PLASMA CELL INFILTRATION AND MUCOID DEGENERATION IN THE MEDIA OF ASCENDING AORTA IN PATIENT WITH CORONARY ARTERY DISEASE

Aims Atherosclerosis results in inflammatory changes in the aortic intima， but little is known regarding medial changes. Atherosclerosis of the ascending aorta coexists with coronary artery disease. The aim of this study was to investigate the atherosclerotic changes in 44 biopsy specimens of media of the ascending aorta associated with coronary artery disease. Plasma cells do not appear in non-inflammatory tissue. Methods We compared plasma cells，and matrix metalloproteinase (MMP)-2-，-9- and -12-positive cells immunohistochemically，and we also compared mucoid degeneration and fibrosis determined by staining using a point-counting method，for groups with a variable number of coronary stenotic (≧75%)lesions. Results In patients with one to three coronary stenotic lesions，plasma cells and mucoid degeneration were low in the aortic media. With four to five lesions，bo th plasma cells and mucoid degeneration increased significantly compared with those in the group with one to three lesions，and MMP-12-positive cells significantly decreased. In patients with six to nine lesions，the number of plasma cells was significantly lower than in patients with four or five lesions，whereas mucoid degeneration significantly increased. There was no change in fibrosis. Conclusions These findings may help us to better understand and treat atherosclerosis

Epicardial Microwave Application in Chronic Atrial Fibrillation Surgery

The search for alternative epicardial energy sources in the treatment of nonvalvular atrial fibrillation (AF) is a relatively new aspect of the evolving spectrum of Maze operations. We tested the hypothesis that epicardial microwave ablation produces identical results to those of the standard cryosurgical Maze. Fourteen consecutive patients with chronic AF underwent on-pump epicardial Maze procedures after routine cardiac surgery. The results were compared with those of 14 control patients selected from our Maze database of 280 patients. There were no differences in age, sex, cardiothoracic ratio, duration of AF, pump time, intensive care unit or hospital stays. The aortic cross clamp time with epicardial microwave was, however, shortened from 110 to 65 minutes (p=0.011). The recurrence rate of AF after discharge showed no significant difference between the two groups (14% vs. 15%, p=0.841). Epicardial microwave ablation might be a valuable alternative to the conventional cryosurgical Maze procedure, especially for those patients without associated mitral valve disease

Reduction in cardiovascular disease events in patients with type 2 diabetes mellitus treated with a sodium–glucose cotransporter 2 inhibitor versus a dipeptidyl peptidase-4 inhibitor: A real-world retrospective administrative database analysis in Japan

AIMS/INTRODUCTION: To evaluate the benefit of sodium–glucose cotransporter 2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP4i) in reducing cardiovascular disease (CVD) events in patients with type 2 diabetes mellitus with and without a CVD history.MATERIALS AND METHODS: This retrospective cohort study used Japanese hospital administrative data from the Medical Data Vision database (January 2015 to April 2020). Patients with type 2 diabetes mellitus (n=625,739) who were new users of an SGLT2i (n=57,070; 9.1%) or DPP4i (n=568,669; 90.9%) were included. Outcomes included hospitalization for heart failure (hHF), all-cause death (ACD) and the composite of hHF or ACD. Hazard ratios (HR) were calculated using the inverse probability weighting Cox proportional hazards model to compare CVD event risks between treatment groups.RESULTS: Compared with DPP4i, SGLT2i was associated with a significant reduction in hHF risk among patients without a CVD history (HR 0.507, 95% confidence interval 0.283–0.907), but not in the full cohort or those with a CVD history. SGLT2i was associated with a significant risk reduction of ACD (HR 0.592, 95% confidence interval 0.481–0.729) and the composite of hHF or ACD (HR 0.712, 95% confidence interval 0.613–0.826), compared with DPP4i in the full cohort; similar results were observed among patients with and without a CVD history.CONCLUSION: In this real-world study, SGLT2i versus DPP4i was associated with a significant reduction in hHF, ACD and hHF or ACD events in patients with type 2 diabetes mellitus without a CVD history

Hiroshima: a catástrofe atômica e suas testemunhas

Ao longo das duas Guerras Mundiais, observou-se o rompimento da humanidade com as normas de conduta inauguradas pelo Iluminismo, legitimando a violência como algo intrínseco à sociedade moderna. Essa mudança de valores foi acompanhada pelo crescente investimento científico e tecnológico, que atingiu um elevado desenvolvimento durante o século XX e trouxe, como um de seus resultados, os maiores genocídios realizados pelos Estados autoritários em nome de seus interesses políticos e econômicos. A barbárie nos leva a considerar um elemento para a reflexão: as testemunhas. Essas corporificam a necessidade de um resgate da humanização, da retomada dos valores morais perdidos com a banalização da violência. Assim, o testemunho confronta a história e demonstra que o desenvolvimento tecnológico não é sinônimo de desenvolvimento humano. Pelo contrário, permite questionar a verdadeira intenção das nações que, em busca de hegemonia, destroem maciçamente populações inteiras. Nesse contexto, emergem as seguintes questões: o que é o testemunho e qual a sua importância para a sociedade moderna? O que levou, historicamente, ao surgimento das testemunhas? Qual o contexto histórico que proporcionou o desenvolvimento da bomba atômica? Por que houve a necessidade, por parte das nações em guerra, de exterminarem milhares de pessoas, principalmente civis? Qual a consequência do rompimento das normas de civilidade pelas duas Guerras Mundiais? Para responder a essas perguntas, investigou-se o Museu Memorial da Paz de Hiroshima no que diz respeito à sua exposição permanente, seus objetivos no que se refere à luta contra o esquecimento da catástrofe atômica e à coleta de testemunhos. Após esse primeiro momento da pesquisa, procedeu-se ao estudo do contexto histórico que culminou nas atrocidades cometidas ao longo das duas Grandes Guerras, os resultados dos extermínios em massa para a sociedade moderna e, finalmente, o estudo sobre o trauma e o testemunho em relação aos sobreviventes do bombardeio atômico de Hiroshima

