To what extent the traffic restriction policies can improve its air quality? An inspiration from COVID-19.

In hazy days, several local authorities always implemented the strict traffic-restriction measures to improve the air quality. However, owing to lack of data, the quantitative relationships between them are still not clear. Coincidentally, traffic restriction measures during the COVID-19 pandemic provided an experimental setup for revealing such relationships. Hence, the changes in air quality in response to traffic restrictions during COVID-19 in Spain and United States was explored in this study. In contrast to pre-lockdown, the private traffic volume as well as public traffic during the lockdown period decreased within a range of 60-90%. The NO2 concentration decreased by approximately 50%, while O3 concentration increased by approximately 40%. Additionally, changes in air quality in response to traffic reduction were explored to reveal the contribution of transportation to air pollution. As the traffic volume decreased linearly, NO2 concentration decreased exponentially, whereas O3 concentration increased exponentially. Air pollutants did not change evidently until the traffic volume was reduced by less than 40%. The recovery process of the traffic volume and air pollutants during the post-lockdown period was also explored. The traffic volume was confirmed to return to background levels within four months, but air pollutants were found to recover randomly. This study highlights the exponential impact of traffic volume on air quality changes, which is of great significance to air pollution control in terms of traffic restriction policy. Supplementary Information: The online version contains supplementary material available at 10.1007/s00477-022-02351-7.

Cerebral oximetry-guided pulmonary artery banding for end-stage heart failure in a child with left ventricular noncompaction cardiomyopathy: a case report.

Pulmonary artery banding (PAB) may reduce the need for left ventricular assist devices and heart transplantation in children with end-stage heart failure. However, excessive banding may increase the right ventricular afterload, leading to worsening of heart failure. The estimated right ventricular pressure and the shifting of the interventricular septum by transesophageal echocardiography (TEE), pulmonary artery pressure, right atrial and ventricular pressure, percutaneous oxygen saturation, and mixed venous oxygen saturation are utilized to determine the optimal circumference for PAB. Here, we report the case of a 5-month-old patient with end-stage heart failure due to left ventricular noncompaction cardiomyopathy (LVNC), with a gene mutation of MYH7, who underwent successful PAB. The exact PAB placement was additionally guided by using cerebral regional oxygen saturation (rSO2) measurement to achieve a tolerable and optimal PAB effect. We monitored rSO2 and other hemodynamic parameters while surgeons banded the pulmonary artery to achieve both highest rSO2 levels and stable hemodynamics. rSO2 was 68% before banding, and increased and remained at over 90% after the banding at same FiO2. Patient's heart failure improved gradually, and the child was discharged home at 6 months after PAB. The rSO2 is a simple and non-invasive monitor for the measurement of oxygen delivery to the brain tissue. rSO2 alone would not be able to guide PAB placement in the vulnerable DCM patients, but it may be of one further monitoring value for the optimal pulmonary artery circumference while patients are undergoing PAB.

Neurologically favourable outcomes of cardiogenic out-of-hospital cardiac arrest with relation to the type of witness in Japan.

AIM: To assess the current situation and neurologically favourable outcomes after out-of-hospital cardiac arrest (OHCA) with respect to the type of witness. METHODS: This retrospective observational study used data from the All-Japan Utstein Registry of the Fire and Disaster Management Agency collected between January 1, 2016, and December 31, 2016. Patients with cardiogenic OHCA aged ≥18 years who were witnessed by bystanders were included. The primary outcome measure was a neurologically favourable outcome 1 month after the OHCA. RESULTS: Among the 123,554 patients with OHCA registered between January 1, 2016, and December 31, 2016, 24,856 patients were included. Of them, 15,139 were witnessed by family, and 9717 were witnessed by non-family (friends, 1306; colleagues, 951; passers-by, 997; others, 6463). When witnessed by family, the rate of neurologically favourable outcomes was significantly lower than that when witnessed by non-family (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.41-0.49, P < 0.001). After adjusting for potential confounders, the rate of neurologically favourable outcomes remained lower when OHCA was witnessed by family (OR = 0.88, 95% CI = 0.79-0.99, P = 0.03). However, in subgroup analysis, adjusted ORs for neurologically favourable outcomes were slightly greater for 65-84-year-old women and ≥85-year-old women with family witnesses than for those with non-family witnesses. For all other groups, non-family witnesses outperformed family witnesses. CONCLUSION: Family-witnessed OHCA events had fewer neurologically favourable outcomes before and after adjusting for confounders. BLS education for family members may lead to improved prognosis of witnessed cardiogenic OHCAs.

