Observation of the Superconducting Proximity Effect from Surface States in SmB_{6}/YB_{6} Thin Film Heterostructures via Terahertz Spectroscopy

The ac conduction of epitaxially grown SmB_{6} thin films and superconducting heterostructures of SmB_{6}/YB_{6} are investigated via time-domain terahertz spectroscopy. A two-channel model of thickness-dependent bulk states and thickness-independent surface states accurately describes the measured conductance of bare SmB_{6} thin films, demonstrating the presence of surface states in SmB_{6}. While the observed reductions in the simultaneously measured superconducting gap, transition temperature, and superfluid density of SmB_{6}/YB_{6} heterostructures relative to bare YB_{6} indicate the penetration of proximity-induced superconductivity into the SmB_{6} overlayer; the corresponding SmB_{6}-thickness independence between different heterostructures indicates that the induced superconductivity is predominantly confined to the interface surface state of the SmB_{6}. This study demonstrates the ability of terahertz spectroscopy to probe proximity-induced superconductivity at an interface buried within a heterostructure, and our results show that SmB_{6} behaves as a predominantly insulating bulk surrounded by conducting surface states in both the normal and induced-superconducting states in both terahertz and dc responses, which is consistent with the topological Kondo insulator picture.

Diagnosis and treatment approaches for simultaneous onset of subarachnoid hemorrhage and thyroid storm: a case report

BACKGROUND

Subarachnoid hemorrhage and thyroid storm are similar in their clinical symptomatology, and diagnosis of these conditions, when they occur simultaneously, is difficult. Here, we report a rare case of concurrent subarachnoid hemorrhage and thyroid storm we encountered at our hospital.

CASE PRESENTATION

The patient was a 52-year-old woman. While bathing at home, the patient experienced a sudden disturbance of consciousness and was brought to our hospital. The main physical findings upon admittance were Glasgow Coma Scale score of E1V2M4, elevated blood pressure (208/145 mmHg), and tachycardia with atrial fibrillation (180 bpm) along with body temperature of 36.1 °C. Brain computed tomography revealed subarachnoid hemorrhage associated with a ruptured aneurysm of the posterior communicating artery branching from the left internal carotid artery, and aneurysm clipping was performed. Blood tests upon admission revealed high levels of free T3 and free T4 and low levels of thyroid-stimulating hormone. Upon determining that the patient had hyperthyroidism, thiamazole was administered. However, due to continuous impaired consciousness, fever, and persistence of tachycardia, the patient was diagnosed with thyroid storm. Oral potassium iodide and hydrocortisone were added to the treatment. The treatment was successful as the patient's symptoms improved, and she became lucid. In this case, we believe that in the presence of untreated hyperthyroidism, the onset of subarachnoid hemorrhage induced thyroid storm. Tachycardia of 130 bpm or higher, which is the diagnostic criterion for thyroid storm, rarely occurs with subarachnoid hemorrhage. Therefore, we believe it is an important factor for recognizing the presence of the thyroid storm. In this case, clipping surgery was prioritized which resulted in a favorable outcome. However, it is possible that invasive surgery may have exacerbated thyroid storm, suggesting that treatment should be tailored as per patient's condition.

CONCLUSION

If a pulse rate of 130 bpm or higher is observed alongside subarachnoid hemorrhage, we recommend considering the possibility of concomitant thyroid storm and testing for thyroid hormone. If concomitant thyroid storm is present, we believe that a treatment plan tailored to the patient's condition is critical, and early diagnosis will lead to a favorable outcome for the patient.

Evaluating the definition of severely injured patients: a Japanese nationwide 5-year retrospective study

OBJECTIVES

The definition of severely injured patients lacks universal consensus based on quantitative measures. The most widely used definition of severe injury is based on the Injury Severity Score (ISS), which is calculated using the Abbreviated Injury Scale in Japan. This study aimed to compare the prevalence, in-hospital mortality and OR for mortality in patients with ISS ≥16, ISS ≥18 and ISS ≥26 by age groups.

DESIGN

Retrospective cohort study.

SETTING

Japan Trauma Data Bank, which is a nationwide trauma registry with data from 280 hospitals.