Usefulness of medium-Energy Collimator for Sentinel Node Lymphoscintigraphy Imaging in Breast Cancer Patients

金沢大学大学院医学系研究科小野口, 昌久This study was performed to investigate the usefulness of a general-purpose medium-energy (ME) collimator for the accurate localization of the sentinel lymph node (SLN) in breast cancer patients. Methods: We compared phantom images and lymphoscintigraphy images obtained under different conditions for a patient with breast cancer. Comparisons were performed between 2 cameras, between a low-energy high-resolution (LEHR) collimator and a general-purpose ME collimator, and between energy windows centered at 141 keV and at 146 keV. Profile curves and image contrast were evaluated along with the visual interpretation of images. The most suitable imaging time was selected from the relationship between contrast and the data acquisition time. Results: The images obtained with the general-purpose ME collimator and the energy window centered at 141 keV were of poorer quality than those obtained with the LEHR collimator and the same energy window. However, the quality of the images obtained with the general-purpose ME collimator improved when the energy window was centered at 146 keV. The method involving the general-purpose ME collimator and the energy window centered at 146 keV showed excellent image quality similar to that obtained with the LEHR collimator. The enhancement of contrast was confirmed at more than 3 cm away from the center of the injection site. Stable contrast was obtained with a data acquisition time of 5 min, with the general-purpose ME collimator, and with the energy window centered at 146 keV. Conclusion: The method involving the general-purpose ME collimator and the energy window centered at 146 keV has the merit of the lymph node not being concealed by a lead shield. This new method is expected to improve the rate of detection of SLN and has the potential for shortening the acquisition time

Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

金沢大学大学院医学系研究科先端医療技術学Objective: To evaluate the advantage of upright position imaging with a medium-energy collimator for the detection of sentinel lymph node (SLN). Methods: Thirty-four patients with operable breast cancer underwent sentinel node lymphoscintigraphy with 99mTc-tin colloid. Images were obtained in 5 different positions and paired images from the same patient were compared using side-by-side interpretation. Images were compared in 3 groups: group 1 (anterior view); supine (SAV) vs. upright (UAV), group 2 (oblique view); supine (SOV) vs. upright (UOV), and group 3 (oblique view); modified supine (MOV) vs. UOV. Image quality was evaluated using a 3-grade scale of clear, faint, and equivocal depiction, and correlated to 3 parameters: distance from injection site to lymph node (hot node), counts in hot node, and image contrast. Parameters in group 1 were compared by classifying the primary tumor site into 4 subregions. Results: Image quality in all 3 groups was more enhanced on the image obtained in the upright position than that in the supine position. Obtaining images in an upright position increased the mean distances by 1.5-3.2 cm, and mean contrasts were significantly increased by 0.13-0.31 (p < 0.05). It was shown that image quality was more greatly affected by image contrast than by counts in the hot node. Image contrast of 0.5 seemed an appropriate threshold level for detection of the hot node. On comparison of tumor sites, the upper outer quadrant (C) region of the 4 subregions demonstrated greater contrast enhancement on upright position images. Conclusion: Clinical images obtained in an upright position with a medium-energy collimator were superior to those obtained in a supine position. Use of this procedure is recommended to enhance lymph node detection on sentinel node lymphoscintigraphy

First measurement of ν¯μ and νμ charged-current inclusive interactions on water using a nuclear emulsion detector

精密測定により素粒子ニュートリノの謎の解明を目指すNINJA実験の物理解析が開始. 京都大学プレスリリース. 2020-10-21.This paper reports the track multiplicity and kinematics of muons, charged pions, and protons from charged-current inclusive ¯νμ and νμ interactions on a water target, measured using a nuclear emulsion detector in the NINJA experiment. A 3-kg water target was exposed to the T2K antineutrino-enhanced beam corresponding to 7.1×1020 protons on target with a mean energy of 1.3 GeV. Owing to the high granularity of the nuclear emulsion, protons with momenta down to 200  MeV/c from the neutrino-water interactions were detected. We find good agreement between the observed data and model predictions for all kinematic distributions other than the number of charged pions and the muon kinematics shapes. These results demonstrate the capability of measurements with nuclear emulsion to improve neutrino interaction models