Podcasts about Kyushu University

Documents related to a 1945 U.S. prisoner-of-war vivisection incident are on exhibit until June 22 at the medical history museum of Kyushu University in the southwestern Japan city of Fukuoka, in hopes of promoting medical and peace education by sharing lessons from the past.

「九大生体解剖事件」について、取材に応じた故東野利夫医師太平洋戦争末期の１９４５年、九州帝国大で米兵捕虜８人が実験的な手術を受け死亡した「九大生体解剖事件」で、当時医学生として手術に立ち会った故東野利夫医師、２０２１年に９５歳で死去、が生前に収集した資料が、「九州大学医学歴史館」で展示されている。 Documents related to a 1945 U.S. prisoner-of-war vivisection incident are on exhibit until June 22 at the medical history museum of Kyushu University in the southwestern Japan city of Fukuoka, in hopes of promoting medical and peace education by sharing lessons from the past.

Are We Ready for AI Twins? Legal and Ethical Challenges Ahead: Innovation, Privacy, and the Future of Digital Identity — Explore everything behind the topic in the latest Arqus podcast episode!What are AI twin assistants and how could they change the way we work, create, and interact? What legal and ethical questions do they raise around data privacy, ownership, and identity? These are the core questions addressed in this episode of the Arqus Knowledge Pills podcast.In this brand-new episode, we welcome a very special guest: Dr Paulius Jurčys, senior lecturer at the Faculty of Law of Vilnius University and expert in data privacy, copyright, and emerging technologies.Together, we explore the fascinating world of AI twin assistants: digital versions of ourselves that can write, speak, and act on our behalf. How do they work? Who owns the content they generate? And what are the legal and ethical risks when our voices and identities can be cloned?From data ownership to AI-generated creativity, and from deepfakes to digital fairness, this episode dives into the evolving intersection of artificial intelligence, law, and innovation. Tune in to discover how AI twins could reshape our understanding of creativity, fairness, and personal data in the digital future and why now is the time to think critically about the rules that will shape it.Learn more about Paulius Jurčys:Paulius Jurčys is a senior lecturer at Vilnius University Law Faculty where teaches data privacy and copyright law courses at Vilnius University Law Faculty and serves as an affiliate fellow with Harvard's CopyrightX program. A technology lawyer and admitted to practice law in California. He is also a co-founder of Prifina, a San Francisco company that builds personal-data technologies for individuals. Paulius Jurčys holds an LL.M. from Harvard and a Ph.D. from Kyushu University, and in 2025 became a visiting scholar at UC Berkeley School of Law. In 2025, he won the MyData Global “Thought Leadership” award. He served as an expert member of the International Law Association committee on Intellectual Property, which drafted the 2021 Guidelines on Intellectual Property and Private International Law. 

Approximately 80% of orange cats are males, including the four orange cats owned by the Short Wave team. Scientists have long suspected that orange color was a sex-linked trait — hiding somewhere on the X chromosome. Now, scientists at Stanford University and Kyushu University in Japan have characterized the mutation responsible for orange cat coloration. Both groups published their results in the journal Cell Biology this week. Have a question about the animals all around us? Email us at shortwave@npr.org — we'd love to hear from you!Listen to Short Wave on Spotify and Apple Podcasts.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

A Japanese research team led by Kyushu University professor Hiroyuki Sasaki has said it discovered a gene that determines the color patterns of the tricolored calico cat, known in Japan as "mike neko."

Chris interviews emeritus professor Naruhiko Inoue from Kyushu University. haswellkyudai@gmail.com, lostincitations@gmail.com 

Send us a textEpisode 42 of the podcast takes us in the mountains once again as we explore Japan's mountain religion of Shugendo. My guest leading us in that discussion is Dr Caleb Swift Carter of Kyushu University. Dr Carter specialises in Buddhist Studies and the medieval and early modern religious history of Japan, with a focus on the mountain tradition of Shugendo. As such, he's ideally-suited to guide us in exploration of my I consider to be one of the more interesting aspects of Japanese culture.We intentionally spend a lot of time in and on the mountains of Japan on the podcast. According to the Ministry of Land, Infrastructure, Transport and Tourism, approximately three-quarters of Japan is designated mountainous or rugged. This is a country of mountains where many peaks are considered sacred and I believe that an understanding of the religious context of mountains in Japan amplifies the enjoyment we take from time spent in such landscapes.In exploration of Shugendo, we focus on the numinous mountain of Togakushi and surrounding peaks in Nagano. It was the focus of Dr Carter's book ‘A Path Into the Mountains: Shugendo and Mount Togakushi' and listeners of the podcast might remember, also the focus of Episode 12 – my travel to Togakushi. For more information, visit Dr Carter's profile on the Kyushu University website.Outland Japan is a bi-weekly podcast hosted by Peter Carnell - a freelance tour guide based in northern Nagano – that transports you to rural, regional and the wilds of Japan in pursuit of stories that lie outside the neon hum of Tokyo and golden trimmings of Kyoto. Stories of travel, life and culture beyond the big cities. Follow the show on Instagram, Facebook and YouTube. Please note, prior to October 2024, Outland Japan was named Snow Country Stories Japan.

Chris interviews Professor Shaun O'Dwyer from the Faculty of Languages and Cultures at Kyushu University. haswell247@gmail.com, lostincitations@gmail.com 

“There was a lot of dilemma, and I wasn't able to definitely deal with the sudden knowledge of my cancer and to be able to impart that information in a more containing and structured manner so that my patients can be held even in that situation. But the consciousness was there about how to go about it. Whenever I was asked by the patient directly, or if the necessity arose where the hospital needed to impart the information, I did agree later that they can let them know about the cancer situation, and the patient can connect to me directly. When I was in a better stage, I knew how to deal with it, but that was months later. I found that the honest submission was more helpful for me and for the patient because when certain larger than life events happen, it probably connects us in a more humble way to the community - that the analyst as healer is not supreme above all of this, and who can also be affected with such aspects of life."    Episode Description: We begin with honoring the clinical difference between fantasies of physical vulnerability from real life mortal danger. Jhuma shares with us her medical journey that entailed suddenly receiving a diagnosis of cancer. She was immediately hospitalized and faced with, among other challenges, the question of how to inform her patients. She describes her fragility and uncertainty and the various engagements she was able to arrange. We discuss the meanings of "honest submission," patient's curiosity, and their aggression and tenderness towards her. She elaborates on the presence of the Hindu notion of an afterlife and her post-hospital awareness that “the clinical becomes vast" - this refers to the importance of bringing analytic sensibilities to the many venues that are 'off the couch'. We close with her sharing clinical vignettes demonstrating how even real-life current trauma can meaningfully awaken a patient's awareness of their forgotten painful past.     Our Guest: Jhuma Basak is a Training & Supervising Psychoanalyst of the Indian Psychoanalytical Society and member of the International Psychoanalytical Association. She holds a Ph.D. in Psychology from the Kyushu University, Fukuoka, Japan. She has specific interest in culture & gender in psychoanalysis. She has publications in Japanese, Italian, French and Spanish. Over the past 20 years, she has presented at various IPA Congresses, along with the Keynote for the 53rd IPA Congress in Cartagena in 2023. Other presentations were at the Washington Baltimore Centre for Psychoanalysis, Hakuoh University, and Kyushu University. She is the co-editor of the book Psychoanalytic & Socio-Cultural Perspectives on Women in India and editor of Sculpting Psychoanalysis in India – Sudhir Kakar. Jhuma has been the past Co-Chair of the Asia Committee on Women & Psychoanalysis and continues to be its consultant.    Reading List: Bernstein, Stephen (2024): The Making of the IPA Podcast: Psychoanalysis On & Off the Couch. Psychoanalytic Inquiry, Vol.44. No.2, 166-177.   Fajardo, B (2001): Life-Threatening Illness in the Analyst. Journal of the American Psychoanalytic Association. 49:569-586.   Feinsilver, David (1998): The Therapist as a Person Facing Death: The Hardest of External Realities and Therapeutic Action. International Journal of Psychoanalysis, 79: 1131-1150   Fieldsteel, N. D. (1989): Analysts' expressed attitudes toward dealing with death and illness. Contemporary Psychoanalysis, 25 (3): 427-432 o    Halpert, Eugene (1982): When the Analyst is Chronically Ill or Dying. Psychoanal. Q., (51):372-389.   Kitayama, O. (1998) Transience: Its Beauty and Danger. International Journal of Psychoanalysis 79:937-942.   Masur, Corinne (ed) (2018): Flirting with Death: Psychoanalysts Consider Mortality. Routledge.   Rosner, Stanley (1986): The Seriously Ill or Dying Analyst & the Limits of Neutrality. Psychoanalytic Psychology, 5(4), 357-371

MosaicML, co-founded by Jonathan Frankle and Michael Carbin, aims to make AI models more accessible.https://news.mit.edu/2024/mosaicml-helps-nonexperts-build-advanced-generative-ai-models-0621 Researchers from Kyushu University have developed an AI tool, QDyeFinder, to map neurons.https://medicalxpress.com/news/2024-06-super-brain-wiring-ai-human.html Meta has been criticized for incorrectly labeling photos as "Made with AI" on its platforms.https://techcrunch.com/2024/06/21/meta-tagging-real-photos-made-with-ai/ Meta's Fundamental AI Research (FAIR) team is releasing five AI research models.https://about.fb.com/news/2024/06/releasing-new-ai-research-models-to-accelerate-innovation-at-scale/ Visit www.integratedaisolutions.com

Chris interviews Greggory Wroblewski from the Faculty of Cultures and Languages at Kyushu University. https://www.researchgate.net/publication/376085803_ChatGPT_and_Anti-White_Bias  

In Episode 2, we will be talking to OGURI Hirofumi about ONUMA Yasuaki's article "When was the Law of International Society Born? – An Inquiry of the History of International Law From an Intercivlizational Perspective", published in JHIL 2(1) (2000) 1-66. Join us, as Hirofumi sheds light on Eurocentrism in and of international law, dives into ONUMA san's ‘intercivilizational approach' and discusses ONUMA san's legacy within the field of international law. Professor Hirofumi Oguri – Associate Professor, Kyushu University, Japan. Faculty Profiles - OGURI Hirofumi (okayama-u.ac.jp).  Music:  “SamuelFrancisJohnson – Lifting Guitar” (https://pixabay.com/de/sound-effects/lifting-guitar-12549/)

Oceans are an important resource for every country and are essential for travel and trade, but there are several critical issues facing maritime order in Asia. A lack of a shared vision, differing interpretations of maritime order, and cooperation over security issues all create friction for use of shared waterways across Asia, which makes fair and equitable access vital. How can Asian states and allies strengthen dialogue, interactions, and coordination to maximise the impact of their efforts in upholding regional and maritime order? Speakers: - Professor Bec Strating (Director, La Trobe Asia) - Professor Alessio Patalano (Department of War Studies, Kings College London) - Professor Kyoko Hatakeyama (Graduate School of International Studies and Regional Development, University of Niigata Prefecture) - Professor Nick Bisley (Chair) (Dean of the School of Humanities and Social Sciences, La Trobe University) - With an introduction from La Trobe University Vice-Chancellor, Professor Theo Farrell. The launch of Issue 10 of the La Trobe Asia Brief. Event recorded on 11th April, 2024. This public panel will present research from a collaborative project between La Trobe Asia, Kyushu University and King's College London. It has received grant funding from the Australia-Japan Foundation of the Department of Foreign Affairs and Trade and the United Kingdom Foreign and Commonwealth Development Office.

