A Fault Detection Approach Based on One-Sided Domain Adaptation and Generative Adversarial Networks for Railway Door Systems.

Fault detection using the domain adaptation technique is one of the more promising methods of solving the domain shift problem, and has therefore been intensively investigated in recent years. However, the domain adaptation method still has elements of impracticality: firstly, domain-specific decision boundaries are not taken into consideration, which often results in poor performance near the class boundary; and secondly, information on the source domain needs to be exploited with priority over information on the target domain, as the source domain can provide a rich dataset. Thus, the real-world implementations of this approach are still scarce. In order to address these issues, a novel fault detection approach based on one-sided domain adaptation for real-world railway door systems is proposed. An anomaly detector created using label-rich source domain data is used to generate distinctive source latent features, and the target domain features are then aligned toward the source latent features in a one-sided way. The performance and sensitivity analyses show that the proposed method is more accurate than alternative methods, with an F1 score of 97.9%, and is the most robust against variation in the input features. The proposed method also bridges the gap between theoretical domain adaptation research and tangible industrial applications. Furthermore, the proposed approach can be applied to conventional railway components and various electro-mechanical actuators. This is because the motor current signals used in this study are primarily obtained from the controller or motor drive, which eliminates the need for extra sensors.

[Two cases of lesser omentum infarction with suggestive findings in esophagogastroduodenoscopy].

We report two cases of lesser omentum infarction with suggestive findings in esophagogastroduodenoscopy (EGD). Both patients were admitted to our hospital who presented with upper abdominal pain accompanied by signs of peritoneal irritation. EGD was performed to rule out gastroduodenal ulcer. No mucosal erythema and ulceration were observed, but we observed two signs suggesting lesser omentum infarction. First, EGD showed a submucosal tumor-like mass at the angular region of the lesser curvature of the stomach in both patients. Second, one of the patients exhibited great tenderness at the site of the tumor when this was depressed by biopsy forceps. We diagnosed the two patients with lesser omentum infarction from the results of abdominal computed tomography, abdominal ultrasonography, and EGD. Conservative management was applied;the patients received analgesic drugs and gradually became asymptomatic. Lesser omentum infarction presents with abdominal pain and sometimes signs of peritoneal irritation, and almost all cases can be successfully managed with conservative treatment. Diagnosing the disease carefully and precisely is essential. We report suggestive findings in EGD, which can assist in the diagnosis of lesser omentum infarction.

Pseudo-aneurysm caused by stent fracture in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions.

Despite the reported favorable patency of stents in the treatment of femoropopliteal lesions, concern regarding stent fracture is increasing. Development of pseudo-aneurysm by stent fracture is rare and has been reported to occur in the chronic phase owing to mechanical fatigue. Here, we present the first report of a pseudo-aneurysm caused by stent fracture in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesion. A 79-year-old man underwent endovascular therapy for an in-stent restenosis lesion of the right superficial femoral artery. Echography 48 days after the treatment showed a saccular pseudo-aneurysm at the proximal stent site, suggestive of stent fracture. Angiography confirmed the pseudo-aneurysm caused by stent fracture. A self-expandable endoluminal stent graft was deployed, which showed complete resolution of the pseudo-aneurysm. A pseudo-aneurysm caused by stent fracture can occur in the "sub-acute" phase after endovascular therapy for in-stent restenosis lesions. .

Combined Use of Excimer Laser and High-Speed Rotational Atherectomy to Overcome a Severely Calcified Lesion in Endovascular Therapy.

