Deep Learning for Echocardiography

Objectives: The aim of this study was to evaluate whether a deep convolutional neural network (DCNN) could detect regional wall motion abnormalities (RWMAs) and differentiate groups of coronary infarction territories from conventional 2-dimensional echocardiographic images compared with cardiologist/sonographer or resident readers. Background: An effective intervention for reduction of misreading of RWMAs is needed. We hypothesized that a DCNN trained with echocardiographic images may provide improved detection of RWMAs in the clinical setting. Methods: A total of 300 patients with history of myocardial infarction were enrolled. In this cohort, 100 each had infarctions of the left anterior descending branch (LAD), left circumflex branch (LCX), and right coronary artery (RCA). The age-matched 100 control patients with normal wall motion were selected from our database. Each case contained cardiac ultrasound images from short axis views at end-diastolic, mid-systolic and end-systolic phases. After 100 steps of training, diagnostic accuracies were calculated on the test set. We independently trained 10 versions of the same model, and performed ensemble predictions with them. Results: For detection of the presence of wall motion abnormality, the area under the receiver-operating characteristic curve (AUC) by deep learning algorithm was similar to that by cardiologist/sonographer readers (0.99 vs. 0.98, p =0.15), and significantly higher than the AUC by resident readers (0.99 vs. 0.90, p =0.002). For detection of territories of wall motion abnormality, the AUC by the deep learning algorithm was similar to the AUC by cardiologist/sonographer readers (0.97 vs. 0.95, p =0.61) and significantly higher than the AUC by resident readers (0.97 vs. 0.83, p =0.003). In a validation group from an independent site (n=40), the AUC by the DL algorithm was 0.90. Conclusions: Our results support the possibility of DCNN use for automated diagnosis of RWMAs in the field of echocardiography

左前下行枝冠動脈周囲の局所心外膜脂肪厚は簡便な冠動脈疾患の予測因子である : フラミンガムリスクスコアと組み合わせた新しい予測モデル

Background: Compared with global cardiac adiposity, the local accumulation of fat surrounding coronary arteries might have a more direct impact on coronary artery disease (CAD). Here, we compared the local epicardial adipose tissue (EAT) thickness and global cardiac adiposity volumes for predicting CAD. Methods and Results: A total of 197 consecutive subjects underwent 320-slice multi-detector computed tomography coronary angiography and were segregated into CAD (≥1 coronary artery branch stenosis ≥50%) and non-CAD groups. EAT thickness was measured at the right coronary artery (EATRCA), the left anterior descending artery (EATLAD), and the left circumflex artery (EATLCX). Although EATRCA and EATLCX were similar between the 2 groups, EATLAD was larger in the CAD group than in the non-CAD group (5.45±2.16 mm vs. 6.86±2.19 mm, P<0.001). EATLAD, after correcting for confounding factors, was strongly associated with CAD (r=0.276, P<0.001) and Gensini score (r=0.239, P<0.001). On multiple regression analysis, Framingham risk score combined with EATLAD was a strong predictor of CAD (adjusted R2=0.121; P<0.001). Conclusions: The local fat thickness surrounding the LAD is a simple and useful surrogate marker for estimating the presence, severity, and extent of CAD, independent of classical cardiovascular risk factors

初年次教育の現状と課題 ―Ａ大学社会福祉学科一年次アンケートから―

日本の大学においても、初年次教育が教育課題の一つとして自覚されるようになってきた。私たちは本学における初年次教育のあり方を模索するために、学生の大学生活への適応を支援するための基礎的知見を獲得することを目的として、人間社会学部社会福祉学科一年次生を対象に、大学生活への適応を把握することを目的としたアンケートを実施した。アンケートの結果、大学生活への適応に関しては、４月から７月の最初の三ケ月間における変化が非常に顕著であり、この期間、学生をいかに支援していくかが初年次教育において重要であるということが示唆された。We statistically clarify some characters of the first-year students who major in social welfare to prepare for the First-Year Experience program. In this paper we show noticeble changes in the first three months in adapting to academic life. We suggest that supporting students for the first three months is very important in the First-Year Experience program

