This paper presents bandgap reference (BGR) and sub-BGR circuits for nanowatt LSIs. The circuits consist of a nano-ampere current reference circuit, a bipolar transistor, and ...proportional-to-absolute-temperature (PTAT) voltage generators. The proposed circuits avoid the use of resistors and contain only MOSFETs and one bipolar transistor. Because the sub-BGR circuit divides the output voltage of the bipolar transistor without resistors, it can operate at a sub-1-V supply. The experimental results obtained in the 0.18-μm CMOS process demonstrated that the BGR circuit could generate a reference voltage of 1.09 V and the sub-BGR circuit could generate one of 0.548 V. The power dissipations of the BGR and sub-BGR circuits corresponded to 100 and 52.5 nW.
Abstract Background Time to awakening after out-of-hospital cardiac arrest (OHCA) and post-resuscitation therapeutic hypothermia (TH) varies widely. We examined the time interval from when comatose ...OHCA patients were rewarmed to 37 °C to when they showed definitive signs of neurological recovery and tried to identify potential predictors of awakening. Methods With IRB approval, a retrospective case study was performed in OHCA patients who were comatose upon presentation to a community hospital during 2006–2010. They were treated with TH (target of 33 °C) for 24 h, rewarmed, and discharged alive. Comatose patients were generally treated medically after TH for at least 48 h before any decision to withdraw supportive care was made. Pre-hospital TH was not used. Data are expressed as medians and interquartile range. Results The 89 patients treated with TH in this analysis were divided into three groups based upon the time between rewarming to 37 °C and regaining consciousness. The 69 patients that regained consciousness in ≤48 h after rewarming were termed “early-awakeners”. Ten patients regained consciousness 48–72 h after rewarming and were termed “intermediate-awakeners”. Ten patients remained comatose and apneic >72 h after rewarming but eventually regained consciousness; they were termed “late-awakeners”. The ages for the early, intermediate and late awakeners were 56 49,65, 62 48,74, and 58 55,65 years, respectively. Nearly 67% were male. Following rewarming, the time required to regain consciousness for the early, intermediate and late awakeners was 9 2,18 (range 0–47), 60.5 56,64.5 (range 49–71), and 126 104,151 h (range 73–259), respectively. Within 90 days of hospital admission, favorable neurological function based on a Cerebral Performance Category (CPC) score of 1 or 2 was reported in 67/69 early, 10/10 intermediate, and 8/10 late awakeners. Conclusion Following OHCA and TH, arbitrary withdrawal of life support <48 h after rewarming may prematurely terminate life in many patients with the potential for full neurological recovery. Additional clinical markers that correlate with late awakening are needed to better determine when withdrawal of support is appropriate in OHCA patients who remain comatose >48 h after rewarming.
Background and purpose
Differential diagnosis of sporadic inclusion body myositis (s‐IBM) and polymyositis (PM)/dermatomyositis (DM) is difficult and can affect proper disease management. Detection ...of heterogeneous muscular involvement in s‐IBM by muscle sonography could be a unique diagnostic feature.
Methods
Sonography of the lower leg and forearm was performed in patients with s‐IBM, PM/DM and control subjects (n = 11 each). Echo intensities (EIs) of the adjacent muscles medial head of the gastrocnemius versus soleus and the flexor digitorum profundus (FDP) versus flexor carpi ulnaris (FCU) were scored by three blinded raters. The mean EIs of these muscles were compared using computer‐assisted histogram analysis.
Results
Both evaluation methods showed high echoic signals in the gastrocnemius of patients with s‐IBM. EIs were significantly different between the gastrocnemius and soleus in patients with s‐IBM, but not in those with DM/PM and the controls. In the forearm, although the EI of the FDP was higher in the s‐IBM group than in the other groups, the EI differences between the FDP and FCU did not differ significantly between disease groups. The difference in area under the curves to differentiate between s‐IBM and DM/PM was greatest between the gastrocnemius−soleus EIs (0.843; P = 0.006).
Conclusions
High echoic signals in the medial gastrocnemius compared with those of the soleus are suggestive of s‐IBM over PM/DM.
Background and purpose
Many epidemiological studies of Guillain−Barré syndrome (GBS) and Fisher syndrome (FS) have been conducted in Europe and America. In contrast, epidemiological studies are rare ...in Asia where the GBS subtypes differ from those in Western countries. This study was undertaken to clarify the incidence of GBS and FS in a local area in Japan as well as their seasonal trends.
