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The paper is concerned with ergodic-type Bellman equations arising typically in linear (exponential) quadratic Gaussian control. We are interested in giving recurrence-transience criteria for associated optimal feedback diffusions in terms of qualitative properties of solutions to the Bellman equation. To establish such criteria, we propose a new approach which is based on the Lyapunov method. It turns out that a certain convexity of the equation plays a key role in our arguments.

In this trial of simvastatin involving critically ill patients with Covid-19, which was stopped owing to reduced cases, simvastatin did not meet the prespecified criteria for superiority to control treatment.

Auditory spatial perception is strongly affected by visual cues. For example, if auditory and visual stimuli are presented synchronously but from different positions, the auditory event is mislocated towards the locus of the visual stimulus—the ventriloquism effect 1 , 2 . This ‘visual capture’ also occurs in motion perception in which a static auditory stimulus appears to move with the visual moving object 3 , 4 . We investigated how the human perceptual system coordinates complementary inputs from auditory and visual senses. Here we show that an auditory aftereffect occurs from adaptation to visual motion in depth. After a few minutes of viewing a square moving in depth, a steady sound was perceived as changing loudness in the opposite direction. Adaptation to a combination of auditory and visual stimuli changing in a compatible direction increased the aftereffect and the effect of visual adaptation almost disappeared when the directions were opposite. On the other hand, listening to a sound changing in intensity did not affect the visual changing-size aftereffect. The results provide psychophysical evidence that, for processing of motion in depth, the auditory system responds to both auditory changing intensity and visual motion in depth.

Phrenic nerve injury (PNI) is recognized as an important complication during atrial fibrillation ablation. This study aimed to investigate the incidence and outcome of PNI during superior vena cava isolation (SVCI) and circumferential pulmonary vein isolation (CPVI) using radiofrequency (RF) energy and the factors associated with its occurrence. Five hundred sixty-seven consecutive patients who underwent SVCI after CPVI without substrate modification who completed a 12-month follow-up were retrospectively analyzed. Point-by-point RF applications were applied with maximum energy settings of 35 W and 30 seconds for the SVCI. In the former 210 patients, sites where pacing captured the PN were avoided whenever possible; however, the maximum power was 35 W. In the latter 357 patients, RF energy was delivered regardless of PN capture; however, the power at PN capture sites was limited to 10 W during continuous diaphragmatic movement monitoring on fluoroscopy. Circumferential pulmonary vein isolation and SVCI were successfully achieved in all. Twelve patients (2.1%) had PNI during SVCI but not during CPVI. Phrenic nerve injury completely recovered in all patients a median of 8.0 months after the procedure. The prevalence was higher in the former period (3.8% vs 1.1%; P = .03). A multivariate logistic regression analysis revealed that the study period (odds ratio 3.546; 95% CI 1.051-11.965; P = .041) was the sole independent predictor for identifying patients with PNI during SVCI. Phrenic nerve injury occurred in 2.1% of the patients. All occurred during SVCI but not during contemporary CPVI. Energy titration and continuous diaphragmatic movement monitoring significantly decreased the incidence during SVCI.

Aims/Introduction Increased incidence of hospitalization for heart failure (HHF) among patients with diabetes is increasingly being reported. We investigated the incidence of adverse cardiovascular events including HHF among patients with type 2 diabetes mellitus, and the potential clinical improvement with sodium–glucose cotransporter 2 inhibitors (SGLT2i) using a contemporary administrative claims database from a large governmental district of Japan. Materials and Methods We included initiators of any oral glucose‐lowering drugs between 2013 and 2018. We estimated the 5‐year cumulative incidence of hospitalization for HF, myocardial infarction and stroke, treating death as a competing risk. We evaluated the possible impact of introducing SGLT2i to the potential recipients of the drug, using the inclusion criteria from Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA‐REG OUTCOME) and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE‐TIMI 58) trials, assuming the same risk reduction as theirs. Results Among 23,340 drug initiators (54.0% men, and 6.4% aged >85 years), the 5‐year cumulative incidence was 5.4% (95% confidence interval 4.9–5.9%) for HHF, 1.9% (95% confidence interval 1.7–2.2%) for myocardial infarction admission and 6.1% (95% confidence interval 5.7–6.6%) for stroke admission. Among 6,192 patients with laboratory test data, 651 (10.5%) and 2,680 (43.3%) patients met the EMPA‐REG‐like and DECLARE‐like criteria, respectively. The 5‐year cumulative incidence among the 2,849 patients meeting either of the criteria was estimated to decrease from 97.1 to 75.6 events through 75% adoption of SGLT2i. Conclusions The incidence of HHF was similar to that of stroke. A significant portion of our cohort met the inclusion criteria for major randomized clinical trials for SGLT2i, and estimated reduction in the HHF events was substantial. We assessed the incidence of adverse cardiovascular events including hospital admissions for heart failure among patients with type 2 diabetes mellitus using a contemporary administrative claims database from a large governmental district in Japan. We found a similar 5‐year cumulative incidence of heart failure admissions at 5.4%, as compared with that of stroke admissions at 6.1%.

