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Protonic solid oxide electrolysis cells (P-SOECs) are a promising technology for water electrolysis to produce green hydrogen. However, there are still challenges related key materials and anode/electrolyte interface. P-SOECs with Zr-rich electrolyte, called Zr-rich side P-SOECs, possess high thermodynamically stability under high steam concentrations but the large reaction resistances and the current leakage, thus the inferior performances. In this study, an efficient functional interlayer Ba0.95La0.05Fe0.8Zn0.2O3−δ (BLFZ) in-between the anode and the electrolyte is developed. The electrochemical performances of P-SOECs are greatly enhanced because the BLFZ can greatly increase the interface contact, boost anode reaction kinetics, and increase proton injection into electrolyte. As a result, the P-SOEC yields high current density of 0.83 A cm−2 at 600 °C in 1.3 V among all the reported Zr-rich side cells. This work not only offers an efficient functional interlayer for P-SOECs but also holds the potential to achieve P-SOECs with high performances and long-term stability.

Multiple randomized controlled trials (RCTs) have examined first-line pharmacological agents such as anticholinergics and β3 agonists for the management of overactive bladder symptoms (OAB). Although earlier systematic reviews and (network) meta-analyses aimed to summarize the evidence, a substantial number of trials were not included, so a comprehensive and methodologically rigorous evaluation of the comparative effectiveness of all first-line pharmacological treatments is lacking. We aim to conduct a series of systematic reviews and network meta-analyses (NMAs) for a comprehensive assessment of the effectiveness and safety of first-line pharmacological treatments for OAB. Eligible studies will include RCTs comparing anticholinergics and β3 agonists to one another or to placebo in adults with OAB or detrusor overactivity. Pairs of reviewers with methodological training will independently evaluate candidate studies to determine eligibility and extract relevant data. We will incorporate patient-important outcomes, including urinary urgency episodes, urgency incontinence episodes, any type of incontinence episodes, urinary frequency, nocturia, and adverse events. We will conduct the NMAs using a frequentist framework and a graph theory model for each outcome. Analysis will follow rigorous methodologies, including handling of missing data and assessment of the risk of bias. We will conduct sensitivity and subgroup analyses and will apply the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate evidence certainty. Our approach aims to address the knowledge gap in the treatment of OAB by synthesizing evidence from RCTs worldwide. We will employ robust statistical methods, including frequentist NMA, to general clinically relevant and patient-important insights. Sensitivity and subgroup analyses will enhance the robustness and generalizability of our findings. Our reviews strive to inform evidence-based decisions in the management of OAB, to ultimate improve patient outcomes. Our study results may guide health policy decisions, such as reimbursement policies, and future studies in functional urology.The protocol for the review series is registered on PROSPERO as CRD42023266915.

Background The lactate albumin ratio (LAR), a simple prognostic marker used in intensive care units (ICUs), combines lactate and serum albumin levels to predict patient outcomes. Despite its potential, the predictive accuracy of the LAR remains insufficiently explored. This study aimed to assess the usefulness of the LAR in predicting mortality among patients in the ICU.Methods This retrospective study conducted a secondary analysis of prospectively obtained clinical data from the Japanese Intensive Care Patient Database. We included all patients admitted to ICUs between 2015 and 2021, excluding those under the age of 16 years. The main outcome was in-hospital mortality. The LAR predictive value for this outcome was assessed by examining the area under the receiver operating characteristic curve and comparing it against prognostic indicators such as age, lactate, albumin and Sequential Organ Failure Assessment score. LAR shape was assessed using unrestricted spline curves, and the optimal cut-off value was identified from sensitivity and negative likelihood ratio. Subgroup analysis was used to evaluate the predictive accuracy of the LAR across different patient attributes and clinical scenarios.Results Of 2 34 774 cases analysed, in-hospital mortality was 8.8% (20 723 deaths). The LAR had an area under the curve of 0.761 (95%CI 0.757 to 0.765), indicating a fair predictive performance for in-hospital mortality. Unrestricted spline curves demonstrated that LAR can predict mortality through a monotonic positive dose–response relationship with 0.4 as the optimal cut-off value. In subgroup analysis, areas under the curve were significantly higher in subgroups defined by younger age, female sex, unplanned ICU admission, non-surgical patients, non-infectious patients, non-heart failure patients and lack of end-stage renal disease.Conclusions The LAR might be a useful predictor for screening mortality in ICU patients. However, further research to establish appropriate cut-off values for the LAR and identify the optimal target population is warranted.

