Head-up Tilt Test May Be Useful for Determining Permission of Flight for Regular Passenger Aircraft Pilots with Vasovagal Syncope

To determine the permissibility of piloting an aircraft with vasovagal syncope （VVS） is a complex responsibility, because it is difficult to evaluate VVS quantitatively. There are no clear guidelines for aircraft pilots with VVS. In some facilities, Head-up Tilt Test （HUTT） is used to determine its reproducibility and treatment effect. In most cases, permission is dependent on the strict examinations by specialists and judgement of the committee established for each country. Therefore, we assessed pilots with VVS and designed an algorism of permission for piloting an aircraft. Here, we describe 7 consecutive regular passenger aircraft pilots with VVS who were restricted to fly. All patients were men and their mean age was 37 years. All pilots were permitted to fly after at least two or more tilt-tests. The observation period was two years after flight permission. None of the pilots in the present study fainted after receiving flight permission. We can make a risk stratification to determine hypotensive susceptibility by multiple tilt tests. Based on the results of multiple HUTT, we can more quantitatively make the judgement as to whether the pilot’s VVS is well managed

Recurrence of Atrial Fibrillation within Three Months after Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation : Analysis Using an External Loop Recorder with Auto-trigger Function

Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective option for patients with symptomatic paroxysmal atrial brillation (AF). The recurrence of AF within 3 months after PVI is not considered a failure of the ablation procedure because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with auto-trigger function (ELR-AUTO) to detect AF following PVI to characterize early recurrence and determine the implication of AF within 3 months after PVI. The study included 53 consecutive patients with symptomatic paroxysmal AF (age, 61.6 ± 12.6 years ; 77％ male) who underwent PVI, and were fitted with an ELR-AUTO for 7 ± 2 days within 3 months after PVI. Of the 33 patients(62.2％) who did not have AF within the 3-month period, only 1 patient had AF recurrence at 12 months. Seven of 20 patients (35％) who experienced AF within 3 months had symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence was 87.5％, 71.1％, 35.0％, and 96.9％, respectively. Thus, AF recurrence detected by ELR-AUTO within 3 months after PVI can predict late AF recurrence. Freedom from AF in the firrst 3 months following ablation significantly predicts long-term freedom from AF. An ELR-AUTO is useful for detecting symptomatic and asymptomatic AF

ムシゲキセイ カプサイシン ルイジ コウゾウ ブッシツ カプシエイト ノ セイリ サヨウ ニ カンスル ケンキュウ

京都大学0048新制・課程博士博士(農学)甲第9598号農博第1226号新制||農||840(附属図書館)学位論文||H14||N3630(農学部図書室)UT51-2002-G356京都大学大学院農学研究科応用生物科学専攻(主査)教授 伏木 亨, 教授 小川 正, 教授 大東 肇学位規則第4条第1項該当Doctor of Agricultural ScienceKyoto UniversityDA

Multilamellar Structures Induced by Hydrophilic and Hydrophobic Ions Added to a Binary Mixture of D2O and 3-Methylpyridine

A phase transition is observed between a one-phase disordered phase and an ordered phase with multilamellar (onion) structures in an off-critical mixture of D2O and 3-methylpyridine (3MP) containing 85 mM of a salt in the absence of a surfactant. The salt consists of hydrophilic cations and hydrophobic anions that interact asymmetrically with the solvent composition fluctuations inducing mesophases. The structure factor of the composition distribution obtained from small-angle neutron scattering has a peak at an intermediate wave number in the disordered phase and multiple peaks in the ordered phase. Lamellar layers forming onions are composed of solvation-induced charged membranes swollen by D2O. The onion phase is realized only for small volume fractions of 3MP (in D2O-rich solvent)

Multilamellar Structures Induced by Hydrophilic and Hydrophobic Ions Added to a Binary Mixture of D2O and 3-Methylpyridine

Phase transition is observed between one-phase disordered phase and an ordered phase with multi-lamellar (onion) structures in an off-critical mixture of D$_2$O and 3-methylpyridine (3MP) containing a salt at 85mM. The salt consists of hydrophilic cations and hydrophobic anions, which interact asymmetrically with the solvent composition fluctuations inducing mesophases. The structure factor of the composition distribution obtained from small-angle neutron scattering has a peak at an intermediate wave number in the disordered phase and multiple peaks in the ordered phase. Lamellar layers forming onions are composed of solvation-induced charged membranes swollen by D$_2$O. The onion phase is realized only for small volume fractions of 3MP (in D$_2$O-rich solvent).Comment: 4 pages, 4 figure

