Supportive pericardial suspension for surgical airway management of tracheobronchomalacia in unilateral pulmonary agenesis

Unilateral pulmonary agenesis, a rare developmental defect of the lung, is often accompanied by tracheobronchial stenosis or malacia due to displacement, distortion, and compression of the surrounding great vessels. We present two cases of unilateral pulmonary agenesis complicated by tracheobronchial problems that were successfully managed surgically with supportive pericardial suspension.Keywords: pericardial suspension, tracheobronchomalacia, unilateral pulmonary agenesi

Augmentation of Positive Valence System–Focused Cognitive Behavioral Therapy by Inaudible High-Frequency Sounds for Anhedonia : A Trial Protocol for a Pilot Study

Importance Recent conceptualizations in Research Domain Criteria have indicated that anhedonia, 1 of 2 core symptoms of depression, which can be treatment resistant, is associated with deficits in the positive valence system, and inaudible high-frequency sound therapy has been shown to enhance reward-related brain circuitry. Hence, cognitive behavioral therapy focusing on the positive valence system enhanced with sound therapy could have a synergistic effect on anhedonia.Objective To test the augmentation effect of inaudible high-frequency sounds on the efficacy of positive valence system–focused cognitive behavioral therapy to treat anhedonia.Design, Setting, and Participants In this individual-level allocation, exploratory, single-center randomized superiority pilot trial, patients, therapists, and evaluators will be masked to intervention or placebo assignment. The trial will take place at a national psychiatric referral hospital in Tokyo, Japan, among 44 adult patients with clinically significant anhedonia and moderate to severe depression. Outcomes will be analyzed following the intent-to-treat principle using a repeated-measures mixed model.Intervention The intervention group will participate in 8 weekly sessions of positive valence system–focused cognitive behavioral therapy with in-session exposure to an inaudible high-frequency sound; the comparison group will undergo cognitive behavioral therapy with in-session exposure to a placebo sound.Main Outcomes and Measures The primary outcome is anhedonia assessed using the self-reported Snaith-Hamilton Pleasure Scale. The secondary outcome is anhedonia assessed using the clinician-administered version of the Snaith-Hamilton Pleasure Scale.Discussion Recruitment for this study began in May 2018, and the projected date of final allocation is January 2020. A total of 21 eligible patients were registered for participation as of May 30, 2019. To date, treatments for depression do not guarantee clinically successful outcomes. This pilot trial will provide preliminary evidence of the augmentation effect of high-frequency inaudible sounds on cognitive behavioral therapy for anhedonia. Overall, exposure to an inaudible high-frequency sounds does not require attentional or cognitive effort from either patients or therapists; therefore, results from a future confirmative trial could indicate that cognitive behavioral therapy can be augmented in an effortless manner

Severe Aortic Stenosis in Dialysis Patients

Background: Characteristics and prognosis of hemodialysis patients with severe aortic stenosis have not yet been well defined. Methods and Results: The CURRENT AS (contemporary outcomes after surgery and medical treatment in patients with severe aortic stenosis) registry, a Japanese multicenter registry, enrolled 3815 consecutive patients with severe aortic stenosis. There were 405 hemodialysis patients (initial aortic valve replacement [AVR] group: N=135 [33.3%], and conservative group: N=270) and 3410 nonhemodialysis patients (initial AVR group: N=1062 [31.1%], and conservative group: N=2348). The median follow‐up duration after the index echocardiography was 1361 days, with 90% follow‐up rate at 2 years. The cumulative 5‐year incidence of all‐cause death was significantly higher in hemodialysis patients than in nonhemodialysis patients in both the entire cohort (71% versus 40%, P<0.001) and in the initial AVR group (63.2% versus 17.9%, P<0.001). Among hemodialysis patients, the initial AVR group as compared with the conservative group was associated with significantly lower cumulative 5‐year incidences of all‐cause death (60.6% versus 75.5%, P<0.001) and sudden death (10.2% versus 31.7%, P<0.001). Nevertheless, the rate of aortic valve procedure–related death, which predominantly occurred within 6 months of the AVR procedure, was markedly higher in the hemodialysis patients than in the nonhemodialysis patients (21.2% and 2.3%, P<0.001). Conclusions: Among hemodialysis patients with severe aortic stenosis, the initial AVR strategy as compared with the conservative strategy was associated with significantly lower long‐term mortality risk, particularly the risk for sudden death, although the effect size for the survival benefit of the initial AVR strategy was smaller than that in the nonhemodialysis patients

Pore-Scale Wetting Process of Capillary-Driven Flow in Unsaturated Porous Media under Micro- and Earth-Gravities

Microgravity hinders capillary-driven water flow in unsaturated porous media. Previous studies proposed pore-scale phenomena such as &ldquo;air entrapment&rdquo;, &ldquo;particle separation&rdquo;, and &ldquo;interruption on widening void space&rdquo; to explain gravity-dependent capillary-driven flows. Our objectives were: (1) to measure the water flux densities of the pore-scale capillary-driven flow in micro- and Earth-gravities and (2) to reveal that what makes water flow slower under microgravity than under 1 G. We found that average macroscopic water flux densities had no significant difference under micro- and Earth-gravities (p = 0.30). We did not observe &ldquo;air entrapment&rdquo; in the pore spaces of porous media. &ldquo;Widening on a single particle&rdquo; and &ldquo;capillary widening&rdquo; disturbed capillary-driven flow; however, &ldquo;widening on a single particle&rdquo; had no significant gravity dependency. &ldquo;Capillary widening&rdquo; may be independent of gravity, since it was observed both under microgravity and under 1 G. Water flux densities in unsaturated porous media may have gravity dependency induced by &ldquo;particle separation&rdquo; only when porosity is large enough to allow particles to move

An Analysis of Vertebral Body Growth after Proton Beam Therapy for Pediatric Cancer.

Impairment of bone growth after radiotherapy for pediatric bone cancer is a well-known adverse event.However, there is limited understanding of the relationship between bone growth and irradiation dose.In this study, we retrospectively analyzed bone growth impairment after proton beam therapy forpediatric cancer. A total of 353 vertebral bodies in 23 patients under 12 years old who received protonbeam therapy were evaluated. Compared to the non-irradiated vertebral body growth rate, the irradiatedvertebral body rate (%/year) was significantly lower: 77.2%, 57.6%, 40.8%, 26.4%, and 14.1% at 10, 20, 30, 40, and 50 Gy (RBE) irradiation, respectively. In multivariate analysis, radiation dose was theonly factor correlated with vertebral body growth. Age, gender, and vertebral body site were notsignificant factors. These results suggest that the growth rate of the vertebral body is dose-dependentand decreases even at a low irradiated dose. This is the first report to show that proton beam therapyhas the same growth inhibitory effect as photon radiotherapy within the irradiated field