Chris interviews Dr. Joe Vitta (Citation 67) from Kyushu University in the newest installment of The Lunchtime Series. Contacts: haswell247@gmail.com, LostInCitations@gmail.com

Babak is the CTO of AI at Cognizant, the 34 billion market cap provider of tech services with more than 350, 000 global employees. He's the former co-founder and CEO of Sentient, a business responsible for the core technology behind the world's largest distributed artificial intelligence system. Before co-founding Sentient, Babak co-founded and was the CTO and a board member of Dejima where he developed the foundational technology that ultimately became Apple's Siri. He's the primary inventor of Dejima's patented technology. Babak has 31 granted or pending patents, is a published author, and is one of the most respected thought leaders in AI.  He holds a PhD in machine intelligence from Kyushu University in Fukuoka, Japan. In our conversation, we discuss: The recent executive order on AI regulation issued by the Biden administration, exploring its key themes such as the development of a national registry for foundational large language models and safety test result sharing by vendors.Babak shares insights into the challenges and engineering intricacies involved in developing and scaling AI systems, emphasizing the importance of understanding the fundamental differences between large language models and human intelligence.The concept of responsible AI and the urgent need for defining unambiguous ethical standards, with Babak expressing concerns about AI potentially being used for destructive or malicious purposes in the wrong hands.Babak's experience as a pioneer in developing foundational technologies for SiriThe limitations and expectations surrounding large language models shed light on the challenges of fine-tuning and reinforcing these models, as well as the misconceptions related to their learning capabilities during interactions.The concept of active ontology and its role in the early development of Siri, highlights the revolutionary approach that focused on modeling functionality and ontology first, offering insights into the evolution of natural language technology over the past 25 years.Additional resourcesBabak's LinkedIn — https://www.linkedin.com/in/babakhodjat/Another episode you might enjoy — https://aiandthefutureofwork.buzzsprout.com/520474/14341487-navrina-singh-founder-ceo-of-credo-ai-discusses-ai-governance-ethics

This week on the pod, Chris interviews Andrew J. Chapman from Kyushu University in our first in-studio interview! Contacts: haswell247@gmail.com, LostInCitations@gmail.com

ON THIS INSTALLMENT…DONATE: PAYPAL.ME/JAPANWUT … Matt discusses beer psyops, the threat — or non-threat — of Fukushima Nuclear Water, AI Rice, WEF Green Transformation in Japan, and the unpredictable effects of depopulation: bug farms and less help for the disabled.Follow Matt: Twitter / Facebook Page / InstagramOfficial Website: matthewpmbigelow.comSHOW NOTES FOR EP. 105NEW PRODUCT/SERVICEFukuoka driving school lets participants try drunk driving to expose dangersFUKUSHIMA WATER RELEASETEPCO: No abnormality detected in monitoring dataJapan says seawater radioactivity below detectable limits near FukushimaS Korean police arrest 14 Fukushima protesters seeking to enter Japanese embassyChina bans all Japanese seafood imports after Fukushima water releaseStones, Eggs Thrown at Japanese Schools in China【親切】新宿のお店「中国人へ。当店の食材は全て福島県産です」SOCIETY 5.0AI-based app created by Japan researchers can predict rice harvest with single photoWhat's next for the energy transition in Japan?Japan and Middle East sign hydrogen cooperation agreementsProsecutors question lawmaker over wind farm bribery caseJapan blockchain startup seeks to build Asian digital payment networkFormer Sony execs laying down data security gambit to tech giantsRetailers in Japan coordinate response as self-checkout shoplifting surges'Like a teacher there 24/7': ChatGPT tool supports English education at Japan univ.EAT THE BUGS"Kabutomushi (Japanese rhinoceros beetle) solves the issues of food, bamboo forests, and depopulation in one fell swoop... The pupa faintly emits the scent of shrimp."A group from Kyushu University is working on research to utilize the Japanese rhinoceros beetle, often called the "king of insects," as insect food.The research is being conducted by a group led by Associate Professor Satoshi Kamitani from the Faculty of Agriculture at Kyushu University. In an effort to address the issue of neglected bamboo forests, while collaborating with Kama City, they discovered that fermented bamboo chips could serve as food for the Japanese rhinoceros beetle. This discovery prompted the exploration of edible applications for the beetles.The pupae, in particular, have a mild shrimp-like aroma and are easy to eat due to their lack of earthy odors and impurities. When dried and ground into powder, they are also suitable for processed food products.They chose the former Chisshu Elementary School building in Kama City, which had closed in 2014, as the experimental site. The bamboo chips used were harvested from neglected bamboo forests by the city and provided at no cost. Starting with 500 beetles in the current fiscal year, they aim to increase the number to 5,000 in the following year and 50,000 two years from now.Local residents take on the role of caretakers for the beetles, with the intention of generating employment opportunities in the depopulated region.The group is conducting detailed analysis of the nutritional components and potential health benefits. They aim to eventually position the beetle as a viable option for human consumption, while also exploring its potential as a pharmaceutical ingredient.Associate Professor Kamitani stated, "The Japanese rhinoceros beetle might become a 'triple-win' solution, simultaneously addressing food scarcity, neglected bamboo forests, and depopulation. We will thoroughly examine its safety as a food product."According to research by the Japan Productivity Center, the global insect food market is predicted to expand from 7 billion yen in 2019 to 100 billion yen by 2025.WARJapan mulls easing restrictions on lethal weapon exports

ON THIS INSTALLMENT…DONATE: PAYPAL.ME/JAPANWUT … Matt discusses smart home markets for Japan, more on why the WEF is weird and needs to go, strange edible bug museum in Kyushu, and workers refusing to return to the office after stupid COVID. Follow Matt: Twitter / Facebook Page / InstagramSHOW NOTES FOR EP 99NEW PRODUCTJapan's new energy drink feels like getting slapped in the face by an anime girlSOCIETY 5.0Japan Smart Home Market Analysis Report 2023-2028 New NTT joint venture using AI and IoT to advance sustainable food security worldwideGreen LED lights found to speed up growth of farmed flounderWARNATO removes Tokyo office mention from joint communiqueJapan, France to hold first-ever joint fighter jet drillCHINAWeaponizing Biotech: How China's Military Is Preparing for a 'New Domain of Warfare'IMF Hints At Allowing Countries To Use Chinese Yuan For Debt RepaymentEAT THE BUGS"Entomophagy TAKEO 'Traveling Cricket Museum Flavor' Available for Pre-Sale at the Kyushu University Museum Open Exhibition 'Fukuoka Great Insect Exhibition'!Experience the quiet and cool 'scent of that museum' by uniquely blending spices and herbs. Create memories of insect food starting from the summer vacation of 2023.""Creating Memories of Entomophagy Starting from the Summer Vacation of 2023'Traveling Cricket Museum Flavor' uniquely blends basil-based spices and herbs to express the imagery of the quiet and cool 'scent of that museum.' It seems that the 'scent of that museum' is derived from the odor of camphor used to preserve specimens. Camphor is a natural component derived from the oil of the camphor tree, and it is known to be present in basil as well. Recently, odorless preservation agents have replaced camphor in specimen preservation, but there are still insect researchers who continue to use camphor because they enjoy that scent.The concept behind TAKEO's 'Traveling Cricket' is to create insect food that brings joy to the people 'in that place.' This time, the stage is the museum shop of the insect exhibition.This product was born from the staff of the Fukuoka Great Insect Exhibition asking, 'Is there any good insect food that can be sold as a museum shop item?'Dr. Munetoshi Maruyama, the curator of the Fukuoka Great Insect Exhibition and a professor at Kyushu University, is actually the senior of Ryohta Mitsuhashi, the developer of TAKEO, from his student days. For us, it is an opportunity that will never come again to work with the admired Dr. Maruyama and Kyushu University Museum, so we put even more effort into product development. Initially, ideas such as cricket with mentaiko (spicy cod roe) flavor or tonkotsu ramen flavor were suggested due to the exhibition being held in Fukuoka. However, with the desire to create a product with longevity, we twisted the idea into the concept of 'museum flavor' and shaped it.While adults reminisce about the memories of the old museum, children create memories of entomophagy starting from here.'Traveling Cricket Museum Flavor' has become a product that will surely bring joy not only to the customers who visit the museum, but also to the museum shop staff."Japan in JapanAs prices soar, Japan returns to human waste fertiliserMovie "How do you live" 2.1 billion yen at the box office for 4 daysJapan and the WorldJapan and Saudi Arabia to Jointly Produce Ammonia Public-Private FrameworkCOVIDJapan poll finds half of workers against returning to office after COVID

In June 2022 Indonesian President Joko Widodo went first to the Ukraine, and later to Moscow, hand delivering a letter from President Zelensky to Vladimir Putin. His purpose, to quote, was to open a dialogue forum for peace, to build peace, because the war has to be stopped. Widodo's carefully worded statement, about ending a war but not necessarily pointing fingers, is emblematic of Asia's response to the Ukraine invasion, to the extent where a UN vote for sanctions against the Ukraine earned the muted response of most Asian counties abstaining from voting. Guest: Associate Professor Nobuhiro Aizawa (School of Social and Cultural Studies at Kyushu University). Recorded on 18th April, 2023.