Background: Although hydrocele is one of the most common urologic pathologies, it is seldom studied, and the major urologic associations have no guidelines for the management of adult hydroceles. Objective: To characterize international practice variation in the treatment of adult hydroceles. Design, setting, and participants: An international survey was conducted addressing the management of hydroceles among urologists in Belgium, Denmark, Finland, Iceland, Japan, and the Netherlands from September to December 2020. We invited a random sample of 170 urologists from each country (except Iceland). Outcome measurements and statistical analysis: Urologists’ treatment options, factors relevant for decision-making, expected patient satisfaction, and outcomes after aspiration versus surgery were assessed. Results and limitations: Of the 864 urologists contacted, 437 (51%) participated. Of the respondents, 202 (53%) performed both hydrocelectomies and aspiration, 147 (39%) performed hydrocelectomies only, and 30 (8%) performed aspiration only. In Belgium (83%), the Netherlands (75%), and Denmark (55%), urologists primarily performed hydrocelectomies only, whereas in Finland (84%), Japan (61%), and Iceland (91%), urologists performed both hydrocelectomies and aspiration. Urologists favored hydrocelectomy for large hydroceles (78.8% vs 37.5% for small), younger patients (66.0% for patients

Background Choosing catecholamines, such as norepinephrine and dopamine, for perioperative blood pressure control is essential for anesthesiologists and intensivists. However, studies specific to noncardiac surgery are limited. Therefore, we aimed to evaluate the effects of postoperative norepinephrine and dopamine on clinical outcomes in adult noncardiac surgery patients by analyzing a nationwide intensive care patient database. Methods The Japanese Intensive care PAtient Database (JIPAD) was used for this multicenter retrospective study. Adult patients in the JIPAD who received norepinephrine or dopamine within 24 h after noncardiac surgery in 2018–2020 were included. We compared the norepinephrine and dopamine groups using a one-to-one propensity score matching analysis. The primary outcome was in-hospital mortality. Secondary outcomes were intensive care unit (ICU) mortality, hospital length of stay, and ICU length of stay. Results A total of 6,236 eligible patients from 69 ICUs were allocated to the norepinephrine (n = 4,652) or dopamine (n = 1,584) group. Propensity score matching was used to create a matched cohort of 1,230 pairs. No differences in the in-hospital mortality was found between the two propensity score matched groups (risk difference: 0.41%, 95% CI [−1.15, 1.96], P = 0.608). Among the secondary outcomes, only the ICU length of stay was significantly shorter in the norepinephrine group than in the dopamine group (median length: 3 vs. 4 days, respectively; P < 0.001). Conclusions In adult patients after noncardiac surgery, norepinephrine was not associated with decreased mortality but was associated with a shorter ICU length of stay than dopamine.

Abstract Background This study compared the effects of remimazolam and sevoflurane on intraoperative hemodynamics including intraoperative hypotension (IOH). Results This study involved adult patients undergoing noncardiac surgery using remimazolam (Group R) or sevoflurane (Group S) for maintenance anesthesia, and invasive arterial pressure measurements, from September 2020 to March 2023 at our hospital. IOH was defined as a mean blood pressure

Abstract Protonic solid oxide electrolysis cells (P‐SOECs) operating at intermediate temperatures, which have low costs, low environmental impact, and high theoretical electrolysis efficiency, are considered promising next‐generation energy conversion devices for green hydrogen production. However, the developments and applications of P‐SOECs are restricted by numerous material‐ and interface‐related issues, including carrier mismatch between the anode and electrolyte, current leakage in the electrolyte, poor interfacial contact, and chemical stability. Over the past few decades, considerable attempts have been made to address these issues by improving the properties of P‐SOECs. This review comprehensively explores the recent advances in the mechanisms governing steam electrolysis in P‐SOECs, optimization strategies, specially designed components, electrochemical performance, and durability. In particular, given that the lack of suitable anode materials has significantly impeded P‐SOEC development, the relationships between the transferred carriers and the cell performance, reaction models, and surface decoration approaches are meticulously probed. Finally, the challenges hindering P‐SOEC development are discussed and recommendations for future research directions, including theoretical calculations and simulations, structural modification approaches, and large‐scale single‐cell fabrication, are proposed to stimulate research on P‐SOECs and thereby realize efficient electricity‐to‐hydrogen conversion.

