Optimal Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

BACKGROUND: Intravascular ultrasound (IVUS) was only rarely used in landmark trials comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel disease. OBJECTIVES: The authors aimed to evaluate clinical outcomes after optimal IVUS-guided PCI in patients undergoing multivessel PCI. METHODS: The OPTIVUS (OPTimal IntraVascular UltraSound)-Complex PCI study multivessel cohort was a prospective multicenter single-arm study enrolling 1, 021 patients undergoing multivessel PCI, including left anterior descending coronary artery using IVUS, aiming to meet the prespecified criteria (OPTIVUS criteria: minimum stent area > distal reference lumen area [stent length ≥28mm], and minimum stent area >0.8 × average reference lumen area [stent length <28mm]) for optimal stent expansion. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) (death/myocardial infarction/stroke/any coronary revascularization). The predefined performance goals were derived from the CREDO-Kyoto (Coronary REvascularization Demonstrating Outcome study in Kyoto) PCI/CABG registry cohort-2 fulfilling the inclusion criteria in this study. RESULTS: In this study, 40.1% of the patients met OPTIVUS criteria in all stented lesions. The cumulative 1-year incidence of the primary endpoint was 10.3% (95% CI: 8.4%-12.2%), which was significantly lower than the predefined PCI performance goal of 27.5% (P < 0.001), and which was numerically lower than the predefined CABG performance goal of 13.8%. The cumulative 1-year incidence of the primary endpoint was not significantly different regardless of meeting or not meeting OPTIVUS criteria. CONCLUSIONS: Contemporary PCI practice conducted in the OPTIVUS-Complex PCI study multivessel cohort was associated with a significantly lower MACCE rate than the predefined PCI performance goal, and with a numerically lower MACCE rate than the predefined CABG performance goal at 1 year

Population health and regional variations of disease burden in Japan, 1990–2015:a systematic subnational analysis for the Global Burden of Disease Study 2015

BackgroundJapan has entered the era of super-ageing and advanced health transition, which is increasingly putting pressure on the sustainability of its health system. The level and pace of this health transition might vary across regions within Japan and concern is growing about increasing regional variations in disease burden. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides a comprehensive, comparable framework. We used data from GBD 2015 with the aim to quantify the burden of disease and injuries, and to attribute risk factors in Japan at a subnational, prefecture-level.MethodsWe used data from GBD 2015 for 315 causes and 79 risk factors of death, disease, and injury incidence and prevalence to measure the burden of diseases and injuries in Japan and in the 47 Japanese prefectures from 1990 to 2015. We extracted data from GBD 2015 to assess mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), life expectancy, and healthy life expectancy (HALE) in Japan and its 47 prefectures. We split extracted data by prefecture and applied GBD methods to generate estimates of burden, and attributable burden due to known risk factors. We examined the prefecture-level relationships of common health system inputs (eg, health expenditure and workforces) to the GBD outputs in 2015 to address underlying determinants of regional health variations.FindingsLife expectancy at birth in Japan increased by 4·2 years from 79·0 years (95% uncertainty interval [UI] 79·0 to 79·0) to 83·2 years (83·1 to 83·2) between 1990 and 2015. However, the gaps between prefectures with the lowest and highest life expectancies and HALE have widened, from 2·5 to 3·1 years and from 2·3 to 2·7 years, respectively, from 1990 to 2015. Although overall age-standardised death rates decreased by 29·0% (28·7 to 29·3) from 1990 to 2015, the rates of mortality decline in this period substantially varied across the prefectures, ranging from -32·4% (-34·8 to -30·0) to -22·0% (-20·4 to -20·1). During the same time period, the rate of age-standardised DALYs was reduced overall by 19·8% (17·9 to 22·0). The reduction in rates of age-standardised YLDs was very small by 3·5% (2·6 to 4·3). The pace of reduction in mortality and DALYs in many leading causes has largely levelled off since 2005. Known risk factors accounted for 34·5% (32·4 to 36·9) of DALYs; the two leading behavioural risk factors were unhealthy diets and tobacco smoking in 2015. The common health system inputs were not associated with age-standardised death and DALY rates in 2015.InterpretationJapan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment.FundingBill &amp; Melinda Gates Foundation, Japan Ministry of Education, Science, Sports and Culture, Japan Ministry of Health, Labour and Welfare, AXA CR Fixed Income Fund and AXA Research Fund

Timing and low-level rf system for an x-ray laser

An x-ray free-electron laser (XFEL), SACLA, designed to open up new science, was constructed for generating coherent x rays with a peak power of more than 10 GW and a very short pulse of below 30 fs. This feature demands a very highly short-term temporal stability of less than 50 fs to the acceleration rf field of SACLA. For this reason, we developed a timing and low-level rf (LLRF) system for SACLA based on that of the SPring8 compact SASE source (SCSS) test accelerator for verifying the feasibility of an XFEL. The performance of the system using the in-phase and quadrature rf manipulation method was improved from SCSS’s system. Since the facility length of SACLA is 700 m, which is 10 times longer than that of the SCSS test accelerator, a phase-stabilized optical-fiber system designed to transmit time standard rf signals with low loss was also developed and deployed. This optical-fiber system equips fiber optical-length feedback control in order to mitigate environmental effects, such as temperature and humidity changes. On the other hand, the demanded maximum rf temporal stability is less than 50 fs, which is almost 10 times smaller than that of the SCSS test accelerator. Hence, reducing electric noise and increasing the temperature stability around timing and LLRF instruments were necessary and realized with a very low-noise power supply and a hemathermal 19-inch enclosure. The short-term temporal performance of the timing LLRF system finally attained a temporal stability of less than 13.6 fs in rms measured by a beam arrival-time measurement. This stability greatly helps to achieve the stable x-ray lasing of SACLA for routine operation during user experiments

A Proposal of a PID Feedback Controller with High Precision and Wide Dynamic Range :It sA pplication to Seismometer

A method of digital feedback control was established more than 20 years ago. Its applications have been developed in fuzzy and adaptive control method used in washing machines. To date, technologies of computers with high speed and ADC (Analog Digital Converter) with wide dynamic range have been advanced. Therefore, the digital feedback control method has enough potential to be employed to a servo-type seismometer instead of its analog feedback circuit. However, to use the digital feedback control, the problems to be overcome still remain. Those are the dynamic range and the data acquisition speed of ADC/DAC (Digital Analog Converter). This paper proposes an idea to obtain ADC/DAC with wide dynamic range and high-speed data acquisition. In a case of DAC, we use two devices for one data output. One is used to convert upper-half bits of the data and the other is for lower-half bits. ADC also has the same situation. By the above-mentioned method using the two devices with smaller bit-width, the higher data-acquisition speed and the data with a wider dynamic range will be obtained. Now, we will try to develop a PID digital feedback control circuit using the method. The method is patent pending.＜論説