Usefulness of Intracardiac Local Ventricular Electrogram to Predict Responders in Patients Undergoing Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) is a well-established, efficient strategy for medically-refractory congestive heart failure (HF) with ventricular conduction disturbances. However, about 30% of patients who undergo CRT do not receive any benefit. Therefore, we investigated the usefulness of the QRS-left ventricle (LV) interval for predicting responders during CRT implantation. This study included 66 patients who underwent CRT implantation. The definition of responder was a ≥15% reduction in LV end-systolic volume or ≥20% increase in LV ejection fraction. The QRS-LV interval was measured from the beginning of the body surface electrocardiogram QRS complex to the LV potential recorded by LV leads. We analyzed the correlations between the QRS-LV intervals and CRT responders, admission for HF and mortality. The patients were 67±12 years old, and their mean LV ejection fraction was 26.3%±8.3%. During follow-up (27.2±19.9 months), 27 patients were admitted for HF (40.1%), and 17 died (25.7%); the median QRS-LV interval was 103±33 msec. Patients were divided into 2 groups: wide QRS-LV (>103 msec), and narrow QRS-LV (<103 msec). The wide QRS-LV group had a lower mortality rate than the narrow QRS-LV group (77% vs. 53%, P<0.05). In patients with dilated cardiomyopathy, the QRS-LV interval was significantly wider in responders, compared to non-responders (112±9.2 vs. 80.0±10 msec, P<0.05). The QRS-LV interval did not correlate with CRT responders or admission for HF. The mortality rate was lower in patients with wide QRS-LV intervals, compared to narrow QRS-LV intervals. Furthermore, a wide QRS-LV interval might be a predictor for CRT responders in patients with dilated cardiomyopathy

Effect of Cardiac Rehabilitation in Preventing Implantable Cardioverter Defibrillator Therapy in Patients with Reduced Left Ventricular Ejection Fraction

In patients with implantable cardioverter defibrillators(ICD)or cardiac resynchronization therapy defibrillators(CRT-D), appropriate and inappropriate shocks lead to a higher risk of mortality. Cardiac rehabilitation(CR)is an established therapy for patients with ischemic heart disease and/or congestive heart failure. However, it is unclear whether CR could reduce the need for device therapies. The purpose of the present study was to investigate whether CR reduces device therapies and mortality in patients with severe cardiac dysfunction and ICD or CRT-D. Of the 390 patients who were implanted with an ICD or CRT-D between 1998 and 2015, 222(178 men, 44 women)with a low ejection fraction(EF; <45%)were investigated in this present study. The study cohort was divided into two groups, the CR group(n=70)and the non-CR group (n=152), and baseline clinical characteristics of the two groups were compared. Furthermore, the number of all device therapies, appropriate therapies, inappropriate therapies, and mortality for 1 year after ICD or CRT-D implantation were compared. There were no significant differences in baseline characteristics between the CR and non-CR groups(e.g. age 68.5 vs 66.2 years[P=0.16]; EF 27.9% vs 29.7%[P=0.14]). Kaplan-Meier analysis revealed that all device therapy events and inappropriate therapy events were lower in the CR than non-CR group(P=0.01 and P=0.03, respectively). Appropriate therapy events and mortality did not differ significantly between the two groups(5.7% vs 13.1%[P=0.09]and 11.4% vs 17.0%[P=0.28], respectively). CR may have beneficial effects in preventing therapy events, especially inappropriate therapy, in patients with an ICD or CRT-D

Recurrence of atrial fibrillation within three months after pulmonary vein isolation for patients with paroxysmal atrial fibrillation: Analysis using external loop recorder with auto-trigger function

Background: Pulmonary vein isolation (PVI) via catheter ablation has been shown to be a highly effective treatment option for patients with symptomatic paroxysmal atrial fibrillation (AF). The recurrence of AF within 3 months after PVI is not considered to be the result of ablation procedure failure, because early recurrence of AF is not always associated with late recurrence. We examined the usefulness of an external loop recorder with an auto-trigger function (ELR-AUTO) for the detection of atrial fibrillation following PVI to characterize early recurrence and to determine the implications of AF occurrence within 3 months after PVI. Methods: Fifty-three consecutive symptomatic patients with paroxysmal AF (age 61.6±12.6 years, 77% male) who underwent PVI and were fitted with ELR-AUTO for 7±2.0 days within 3 months after PVI were enrolled in this study. Results: Of the 33 (62.2%) patients who did not have AF recurrence within 3 months after PVI, only 1 patient experienced AF recurrence at 12 months. Seven (35%) of the 20 patients who experienced AF within 3 months of PVI experienced symptomatic AF recurrence at 12 months. The sensitivity, specificity, positive predictive value, and negative predictive value of early AF recurrence for late recurrence were 87.5%, 71.1%, 35.0%, and 96.9%, respectively. Conclusions: AF recurrence measured by ELR-AUTO within 3 months after PVI can predict the late recurrence of AF. Freedom from AF in the first 3 months following ablation significantly predicts long-term AF freedom. ELR-AUTO is useful for the detection of symptomatic and asymptomatic AF