PARTICIPANTS

We used data of 117 199 injured patients from a national database. We included injured patients who were transferred from the scene of injury by ambulance and/or physician.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence, in-hospital mortality and OR for mortality with respect to age and injury level (ISS group).

RESULTS

In all age categories, the in-hospital mortality of patient groups with an ISS ≥16, ISS ≥18 and ISS ≥26 was 13.3%, 17.4% and 23.5%, respectively. The in-hospital mortality for patients aged >75 years was the highest (20% greater than that of the other age groups). Moreover, in-hospital mortality for age group 5-14 years was the lowest (4.0-10.9%). In all the age groups, the OR for mortality for patients with ISS ≥16, ISS ≥18 and ISS ≥26 was 12.8, 11.0 and 8.4, respectively.

CONCLUSIONS

Our results revealed the lack of an acceptable definition, with a high in-hospital mortality and high OR for mortality for all age groups.

Safe RuleFit: Learning Optimal Sparse Rule Model by Meta Safe Screening

We consider the problem of learning a sparse rule model, a prediction model in the form of a sparse linear combination of rules, where a rule is an indicator function defined over a hyper-rectangle in the input space. Since the number of all possible such rules is extremely large, it has been computationally intractable to select the optimal set of active rules. In this paper, to solve this difficulty for learning the optimal sparse rule model, we propose Safe RuleFit (SRF). Our basic idea is to develop meta safe screening (mSS), which is a non-trivial extension of well-known safe screening (SS) techniques. While SS is used for screening out one feature, mSS can be used for screening out multiple features by exploiting the inclusion-relations of hyper-rectangles in the input space. SRF provides a general framework for fitting sparse rule models for regression and classification, and it can be extended to handle more general sparse regularizations such as group regularization. We demonstrate the advantages of SRF through intensive numerical experiments.

Energy Efficient Neuro-Inspired Phase-Change Memory Based on Ge4 Sb6 Te7 as a Novel Epitaxial Nanocomposite

Phase-change memory (PCM) is a promising candidate for neuro-inspired, data-intensive artificial intelligence applications, which relies on the physical attributes of PCM materials including gradual change of resistance states and multilevel operation with low resistance drift. However, achieving these attributes simultaneously remains a fundamental challenge for PCM materials such as Ge₂ Sb₂ Te₅ , the most commonly used material. Here bi-directional gradual resistance changes with ≈10× resistance window using low energy pulses are demonstrated in nanoscale PCM devices based on Ge₄ Sb₆ Te₇ , a new phase-change nanocomposite material . These devices show 13 resistance levels with low resistance drift for the first 8 levels, a resistance on/off ratio of ≈1000, and low variability. These attributes are enabled by the unique microstructural and electro-thermal properties of Ge₄ Sb₆ Te₇ , a nanocomposite consisting of epitaxial SbTe nanoclusters within the Ge-Sb-Te matrix, and a higher crystallization but lower melting temperature than Ge₂ Sb₂ Te₅ . These results advance the pathway toward energy-efficient analog computing using PCM.

Predictors of Outcomes Six Months after Endovascular Coil Embolization of Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Objective

To identify factors associated with the outcome and prognosis of coil embolization for poor-grade aneurysmal subarachnoid hemorrhage (aSAH).

Methods

We retrospectively reviewed 118 patients with World Federation of Neurosurgical Societies (WFNS) grade IV or V subarachnoid hemorrhage at our institute between January 2010 and December 2020. Outcomes were assessed using modified Rankin Scale (mRS) scores at discharge and at six months after aSAH onset. In addition, patient background, aneurysm characteristics, and treatment outcome were compared between patients showing favorable (mRS scores: 0-2) and unfavorable (mRS scores: 3-6) outcomes at six months. Factors for change of mRS during follow-up were explored, and cut off values were calculated for age using the receiver operating characteristic analysis.

Results

Endovascular treatment was performed in 51 of the 118 enrolled patients. Data were analyzed for 43 of these patients who underwent coil embolization of ruptured aneurysms and had complete datasets. The mean age was 61.7 years and 24 (55.8%) patients had WFNS grade V aSAH. Coil embolization-related complications were observed in three patients. There were no treatment-related deaths; however, eight patients (18.6%) died at three months. Multivariate analysis showed that the maximum diameter of the aneurysm (p=0.041) and the postoperative dual antiplatelet therapy (DAPT) (p=0.040) were associated with unfavorable and favorable outcomes, respectively. Older age (p=0.033) was independently associated with mRS score deterioration following discharge. Age 72 years and older was the cut off value for mRS deterioration.