This month on Episode 48 of Discover CircRes, host Cynthia St. Hilaire highlights three original research articles featured in the April 28th issue of Circulation Research. This Episode also includes a discussion between Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova, who all contributed to manuscripts to the May 12th Compendium on Covid-19 and the Cardiovascular System.     Article highlights:   Heijman, et al. Mechanisms of Enhanced SK-Channel Current in AF   Chen, et al. IL-37 Attenuates Platelet Activation   Enzan, et al. ZBP1 Protects Against Myocardial Inflammation   Compendium on Covid-19 and the Cardiovascular System.   Cindy St. Hilaire: Hi, and welcome to Discover CircRes, the podcast of the American Heart Association's journal, Circulation Research. I'm your host, Dr Cindy St. Hilaire, from the Vascular Medicine Institute at the University of Pittsburgh. Today, I'm going to be highlighting articles from our April 28th and May 12th issues of Circulation Research. I'm also going to have a chat with Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova, who all contributed to articles in the May 12th COVID Compendium. But before we have that interview, let's first talk about some highlights.   The first article I want to present is titled Enhanced Calcium-Dependent SK-Channel Gating and Membrane Trafficking in Human Atrial Fibrillation. This article is coming from the University of Essen by Heijman and Zhou, et al. Atrial fibrillation is one of the most common forms of heart arrhythmia in humans and is characterized by irregular, often rapid heartbeats that can cause palpitations, dizziness and extreme fatigue. Atrial fibrillation can increase a person's risk of heart failure, and though treatments exist such as beta blockers, blood thinners and antiarrhythmia medications, they can have limited efficacy and side effects. A new family of drugs in development are those blocking small-conductance calcium-activated potassium channels called SK channels, which exhibit increased activity in animal models of AF and suppression of which attenuates the arrhythmia. In humans however, the relationship between SK channels and atrial fibrillation is less clear, at least in terms of SK channel mRNA levels. Because mRNA might not reflect actual channel activity, this group looked at just that and they found indeed that channel activity was increased in cardiomyocytes from atrial fibrillation patients compared to those from controls even though the mRNA and protein levels themselves were similar. The altered currents were instead due to changes in SK channel trafficking and membrane targeting. By confirming that SK channels play a role in human atrial fibrillation, this work supports the pursuit of SK channel inhibitors as possible new atrial fibrillation treatments.   The next article I want to present is titled IL-37 Attenuates Platelet Activation and Thrombosis Through IL-1R8 Pathway. This article comes from Fudan University by Chen and Hong, et al. Thrombus formation followed by the rupture of a coronary plaque is a major pathophysiological step in the development of a myocardial infarction. Understanding the endogenous antithrombotic factors at play could provide insights and opportunities for developing treatments. With this in mind, Chen and Hong, et al. investigated the role of interleukin-1 receptor 8, or IL-1R8, which suppresses platelet aggregation in mice, and of IL-37, a newly discovered human interleukin that forms a complex with IL-1R8 and is found at increased levels in the blood of patients with myocardial infarction. Indeed, the amount of IL-37 in myocardial infarction patients negatively correlates with platelet aggregation. They also show that treatment of human platelets in vitro with IL-37 suppresses the cell's aggregation and does so in a concentration-dependent manner. Moreover, injection of the protein into the veins of mice inhibits thrombus development and better preserves heart function even after myocardial infarction. Such effects were not seen in mice lacking IL-1R8. This suggests IL-37's antithrombotic action depends on its interaction with the receptor. Together, the results suggest IL-37 could be developed as a antithrombotic agent for use in MI patients or indeed perhaps other thrombotic conditions.   The last article I want to present before our interview is titled ZBP1 Protects Against Mitochondrial DNA-Induced Myocardial Inflammation in Failing Hearts. This article is coming from Kyushu University and is by Enzan, et al. Myocardial inflammation is a key factor in the pathological progression of heart failure and occurs when damaged mitochondria within the stricken cardiomyocyte release their DNA, triggering an innate inflammatory reaction. In a variety of cells, DNA sensors such as Z-DNA-binding protein 1 or ZBP1 are responsible for such mitochondrial DNA-induced inflammation. In theory then, it's conceivable that therapeutic suppression of ZBP1 might reduce myocardial inflammation in heart failure and preserve function. But as Enzan and colleagues have now discovered to their surprise, mice lacking ZBP1 exhibited worse, not better heart inflammation and more failure after induced myocardial infarction. Indeed, the test animals' hearts had increased infiltration of immune cells, production of inflammatory cytokines and fibrosis together with decreased function compared with the hearts of mice with normal ZBP1 levels. Experiments in rodent cardiomyocytes further confirmed that loss of ZBP1 exacerbated mitochondrial DNA-induced inflammatory cytokine production while overexpression of ZBP1 had the opposite effect. While the reason behind ZBP1's opposing roles in different cells is not yet clear, the finding suggests that boosting ZBP1 activity in the heart might be a strategy for mitigating heart inflammation after infarction.   Cindy St. Hilaire:         The May 12th issue of Circulation Research is our COVID compendium, which consists of a series of 10 reviews on all angles of COVID-19 as it relates to cardiovascular health and disease. Today, three of the authors of the articles in this series are here with me. Dr Mina Chung is a professor of medicine at the Cleveland Clinic. She and Dr Tamanna Singh and their colleagues wrote the article, A Post Pandemic Enigma: The Cardiovascular Impact of Post-Acute Sequelae of SARS-CoV-2. Dr DeLisa Fairweather, professor of medicine, immunology and clinical and translational science at the Mayo Clinic, and she and her colleagues penned the article, COVID-19 Myocarditis and Pericarditis. Dr Milka Koupenova is an assistant professor of medicine at the UMass Chan School of Medical and she led the group writing the article, Platelets and SARS-CoV-2 During COVID-19: Immunity, Thrombosis, and Beyond. Thank you all for joining me today.   DeLisa Fairweather:    Thank you so much for having us.   Mina Chung:   Thank you.   Milka Koupenova:       Thank you for having us, Cindy.   Cindy St. Hilaire:         In addition to these three articles, we have another seven that are on all different aspects of COVID. Dr Messinger's group wrote the article, Interaction of COVID-19 With Common Cardiovascular Disorders. Emily Tsai covered cell-specific mechanisms in the heart of COVID-19 patients. Mark Chappell and colleagues wrote about the renin-angiotensin system and sex differences in COVID-19. Michael Bristow covered vaccination-associated myocarditis and myocardial injury. Jow Loacalzo and colleagues covered repurposing drugs for the treatment of COVID-19 and its cardiovascular manifestations. Dr Stephen Holby covered multimodality cardiac imaging in COVID, and Arun Sharma covered microfluidic organ chips in stem cell models in the fight against COVID-19.   Cindy St. Hilaire          As of today, worldwide, there have been over six hundred million individuals infected with the virus and more than six and a half million have died from COVID-19. In the US, we are about a sixth of all of those deaths. Obviously now we're in 2023, the numbers of individuals getting infected and dying are much, much lower. As my husband read to me this morning, one doctor in Boston was quoted saying, "People are still getting wicked sick." In 75% of deaths, people have had underlying conditions and cardiovascular disease is found in about 60% of all those deaths. In the introduction to the compendium, you mentioned that the remarkable COVID-19 rapid response initiative released by the AHA, which again is the parent organization of Circ Research and this podcast, if I were to guess when that rapid response initiative started, I would've guessed well into the pandemic, but it was actually March 26th, 2020. I know in Pittsburgh, our labs have barely shut down. So how soon after we knew of SARS-CoV-2 and COVID, how soon after that did we know that there were cardiovascular complications?   Mina Chung:               I think we saw cardiovascular complications happening pretty early. We saw troponin increases very early. It was really amazing what AHA did in terms of this rapid response grant mechanism. You mentioned that the RFA was announced, first of all, putting it together by March 26th when we were just shutting down in March was pretty incredible to get even the RFA out. Then the grants were supposed to be submitted by April 6th and there were 750 grants that were put together and submitted. They were all reviewed within 10 days from 150 volunteer reviewers. The notices were distributed April 23rd, less than a month out.   Cindy St. Hilaire:         Amazing.   Mina Chung:               So this is an amazing, you're right, paradigm for grant requests and submissions and reviews.   DeLisa Fairweather:    For myocarditis, reports of that occurred almost immediately coming out of China, so it was incredibly rapid.   Cindy St. Hilaire:         Yeah, and that was a perfect lead up to my next question. Was myocarditis, I guess, the first link or the first clue that this was not just going to be a respiratory infection?   DeLisa Fairweather:    I think myocarditis appearing very early, especially it has a history both of being induced by viruses, but being strongly an autoimmune disease, the combination of both of those, I think, started to hint that something different was going to happen, although a lot of people probably didn't realize the significance of that right away.   Cindy St. Hilaire:         What other disease states, I guess I'm thinking viruses, but anything, what causes myocarditis and pericarditis normally and how unique is it that we are seeing this as a sequelae of COVID?   DeLisa Fairweather:    I think it's not surprising that we find it. Viruses around the world are the primary cause of myocarditis, although in South America, it's the parasite Trypanosoma cruzi. Really, many viruses that also we think target mitochondria, including SARS-CoV-2, have an important role in driving myocarditis. Also, we know that SARS-CoV-1 and MERS also reported myocarditis in those previous infections. We knew about it beforehand that they could cause myocarditis.   Cindy St. Hilaire:        Is it presenting differently in a COVID patient than say those South American patients with the... I forget the name of the organism you said, but does it come quickly or get worse quickly or is it all once you get it, it's the same progression?   DeLisa Fairweather:    Yeah. That's a good question. Basically, what we find is that no matter what the viral infection is, that myocarditis really appears for signs and symptoms and how we treat it identically and we see that with COVID-19. So that really isn't any different.   Cindy St. Hilaire:         Another huge observation that we noticed in COVID-19 patients, which was the increased risk of thrombic outcomes in the patients. Dr Koupenova, Milka, you are a world expert in platelets and viruses and so you and your team were leading the writing of that article. My guess is knowing what you know about platelets and viruses, this wasn't so surprising to you, but could you at least tell us the state of the field in terms of what we knew about viruses and platelets before COVID, before Feb 2020?   Milka Koupenova:       Before Feb 2020, we actually knew that influenza gets inside in platelets. It leads to not directly prothrombotic events, but it would lead to release of complement 3 from them. That complement 3 would actually increase the immunothrombosis by pushing neutrophils to release their DNA, forming aggregates. In cases when you have compromised endothelium and people with underlying conditions, you would expect certain thrombotic outcomes. That, we actually published 2019 and then 2020 hit. The difference between influenza and SARS-CoV-2, they're different viruses. They carry their genome in a different RNA strand. I remember thinking perhaps viruses are getting inside in platelets, but perhaps they do not. So we went through surprising discoveries that it seemed like it is another RNA virus. It also got into platelets. It was a bit hard to tweak things surrounding BSL-3 to tell you if the response was the same. It is still not very clear how much SARS or rather what receptor, particularly when it gets inside would induce an immune response. There are some literature showing the MDA5, but not for sure, may be responsible. But what we found is that once it gets in platelets, it just induces this profound activation of programmed cell death pathways and release of extracellular vesicles and all these prothrombotic, procoagulant form of content that can induce damage around, because platelets are everywhere. So that how it started in 2019 and surprisingly progressed to 2021 or 2020 without the plan of really studying this virus.   Cindy St. Hilaire:         How similar and how different is what you observe in platelets infected, obviously in the lab, so I know it's not exactly the same, but how similar and how different is it between the flu? Do you know all the differences yet?   Milka Koupenova:       No offense here, they don't get infected.   Cindy St. Hilaire:         Okay.   Milka Koupenova:       Done the proper research. The virus does not impact platelets, but induces the response.   Cindy St. Hilaire:         Okay.   Milka Koupenova:       That goes back to sensing mechanism. Thank goodness platelets don't get infected because we would be in a particularly bad situation, but they remove the infectious virus from the plasma from what we can see with function.   Cindy St. Hilaire:         Got it. So they're helping the cleanup process and in that cleaning up is where the virus within them activates. That is a really complicated mechanism.    Milka Koupenova:       Oh, they're sensing it in some form to alert the environment. It's hard to say how similar and how different they are unless you study them hint by hint next to each other. All I can tell is that particularly with SARS-C, you definitely see a lot more various kinds of extracellular vesicles coming out of them that you don't see the same way or rather through the same proportion with influenza. But what that means in how platelet activates the immune system with one versus the other, and that goes back to the prothrombotic mechanisms. That is exactly what needs to be studied and that was the call for this COVID compendium is to point out how much we have done as a team. As scientists who put heads together, as Mina said, superfast response, it's an amazing going back and looking at what happened to think of what we achieved. There is so much more, so much more that we do not understand how one contributes to all of these profound responses in the organs themselves, such as myocarditis. We see it's important and that will be the problem that we're dealing from here on trying to figure it out and then long COVID, right?   Cindy St. Hilaire:         Yeah. Related to what you just said about the mechanism, this cleanup by the platelets or the act of cleaning up helps trigger their activation, is that partly why the antiplatelet and anticoagulant therapies failed in patients? Can you speculate on that? I know the jury's still out and there's a lot of work to be done, but is that part of why those therapies weren't beneficial?   Milka Koupenova:       The answer to that in my personally biased opinion is yes. Clearly, the antiplatelet therapies couldn't really control the classical activation of a platelet. So what I think we need to do from here on is to look at things that we don't understand that non-classically contribute to the thrombotic response downstream. If we manage to control the immune response in some way or the inflammation of the infection or how a platelet responds to a virus, then perhaps we can ameliorate a little bit of the downstream prothrombotic effect. So it's a lot more for us to trickle down and to understand in my personal opinion.   DeLisa Fairweather:    There is one thing that was really remarkable to me in hearing your experience, Milka, is that I had developed an autoimmune viral model of myocarditis in mice during my postdoc. So I've been studying that for the last 20 years. What is unique about that model is rather than using an adjuvant, we use a mild viral infection so it doesn't take very much virus at all going to the heart to induce it. I also, more recently, started studying extracellular vesicles really as a therapy, and in doing that, inadvertently found out that actually, the model that I'd created where we passage the virus through the heart to induce this autoimmune model, we were actually injecting extracellular vesicles into the mice and that's what was really driving the disease. This is really brought out. So from early days, I did my postdoc with Dr Noel Rose. If you've heard of him, he came up with the idea of autoimmune disease in the '50s. We had always, in that environment, really believed that viruses were triggering autoimmune disease and yet it took COVID before we could really prove that because no one could identify them. Here we have an example and I think the incidence rates with COVID were so high for myocarditis because for the first time, we had distinguished symptoms of patients going to the doctor right at the beginning of their infection having an actual test to examine the virus, knowing whether it's present or not, whether PCR or antibody test, and then being able to see when myocarditis happened.   Cindy St. Hilaire:         Yeah. I think one thing we can all appreciate now is just some of the basic biology we've learned on the backend of this. Actually, those last comments really led well to the article that your team led, Dr Chung, about what we call long COVID, which I guess I didn't realize has an actual name, post-acute sequelae of SARS-CoV-2 or PASC is the now more formal name for long COVID. But what is it? We hinted at it that there's these bits about autoimmune and things like that. What counts as long COVID?   Mina Chung:   Yeah. Our article was led by Tamanna Singh. She did a fantastic job of putting this together. We've had, and others, theorized that the huge palette of symptoms that you can experience post-COVID, they can affect all these organ systems with brain fog, these atypical chest pains, postural orthostatic tachycardia, a lot of palpitations, atrial fibrillation, many weakness and fatigue. To us, really, you can get GI symptoms. We've been very interested in, is this an autoimmune phenomenon directed against nerves and all those things. It's also very interesting because many of the non-COVID syndromes that existed pre-COVID like POTS and chronic fatigue syndrome and a lot of other syndromes are associated with autoantibodies. So that is a very interesting area to explore. Is there a persistence of viral fragments. Is there autoimmunity? Is it also a component of persistence of the damage from the initial infection? So it's an area that still needs a lot of work and a lot of work is going into it, but this is like a post or inter pandemic of itself, so hopefully we'll get more insights into that.   Cindy St. Hilaire:         Yeah, it's really interesting. I have a friend who has very debilitating long COVID and one of her doctors had said, "If I didn't know any better, I would just describe this as a autoimmune type X." What do we know, I guess, about the current hypothesis of the pathogenesis of PASC? Are there any prevailing theories right now as to why it's occurring? Is the virus still active or is it these domino effects that are leading to multi-organ collapse of some sort?   Mina Chung:   Yeah. In some people, persistent viral particles can be identified for months, but whether or not that's what's triggering it, it's hard to know. We see more autoimmune disease that's been reported and various antibodies being reported. So those are clearly processes to be investigated. The microthrombosis is still up there in terms of potentially playing a role in long COVID.   Milka Koupenova:       Mina, you probably know better because you see patients, but to all I have been exposed to, long COVID does not really have a homogeneous symptom presentation and then a few theories as to what may be going on in these patients. Not everybody has a microthrombosis. Not everybody have a D-dimer elevated, but some people do. Some people have, as you pointed out, these spectacularly profound brain fog. People can't function. It's probably your friend, Cindy, right?   Cindy St. Hilaire:         Yeah.   Milka Koupenova:       So one of the theories that I have been, from a viral perspective, very interested in is that a lot of the symptoms in certain individuals such as fatigue, brain fog, sensitivity to light and skin can very well be explained by a flare-up of Epstein-Barr virus that may be what SARS-CoV-2 somehow is inducing. I don't know, DeLisa, what your experience with long COVID is as a scientist. I hope only. But I would like to hear your perspective too because it's so heterogeneous and it is amazing what happens.   DeLisa Fairweather:    I have a very interesting perspective from a number of different directions. One, as I mentioned before, my long history with Dr Rose and I've written many articles theorizing how viruses could cause autoimmune disease. This has grown and really, I think this has been extremely revealing during COVID for many of those theories. One thing that I write about in the review for this article is that mast cells, from all the research I've done with myocarditis in our model, mast cells are central to what is driving everything. We show they're the first innate immune cell acting as an antigen-presenting cell, completely driving the response in a susceptible pattern. One of the things that's very important in autoimmune disease is both sex and race. I'd say one of the big weaknesses we have in myocarditis pre-COVID and post-COVID has been ignoring what's going on with race. In the United States, myocarditis is 90%, 95% white men that are under 50 years of age and most of the cases are under 40 or some of the ones really associated with sudden cardiac death are under 30. So it's very specific. I've been studying sex and race differences and we see those exact differences in our animal models. In animal models, whether you're susceptible or not depends on how many mast cells you have. Well, I've proposed from the beginning, looking, I've written a lot of different sex difference reviews looking at viruses and autoimmune disease with different autoimmune diseases and hypothesizing and really seeing that mast cells do a lot of the things we're talking about. They have all of the receptors, the whole group of them that have been related to SARS-CoV-2 so they can be activated or stimulated by the virus itself. They act as a antigen-presenting cell. They're critical in the complement pathway as well as macrophages. We see the dominant immune phenotype really being macrophages. Mast cells just are usually not counted anywhere. And of course, these receptors, a lot of them have to do with enzymes and things that are all related to mast cells pathways. Then how they activate the immune response and lead it towards the pathway that leads to chronic autoimmune disease with increased autoantibodies in females, mast cells are very different by sex. This has to do also when we talked in the Review about myocarditis and pericarditis. It's both those appearing. Although clinically, we have really boxed them as separate things, because there is some definite clinical pericarditis phenotypes that are different, myocarditis in animal models is always myopericarditis. It always then, in that outer pericardial areas where mast cells sit, they sit around the vascular area in most concentrated. So when they degranulate, we see inflammation coming in the vessel, but really concentrated with fibrosis there and along the pericardium. So that's very typical of what's going on. When we shift anything that shifts that, it changes whether you have more pericarditis or less pericarditis and the vascular inflammation by altering anything that affects the mast cells. I talk a little bit about in the review, I think there's only been a few recent things looking at it in COVID, but I think mast cells and certain susceptibility to autoimmune diseases that occur more often in women can really predispose.We need to pay more attention to mast cells and what they might indicate for all these pathways.   Milka Koupenova:       I think we should study the platelet mast cell access at this point.   DeLisa Fairweather:    Yes.   Milka Koupenova:       Because as you're talking about these sex differences, which is spectacular, these things to me are so mind-boggling how one, the infection itself would be more prevalent in men, but then long COVID is more prevalent in women. All of these things and why we understand so very little, what we found about a few years ago in the Framingham Heart Study in the platelets from those people is that all toll-like receptors are expressed at the higher level in women and they associate with different things between men and female. For instance, toll-like receptors in women will associate more with a prothrombotic response while in male with pro-inflammatory response. I think they grossly underestimate the amount of our sex differences from cell to cell.   DeLisa Fairweather:    It is, yeah.   Mina Chung:   One other thing that I learned about the sex differences from this compendium is Mark Chappell also notes, you mentioned TLR and TLR7 and ACE2 are X chromosome in an area that he says escapes X-linked inactivation. So it could very well be involved in further.   DeLisa Fairweather: Further, yeah. And ACE2 is expressed more highly in male cells for what's been researched because of the sex difference in COVID, both the COVID infection   Cindy St. Hilaire:         So a variety of organ systems are impacted in patients with PASC, also referred to as long COVID, the lungs, the heart, the pancreas, the GI system, pretty much any system, the brain, nervous system. We've just been talking about the mast cell impact. I was really thinking in my head, well, the one thing that connects all of it is the vasculature. I'm a vascular biologist, so I have certain biases, I'm sure, but how much of the sequelae that we see is a function of vascular phenotypes?       Milka Koupenova:       I do think the vasculature is super important. It's clear that not all endothelial cells, for instance, will pick up the virus and respond to it. That's why you have this patchy breakage when you look at autopsies. Hence, platelets will respond according to what's local. That's why you find these micro thrombotic events at certain places. Why does it happen in each organ? How does the virus get to each organ to respond? Or is it just inflammation, but why is it in specific places? That's what we don't understand. That's where we need to go. Perhaps, as DeLisa points out, perhaps it's a lot more complicated than how we traditionally think of thrombosis. Actually, my personal bias, again 100% sure that it is a lot more complicated than the traditional mechanisms that we have understood, and that's where the immune system comes and autoimmunity perhaps stems from and they probably speak to each other, right? It's not just one thing.   DeLisa Fairweather:    Yeah. I think really, EVs are bringing lots of understanding. A lot of things we used to just think were maybe free-floating and the serum are inside EVs. I think that the immune response is perhaps even more specific than we ever thought and more regulated than we ever understood.   When an EV comes through a cardiomyocyte, whether it's from the mitochondria or through a lysosome, is part of what goes into its outer membrane, something that tells the immune system that that came from the heart, so it knows to go. This will solve a lot of our questions with autoimmune disease if it's very specific like that. It doesn't just have to be the release of free-floating cardiac myosin. We know cardiac myosin is the driver of the autoimmune response in myocarditis, but they're probably  much more fine-tuned.   Cindy St. Hilaire:         Yeah. I just would love to end with hearing from each of you. You each have your own domain of specialty. If I gave you a massive pot of money, what would be the question you would want to tackle? What's the gap you would love to answer?   Milka Koupenova:       We still don't understand specifically what kind of vesicles are coming out, what are their contents in addition to those vesicles. We don't understand. When it comes to platelets, what comes from their granules? We see these breakages of the membrane. Those are non-granule proteins, and non-granule proteins, they serve as dangerous associated molecular pattern signals and can be profoundly inflammatory to the surrounding environment, can be procoagulant. What are those? How are they affecting the surrounding environment? Ultimately, why is there a microthrombi? Why is there not a profound thrombosis everywhere? Thank goodness there isn't, but why isn't? That's what I would do with my money.   DeLisa Fairweather:    I think I would do something very similar. All of our research in our animal model, on the one side, we are looking in this viral myocarditis animal model and finding the EVs that come from that are driving myocarditis. On the other hand, we're using EVs that come from healthy human plasma or fat, and we're seeing a profound downregulation of everything if you give it early and we're trying to see how late you can give it and still get an effect. So looking at those and really understanding the components in the context of COVID and COVID vaccines to understand those components, I really think that's the future of where we're going to find what's causing disease and also how we can find therapies. They may be able to reverse this.   Mina Chung:   Yeah, I'm interested very much in the autoimmunity and the autoantibodies that are    and how they may react with those microthrombi. Perhaps there's autoantibodies within a lot of that material. We're looking at using human and pluripotent stem cell-derived cell models to study the effects of those. That is what I would use our money for.   Cindy St. Hilaire:        Well, Dr Mina Chung, Dr DeLisa Fairweather, Dr Milka Koupenova, thank you all so much for joining me today and talking about not only the articles that you wrote and with your colleagues, but also other articles in this amazing compendium. I do think this is one of the first all-encompassing compendiums or group of articles that focus specifically on COVID and cardiovascular disease. So thank you all so much.   Mina Chung:   Thank you.   DeLisa Fairweather:    Thank you.   Milka Koupenova:       You're welcome.   Cindy St. Hilaire:         That's it for highlights from the April 28th and May 12th issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle @circres and #DiscoverCircRes. Thank you to our guests, Dr Mina Chung, Dr DeLisa Fairweather and Dr Milka Koupenova. This podcast is produced by Ishara Ratnayaka, edited by Melissa Stoner and supported by the editorial team of Circulation Research. Some of the copy text for the highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire, and this is Discover CircRes, your on-the-go source for the most exciting discoveries in basic cardiovascular research. This program is copyright of the American Heart Association 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more information, visit ahajournals.org.    

