Observations of eight gamma-ray flares were made by the Hintori satellite between April 1981 and June 1982. The energy spectra of the flares extend to energies of 7 MeV. Some of the flares show ...gamma-ray spectra with two different components of electron bremsstrahlung continuum and the gamma-ray lines. Other flares do not show the apparent gamma-ray line emission. The time histories of the flares are described in detail. 22 refs.
Abstract Background The causative organism in cardiovascular implantable electronic device (CIED) infection is usually diagnosed with the cultures from blood, removed leads, and/or infected pocket ...material. The cultured organism, however, is sometimes different among these samples. Methods Two hundred sixty patients with CIED infection, who underwent lead extraction between April 2005 and December 2014, were analyzed. More than two blood culture sets, all the extracted leads, and swab culture of the pocket were sent to the laboratory for culture. Among the patients all of whose microbiological examinations were available, we analyzed the causative organism defined as the species detected in at least two different sites. Results All the culture results were available in the 208 patients, showing 69 systemic infections (including 30 cases of infectious endocarditis) and 139 local infections. Blood culture, lead culture, and swab culture were positive in 57 (27%), 169 (81%), and 152 (73%), respectively. Staphylococcus aureus 37% including methicillin-resistant S. aureus (MRSA) (12%) and coagulase-negative staphylococci (CoNS, 36%) were the most common causative organism, followed by non-staphylococci (23%), and poly-microbial infection (4%). The detection of S. aureus from pocket or removed leads rendered higher predictive value of a causative organism than that of CoNS. The detection of Gram-negative bacteria, fungi, and mycobacteria indicated that it was most likely a causative organism. Gram-positive bacteria excluding Staphylococcus , such as Corynebacterium spp., tended to coexist as a benign organism. Conclusions The causative organism is mostly S. aureus and CoNS. Detection of S. aureus or Gram-negative bacteria means that it is more likely a causative organism.
Yohkoh observed strong γ-ray emission from a flare (
X9
2B
) at 11:52 UT on November 6, 1997. We found that fluxes of narrow lines from elements with similar FIPs correlated with one another during ...the flare, while there is a temporal variation of a ratio of low-FIP (Mg, Si and Fe) to high-FIP (C, N, O and Ne) narrow line fluxes. The ratio measured for the decay phase was enhanced by about factor of 3 compared to those for the rise and peak phases. It suggests two possibilities: (1) the low-FIP/high-FIP elemental abundance ratio at the γ-ray emission site was increased in the decay phase or (2) the location of the γ-ray production site could have changed with time, progressing from the chromosphere-photosphere toward the corona.
Background Thoracic aortic operations still remain associated with substantial risks of death and neurologic injury. This study investigated the impact of surgical stroke on the early and late ...outcomes, focusing on the physical status and quality of life (QOL). Methods From 1986 to 2008, 500 patients (aged 63 ± 13 years) underwent open thoracic aortic repair for root and ascending (31%), arch (39%), extended arch (10%), and descending and thoracoabdominal (19%) aneurysms. Brain protection consisted of retrograde cerebral perfusion (52%), antegrade cerebral perfusion (29%), and simple deep hypothermic circulatory arrest (19%). Surgical stroke was defined as a neurologic deficit persisting more than 72 hours after the operation. QOL was assessed with the Short-Form 36 Health Survey Questionnaire 5.9 ± 4.2 years after the operation. Results Stroke occurred in 10.3% of patients. Hospital mortality was 21% in the stroke group and 2.7% in the nonstroke group ( p < 0.001). At hospital discharge, 76% of survivors in the stroke group had permanent neurologic deficits (PNDs), with sustained tracheostomy in 39%, tube feeding in 46%, and gastrostomy in 14%, and 89% required transfer to other facilities. PND was an independent risk factor for late death (hazard ratio, 2.29; 95% confidence interval, 1.04 to 4.62; p = 0.041) in a multivariate analysis. The physical component of the QOL score was worse in the PND group (51% vs 100%; p = 0.039), whereas the mental component was similar in both groups (14% vs 14%). Conclusions Surgical stroke is associated with high hospital mortality and PNDs that decrease late survival and the physical component score of the QOL survey.