Conclusion

Aneurysm size and postoperative DAPT might be associated with outcomes at 6 months. Moreover, we identified older age as an independent factor that influences mRS deterioration following discharge; thus, especially in cases of elderly patients over 72 years of age, it is highly likely that long-term care to prevent disuse and regular follow-up on imaging will be necessary.

Transformer-based personalized attention mechanism for medical images with clinical records

In medical image diagnosis, identifying the attention region, i.e., the region of interest for which the diagnosis is made, is an important task. Various methods have been developed to automatically identify target regions from given medical images. However, in actual medical practice, the diagnosis is made based on both the images and various clinical records. Consequently, pathologists examine medical images with prior knowledge of the patients and the attention regions may change depending on the clinical records. In this study, we propose a method, called the Personalized Attention Mechanism (PersAM) method, by which the attention regions in medical images according to the clinical records. The primary idea underlying the PersAM method is the encoding of the relationships between medical images and clinical records using a variant of the Transformer architecture. To demonstrate the effectiveness of the PersAM method, we applied it to a large-scale digital pathology problem involving identifying the subtypes of 842 malignant lymphoma patients based on their gigapixel whole-slide images and clinical records.

Association of obesity paradox with prognosis of veno-venous-extracorporeal membrane oxygenation in patients with coronavirus disease 2019

Aim

Although the obesity paradox is known for various diseases, including cancer and acute respiratory distress syndrome, little is known about veno-venous extracorporeal membrane oxygenation (VV-ECMO) in patients with coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate the association between body mass index (BMI) and prognosis in critical patients with COVID-19 requiring VV-ECMO.

Methods

We conducted a retrospective observational single-center study at Yokohama City University Civic General Medical Center between March 2020 and October 2021. Participants were patients with COVID-19 who required VV-ECMO. They were classified into two groups: BMI ≤30 kg/m² and >30 kg/m².

Results

In total, 23 patients were included in the analysis, with a median BMI of 28.7 kg/m². Overall, 22 patients were successfully weaned from the ECMO. When comparing the two groups, there was a trend toward fewer days from onset to ECMO induction in the BMI >30 kg/m² group. Moreover, the two groups had a similar prognosis. There were no statistically significant differences in the number of days from onset to hospitalization or the duration of ECMO induction between the groups.

Conclusion

VV-ECMO induction for patients with COVID-19 may lead to earlier indications in patients with BMI >30 kg/m² than in those with BMI ≤30 kg/m².

Continuous positive airway pressure treatment from the prehospital field in a Japanese regional Doctor Car system

Background

Continuous positive airway pressure (CPAP) therapy is an effective treatment for patients with severe heart failure, and certain guidelines recommend its early initiation. However, the current Japanese law strictly prohibits paramedics from administering this treatment. To demonstrate the efficacy and safety of prehospital administration of CPAP therapy, this study was conducted by the Yokohama Medical Control Council (Yokohama MC).

Methods

The Yokohama MC established a protocol for CPAP treatment and dispatched Doctor Cars to attend to patients with severe respiratory failure. The Boussignac CPAP system was installed in all Yokohama Doctor Cars, including Workstation-type Doctor Cars and Hospital-type Doctor Cars. Data from this study were collected and recorded in the Yokohama City Doctor Car Registry system from October 2020 to January 2022.

Results

The Doctor Car was dispatched 661 times, and CPAP therapy was administered to 13 patients in the prehospital field. It is important to note that the number of CPAP cases was lower than anticipated due to the coronavirus disease 2019 (COVID-19) pandemic, given concerns about aerosol production. When assessing changes over time in oxygen saturation (SpO2), the median (interquartile range), excluding missing values, was 89% (83%-93%) without oxygen, 95% (94%-99.3%) with oxygen, and 100% (97%-100%) with CPAP. The differences between these groups were statistically significant with a p-value of <0.0001. Respiratory distress was primarily attributed to heart failure in 10 patients (91%) and pneumothorax in 1 patient (9%). Notably, none of the patients' conditions worsened after the use of CPAP.

