Predictive importance of left ventricular myocardial stiffness for the prognosis of patients with congestive heart failure

SummaryObjectivesThis study was designed to determine the prognostic importance of left ventricular (LV) myocardial stiffness, a hemodynamic index which is closely related to B-type natriuretic peptide (BNP) concentration in patients with congestive heart failure (CHF).BackgroundWhile elevated BNP, an abnormality of cardiac neurohormones, is known to be an independent marker of death or re-admission, it remains to be clarified whether there is also a strong predictor directly related to cardiac dysfunction.MethodsLV performance variables and stress–strain analyses including diastolic myocardial stiffness constant (Km) were obtained from 37 patients with initial CHF by the combined simultaneous measurement of echocardiographic and hemodynamic data. Survivors were monitored for a mean of 23 months, with the main endpoint being combined death or first re-admission for CHF.ResultsTen patients (27%) were primary endpoint cases. Both Km and plasma BNP levels were higher in the event than in the event-free group. By Cox proportional hazards analysis, Km≥4.0 was identified as the only variable with significant and independently incremental predictive power to affect the primary endpoint (adjusted hazard ratio=7.354, 95% confidence interval 1.379–39.232, p=0.02).ConclusionsIn patients with CHF, increased myocardial stiffness may have greater prognostic significance compared to other conventional predictors. Increased myocardial stiffness may be considered to be an important prognostic factor independent of the loading conditions

Repeated intra-stent thrombus formation in a patient with acute coronary syndrome due to poor responsiveness to clopidogrel may be associated with cytochrome P-450 2C19*2 polymorphism

SummaryA drug-eluting stent was implanted at the culprit lesion in a 65-year-old man with acute coronary syndrome. Nine days after the procedure, he suffered stent thrombosis, and a bare-metal stent was subsequently implanted. Twelve days after this second procedure, a follow-up angiogram showed a newly emerged thrombus at the site of stent implantation. Although the patient had continued dual anti-platelet therapy with aspirin and clopidogrel since the first procedure, platelet optical aggregation test showed no inhibition of aggregation. Further, genetic analysis revealed him to be homozygous for the CYP2C19*2 polymorphism. This case suggests that the mechanism of stent thrombosis, while multi-factorial, is affected greatly by crossover of poor responsiveness to clopidogrel due to the CYP2C19*2 polymorphism

Very late thrombosis of sirolimus-eluting stent due to late malapposition: Serial observations with optical coherence tomography

SummaryA 54 years old man underwent directional coronary atherectomy in segment 7 with a partial deep-cut injury. A sirolimus-eluting stent (SES) was implanted at the restenosed post-atherectomy lesion. Six months after SES implantation, intravascular ultrasound (IVUS) examination revealed slight vessel enlargement although there were no malapposed struts. Optical coherence tomography (OCT) revealed partial stent malapposition. Ticlopidine was discontinued 3 months after SES implantation, but aspirin was continued. Twenty-nine months after SES implantation, after discontinuing aspirin for 7 days for colon polypectomy, the patient suffered an acute myocardial infarction at the SES implantation site. IVUS revealed further positive vessel remodeling and slight stent malapposition and OCT revealed extension of the previous stent malapposition and ulcer-like appearance around the stent struts. This case demonstrates that even a small partial SES malapposition that can be detected only by OCT has the potential to enlarge over time and the late malapposition may result in late thrombosis when anti-platelet therapy is discontinued

A 12.5+12.5 Gb/s Full-Duplex Plastic Waveguide Interconnect

A new interconnect solution with plastic waveguide is demonstrated. The system consists of a pair of transceivers and a plastic waveguide. Millimeter wave signal is transmitted in a low-cost long piece of solid plastic dielectric acting as a waveguide. The plastic waveguide medium offers a large bandwidth for data communication using mm-wave carrier frequencies. Plastic waveguide interconnects do not require costly electrical-to-optical and optical-to-electrical conversion devices or precise alignment and offer longer transmission distances than wireless solutions due to better field confinement and lower path loss. Multiple plastic waveguides can be used in parallel and the modulated data at different frequencies can be multiplexed to increase the data rate. The demonstrated transceiver chips operate at carrier frequencies of 57 GHz and 80 GHz, and are fabricated in 40 nm low-power logic CMOS. The total area and power consumption of two transceivers are 0.41 mm^2 and 140 mW, respectively. The fabricated demonstrator with Yagi-couplers achieves full-duplex transmission of 12.5 Gb/s ASK modulated signal in each direction over the 120 mm polystyrene waveguide with no equalization. The observed bit error rates for both channels are less than 10^(-12) for a PRBS length of 2^(7)-1 at the total data rate of 25 Gb/s. This paper shows the feasibility of the plastic waveguide interconnect as a promising alternative to electrical, optical, and wireless interconnects

300 Mbps Downlink Communications from 50kg Class Small Satellites

Recently small satellites start playing important roles in earth observation missions. It, however, is true that small satellites have drawbacks of sensor resolutions and down link data rate. As a solution to the latter drawback, we have developed novel communications system for 320Mbps down link with 16QAM for small satellites with 50kg class. We developed a new GaN HEMT X-band amplifier with high efficiency and small distortion, digital filter and pre-distortion processing with relatively low clock frequency in FPGAs, and small X-band on-board antennas. As ground segments, we are developing a compact S/X dual band ground antenna station and a high performance demodulator with turbo equalizer/decoder based on CCSDS high rate telemetry standard. These technologies will be demonstrated in 2014 by Japanese Hodoyoshi-4 satellite with 50 kg mass