The repeating dislodgement of an ASO device

Transcatheter closure with an Amplatzer Septal Occluder (ASO) has become the standard treatment for secundum atrial septal defect (ASD). However, this procedure is associated with complications, such as device dislodgement. A 52-year-old woman was admitted with exertional dyspnea. Transesophageal echocardiography showed an ASD involving a 29 mm defect. Calculated Qp/Qs was 5.6 and all the rims were > 5 mm, with the exception of the posterior rim, which was 3 mm. Transcatheter ASD closure with an ASO was performed under general anesthesia. During emergence from anesthesia, tachycardia developed and the ASO device became dislodged. Hemodynamic changes associated with the end of anesthetic administration were believed to have led to device dislodgement. In a second transcatheter ASD closure, a low dose of propofol and remifentanil was maintained during emergence from anesthesia to reduce hemodynamic changes. However, device dislodgement occurred with nonsustained ventricular tachycardia. Finally, surgical ASD closure was performed. The large defect size, high Qp/Qs, and rim deficiency may have predisposed to device dislodgement after transcatheter ASD closure with ASO. The risk of device dislodgement should be considered in advance of surgery and, in high-risk cases, the patient's cardiovascular status should be closely monitored

Isolation of mixis-related genes from the rotifer Brachionus plicatilis using subtractive hybridization

The monogonont rotifer Brachionus plicatilis produces resting eggs through sexual reproduction (mixis), which is affected by external and internal factors. We collected resting eggs from rotifers cultured at 15 and 25°C and hatched them with and without 14-day dormancy in the dark. Stem females hatched from both conditions were further cultured at 15, 20 and 25°C. We obtained two phenotypes, one with high mixis (more than 50%), which was hatched from resting eggs formed at 15°C without dormancy, and another in which sexual reproduction occurred at 25°C and resting eggs were formed at 15°C with a 14-day dormancy. In the latter phenotype, mictic females appeared at 15°C, but not at 25°C. Using subtractive hybridization, we isolated one gene from the latter phenotype of females that had no significant similarity to known genes in BLAST searches. We propose that this gene is unique to rotifer mictic reproduction. Ongoing characterization of this gene attempts understand its role in mixis.The original publication is available at www.springerlink.co

Evolutionary Multiobjective Optimization including Practically Desirable Solutions

In many practical situations the decision-maker has to pay special attention to decision space to determine the constructability of a potential solution, in addition to its optimality in objective space. Practically desirable solutions are those around preferred values in decision space and within a distance from optimality. This work investigates two methods to find simultaneously optimal and practically desirable solutions. The methods expand the objective space by adding fitness functions that favor preferred values for some variables. In addition, the methods incorporate a ranking mechanism that takes into account Pareto dominance in objective space and desirability in decision space. One method searches with one population in the expanded space, whereas the other one uses two populations to search concurrently in the original and expanded space. Our experimental results on benchmark and real world problems show that the proposed method can effectively find optimal and practically desirable solutions

Disorder-Enhanced Dimensionless Thermoelectric Figure of Merit zT of Non-stoichiometric Organic Conductor (TTT)2I3+δ (δ ≤ 0.1)

Sample dependence of dimensionless thermoelectric figure of merit (zT) and power factor (PF) were determined for the non-stoichiometric organic conductor (TTT)2I3+δ (TTT = tetrathiatetracene, δ ≤ 0.1) with the simultaneous measurement of the electrical resistivity (ρ), thermopower (S) and thermal conductivity on small single crystals. Both the zT and PF show large sample dependence between 10 and 310 K, even though all the samples have nearly stoichiometric composition of TTT : I3- ~ 2 : 1 (δ ∼ 0). It was found that both the electrical conductivity (σ = 1/ρ) and S increase at room temperature as disorder — that is phase mismatch among the iodine chains — becomes more pronounced. This behavior contrasts the usual tendency that the S decreases as the σ increases in conventional conductors; and suggests a new strategy to improve the zT and PF by introducing an appropriate type of disorder