Conclusion

We have detailed the administration of CPAP therapy in the prehospital field within a local city in Japan. To the best of our knowledge, this represents the inaugural report of a prospective observational study on the prehospital administration of CPAP therapy originating from Japan.

Association Between Thrombin-Antithrombin Complex and Acute Kidney Injury After Pediatric Cardiopulmonary Bypass Surgery: A Single-Center Retrospective Observational Study

Vascular endothelial damage may activate hypercoagulation and contribute to the development of acute kidney injury (AKI). This study aimed to investigate whether early alteration in coagulation was associated with AKI onset following surgeries involving cardiopulmonary bypass (CPB) in children. This single-center retrospective cohort study included 154 infants and toddlers who underwent cardiovascular surgery with CPB. At admission to the pediatric intensive care unit, the absolute thrombin-antithrombin complex (TAT) level in each patient was measured. Moreover, the presence or absence of AKI onset in the early postoperative period was observed. Of the total participants, 55 (35%) developed AKI. A comparison within the toddler group based on the TAT cut-off value showed that both univariate and multivariable associations were found between increased absolute TAT level and AKI onset (odds ratio, 4.70; 95% confidence interval [1.20-17.90]; P = .023). The increase in absolute TAT level in toddlers during the early postoperative period following CPB was associated with AKI onset. However, a further prospective multicenter study with a larger sample size is required for validating these findings.

Monogenic inflammatory bowel disease with STXBP2 mutations is not resolved by hematopoietic stem cell transplantation but can be alleviated via immunosuppressive drug therapy

STXBP2, encoding syntaxin-binding protein 2, is involved in intracellular organelle trafficking and is associated with familial hemophagocytic lymphohistiocytosis type 5. Although STXBP2 mutations reportedly cause monogenic inflammatory bowel disease, the clinical course and underlying pathogenic mechanisms remain unclear. We identified a novel mutation in STXBP2 [c.1197delC, p.Ala400fs] in a boy with congenital intractable diarrhea and hemophagocytic lymphohistiocytosis (HLH). HLH was treated with intravenous prednisolone, cyclosporine, and dexamethasone palmitate. Hematopoietic stem cell transplantation (HSCT) along with prophylaxis for graft-versus-host-disease was performed at 5 months of age. Additionally, colonoscopies done before and after HSCT showed mild colitis with cryptitis. The patient showed elevated fecal calprotectin levels and persistent diarrhea even after HSCT and required partial parenteral nutrition. While anti-inflammatory treatment reduced diarrhea, it was not completely normalized even after HSCT, suggesting that the pathogenesis of inflammatory bowel disease associated with STXBP2 mutations involves both hyperinflammation and functional epithelial barrier defects.

Utility of dual-energy computed tomography in the association of COVID-19 pneumonia severity

Aim

Coronavirus disease 2019 pneumonia differs from ordinary pneumonia in that it is associated with lesions that reduce pulmonary perfusion. Dual-energy computed tomography is well suited to elucidate the etiology of coronavirus disease 2019 pneumonia, because it highlights changes in organ blood flow. In this study, we investigated whether dual-energy computed tomography could be used to determine the severity of coronavirus disease 2019 pneumonia.

Methods

Patients who were diagnosed with coronavirus disease 2019 pneumonia, admitted to our hospital, and underwent dual-energy computed tomography were included in this study. Dual-energy computed tomography findings, plane computed tomography findings, disease severity, laboratory data, and clinical features were compared between two groups: a critical group (18 patients) and a non-critical group (30 patients).

Results

The dual-energy computed tomography results indicated that the percentage of flow loss was significantly higher in the critical group compared with the non-critical group (P < 0.001). Additionally, our data demonstrated that thrombotic risk was associated with differences in clinical characteristics (P = 0.018). Receiver operating characteristic analysis revealed that the percentage of flow loss, evaluated using dual-energy computed tomography, could predict severity in the critical group with 100% sensitivity and 77% specificity. However, there were no significant differences in the receiver operating characteristic values for dual-energy computed tomography and plane computed tomography.

Conclusion

Dual-energy computed tomography can be used to associate the severity of coronavirus disease 2019 pneumonia with high accuracy. Further studies are needed to draw definitive conclusions.