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/east-asian-studies

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/anthropology

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/sociology

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/religion

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/communications

Ioannis Gaitanidis' book Spirituality and Alternativity in Contemporary Japan: Beyond Religion? (Bloomsbury, 2022) critically examines the spirituality phenomenon in contemporary Japan by looking at the main actors involved in the discourse: spiritual therapists as practitioners, scholars of spirituality studies, and the people in the publishing industry. Ioannis Gaitanidis challenges the common understanding of spirituality as simply a new emergent form of “religion” by considering alternativity as a framework to understand how it has been framed in relation to something else. This book critically analyses the creation and effects of spirituality as both discourse and practice in Japan. It shows how the value of spirituality has been sustained by scholars who have wished for a more civic role for religion; by the publishing industry whose exponential growth in the 1980s fashioned those who later identified as the representatives of this “new spirituality culture”; by “spiritual therapists” who have sought to eke out a livelihood in an increasingly professionalized and regulated therapeutic field; and by the cruel optimism of an increasingly precarious workforce placing its hopes in the imagined alternative that the supirichuaru represents. Ioannis Gaitanidis offers a new transdisciplinary conceptualisation of 'alternativity' that can be applied across and beyond the disciplines of religious studies, media studies, popular culture studies and the anthropology/sociology of medicine. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/japanese-studies

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/history

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/east-asian-studies

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/intellectual-history

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/religion

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/japanese-studies

The God Susanoo and Korea in Japan's Cultural Memory: Ancient Myths and Modern Empire (Bloomsbury, 2022) traces reiterations and reinterpretations of the deity Susanoo regarding his relationship with Korea vis-a-vis Japan. Through careful examination of mythological texts and other primary sources, David Weiss examines Susanoo's role in the construction of Korea's image as Japan's periphery. This book discusses how ancient Japanese mythology was utilized during the colonial period to justify the annexation of Korea to Japan, with special focus on the god Susanoo. Described as an ambivalent figure and wanderer between the worlds, Susanoo served as a foil to set off the sun goddess, who played an important role in the modern construction of a Japanese national identity. Susanoo inhabited a sinister otherworld, which came to be associated with colonial Korea. Imperialist ideologues were able to build on these interpretations of the Susanoo myth to depict Korea as a dreary realm at the margin of the Japanese empire that made the imperial metropole shine all the more brightly. At the same time, Susanoo was identified as the ancestor of the Korean people. Thus, the colonial subjects were ideologically incorporated into the homogeneous Japanese “family state.” The book situates Susanoo in Japan's cultural memory and shows how the deity, while being repeatedly transformed in order to meet the religious and ideological needs of the day, continued to symbolize the margin of Japan. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/korean-studies

What makes someone an ESG expert? Listen to Jason Mitchell discuss with Professor Kim Schumacher at Kyushu University, about what competence greenwashing represents; how to capacity plan and build around subject matter expertise in the natural sciences; and why we need to consider an ESG Skills Materiality framework towards this effort. Professor Kim Schumacher is an Associate Professor in Sustainable Finance and ESG at Kyushu University in Japan. He's also a Visiting Lecturer at the Tokyo Institute of Technology Japan and an Honorary Research Associate at the University of Oxford. His research focuses on ESG data and impact metrics, sustainability reporting, greenwashing, green bonds, natural capital, nature-based carbon offsets, biodiversity and ecosystem services, renewable energy project development, and TCFD/TNFD disclosures. He is also a Lead Author for the UN's Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services, a member of the Technical Working Groups of the Climate Disclosure Standards Board, the Climate Bonds Initiative, and the Green Finance Network Japan. Learn more about your ad choices. Visit megaphone.fm/adchoices

The world has produced more than 6 billion tons of plastic to date and much of that has become waste that has not been recycled, incinerated, or otherwise properly contained.  A great deal of it has ended up in the oceans of the world. Researchers at Kyushu University in Japan have done an analysis to […]

