The potential hazard of a non-slip element balloon causing distal longitudinal stent deformation: the first clinical experience and in vitro assessment

Background: A new complication, longitudinal stent deformation (LSD), is increasingly reported withrecent intracoronary stent designs. There have been experiences of unusual cases of distal LSD causedby entrapment of a Lacrosse® non-slip element (NSE) balloon (Goodman Co., Ltd., Nagoya, Japan),which has three flexible nylon elements to prevent slippage. Accordingly, the aim of this study is to reportthe clinical experience of distal LSD caused by the NSE in the documented center and to investigate theincidence and mechanisms involved.Methods: Coronary intervention cases were retrospectively reviewed using the NSE balloon in hospitalbetween May 2014 and June 2017. In bench testing, distal LSD was reproduced in a silicon tube modelto identify its mechanism.Results: A total of 95 patients with 107 lesions underwent coronary interventions with NSE. Of these,72 lesions (12 de-novo lesions and 60 in-stent restenosis) were treated using in-stent dilatation. Twodistal LSD cases occurred, representing an incidence of 2.78% (2/72) among all procedures; 16.7%(2/12) of the de-novo lesions developed LSD. In vitro experimentation allowed indentification of themechanisms involved and bailout strategies.Conclusions: This is the first study to evaluate NSE balloon catheter entrapment complicated by distalLSD in which reconstruction of the deformed stent and retrieval of the NSE could be achieved successfully.There is a potential hazard for distal LSD during post-dilatation using the NSE balloon due to itsstructural characteristics. Careful assessment is needed to prevent this complication

心不全を合併した心房細動患者のカテーテルアブレーション後の長期予後 : 左室駆出率に基づいた心不全のサブタイプ間における比較

Aims: Heart failure (HF) prognosis has been reported similar in patients with preserved vs. reduced left ventricular ejection fraction (LVEF). This study compared the long-term prognosis of HF patients undergoing radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF). Methods and results: Among 5010 patients undergoing RFCA in Kansai Plus AF registry, 656 patients (13.1%) with a documented history of HF were enrolled in the study before RFCA. The primary endpoint was a composite of all-cause death, HF hospitalization, and stroke or systemic embolism. Patients with reduced (<40%), mid-range (40-49%), and preserved (≥50%) LVEF were 98 (14.9%), 107 (16.3%), and 451 (68.8%) patients, respectively. The prevalence of ischaemic heart disease and cardiomyopathies was higher among patients with reduced as compared with preserved LVEF (27.6% vs. 10.0%, P < 0.05 and 36.7% vs. 15.3%, P < 0.05, respectively). The median follow-up period was 2.9 years. The 3-year cumulative risk for the primary endpoint was higher in patients with reduced LVEF (32.7%) compared to those with mid-range (11.7%) or preserved (11.6%) LVEF (P < 0.001). Reduced LVEF was the most significant independent risk factor for primary endpoint (hazard ratio, 2.83; 95% confidence interval 1.74-4.61, P < 0.001). The 3-year arrhythmia recurrence rate was similar among the groups (48.2%, 42.8%, and 47.3%, respectively, P = 0.75). Conclusion : This study raises hypothesis that patients with HFrEF and AF had approximately three times higher risk for a composite of all-cause death, HF hospitalization, and stroke or systemic embolism after AF ablation compared with patients with HFmrEF or HFpEF.博士（医学）・甲第802号・令和3年12月21日Copyright: © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021.This is a pre-copyedited, author-produced version of an article accepted for publication in Europace following peer review. The version of record "Europace Online ahead of print (2021 Aug 31;euab201) is available online at: https://doi.org/10.1093/europace/euab201.発行元が定める登録猶予期間終了の後、本文を登録予定（2022.08

Ectopic fat accumulation and distant organ-specific insulin resistance in Japanese people with nonalcoholic fatty liver disease