STAT6 gain-of-function variant exacerbates multiple allergic symptoms

BACKGROUND

Allergic diseases were long considered to be complex multifactorial disorders. However, recent findings indicate that severe allergic inflammation can be caused by monogenic immune defects.

OBJECTIVES

We sought to clarify the molecular pathogenesis of a patient with early-onset multiple allergic diseases, a high serum IgE level, hypereosinophilia, treatment-resistant severe atopic dermatitis with increased dermal collagen fiber deposition, and eosinophilic gastrointestinal disorder with numerous polypoid nodules.

METHODS

A missense variant in STAT6 was identified, and its function was examined using peripheral blood, transfected HEK293 cells, lymphoblastoid cell lines, and knock-in mice with the corresponding mutation.

RESULTS

Whole-exome sequencing identified a de novo heterozygous missense variant in signal transducer and activator of transcription 6 (STAT6) (p.Asp419Asn). Luciferase reporter assay revealed that the transcriptional activity of this STAT6 mutant was upregulated even without IL-4 stimulation. Phosphorylation of STAT6 was not observed in either the patient's T_H2 cells or lymphoblastoid cell lines without stimulation, whereas it was induced more strongly in both by IL-4 stimulation compared with healthy controls. STAT6 protein was present in the nuclear fraction of the lymphoblastoid cell lines of the patient even in the absence of IL-4 stimulation. The patient's gastric mucosa showed upregulation of STAT6-, fibrosis-, and germinal center formation-related molecules. Some of the knock-in mice with the corresponding mutation spontaneously developed dermatitis with skin thickening and eosinophil infiltration. Moreover, serum IgE levels and mRNA expression of type 2 cytokines were increased in the knock-in mice-with or without development of spontaneous dermatitis-compared with the wild-type mice.

CONCLUSIONS

A novel STAT6 gain-of-function variant is a potential cause of primary atopic disorders.

Early alveolar epithelial cell necrosis is a potential driver of COVID-19-induced acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) with COVID-19 is aggravated by hyperinflammatory responses even after the peak of the viral load has passed; however, its underlying mechanisms remain unclear. In the present study, analysis of the alveolar tissue injury markers and epithelial cell death markers in patients with COVID-19 revealed that COVID-19-induced ARDS was characterized by alveolar epithelial necrosis at an early disease stage. Serum levels of HMGB-1, one of the DAMPs released from necrotic cells, were also significantly elevated in these patients. Further analysis using a mouse model mimicking COVID-19-induced ARDS showed that the alveolar epithelial cell necrosis involved two forms of programmed necrosis, namely necroptosis, and pyroptosis. Finally, the neutralization of HMGB-1 attenuated alveolar tissue injury in the mouse model. Collectively, necrosis, including necroptosis and pyroptosis, is the predominant form of alveolar epithelial cell death at an early disease stage and subsequent release of DAMPs is a potential driver of COVID-19-induced ARDS.

SMG6 regulates DNA damage and cell survival in Hippo pathway kinase LATS2-inactivated malignant mesothelioma

Many genes responsible for Malignant mesothelioma (MM) have been identified as tumor suppressor genes and it is difficult to target these genes directly at a molecular level. We searched for the gene which showed synthetic lethal phenotype with LATS2, one of the MM causative genes and one of the kinases in the Hippo pathway. Here we showed that knockdown of SMG6 results in synthetic lethality in LATS2-inactivated cells. We found that this synthetic lethality required the nuclear translocation of YAP1 and TAZ. Both are downstream factors of the Hippo pathway. We also demonstrated that this synthetic lethality did not require SMG6 in nonsense-mediated mRNA decay (NMD) but in regulating telomerase reverse transcriptase (TERT) activity. In addition, the RNA-dependent DNA polymerase (RdDP) activity of TERT was required for this synthetic lethal phenotype. We confirmed the inhibitory effects of LATS2 and SMG6 on cell proliferation in vivo. The result suggests an interaction between the Hippo and TERT signaling pathways. We also propose that SMG6 and TERT are novel molecular target candidates for LATS2-inactivated cancers such as MM.

