Predictive scoring model of mortality after surgical or endovascular revascularization in patients with critical limb ischemia

ObjectiveThe latest guideline points to life expectancy of <2 years as the main determinant in revascularization modality selection (bypass surgery [BSX] or endovascular therapy [EVT]) in patients with critical limb ischemia (CLI). This study examined predictors and a predictive scoring model of 2-year mortality after revascularization.MethodsWe performed Cox proportional hazards regression analysis of data in a retrospective database, the Bypass and Endovascular therapy Against Critical limb ischemia from Hyogo (BEACH) registry, of 459 consecutive CLI patients who underwent revascularization (396 EVT and 63 BSX cases between January 2007 and December 2011) to determine predictors of 2-year mortality. The predictive performance of the score was assessed with the area under the time-dependent receiver operating characteristic curve.ResultsOf 459 CLI patients (mean age, 72 ± 10 years; 64% male; 49% nonambulatory status, 68% diabetes mellitus, 47% on regular dialysis, and 18% rest pain and 82% tissue loss as treatment indication), 84 died within 2 years after revascularization. In a multivariate model, age >75 years (hazard ratio [HR], 1.77; 95% confidence interval [CI], 1.10-2.85), nonambulatory status (HR, 5.32; 95% CI, 2.96-9.56), regular dialysis (HR, 1.90; 95% CI, 1.10-3.26), and ejection fraction <50% (HR, 2.49; 95% CI, 1.48-4.20) were independent predictors of 2-year mortality. The area under the time-dependent receiver operating characteristic curve for the developed predictive BEACH score was 0.81 (95% CI, 0.76-0.86).ConclusionsPredictors of 2-year mortality after EVT or BSX in CLI patients included age >75 years, nonambulatory status, regular dialysis, and ejection fraction <50%. The BEACH score derived from these predictors allows risk stratification of CLI patients undergoing revascularization

Effects of Weaning by Surrogate Mothers (ACI) on Tumor Development in SD Rats Treatedwith Methylnitrosourea (MNU) and/or N-Methyl-N-nitro-N-nitrosoguanidine (MNNG)

In this experiment, MNU was administered, followed by MNNG, to assess effects ofsurrogate mothering on tumor. One or two day old male SD pups were treated with or without30mg/kg body weight of methylnitrosourea (MNU) and nursed by SD or ACI surrogate mothersfor 5 weeks. When 6-weeks-old they were then treated with 100ppmN-methyl-N-nitro-N-nitrosoguanidine (MNNG) or tap water for 16 weeks. The tumor incidencein the MNNG alone group was significantly lower than with MNU alone or MNU+MNNG (p<0.01).Kidney or nerve tumors mainly developed in the MNU group, gastric tumors in the MNNG group,and the two combined in the MNU+MNNG group. The incidence and mean number of tumors didnot significantly differ between the two weaning groups. However, mean survival time withthe ACI surrogate mothers after treatment with MNU was increased as compared with the SDmother group. Cumulative development of tumors in the ACI surrogate mother group was alsodelayed (p<0.05). Similar results were obtained with MNU+MNNG and MNNG alone. The presentexperiment suggested that tumor induction might be effected by components of the mother'smilk

Impact of baseline yellow plaque assessed by coronary angioscopy on vascular response after stent implantation

Tsujimura T., Mizote I., Ishihara T., et al. Impact of baseline yellow plaque assessed by coronary angioscopy on vascular response after stent implantation. Journal of Cardiology , (2024); https://doi.org/10.1016/j.jjcc.2024.04.004.Background: The relationship between baseline yellow plaque (YP) and vascular response after stent implantation has not been fully investigated. Methods: This was a sub-analysis of the Collaboration-1 study (multicenter, retrospective, observational study). A total of 88 lesions from 80 patients with chronic coronary syndrome who underwent percutaneous coronary intervention were analyzed. Optical coherence tomography (OCT) and coronary angioscopy (CAS) were serially performed immediately and 11 months after stent implantation. YP was defined as the stented segment with yellow or intensive yellow color assessed by CAS. Neoatherosclerosis was defined as a lipid or calcified neointima assessed by OCT. OCT and CAS findings at 11 months were compared between lesions with baseline YP (YP group) and lesions without baseline YP (Non-YP group). Results: Baseline YP was detected in 37 lesions (42 %). OCT findings at 11 months showed that the incidence of neoatherosclerosis was significantly higher in the YP group (11 % versus 0 %, p = 0.028) and mean neointimal thickness tended to be lower (104 ± 43 μm versus 120 ± 48 μm, p = 0.098). CAS findings at 11 months demonstrated that the dominant and minimum neointimal coverage grades were significantly lower (p = 0.049 and P = 0.026) and maximum yellow color grade was significantly higher (p < 0.001) in the YP group. Conclusions: Baseline YP affected the incidence of neoatherosclerosis as well as poor neointimal coverage at 11 months after stent implantation

Radioprotective Effects of Miso (Fermented Soy Bean Paste) Against Radiation in B6C3Fl Mice : Increased Small Intestinal Crypt Survival, Crypt Lengths and Prolongation of Average Time to Death

The radioprotective effect of miso, a fermentation product from soy bean, was investigated with reference to the survival time, crypt survival and jejunum crypt length in male B6C3F1 mice. Miso at three different fermentation stages (early-, medium- and long-term fermented miso) was mixed in MF diet into biscuits at 10% and was administered from 1 week before irradiation. Animal survival in the long-term fermented miso group was significantly prolonged as compared with the short-term fermented miso and MF cases after 8 Gy of 60Co-γ-ray irradiation at a dose rate of 2Gy min-1. Delay in mortality was evident in all three miso groups, with significantly increased survival. At doses of 10 and 12 Gy X-irradiation at a dose rate of 4 Gy min-1 the treatment with long-term fermented miso significantly increased crypt survival. Also the protective influence against irradiation in terms of crypt lengths in the long-term fermented miso group was significantly greater than in the short-term or medium-term fermented miso and MF diet groups. Thus, prolonged fermentation appears to be very important for protection against radiation effects