Objectives Surgical papillary muscle (PM) imbrication has been reported to be effective to relieve leaflet tethering in patients with functional mitral regurgitation (FMR). However, the mechanism ...that contributes to improvement of FMR by shortening the interpapillary muscle distance (IPMD) has not been well investigated. The purpose of the present study was to investigate whether IPMD can affect MR severity independently of PM tethering distance in patients with left ventricular dysfunction (LVD) using multislice computed tomography. Methods We analyzed volumetric multislice computed tomography images of mitral apparatus in 83 patients with LVD (ejection fraction <50%): 37 patients with FMR and 46 patients without FMR. By using the original software, we assessed the 3-dimensional geometry of mitral apparatus including IPMD, tethering distances, and mitral tenting volume at end-systole. The severity of FMR was assessed using vena contracta (VC) width by 2-dimensional echocardiography. Results Posterior and anterior tethering distance and IPMD were increased significantly in patients with FMR than in those without FMR. Patients with IPMD in the highest tertile had a significantly higher degrees of MR (mean ± standard error VC width, 4.5 ± 0.3 mm) compared with patients in the lowest and the middle tertiles, adjusting for PM tethering distance (mean ± standard error VC width, 3.0 ± 0.4 and 2.9 ± 0.3 mm; P < .001, respectively). Multivariate analysis showed that anteroposterior annular diameter and IPMD were the strongest determinants of FMR severity and mitral tenting volume. Conclusions IPMD, which affects leaflet tethering independently of PM tethering distance, was the major determinant of mitral tenting volume and FMR severity in patients with LVD.
The present research examines the differences in the concept of the corporation, and their possible implications for corporate performance, between Japan on one hand and the US and Europe (Germany, ...the UK, and France) on the other. The Japanese concept is used as the standard against which the other models are compared. The concept of the corporation is defined here as the answer to the question: In whose interest should the firm be managed? This is the foundation on which corporate governance and the monitoring system for the CEO is built. The analysis is focused on large publicly held corporations with widely diffused ownership.
Chemotherapy is of limited value in the treatment of hepatocellular carcinoma (HCC), since there are no established chemotherapeutic regimens proven to be effective. The aim of the present study was ...to determine predictive factors for tumor response to systemic chemotherapy in HCC patients. The relationship between patients' characteristics and tumor response was examined in 147 previously untreated HCC patients receiving systemic chemotherapy. Ten patients showed partial response (PR) and none showed complete response (CR). The response rate for all single anticancer agents was less than 10% and the overall response rate was 6.8%. The response rate in patients with unilateral HCC was significantly higher than in those with bilateral HCC. However, there were no responders among patients with a performance status of 2–3, ascites, a tumor occupying more than 50% of the entire liver, tumor thrombus in the main portal trunk or a serum bilirubin level of more than 2.0 mg/dl. There was a close relationship between patients' characteristics and tumor response. It is concluded that patients with fairly advanced HCC and/or poor hepatic reserve should not be given systemic chemotherapy.
The HXS and GRS detectors on Yohkoh observed the 14 July 2000, X5.7 flare, beginning at similar to 10:20 UT, similar to 4 min before the peak in soft X-rays. The hard X-rays and gamma -rays peaked ...similar to 3 min later at similar to 10:27 UT. Solar gamma -ray emission lasted until similar to 10:40 UT. Impact of high-energy ions at the Sun is revealed by the gamma -ray lines from neutron capture, annihilation radiation and de-excitation that are visible above the bremsstrahlung continuum. From measurement of these lines we find that the flare-averaged spectrum of accelerated protons is consistent with a power law greater than or equal to 10 MeV with index 3.14 plus or minus 0.15 and flux 1.1 x 10 super(32) protons MeV super(-1) at 10 MeV. We estimate that there were similar to 1.5 x 10 super(30) erg in accelerated ions if the power law extended without a break down to 1 MeV; this is about 1% of the energy in electrons > 20 keV from measurements of the hard X-rays. We find no evidence for spectral hardening in the hard X-rays that has been suggested as a predictor for the occurrence of solar energetic particle (SEP) events. This was the third largest proton event above 10 MeV since 1976. The GRS and HXS also observed gamma -ray lines and continuum produced by the impact of SEP on the Earth's atmosphere beginning about 13 UT on 14 July. These measurements show that the SEP spectrum softened considerably over the next 24 hours. We compare these measurements with proton measurements in space.
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