Abstract Background De-implementation of low-value care can increase health care sustainability. We evaluated the reporting of direct costs of de-implementation and subsequent change (increase or decrease) in health care costs in randomized trials of de-implementation research. Methods We searched MEDLINE and Scopus databases without any language restrictions up to May 2021. We conducted study screening and data extraction independently and in duplicate. We extracted information related to study characteristics, types and characteristics of interventions, de-implementation costs, and impacts on health care costs. We assessed risk of bias using a modified Cochrane risk-of-bias tool. Results We screened 10,733 articles, with 227 studies meeting the inclusion criteria, of which 50 included information on direct cost of de-implementation or impact of de-implementation on health care costs. Studies were mostly conducted in North America (36%) or Europe (32%) and in the primary care context (70%). The most common practice of interest was reduction in the use of antibiotics or other medications (74%). Most studies used education strategies (meetings, materials) (64%). Studies used either a single strategy (52%) or were multifaceted (48%). Of the 227 eligible studies, 18 (8%) reported on direct costs of the used de-implementation strategy; of which, 13 reported total costs, and 12 reported per unit costs (7 reported both). The costs of de-implementation strategies varied considerably. Of the 227 eligible studies, 43 (19%) reported on impact of de-implementation on health care costs. Health care costs decreased in 27 studies (63%), increased in 2 (5%), and were unchanged in 14 (33%). Conclusion De-implementation randomized controlled trials typically did not report direct costs of the de-implementation strategies (92%) or the impacts of de-implementation on health care costs (81%). Lack of cost information may limit the value of de-implementation trials to decision-makers. Trial registration OSF (Open Science Framework): https://osf.io/ueq32 .

Abstract Background Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted in a primary care setting, 163 (72%) aimed to reduce the use of drug treatment, 194 (85%) measured the total volume of care, and 64 (28%) low-value care use as outcomes. Of the trials, 48 (21%) described a theoretical basis for the intervention, and 40 (18%) had the study tailored by context-specific factors. Of the de-implementation interventions, 193 (85%) were targeted at physicians, 115 (51%) tested educational sessions, and 152 (67%) multicomponent interventions. Missing data led to high risk of bias in 137 (60%) trials, followed by baseline imbalances in 99 (44%), and deficiencies in allocation concealment in 56 (25%). Conclusions De-implementation trials were mainly conducted in primary care and typically aimed to reduce low-value drug treatments. Limitations of current de-implementation research may have led to unreliable effect estimates and decreased clinical applicability of studied de-implementation strategies. We identified potential research gaps, including de-implementation in secondary and tertiary care settings, and interventions targeted at other than physicians. Future trials could be improved by favoring simpler intervention designs, better control of potential confounders, larger number of clusters in cluster trials, considering context-specific factors when planning the intervention (tailoring), and using a theoretical basis in intervention design. Registration OSF Open Science Framework hk4b2

Abstract Background Fentanyl is selected to manage pain in critical care patients on mechanical ventilation in the intensive care unit (ICU). However, the usefulness of fentanyl compared with other opioids is unknown. This study examined the evidence for using fentanyl to improve the clinical outcomes of ICU patients, using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Methods We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases in June 2021. Two independent assessors reviewed studies to identify randomized, controlled trials (RCTs) that compared the intravenous administration of fentanyl and other opioids in mechanically ventilated patients in the ICU. The study quality was assessed using the GRADE system and Cochrane methodology. The primary outcome was mortality. The secondary outcomes were the duration of mechanical ventilation, duration of the ICU stay, incidence of severe adverse events, and incidence of delirium. We integrated outcome data using a random-effects model and showed absolute values and certainty of evidence in the GRADE evidence profile. Results Seven RCTs met the study inclusion criteria with 534 patients (251 were treated with fentanyl and 283 with other opioids, including 242 with remifentanil and 41 with morphine). Among 191 participants from 2 RCTs, fentanyl was not associated with mortality (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.24 to 2.60; low-quality evidence). Regarding the secondary outcomes, fentanyl did not shorten the duration of mechanical ventilation (mean difference, 0.49 h; 95% CI, − 0.90 to 1.88; moderate-quality evidence) or the duration of the ICU stay (mean difference, 7.04 h; 95% CI, − 3.27 to 17.35; moderate-quality evidence) compared with other opioids. Fentanyl did not increase the incidence of severe adverse events (RR, 0.98; 95% CI, 0.50 to 1.90; low-quality evidence) or delirium (RR, 1.27; 95% CI, 0.79 to 2.04; low-quality evidence). Conclusions Although fentanyl is a frequently administered opioid in the ICU, patients’ outcomes are not different between fentanyl use and use of other opioids. However, the GRADE evaluation provides little certainty to support the results of this systematic review. Therefore, further large RCTs are required to confirm our conclusions. Trial registration PROSPERO, CRD42019130648 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130648 ).

