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Acute respiratory distress syndrome (ARDS) is characterized by the heterogeneous distribution of lung aeration along a gravitational direction due to increased lung density. Therefore, the lung available for ventilation is usually limited to ventral, nondependent lung regions and has been called the “baby” lung. In ARDS, ventilator‐induced lung injury is known to occur in nondependent “baby” lungs, as ventilation is shifted to ventral, nondependent lung regions, increasing stress and strain. To protect this nondependent “baby” lung, the clinician targets and limits global parameters such as tidal volume and plateau pressure. In addition, positive end‐expiratory pressure (PEEP) is used to prevent dorsal, dependent atelectasis and, if successful, increases the size of the baby lung and lessens its susceptibility to injury from inspiratory stretch. Although many clinical trials have been performed in patients with ARDS over the last two decades, there are few successfully showing benefits on mortality (ie, prone positioning and neuromuscular blocking agents). These disappointing results contrast with other medical disciplines, especially in oncology, where the heterogeneity of diseases is recognized widely and precision medicine has been promoted. Thus, lung‐protective ventilation strategies need to take an innovative approach that accounts for the heterogeneity of injured lungs. This article summarizes ventilator‐induced lung injury and ARDS and discusses how to implement precision medicine in the field of ARDS. Potentially useful methods to individualize PEEP with esophageal balloon manometry, lung recruitability, and electrical impedance tomography were discussed. This article overviews ventilator‐induced lung injury, ARDS, and discusses how to implement precision medicine in the field of ARDS.

In Japan, the quantity of domestically produced fruit has been gradually decreasing, while wholesale prices have continued to rise due to declining production volumes and a shift toward high-quality varieties. To address these trends, improving quality and reducing labor through automation have become urgent challenges. In precision viticulture, monitoring the growth of grape clusters plays a key role in yield estimation, disease management, and optimal harvest timing. Although recent advances in deep learning and 3D reconstruction have enabled accurate fruit detection and modeling in vineyards, tracking the same clusters on different days remains challenging because of branch movement, fruit growth, and varying imaging conditions. This study proposes a branch-based 3D alignment framework for the cross-day tracking of grape clusters. Stable vine structures, such as trunks and main branches, are reconstructed using Structure from Motion, and their spatial correspondences are estimated through SIFT-based matching and similarity transformation. Once the coordinate systems of different days are aligned, the grape clusters detected by CenterNet are associated based on spatial proximity in the unified 3D space. Experiments over multiple observation days demonstrated that the proposed method successfully maintained the consistent tracking of grape clusters throughout the growth period. These results indicate that branch-based alignment effectively stabilizes multi-day observations and facilitates the temporal monitoring of fruit growth, supporting automated phenotyping and future field robot applications in viticulture.

This paper presents a localization method using deep learning and light detection and ranging (LiDAR) for unmanned ground vehicle (UGV) in field environment. We develop a sensor fusion algorithm that UGV recognizes natural objects from RGB camera using deep learning and measures the distance to the recognized objects with LiDAR. UGV calculates its position relative to the objects, creates a reference path, and then executes path following control. The method is applied to autonomous mowing operation in orchard. A mower is tracked by UGV. UGV needs to run along a tree row keeping an appropriate distance from tree trunks, by which the mowing arm of the tracked mower properly touches the trunks. Field experiments are conducted in pear and apple orchards. UGV localizes self position relative to trees and performs autonomous mowing successfully. The results show that the presented method is effective.

To investigate early postoperative changes in retinal light sensitivity at the foveal and paramacular points in open angle glaucoma patients. Retrospective cohort study. Twenty-four eyes undergoing trabeculectomy were analyzed. Retinal light sensitivity thresholds were measured using microperimetry both before and 7 days after surgery. Linear regression analysis identified factors affecting postoperative sensitivity changes. We also evaluated the correlation between changes in the threshold of retinal light sensitivity at the foveal and paramacular points. Intraocular pressure significantly decreased postoperatively. The mean threshold values of retinal light sensitivity following surgery showed no statistically significant changes compared with preoperative values across all eyes. Specifically, the mean threshold values increased in 4 eyes, decreased in 2, and remained stable in 18. Upon analyzing each examination point, 71.8% eyes exhibited stability, 12.8% showed a decrease of less than -6 dB, and 15.4% demonstrated an improvement of more than +6 dB in threshold values of retinal light sensitivity post-surgery. Changes in retinal light sensitivity at most paramacular points were found to be independent of those at the fovea. Excessive IOP reduction was identified as a significant risk factor for central visual field impairment. Localized changes in retinal light sensitivity thresholds can vary in the early postoperative period following trabeculectomy, highlighting the need to monitor localized retinal function to better understand its impact on visual outcomes.