Marose comes from a family of inspirational women and she will definitely inspire you with her outlook on life and how she has made the most of opportunities that have presented themselves to her. Marose shares with us how her outside activities are actually a way to improve her knowledge and network in her chosen area of arbitration. If you enjoyed this episode and it inspired you in some way, we'd love to hear about it and know your biggest takeaway. Head over to Apple Podcasts to leave a review and we'd love it if you would leave us a message here! In this episode you'll hear: How Marose was first inspired by her own mother studying law and running for office Why Marose chose Japan to do postgraduate study How she was able to help orchestrate an internship at the law firm she would then work at Improving yourself outside of legal study, taking part in volunteer activities as a way to learn Her favourite podcast and other fun facts About Marose Marose is a Counsel at Oh-Ebashi LPC & Partners and is a registered foreign lawyer licensed in both the Philippines and the State of New York. Marose joined Oh-Ebashi in 2008 after briefly working at the Graduate School of Law of Kyushu University, where she completed her LL.M. in International Economic and Business Law in 2007. Prior to studying at Kyushu University, for almost six years until 2006, she worked at Picazo Buyco Tan Fider & Santos Law Offices, one of the top corporate firms in the Philippines. Marose serves as a Volunteer Public Relations Officer of the Japan Commercial Arbitration Association (JCAA), which is the leading commercial arbitral institution in Japan. She is also the co-Founder and Vice-Chair on the Executive Committee of Energy Related Arbitration Practitioners (ENERAP) - Japan Chapter (since 2021) and is Vice-Chair, Technology, Media and Telecommunications Committee of the Inter-Pacific Bar Association. Marose also lectures at Kyushu University, and in 2023 will teach a course at Temple University in Tokyo. She has also published several articles about Philippine legal updates and the rules of the JCAA. Connect with Marose LinkedIn: https://www.linkedin.com/in/marose-pereira-02394aab/ Links Rose Bakery: https://www.rose-bakery.jp/ Connect with Catherine Linked In https://www.linkedin.com/in/oconnellcatherine/ Instagram: https://www.instagram.com/lawyeronair Facebook: https://www.facebook.com/catherine.oconnell.148 Twitter: https://twitter.com/oconnelllawyer YouTube: https://youtube.com/@lawyeronair