Hydrogen, especially the “green hydrogen” based on water electrolysis, is of great importance to build a sustainable society due to its high-energy-density, zero-carbon-emission features, and wide-range applications. Today's water electrolysis is usually carried out in either low-temperature (700 °C) applications, e.g., solid oxide electrolyzer. However, the low-temperature devices usually suffer from high applied voltages (usually >1.5 V @0.01 A cm−2) and high cost; meanwhile, the high-temperature ones have an unsatisfied lifetime partially due to the incompatibility among components. Reasonably, an intermediate-temperature device, namely, proton ceramic cell (PCC), has been recently proposed. The widely-used air electrode for PCC is based on double O2-/e- conductor or composited O2-/e-−H+ conductor, limiting the accessible reaction region. Herein, we designed a single-phase La0.8Sr0.2Co1-xMnxO3-δ (LSCM) with triple H+/O2-/e- conductivity as the air electrode for PCCs. Specifically, the La0.8Sr0.2Co0.8Mn0.2O3-δ (LSCM8282) incorporates 5.8% proton carriers in molar fraction at 400 °C, indicating superior proton conducting ability. Impressively, a high current density of 1580 mA cm−2 for hydrogen production (water electrolysis) is achieved at 1.3 V and 650 °C, surpassing most low- and high-temperature devices reported so far. Meanwhile, such a PCC can also be operated under a reversible fuel cell mode, with a peak power density of 521 mW cm−2 at 650 °C. By correlating the electrochemical performances with the hydrated proton concentration of single-phase triple conducting air electrodes in this work and our previous work, a principle for rational design of high-performance PCCs is proposed.

Abstract Background The joint committee of the Japanese Society of Intensive Care Medicine/Japanese Respiratory Society/Japanese Society of Respiratory Care Medicine on ARDS Clinical Practice Guideline has created and released the ARDS Clinical Practice Guideline 2021. Methods The 2016 edition of the Clinical Practice Guideline covered clinical questions (CQs) that targeted only adults, but the present guideline includes 15 CQs for children in addition to 46 CQs for adults. As with the previous edition, we used a systematic review method with the Grading of Recommendations Assessment Development and Evaluation (GRADE) system as well as a degree of recommendation determination method. We also conducted systematic reviews that used meta-analyses of diagnostic accuracy and network meta-analyses as a new method. Results Recommendations for adult patients with ARDS are described: we suggest against using serum C-reactive protein and procalcitonin levels to identify bacterial pneumonia as the underlying disease (GRADE 2D); we recommend limiting tidal volume to 4–8 mL/kg for mechanical ventilation (GRADE 1D); we recommend against managements targeting an excessively low SpO2 (PaO2) (GRADE 2D); we suggest against using transpulmonary pressure as a routine basis in positive end-expiratory pressure settings (GRADE 2B); we suggest implementing extracorporeal membrane oxygenation for those with severe ARDS (GRADE 2B); we suggest against using high-dose steroids (GRADE 2C); and we recommend using low-dose steroids (GRADE 1B). The recommendations for pediatric patients with ARDS are as follows: we suggest against using non-invasive respiratory support (non-invasive positive pressure ventilation/high-flow nasal cannula oxygen therapy) (GRADE 2D), we suggest placing pediatric patients with moderate ARDS in the prone position (GRADE 2D), we suggest against routinely implementing NO inhalation therapy (GRADE 2C), and we suggest against implementing daily sedation interruption for pediatric patients with respiratory failure (GRADE 2D). Conclusions This article is a translated summary of the full version of the ARDS Clinical Practice Guideline 2021 published in Japanese (URL: https://www.jsicm.org/publication/guideline.html ). The original text, which was written for Japanese healthcare professionals, may include different perspectives from healthcare professionals of other countries.