Although endovascular therapy (EVT) is commonly used in treatment of peripheral artery disease (PAD), severely calcified lesions pose a challenge, in spite of the technical advancement. In this report, we discuss the case of a 74-year-old male with coronary artery disease and end-stage renal disease who presented at our institution with bilateral intermittent claudication. Angiography showed chronic total occlusion (CTO) of the right superficial femoral arteries (SFA). Because the bilateral external iliac arteries demonstrated moderate stenosis, we performed endovascular therapy on the right SFA-CTO using a contralateral approach. With the antegrade wire progressing into the subintimal space, direct distal-SFA puncture was performed and wire externalization was established. However, no devices (minimal balloon, microcatheter, or Crosser system) were able to pass the lesion in antegrade or retrograde manner, even though the child catheter support or needle cracking technique from outside/inside was applied. Therefore, we used a combination of an excimer laser and high-speed rotational atherectomy to overcome the severely calcified lesion. First, the excimer laser catheter (Turbo Elite 0.9 mm) ablated the entry to the CTO; however, it did not pass through completely. Thereafter, the thin microcatheter (Caravel) succeeded in crossing the CTO in an antegrade manner using the BAlloon Deployment using FORcible Manner (BADFORM) technique. After wire-exchange to the Rota-wire, rotational atherectomy (RotaLink Plus 1.5 mm) passed through the CTO. Subsequently, we could dilate the CTO lesion with a conventional balloon followed by bare metal stent deployment. The right ankle-brachial index of the patient improved from being unmeasurable to 0.79, and the intermittent claudication disappeared. This combination therapy, described as the "RASER" technique in coronary section, is accepted for reimbursement. However, these devices in EVT section are considered off-label use in Japan. Therefore, we have to refrain from frequent use of this strategy; however, this method provides an option for severely calcified lesions.

Simple percutaneous coronary interventions using the modification of complex coronary lesion with excimer laser.

Excimer laser coronary atherectomy (ELCA), a unique percutaneous coronary intervention (PCI) device, comprises a monorail-type system and is compatible with any standard 0.014-inch guidewire. ELCA is the only device that vaporizes the atherosclerotic plaques or modifies underlying plaque located underneath to a hard tissue, such as severe calcification or a stent. Therefore, ELCA differs from other coronary atherectomy devices and is useful for patients with acute coronary syndrome, chronic total occlusion or under-expanded stents. This case series reports on patients treated using ELCA to simplify complex PCI procedures. Furthermore, we review and discuss ELCA in several situations.

Variations in the eicosapentaenoic acid-arachidonic acid ratio associated with age in acute myocardial infarction patients undergoing primary percutaneous coronary intervention.

Acute myocardial infarction (AMI) is a life-threatening disease, and its incidence has been increasing even in the young population. Although a low eicosapentaenoic acid (EPA)-arachidonic acid (AA) ratio is associated with an increased risk of coronary artery disease, the effect of age on EPA/AA ratios in AMI patients remains unclear. This study aimed to clarify the independent polyunsaturated fatty acid (PUFA)-related determinants of age in younger and older AMI patients. A total of 153 consecutive patients who underwent primary percutaneous coronary interventions (PCIs) for de novo AMIs were enrolled in this study. Patients' background data, including PUFA and lipid profiles during PCI, were evaluated retrospectively. The EPA/AA ratio correlated positively with age (r = 0.21; P = 0.011) and increased markedly from age 60 years. Patients aged < 60 years (n = 35) had a lower mean EPA/AA ratio (0.25 ± 0.16) than patients aged ≥ 60 years (n = 118) (0.38 ± 0.25) (P < 0.001). The AA level was more dependent on age than on EPA level (r = - 0.34, P < 0.001 vs. r = 0.12, P = 0.16). The multivariate analysis revealed that a 0.1 EPA/AA ratio increase (odds ratio 1.50; 95% confidence interval 1.09-2.06), body mass index, triglyceride level, and aspirin administration were independently associated with the age stratification of AMI patients. The EPA/AA ratio was higher in younger AMI patients who have undergone primary PCIs than in older patients. Younger population at risk for AMI should be managed with multiple interventions including PUFA profiling.

The Wire Rendezvous and Chasing Wire Technique in the Bidirectional Approach for the Percutaneous Coronary Intervention for Chronic Total Occlusion with a Single Guiding Catheter.

A bidirectional approach for percutaneous coronary intervention for chronic total occlusion (CTO-PCI) using ipsilateral collaterals with a single guiding catheter limits procedural choices. The CTO of the left circumflex artery with ipsilateral collateral artery was treated by the bidirectional approach using a single guiding catheter. While the retrograde wire directly crossed the CTO lesion, the microcatheter could not pass the CTO lesion despite the conventional strategies. Therefore, we performed the wire rendezvous and chasing wire techniques. The wire rendezvous technique enables deeper retrograde guidewire progression, and the antegrade microcatheter can reach the CTO entry. The chasing wire technique enables the antegrade guidewire to pass the route made by the retrograde guidewire. These techniques might offer a possible solution for bidirectional CTO-PCI using a single guiding catheter. However, this technique should be considered as a last resort because of the risk of rapid reocclusion.

