Kenichi Nitta

A 65nm Single-Chip Application and Dual-Mode Baseband Processor with Partial Clock Activation and IP-MMU

The paper presents a single-chip application and dual-mode baseband processor. It features triple V design - a technology in a low-power 65nm CMOS process that achieves 500MHz for two CPUsp; power domains are separated into 21 sub-blocks to reduce leakage power; introduces a new IP-MMU, which translates virtual address to physical address or physical address to physical address, to 17 different kinds of media IPs; and the interconnect buffer (ICB) extends its function to involve the IP-MMU.

A 65 nm Single-Chip Application and Dual-Mode Baseband Processor With Partial Clock Activation and IP-MMU

Supporting both WCDMA with HSDPA and GSM/GPRS/EDGE, the 9.3 times 9.3 mm2 SoC fabricated in triple-Vth 65 nm CMOS, has three CPU cores and 20 separate power domains. Unused power domains can be powered down to reduce the leakage power. Partial clock activation scheme especially focused on music playback scene dynamically stops a PLL and clock trees when not necessary and reduces power consumption from 33.6 mW to 19.6 mW. IP-MMU translates virtual address to physical address for 18 hardware-IPs and virtual address space can be allocated when necessary and can be freed after its operation, reducing external memory by 43 MB. Video performance of D1 (720 times 520) size with 30 frames per second for MPEG/AVC decoding and encoding can be achieved under mixed virtual and physical address usage.

Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single-center, case-control study

The purpose of the present study was to investigate the predictors of clinical deterioration soon after emergency department (ED) discharge.

Impact of a negative D-dimer result on the initial assessment of acute aortic dissection

BACKGROUND D-dimer shows high sensitivity but low specificity for the diagnosis of acute aortic dissection (AAD). Previous reports indicated that negative D-dimer patients have shorter dissection length. However, whether patients with negative D-dimer results have a good prognosis is unknown. This study aimed to elucidate the clinical characteristics and implications of a negative D-dimer result on AAD diagnosis. METHODS The study group comprised 126 patients (71 males, 55 females; mean age, 69 ± 11 years) with AAD admitted to our hospital between April 2009 and March 2015. Blood samples on presentation were used for D-dimer measurement. Clinical characteristics and outcomes were assessed. RESULTS Nine (7.1%) and 117 (92.9%) exhibited negative and positive D-dimer results, respectively. The negative group showed a significantly lower extension score and a higher platelet count than the positive group. Multivariate analysis demonstrated that platelet count (odds ratio, 1.31 (1.09-1.58), p = 0.003) and extension score (odds ratio, 0.56 (0.33-0.96), p = 0.03) were significantly related to a negative result. Notably, 44% of patients in the negative group had type A dissection and 33% underwent an emergency operation due to cardiac tamponade. CONCLUSION We found that high platelet count and low extension score were independent factors related to a negative D-dimer result. Even if the length of the dissection is short, an emergency operation is necessary in some patients with a negative D-dimer result. Physicians should recognize that a negative D-dimer result alone cannot exclude patients with fatal AAD conditions.

A 65nm dual-mode baseband and multimedia application processor SoC with advanced power and memory management

A Dual-mode baseband (W-CDMA/HSDPA and GSM/GPRS/EDGE) and multimedia application processor SoC is described. The SoC fabricated in triple-Vth 65nm CMOS has 3 CPU cores and 20 separate power domains to achieve both high performance and low power. The SoC adopts the Partial Clock Activation scheme that reduces power by 42% for long-time music replay. The IP-MMU is introduced to reduce maximum memory footprint by 43MB, sharing external memory among CPUs and HW-IPs using virtual address space that enables reuse of physically fragmented memory.

Diffuse Alveolar Hemorrhage Associated with Edoxaban Therapy

Introduction. The main adverse effect of anticoagulant therapy is bleeding, and major bleeding, including intracranial, gastrointestinal, and retroperitoneal bleeding, has been reported as an adverse effect of edoxaban, a direct oral anticoagulant (DOAC). Bleeding during systemic anticoagulation with edoxaban presents a therapeutic conundrum, because there is currently no safe or efficacious reversal agent to stop major bleeding. Case Report. A 51-year-old woman had multiple traumatic injuries, including lower limb fractures. On day 8, she developed deep venous thrombosis, and edoxaban was administered orally. On day 38, she developed fungemia, which was treated with an antifungal drug. On day 43, she presented with dyspnea. Chest computed tomography scan showed bilateral diffuse ground-glass opacities in the whole lung fields. The results of the subsequent workup (i.e., serum levels of the antineutrophil cytoplasmic antibody, antinuclear antibody, and antiglomerular basement membrane antibody) and microbiological study were unremarkable. Based on these findings, her condition was diagnosed as diffuse alveolar hemorrhage (DAH) associated with edoxaban therapy. The lung opacities disappeared spontaneously after edoxaban therapy was discontinued. Conclusion. DAH is a dangerous complication associated with edoxaban therapy. DOACs, including edoxaban, should be prescribed with caution, especially for patients in a critical condition.