Ohutlevytuotteen välivarastoinnin ja identifioinnin menetelmäkehitystyö

Työssä tutkittiin ohutlevytuotteiden identifioimisen ja välivarastoinnin automatisointia Stofix Montage Teamin toimeksiannosta. Työn tavoitteena oli kehittää menetelmäratkaisut pakattujen ohutlevytuotteiden identifioimiseen ja niiden kuljettamiseen välivarastoon. Stofixilla ohutlevytuotteet identifioidaan ja välivarastoidaan manuaalisesti, mikä sitoo työntekijän samanaikaisesti kahteen eri työvaiheeseen. Tuotteet identifioidaan käyttäen tussikynää ja teippiä ja se on havaittu yrityksessä hitaaksi identifiointimenetelmäksi. Välivarastoidessa pakatut tuotteet nostetaan seinään vasten varastointitilaan, mikä altistaa tuotteet virumiselle ja vaurioitumiselle. Lisäksi tuotteen painon ylittäessä työturvallisuusmääräyksen salliman maksimipainon joutuu työvaiheeseen sitomaan kaksi työntekijää. Ongelmanratkaisuun ja kehitystyöhön käytettiin aikaisempien vuosien robotiikkaa käsitteleviä insinööritöitä sekä automatisoinnin suunnitteluohjekirjoja. Välivarastoinnin ja identifioinnin nykyinen prosessi analysoitiin lähtötilanne-, prosessi- ja kappaleanalyysin pohjalta, jonka kautta menetelmille valittiin komponentteja vertailua varten. Projektin läpiviemiseen käytettiin projektihallinnan aikataulu- ja projekti-suunnitelmapohjia sekä budjettilaskelman muodostavia hintavertailuja tarjouspyynnöistä. Analyysin perusteella menetelmän toteuttamiseen valittiin kattoon sijoitettava lineaarijohteella paikoittava kuusiakselinen robottikäsivarsi ja automaattisesti tulostava tarroituskone. Työn lopputulokseksi tuli robotiikalla ja alipainetarttujalla tehtävä tuotteiden välivarastointi sekä automaattisella tarroituskoneella tapahtuva identifiointi. Työ onnistui odotetusti, ja se tuotti yritykselle robottikäsivarren, alipainetarttujan ja tarroituskoneen komponenttivalinnat budjetoinnin lisäksi. Yritys voi hyödyntää työn tuloksia, kun tuotantoprosessia aletaan automatisoida. Työn jatkokehityskohteena voidaan tehdä robottisolun turvallisuussuunnitelma ja ohjelmointi, lineaarijohteen kompo-nenttivalinnat ja robotin kiinnitysrakenteen mekaniikkasuunnittelu

Technique for single-step lymphocyte isolation from an endoscopic biopsy specimen for the diagnosis of gastrointestinal lymphoma

In this paper, we introduce a simplified, one-step procedure for lymphocyte isolation from an endoscopically biopsied fragment. For lymphocyte isolation, an endoscopically harvested specimen and 5 mL of normal saline solution were placed in a wire mesh strainer set in a porcelain bowl. To obtain the lymphocyte suspension, the solid specimen was crushed using the rubber portion of a plunger of a 10 mL injection syringe. Flow cytometry was performed using the lymphocyte suspension. For validating our methods, the one-step lymphocyte isolation technique was used to perform flow cytometry on samples from 23 patients with (n = 12) or without (n = 11) gastrointestinal lymphoma. Flow cytometry of light chain expression was performed in all patient samples (feasibility: 100%). Sensitivity was 83.3% (10/12) and specificity was 100% (11/11). In conclusion, lymphocytes isolated from a single endoscopic biopsy specimen using our simplified and quick procedure are suitable for flow cytometry. Considering that flow cytometry has an important advantage of providing the results on the examination day itself, the results of this study suggest that flow cytometric analysis using our single-step lymphocyte isolation technique can be potentially used to diagnose lymphoma in the gastrointestinal mucosa

Lambert-Eaton Myasthenic Syndrome Caused by Nivolumab in a Patient with Squamous Cell Lung Cancer

Lambert-Eaton myasthenic syndrome (LEMS) is a representative paraneoplastic neurological syndrome. Recently, nivolumab, an anti-programmed cell death 1 inhibitor, has been approved for advanced non-small-cell lung cancer. Careful attention should be paid to immune-related adverse events (irAEs), including neurotoxicity. We herein report a 73-year-old woman with LEMS that occurred during nivolumab treatment for pulmonary squamous cell carcinoma. After the 20th week of nivolumab, she experienced various neurological symptoms such as ptosis, lower limb weakness, and photophobia. Findings from a nerve conduction study and a positive anti-P/Q-type voltage-gated calcium channel antibody made a diagnosis of LEMS. Pyridostigmine and 3,4-diaminopyridine temporarily improved her symptoms. This was the first case of LEMS as a neurological irAE. LEMS should be considered as a possible neurological irAE

Association of dorsal malunion in distal radius fractures with wrist osteoarthritis: Alterations of bone density and stress-distribution patterns in relation to deformation angles