On Episode 23 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the December 2022 issue of Stroke: “Direct, Indirect, and Combined Extracranial-to-Intracranial Bypass for Adult Moyamoya Disease” and “Contemporary Incidence and Burden of Cerebral Venous Sinus Thrombosis in Children of the United States.” She also interviews Drs. Koji Tanaka and Andrew Demchuk about article “Significance of Baseline Ischemic Core Volume on Stroke Outcome After EVT in Patients Age ≥75 Years.” Dr. Negar Asdaghi:         Let's start with some questions. 1) Is direct bypass better than indirect bypass in preventing the future risk of vascular events in adult patients with moyamoya disease? 2) What is the contemporary incidence of cerebral venous sinus thrombosis in the pediatric population? 3) And finally, is endovascular therapy beneficial for patients presenting with a large ischemic core? We have the answers and much more in today's podcast. You're listening to the Stroke Alert Podcast, and this is the best in Stroke. Stay with us. Welcome back to another issue of the Stroke Alert Podcast. My name is Negar Asdaghi. I'm an Associate Professor of Neurology at the University of Miami Miller School of Medicine and your host for the monthly Stroke Alert Podcast. In our final podcast for the year, I'm thrilled to announce that Drs. Nastajjia Krementz and Eric Goldstein have joined our podcast as assistant editors to help us cover the latest and the best in the field of cerebrovascular disorder. And together, here's our article selection to close the year. As part of our Advances in Stroke, in the article titled "Focus on Anticoagulation for Valvular Heart Disease With and Without Atrial Fibrillation," we get an update on current evidence from randomized controlled trials on the use of direct oral anticoagulants or vitamin K antagonists in patients with valvular heart disease that are mechanical valves, moderate to severe mitral stenosis, or bioprosthetic valves from the perspective of stroke physicians. What that means is that data from randomized trials was analyzed based on whether the patient had a prior history of stroke or TIA. In this review, we learned that direct oral anticoagulants may be used in patients with bioprosthetic valves who have atrial fibrillation, although DOACs have never been shown to be superior over vitamin K antagonists. We also learned that vitamin K antagonists should be used in patients with rheumatic moderate to severe mitral valve stenosis or patients with mechanical valves with or without atrial fibrillation and, of course, sometimes during the first few months after either surgical or transcatheter aortic valve replacement in patients without atrial fibrillation. And finally, patients with bioprosthetic valves without AFib don't have any other indications to be treated with anticoagulants should be treated with antiplatelet monotherapy in the long run. In a separate article in this issue of the journal, from Dr. Yang and colleagues from China, we learn about the pathophysiology of radiation-induced brain injury with special attention to radiation-induced vasculopathy. These investigators show that hyperactivity of notch signaling pathway that in normal state is essential in vascular morphogenesis and maintenance of arterial identity actually results in abnormal accumulation and disturbance of vascular smooth muscle cells, resulting in arterial muscularization and arterial dysfunction seen in radiation-induced vasculopathy. What's interesting is that inhibition of the notch signaling pathway in their study resulted not only in a measurable reduction in radiation induced vasculopathy, but also an overall improvement in radiation-induced brain injury as measured by the cognitive function of the mice exposed to radiation in their study. This study takes us a step closer to possible therapeutic options for radiation-induced vasculopathy and radiation-induced brain injury using compounds that can potentially inhibit the notch signaling pathway. As always, I encourage you to review these articles in detail in addition to listening to our podcast. For our interview today, I have a special guest who's not only a prominent researcher and a pioneer in the field of acute stroke therapies, but also, he's an experienced educator who has trained many of the current leaders in the field of vascular neurology and has been influential in shaping the careers of many vascular neurology fellows over the years. Take a listen. Dr. Andrew Demchuk:   I've had the privilege of training fellows. I've been the director since 2004, and we've trained close to 100 fellows in Calgary over 20-some years now. Really, it's frankly an honor and privilege to be able to do that. These individuals come from all over the world. They're here to dedicate themselves to learning a subspecialty really, really well, and it's just a fantastic experience to interact with them all and all their cultures to help them learn those things, and doing it in a fun, enjoyable, comprehensive way. Dr. Negar Asdaghi:         And those are the words of Dr. Andrew Demchuk, who's incidentally my own vascular fellowship director as well. Andrew joins me all the way from Canada to talk about his latest paper on the very hot topic of outcomes of endovascular therapy in patients presenting with a large ischemic core. And true to form, he's accompanied by one of his current vascular fellows. The interview is definitely worth the wait after we review these two articles. Most of us have heard of the term "moyamoya." First described in Japan in 1950s, the term refers to occlusion or stenosis of the terminal portion of the internal carotid artery and is associated with dilated collateral vessels of the proximal middle cerebral artery. These collaterals have a hazy appearance on angiography resembling the puff of smoke, which is Japanese for "moyamoya." Moyamoya is categorized into two broad categories of moyamoya syndrome and moyamoya disease. Syndrome refers to the situations where the occlusion occurs due to another condition. Conditions such as Down syndrome, sickle cell disease, neurofibromatosis type one have all been recognized as associated with moyamoya syndrome. Of course, moyamoya syndrome can occur due to a secondary insult to the blood vessels, anything from radiation vasculopathy, as we reviewed earlier in the podcast, to autoimmune vasculitis, or even good old advanced intracranial atherosclerosis involving the distal ICA region can cause moyamoya syndrome. Now, in contrast to moyamoya syndrome, the term "moyamoya disease" is reserved for individuals with no vascular risk factors or known moyamoya predisposing conditions other than, of course, some potential genetic factors. The most recognized genetic association for moyamoya disease is polymorphism in the ring finger protein 213, or RNF213, gene on chromosome 17. But we also have to keep in mind that the majority of moyamoya disease patients have no identified genetic abnormalities. So, moyamoya is truly a complex condition, and the physicians have to navigate the many possible etiologies that may cause or be associated with this condition. But when it comes to treatment options, we're really limited here. Antiplatelets are generally used and have been shown to reduce mortality in both moyamoya disease and syndrome, and especially cilostazol, which is the favorite antiplatelet therapy of our own assistant editor, Eric, has been shown to be significantly associated with increased survival rate in patients with moyamoya disease. Eric really wanted me to talk about a recently published study out of Korea, which included over 9,000 patients, and that showed that patients treated with cilostazol had a better survival rate than any other antiplatelet therapies. Apart from antiplatelet therapies, medical treatment includes optimizing all other vascular risk factors, which, as we mentioned, are rarely present in this population. So, it all comes down to most cases, at some point, needing surgical treatment, with bypass surgery being the most commonly surgical intervention for this population. Three flavors of bypass are used: indirect, direct, or combination of the two. Indirect bypasses are kind of like long-term investments where the surgeon moves vascular tissue to the surface of the brain in hopes of promoting angiogenesis. Several procedures, such as performing multiple burr holes, pial synangiosis, dural inversion, or omental transposition, among other methods, are used. And broadly speaking, we can think of indirect procedures as angiogenesis-dependent methods, the effect of which takes months to recognize and, in general, are thought to be more efficacious in the pediatric population than the adult population. The direct bypass, in contrast, commonly referred to as extracranial-to-intracranial, or ECIC, bypass, is more of an immediate reward where the surgeon stitches a vessel directly from a donor extracranial branch, typically the superficial temporal artery, to a recipient artery, typically the middle cerebral artery, to provide a direct anastomosis between the two vessels. There are technical variations, of course, especially with regards to the number of donors and recipient arteries used, but essentially this method is an angiogenesis-independent method that results in a quicker revascularization, but it's unclear if this strategy is long lasting. A combination of direct and indirect bypass can also be used. So, the question is, which method is better, especially in the adult population? In this issue of the journal, in the study titled "Direct, Indirect, and Combined ECIC Bypass for Adult Moyamoya Disease," Dr. Nickalus Khan and colleagues report on a meta-analysis and systematic review of those with adult moyamoya disease who underwent either direct, indirect, or a combination bypass. The main study question was whether there's a difference in the rates of early ischemic or hemorrhagic strokes, defined as strokes occurring within 30 days of bypass, or late strokes, defined as strokes occurring after 30 days of bypass, in this population when comparing the different surgical techniques. They also compared the "favorable" outcome rate; however, this outcome was defined in each study between the various broad techniques of direct, indirect, and combined bypass. So, with that, let's take a very quick look at their methodology. They screened more than 4,000 articles and identified 143 articles for their pooled analysis, the majority of articles being from Eastern Asian-based regions, and they had close to 4,000 combined, 4,000 direct, and 4,000 indirect bypass procedures for this analysis. And they had an average follow-up of over three and a half years. So, this is a great sample size for this large, pooled analysis. But they also performed a smaller meta-analysis where they were much more stringent with article selection, excluding pediatric papers, excluding articles containing only one surgical modality, or articles with insufficient outcome data. So, for that meta-analysis, they only had 43 articles qualified and were included in that meta-analysis. So, what did they find? In the larger pooled analysis, a significant benefit in favor of both direct and combined bypass techniques were noted in reduction of early and late ischemic strokes and late intracerebral hemorrhage. Also, a higher rate of that sort of vague favorable outcome was noted with both the direct or combined methods as compared to when indirect bypass techniques were used alone. So, everything in the large, pooled analysis pointed towards the direct bypass or combined technique performing better than all indirect bypass techniques, with only one exception, which was a lower incidence of early intracerebral hemorrhage rate in indirect bypass cases. So, that's one point to keep in mind. The second point was when they compared combined techniques to direct bypass. Overall, these procedures had more or less the same outcomes with the exception that the rate of late ischemic stroke was lower in the combined group than the direct bypass group. So, this is sort of the overall summary of what they found in that large, pooled analysis. When they were much more stringent with their selection criteria, focusing on the smaller meta-analysis portion of the study, what they found was that in the short term, there were no differences in outcomes of any type of stroke between any of these methods. So, basically, people, regardless of the type of bypasses they received, did the same with regards to the risk of intracerebral hemorrhage and ischemic stroke recurrence within the first 30 days after the bypass. But for the late stroke outcomes, whether ischemic or hemorrhagic, those with indirect bypass were nearly twofold more likely to develop late stroke after 30 days compared to those who've undergone the direct bypass. A similar pattern was found comparing combined bypass versus indirect bypass, in general, beyond the 30 days, with combined bypass doing better. Comparing direct versus combined bypass showed no difference regardless of timeframe. So, in summary, overall, it appears that combined or direct bypasses may be the best surgical strategies for treatment of adult patients with moyamoya disease. This study, of course, has many limitations, as does any meta-analysis, but most importantly, the authors focused on moyamoya disease in their analysis. It is presumed, but really unclear if patients with moyamoya syndrome would respond similarly to these different techniques. So, the question is, what surgical procedure are you using at your institution for treatment of adult moyamoya disease patients? And, of course, Eric wanted me to ask if your antiplatelet of choice is cilostazol for this population, yes or no. Leave us your comments, and let us know. Venous sinus thrombosis, or CVST, is a less common form of stroke most commonly affecting women and young individuals. In our past podcast, we've covered many aspects of CVST, especially when it comes to therapy with anticoagulation, anticoagulant of choice, and duration of therapy. In the October podcast, we reviewed a systematic review and meta-analysis comparing direct oral anticoagulants to vitamin K antagonists in the adult patients with CVST. But there are many aspects of this disease that we have not yet covered. For instance, you may ask, how common is this relatively uncommon condition? In the adult population, the incidence of CVST varies depending on the age of individuals studied, and ranges between 1.3 to 2.7 per 100,000 in women between the ages of 31 to 50, which is the adult population at highest risk for this disease. But the incidence of CVST, for instance, in the pediatric population is largely unknown. Some studies suggested an incidence rate of 0.67 per 100,000 in the pediatric population. That's roughly less than half the incidence rate in young female adults, but these reports are from the 1990s and are likely very outdated. Nowadays, many of the pediatric conditions, especially infectious conditions, that can predispose children to CVST are more readily diagnosed and treated. On the other hand, we now perform a lot more imaging than 30 years ago. Our neuroimaging modalities are more accurate, so we are more likely to diagnose CVST than before. So, the question is, what is the contemporary incidence of pediatric cerebral venous sinus thrombosis? In this issue of the journal, in the study titled "Contemporary Incidence and Burden of Cerebral Venous Sinus Thrombosis in Children of the United States," Dr. Fadar Otite and colleagues conducted a retrospective analysis of the New York State Inpatient Database, or SID, from 2006 to 2018, and the National Kids Inpatient Database, referred to as KID, from 2006 to 2019, for all hospitalized CVST cases. KID is the largest publicly-available pediatric inpatient care database in the United States, containing about 3 million pediatric discharges. They included over 700 hospitalized CVST cases from the SID database and 6,100 hospitalizations from the national KID database for the current analysis. And here's what they found. Number one, in terms of significant risk factors associated with CVST, congenital circulatory system anomalies, infections, head trauma, dehydration, and anemia were amongst the top CVST risk factors in the pediatric population. So that's very good to know. Number two, in terms of presentation, seizures were the most common presentation among all pediatric age groups, with close to half of infants with CVST presenting with seizures. Number three, in terms of outcomes, the rate of mortality was twice higher in the infants group as compared to all other age groups. And finally, the overall incidence of CVST, which was the main question of the paper, in this population was 1.1 per 100,000 per year, with a peak incidence during infancy of 6.4 per 100,000 per year. Interestingly, incident admissions also increased annually by 3.8% throughout the study period, which was close to 15 years in this paper. And the national burden of hospitalization dramatically and exponentially grew during the study period. So, here are the top three points from this study. Point one: Girls included less than half of all admissions nationally and statewide, and the overall burden of CVST was higher in boys than girls. That's a dramatic difference between the pediatric and adult populations. Point two: Incidence of CVST in infants was higher than five times that of other age groups at 6.4 per 100,000 compared to overall incidence in children, which was 1.1 per 100,000 people per year. Mortality was also two times higher in infants than in any other age group. And finally, point 3, incident admissions and national burden of hospitalization have dramatically increased over time, but it remains unclear whether true incidence has been on the rise or if simply more cases are recognized nowadays due to heightened awareness of this condition and our advanced neuroimaging capabilities. This study, of course, has some limitations. Data was only obtained on patients admitted, so many patients that may have had CVST but not admitted are not captured in this database. So, in summary, CVST can have catastrophic consequences in children and lead to long-term neurological deficits. Having a high clinical suspicion and early recognition remain crucial for prompt treatment and improved outcomes in this population. Dr. Negar Asdaghi:         Endovascular treatment, or EVT, is an effective method to achieve recanalization and to improve clinical outcomes in ischemic stroke patients with a target vessel occlusion. Both advanced age and having a large infarct volume at the time of presentation are negative predictors of beneficial outcomes post-EVT. Despite this, the neurological benefits of EVT seem to persist across the spectrum of age, and the same has been observed for a range of ischemic core volumes. But it's important to note that, in general, patients presenting with large ischemic core volumes were excluded from the original thrombectomy studies, and currently there's several ongoing trials to determine whether EVT is beneficial for the large core population. Now, the question that everyone is interested in answering is whether there is an actual ischemic core volume beyond which endovascular therapy is either futile or potentially even harmful, and if this magic futile core volume is the same for all patients, or does it differ depending on the age and other factors. In a previous podcast, in an interview with Dr. Osama Zaidat, we learned about that important interaction between the presenting ischemic core volume as measured by ASPECTS score and advanced age in an analysis of patients enrolled in the STRATIS registry. In that study, no one over the age of 75 achieved functional independence post-EVT if the presenting ASPECTS score was under 5 regardless of the angiographic outcomes. In that interview, we also discussed the limitations of STRATIS registry as a non-randomized, single-arm study, and the issues surrounding using ASPECTS score to define ischemic core. In today's podcast, we're going to revisit the important interaction between the presenting ischemic core volume and age while reviewing a pooled analysis of seven endovascular clinical trials in the paper titled "Significance of Baseline Ischemic Core Volume on Stroke Outcome After Endovascular Therapy in Patients Age 75 Years or Older." I'm delighted to be joined today by the first and senior authors of this paper, Drs. Koji Tanaka and Andrew Demchuk. Dr. Tanaka is an Assistant Professor of Neurology at Kyushu University in Japan. With his experience working at the leading center for conducting stroke clinical trials in Osaka, he has now joined the Calgary Stroke Program as a research fellow. And he's accompanied today by his fellowship director, Dr. Demchuk. Dr. Demchuk, of course, needs no introduction to our Stroke readership and our podcast audience. He's a Professor of Neurology at the University of Calgary Cumming School of Medicine. He's a stroke neurologist and a leader in the field of cerebrovascular research who has been involved in multiple clinical studies and randomized trials, including the seminal studies that led to the approval of EVT as the standard of care for treatment of stroke. And, of course, he's a very special guest of this podcast this morning as he was my very own fellowship director. Top of the morning to you both, Andrew and Koji. Welcome to the podcast. Dr. Andrew Demchuk:   Thanks, Negar. It's great to be here. Dr. Koji Tanaka:               Thank you very much for your invitation. That is a great honor to be here. Dr. Negar Asdaghi:         Thank you both. Andrew, let's start with you. Can you please provide us some background on the pooled analysis and the HERMES collaboration, please? Dr. Andrew Demchuk:   Yeah, HERMES is a really, it's been a really fun journey. Years back, when these trials all came out roughly at the same time, right? There was a real quick succession of trials, the MR CLEAN trial was obviously first, and ESCAPE and others quickly followed it. It became very clear to us that it just made total sense to collaborate. And so we got together as a group and decided we will pool the data. We'll do it in a very careful scientific way with basically an independent statistical analysis, and develop a core imaging lab, and really actually share the workload amongst us. I remember one of the really interesting tidbits about HERMES is when we got together, in order, I think, to really build trust in the group, one of the important things we decided early was we were going to have a snake draft. If you don't know what a snake draft is, Negar, it's essentially where you take turns selecting a topic through each of the trials. So, every trialist got an opportunity to pick a topic, and we just went down the list until everyone had their turn, and then we'd start over again and do it again. And I think that really worked very well to be as democratic as possible with this, and as fair. And it really allowed for a lot to get done because whoever was motivated in the collaboration was able to do an analysis. Dr. Negar Asdaghi:         So, what a great summary of this collaboration. So, it's true collaboration between the trialists that basically gave us those seven original randomized trials. Andrew, can I just stay with you, and can you tell us a little bit about the patient population that were enrolled in those trials? Dr. Andrew Demchuk:   Yeah, I think one of the important things to know, and I think a limitation for any kind of analysis like this, is the trials generally were small core trials, right? I mean there are some, MR CLEAN was certainly a more generalized population, but many other trials, including ESCAPE, I mean the "S" and the "C" in ESCAPE is "small core," right? And so a lot of these trials were small core. So, we don't have a lot of data in larger core patients. But, as you can imagine when you do core lab analysis, you realize that some of the stroke patients weren't as small core as we thought they were when we enrolled them. So, there is some sufficient data to hypothesize. I would consider this paper very much hypothesis-generating. So, yeah, it is a limitation to be considered here. I mean, our sample size isn't very large in the big core patients. Dr. Negar Asdaghi:         Perfect. Thank you, Andrew. So, again, a recap for our listeners, that we are looking at pooled analysis of seven original trials of thrombectomy, but keeping in mind that those patients that were enrolled in the trials had, generally speaking, small presenting ischemic core. So, now, Koji, on to you. Can you walk us please through the current study, and what was the premise of it, and who was actually included in this study? Dr. Koji Tanaka:               Yes. In this study, we aimed to evaluate association between baseline ischemic core volume and the benefit of endovascular therapy over the best medical treatment on functional outcomes. Patients were categorized age over 75 years, and less than 75 years old. The primary outcome of interest was a modified Rankin Scale of three or less, and we included 899 patients who underwent this baseline ischemic core volume measurement, which corresponds to 51% of our patients in the HERMES collaboration dataset. Dr. Negar Asdaghi:         All right. So, just a quick recap of what you said. Thank you for this. So, we have 899 patients. Those patients were all included in the HERMES collaboration, but, of course, these are patients in whom we had presenting ischemic core measurements. And that will get me, actually, Koji, to my second question. Can you please walk us through how you did analysis of ischemic core volume measurements in this study? Dr. Koji Tanaka:               In this study, ischemic core volume was measured by CT perfusion in 591 patients and by diffusion-weighted imaging in 309 patients. We defined the ischemic core volume as a relative cerebral blood flow of less than 30% in CT perfusion and diffusion coefficient of less than 620 square micrometers per second in diffusion-weighted imaging. Previous studies showed ASPECTS moderately correlate with ischemic core volume in both CT perfusion and diffusion-weighted imaging. For example, ASPECTS of eight can be considered as ischemic core volume of 20 milliliters. But underlying [inaudible 00:28:21] were different between CT perfusion and diffusion-weighted imaging, and previous studies suggested CT perfusion occasionally overestimates the ischemic core volume was on diffusion-weighted imaging. In this study, the results did not change when analyzing CT perfusion and diffusion-weighted imaging separately. Dr. Andrew Demchuk:   Yeah, that's a really important point Koji makes, is that because we had sort of a, not quite a 50/50 split, we had a 60/40 split of CTP and DWI, we did analyze them separately, and the odds ratios of treatment effect were pretty similar at different core thresholds. So, they're fairly similar when you separate them out, but obviously the methodology is a little different between a CTP and a diffusion. And to Koji's point, he's absolutely right, the CTP has a tendency to slightly overestimate core when you compare to diffusion. Dr. Negar Asdaghi:         Yeah, and thank you. I think you already sort of alluded to what I was going to ask you and Koji, because, in reality, we have different ways of measuring core. We have the ASPECTS score, which is just a quick and dirty way of estimating or guesstimating core, and then we have CT perfusion, and we also have diffusion that sometimes is available to us, but not always. And the question is, in the heat of it, how we're going to measure the volume. With post-processing softwares, with CT perfusion, we get a quick potential ischemic core volume, but we don't have that capability with diffusion even if we did get diffusion. So, I think it's important to know that what Koji mentioned, an ASPECTS of eight can, more or less, in a quick fashion, be thought of as about 20 cc of core. And the other point that Koji raised was that CTP, again, this is sort of ballpark, can tend to overestimate ischemic core if you were to compare that with diffusion-weighted data. So, with that, now we have a study in which we have core volumes, and we're going to look at outcomes from endovascular thrombectomies compared to best medical management and see whether there is a correlation or interaction between ischemic core presentation, especially age. So, my next question would be to Andrew, can you walk us please through the main findings of the paper? Dr. Andrew Demchuk:   The whole goal of this paper was really to understand, are there thresholds in the older patients? When we looked at overall, and Bruce Campbell and the team wrote an important paper with HERMES and the CTP cohort overall, and the sort of message there was if you looked at shift analysis, there wasn't actually a core threshold found at all in HERMES for lack of benefit. There was a benefit across all the core volumes, but, of course, that's all ages. So, we were really interested in looking at the older patients because we felt there's more likelihood the core volume will matter in the elderly than in the younger patient. We know the younger population, it benefits overwhelmingly with EVT, it's hard to even find a core volume threshold. So, that was a premise. Essentially, we had 247 patients over 75 in the overall cohort, of which 98 had EVT. So, it was a decent population, and not a huge sample, but a decent sample. And so we looked at various things. The first thing that was interesting we found was that infarct volumes, the average infarct volume to achieve an mRS three or less, was lower in the older patients, significantly lower, was 23.9 for younger patients under 75 and 10.7 for the older patients. You tend to have much smaller infarcts to achieve good outcome. And so that was kind of interesting, and I think that's been shown by others. Then we got into the weeds to try to figure out, OK, what are these thresholds? And if there's one figure that matters, Negar, you know me to always point out that there's always one figure or table in a paper that's kind of where the money is, where the real learning is, and that's Figure 2 on this paper in my opinion, beautiful figure with four figure A, B, C, and D. And it really sort of nicely highlights these issues and these cutoffs. But what we saw is that in the older patients who received EVT, around 50 mils seemed to be a threshold to achieve zero three, you had to, to see treatment effect, you had to have a baseline infarct volume less than 50 mils for a zero three outcome advantage. For zero four, it was 85 mils. And then we looked at this issue of what we called futility, true futility. And that's a very controversial thing. What is futility, or how do you measure futility? And really, I think, we even had a debate about this as a HERMES group when we were designing the analysis, and we sort of landed on mRS five six. A 90% chance of mRS five six, right? That's quite the bar, right, to say true futility because some people argue mRS four is still not a horrible outcome. Culturally, that is an OK outcome in some situations. But when we did use that five six 90% threshold, it was 132 mils. So, you're getting up to these really large volumes. But here's the catcher in the whole thing, and Koji will probably speak to this a bit more. I don't want to steal his thunder too much, but this issue of reperfusion seemed to matter in this. And we'll come back to that maybe with another question. Reperfusion matters a lot when you think about these thresholds. Dr. Negar Asdaghi:         OK, so, Andrew, a lot of information, I don't know if I need a recap myself to recap, but basically what you mentioned is that for the older patients who received EVT, if we keep our eyes on the outcome of mRS of zero to three, it seems to be the magic core volume for that outcome post-endovascular therapy that it lands on the magic volume of 50 cc core. Did I get that right? Dr. Andrew Demchuk:   That's correct. Dr. Negar Asdaghi:         Then if you're still a bit more lenient with the definitions of what is favorable outcome, what outcomes we're looking at and so on, so forth, for an mRS of five to six, then when we talk about futility of endovascular thrombectomy, the volume that you mentioned, and again I want to ask you this, this volume is for elderly over the age of 75, is 130 mil. Dr. Andrew Demchuk:   132, but yeah, absolutely. But there's a real catcher here, and we need to really emphasize the catcher in this. Dr. Negar Asdaghi:         Okay. I will ask you one more question before I go to Koji, which I'm sure is going to tell us more about that catcher. Andrew, can you please tell us about the factor of time? I feel like that is something that we need to discuss, as well. Your study included patients early on in their stroke onset, but we're talking about an important interaction. The question is, do you think the results of this interaction would be different or impacted by the value of time? Dr. Andrew Demchuk:   Hypothetically? It must, right? I think that that must be the case. We don't have any data specific to this. That would be an interesting Aurora analysis to do. Now, of course, the challenge with late window analysis is, we are really small core in our late window trials, we probably have even a much smaller proportion of large cores. So, to be able to even tackle that question in the late window is, I don't know if we have the data yet, to be honest. But it makes sense that you would expect the thresholds to be a bit lower the later you are in the window. But that is a hypothetical opinion. Dr. Negar Asdaghi:         Right, so, I want to take that and come to Koji. I want to digress a little bit to Koji and see how we can understand the finding of this current analysis of this paper. So, small core patients early on into their onset, we're looking at the interaction between age and their core volume and coming up with numbers 50 cc for the elderly population. If you're looking at the outcome of zero to three or 132, as Andrew pointed out, for an MRS of much higher, four or five. Dr. Andrew Demchuk:   Actually five, six, 90% chance of five, six. So, it's there. It's like almost everybody got five, six, took 132 mils to get there. So, it's like this extreme outcome. Dr. Negar Asdaghi:         Right, so, exactly, and I have to correct it, again, mRS of five or six or dead or almost dead mRS basically. Dr. Andrew Demchuk:   In 90% of patients. Dr. Negar Asdaghi:         90% of patients. So, we have these important numbers here, and I want us to basically understand these numbers in these volumes in the context of the recently published RESCUE-Japan LIMIT study. Can you tell us a little bit about that study and how we can make sense of these volumes in the setting of that paper? Dr. Koji Tanaka:               In the recent RESCUE-Japan LIMIT trial, the median ASPECTS was lower, and baseline ischemic core volume was greater than those in our study. And surprisingly, the median ischemic core volume in that trial was close to our threshold to predict less than 10% of patients achieve a modified Rankin Scale of four or less after endovascular therapy. We thought this is due to much higher complete reperfusion rate in HERMES patient. We have much interest in their additional analysis for outcomes in elderly patients by reperfusion status. This potential benefit of endovascular therapy in the area is promising for the future clinical trials. Dr. Andrew Demchuk:   I think just to add to that, it was actually really interesting, Negar, because when we were analyzing all of this and then the trial came up and it was actually really nice because we're like, OK, how does our data relate to their data? And that's where Table 2 comes in, and it would almost be worth putting on the pod, whatever, I don't know if you have on your podcast website, you have one figure that you can sit there with as you listen to the podcast, because that would be the figure. Dr. Negar Asdaghi:         We'll work on that Andrew, but tell us a little bit more because, really, when I read the trial results, the way I understand it is that people enrolled in RESCUE-Japan that were older than 75, and these are all large core patients, benefited more from endovascular therapy than their younger counterpart. How do I understand that? I don't know how to wrap my head around that finding. Dr. Andrew Demchuk:   You want to try to answer that, and then I'll add? Dr. Koji Tanaka:               As I mentioned previously, we want to know about the exact patient population just only for elderly patients, whether they have a exactly larger ischemic core volume or as well as their functional outcome. How many patients achieved modified Rankin Scale four or less or three or less, or more than five or six? Dr. Andrew Demchuk:   Koji's point's very important. We actually don't have the breakdown of the mRS, so we don't know if they created a lot of fours, or threes, or what. So, that's one issue. But I think that the key to this whole thing is to understand that this is a 2022 trial. HERMES data is essentially a 2015 equivalent where we're looking at a number of clinical trials who roughly ended between 2014, 2016. So, the technology, the technique, the operators, are just at a different level back then than now. And quite frankly, EVT is an improving treatment. We probably don't even fully understand how much, I mean, we're just getting better at it. And I think what's happened here is the reperfusion rates have improved. And our HERMES reperfusion rates, remind me, Koji, I think they're about half, we think, in HERMES, than like the TICI 2bs, threes, are half in HERMES what they got in RESCUE-Japan LIMIT. So, when you achieve successful reperfusion, what were the numbers here? TICI 3 was 43% in the Japan RESCUE LIMIT, and 8.6% in HERMES. Okay, TICI 3s were not ... Now that may be slight differences in core lab interpretation, but we were just starting to get good at 3s. We were getting a lot of 2bs and some 2cs, but we weren't getting a massive number of 3s back in 2015. Well, voilà, now we are, right? We're hitting home runs when we didn't before. And I think that has really shifted the goalposts on the large core. If you open the vessel, they can still do well if they're elderly, but you've got to really open that vessel. And in HERMES, we only did that in a small portion of patients. So, these thresholds are sort of representative of 2015 skill. Dr. Negar Asdaghi:         Golden points, Andrew and Koji, both of you. I want to recap what you mentioned here. A note to all of our audience and listeners that we are looking at an analysis with RESCUE-Japan, an analysis of a 2022 study. And the patient population that were enrolled were also treated much later in terms of time than the patient population that was enrolled in the HERMES collaboration and in all of the trials that contributed to HERMES. So, we've got to remember that EVT is this fluid, ongoing, everyday-improving therapy, from our techniques to everything else, you know, how fast we get patients to the angiosuite. And the point that you raise, I want to repeat that, the percentage or the odds of achieving a perfect reperfusion was, in RESCUE-Japan, was 43% odds of TICI 3 reperfusion, whereas only 8.6%. So, when we're talking about all of these predictive modeling or predictive factors that will tell us who's going to do well, who's not going to do well, it also is predicated on the angiographic success. And perhaps in the earlier trials or even the early study that we covered as part of the STRATIS registry, we put everybody, TICI 3s with TICI 2b or better, whereas nowadays we accept the best, TICI 3s, and maybe that improved percentage in the most recent trial, the RESCUE-Japan, really did what it had to be done for the elderly population to keep that in mind. And Andrew, before we end our interview, I want us to get your top two takeaway messages from this paper. Dr. Andrew Demchuk:   Clearly, elderly patients do better when their strokes are smaller, that we know, compared to younger patients. But it's all about hitting the home run. It's all about hitting the home run. Figure 2C and 2D, you can see that if you achieve that high TICI score, a significant proportion of elderly patients potentially could still benefit, 30–40% reasonable outcomes with bigger cores if you get those high TICI scores. So, it is about hitting the home run in reperfusion in the elderly. You need to go for it, and hopefully you're successful, because if reperfusion isn't successful, then generally the outcomes are not ideal and they certainly worsen as the core volumes become larger, bigger. Dr. Negar Asdaghi:         Before I ended the interview, given Andrew's tremendous experience as a longtime fellowship director and seeing that he was flanked by two of his fellows, one past, myself, and one present, Koji, I had to ask him one final question of what his philosophy is as an educator. Dr. Andrew Demchuk:   I have a sort of philosophy on life with fellows. I always look for the special power in a fellow. I realized a long time ago we're all, we're not perfect, nobody's perfect, I'm not perfect, but there's usually a special power in people, and if you spend the time to get to know them, you identify that special power, and you really help harness it because you know that if they can harness it when they go back to their faculty job, they're going to really contribute something special to their team, right? You can imagine six special powers from six different people in a team. Now you've got a real team, right? If you know what your power is, you know your limitations, but you know where your strengths you can add to the group, and that's what we try to do here when we can. It's not always, you know, special powers, you have to kind of seek them out. But they're there in most people, and that's really important for career down the line. Dr. Negar Asdaghi:         And this concludes our podcast for the December 2022 issue of Stroke. Please be sure to check out this month's table of contents for the full list of publications, including our very interesting Stroke Images series. In this month, we have a case of progressive cervical myelopathy secondary to a dural AV fistula supplied by the anterior inferior cerebellar artery. We also have a separate case of carotid rete mirabile imaged with a four-dimensional flow MRI study. And with these cases, we bring our 2022 Stroke Alert Podcast series to an end. Over the past 12 months, we've ended our podcasts with various inspirational tales. From the moving account of the American runner Steve Prefontaine and the remarkable journey of the Syrian refugee and Olympian swimmer Yusra Mardini, to the discovery of positron and Commander Armstrong's landing on the moon, our podcast stories have but one thing in common, which is the story of human perseverance and consistency in the face of hardship. So, as we end 2022 to start 2023 anew, Andrew's comments on finding that special power in each of us resonate with our resolution to stay alert with Stroke Alert. This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, visit AHAjournals.org.

