The Results of a New Distal Protection Method in Intervention for Chronic Total Occlusion of the Superficial Femoral Artery

Aims. To determine the efficacy of a new distal protection method in SFA CTO interventions. Methods and Results. From June 2003 to February 2009, ninety-two consecutive, chronic total occlusions of superficial femoral arteries were treated with catheter-based intervention using a bidirectional approach. Nine of these cases were managed with our original, distal protection method, based on symptoms, angiographic images, wire resistance, and intravascular ultrasound images. The average age was 73 years; eight patients were male. The mean occlusion length was 17.1 cm. A distal protection balloon was inserted from the retrograde sheath in the popliteal artery and placed distal to the occluded lesion after successful wire crossing. Lesion dilatation with a balloon was performed antegradely and debris was removed by 6Fr. guiding catheter. Debris was retrieved from all lesions, consisting mainly of thrombus. Where we decided not to use the distal protection method, there was no distal thromboembolism. Conclusion. In SFA-CTO intervention, the risk of distal embolization is 10%, which can be anticipated and eliminated by the distal protection method

Przezskórna ablacja opornego na farmakologiczne leczenie ustawicznego migotania komór w przebiegu ostrego incydentu wieńcowego

Mężczyznę w wieku 77 lat przyjęto do szpitala z powodu ostrego incydentu wieńcowego, ciężkiej niewydolności serca oraz nawracających epizodów migotania komór. Pojedyncze przedwczesne skurcze komorowe wywoływały częstoskurcz komorowy, który powtarzalnie przechodził w migotanie komór. W wyniku zastosowania ablacji tylno-przegrodowej części lewej komory, gdzie poprzednio rejestrowano podwójne potencjały pochodzące z włókien Purkinjego, wyeliminowano dodatkowe przedwczesne skurcze komorowe. Po zabiegu ustąpiły objawy „burzy elektrycznej” serca, a podczas wykonywanej po ablacji programowanej stymulacji komór nie wywołano żadnej tachyarytmii. Dodatkowe przedwczesne skurcze komorowe stały się mechanizmem wyzwalającym, a zarazem również substratem dla powstania częstoskurczu komorowego oraz migotania komór w przebiegu ostrego incydentu wieńcowego współistniejącego z niewydolnością serca. (Folia Cardiologica Excerpta 2006; 1: 492-496

Translocator protein imaging with 18F-FEDAC-positron emission tomography in rabbit atherosclerosis and its presence in human coronary vulnerable plaques

Background and aims: This study aimed to investigate whether N-benzyl-N-methyl-2-[7,8-dihydro-7-(2-[18F]fluoroethyl)-8-oxo-2-phenyl-9H-purin-9-yl]acetamide (18F-FEDAC), a probe for translocator protein (TSPO), can visualize atherosclerotic lesions in rabbits and whether TSPO is localized in human coronary plaques.Methods: 18F-FEDAC-PET of a rabbit model of atherosclerosis induced by a 0.5% cholesterol diet and ballooninjury of the left carotid artery (n = 7) was performed eight weeks after the injury. The autoradiography intensity of 18F-FEDAC in carotid artery tissue sections was measured, and TSPO expression was evaluated immunohistochemically.TSPO expression was examined in human coronary arteries obtained from autopsy cases (n = 16), and in human coronary plaques (n = 12) aspirated from patients with acute myocardial infarction (AMI).Results: 18F-FEDAC-PET visualized the atherosclerotic lesions in rabbits as high-uptake areas, and the standard uptake value was higher in injured arteries (0.574 ± 0.24) than in uninjured arteries (0.277 ± 0.13, p < 0.05) or myocardium (0.189 ± 0.07, p < 0.05). Immunostaining showed more macrophages and more TSPO expression in atherosclerotic lesions than in uninjured arteries. TSPO was localized in macrophages, and arterial autoradiography intensity was positively correlated with macrophage concentration (r = 0.64) and TSPO (r = 0.67). TSPO expression in human coronary arteries was higher in AMI cases than in non-cardiac death, or in the vulnerable plaques than in early or stable lesions, respectively. TSPO was localized in macrophages in all aspirated coronary plaques with thrombi.Conclusions: 18F-FEDAC-PET can visualize atherosclerotic lesions, and TSPO-expression may be a marker of highrisk coronary plaques

Development of a Laboratory Risk-Score Model to Predict One-Year Mortality in Acute Myocardial Infarction Survivors

The high post-discharge mortality rate of acute myocardial infarction (AMI) survivors is concerning, indicating a need for reliable, easy-to-use risk prediction tools. We aimed to examine if a combined pre-procedural blood testing risk model predicts one-year mortality in AMI survivors. Overall, 1355 consecutive AMI patients who received primary coronary revascularization were divided into derivation (n = 949) and validation (n = 406) cohorts. A risk-score model of parameters from pre-procedural routine blood testing on admission was generated. In the derivation cohort, multivariable analysis demonstrated that hemoglobin &lt; 11 g/dL (odds ratio (OR) 4.01), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (OR 3.75), albumin &lt; 3.8 mg/dL (OR 3.37), and high-sensitivity troponin I &gt; 2560 ng/L (OR 3.78) were significantly associated with one-year mortality after discharge. An increased risk score, assigned from 0 to 4 points according to the counts of selected variables, was significantly associated with higher one-year mortality in both cohorts (p &lt; 0.001). Receiver-operating characteristics curve analyses of risk models demonstrated adequate discrimination between patients with and without one-year death (area under the curve (95% confidence interval) 0.850 (0.756&ndash;0.912) in the derivation cohort; 0.820 (0.664&ndash;0.913) in the validation cohort). Our laboratory risk-score model can be useful for predicting one-year mortality in AMI survivors