Background Tracheostomy is commonly performed in critically ill patients because of its clinical advantages over prolonged translaryngeal endotracheal intubation. Early tracheostomy has been demonstrated to reduce the duration of mechanical ventilation and length of stay. However, its association with mortality remains ambiguous. This study aimed to evaluate the association between the timing of tracheostomy and mortality in patients receiving mechanical ventilation. Methods We performed a retrospective cohort analysis of adult patients who underwent tracheostomy during their intensive care unit (ICU) admission between April 2015 and March 2019. Patients who underwent tracheostomy before or after 29 days of ICU admission were excluded. Data were collected from the nationwide Japanese Intensive Care Patient Database. The primary outcome was hospital mortality. The timing of tracheostomy was stratified by quartile, and the association between patient outcomes was evaluated using regression analysis. Results Among the 85558 patients admitted to 46 ICUs during the study period, 1538 patients were included in the analysis. The quartiles for tracheostomy were as follows: quartile 1, ≤ 6 days; quartile 2, 7–10 days; quartile 3, 11–14 days; and quartile 4, > 14 days. Hospital mortality was significantly higher in quartile 2 (adjusted odds ratio [aOR]: 1.52, 95% confidence interval [CI]: 1.08–2.13), quartile 3 (aOR: 1.82, 95% CI: 1.28–2.59), and quartile 4 (aOR: 2.26, 95% CI: 1.61–3.16) ( p for trend < 0.001) than in quartile 1. A similar trend was observed in the subgroup analyses of patients with impaired consciousness (Glasgow Coma Scale score < 8) and respiratory failure (PaO 2 :FiO 2  ≤ 300) at ICU admission ( p for trend = 0.081 and 0.001, respectively). Conclusions This multi-institutional observational study demonstrated that the timing of tracheostomy was significantly and independently associated with hospital mortality in a stepwise manner. Thus, early tracheostomy may be beneficial for patient outcomes, including mortality, and warrants further investigation.

In this study, we propose a method to automate fruit harvesting with a fruit harvesting robot equipped with robotic arms. Given the future growth of the world population, food shortages are expected to accelerate. Since much of Japan’s agriculture is dependent on imports, it is expected to be greatly affected by this upcoming food shortage. In recent years, the number of agricultural workers in Japan has been decreasing and the population is aging. As a result, there is a need to automate and reduce labor in agricultural work using agricultural machinery. In particular, fruit cultivation requires a lot of manual labor due to the variety of orchard conditions and tree shapes, causing mechanization and automation to lag behind. In this study, a dual-armed fruit harvesting robot was designed and fabricated to reach most of the fruits on joint V-shaped trellis that was cultivated and adjusted for the robot. To harvest the fruit, the fruit harvesting robot uses sensors and computer vision to detect and estimate the position of the fruit and then inserts end-effectors into the lower part of the fruit. During this process, there is a possibility of collision within the robot itself or with other fruits depending on the position of the fruit to be harvested. In this study, inverse kinematics and a fast path planning method using random sampling is used to harvest fruits with robot arms. This method makes it possible to control the robot arms without interfering with the fruit or the other robot arm by considering them as obstacles. Through experiments, this study showed that these methods can be used to detect pears and apples outdoors and automatically harvest them using the robot arms.