Basic life support by citizens in Kawasaki City, Japan - a descriptive epidemiological study of out-of-hospital cardiac arrest patients.

AIM: To better understand the current status and barriers to making basic life support a common practice among the citizens of Kawasaki City, Japan. METHOD: We extracted data according to the Utstein-style guidelines specifically regarding out-of-hospital cardiac arrests (OHCAs) of cardiac etiology. The items were as follows: (i) OHCA witnessed by a citizen, (ii) the victim received bystander cardiopulmonary resuscitation (CPR), (iii) an automatic external defibrillator was used by the witness. We compared the rate of each item and the 1-month survival rates with the national average in Japan. We further divided Kawasaki City into three areas and compared each item. We also examined the rate of bystander CPR in each time period and location. Statistical analysis was carried out using the χ2-test and Fisher's test. RESULTS: The 1-month survival rates did not differ significantly from the national average for cases meeting conditions (i)-(iii): (i) 14.0% versus 13.3%, (ii) 19.1% versus 16.4%, (iii) 71.4% versus 53.3%, respectively. However, the rate of condition (i) was significantly lower (47.5% versus 55. 8%, P = 0.01). The rate of condition (ii) was higher in the northern area of Kawasaki City, as well as in a location other than the home in the daytime. The rate of condition (ii) was low in the home. CONCLUSIONS: Although the 1-month survival rates of OHCAs witnessed by citizens in Kawasaki City did not differ significantly from the national average, the low rate of bystander CPR was notable, especially in the southern and middle areas of the city and when the location was in the home, which implies that basic life support knowledge should be spread to these areas.

Recent decline of DDTs among several organochlorine pesticides in background air in East Asia.

Hexachlorocyclohexanes (HCHs), chlordanes (CHLs), and dichlorodiphenyltrichloroethanes (DDTs) in air-mass outflows from East Asia were recorded monthly from April 2009 to March 2014 at Cape Hedo in Japan. These organochlorine pesticides (OCPs) were collected by a high volume air sampler equipped with a quartz fiber filter, a polyurethane foam plug, and activated carbon fiber and analyzed by using a gas chromatograph-high resolution mass spectrometer. The overall (and geometric mean ± SD) concentration over the period was 4.9-43 pg m(-3) (15 ± 7.8 pg m(-3)) in HCHs (sum of α-/ß-/γ-/δ-HCH), 1.5-83 pg m(-3) (8.8 ± 11 pg m(-3)) in CHLs (sum of cis-/trans-chlordane, cis-/trans-nonachlor, and oxychlordane), and 0.71-16 pg m(-3) (2.5 ± 2.0 pg m(-3)) in DDTs (sum of o,p'-/p,p'-DDD, o,p'-/p,p'-DDE, and o,p'-/p,p'-DDT). Clear seasonal changes, i.e. higher in summer and lower in winter, were observed in HCHs and CHLs, suggesting the dominant effect of temperature-dependence, secondary sources in these OCPs. DDT concentration as well as the ratio of (o,p'-DDT + p,p'-DDT) to total DDTs, on the other hand, showed clear a declining trend during the five year sampling period, suggesting the decrease of input of newly produced DDTs in the regional environment by reflecting recent activities in the East Asian region to eliminate production and use of DDTs under the Stockholm Convention.

What range of extra-cardiac conduit flow velocity is detectable intraoperatively following the completion of a total cavo-pulmonary connection?