Long-Term Efficacy and Safety of Golimumab for Ulcerative Colitis in a Pediatric Inflammatory Bowel Disease Center in Japan

PURPOSE

Golimumab (GLM) is an anti-tumor necrosis factor (TNF)-α antibody preparation known to be less immunogenic than infliximab (IFX) or adalimumab. Few reports on GLM in pediatric patients with ulcerative colitis (UC) are available. This study aimed to review the long-term durability and safety of GLM in a pediatric center.

METHODS

The medical records of 17 pediatric patients (eight boys and nine girls) who received GLM at the National Center for Child Health and Development were retrospectively reviewed.

RESULTS

The median age at GLM initiation was 13.9 (interquartile range 12.0-16.3) years. Fourteen patients had pancolitis, and 11 had severe disease (pediatric ulcerative colitis activity index ≥65). Ten patients were biologic-naïve, and 50% achieved corticosteroid-free remission at week 54. Two patients discontinued prior anti-TNF-α agents because of adverse events during remission. Both showed responses to GLM without unfavorable events through week 54. However, the efficacy of GLM in patients who showed primary nonresponse or loss of response to IFX was limited. Four of the five patients showed non-response at week 54. Patients with severe disease had significantly lower corticosteroid-free remission rate at week 54 than those without severe disease. No severe adverse events were observed during the study period.

CONCLUSION

GLM appears to be safe and useful for pediatric patients with UC. Patients with mild to moderate disease who responded to but had some adverse events with prior biologics may be good candidates for GLM. Its safety and low immunogenicity profile serve as favorable options for selected children with UC.

Severity predictors of COVID-19 in SARS-CoV-2 variant, delta and omicron period; single center study

Background

The outcomes of coronavirus disease 2019 (COVID-19) treatment have improved due to vaccination and the establishment of better treatment regimens. However, the emergence of variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, and the corresponding changes in the characteristics of the disease present new challenges in patient management. This study aimed to analyze predictors of COVID-19 severity caused by the delta and omicron variants of SARS-CoV-2.

Methods

We retrospectively analyzed the data of patients who were admitted for COVID-19 at Yokohama City University Hospital from August 2021 to March 2022.

Results

A total of 141 patients were included in this study. Of these, 91 had moderate COVID-19, whereas 50 had severe COVID-19. There were significant differences in sex, vaccination status, dyspnea, sore throat symptoms, and body mass index (BMI) (p <0.0001, p <0.001, p <0.001, p = 0.02, p< 0.0001, respectively) between the moderate and severe COVID-19 groups. Regarding comorbidities, smoking habit and renal dysfunction were significantly different between the two groups (p = 0.007 and p = 0.01, respectively). Regarding laboratory data, only LDH level on the first day of hospitalization was significantly different between the two groups (p<0.001). Multiple logistic regression analysis revealed that time from the onset of COVID-19 to hospitalization, BMI, smoking habit, and LDH level were significantly different between the two groups (p<0.03, p = 0.039, p = 0.008, p<0.001, respectively). The cut-off value for the time from onset of COVID-19 to hospitalization was four days (sensitivity, 0.73; specificity, 0.70).

Conclusions

Time from the onset of COVID-19 to hospitalization is the most important factor in the prevention of the aggravation of COVID-19 caused by the delta and omicron SARS-CoV-2 variants. Appropriate medical management within four days after the onset of COVID-19 is essential for preventing the progression of COVID-19, especially in patients with smoking habits.

Bayesian optimisation with transfer learning for NASICON-type solid electrolytes for all-solid-state Li-metal batteries

