kaplan-Meier curves and Cox proportional hazards regression modelling.ResultsThe analysis included 216 patients (COMB, n=117; MONO, n=99). The risk of clinical failure was lower with COMB versus MONO (risk reduction: CTD-PAH 51.7%, SSc-PAH 53.7%), particularly in patients with haemodynamic parameters characteristic of typical PAH without features of left heart disease and/or restrictive lung disease at baseline. The risk of clinical failure was lower with COMB versus MONO in the baseline low-risk group (HR not calculated due to no events in COMB), baseline intermediate-risk group (HR 0.519, 95% CI 0.297 to 0.905) and in the week 16 low-risk group (HR 0.069, 95% CI 0.009 to 0.548).ConclusionsThe benefit of COMB over MONO was demonstrated in patients with CTD-PAH, particularly in those with typical PAH haemodynamic characteristics at baseline. COMB is appropriate for patients categorised as low risk and intermediate risk at baseline and low risk at follow-up.Trial registration numberNCT01178073.

Background: The AMBITION study (NCT01178073, sponsored by GSK and Gilead) demonstrated a reduced risk of clinical failure event in patients receiving initial combination therapy of ambrisentan and tadalafil (COMB) compared with initial monotherapy of either agent (MONO) in treatment-naive patients with pulmonary arterial hypertension (PAH)1). A similar treatment outcome was observed in connective tissue disease (CTD)-PAH or systemic sclerosis (SSc)-PAH subgroups in both the primary analysis set and modified intention to treat (mITT) population2,3). The 2015 ESC/ERS guidelines4) and 2018 WSPH consensus recommended the use of risk assessment (classified as low, intermediate, and high risk) based on the variables to predict prognosis, but the clinical utility of risk stratification in patients with CTD- or SSc-PAH has not been established. Objectives: To evaluate utility of risk stratification strategy in predicting outcomes in CTD-PAH patients by post-hoc analysis of prospectively collected AMBITION data. Methods: This study examined 216 patients with CTD (COMB; n=117: MONO n=99) enrolled in the AMBITION study mITT population. The most common underlying CTD etiology was SSc (n=137). Abbreviated average risk score5) was determined at baseline and at 16 weeks based on 6-minute walking distance, NT-proBNP, and WHO-FC. Time to clinical failure (TtCF) was compared between groups stratified by the risk stratification and/or treatment assignment using the log-rank test. Results: At baseline, CTD patients were divided into low (n=27, 12.5%), intermediate (n=179, 82.9%), and high risk (n=10, 4.6%) and at Week 16, subjects were classified as low (n=55, 27.9%), intermediate (n=135, 68.5%), and high risk (n=7, 3.6%). Risk of clinical failure was lowest for subjects in the baseline low risk group and highest in the baseline high risk group. When TtCF was compared between COMB and MONO arms of CTD-PAH patients in individual risk groups at baseline, risk of clinical failure event was lower in COMB than in MONO in the low and the intermediate risk groups (P=0.05, hazard ratio [HR] NA due to no event in COMB, and P= 0.02, HR 0.519, 95%CI 0.297-0.905, respectively), however, no difference in the high risk group was observed. The same analysis was conducted using risk stratification at week 16, resulting in a 93% risk reduction in TtCF after Week 16 in COMB, compared with MONO in the low risk group (P Conclusion: A simplified risk stratification at baseline and week 16 may be useful in predicting PAH related outcomes in patients with CTD-PAH. Among those achieving a low risk status at week 16, which could be considered a treatment goal, COMBO was associated with an improved outcome, when compared to MONO. References: [1] Galie N, et al. N Engl J Med2015; 373:834-44. [2] Kuwana M, et al. J Scleroderma Relat Disord2018 ;3: suppl. [3] Coghlan JG, et al. Ann Rheum Dis. 2017; 76:1219-27. [4] Galie N, et al. Eur Heart J. 2016; 37:67-119. [5] Kylhammar D, et al. Eur Heart J. 2017 (e-pub). Disclosure of Interests: Masataka Kuwana Grant/research support from: Actelion, Consultant for: Chugai, Reata, GlaxoSmithKline, Bayer, Boehringer-Ingelheim, Corpus, CSL-Berling, Mochida, Speakers bureau: Actelion, Pfizer, Bayer, Nippon Shinyaku, Chugai, Christiana Blair Employee of: Gilead Sciences, Jonathan Langley Employee of: GlaxoSmithKline, Tomohiko Takahashi Employee of: GlaxoSmithKline, Gerry Coghlan Grant/research support from: Actelion Pharmaceuticals, GlaxoSmithKline, Speakers bureau: Actelion Pharmaceuticals, GlaxoSmithKline, Bayer, Endotronix, Pfizer, United Therapeutics