Utility of Computed Tomographic Enteroclysis/Enterography for the Assessment of Mucosal Healing in Crohn's Disease

Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD) precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE) with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE. Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens. Results. According to the CTE findings, patients were determined to be in the active CD group (n=31) or inactive CD group (n=8). The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P<0.0001), whereas mucosal healing was found in 62.5% of inactive group patients but in only 3.2% of active group patients (P<0.0001). Conclusion. CTE appeared to be a useful diagnostic method for assessment of mucosal healing in Crohn's disease

Development of a cloud particle sensor for radiosonde sounding

A meteorological balloon-borne cloud sensor called the cloud particle sensor (CPS) has been developed.The CPS is equipped with a diode laser at 790 nm and two photodetectors, with a polarization plate in front of one of the detectors, to count the number of particles per second and to obtain the cloud-phase information (i.e. liquid, ice, or mixed). The lower detection limit for particle size was evaluated in laboratory experiments as 2 μm diameter for water droplets. For the current model the output voltage often saturates for water droplets with diameter equal to or greater than 80 μm. The upper limit of the directly measured particle number concentration is ～2 cm⁻³ (2×10³ L⁻¹/, which is determined by the volume of the detection area of the instrument. In a cloud layer with a number concentration higher than this value, particle signal overlap and multiple scattering of light occur within the detection area, resulting in a counting loss, though a partial correction may be possible using the particle signal width data. The CPS is currently interfaced with either a Meisei RS-06G radiosonde or a Meisei RS-11G radiosonde that measures vertical profiles of temperature, relative humidity, height, pressure, and horizontal winds. Twenty-five test flights have been made between 2012 and 2015 at midlatitude and tropical sites. In this paper, results from four flights are discussed in detail. A simultaneous flight of two CPSs with different instrumental configurations confirmed the robustness of the technique. At a midlatitude site, a profile containing, from low to high altitude, water clouds, mixed-phase clouds, and ice clouds was successfully obtained. In the tropics, vertically thick cloud layers in the middle to upper troposphere and vertically thin cirrus layers in the upper troposphere were successfully detected in two separate flights. The data quality is much better at night, dusk, and dawn than during the daytime because strong sunlight affects the measurements of scattered light

Serum uric acid is associated with left ventricular hypertrophy independent of serum parathyroid hormone in male cardiac patients.

BACKGROUND: Several studies have shown that serum uric acid (UA) is associated with left ventricular (LV) hypertrophy. Serum levels of parathyroid hormone (PTH), which has bbe shown to be correlated with UA, is also known to be associated with cardiac hypertrophy; however, whether the association between UA and cardiac hypertrophy is independent of PTH remains unknown. PURPOSE: We investigated whether the relationship between serum uric acid (UA) and LV hypertrophy is independent of intact PTH and other calcium-phosphate metabolism-related factors in cardiac patients. METHODS AND RESULTS: In a retrospective study, the association between UA and left ventricular mass index was assessed among 116 male cardiac patients (mean age 65 ± 12 years) who were not taking UA lowering drugs. The median UA value was 5.9 mg/dL. Neither age nor body mass index differed significantly among the UA quartile groups. Patients with higher UA levels were more likely to be taking loop diuretics. UA showed a significant correlation with intact PTH (R = 0.34, P<0.001) but not with other calcium-phosphate metabolism-related factors. Linear regression analysis showed that log-transformed UA showed a significant association with left ventricular mass index, and this relationship was found to be significant exclusively in patients who were not taking loop and/or thiazide diuretics. Multivariate logistic regression analysis showed that log-transformed UA was independently associated with LV hypertrophy with an odds ratio of 2.79 (95% confidence interval 1.48-5.28, P = 0.002 per one standard deviation increase). CONCLUSIONS: Among cardiac patients, serum UA was associated with LV hypertrophy, and this relationship was, at least in part, independent of intact PTH levels, which showed a significant correlation with UA in the same population

A Novel Predictive Model for In-Hospital Mortality Based on a Combination of Multiple Blood Variables in Patients with ST-Segment-Elevation Myocardial Infarction

In emergency clinical settings, it may be beneficial to use rapidly measured objective variables for the risk assessment for patient outcome. This study sought to develop an easy-to-measure and objective risk-score prediction model for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 1027 consecutive STEMI patients were recruited and divided into derivation (n = 669) and validation (n = 358) cohorts. A risk-score model was created based on the combination of blood test parameters obtained immediately after admission. In the derivation cohort, multivariate analysis showed that the following 5 variables were significantly associated with in-hospital death: estimated glomerular filtration rate &lt;45 mL/min/1.73 m2, platelet count &lt;15 &times; 104/&mu;L, albumin &le;3.5 g/dL, high-sensitivity troponin I &gt;1.6 ng/mL, and blood sugar &ge;200 mg/dL. The risk score was weighted for those variables according to their odds ratios. An incremental change in the scores was significantly associated with elevated in-hospital mortality (p &lt; 0.001). Receiver operating characteristic curve analysis showed adequate discrimination between patients with and without in-hospital death (derivation cohort: area under the curve (AUC) 0.853; validation cohort: AUC 0.879), and there was no significant difference in the AUC values between the laboratory-based and Global Registry of Acute Coronary Events (GRACE) score (p = 0.721). Thus, our laboratory-based model might be helpful in objectively and accurately predicting in-hospital mortality in STEMI patients