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Airborne ultrasound radiation pressure, a nonlinear effect that appears as a static force in mid-air in the presence of strong ultrasound, has recently been applied in novel scientific and industrial fields. However, the output power of an ultrasound transducer remains low mainly due to the significant mismatch in acoustic impedance between a solid diaphragm and air. To circumvent this fundamental challenge, we propose to emit amplified airborne ultrasound pulses by instantaneously releasing stored acoustic energy into free-space. Specifically, we implement an acoustic cavity with a mechanically rotating shutter covering its open top. Once the acoustic cavity is fully charged, the stored energy is released by opening the shutter. By developing a choke structure that reduces leakage of the stored energy, we generate ultrasound pulses with 2.5 times higher peak power than the input continuous waves at 40 kHz. This preliminary result has a great potential to generate high-power ultrasound pulses using a conventional air-coupled transducer by separating the storage and radiation process, thus circumventing the fundamental limitation brought by impedance mismatch.

Objective Co-reactivation of cytomegalovirus (CMV) and Epstein–Barr virus (EBV) occurs in iatrogenically immunosuppressed patients, but the clinical relevance of this is unknown. We aimed to determine the frequency of EBV reactivation in patients with CMV viremia and to explore its clinical significance. Methods Serum or plasma CMV and EBV DNA was detected by quantitative real-time PCR in 82 patients who received immunosuppressive therapy and/or chemotherapy and underwent CMV antigenemia tests. Results CMV DNA was positive in 55 patients, with EBV reactivation being found in 29 of these (52.7%). EBV co-reactivation was significantly associated with aging (>64 years vs. ≤64 years, odds ratio 4.07, 95% confidence interval 1.06–15.6). When older patients were divided into two groups according to age, EBV co-reactivation occurred more frequently in early-old patients (aged 65–74 years) than in late-old patients (aged ≥75 years) (100.0% vs. 53.3%, respectively). Steroid pulse treatment was administered significantly more often in the early-old group than in those aged ≤64 years and ≥75 years (72.7% vs 27.6% vs 14.3%, respectively). Conclusions Co-reactivation of EBV in patients with CMV viremia highlighted early-old patients and may reflect treatment intensity as well as immunosenescence.

Controlling center of mass (CoM) movement in the mediolateral direction is imperative for stable walking. During walking, CoM movement is adjusted by the coordination of each body segment, which can be evaluated using uncontrolled manifold (UCM) analysis. UCM analysis evaluates segmental coordination by analyzing variablity in motor movement among the different segments of the body. The vibrotactile stimulation of the hallux nail can augment the sensory information of the plantar surface for necessary motor control. This study aims to investigate the effect of the vibrotactile stimulation of the hallux nail on segmental coordination to control CoM movement in the mediolateral direction during walking. Thirteen healthy men participated in the study. A vibrator was attached to each hallux nail, and pressure sensors were placed under the hallux balls. When the hallux ball was in contact with the floor, vibration stimulation was applied. A three-dimensional motion analysis system was used to measure the segment angles during walking, and UCM analysis was used to evaluate kinematic synergy for controlling CoM movement in the mediolateral direction. Subsequently, segment angles were used as an elemental variable. The synergy index and bad variability as motor noise were negatively related to the status without the stimulation. Vibrotactile stimulation in young people was more effective for people with large motor noise and a small synergy index during the single-stance phase. Thus, kinematic synergy can be immediately changed by sensory input using vibrotactile stimulation of the hallux nail, although applying vibration stimulation should be considered in advance.