This study demonstrates the highly enhanced photocatalytic activity of Fe2O3 nanotubes by making a heterojunction with Fe2WO6 and doping of W6+ ions into the α-Fe2O3 phase for water splitting and decomposition of an organic pollutant. Both nanotubular and compact Fe2O3/Fe2WO6 films are formed by anodizing the magnetron-sputtered Fe-9 at% W alloy in fluoride-containing ethylene glycol electrolyte and subsequent annealing at 450 °C. Their photocatalytic activities are compared with W-free nanoporous Fe2O3 film formed on high-purity Fe. The nanotubular Fe2O3/Fe2WO6 film exhibits a markedly enhanced photoelectrochemical oxygen evolution reaction and photocatalytic degradation of methylene blue compared with the nanoporous W-free Fe2O3 film. Because of the larger surface area, the nanotubular Fe2O3/Fe2WO6 film reveals further increased activity than the compact Fe2O3/Fe2WO6 film. The STEM study discloses the dispersion of Fe2WO6 nanoparticles in the α-Fe2O3 phase after annealing at 450 °C, and XRD analysis shows the possible doping of W species into α-Fe2O3. The formation of the W-doped α-Fe2O3/Fe2WO6 heterojunction likely promotes the separation of photogenerated electron-hole pairs, enhancing photocatalytic activity. Hence, the nanotubular Fe2O3/Fe2WO6 film is a possible candidate for visible-light-driven photocatalysts.

In this paper, we describe new strategies to reduce the resistances related to cathode reactions and interfacial proton transfer in protonic solid oxide fuel cells (H+-SOFCs) based on proton-conducting BaZrxCe0.8−xM0.2O3−δ (M = Y, Yb, Sc etc.) by means of material and cell-structure design changes. First, an extension of the effective cathode reaction areas by employing the H+/O2−/e− triple-conducting cathode is described. Cubic La0.7Sr0.3Mn1−xNixO3−δ (x = 0–0.3) can be hydrated under fuel cell conditions due to its large hydration enthalpy (∼100 kJ mol−1), whereas rhombohedral La0.7Sr0.3Mn1−xNixO3−δ does not exhibit hydration capabilities; hence, the porous anode cermet support fuel cells (PAFCs), which use the former as a cathode, possess significantly smaller cathode polarization resistances than the PAFCs that use the latter. Second, we describe a new thermodynamic mechanism for reducing the electrolyte and cathode reaction resistances in a hydrogen-permeable metal-support fuel cell (HMFC), which involves the blocking of the oxide ion minor conduction in the BaZrxCe0.8−xM0.2O3−δ electrolyte at metal/oxide heterointerfaces. The BaZrxCe0.8−xM0.2O3−δ membrane of HMFCs is forced to gain extra protons to compensate for the charge from the oxide ions accumulating near the heterointerfaces via blocking, resulting in extremely high proton conductivity. This promotes significant interfacial proton diffusion for cathode reactions.

Abstract Background We herein present a case of venous thrombosis that developed more than 20 years after diagnosis of granulomatosis with polyangiitis (GPA), although many reports of GPA have described venous thrombosis within 1 year of diagnosis. Case presentation A 73-year-old man with GPA was admitted for lower extremity swelling and diagnosed with venous thrombosis and pulmonary embolism. On the second day, catheter-based thrombolysis was unsuccessful, and inferior vena cava filter insertion and anticoagulation were performed. On the third day, respiratory disturbance and loss of consciousness appeared and progressed. The patient died on the fifth day. The autopsy revealed a large thrombus in the inferior vena cava filter, and death of progressive venous thrombosis was suspected. Conclusions We experienced a case of venous thrombosis that developed 20 years after diagnosis of GPA, although GPA is frequently associated with venous thrombosis immediately after diagnosis. The thrombosis progressed rapidly and was resistant to treatment.

Abstract The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

Abstract Since the start of the coronavirus disease 2019 (COVID-19) pandemic, it has remained unknown whether conventional risk prediction tools used in intensive care units are applicable to patients with COVID-19. Therefore, we assessed the performance of established risk prediction models using the Japanese Intensive Care database. Discrimination and calibration of the models were poor. Revised risk prediction models are needed to assess the clinical severity of COVID-19 patients and monitor healthcare quality in ICUs overwhelmed by patients with COVID-19.

Abstract Anticholinergics, therapeutic agents for overactive bladder, are clinically suggested to reduce urine output. We investigated whether this effect is due to bladder or kidney urine reabsorption. Various solutions were injected into the bladder of urethane-anesthetized SD rats. The absorption rate for 2 h was examined following the intravenous administration of the anticholinergics imidafenacin (IM), atropine (AT), and tolterodine (TO). The bilateral ureter was then canulated and saline was administered to obtain a diuretic state. Anticholinergics or 1-deamino-[8-D-arginine]-vasopressin (dDAVP) were intravenously administered. After the IM and dDAVP administrations, the rat kidneys were immunostained with AQP2 antibody, and intracellular cAMP was measured. The absorption rate was ~ 10% of the saline injected into the bladder and constant even when anticholinergics were administered. The renal urine among peaked 2 h after the saline administration. Each of the anticholinergics significantly suppressed the urine production in a dose-dependent manner, as did dDAVP. IM and dDAVP increased the intracellular cAMP levels and caused the AQP2 molecule to localize to the collecting duct cells' luminal side. The urinary reabsorption mechanism through the bladder epithelium was not activated by anticholinergic administration. Thus, anticholinergics suppress urine production via an increase in urine reabsorption in the kidneys' collecting duct cells via AQP2.

