Percutaneous Transcatheter Ballon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve

Article信州医学雑誌 67(5): 289-292(2019)journal articl

Comparative analysis of the production of nitric oxide (NO) and tumor necrosis factor-alpha (TNF-alpha) from macrophages exposed to high virulent and low virulent strains of Edwardsiella tarda.

We previously reported that high virulent strain (NUF251) of Edwardsiella tarda has an ability to prevent the production of reactive oxygen species by macrophages, and is even capable of surviving and multiplying within Japanese flounder (Paralichthys olivaceus) peritoneal macrophages, whereas the low virulent strain (NUF194) has no such ability. In this study, we found that NUF251 and NUF194 induced NO and TNF-alpha production from Japanese flounder peritoneal macrophages, and NUF251 caused faster induction of NO release and much higher level of TNF-alpha production than NUF194. In addition, similar differences between two strains in terms of the induction of NO and TNF-alpha production were also observed in mouse macrophage cell line RAW264.7 cells. Our results suggest that the potent ability to induce the production of NO and TNF-alpha from macrophages may be one of the factors responsible for the virulence of E. tarda

Multicolor and multi-spot observations of Starlink's Visorsat

This study provides the results of simultaneous multicolor observations for the first Visorsat (STARLINK-1436) and the ordinary Starlink satellite, STARLINK-1113 in the $U$, $B$, $V$, $g'$, $r$, $i$, $R_{\rm C}$, $I_{\rm C}$, $z$, $J$, $H$, and $K_s$ bands to quantitatively investigate the extent to which Visorsat reduces its reflected light. Our results are as follows: (1) in most cases, Virorsat is fainter than STARLINK-1113, and the sunshade on Visorsat, therefore, contributes to the reduction of the reflected sunlight; (2) the magnitude at 550 km altitude (normalized magnitude) of both satellites often reaches the naked-eye limiting magnitude ($<$ 6.0); (3) from a blackbody radiation model of the reflected flux, the peak of the reflected components of both satellites is around the $z$ band; and (4) the albedo of the near infrared range is larger than that of the optical range. Under the assumption that Visorsat and STARLINK-1113 have the same reflectivity, we estimate the covering factor, $C_{\rm f}$, of the sunshade on Visorsat, using the blackbody radiation model: the covering factor ranges from $0.18 \leq C_{\rm f} \leq 0.92$. From the multivariable analysis of the solar phase angle (Sun-target-observer), the normalized magnitude, and the covering factor, the phase angle versus covering factor distribution presents a moderate anti-correlation between them, suggesting that the magnitudes of Visorsat depend not only on the phase angle but also on the orientation of the sunshade along our line of sight. However, the impact on astronomical observations from Visorsat-designed satellites remains serious. Thus, new countermeasures are necessary for the Starlink satellites to further reduce reflected sunlight.Comment: 31 pages, 9 figures, published in PAS

Preoperative biliary drainage for biliary tract and ampullary carcinomas

We posed six clinical questions (CQ) on preoperative biliary drainage and organized all pertinent evidence regarding these questions. CQ 1. Is preoperative biliary drainage necessary for patients with jaundice? The indications for preoperative drainage for jaundiced patients are changing greatly. Many reports state that, excluding conditions such as cholangitis and liver dysfunction, biliary drainage is not necessary before pancreatoduodenectomy or less invasive surgery. However, the morbidity and mortality of extended hepatectomy for biliary cancer is still high, and the most common cause of death is hepatic failure; therefore, preoperative biliary drainage is desirable in patients who are to undergo extended hepatectomy. CQ 2. What procedures are appropriate for preoperative biliary drainage? There are three methods of biliary drainage: percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD) or endoscopic retrograde biliary drainage (ERBD), and surgical drainage. ERBD is an internal drainage method, and PTBD and ENBD are external methods. However, there are no reports of comparisons of preoperative biliary drainage methods using randomized controlled trials (RCTs). Thus, at this point, a method should be used that can be safely performed with the equipment and techniques available at each facility. CQ 3. Which is better, unilateral or bilateral biliary drainage, in malignant hilar obstruction? Unilateral biliary drainage of the future remnant hepatic lobe is usually enough even when intrahepatic bile ducts are separated into multiple units due to hilar malignancy. Bilateral biliary drainage should be considered in the following cases: those in which the operative procedure is difficult to determine before biliary drainage; those in which cholangitis has developed after unilateral drainage; and those in which the decrease in serum bilirubin after unilateral drainage is very slow. CQ 4. What is the best treatment for postdrainage fever? The most likely cause of high fever in patients with biliary drainage is cholangitis due to problems with the existing drainage catheter or segmental cholangitis if an undrained segment is left. In the latter case, urgent drainage is required. CQ 5. Is bile culture necessary in patients with biliary drainage who are to undergo surgery? Monitoring of bile cultures is necessary for patients with biliary drainage to determine the appropriate use of antibiotics during the perioperative period. CQ 6. Is bile replacement useful for patients with external biliary drainage? Maintenance of the enterohepatic bile circulation is vitally important. Thus, preoperative bile replacement in patients with external biliary drainage is very likely to be effective when highly invasive surgery (e.g., extended hepatectomy for hilar cholangiocarcinoma) is planned