Extracellular vesicles (EVs) such as exosomes and microvesicles serve as messengers of intercellular network, allowing exchange of cellular components between cells. EVs carry lipids, proteins and RNAs derived from their producing cells and have potential as biomarkers specific to cell types and even cellular states. However, conventional methods (such as ultracentrifugation or polymeric precipitation) for isolating EVs have disadvantages regarding purity and feasibility. Here, we have developed a novel method for EV purification by using Tim4 protein, which specifically binds the phosphatidylserine displayed on the surface of EVs. Because the binding is Ca 2+ -dependent, intact EVs can be easily released from Tim4 by adding Ca 2+ chelators. Tim4 purification, which we have applied to cell conditioned media and biofluids, is capable of yielding EVs of a higher purity than those obtained using conventional methods. The lower contamination found in Tim4-purified EV preparations allows more EV-specific proteins to be detected by mass spectrometry, enabling better characterization and quantification of different EV populations’ proteomes. Tim4 protein can also be used as a powerful tool for quantification of EVs in both ELISA and flow cytometry formats. Thus, the affinity of Tim4 for EVs will find abundant applications in EV studies.

Purpose We aimed to identify peripheral visual field (VF) defect pathogenesis in high myopia using optical coherence tomography (OCT) and microperimetry and to investigate the association between focal lamina cribrosa defects (fLCDs) and high myopia-specific peripheral visual field defects (HM-pVFDs). Study design Retrospective case–control study. Methods Thirty-five highly myopic patients (refractive error ≥ 8.0 D or axial length > 26.5 mm) with an HM-pVFD, diagnosed using the V-4 isopter in Goldmann perimetry, and 35 age- and 35 sex-matched controls were studied. The optic nerve head (ONH) morphology was analyzed by use of OCT; retinal light sensitivities around the ONH were evaluated by use of microperimetry. The main outcome measures were best-corrected visual acuity (BCVA), axial length (AL), refractive error, intraocular pressure (IOP), the OCT findings, and the microperimetry findings. Results The BCVA, AL, IOP, and refractive error did not differ significantly between the patient and the control groups. Of the 35 eyes with an HM-pVFD, twenty-four had fLCDs detected by use of OCT, one showed no evidence of fLCDs, and ten had inadequate images due to excessive ONH tilting. Of the 35 control eyes, two had fLCDs, twenty-eight showed no evidence of fLCDs, and five had inadequate images. The peripapillary retinal light sensitivity was decreased in 29 of the 35 eyes with an HM-pVFD; no such decrease was noted in 30 of the 35 control eyes. Peripheral VF abnormality detection by use of microperimetry had 82.9% sensitivity and 85.7% specificity. Conclusions Our findings indicate an important relationship between HM-pVFDs and fLCDs, suggesting fLCD involvement in peripheral VF abnormality pathogenesis in highly myopic patients. Furthermore, microperimetry is reproducible for evaluating HM-pVFDs.

IntroductionThe nonexposed variant of antiresorptive agent-related osteonecrosis of the jaw (ARONJ) presents with nonspecific clinical findings. The diagnosis of nonexposed ARONJ poses a critical challenge, and there is little evidence regarding its treatment and outcomes. This study aimed to examine the clinical outcomes in patients with nonexposed antiresorptive agent-related osteomyelitis of the jaw (AROMJ). The terms ARONJ and AROMJ were used separately in this study.Materials and methodsWe enrolled patients with nonexposed AROMJ (osteomyelitis of the jaw without bone exposure associated with antiresorptive agents) with partial reference to an existing position paper on ARONJ. The initiating event of osteomyelitis was limited to periodontitis. Based on the findings of bone scintigraphy, panoramic radiography, computed tomography, and histopathological examination, we also used the hierarchical diagnostic criteria (HDC) for osteomyelitis of the jaw.ResultsThere were 58 confirmed cases of nonexposed AROMJ based on the HDC. All patients had sufficient clinical findings to be diagnosed with nonexposed AROMJ as osteomyelitis underwent extraction with bone debridement. The healing rate was 93.1% (54/58). Univariable analysis showed a strong association between the healing status and malignant disease, while multivariable analysis showed no strong association between them.ConclusionsThe present study had a relatively large sample size of patients with nonexposed AROMJ. The primary disease in patients with nonexposed AROMJ may not have a strong association with the healed status of the lesion. Based on its high healing rate, extraction with bone debridement in confirmed nonexposed AROMJ may prevent progression.