Abstract Combined therapy with adrenal arterial embolization and RF ablation may represent a useful therapeutic option with curative properties in select patients with pheochromocytoma.

Abstract Background The Acute Physiology and Chronic Health Evaluation (APACHE) III-j model is widely used to predict mortality in Japanese intensive care units (ICUs). Although the model’s discrimination is excellent, its calibration is poor. APACHE III-j overestimates the risk of death, making its evaluation of healthcare quality inaccurate. This study aimed to improve the calibration of the model and develop a Japan Risk of Death (JROD) model for benchmarking purposes. Methods A retrospective analysis was conducted using a national clinical registry of ICU patients in Japan. Adult patients admitted to an ICU between April 1, 2018, and March 31, 2019, were included. The APACHE III-j model was recalibrated with the following models: Model 1, predicting mortality with an offset variable for the linear predictor of the APACHE III-j model using a generalized linear model; model 2, predicting mortality with the linear predictor of the APACHE III-j model using a generalized linear model; and model 3, predicting mortality with the linear predictor of the APACHE III-j model using a hierarchical generalized additive model. Model performance was assessed with the area under the receiver operating characteristic curve (AUROC), the Brier score, and the modified Hosmer–Lemeshow test. To confirm model applicability to evaluating quality of care, funnel plots of the standardized mortality ratio and exponentially weighted moving average (EWMA) charts for mortality were drawn. Results In total, 33,557 patients from 44 ICUs were included in the study population. ICU mortality was 3.8%, and hospital mortality was 8.1%. The AUROC, Brier score, and modified Hosmer–Lemeshow p value of the original model and models 1, 2, and 3 were 0.915, 0.062, and < .001; 0.915, 0.047, and < .001; 0.915, 0.047, and .002; and 0.917, 0.047, and .84, respectively. Except for model 3, the funnel plots showed overdispersion. The validity of the EWMA charts for the recalibrated models was determined by visual inspection. Conclusions Model 3 showed good performance and can be adopted as the JROD model for monitoring quality of care in an ICU, although further investigation of the clinical validity of outlier detection is required. This update method may also be useful in other settings.

Graphene-covering technology provides a promising approach for achieving a non-noble-metal-catalyst with corrosion protection and catalytic activity under acidic media. Here, the authors unveil that the electrochemical hydrogen evolution mechanism is governed by the proton penetration phenomenon.

Development of highly active bifunctional electrocatalysts for oxygen evolution reaction (OER) and oxygen reduction reaction (ORR) is required for air electrodes of zinc-air secondary batteries (ZAB). In this study, we synthesize spinel-type MnCo2O4 (MCO) nanoparticles on highly graphitized platelet-type carbon nanofibers (pCNF) via a solvothermal method. The pCNF is selected as carbon support in this study because of the excellent stability against anodic degradation under the OER condition. The MCO nanoparticles of 2–5 nm in diameter are uniformly dispersed on pCNF and the catalyst exhibits high activities for ORR due to strong interaction pCNF and MCO, in addition to the improvement of OER activities. The MCO/carbon hybrids show comparable electrocatalytic performances to state-of-the-art bifunctional electrodes for OER and ORR.

Abstract Introduction Landiolol hydrochloride reduces the incidence of perioperative atrial fibrillation (AF) in cardiac surgery; however, little evidence is available regarding its effects in other types of surgery, including esophagectomy. We assessed the hypothesis that landiolol reduces perioperative AF and other complications associated with esophagectomy. Methods This single-center, randomized, double-blind, parallel-group study enrolled patients scheduled for esophagectomy. Patients were divided into those given landiolol at 3 μg/kg/min or placebo for 24 h. The primary outcome was the proportion of patients who developed AF within 96 h starting at 9:00 am on the day of surgery. The secondary outcomes were the proportion of patients whose AF appeared within 24 h, other complications based on the Clavien–Dindo classification, and the intensive care unit and hospital stays. Results Despite early study termination, 80 patients were screened, and 56 were enrolled (28/group) from September 2016 to June 2018. AF occurred within 96 h of surgery in six (21.4%) patients in the landiolol group and five (17.9%) patients in the placebo group (odds ratio, 1.26; 95% confidence interval, 0.33–4.7) and within 24 h of surgery in three (10.7%) patients in the landiolol group and two (7.1%) patients in the placebo group. There were no significant differences in the incidence of complications or in the number of intensive care unit or hospital stays between the groups. Conclusion Although our small sample size prevents definitive conclusions, landiolol might not reduce the occurrence of AF or other complications. Trial registration UMIN, UMIN000024040. Registered 13 September 2016, http://www.umin.ac.jp/ctr/index/htm

