Design of a reflection-suppressed all-optical diode based on asymmetric L-shaped nonlinear photonic crystal cavity

A simple design method for suppressing the reflection of the all-optical diode based on the L-shaped photonic crystal (PC) cavity is proposed. Analyzing the linear resonant characteristics of the PC cavity and using the nonlinear coupled-mode theory, the strategy for obtaining reflection-suppressed structure is illustrated. Based on the design rule, a “reflection-suppressed all-optical diode” is presented, and numerical solutions indicate that the designed structure has a small reflection as well as an extremely large nonreciprocal transmission ratio

Slow-roll corrections to inflaton fluctuations on a brane

Quantum fluctuations of an inflaton field, slow-rolling during inflation are coupled to metric fluctuations. In conventional four dimensional cosmology one can calculate the effect of scalar metric perturbations as slow-roll corrections to the evolution of a massless free field in de Sitter spacetime. This gives the well-known first-order corrections to the field perturbations after horizon-exit. If inflaton fluctuations on a four dimensional brane embedded in a five dimensional bulk spacetime are studied to first-order in slow-roll then we recover the usual conserved curvature perturbation on super-horizon scales. But on small scales, at high energies, we find that the coupling to the bulk metric perturbations cannot be neglected, leading to a modified amplitude of vacuum oscillations on small scales. This is a large effect which casts doubt on the reliability of the usual calculation of inflaton fluctuations on the brane neglecting their gravitational coupling.Comment: 18 pages, 4 figure

Slow-roll corrections to inflaton fluctuations on a brane

Quantum fluctuations of an inflaton field, slow-rolling during inflation are coupled to metric fluctuations. In conventional four dimensional cosmology one can calculate the effect of scalar metric perturbations as slow-roll corrections to the evolution of a massless free field in de Sitter spacetime. This gives the well-known first-order corrections to the field perturbations after horizon-exit. If inflaton fluctuations on a four dimensional brane embedded in a five dimensional bulk spacetime are studied to first-order in slow-roll then we recover the usual conserved curvature perturbation on super-horizon scales. But on small scales, at high energies, we find that the coupling to the bulk metric perturbations cannot be neglected, leading to a modified amplitude of vacuum oscillations on small scales. This is a large effect which casts doubt on the reliability of the usual calculation of inflaton fluctuations on the brane neglecting their gravitational coupling.Comment: 18 pages, 4 figure

An open-label continuation trial of tocilizumab for familial Mediterranean fever with colchicine ineffective or intolerance

Background:Colchicine is the first-line treatment for familial Mediterranean fever (FMF), but secondary amyloidosis resulting from persistent inflammation is a concern in patients with colchicine-resistant or colchicine-intolerant FMF. Although tocilizumab (TCZ), which is a recombinant, humanized, anti-human interleukin 6 receptor monoclonal antibody, has been reported to prevent FMF attacks, the long-term safety and efficacy of TCZ on individuals with colchicine-resistant or colchicine-intolerant FMF have not been evaluated.Methods/design:In this investigator-initiated, multicenter, open-label trial, the long-term safety of TCZ will be evaluated in patients participating in a placebo-controlled, randomized, double-blind, parallel-group trial on colchicine-resistant or colchicine-intolerant FMF. The study will be conducted in 9 centers in Japan. After the evaluation and examination for 24 weeks in the preceding study, this trial will be started promptly. The trial will be completed by the time the drug is approved for FMF treatment in Japan. The primary endpoint is the incidence of adverse events, and the secondary endpoints include the number of FMF attacks, number of occurrences of accompanying symptoms during attacks, serum C-reactive protein and amyloid A levels, general evaluation by a physician (100mm visual analog scale [VAS]), general evaluation by a patient (100mm VAS), and body temperature.Discussion:The study is expected to obtain evidence regarding the long-term safety of TCZ as a potential new therapeutic agent for patients with colchicine-resistant or colchicine-intolerant FMF.Trial registration:This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (https://upload.umin.ac.jp/cgi-open-bin/ctr-e/ctr-view.cgi?recptno=R000037116) as UMIN000032557 on May 30 2018

Maximum and minimum lactate levels within 24 hours after veno-arterial extracorporeal membrane oxygenation induction are risk factors for intensive care unit mortality: a retrospective observational study

Introduction: Lactate level and clearance were hypothesized to be potential prognostic factors for mortality in patients withrefractory cardiogenic shock who underwent veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). This study aimed to determine the prognosis of VA-ECMO patients and whether the lactate level at intensive care unit (ICU) admission(La) and at 24 h after VA-ECMO induction (L24), minimum (L24min) or maximum (L24max) lactate level within 24 h after VAECMO induction, and/or maximum lactate level after ICU admission (Lmax) could predict ICU mortality in VA-ECMO patients.Materials and Methods: This retrospective observational study included consecutive patients who underwent VA-ECMO for severe cardiogenic shock and admitted to the ICU in a hospital from April 2009 to March 2017. Risk factors for ICU mortalitywith respect to lactate levels after VA-ECMO induction were determined through multiple logistic regression analysis.Results: VA-ECMO induction was performed in 67 adult patients, of whom 23 (34.3%) survived to ICU discharge. La, L24min,L24max, and Lmax were risk factors for ICU mortality in VA-ECMO patients after adjustment for the Acute Physiology and Chronic Health Evaluation II score and use of continuous renal replacement therapy and refractory ventricular arrhythmia after VA-ECMO induction, which were confounding factors in univariate analysis (La: odds ratio [OR], 1.44; 95% confidence interval[CI], 1.13-2.05; L24min: OR, 1.20; 95% CI, 1.01-2.56; L24max: OR, 1.44; 95% CI, 1.11-2.02; Lmax: OR, 1.52; 95% CI, 1.14-2.21).Conclusion: Lactate levels can be a therapeutic target and indicator of the need for improved patient management after VAECMO induction

The Efficacy of Software to Help Patients Understand Drug for Adjuvant Treatment for Breast Cancer: A Pilot Randomized Controlled Trial

We assessed the usefulness of ChemoCalc, a software package for calculating drug costs, in helping patients understand these costs. We randomly assigned, in a 1 : 1 ratio, 20 women who had undergone surgery for early breast cancer to a group that discussed adjuvant treatment with their physicians using the ChemoCalc software (ChemoCalc group) or a group that discussed adjuvant treatment without ChemoCalc (Usual Explanation group). The participants completed a five-grade evaluation questionnaire after these discussions. The primary endpoint was the intergroup comparison of the questionnaire scores regarding participants’ understanding of their treatment-associated drug costs. Median age was not significantly different between the ChemoCalc group and Usual Explanation group (57 vs. 50, respectively; p=0.27). Patients in the ChemoCalc group had a significantly higher perceived level of understanding of the drug cost than those in the Usual Explanation group (5 [4-5] vs. 2.5 [1-5], respectively; p=0.002). Scores related to the patients’ perception that understanding drug costs is an important part of breast cancer treatment were also higher in the ChemoCalc group than the Usual Explanation group (5 [2-5] vs. 3 [1-5], respectively; p=0.049). ChemoCalc was found to be useful for understanding drug costs