For the treatment of chylothorax, the most common procedure is a thoracic duct ligation; however, recurrence of the issue is often common, generally due to the incomplete ligation of all thoracic duct tributaries. Therefore, accurate localisation of the thoracic duct tributaries is required to determine the ligation sites in each patient. The concept of the perirectal injection of the imaging materials, which provides a simple and minimally invasive approach, is investigated for computed tomographic (CT) lymphography and near infrared fluorescent thoracoscopy in cats. Three clinically healthy cats were used for the CT lymphography, and two clinically healthy cats were used for the near infrared fluorescent thoracoscopy. Iodine contrast agent for the CT or indocyanine green for the thoracoscopy was injected subcutaneously into the peri-anal tissue. The injection site was massaged for 5 min post-injection. However, in the indirect injection of the imaging materials, in three iohexol-administered cats, the abdominal lymphatics, cisterna chyle, and thoracic duct could be depicted by the CT lymphography; and in both indocyanine green-administered cats, the thoracic duct was depicted running alongside the aorta by the near infrared fluorescent thoracoscopy. The ideal imaging procedure for the thoracic duct ligation involves the pre-operative CT lymphography of the entire pathway of the lymphatic vessels in advance, followed by the direct visualisation using a thoracoscopy. A combined CT lymphography and thoracoscopy could be a reliable method for successful surgeries. Crucially, the subcutaneous peri-anal injection of a contrast/dye provides a simple and minimally invasive method for the pre-operative and intra-operative depiction of the lymphatic pathways.

We study the large time behavior of solutions to the Cauchy problem for semilinear parabolic equations having quadratic nonlinearity in gradients. Equations of this kind appear in stochastic control theory. It turns out that as time tends to infinity the solution of the Cauchy problem converges to a solution of the associated ergodic problem. Our approach relies on PDE and probabilistic arguments.

Alpha2-macroglobulin is a protease inhibitor that enhances procoagulant properties via the neutralization of plasmin, plasminogen activators and metalloproteinases. Additionally, alpha2-macroglobulin is thought to be involved in inflammatory reactions as a carrier protein for interleukin-6 (IL-6). The objective of this study was to evaluate the usefulness of alpha2-macroglobulin as a biomarker for cerebrovascular diseases. Patients with acute ischemic stroke ( n  = 159; 93 male and 66 female, 71.6 ± 10.3 years) and patients with no previous history of stroke ( n  = 77; 38 male and 39 female, 70.7 ± 9.5 years) were consecutively enrolled in this study. White matter lesions were assessed via the fluid-attenuated inversion recovery image of magnetic resonance images using the Fazekas classification. The serum alpha2-macroglobulin levels were measured by nephelometry. The serum alpha2-macroglobulin levels at admission in patients with acute ischemic stroke were higher than those in the control patients (230.2 ± 73.7 vs. 205.0 ± 55.8 mg/dl, p  = 0.009). The serum alpha2-macroglobulin levels were positively correlated with age and the severity of the white matter lesions ( R 2  = 0.048, p  < 0.001 and R 2  = 0.058, p  < 0.001, respectively), although there was no significant association between serum alpha2-macroglobulin levels and IL-6 levels. In addition, multivariate analysis showed that increased serum alpha2-macroglobulin levels were independently associated with the severity of white matter lesions [standardized partial regression coefficient (β) 0.102, p  = 0.026]. Increased serum alpha2-macroglobulin levels might be involved in the pathophysiology of acute ischemic stroke. Furthermore, serum alpha2-macroglobulin levels, which were associated with high-grade white matter lesions, may reflect the chronic pathophysiological condition of cerebral small vessel disease.

REMAP-CAP, a randomized, embedded, multifactorial adaptive platform trial for community-acquired pneumonia, is an international clinical trial that is rapidly expanding its scope and scale in response to the COVID-19 pandemic. Japan is now joining REMAP-CAP with endorsement from Japanese academic societies. Commitment to REMAP-CAP can significantly contribute to population health through timely identification of optimal COVID-19 therapeutics. Additionally, it will promote the establishment of a national and global network of clinical trials to tackle future pandemics of emerging and re-emerging infectious diseases, in collaboration with multiple stakeholders, including front-line healthcare workers, governmental agencies, regulatory authorities, and academic societies.