Background
Chronic rhinosinusitis (CRS) can be classified into CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). CRSwNP displays more intense eosinophilic infiltration and the ...presence of Th2 cytokines. Mucosal eosinophilia is associated with more severe symptoms and often requires multiple surgeries because of recurrence; however, even in eosinophilic CRS (ECRS), clinical course is variable. In this study, we wanted to set objective clinical criteria for the diagnosis of refractory CRS.
Methods
This was a retrospective study conducted by 15 institutions participating in the Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC). We evaluated patients with CRS treated with endoscopic sinus surgery (ESS), and risk of recurrence was estimated using Cox proportional hazard models. Multiple logistic regression models and receiver operating characteristics curves were constructed to create the diagnostic criterion for ECRS.
Results
We analyzed 1716 patients treated with ESS. To diagnose ECRS, the JESREC scoring system assessed unilateral or bilateral disease, the presence of nasal polyps, blood eosinophilia, and dominant shadow of ethmoid sinuses in computed tomography (CT) scans. The cutoff value of the score was 11 points (sensitivity: 83%, specificity: 66%). Blood eosinophilia (>5%), ethmoid sinus disease detected by CT scan, bronchial asthma, aspirin, and nonsteroidal anti‐inflammatory drugs intolerance were associated significantly with recurrence.
Conclusion
We subdivided CRSwNP in non‐ECRS, mild, moderate, and severe ECRS according to our algorithm. This classification was significantly correlated with prognosis. It is notable that this algorithm may give useful information to clinicians in the refractoriness of CRS before ESS or biopsy.
Novel high-resolution convection-permitting regional climate simulations over the US employing the pseudo-global warming approach are used to investigate changes in the convective population and ...thermodynamic environments in a future climate. Two continuous 13-year simulations were conducted using (1) ERA-Interim reanalysis and (2) ERA-Interim reanalysis plus a climate perturbation for the RCP8.5 scenario. The simulations adequately reproduce the observed precipitation diurnal cycle, indicating that they capture organized and propagating convection that most climate models cannot adequately represent. This study shows that weak to moderate convection will decrease and strong convection will increase in frequency in a future climate. Analysis of the thermodynamic environments supporting convection shows that both convective available potential energy (CAPE) and convective inhibition (CIN) increase downstream of the Rockies in a future climate. Previous studies suggest that CAPE will increase in a warming climate, however a corresponding increase in CIN acts as a balancing force to shift the convective population by suppressing weak to moderate convection and provides an environment where CAPE can build to extreme levels that may result in more frequent severe convection. An idealized investigation of fundamental changes in the thermodynamic environment was conducted by shifting a standard atmospheric profile by ± 5 °C. When temperature is increased, both CAPE and CIN increase in magnitude, while the opposite is true for decreased temperatures. Thus, even in the absence of synoptic and mesoscale variations, a warmer climate will provide more CAPE and CIN that will shift the convective population, likely impacting water and energy budgets on Earth.
Endoscopic submucosal dissection (ESD) has the advantage over conventional endoscopic mucosa resection, permitting removal of early gastric cancer (EGC) en bloc, but long-term clinical outcomes ...remain unknown. A follow-up study on tumour recurrence and survival after ESD was conducted.
ESD was performed for patients with EGC that fulfilled the expanded criteria: mucosal cancer without ulcer findings irrespective of tumour size; mucosal cancer with ulcer findings <or=3 cm in diameter; and minute submucosal invasive cancer <or=3 cm in size. 551 patients with 589 EGC lesions were enrolled. The patients underwent ESD and then received periodic endoscopic follow-up and metastatic surveys for 6-89 months (median, 30 months). The main outcome measures were resectability (en bloc or piecemeal resection), and curability (curative or non-curative). Complications were assessed, and factors related to each were analysed statistically. The overall and disease-free survival rates were estimated.
En bloc resection was achieved in 94.9% (559/589), and larger lesions were at higher risk of piecemeal resection. 550 of 581 lesions (94.7%) were deemed to have undergone curative resection. En bloc resection was the only significant contributor to curative ESD. Patients with non-curative resection developed local recurrence more frequently. The 5-year overall and disease-specific survival rates were 97.1% and 100%, respectively.
Precise assessment of curability with successful one-piece resection may reduce tumour recurrence after ESD. The prognosis of EGC patients treated by ESD is likely to be excellent, though further longer follow-up studies are warranted.