BACKGROUND: Very few studies have investigated the blood flow velocity from the inferior vena cava (IVC) to the pulmonary artery following the Fontan operation using an extra-cardiac conduit (ECC). No studies at all have investigated the velocity immediately after the circulation is established. The purpose of this retrospective study was to find an acceptable flow velocity at the ECC following the completion of a total cavo-pulmonary connection (TCPC) via transesophageal echocardiography. FINDINGS: We measured the mean velocity (m-V) of the blood flow proximal to the anastomosis between the IVC and ECC in eight patients and compared the results with theoretically predicted values based on assumptions regarding the cardiac output, the ratio of the IVC flow to the superior vena cava flow, and the cross-sectional form of the ECC. Mean velocities ranging from about 15 to 60 cm/s were detected in the absence of any observable stenosis. The measured m-V was significantly faster than the predicted value in our study, both collectively and in every patient individually. The shrinking and compression of the ECC might account for the faster velocities measured in our cases. CONCLUSION: The observed range of m-V at the ECC, about 15-60cm/s, may be acceptable for the establishment of TCPC circulation.

Factors Affecting Time to Sputum Culture Conversion in Adults with Pulmonary Tuberculosis: A Historical Cohort Study without Censored Cases.

BACKGROUND: In patients with pulmonary tuberculosis (TB), shortening the time to sputum culture conversion is desirable to reduce the likelihood of mycobacterial transmission. A persistent positive sputum culture after 2 months of treatment is reported to be associated with the presence of cavitation and the extent of disease on chest X-ray, high colony count, diabetes mellitus, and smoking. However, little is known about factors affecting the time to sputum culture conversion. This study was conducted to evaluate factors affecting the time to sputum culture conversion throughout the course of treatment in adults with pulmonary TB. METHODS: This study was performed using a database of the medical records of patients with active pulmonary TB who were treated at Hirakata Kohsai Hospital in Hirakata City, Osaka, Japan, from October 2000 to October 2002. Cox proportional-hazards analysis was used to evaluate factors affecting the time to sputum culture conversion after adjusting for potential confounders. RESULTS: The data of 86 patients with pulmonary TB were analyzed. The median time to sputum culture conversion was 39 days, and the maximum time was 116 days. The Cox proportional-hazards analysis showed that a higher smear grading (HR, 0.40; 95%CI, 0.23-0.71) and a history of ever smoking (HR, 0.48; 95%CI, 0.25-0.94) were associated with delayed sputum culture conversion. CONCLUSION: High smear grading and smoking prolonged the time to sputum culture conversion in adults with pulmonary TB. To effectively control TB, measures to decrease the cigarette smoking rate should be implemented, in addition to early detection and timely anti-TB treatment.

Osteoinduction on acid and heat treated porous Ti metal samples in canine muscle.

Samples of porous Ti metal were subjected to different acid and heat treatments. Ectopic bone formation on specimens embedded in dog muscle was compared with the surface characteristics of the specimen. Treatment of the specimens by H2SO4/HCl and heating at 600 °C produced micrometer-scale roughness with surface layers composed of rutile phase of titanium dioxide. The acid- and heat-treated specimens induced ectopic bone formation within 6 months of implantation. A specimen treated using NaOH followed by HCl acid and then heat treatment produced nanometer-scale surface roughness with a surface layer composed of both rutile and anatase phases of titanium dioxide. These specimens also induced bone formation after 6 months of implantation. Both these specimens featured positive surface charge and good apatite-forming abilities in a simulated body fluid. The amount of the bone induced in the porous structure increased with apatite-forming ability and higher positive surface charge. Untreated porous Ti metal samples showed no bone formation even after 12 months. Specimens that were only heat treated featured a smooth surface composed of rutile. A mixed acid treatment produced specimens with micrometer-scale rough surfaces composed of titanium hydride. Both of them also showed no bone formation after 12 months. The specimens that showed no bone formation also featured almost zero surface charge and no apatite-forming ability. These results indicate that osteoinduction of these porous Ti metal samples is directly related to positive surface charge that facilitates formation of apatite on the metal surfaces in vitro.