The current study aimed to investigate the time course of changes in choroidal circulation hemodynamics and their relationship to systemic circulation dynamics during the normal menstrual cycle in young, healthy women using laser speckle flowgraphy (LSFG). This prospective study included 26 eyes from 13 young, healthy women (21.3 ± 4.0 years) with a normal menstrual cycle and 24 eyes from 12 young, healthy men (21.8 ± 4.4 years) as a control group. The macular mean blur rate (MBR), a quantitative index of relative blood flow velocity in the choroid, was measured using LSFG. MBR, intraocular pressure (IOP), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), and ocular perfusion pressure (OPP) were evaluated in the late follicular phase and mid-luteal phase in women and at baseline and 10 days after baseline in men, respectively. In the female group, IOP, SBP, DBP, MBP, and OPP values were significantly higher in the mid-luteal phase than those observed in the late follicular phase (P = 0.035, P < 0.001, P = 0.041, P = 0.001, P = 0.014, respectively). The average macular MBR values in the late follicular phase and mid-luteal phase were 12.7 ± 5.3 and 13.7 ± 6.6 (+7.7 ± 19.4%), representing a significant increase in the mid-luteal phase (P = 0.041). The rate of change in MBR exhibited a significant positive correlation with changes in DBP and MBP (R = 0.456, P = 0.019 and R = 0.474, P = 0.014). However, there were no significant changes in any of the factors in the male group during the study period. Our results suggest that in young, healthy women with a normal menstrual cycle, choroidal blood flow velocity decreases during the late follicular phase and increases during the mid-luteal phase, depending on systemic circulatory dynamics.

This study aims to determine the approximate number of hospitalizations of persons without family and the medical challenges they encounter in hospitals across Japan. Self-administered questionnaires were mailed to 4,000 randomly selected hospitals nationwide to investigate the actual conditions and problems, decision-making processes, and use of the government-recommended Guidelines for the hospitalization of, and decision-making support for, persons without family. To identify the characteristics of each region and role of hospitals, chi-square tests were used to make separate group comparisons by hospital location and type. Responses were received from 1,271 hospitals (31.2% response rate), of which 952 hospitals provided information regarding the number of admissions of persons without family. The mean (SD) and median number of hospitalizations (approximate number per year) of patients without family was 16 (79) and 5, respectively. Approximately 70% of the target hospitals had experienced the hospitalization of a person without family, and 30% of the hospitals did not. The most common difficulties encountered during the hospitalization were collecting emergency contact information, decision-making related to medical care, and discharge support. In the absence of family members and surrogates, the medical team undertook the decision-making process, which was commonly performed according to manuals and guidelines and by consulting an ethics committee. Regarding the use of the government-recommended Guidelines, approximately 70% of the hospitals that were aware of these Guidelines responded that they had never taken any action based on these Guidelines, with significant differences by region and hospital type. To solve the problems related to the hospitalization of persons without family, the public should be made aware of these Guidelines, and measures should be undertaken to make clinical ethics consultation a sustainable activity within hospitals.

Real-time monitoring of heart rate is useful for monitoring workers. Wearable heart rate monitors worn on the upper body are less susceptible to artefacts caused by arm and wrist movements than popular wristband-type sensors using the photoplethysmography method. Therefore, they are considered suitable for stable and accurate measurement for various movements. In this study, we conducted an experiment to verify the accuracy of our developed and commercially available wearable heart rate monitor consisting of a smart shirt with bioelectrodes and a transmitter, assuming a real-world work environment with physical loads. An exercise protocol was designed to light to moderate intensity according to international standards because no standard exercise protocol for the validation simulating these works has been reported. This protocol includes worker-specific movements such as applying external vibration and lifting and lowering loads. In the experiment, we simultaneously measured the instantaneous heart rate with the above wearable device and a Holter monitor as a reference to evaluate mean absolute percentage error (MAPE). The MAPE was 0.92% or less for all exercise protocols conducted. This value indicates that the accuracy of the wearable device is high enough for use in real-world cases of physical load in light to moderate intensity tasks such as those in our experimental protocol. In addition, the experimental protocol and measurement data devised in this study can be used as a benchmark for other wearable heart rate monitors for use for similar purposes.