There are few reports to explore immobilization of undesirable anionic species released from fly ash (FA) blended cement. This study clarifies the stabilities of several undesirable anionic species, through dissolution tests under a different matrix. The immobilization mechanism mainly involves co-precipitation with ettringite and hydrocalumite, the marginal formation of insoluble Ca salts, and occlusion in calcium silicate hydrates and amorphous phases produced during the pozzolanic reaction. The products released some amounts of chromate, arsenate, and selenite but not borate in dissolution tests. Elution of borate was the most effectively immobilized by Ca additives, owing to selective incorporation in ettringite. Moreover, selenite showed a trend of dissolving in acidic conditions, presumably owing to the dissolution of CaSeO3 with relatively high Ksp in addition to coprecipitation with hydrocalumite and ettringite. Under the present mixing condition of cementation, only selenite is a cautionary species which excessively eluted over the environmental standard.

We revisit the identity-based solutions for tachyon condensation in open bosonic string field theory (SFT) from the viewpoint of the sine-square deformation (SSD). The string Hamiltonian derived from the simplest solution includes the sine-square factor, which is the same as that of an open system with SSD in the context of condensed matter physics. We show that the open string system with SSD or its generalization exhibits decoupling of the left and right moving modes and so it behaves like a system with a periodic boundary condition. With a method developed by Ishibashi and Tada, we construct pairs of Virasoro generators in this system, which represent symmetries for a closed string system. Moreover, we find that the modified BRST operator in the open SFT at the identity-based tachyon vacuum decomposes to holomorphic and antiholomorphic parts, and these reflect closed string symmetries in the open SFT. On the basis of SSD and these decomposed operators, we construct holomorphic and antiholomorphic continuous Virasoro algebras at the tachyon vacuum. These results imply that it is possible to formulate a pure closed string theory in terms of the open SFT at the identity-based tachyon vacuum., 1+30 pages, 5 figures; v2: minnor corrections

We study profiles and gauge invariant observables of classical solutions corresponding to a constant magnetic field on a torus in open string field theory. We numerically find that the profile is not discontinuous on the torus, although the solution describes topologically nontrivial configurations in the context of low energy effective theory. From the gauge invariant observables, we show that the solution provide correct couplings of closed strings to a D-brane with constant magnetic field., 1+20 pages, 4 figures; v2: minor corrections

Pulmonary arterial hypertension (PAH) is an intractable and rare disease and the accumulation of clinical evidence under real-world setting is needed. A post-marketing surveillance for the endothelin receptor antagonist ambrisentan (Volibris tablet) has been conducted by all-case investigation since September 2010. This paper is an interim report on the safety and efficacy of ambrisentan in 702 patients with PAH. PAH patients aged 15 years or older were subjected to the analysis. The safety analysis by overall cases or stratification of patient backgrounds and the efficacy analysis were investigated. Regarding patient characteristics, the 702 patients subjected to safety analysis included 543 (77.4%) women and 546 (77.8%) patients at WHO functional class II/III. The mean observational time was 392.7 days. A total of 324 adverse drug reaction (ADR) occurred in 204 (29.1%) patients. Common ADRs (≥ 2%) included anemia (4.6%), peripheral edema (4.1%), headache (3.6%), edema and face edema (2.6% each), abnormal hepatic function (2.3%), and epistaxis (2.1%). There were 82 serious ADRs occurring in 44 (6.3%) patients (385 serious adverse events in 184 (26.2%) patients). Although 11 (1.6%) interstitial lung disease (ILD) cases were reported, all were observed in patients with disease that may contribute to ILD and therefore it is difficult to assess if ambrisentan was associated with these events. There was no difference in safety in relation to the presence/absence of connective tissue disease-related PAH (CTD-PAH) or combination therapy. Among 677 patients subjected to efficacy analysis, those in whom hemodynamic status was determined before and after treatment showed improvement in the mean pulmonary arterial pressure and pulmonary vascular resistance after treatment. The interim results showed safety consistent with the known profile of ambrisentan in terms of the types and frequencies of ADRs in patients with PAH in real clinical practice, in comparison with previous clinical trials in Japan and the rest of the world. Thus, these results provided another corroboration of the tolerability of ambrisentan and we continue to monitor proper use information via the post-marketing surveillance to ensure any new safety signals are identified in a timely manner (ClinTrial.gov: NCT01406327).