Reduced-port endo-laparoscopic surgery using umbilical zigzag incision for concomitant operations: A case series.

INTRODUCTION: Recently, use of reduced-port surgery has become widespread; however, it is a difficult operation. Hachisuka et al. developed a method called the umbilical zigzag incision, which enlarges the fascial incision using only an umbilical skin incision. We believe this method will be feasible for concomitant laparoscopic surgery. We report our surgical techniques for concomitant laparoscopic surgery using an umbilical zigzag incision. METHODS: The patient who should receive more than 2 places of abdominal operation were indicated this procedure. In all cases, we made the zigzag incision in the umbilical region. After the linea alba and peritoneum were incised, the wound retractor was inserted through the incision, which enlarges the fascial opening. GelPoint was attached to the wound retractor and the operation was started. RESULTS: We could create a fascial opening of up to 6 cm with the umbilical zigzag incision, which improves the triangulation of forceps and reduces interference among the trocars. The trocars in the center of the abdomen could be utilized for almost all intraperitoneal operations. This procedure was especially useful in cases that included lymph node dissection because dissection of a malignant tumor is a delicate procedure. Furthermore, extraction of specimens and anastomosis went very smoothly because the fascial incision was large enough such that no extension of the incision was needed. No early or late postoperative complications occurred in any case. Postoperative wounds were clear and therefore patient satisfaction levels were high. CONCLUSION: Umbilical zigzag incision may be feasible especially in concomitant laparoscopic surgery.

Risk factors of catheter-related bloodstream infection caused by Bacillus cereus: Case-control study in 8 teaching hospitals in Japan.

In this multicenter, matched case-control study, patients diagnosed with catheter-related bloodstream infection (CRBSI) caused by Bacillus cereus (n = 108) were matched to controls (n = 269). In the multivariable analysis, administration of an amino acid preparation and an indwelling peripheral catheter were significant variables for B cereus-related CRBSI.

A novel lesion crossing technique: Balloon deployment using FORcible Manner (BADFORM) technique.

OBJECTIVES: We evaluated the efficacy and safety of a novel endovascular technique for crossing arterial lesions: The BAlloon Deployment using FORcible Manner (BADFORM) technique. BACKGROUND: Endovascular treatment (EVT) for peripheral artery disease has been widely adopted, and developments in device technology and techniques have resulted in acceptable success rates. However, it may be difficult to deliver devices even after wire externalization, especially in the presence of an extremely long chronic total occlusion or severely calcified lesion. The BADFORM technique might be useful in these cases. METHODS: We retrospectively reviewed ten consecutive EVT cases using the BADFORM technique performed at our institution between April 2015 and September 2016. In all cases, wire externalization was established with the rendezvous technique. The BADFORM technique was performed when antegrade passage of any device was impossible after wire externalization. Physicians positioned a low-profile balloon or microcatheter just proximal to the calcified lesion and attached the device to the externalized wire using a torque device at the proximal catheter exit port. The externalized wire was then pulled retrogradely. RESULTS: All patients were receiving hemodialysis and had critical limb ischemia. All lesions were severely calcified, and 90% were chronic total occlusions. The technical success and procedure success rates were 90% and 70%, respectively. Delivered devices included five balloon catheters and four microcatheters. One procedure-related vessel injury occurred at the distal puncture site (digital artery), however, this was controlled by external manual compression. CONCLUSIONS: The efficacy and safety of the BADFORM technique might be acceptable. © 2017 Wiley Periodicals, Inc.

Utility of a 0.035″ compatible rapid-exchange balloon (Metacross RX™) as a perfusion balloon in endovascular therapy compared with conventional percutaneous coronary intervention: A mini-review.