Method
Seventy‐one GBS and 37 FS patients were recorded from 2006 to 2015 in an area of approximately 1.5 million inhabitants in Japan. The incidence, seasonal trends and clinical features of GBS and FS were examined.
Results
The incidence rate of GBS was 0.42 cases per 100 000 person‐years and that of FS was 0.22 cases per 100 000 person‐years. The incidence of GBS increased with age and FS affected predominantly patients aged from 45 to 64 years old. There was some seasonal clustering of acute motor axonal neuropathy (AMAN) and FS in spring and summer, but it was not significant. AMAN and FS patients had a high frequency of preceding infection (AMAN, 68% gastrointestinal infection; FS, 65% upper respiratory infection). Antecedent respiratory infection was significantly associated with FS as an outcome. Serum antibodies to ganglioside GM1 were detected in 71% of AMAN patients and antibodies to GQ1b were detected in 81% of FS patients.
Conclusions
Our study offers evidence of a lower incidence of GBS and a higher incidence of FS in a local area in Japan than in Western countries.
Background and purpose
In myotonic dystrophy type 1 (DM1), weakness of distal limb muscles affects quality of life. Non‐invasive evaluation of muscular involvement by muscle sonography could be ...useful for characterizing muscle‐specific involvement.
Methods
Sonography of the lower leg and forearm was performed in 19 patients with DM1 and 10 control subjects. The mean echo intensities (EIs) of seven limb muscles were obtained by computer‐assisted histogram analysis and compared within DM1 according to the overall clinical severity.
Results
The EIs of the muscles were significantly higher in DM1 than in the controls (P < 0.01), except for the soleus (P = 0.4). Comparison of adjacent muscles showed the following: (i) greater EIs in flexor digitorum profundus than flexor carpi ulnaris (P < 0.01) and flexor digitorum superficialis (P = 0.02), and (ii) greater EIs in the medial head of the gastrocnemius than the soleus (P < 0.00001). In a subgroup analysis of DM1 according to the modified Rankin Scale (mRS), the more severe subgroup (mRS = 4−5) had lower mean EIs than the less severe subgroup (mRS from 1−3) (P = 0.01) in the flexor digitorum superficialis but not in other muscles.
Conclusions
Preferential high echogenicity in the medial gastrocnemius and deep finger flexors is suggestive of DM1. Muscle echogenicity is not generally related to functional dysfunction in DM1.
Outburst mechanisms of SU UMa-type dwarf novae are discussed. Two competing models were proposed; a pure disk instability model called the thermal-tidal instability model (TTI model) and the enhanced ...mass transfer model (EMT model). Observational evidence for enhanced mass transfer from the secondary star during outbursts is critically examined. It is demonstrated that most evidence for enhanced mass transfer is not well substantiated. Patterson et al. (CITE) have recently claimed to have found evidence for enhanced mass transfer during the 2001 outburst of WZ Sge. We show that their evidence is probably due to a misinterpretation of their observed light curves. Our theoretical analysis also shows that irradiation during outburst should not affect the mass transfer rate. A refinement of the TTI model is proposed that can explain why superhumps appear a few days after the superoutburst maximum in some SU UMa stars. We present our own interpretation of the overall development of the 2001 outburst of WZ Sge based on the TTI model that does not require the assumption of an unproved enhanced mass transfer.
Early humps in WZ Sge stars Osaki, Y.; Meyer, F.
Astronomy and astrophysics (Berlin),
02/2002, Volume:
383, Issue:
2
Journal Article
Peer reviewed
Open access
Photometric humps in outburst that are locked with the binary orbital period have been observed exclusively in the early phase of outbursts of WZ Sge stars. It is suggested that this “early hump” ...phenomenon is the manifestation of the tidal 2:1 resonance in accretion disks of binary systems with extremely low mass ratios. The “early humps” can be understood by the two-armed spiral pattern of tidal dissipation generated by the 2:1 resonance, first discussed by Lin & Papaloizou (CITE). The tidal removal of angular momentum from the disk during outbursts of dwarf novae, an important feature, is discussed in the context of the disk instability model. The ordering of tidal truncation radius, the 3:1 and 2:1 resonance radius in systems of different mass ratio naturally leads to a classification of dwarf nova systems in three groups according to their mass ratio. The WZ Sge stars are those systems which have the lowest mass ratios and are therefore characterized by “early humps”.
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