The monolithic integration of four-colour indium gallium nitride (InGaN)-based nanocolumn light-emitting diodes (LEDs) is demonstrated. In the integrated nanocolumn LED unit, blue-, sky-blue-, green- ...and yellow-emitting micro-LEDs (LEDs 1–4) with a 65 μm diameter circular indium tin oxide emission window were arrayed in a 2 × 2 square lattice with a lattice constant of 190 μm. LEDs 1–4 consisted of nanocolumn arrays arranged in a triangular lattice with a lattice constant of 300 nm and their nanocolumn diameters at the position of the InGaN/gallium nitride (GaN) multiple quantum wells (MQWs) were 119, 145, 188 and 231 nm, respectively. The increase in nanocolumn diameter from LED 1 to LED 4 resulted in increasing emission peak wavelengths, which were 465, 489, 510 and 570 nm for LEDs 1–4, respectively. On the same substrate, a red-emitting micro-LED was prepared, in which the nanocolumn diameter was increased to 260 nm by using a 350 nm-lattice-constant nanocolumn array. A combination of different lattice constants in an integrated LED unit is expected to contribute to the achievement of red–green–blue–yellow (RGBY)-colour-integrated nanocolumn LEDs.
Key points
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The partial pressures of arterial carbon dioxide () and oxygen () has a marked influence on brain blood flow.
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It is unclear if the larger brain arteries are also sensitive to ...changing and and if different areas of the brain possess different sensitivities.
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We separately altered and and measured the diameter and blood flow in the main arteries delivering blood to the cortex and brainstem.
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During alterations in and , the large arteries changed diameter and blood flow to the brainstem changed more than that to the cortex.
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These findings change the basis of our understanding of brain blood flow control in humans.
Despite the importance of blood flow on brainstem control of respiratory and autonomic function, little is known about regional cerebral blood flow (CBF) during changes in arterial blood gases. We quantified: (1) anterior and posterior CBF and reactivity through a wide range of steady‐state changes in the partial pressures of CO2 () and O2 () in arterial blood, and (2) determined if the internal carotid artery (ICA) and vertebral artery (VA) change diameter through the same range. We used near‐concurrent vascular ultrasound measures of flow through the ICA and VA, and blood velocity in their downstream arteries (the middle (MCA) and posterior (PCA) cerebral arteries). Part A (n= 16) examined iso‐oxic changes in , consisting of three hypocapnic stages (=∼15, ∼20 and ∼30 mmHg) and four hypercapnic stages (=∼50, ∼55, ∼60 and ∼65 mmHg). In Part B (n= 10), during isocapnia, was decreased to ∼60, ∼44, and ∼35 mmHg and increased to ∼320 mmHg and ∼430 mmHg. Stages lasted ∼15 min. Intra‐arterial pressure was measured continuously; arterial blood gases were sampled at the end of each stage. There were three principal findings. (1) Regional reactivity: the VA reactivity to hypocapnia was larger than the ICA, MCA and PCA; hypercapnic reactivity was similar. With profound hypoxia (35 mmHg) the relative increase in VA flow was 50% greater than the other vessels. (2) Neck vessel diameters: changes in diameter (∼25%) of the ICA was positively related to changes in (R2, 0.63 ± 0.26; P < 0.05); VA diameter was unaltered in response to changed but yielded a diameter increase of +9% with severe hypoxia. (3) Intra‐ vs. extra‐cerebral measures: MCA and PCA blood velocities yielded smaller reactivities and estimates of flow than VA and ICA flow. The findings respectively indicate: (1) disparate blood flow regulation to the brainstem and cortex; (2) cerebrovascular resistance is not solely modulated at the level of the arteriolar pial vessels; and (3) transcranial Doppler ultrasound may underestimate measurements of CBF during extreme hypoxia and/or hypercapnia.
ZnO nanostructures were grown on carbon fabric with and without a capping agent using a simple hydrothermal method, and the growth times were varied in order to study the effect of the capping agent. ...The formation of ZnO wurtzite nanostructures was observed from the structural analysis of the sample with a capping agent. Morphological and mapping analyses observed the varied morphology of the capping agent over the different growth times. The interaction between the carbon fabric and the grown ZnO nanostructures was then studied via elemental analysis, and the strongest C–O–Zn bond was observed for the capping agent sample with the highest growth time. The formation of OH
−
ions induced when the growth time increased resulted in the formation (Zn
2+
) of densely grown ZnO nanostructures and improved stability was obtained via TGA analysis. The maximum thermopower calculated is + 5.9 μV K
−1
, and all the samples exhibited p-type in nature.
Magneto-optical Faraday effect is widely applied in optical devices and is indispensable for optical communications and advanced information technology. However, the bismuth garnet Bi-YIG is only the ...Faraday material since 1972. Here we introduce (Fe, FeCo)-(Al-,Y-fluoride) nanogranular films exhibiting giant Faraday effect, 40 times larger than Bi-YIG. These films have a nanocomposite structure, in which nanometer-sized Fe, FeCo ferromagnetic granules are dispersed in a Al,Y-fluoride matrix.
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