Objective To compare the effects of remifentanil versus fentanyl during light sedation with dexmedetomidine in adults receiving mechanical ventilation (MV) in the intensive care unit. Methods In this retrospective cohort study, we compared the use of remifentanil versus fentanyl in adults receiving MV with dexmedetomidine sedation. The primary outcome was the proportion of time under light sedation (Richmond Agitation–Sedation Scale score between −1 and 0) during MV. Results We included 94 patients and classified 58 into the remifentanil group and 36 into the fentanyl group. The mean proportion of time under light sedation during MV was 66.6% ± 18.5% in the remifentanil group and 39.9% ± 27.3% in the fentanyl group. In the multivariate analysis with control for confounding factors, patients in the remifentanil group showed a significantly higher proportion of time under light sedation than patients in the fentanyl group (mean difference: 24.3 percentage points; 95% confidence interval: 12.9–35.8). Conclusions Remifentanil use might increase the proportion of time under light sedation in patients receiving MV compared with fentanyl administration.

Introduction Sexual dysfunction is a common complication in men with type 2 diabetes and is often refractory to treatment. This study investigated the long-term influence of the phosphodiesterase 5 inhibitor (PDE5I) tadalafil on the level of sex hormones and sexual function in male Otsuka Long-Evans Tokushima Fatty (OLETF) rats as an animal model of spontaneous type 2 diabetes.Research design and methods We treated 36-week-old male OLETF and non-diabetic Long-Evans Tokushima Otsuka (LETO) rats with oral tadalafil (100 µg/kg/day) for 12 weeks; sham groups received vehicle for 12 weeks. Before and after tadalafil treatment, serum levels of total and free testosterone, estradiol, luteinizing hormone (LH), follicle-stimulating hormone and proinflammatory cytokines were compared among four treatment groups. Copulatory function was examined by matching each rat to an estrous female. After completion of the experiment, total fat mass in the abdomen was measured.Results Testosterone levels were significantly lower in OLETF versus LETO rats at 36 weeks. After 12 weeks of tadalafil treatment, levels of testosterone were significantly increased both in OLETF-tadalafil and LETO-tadalafil groups versus vehicle groups. Tadalafil decreased estradiol levels both in OLETF and LETO rats. Furthermore, tadalafil increased serum LH levels with a reduction of proinflammatory cytokines. Total fat mass was significantly lower in the OLETF-tadalafil group versus the OLETF-vehicle group. A significant suppression of copulatory behavior, that is, elongation of intromission latency was found in OLETF rats. However, tadalafil treatment for 12 weeks shortened the intromission latency.Conclusion Our results indicate that tadalafil treatment might improve copulatory disorder in the type 2 diabetic model via improvement of an imbalance in sex hormones and an increase in LH levels.

Abstract Background Variegate porphyria (VP) is an inherited type of porphyria characterized by cutaneous manifestations and/or acute neurovisceral attacks. We report successful anesthetic management of VP. Case presentation A 66-year-old woman with VP was scheduled to undergo distal pancreatectomy for pancreatic cancer. Medical history was unremarkable except for sudden onset of abdominal pain that occurred every few months, possibly due to VP. There was no abnormality in laboratory data except for a mild increase in creatinine levels. General anesthesia was induced and maintained with total intravenous anesthesia using propofol, remifentanil, and rocuronium. Blood glucose levels were measured every hour and glucose administered to prevent hypoglycemia. Amino acids were also infused to treat hypothermia. Upon completion of distal pancreatectomy, sugammadex was administered to reverse neuromuscular blockade. She was neurologically intact and discharged on postoperative day 15 with no acute attack. Conclusions Sugammadex and amino acids can be used safely in patients with VP.