Oxygen management in mechanically ventilated patients: A multicenter prospective observational study

Purpose: To observe arterial oxygen in relation to fraction of inspired oxygen (FIO2) during mechanical ventilation (MV). Materials and methods: In this multicenter prospective observational study, we included adult patients required MV for >48 h during the period from March to May 2015. We obtained FIO2, PaO2 and SaO2 from commencement of MV until the 7th day of MV in the ICU. Results: We included 454 patients from 28 ICUs in this study. The median APACHE II score was 22. Median values of FIO2, PaO2 and SaO2 were 0.40, 96 mm Hg and 98%. After day two, patients spent most of their time with a FIO2 between 0.3 and 0.49 with median PaO2 of approximately 90 mm Hg and SaO2 of 97%. PaO2 was ≥100 mm Hg during 47.2% of the study period and was ≥130 mm Hg during 18.4% of the study period. FIO2 was more likely decreased when PaO2 was ≥130 mm Hg or SaO2 was ≥99% with a FIO2 of 0.5 or greater. When FIO2 was <0.5, however, FIO2 was less likely decreased regardless of the value of PaO2 and SaO2. Conclusions: In our multicenter prospective study, we found that hyperoxemia was common and that hyperoxemia was not corrected. HIGHLIGHTSThis is multicentre prospective study to observe the oxygen management in ventilated patients.Hyperoxemia was common as PaO2 was ≥100 mm Hg during 47.2% of the study period.Hyperoxemia was not corrected as FIO2 was less likely decreased when FIO2 was <0.5.

Cardiac hyaluronan may be associated with the persistence of atrial fibrillation

Hyaluronan (HA), a primary component of the extracellular matrix, is associated with several cardiovascular diseases. However, its precise cardiac origin and role in atrial fibrillation (AF) remain unclear. We investigated chamber-specific HA levels in patients with paroxysmal AF (PAF) or persistent AF (PSAF). The levels of HA, a diacron-reactive oxygen metabolite (dROM) as a marker for oxidative stress, at different cardiac sites, and peripheral brain natriuretic peptide (BNP) levels were measured in patients with PAF (n = 50) or PSAF (n = 35). HA levels in the coronary sinus (CS-HA) were significantly higher than those other sites, in both PAF and PSAF patients, and CS-HA levels were significantly higher in PSAF patients than in PAF patients [37.1 (interquartile range, 31.2–48.3) vs. 30.6 (23.7–40.2) pg/mL, P < 0.01]. CS-HA levels were correlated with CS-dROM levels and peripheral BNP levels in PSAF patients (r = 0.417, P = 0.03 and r = 0.579, P < 0.001, respectively), but not in PAF patients (r = −0.115, P = 0.421 and r = 0.048, P = 0.740, respectively). CS-HA levels were elevated in both PAF and PSAF patients and were correlated with cardiac oxidative stress and BNP levels in PSAF patients. Cardiac HA may be associated with the persistence of AF.

Influence of body position during Heimlich maneuver to relieve supralaryngeal obstruction: a manikin study

To study the most effective body position for Heimlich maneuver.

Rupture of gastrointestinal stromal tumor presenting with sudden onset chest and back pain and accompanied by gastric dilatation

A 72‐year‐old man with hypertension was admitted with acute‐onset chest and back pain followed by epigastralgia. He was transported by helicopter due to suspected acute aortic dissection. Systolic blood pressures were equal in both arms. Physical examination showed epigastric tenderness without rebound. Blood tests showed leukocytosis. Electrocardiogram and echocardiogram were normal. Abdominal radiography showed acute gastric dilatation with an air‐outlined large mass‐like shadow. Abdominal computed tomography revealed a 6‐cm exophytic mass and large intramural hematoma in the lesser curvature of the gastric body.