NASICON-type LiZr2(PO4)3 (LZP) has attracted significant attention as a solid oxide electrolyte for all-solid-state Li-ion or Li-metal batteries owing to its high Li-ion conductivity, usability in all-solid-state batteries, and electrochemical stability against Li metal. In this study, we aim to improve the Li-ion conductivity of Li-rich NASICON-type LZPs doped with CaO and SiO2, i.e., Li1+x+2y Ca y Zr2-y Si x P3-x O12(0 ≤ x ≤ 0.3, 0 ≤ y ≤ 0.3) (LCZSP). Herein, a total of 49 compositions were synthesised, and their crystal structures, relative densities, and Li-ion conductivities were characterised experimentally. We confirmed the improvement in Li-ion conductivity by simultaneous replacement of Zr and P sites with Ca and Si ions, respectively. However, the intuition-derived determination of the composition exhibiting the highest Li-ion conductivity is technically difficult because the compositional dependence of the relative density and the crystalline phase of the sample is very complex. Bayesian optimisation (BO) was performed to efficiently discover the optimal composition that exhibited the highest Li-ion conductivity among the samples evaluated experimentally. We also optimised the composition of the LCZSP using multi-task Gaussian process regression after transferring prior knowledge of 47 compositions of Li1+x+2y Y x Ca y Zr2-x-y P3O12 (0 ≤ x ≤ 0.376, 0 ≤ y ≤ 0.376) (LYCZP), i.e., BO with transfer learning. The present study successfully demonstrated that BO with transfer learning can search for optimal compositions two times as rapid as the conventional BO approach. This approach can be widely applicable for the optimisation of various functional materials as well as ionic conductors.

Bayesian Optimization for Cascade-Type Multistage Processes

Complex processes in science and engineering are often formulated as multistage decision-making problems. In this letter, we consider a cascade process, a type of multistage decision-making process. This is a multistage process in which the output of one stage is used as an input for the subsequent stage. When the cost of each stage is expensive, it is difficult to search for the optimal controllable parameters for each stage exhaustively. To address this problem, we formulate the optimization of the cascade process as an extension of the Bayesian optimization framework and propose two types of acquisition functions based on credible intervals and expected improvement. We investigate the theoretical properties of the proposed acquisition functions and demonstrate their effectiveness through numerical experiments. In addition, we consider suspension setting, an extension in which we are allowed to suspend the cascade process at the middle of the multistage decision-making process that often arises in practical problems. We apply the proposed method in a test problem involving a solar cell simulator, the motivation for this study.

The association between age and vital signs documentation of trauma patients in prehospital settings: analysis of a nationwide database in Japan

Background

Emergency medical service (EMS) providers are the first medical professionals to make contact with patients in an emergency. However, the frequency of care by EMS providers for severely injured children is limited. Vital signs are important factors in assessing critically ill or injured patients in the prehospital setting. However, it has been reported that documentation of pediatric vital signs is sometimes omitted, and little is known regarding the performance rate of vital sign documentation by EMS providers in Japan. Using a nationwide data base in Japan, this study aimed to evaluate the relationship between patients’ age and the documentation of vital signs in prehospital settings.

Methods

This study was a secondary data analysis of the Japan Trauma Data Bank. The inclusion criterion was patients with severe trauma, as defined by an Injury Severity Score ≥ 16. Our primary outcome was the rate of recording all four basic vital signs, namely blood pressure, heart rate, respiratory rate, and level of consciousness in the prehospital setting among different age groups. We also compared the prehospital vital sign completion rate, that is, the rate at which all four vital signs were recorded in a prehospital setting based on age groups. Multivariate analysis was performed to evaluate factors associated with the prehospital vital sign completion rate.

Results

We analyzed 75,777 severely injured patients. Adults accounted for 94% (71400) of these severely injured patients, whereas only 6% of patients were children. The rate of prehospital recording of vital signs was lower in children ≤5 years than in adult patients for all four vital signs. When the adult group was used as a reference, the adjusted odds ratios of vital sign completion rate in infants (0 years), younger children (1–5 years), older children (6–11 years), and teenagers (12–17 years) were 0.09, 0.30, 0.78, and 0.87, respectively.

Conclusions

Analysis of the nationwide trauma registry showed that younger children tended to have a lower rate of vital sign documentation in prehospital settings.

Clinical utility of minimally invasive posterior internal fixation within the pelvic ring using S2 alar iliac screws for unstable pelvic ring fracture

INTRODUCTION

Posterior internal fixation for unstable pelvic ring fractures is often associated with complications, including pelvic hemorrhage and gluteal necrosis. Pelvic ring fixation using the S2 alar iliac screw (SAIS) without fixation of the lumbosacral vertebrae may have potential as a novel, minimally invasive technique for treating unstable pelvic ring fractures. The present study compared clinical outcomes in patients who underwent SAIS fixation within the pelvic ring with a historical control group of patients who underwent conventional trans-iliac plate fixation for the treatment of unstable pelvic ring fractures.