Presented by 3CHi. Tsutomu Yamaguchi, Mother of All Bombs, Kyushu University, Julius Caesar, Vlad the Impaler, Story of Dinah, The Alaskan Avenger, and more!You can find every episode of this show on Apple Podcasts, Spotify or YouTube. Prime Members can listen ad-free on Amazon Music. For more, visit barstool.link/twistedhistory

Through extensive use of primary resources and fieldwork, Karli Shimizu's book Overseas Shinto Shrines: Religion, Secularity and the Japanese Empire (Bloomsbury, 2022) examines overseas Shinto shrines and their complex role in the colonization and modernization of newly Japanese lands and subjects. Shinto shrines became one of the most visible symbols of Japanese imperialism in the early 20th century. From 1868 to 1945, shrines were constructed by both the government and Japanese migrants across the Asia-Pacific region, from Sakhalin to Taiwan, and from China to the Americas. Drawing on theories about the constructed nature of the modern categories of 'religion' and the 'secular', this book argues that modern Shinto shrines were largely conceived and treated as secular sites within a newly invented Japanese secularism, and that they played an important role in communicating changed conceptions of space, time and ethics in imperial subjects. Providing an example of the invention of a non-Western secularity, this book contributes to our understanding of the relationship between religion, secularism and the construction of the modern state. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Through extensive use of primary resources and fieldwork, Karli Shimizu's book Overseas Shinto Shrines: Religion, Secularity and the Japanese Empire (Bloomsbury, 2022) examines overseas Shinto shrines and their complex role in the colonization and modernization of newly Japanese lands and subjects. Shinto shrines became one of the most visible symbols of Japanese imperialism in the early 20th century. From 1868 to 1945, shrines were constructed by both the government and Japanese migrants across the Asia-Pacific region, from Sakhalin to Taiwan, and from China to the Americas. Drawing on theories about the constructed nature of the modern categories of 'religion' and the 'secular', this book argues that modern Shinto shrines were largely conceived and treated as secular sites within a newly invented Japanese secularism, and that they played an important role in communicating changed conceptions of space, time and ethics in imperial subjects. Providing an example of the invention of a non-Western secularity, this book contributes to our understanding of the relationship between religion, secularism and the construction of the modern state. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/history