Since endovascular treatment for peripheral artery disease has been rapidly and widely adopted as the preferred strategy, interventionists sometimes experience complications such as vessel perforation and severe dissections. We have a long-time inflation strategy for perfusion balloon catheters, which could be a solution for vessel complications in coronary sections, but not in peripheral sections. We invented a simple device for application as a perfusion balloon in peripheral sections, using a 0.035″ wire compatible rapid-exchange balloon Metacross RX™ (TERUMO, Tokyo, Japan) and reviewed this strategy using three cases as examples and compared them with the coronary perfusion balloon. TABLE OF CONTENTS SUMMARY: Metacross RX (TERUMO, Tokyo, Japan) is being used as a rapid exchange balloon and can be potentially used as a perfusion balloon. We report a series of cases in which patients were treated using the Metacross RX at a single-center for endovascular treatment of peripheral artery disease. We review and discuss the use of this device in comparison with the conventional coronary perfusion balloon catheter.

Effects of losartan on serum total and high-molecular weight adiponectin concentrations in hypertensive patients with metabolic syndrome.

High-molecular weight (HMW) adiponectin may have the most biologic activity among several isoforms. We investigated long-term effects of losartan on serum concentrations of total and HMW adiponectin in hypertensive patients with metabolic syndrome (MS) by serial measurements over 6 months. Forty hypertensive patients first received 50 mg of losartan. Upward titration of the losartan dose was implemented to reach a target blood pressure of less than 140/90 mm Hg. Serum total adiponectin and HMW adiponectin were measured at study entry (baseline), the 3-month treatment time point, and the end of the 6-month period. Non-HMW adiponectin (ie, medium- and low-molecular weight adiponectin) was calculated as total adiponectin--HMW adiponectin. Diagnosis of MS was done by current standard criteria. In hypertensive patients without MS (n = 21), the serum total adiponectin increased from 9.8 +/- 5.4 microg/mL at baseline to 11.1 +/- 6.2 microg/mL at 6 months (P < .01). Furthermore, the serum total adiponectin was significantly higher at 6 months than at 3 months (P < .01). Serum HMW adiponectin also increased from 5.7 +/- 3.9 microg/mL at baseline to 6.6 +/- 4.4 microg/mL at 6 months (P < .01). In hypertensive patients with MS, the serum total adiponectin increased from 6.0 +/- 2.7 mug/mL at baseline to 6.7 +/- 3.3 microg/mL at 3 months and to 7.0 +/- 3.1 microg/mL at 6 months (P < .01 for both). Furthermore, the serum HMW adiponectin concentration was significantly higher at 6 months than at 3 months (P < .001). However, the serum non-HMW adiponectin concentration did not change during treatment in either group. In conclusion, serum total and HMW adiponectin concentrations increase after 6 months of losartan treatment in hypertensive patients, irrespective of the presence or absence of MS.

Mobilization of CD34-positive bone marrow-derived cells after coronary stent implantation: impact on restenosis.

BACKGROUND: Recently, accumulating evidence has indicated that bone marrow-derived stem cells are capable of differentiating into vascular cells. It has been hypothesized that the inflammatory response after vascular injury triggers the mobilization of endothelial and smooth muscle progenitor cells from bone marrow. METHODS AND RESULTS: We measured circulating CD34-positive mononuclear cells, activation of integrin Mac-1 on the surface of neutrophils, and plasma granulocyte-colony stimulating factor levels in 40 patients undergoing coronary stenting. After bare-metal stenting, CD34-positive cells increased, reaching a maximum on day 7 after stenting. The maximum change compared with baseline before stenting was more striking in patients with restenosis than without restenosis (332+/-108% versus 148+/-49%; P<0.05). In contrast, CD34-positive cells decreased after sirolimus-eluting stenting (72+/-21% on day 7). The change in CD34-positive cells on day 7 relative to baseline was closely correlated with that in activated Mac-1 at 48 hours (R=0.52, P<0.01) and that in granulocyte-colony stimulating factor levels at 24 hours (R=0.42, P<0.05). Cell culture assay on day 7 showed that mononuclear cells differentiated into CD31-positive endothelium-like cells after bare-metal stenting. In patients with restenosis, mononuclear cells differentiating into alpha-smooth muscle actin-positive smooth muscle-like cells also were observed. Implantation of sirolimus-eluting stents suppressed both types of differentiation. CONCLUSIONS: Stent implantation may induce differentiation of bone marrow cells into endothelial or smooth muscle cells. Endothelial cells may participate in reendothelialization, a protective reaction against vascular injury, whereas smooth muscle cells may participate in neointimal thickening and restenosis. Sirolimus-eluting stents appear to inhibit the mobilization and differentiation of bone marrow cells.