Kazui A., Miyamura S., Shiode R., et al. Association of dorsal malunion in distal radius fractures with wrist osteoarthritis: Alterations of bone density and stress-distribution patterns in relation to deformation angles. Osteoarthritis and Cartilage, (2024); https://doi.org/10.1016/j.joca.2024.08.006.Objective: Distal radius fractures (DRFs) with dorsal malunion increase the risk of osteoarthritis (OA), although the cause of post-DRF OA is yet to be elucidated. To clarify the abnormal effects of a post-DRF dorsal radius deformity, we evaluated the bone density (BD) and stress-distribution patterns of the articular surface in dorsally malunited DRFs. Design: In 36 cases of dorsally malunited DRFs following extra-articular fractures, we generated three-dimensional computerized models of the malunited distal radius from computed tomography data and extracted the subchondral bones of the radiocarpal joint (RCJ) and distal radioulnar joint (DRUJ). Both BD and stress distribution in the subchondral bones were quantitatively evaluated by comparing the affected and normal sides. Correlations of alterations in high-BD distribution and deformation angles were analyzed. Results: The center of high-BD distribution from the center of the RCJ in the volar(-)-dorsal(+) direction was dorsal (0.56 ± 0.72 mm) on the affected side compared with the normal side (−0.15 ± 0.63 mm) [95% CI: 0.43, 1.00, P < 0.0001]. The maximum stress distribution was also dorsal on the affected side (2.34 ± 3.52 mm) compared with the normal side (−2.49 ± 1.62 mm) [95% CI: 0.89, 1.79, P < 0.0001]. The alterations in BD and stress distribution correlated with the dorsiflexion and radial deviation angles. In the DRUJ, there was no significant difference in BD between the affected and normal sides. Conclusions: In dorsally malunited DRFs, the alignment change of the RCJ resulted in high BD-concentration areas and stress distribution on the dorsal side of the radius, which may constitute a precursor for OA

Simulating tDCS electrode placement to stimulate both M1 and SMA enhances motor performance and modulates cortical excitability depending on current flow direction

IntroductionThe conventional method of placing transcranial direct current stimulation (tDCS) electrodes is just above the target brain area. However, this strategy for electrode placement often fails to improve motor function and modulate cortical excitability. We investigated the effects of optimized electrode placement to induce maximum electrical fields in the leg regions of both M1 and SMA, estimated by electric field simulations in the T1and T2-weighted MRI-based anatomical models, on motor performance and cortical excitability in healthy individuals.MethodsA total of 36 healthy volunteers participated in this randomized, triple-blind, sham-controlled experiment. They were stratified by sex and were randomly assigned to one of three groups according to the stimulation paradigm, including tDCS with (1) anodal and cathodal electrodes positioned over FCz and POz, respectively, (A-P tDCS), (2) anodal and cathodal electrodes positioned over POz and FCz, respectively, (P-A tDCS), and (3) sham tDCS. The sit-to-stand training following tDCS (2 mA, 10 min) was conducted every 3 or 4 days over 3 weeks (5 sessions total).ResultsCompared to sham tDCS, A-P tDCS led to significant increases in the number of sit-to-stands after 3 weeks training, whereas P-A tDCS significantly increased knee flexor peak torques after 3 weeks training, and decreased short-interval intracortical inhibition (SICI) immediately after the first session of training and maintained it post-training.DiscussionThese results suggest that optimized electrode placement of the maximal EF estimated by electric field simulation enhances motor performance and modulates cortical excitability depending on the direction of current flow

Cubitus varus deformity following paediatric supracondylar humeral fracture remodelling predominantly in the sagittal direction: A three-dimensional analysis of eighty-six cases

The version of record of this article, first published in International Orthopaedics, is available online at Publisher’s website: https://doi.org/10.1007/s00264-024-06197-2.Purpose: Three-dimensional (3D) capacity for remodelling in cubitus varus deformity (CVD) after paediatric supracondylar humeral fractures (PSHFs) remains unelucidated. This study investigated remodelling patterns after PSHFs by examining 3D deformity distribution over time after injury. Methods: Computed tomography (CT) data of 86 patients with CVD after PSHFs were analysed. The 3D deformity angles in the sagittal, coronal, and axial directions were assessed and correlated with the duration between the age at injury and CT evaluation. For the subgroup analysis, we performed the same correlation analysis in a younger (< 8 years old) and an older group (≥ 8 years old); we categorized the duration into early (< 2 years), middle (≥ 2 to < 5 years), and late periods (≥ 5 years) and compared the deformity angles of each direction among the three groups. Results: Sagittal deformity showed a moderate correlation with the duration of deformity (r = -0.54; P < 0.001), while coronal and axial deformities showed a negligible correlation. Sagittal deformity showed moderate correlations with the duration in the younger group (r = -0.62; P < 0.001) and weak correlations in the older group (r = -0.37; P = 0.091). In the sagittal direction, the deformity angle in the early period was significantly larger than those in the mid and late periods (P < 0.001). However, there were no significant differences among the three groups in the coronal and axial directions. Conclusion: Sagittal deformities in CVDs are capable of remodelling, especially in the early period and at a younger age, whereas coronal and axial deformities are less likely to undergo remodelling