初年次教育の現状と課題 －A大学社会福祉学科一年次アンケートから(2)－

本稿では、本学における初年次教育のあり方を模索するために、学生の大学生活への適応を支援するための基礎的知見を獲得することを目的として、社会福祉学科一年次生を対象に、大学生活への適応を把握するための調査を２年間（２００７年から２００８年度）に渡って実施した。調査の結果から、受け身の姿勢を持つ学生が多く見られることから、教職員が理解したうえで学生の“育ち”を支援する必要性が示唆された。In this paper we statistically clarity some characters of the first-year students who major in social welfare to prepare for the First-Year Experience program. Many students shows passive posture in our research, therefore it is suggested the necessity for the school personnel to understand their passive attitude in supporting their “growth"

私立高等学校の「建学の精神」に関する研究

　This study is a part of a survey of private high schools in Japan, dealing with the spirit behind the founding of a private school, the integrated secondary education system, and tne dormitory education. This study is linked with the survey of private elementary and junior-high schools, that began in AY1993. 　The study, first, reconsiders the justification for the existence of Christian schools in Japan. We feel this study is necessary as Christian schools seem to be dying out as a result of thing like a decrease in the number of Christian teachers and a decrease in the number of students interested in attending this type of school. The second motivation for the survey is more general one: to determine the School Identities of private schools, facing a crisis that the number of students is decreasing in Japan, by reconsidering the spirit behind the founding of a private school. 　The make-up of the spirit behind the founding of a private school are varied; each school lays stress on different points; and the efforts made toward realization of this spirit are also varied in accordance to the type of school. The first step of this study is to extract the make-up of the spirit behind the founding of a private school and categorize the various parts. This categorization helps answer the questions, "What kind of the \u27spirit\u27 can survive the changes of time?" "What kind of \u27spirit\u27 has been compelled to change with the times or as a result of other factors?" Due to the limited space of this paper, the problems of the persistence of the spirit behind the founding of a private school and the reasons for these problems will be mentioned on another occasion. 　It is quite difficult to categorize the make-up of the "spirit" of each school, as there is no standardized format. After a pilot study of 379 high schools in 10 prefectures, some keywords have been discovered. In general, the make-up of the spirit behind the founding of a private school can be categorized by the following 5 subject areas: 1. Educational philosophy (specific religion, thought and objectives for establishment) 2. The subject of education 3. Concrete educational objectives 4. The way the school will contribute to society 5. The approach or practice of education utilized to realize the spiri of behind the founding of a private school 　These categories typically fit into a school charter in the following manner: 　"Based on 1 (religion/thought ), this school considers 2 to be of primary importance. It aims at educating the person who can be equipped with such characteristics and skills as 3, and expects him/her to contribute the society or community in 4. This school attempts to achieve this purpose through 5." 　After readjustment of the keywords, the subcategories are as seen in Table 3 (in Japanese ). Questionnaires based on the table were sent to all the private high schools in Japan (1238 high schools), and the answers have been analyzed. A preceding study on the categorization of private schools points out that the schools with religious backgrounds earnestly exert themselves toward achievement of their spirit behind the founding of their individual school. This study analyzes the spirit behind the founding of a private school in terms of religious or non-religious backgrounds, and considers the changes wrought by time

Two mechanisms of the enhanced antibody-dependent cellular cytotoxicity (ADCC) efficacy of non-fucosylated therapeutic antibodies in human blood