Blunt cardiac injury is a life-threatening condition. We report 3 successful cases in which we performed surgery for blunt cardiac injury. Three individuals were injured, 2 in traffic accidents and the other being caught between a crane and a steel frame. Echocardiograms and computed tomography scans revealed pooling of bloody pericardial fluid in all 3 patients, who underwent emergency surgery. Two patients needed sutures to control persistent bleeding. Although a heart-lung machine was prepared at the start of surgery in all 3 cases, we did not need to use it for any patient. Thus, prior to performing such surgery, it is necessary to ascertain its need.

A γ-ray spectroscopy experiment via the C 12 ( π + , K + ) reaction was carried out at KEK-PS in 2005. The K6 beam line and Superconducting Kaon Spectrometer (SKS) were employed to obtain a missing mass spectrum for 12ΛC. An upgraded germanium detector array, Hyperball2, was introduced to detect γ rays emitted from hypernuclei in coincidence with the ( π + , K + ) reaction. As a result of further analysis, a γ-ray peak at 6048 keV (preliminary) was newly observed and assigned as the M1 transition from the 6-MeV excited state to the ground state.

We are planning to perform an experiment at J-PARC and produce new neutron-rich Λ hypernuclei by using the (π −, K +) reaction (J-PARC E10). As the first step, we are planning to produce $${^6_{\Lambda}{\rm H}}$$ hypernuclei with a 6Li target. To conduct this experiment, we are developing new detectors, those are scintillating fiber tracker, and silicon strip detector, for high rate operation to aim at increasing beam intensity up to 107/spill. As a result of beam test in Jun 2012, we are going to use high-rate beam at least 107/spill.

Following the method recently proposed by Erler and Maccaferri, we construct solutions to the equation of motion of Witten's cubic string field theory, which describe constant magnetic field background. We study the boundary condition changing operators relevant to such background and calculate the operator product expansions of them. We obtain solutions whose classical action coincide with the Born-Infeld action., 1+22 pages, 1 figure; v2: a reference added, minor corrections

We construct the homotopy operators for the BRST operator in the theory around the identity-based solutions, which are believed to represent the tachyon vacuum in cubic bosonic open string field theory. Using the homotopy operators, we find that the one-loop vacuum energy at the tachyon vacuum is independent of moduli such as interbrane distances, which are included in the BRST operator. We also revisit the cohomology problem, which was solved earlier without the homotopy operators., Comment: 16 pages, LaTeX with PTPTeX.cls;v2: comments and footnotes added

Terahertz (THz) coherent synchrotron radiation (CSR) is emitted not only from ultra-short electron bunches, but also from electron bunches with micro-structures. Formation of micro-structures at the sub-picosecond scale in electron bunches by a laser slicing technique is experimentally studied through observation of the THz CSR. The THz CSR spectrum was found to depend strongly on the intensity and the pulse width of the laser. The results agreed qualitatively with a numerical simulation. It was suggested that the evolution of the micro-structure during CSR emission is important under some experimental conditions.

Bosonic Open String field theory has classical solutions describing a tachyon vacuum where D-branes completely annihilate. First, a numerical solution was constructed by using level truncation approximation in the Siegel gauge.1),2) Then, analytic classical solutions were constructed in terms of an identity string field∗) or wedge-like states.4) Although there are some differences, it is thought that these types of solutions possess certain properties of the tachyon vacuum: its vacuum energy density cancels a D-brane tension and the kinetic operator on its vacuum has vanishing cohomology.6),7) This makes us believe that these solutions correspond to the tachyon vacuum, but an important problem remains unsolved. How can we find closed strings on the vacuum? It has been noted that the identity-based solution provides the possibility of understanding closed strings on the vacuum. In the theory expanded around the identity-based solution, we can construct a Siegel gauge propagator acting on the usual open string Fock space. As pointed out by Drukker, the propagator generates a worldsheet swept by an open string, but the boundary is fixed at a point in the case of the tachyon vacuum solution.8) Hence, an amplitude calculated by the propagator corresponds to a worldsheet without boundaries, that is a closed string surface generated by closed strings. This closed worldsheet picture around the identity-based solution provides fascinating possibility to find closed strings of the tachyon vacuum. However, we encounter divergence difficulties if we calculate the amplitude explicitly. In this talk, we regularize this divergent amplitude by using level truncation approximation in order to explore the possibility of finding closed strings of the tachyon vacuum. In §2, we will give a brief review on the identity-based solution. In §3, we will provide a vacuum loop amplitude of an open string in the expanded theory. Finally, we will give concluding remarks in §4. This talk is based on the work in collaboration with S. Inatomi, I. Kishimoto and Y. Saito.

