Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease

AimsLimited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH.MethodsThis retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death.ResultsThe 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45–13.73; P = .009).ConclusionsThe IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered

Development of Common Mode Choke Coil Made of New Nanocrystalline Soft Magnetic Alloy "NANOPERM^[○!R]"

We have developed the common mode choke coils made of a kind of new nanocrystalline soft magnetic Fe-M-B (M=Zr, Nb, Hf) based alloys, "NANOPERM^[○!R], " with high saturation magnetic flux density above 1.5 T as well as excellent soft magnetic properties. The very low remanence ratio, which is necessary to obtain good pulse voltage attenuation characteristics of the common mode choke coils, has been obtained by annealing treatment in a static transverse magnetic field. Insertion loss and the pulse voltage attenuation characteristics of the NANOPERM^[○!R] common mode choke coil have been found to be superior to those of the choke coil made of MnZn-ferrite. Furthermore, the NANOPERM^[○!R] common mode choke coil exhibits stable inductance characteristics against temperature change. It can be concluded that NANOPERM^[○!R] is suitable for a core material of the common mode choke coils

Hand-Assisted Retroperitoneoscopic Nephroureterectomy

Summary. In laparoscopic operations for upper urinary tract transitional cell carcinoma (TCC), three kinds of approach, the transperitoneal, retroperitoneal, and hand-assisted transperitoneal, have been reported. We have performed hand-assisted retroperitoneoscopic nephroureterectomy (HALS) since 2000. The surgical techniques and the operative results of 61 cases of HALS are described and analyzed. These procedures were effective and safe for upper urinary tract TCC