<p>Abstract</p> <p>Background</p> <p>Antibody-dependent cellular cytotoxicity (ADCC) has recently been identified as one of the critical mechanisms underlying the clinical efficacy of therapeutic antibodies, especially anticancer antibodies. Therapeutic antibodies fully lacking the core fucose of the Fc oligosaccharides have been found to exhibit much higher ADCC in humans than their fucosylated counterparts. However, data which show how fully non-fucosylated antibodies achieve such a high ADCC in human whole blood have not yet been disclosed. The precise mechanisms responsible for the high ADCC mediated by fully non-fucosylated therapeutic antibodies, even in the presence of human plasma, should be explained based on direct evidence of non-fucosylated antibody action in human blood.</p> <p>Methods</p> <p>Using a human <it>ex vivo </it>B-cell depletion assay with non-fucosylated and fucosylated anti-CD20 IgG1s rituximab, we monitored the binding of the therapeutic agents both to antigens on target cells (target side interaction) and to leukocyte receptors (FcγR) on effector cells (effector side interaction), comparing the intensities of ADCC in human blood.</p> <p>Results</p> <p>In the target side interaction, down-modulation of CD20 on B cells mediated by anti-CD20 was not observed. Simple competition for binding to the antigens on target B cells between fucosylated and non-fucosylated anti-CD20s was detected in human blood to cause inhibition of the enhanced ADCC of non-fucosylated anti-CD20 by fucosylated anti-CD20. In the effector side interaction, non-fucosylated anti-CD20 showed sufficiently high FcγRIIIa binding activity to overcome competition from plasma IgG for binding to FcγRIIIa on natural killer (NK) cells, whereas the binding of fucosylated anti-CD20 to FcγRIIIa was almost abolished in the presence of human plasma and failed to recruit NK cells effectively. The core fucosylation levels of individual serum IgG1 from healthy donors was found to be so slightly different that it did not affect the inhibitory effect on the ADCC of fucosylated anti-CD20.</p> <p>Conclusion</p> <p>Our results demonstrate that removal of fucosylated antibody ingredients from antibody therapeutics elicits high ADCC in human blood by two mechanisms: namely, by evading the inhibitory effects both of plasma IgG on FcγRIIIa binding (effector side interaction) and of fucosylated antibodies on antigen binding (target side interaction).</p

OMI-VT stormに対するカテーテルアブレーション

A ６８-year-old woman with VT storm and frequent appropriate ICD therapy was referred for catheter ablation. Her past history was notable for aortic valve replacement by mechanical valve due to infectious endocarditis １７ years prior to presentation and left ventricular apical old myocardial infarction with unknown onset. At ６７ years old, She admitted to the prior hospital due to ventricular tachycardia with LBBB and superior axis at heart rate of ２１０ per minutes. Administration of amiodarone and magnesium sulfate was ineffective and cardioversion of ２００J was successfully terminated the tachycardia. Intra-cardiac defibrillator was implanted and the administration of amiodarone and mexiletine was started. ５ months after, she admitted to the hospital due to the frequent appropriate shock against the same ventricular tachycardia. Administration of lidocaine, sotalol, pilsicainide, and magnesium sulfate could not control the tachycardia and she was referred to our hospital for catheter ablation. During the first session, ventricular tachycardia was easily induced and electroanatomical mapping was performed both during tachycardia and during sinus rhythm. Late diastolic potential preceding the onset of QRS wave by ４５ms was detected at the infero-septal side of the apical aneurysm. ７．５s of the RF energy application at this site could terminate the tachycardia and thereafter no ventricular tachycardia was induced. But after dose-reduction or cessation of some anti-arrhythmic drugs, ventricular tachycardia was recurred and second session was performed. This time, no ventricular tachycardia was induced, then we performed isthmus transection and core isolation against the apical aneurysm. Thereafter no ventricular tachycardia was occurred in spite of dose-reduction or cessation of some anti-arrhythmic drugs

Mach 4 Simulating Experiment of Pre-Cooled Turbojet Engine Using Liquid Hydrogen

This study investigated a pre-cooled turbojet engine for a Mach 5 class hypersonic transport aircraft. The engine was demonstrated under takeoff and Mach 2 flight conditions, and a Mach 5 propulsion wind tunnel test is planned. The engine is composed of a pre-cooler, a core engine, and an afterburner. The engine was tested under simulated Mach 4 conditions using an air supply facility. High-temperature air under high pressure was supplied to the engine components through an airflow control valve and an orifice flow meter, and liquid hydrogen was supplied to the pre-cooler and the core engine. The results confirmed that the starting sequence of the engine components was effective under simulated Mach 4 conditions using liquid hydrogen fuel. The pre-cooling effect caused no damage to the rotating parts of the core engine in the experiment