Osteoconduction of porous Ti metal enhanced by acid and heat treatments.

Bone ingrowth into porous Ti metal is important for stable fixation of Ti metal implants to surrounding bone. However, without surface treatment this is limited to only a thin region of the outer surface of the Ti metal. In the present study, a porous Ti metal with a porosity of ~60 % and interpore connections of 70-200 micrometers in diameter was investigated in terms of its chemical and heat treatments, by implanting it into rabbit femur for periods varying from 3 to 12 weeks. The porous Ti metal subjected to heat treatment at 600 °C after H2SO4/HCl mixed acid treatment showed the largest bone ingrowth in comparison with those subjected to no treatment, only acid treatment, and only heat treatment even at an early stage after implantation, and remained as such even 12 weeks after implantation. Their bone ingrowths were well interpreted in terms of apatite-forming abilities of the Ti metals in body environment. Their apatite-forming abilities did not depend upon their surface roughness nor type of crystalline phase, but upon the positive surface charge.

A novel synthetic material for spinal fusion: a prospective clinical trial of porous bioactive titanium metal for lumbar interbody fusion.

The objective of this study was to establish the efficacy and safety of porous bioactive titanium metal for use in a spinal fusion device, based on a prospective human clinical trial. A high-strength spinal interbody fusion device was manufactured from porous titanium metal. A bioactive surface was produced by simple chemical and thermal treatment. Five patients with unstable lumbar spine disease were treated surgically using this device in a clinical trial approved by our Ethics Review Committee and the University Hospital Medical Information Network. Clinical and radiological results were reported at the minimum follow-up period of 1 year. The optimal mechanical strength and interconnected structure of the porous titanium metal were adjusted for the device. The whole surface of porous titanium metal was treated uniformly and its bioactive ability was confirmed before clinical use. Successful bony union was achieved in all cases within 6 months without the need for autologous iliac crest bone grafting. Two specific findings including an anchoring effect and gap filling were evident radiologically. All clinical parameters improved significantly after the operation and no adverse effects were encountered during the follow-up period. Although a larger and longer-term follow-up clinical study is mandatory to reach any firm conclusions, the study results show that this porous bioactive titanium metal is promising material for a spinal fusion device.

[Case of obstructive sleep apnea possibly having led to postoperative appearance of generalized convulsion].

Adverse surgical outcomes appear to be more frequent in patients with known obstructive sleep apnea (OSA). However, OSA patients may present for surgery without a prior diagnosis. A 37-year-old man underwent craniotomy for surgical direct neck clipping of the right ruptured internal carotid aneurysm. His intraoperative and early postoperative courses were uneventful. At night, about 48 hr after surgery, he developed sudden generalized tonic-clonic convulsion and temporary depressed consciousness resulting in marked hypercapnea (Pa(CO2)>100 mmHg). His respiration was transiently supported by PSV mode via LMA. He soon got well without neurologic deficits. At night, about 74 hr postoperatively, a generalized convulsion was again observed with hypercapnea. Aside from the respiratory support, percutaneous cricothyroidotomy was performed using Minitrach II system for his airway control, leading to no further recurrence of seizure. He was suspected to have unrecognized OSA due to such characteristic findings of sleep apnea as obesity (BMI>30) and witnessed apneas by his family. Postoperative rapid eye movement (REM) sleep rebound has been suggested to contribute to two consecutive night appearance of seizure. Clinical suspicion for OSA should be required preoperatively and perioperative heightened awareness is recommended.

Self-assembling monolayer formation of glucose oxidase covalently attached on 11-aminoundecanethiol monolayers on gold.

Glucose oxidase (GOx) has been attached covalently to form uniform enzyme monolayers on self-assembled monolayers (SAMs) from 11-aminoundecanethiol (AUDT) by taking advantage of chemical oxidation of GOx carbohydrate residues followed by coupling the resulting 'aldehydic' enzyme with the terminal amino group in the SAM as characterized by AFM imaging, IR, QCM, and electrochemical measurements.