Through extensive use of primary resources and fieldwork, Karli Shimizu's book Overseas Shinto Shrines: Religion, Secularity and the Japanese Empire (Bloomsbury, 2022) examines overseas Shinto shrines and their complex role in the colonization and modernization of newly Japanese lands and subjects. Shinto shrines became one of the most visible symbols of Japanese imperialism in the early 20th century. From 1868 to 1945, shrines were constructed by both the government and Japanese migrants across the Asia-Pacific region, from Sakhalin to Taiwan, and from China to the Americas. Drawing on theories about the constructed nature of the modern categories of 'religion' and the 'secular', this book argues that modern Shinto shrines were largely conceived and treated as secular sites within a newly invented Japanese secularism, and that they played an important role in communicating changed conceptions of space, time and ethics in imperial subjects. Providing an example of the invention of a non-Western secularity, this book contributes to our understanding of the relationship between religion, secularism and the construction of the modern state. Raditya Nuradi is a Phd student at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/religion

Often represented as a tradition of ancient origins, Shugendō has retained a quality of mystery and nostalgia in the public imagination and scholars as the “original” champions of mountain asceticism.  In his monograph, A Path Into the Mountains: Shugendō and Mount Togakushi (U Hawaii Press, 2022), Caleb Carter challenges this conceptualization by examining historical documents of Mount Togakushi. By focusing on themes of narratives, institution, and ritual, Carter explores how the transmission of this complex religious system at Togakushi was not a natural phenomenon, but a conscious act by a practitioner from Mount Hiko. Using a variety of textual sources including origin stories (engi) and temple records, Carter demonstrates how the practitioners of Mount Togakushi utilize storytelling, institutional support, and ritual processes to not only provide legitimacy but also establish a foundation for Shugendō at Togakushi. With discussions on Shinto and women's exclusion (nyonin kekkai), staple topics in Japanese religions, A Path Into the Mountains offers something for those interested in not just Shugendō but also Buddhism, mountain religions, and religious history. Raditya Nuradi is a Phd candidate at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/new-books-network

Often represented as a tradition of ancient origins, Shugendō has retained a quality of mystery and nostalgia in the public imagination and scholars as the “original” champions of mountain asceticism.  In his monograph, A Path Into the Mountains: Shugendō and Mount Togakushi (U Hawaii Press, 2022), Caleb Carter challenges this conceptualization by examining historical documents of Mount Togakushi. By focusing on themes of narratives, institution, and ritual, Carter explores how the transmission of this complex religious system at Togakushi was not a natural phenomenon, but a conscious act by a practitioner from Mount Hiko. Using a variety of textual sources including origin stories (engi) and temple records, Carter demonstrates how the practitioners of Mount Togakushi utilize storytelling, institutional support, and ritual processes to not only provide legitimacy but also establish a foundation for Shugendō at Togakushi. With discussions on Shinto and women's exclusion (nyonin kekkai), staple topics in Japanese religions, A Path Into the Mountains offers something for those interested in not just Shugendō but also Buddhism, mountain religions, and religious history. Raditya Nuradi is a Phd candidate at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/history

Often represented as a tradition of ancient origins, Shugendō has retained a quality of mystery and nostalgia in the public imagination and scholars as the “original” champions of mountain asceticism.  In his monograph, A Path Into the Mountains: Shugendō and Mount Togakushi (U Hawaii Press, 2022), Caleb Carter challenges this conceptualization by examining historical documents of Mount Togakushi. By focusing on themes of narratives, institution, and ritual, Carter explores how the transmission of this complex religious system at Togakushi was not a natural phenomenon, but a conscious act by a practitioner from Mount Hiko. Using a variety of textual sources including origin stories (engi) and temple records, Carter demonstrates how the practitioners of Mount Togakushi utilize storytelling, institutional support, and ritual processes to not only provide legitimacy but also establish a foundation for Shugendō at Togakushi. With discussions on Shinto and women's exclusion (nyonin kekkai), staple topics in Japanese religions, A Path Into the Mountains offers something for those interested in not just Shugendō but also Buddhism, mountain religions, and religious history. Raditya Nuradi is a Phd candidate at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/east-asian-studies

Often represented as a tradition of ancient origins, Shugendō has retained a quality of mystery and nostalgia in the public imagination and scholars as the “original” champions of mountain asceticism.  In his monograph, A Path Into the Mountains: Shugendō and Mount Togakushi (U Hawaii Press, 2022), Caleb Carter challenges this conceptualization by examining historical documents of Mount Togakushi. By focusing on themes of narratives, institution, and ritual, Carter explores how the transmission of this complex religious system at Togakushi was not a natural phenomenon, but a conscious act by a practitioner from Mount Hiko. Using a variety of textual sources including origin stories (engi) and temple records, Carter demonstrates how the practitioners of Mount Togakushi utilize storytelling, institutional support, and ritual processes to not only provide legitimacy but also establish a foundation for Shugendō at Togakushi. With discussions on Shinto and women's exclusion (nyonin kekkai), staple topics in Japanese religions, A Path Into the Mountains offers something for those interested in not just Shugendō but also Buddhism, mountain religions, and religious history. Raditya Nuradi is a Phd candidate at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices

Often represented as a tradition of ancient origins, Shugendō has retained a quality of mystery and nostalgia in the public imagination and scholars as the “original” champions of mountain asceticism.  In his monograph, A Path Into the Mountains: Shugendō and Mount Togakushi (U Hawaii Press, 2022), Caleb Carter challenges this conceptualization by examining historical documents of Mount Togakushi. By focusing on themes of narratives, institution, and ritual, Carter explores how the transmission of this complex religious system at Togakushi was not a natural phenomenon, but a conscious act by a practitioner from Mount Hiko. Using a variety of textual sources including origin stories (engi) and temple records, Carter demonstrates how the practitioners of Mount Togakushi utilize storytelling, institutional support, and ritual processes to not only provide legitimacy but also establish a foundation for Shugendō at Togakushi. With discussions on Shinto and women's exclusion (nyonin kekkai), staple topics in Japanese religions, A Path Into the Mountains offers something for those interested in not just Shugendō but also Buddhism, mountain religions, and religious history. Raditya Nuradi is a Phd candidate at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/buddhist-studies

Often represented as a tradition of ancient origins, Shugendō has retained a quality of mystery and nostalgia in the public imagination and scholars as the “original” champions of mountain asceticism.  In his monograph, A Path Into the Mountains: Shugendō and Mount Togakushi (U Hawaii Press, 2022), Caleb Carter challenges this conceptualization by examining historical documents of Mount Togakushi. By focusing on themes of narratives, institution, and ritual, Carter explores how the transmission of this complex religious system at Togakushi was not a natural phenomenon, but a conscious act by a practitioner from Mount Hiko. Using a variety of textual sources including origin stories (engi) and temple records, Carter demonstrates how the practitioners of Mount Togakushi utilize storytelling, institutional support, and ritual processes to not only provide legitimacy but also establish a foundation for Shugendō at Togakushi. With discussions on Shinto and women's exclusion (nyonin kekkai), staple topics in Japanese religions, A Path Into the Mountains offers something for those interested in not just Shugendō but also Buddhism, mountain religions, and religious history. Raditya Nuradi is a Phd candidate at Kyushu University. He works on religion and popular culture, particularly anime pilgrimages. His research explores pilgrims' experiences through space and materiality. Learn more about your ad choices. Visit megaphone.fm/adchoices Support our show by becoming a premium member! https://newbooksnetwork.supportingcast.fm/religion

We are covering one of my favorite subjects this week: Artificial Intelligence! My guest is Nick Romano, Co-Founder & CEO of Deeplite AI. We investigate their new Deeplite Runtime which makes AI models smaller and faster in production deployment, why smart manufacturing is a great application for Deeplite AI, and why ultra-compact quantization is key to making AI smarter, faster, and smaller than ever before. Also this week, I examine "Raw Zero-Shot" – a new AI learning method developed by a team of researchers at Kyushu University that has potential to make AI more robust and reliable in the future.    

The two Mongol-Yuan invasions of Japan (1274 and 1281) were important events in Japanese history. The two typhoons that destroyed the Mongol fleet, known as "divine wind," (shinpū 神風, better known today as kamikaze) would forever be etched into Japanese historical memory, directly influencing the so-called kamikaze suicide bombers of World War II. Most scholarship on the topic has focused primarily on the military aspect, but before and after the invasions there was also an intense diplomatic effort behind the scenes involving the Mongol-Yuan, Kamakura Japan, and Koryŏ Korea in an attempt to integrate Japan peacefully into the Mongol world order. In this episode, Greg speaks to USC PhD candidate Lina Nie about her dissertation research on this diplomatic effort. Lina will share with us some new perspectives on why the Mongols wanted to engage and ultimately invade Japan, what the diplomatic negotiations can tell us about the interstate order of East Asia during that time, and how her research both complements existing scholarship and adds a new layer in our understanding of the Mongol invasions of Japan. Contributors Lina Nie Lina Nie is a Ph.D. candidate in the Department of History at the University of Southern California. She graduated from the Hong Kong University with double majors in Chinese History and Japanese Studies and received her MA from Harvard University. Her research interests are on maritime, diplomatic, military, and cultural exchanges among China, Korea, and Japan. She is also interested in global history and comparative history in a broader geographical context that goes beyond East Asia. Her Japanese article discussing the traditions of Japanese culture won the second runner-up in the annual essay contest held by the Japanese Consulate General in New England in 2017. Greg Sattler Gregory Sattler is a Ph.D. student in the Department of History at the University of California, Los Angeles. His research focuses on sea merchants in East Asia from the ninth to thirteenth centuries, with a particular consideration of their place in society, their trade networks, and their relationships with government officials. Gregory has recently published an article titled “The Ideological Underpinnings of Private Trade in East Asia, ca. 800–1127” (Journal of Asian Humanities at Kyushu University 6) and he is currently working on two additional manuscripts. He has received degrees in Taiwan and Japan, and is a proficient speaker of both Chinese and Japanese. Credits Episode no. 10 Release date: April 3, 2022 Recording location: Los Angeles, CA Transcript Bibliography courtesy of Lina Nie Images Cover Image: The famous battle scene depicting the samurai Takezaki Suenaga escaping the Mongol forces. (Image Source) Map of the two Mongol invasions. (Image Source) A 1266 letter Khubilai sent to Japan. (Image Source) Japanese samurai boarding a Yuan ship during the 1281 invasion. (Image Source) References Andrade, Tonio. The Gunpowder Age: China, Military Innovation, and the Rise of the West in World History. New Jersey: Princeton University Press, 2016. Conlan, Thomas. In Little Need of Divine Intervention: Takezaki Suenaga's Scrolls of the Mongol Invasions of Japan. Ithaca: Cornell University, 2001.  Fukuokashi maizō bunka zai 福岡市埋蔵文化財年報. Ed. Fukuokaken Kyoiku Iinkai福岡県教育委員会, vol. 274, 2019. Kamakura ibun鎌倉遺文. Ed. Takeuchi Rizō竹内理三. Tokyo: Tōkyōdō Shuppan, 2008. Cambridge History of Japan: Medieval Japan (vol. 3), eds. John Hall, Marius Jansen, Madoka Kanai, and Denis Twitchett. Cambridge: Cambridge University, 1990. Kim Gu 金坵. Chipojip 止浦集. Han'guk munjip ch'onggan 韓國文集叢刊. Seoul: Minjok Munhwa Ch'ujinhoe, 1991. Kuraki kaitei iseki hakkutsu chōsa gaihō 倉木崎海底遺跡発掘調査概報. Ed. Ukenson Kyoiku Iinkai宇検村教育委員会. 1993. Mass, Jeffery. Yoritomo and the Founding of the Kamakura Bakufu. Stanford: Stanford University Press 1995. Robinson, David. Empire's Twilight: Northeast Asia Under the Mongols. Cambridge, MA: Harvard Yenching Monograph, 2009. Cambridge History of China vol.6: Alien Regimes and Border States, eds. Herbert Franke and Denis Twitchett. Cambridge: Cambridge University, 1994. Rossabi, Morris. Khubilai Khan: His Life and Times. Berkeley: University of California Press, 2009. Shultz, Edward. Generals and Scholars: Military Rule in Medieval Korea. Honolulu: University of Hwaii Press. 2000. Wang, Sixiang. “What Tang Taizong Could Not Do: The Korean Surrender of 1259 and the Imperial Tradition.” T'oung Pao (2018), pp.338-383. Yamauchi Shinji 山内晋次. Nichisō bōeki to iō no michi 日宋貿易と「硫黄の道」.Tokyo: Yamakawa Shuppansha, 2009.