Paracentesis temporarily relieves malignant ascites but causes hypoalbuminemia. Cell-free and concentrated ascites reinfusion therapy (CART) reinfuses autologous proteins to prevent hypoalbuminemia and has been increasingly used in Japan. However, CART has not been widely adopted outside of Japan, and its benefit remains unclear. We evaluated the clinical outcomes and healthcare costs of CART compared with paracentesis in metastatic cancer. This retrospective cohort study included hospitalized patients with metastatic solid cancer receiving CART or paracentesis across Japan (April 2016-March 2023). Baseline characteristics were balanced using overlap propensity-score weighting. Primary outcomes were in-hospital mortality, functional disability, and 30-day unplanned readmission. Secondary outcomes were length of stay (LOS), albumin administration or re-drainage rates, and costs. Mortality risk was assessed using a modified Poisson regression. The composite primary outcomes were assessed using a win-ratio approach. Among 1159 patients (CART: 457, paracentesis: 702) from 51 hospitals, the CART group had lower mortality than the paracentesis group (28.6% vs. 36.7%; risk ratio: 0.78, 95% confidence intervals [95% CI]: 0.64-0.94). The win-ratio analysis also favored the CART group over the paracentesis group (win ratio: 1.34, 95% CI: 1.09-1.64). Additionally, CART was associated with lower mortality and better composite outcomes than paracentesis, particularly among males, patients with serum albumin ≤ 2.5 g/dL, and those with non-gastrointestinal cancer. Despite higher procedural costs, CART was associated with shorter median LOS (14.1 vs. 19.0 days), lower albumin administration (11.6% vs. 17.3%) and re-drainage (32.7% vs. 52.7%) rates, and lower total median costs (4490.9 [interquartile range: 2042.3-7054.5] vs. 5084.1 [interquartile range: 3054.7-8659.7] USD) than paracentesis. CART was associated with improved clinical outcomes and healthcare costs over paracentesis among hospitalized patients with metastatic cancer, particularly in males, patients with serum albumin ≤ 2.5 g/dL, and those with non-gastrointestinal cancer. These findings may support clinical decision-making and resource allocation.

In this study, we propose a deep-learning technique for functional MRI analysis. We introduced a novel self-supervised learning scheme that is particularly useful for functional MRI wherein the subject identity is used as the teacher signal of a neural network. The neural network is trained solely based on functional MRI-scans, and the training does not require any explicit labels. The proposed method demonstrated that each temporal volume of resting state functional MRI contains enough information to identify the subject. The network learned a feature space in which the features were clustered per subject for the test data as well as for the training data; this is unlike the features extracted by conventional methods including region of interests (ROIs) pooling signals and principal component analysis. In addition, applying a simple linear classifier to the per-subject mean of the features (namely “identity feature”), we demonstrated that the extracted features could contribute to schizophrenia diagnosis. The classification accuracy of our identity features was comparable to that of the conventional functional connectivity. Our results suggested that our proposed training scheme of the neural network captured brain functioning related to the diagnosis of psychiatric disorders as well as the identity of the subject. Our results together highlight the validity of our proposed technique as a design for self-supervised learning.

Olprinone (OLP) is a selective inhibitor of phosphodiesterase III and is used clinically in patients with heart failure and those undergoing cardiac surgery; however, little is known about the effects of OLP on hepatoprotection. The purpose of this study aimed to determine whether OLP has protective effects in in vivo and in vitro rat models of endotoxin-induced liver injury after hepatectomy and to clarify the mechanisms of action of OLP. In the in vivo model, rats underwent 70% partial hepatectomy and lipopolysaccharide treatment (PH/LPS). OLP administration increased survival by 85.7% and decreased tumor necrosis factor-α, C-X-C motif chemokine ligand 1, and inducible nitric oxide synthase (iNOS) mRNA expression in the livers of rats treated with PH/LPS. OLP also suppressed nuclear translocation and/or DNA binding ability of nuclear factor kappa B (NF-κB). Pathological liver damage induced by PH/LPS was alleviated and neutrophil infiltration was reduced by OLP. Primary cultured rat hepatocytes treated with the pro-inflammatory cytokine interleukin-1β (IL-1β) were used as a model of in vitro liver injury. Co-treatment with OLP inhibited dose-dependently IL-1β-stimulated iNOS induction and NF-κB activation. Our results demonstrate that OLP may partially inhibit the induction of several inflammatory mediators through the suppression of NF-κB and thus prevent liver injury induced by endotoxin after liver resection.