MATERIALS AND METHODS

Thirty-two patients diagnosed with unstable pelvic fractures with sacral fracture or sacroiliac joint fracture dislocation were retrospectively evaluated. Eight consecutive patients underwent trans-iliac plate fixation from April 2012 to March 2015, and 24 consecutive patients underwent SAIS fixation from April 2015 to February 2020. Rates of soft tissue complications, intraoperative blood loss, and intraoperative blood transfusion volume were compared in these two groups.

RESULTS

Mean intraoperative blood loss was significantly lower in patients who underwent SAIS fixation than in those who underwent trans-iliac plate fixation (141.0 ml vs 315.0 ml; P = 0.027), although there were no between-group differences in intraoperative blood transfusion volume (0.0 ml vs 140 ml; P = 0.105), incidence rate of soft tissue complications (4.2% vs 0%; P = 1.000), and operation time (88.5 min vs 93.0 min; P = 0.862). Bone healing was confirmed in all patients who underwent SAIS fixation without dislocation of the fracture site, whereas one patient who underwent trans-iliac plate fixation experienced a dislocation of the fracture site during follow-up (0% vs 12.5%; P = 0.250).

CONCLUSIONS

SAIS fixation reduces intraoperative blood loss and ensures bone healing without major complications, including dislocation of the fracture site. SAIS fixation may therefore be an alternative, minimally invasive method of treating unstable pelvic fractures.

Ten-year in-hospital mortality trends among Japanese injured patients by age, injury severity, injury mechanism, and injury region: A nationwide observational study

The Injury Severity Score (ISS) is widely used in trauma research worldwide. An ISS cutoff value of ≥16 is frequently used as the definition of severe injury in Japan. The mortality of patients with ISS ≥16 has decreased in recent years, owing to the developing the trauma care system. This study aimed to analyze the prevalence, in-hospital mortality, and odds ratio (OR) for mortality in Japanese injured patients by age, injury mechanism, injury region, and injury severity over 10 years. This study used the Japan Trauma Data Bank (JTDB) dataset, which included 315,614 patients registered between 2009 and 2018. 209,290 injured patients were utilized. This study evaluated 10-year trends of the prevalence and in-hospital mortality and risk factors associated with in-hospital mortality. The overall in-hospital mortality was 10.5%. During the 10-year study period in Japan, the mortality trend among all injured patient groups with ISS 0–15, 16–25, and ≥26 showed significant decreases (p <0.001). Moreover, the mortality risk of patients with ISS ≥26 was significantly higher than that of patients with ISS 0–15 and 16–25 (p <0.001, OR = 0.05 and p<0.001, OR = 0.22). If we define injured patients who are expected to have a mortality rate of 20% or more as severely injured, it may be necessary to change the injury severity definition according to reduction of trauma mortality as ISS cutoff values to ≥26 instead of ≥16. From 2009 to 2018, the in-hospital mortality trend among all injured patient groups with ISS 0–15, 16–25, and ≥26 showed significant decreases in Japan. Differences were noted in mortality trends and risks according to anatomical injury severity.

Na superionic conductor-type LiZr2(PO4)3 as a promising solid electrolyte for use in all-solid-state Li metal batteries

All-solid-state Li-ion batteries are of considerable interest as safer alternatives to Li-ion batteries containing flammable organic electrolytes. To date, however, achieving sufficient charging and discharging rates, in addition to capacity, at room temperature using these all-solid-state batteries has been challenging. To overcome these issues, material simulations and informatics investigations of a relatively new Na superionic conductor (NASICON)-type LiZr₂(PO₄)₃ (LZP) electrolyte were conducted to elucidate its characteristics and material functions. The following thermodynamic and/or kinetic properties of NASICON-type Li-ion conductive oxides were investigated with respect to the crystal structure mainly using material simulation and informatics approaches: (1) the electrochemical stabilities of LZP materials with respect to Li metal and (2) Li-ion conductivities in the bulk and at the grain boundaries. An efficient materials informatics search method was employed to optimise the material functions of the LZP electrolyte via Bayesian optimisation. This study should promote the application of LZP in all-solid-state batteries for use in technologies such as mobile devices and electric vehicles and enable more complex composition and process control.