We explore the vacuum structure in bosonic open string field theory expanded around an identity-based solution parameterized by $a(>=-1/2)$. Analyzing the expanded theory using level truncation approximation up to level 20, we find that the theory has the tachyon vacuum solution for $a>-1/2$. We also find that, at $a=-1/2$, there exists an unstable vacuum solution in the expanded theory and the solution is expected to be the perturbative open string vacuum. These results reasonably support the expectation that the identity-based solution is a trivial pure gauge configuration for $a>-1/2$, but it can be regarded as the tachyon vacuum solution at $a=-1/2$.

The updated results from the hypernuclear γ -ray spectroscopy experiment, KEK-E566, are presented in this paper with emphasis on the γ -ray spin assignment. The KEK-E566 experiment was performed at the KEK-PS K6 beam line in 2005. In this experiment, C 12 ( π + , K + ) C Λ 12 reaction was used to produce C Λ 12 / B Λ 11 hypernuclei. A germanium detector array, Hyperball2, was constructed to detect γ rays emitted from the hypernuclei. Six hypernuclear γ -ray peaks were observed and assigned successfully.

In this paper, a preliminary result from the latest hypernuclear γ -ray spectroscopy experiment (KEK-E566) is presented together with a short discussion. The experiment was performed at the KEK-PS K6 beam line in 2005. In this experiment, the 12C(π+, K +)12 ΛC reaction was employed to populate 12 ΛC/11 ΛB hypernuclei. A germanium detector array, Hyperball2, was constructed to detect γ -rays emitted from the hypernuclei produced. Three hypernuclear γ -ray peaks were observed and assigned.

We show that the action expanded around Erler-Maccaferri's N D-brane solution describes the N+1 D-brane system where one D-brane disappears due to tachyon condensation. String fields on multi-branes can be regarded as block matrices of a string field on a single D-brane in the same way as matrix theories., Comment: 9 pages; v2: adding one paragraph about overlaps and minor corrections; v3: final version

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We study the physical spectrum of cubic open string field theory around universal solutions, which are constructed using the matter Virasoro operators and the ghost and anti-ghost fields. We find the cohomology of the new BRS charge around the solutions, which appear with a ghost number that differs from that of the original theory. Considering the gauge-unfixed string field theory, we conclude that open string excitations perturbatively disappear after the condensation of the string field to the solutions., Comment: 14 pages, LaTeX with ptptex.cls, typos corrected

We consider a modified KBc algebra in bosonic open string field theory expanded around identity-based scalar solutions. By use of the algebra, classical solutions on the background are constructed and observables for them, including energy densities and gauge invariant overlaps, are calculable. These results are applied to evaluate observables analytically for both of the identity-based trivial pure gauge solution and the identity-based tachyon vacuum solution., Comment: 20 pages; v2: minor corrections

We construct an analytic solution for tachyon condensation around identity-based marginal solutions in Berkovits' WZW-like open superstring field theory. Using this, which is a kind of wedge-based solution, the gauge invariant overlaps for the identity-based marginal solutions can be calculated analytically. This is a straightforward extension of a method in bosonic string field theory, which has been elaborated by the authors, to superstring. We also comment on a gauge equivalence relation between the tachyon vacuum solution and its marginally deformed one. From this viewpoint, we can find the vacuum energy of the identity-based marginal solutions to be zero, which agrees with the previous result as a consequence of $\xi$ zero mode counting., Comment: 16 pages

An infrared (IR) beamline, BL43IR, at SPring-8 has been constructed for IR spectroscopies under extreme conditions. The beamline covers a very wide photon energy range in the IR region and offers a brilliant IR photon beam to the experimental end stations. The IR light from SPring-8 is collected by a newly designed optical system including a so-called “magic mirror”. The design of the optical system and the obtained results are reported.