We herein report a facile one-pot synthesis of MnO/N-doped carbon (NâC) composites via a sustainable cotton-template glycineânitrate combustion synthesis to yield superior anode materials for Li ion batteries. MnO nanoparticles with several nanometers were well-embedded in a porous N-doped carbon matrix. It displays the unique characteristics, including the shortened Li+-ion transport path, increased contact areas with the electrolyte solution, inhibited volume changes and agglomeration of nanoparticles, as well as good conductivity and structural stability during the cycling process, thereby benefiting the superior cycling performance and rate capability. This favorable electrochemical performance of obtained MnO/NâC composites via a one-pot biomass-templated glycine/nitrate combustion synthesis renders the suitability as anode materials for Li-ion batteries. Keywords: Biomass, Cotton, Manganese oxide, Lithium ion battery, Porous carbon

Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribonucleic acid repair. Along with cutaneous symptoms, neurological symptoms are important clinical features of XP. However, information on neurogenic bladder occurrence among XP cases is rare. Herein, we describe a case of neurogenic bladder in a patient with XP type A (XPA). In this case, low bladder compliance, impaired bladder emptying, and urethral sphincter discoordination were significant cystometric findings, and frequent febrile urinary tract infection was a clinical problem. XPA patients often cannot express their symptoms because of cognitive dysfunction. Close follow-up and assessments are necessary. Keywords: Xeroderma pigmentosum, Neurogenic bladder

The formation of crystalline anatase films having important applications such as photocatalysis, solar cells, electrochromic applications, and bio-implants requires time-consuming multiple processes including heat treatments. In this paper, ultra-rapid formation of a crystalline anatase film on a tin substrate is realized by a cathodic deposition method, which is performed only for 3 s in an aqueous solution containing TiF62− at 60 °C without any heat treatment. The deposited nanocrystalline anatase film of ~90 nm thickness contains high concentration of tin species derived from the substrate metal and shows superhydrophilicity after UV light irradiation. The process utilized in this study provides a novel annealing-free approach for the rapid formation of a photoactive crystalline anatase film on heat-labile substrates. Keywords: Cathodic deposition, Anatase, Heat-labile substrate, Doped TiO2

Human papillomavirus (HPV) infection is now identified as a major etiologic factor for oropharyngeal cancer (OPC), and HPV positivity is well established better prognostic marker in OPC. Now, predictable markers for the prognosis of the patients who are stratified by HPV has been investigated in. Semaphorin 3A (SEMA3A) is a well-known axon guidance molecule in the nervous system. It is also known as a tumor suppressor in various cancers. In the present study, we examined the relationships between SEMA3A and clinicopathologic features, especially HPV status, and neoangiogenesis, and its prognostic significance for OPC patients. Thirty-two OPC patients and 17 normal patients were analyzed for SEMA3A expression by immunohistochemical analysis. We also analyzed 22 OPC specimens for CD34 expression as a marker of neoangiogenesis. SEMA3A was significantly downregulated in OPC compared with chronic tonsillitis tissues (p = 0.005). SEMA3A expression was negatively correlated with CD34 expression (r = −0.466, p = 0.033). Moreover, the higher SEMA3A expression cohort showed better survival than the lower SEMA3A expression cohort regardless of HPV status (p = 0.035). These results suggest that SEMA3A expression is a prognostic marker for survival regardless of HPV status and is associated with anti-angiogenesis in OPC.

Abstract A direct ammonia‐type intermediate temperature fuel cell is examined by means of a hydrogen membrane fuel cell (HMFC) comprising 1‐µm‐thick BaZr0.1Ce0.7Y0.2O3−δ (BZCY) thin‐film electrolyte and Pd solid anode. It generates the maximum power density of 0.58 W cm−2 at 600 °C with ammonia fuels, and this value is found to be three times larger than the champion data of the recently reported direct ammonia‐type proton‐conducting ceramic fuel cells (PCFCs). AC impedance spectroscopy is performed to determine the interfacial polarization resistances, disclosing that the anodic overpotentials of HMFCs are at least one order of magnitude smaller than those of anode‐supported PCFC under relatively high DC outputs. The anode reactions are driven by the oxidation of monoatomic hydrogen dissolving at the BZCY/Pd solid–solid interface, mediated via proton transfer from Pd to BZCY. The electrochemical analysis reveals that the BZCY/Pd junction forms Ohmic contact without growth of wide depletion layer and thus facilitates the proton transfer reactions because the interfacial region beneath Pd electrode can accommodate amounts of protonic defects as well as the bulk of BZCY due to the small depletion of holes under hole–proton thermodynamic equilibrium.