Objective: The aim of this study was to examine the association between ectopic fat and organ-specific insulin resistance (IR) in insulin-target organs in patients with nonalcoholic fatty liver disease (NAFLD). Methods: Organ-specific IR in the liver (hepatic glucose production (HGP)6fasting plasma insulin (FPI) and suppression of HGP by insulin [%HGP]), skeletal muscle (insulin-stimulated glucose disposal [Rd]), and adipose tissue (suppression of FFA by insulin [%FFA]) was measured in 69 patients with NAFLD using a euglycemic hyperinsulinemic clamp with tracer infusion ([6,6-2H2]glucose). Liver fat, intramyocellular lipid (IMCL), and body composition were measured by liver biopsy, proton magnetic resonance spectroscopy, and bioelectrical impedance analysis, respectively

Kansainvälinen opiskelija – kuka olet, minne menet?

Kansainvälisten opiskelijoiden määrä Suomessa on lisääntynyt nopeasti lyhyessä ajassa. Globaalien työelämän ja liikkuvuuden muutosten sekä opiskelijoiden määrällisen kasvun myötä joukko moninaistuu entisestään. Suomeen tullaan monenlaisin kieli-, kulttuuri- ja koulutustaustoin, eikä opiskelijan polku korkeakouluopintojen jälkeen ole kiveen hakattu: jäädä vai lähteä? Tässä artikkelissa tarkastellaan kansainvälisen opiskelijan käsitettä ja muutaman kansainvälisen opiskelijan ajatuksia opiskelusta ja tulevaisuudesta Suomessa. Artikkeli pohjautuu keväällä 2016 julkaistuun selvitykseen (Saarinen, Vaarala, Haapakangas & Kyckling 2016).nonPeerReviewe

A type 2 ryanodine receptor variant associated with reduced Ca2+ release and short-coupled torsades de pointes ventricular arrhythmia

BackgroundVentricular fibrillation may be caused by premature ventricular contractions (PVCs) whose coupling intervals are <300 ms, a characteristic of the short-coupled variant of torsades de pointes (scTdP).ObjectiveThe purpose of this study was to analyze the underlying cardiac ryanodine receptor (RyR2) variants in patients with scTdP.MethodsSeven patients with scTdP (mean age 34 ± 12 years; 4 men and 3 women) were enrolled in this study. The RyR2 gene was screened by targeted gene sequencing methods; variant minor allele frequency was confirmed in 3 databases; and the pathogenicity was investigated in silico analysis using multiple tools. The activity of wild-type and mutant RyR2 channels was evaluated by monitoring Ca2+ signals of HEK293 cells with a [3H]ryanodine binding assay.ResultsThe mean coupling interval of PVCs was 282 ± 13 ms. The 12-lead electrocardiogram had no specific findings except PVCs with an extremely short-coupling interval. Genetic analysis revealed 3 novel RyR2 variants and 1 polymorphism, all located in the cytoplasmic region. p.Ser4938Phe was not detected in 3 databases, and in silico analysis indicated its pathogenicity. In functional analysis, p.Ser4938Phe demonstrated loss of function and impaired RyR2 channel Ca2+ release, while 2 other variants, p.Val1024Ile and p.Ala2673Val, had mild gain-of-function effects but were similar to the polymorphism p.Asn1551Ser.ConclusionWe identified an RyR2 variant associated with reduced Ca2+ release and short-coupled torsades de pointes ventricular arrhythmia. The mechanisms of arrhythmogenesis remain unclear

Univariate correlation between ectopic fat and organ-specific insulin resistance.

<p>HGP, hepatic glucose production; FPI, fasting plasma insulin; SSPI, steady state plasma insulin; IHL, intrahepatic lipid; IMCL, intramyocellular lipid; VO₂, basal oxygen consumption rate per body weight.</p>a<p><i>P</i><0.05,</p>b<p><i>P</i><0.01,</p>c<p><i>P</i><0.001.</p