Japanese VLBI Network observations of radio-loud narrow-line Seyfert 1 galaxies

We performed phase-reference very long baseline interferometry (VLBI) observations on five radio-loud narrow-line Seyfert 1 galaxies (NLS1s) at 8.4 GHz with the Japanese VLBI Network (JVN). Each of the five targets (RXS J08066+7248, RXS J16290+4007, RXS J16333+4718, RXS J16446+2619, and B3 1702+457) in milli-Jansky levels were detected and unresolved in milli-arcsecond resolutions, i.e., with brightness temperatures higher than 10^7 K. The nonthermal processes of active galactic nuclei (AGN) activity, rather than starbursts, are predominantly responsible for the radio emissions from these NLS1s. Out of the nine known radio-loud NLS1s, including the ones chosen for this study, we found that the four most radio-loud objects exclusively have inverted spectra. This suggests a possibility that these NLS1s are radio-loud due to Doppler beaming, which can apparently enhance both the radio power and the spectral frequency.Comment: 8 pages, 2 figures, accepted for publication in PAS

The impact of CK-MB elevation in patients with acute type A aortic dissection with coronary artery involvement

Background:Acute type A aortic dissection (ATAAD) is a fatal disease and requires emergency surgery. In particular, it is known that mortality is high when a coronary artery is involved. However, the degree of myocardial damage of the coronary acute artery involvement (ACI) varies and may or may not increase creatine kinase muscle and brain isoenzyme (CK-MB). It is unknown how CK-MB elevation affects the surgical outcome. This study compared the surgical results between the two groups of ACI with or without CK-MB elevation.Methods:Among 348 patients who underwent an emergency operation for acute type A aortic dissection, there were 28 (8.0%) patients complicated by ACI and underwent additional coronary artery bypass grafting. We divided 26 of those patients into two groups; the MI group ( with CK-MB elevation) and the NMI group (without CK-MB elevation), and compared both groups.Results:Of the 26, sixteen were in the MI group, and ten were in the NMI group. The average CK-MB in the MI group was 225.5 IU/L, and that in the NMI group was 13.5 IU/L. The mean time from onset to surgery was 248 min in the MI group and 250 min in the NMI group. There was statistical significance in mortality ( 69% vs. 13%, p = 0.03). There was no significance in major complications (ICU days, reintubation, reoperation, pneumonia, sepsis).Conclusions:Acute coronary artery involvement was associated with 8.0% of patients with ATAAD, and 62% had myocardial ischemia with CK-MB elevation. The MI group had significantly higher mortality than the NMI group. It is crucial for cases with suspected ACI to obtain coronary perfusion as soon as possible to prevent CK-MB from elevating

Transit-Time Flow Measurement of Saphenous Vein Graft Used for Surgery of Acute Type A Aortic Dissection with Coronary Malperfusion.

Purpose:Transit-time flow measurement (TTFM), consisting of pulsatility index (PI), mean graft flow, and diastolic filling, is mainly used as a bypass assessment for coronary artery disease (CAD). However, little was known about TTFM in the case of coronary malperfusion (CMP). This study aimed to clarify the difference in the results of TTFM between two different diseases.Methods:Between 2010 and 2020, 138 patients underwent aortic surgery and coronary artery bypass grafting (CABG) with vein grafts. Patients were divided into two groups: CMP (n = 26) and CAD (n = 27). Their results were compared. The primary endpoints were the results of TTFM. Secondary endpoints were the relation between TTFM and mortality, morbidity, and short-term patency in each group.Results:The PI in the CMP group was significantly higher than the other group (4.7 ± 2.9 vs. 3.4 ± 1.9, p = 0.04). There was no statistical significance in the other two elements. In both groups, the short-term graft patency, mortality, and morbidity but for cardiac tamponade did not significantly change depending on the TTFM results.Conclusions:Patients with CMP tended to have a higher PI than those with CAD. With additional CABG for aortic dissection, insufficient TTFM results did not necessarily mean poor short-term graft patency, complications, or case mortality

ワルファリン ト アミオダロン オ ヘイヨウ シテイル ソウボウベン ケイセイ ジュツゴ カンジャ ニオイテ レモン カヒ オ ガンユウスル ミズ ノ ジョウヨウ ニヨリ シュッケツ ケイコウ オ クリカエシタ ト カンガエラレタ イチレイ

今回レモン果皮を用いた水を常用したことで出血傾向を繰り返したと考えられる症例を経験したため報告する。症例は61歳女性で、僧房弁狭窄症に対して11年前と4年前に僧帽弁形成術を施行された。発作性心房細動再発および軽度僧帽弁狭窄症に対してワルファリンおよびアミオダロンを処方し外来加療を続けていた。1年前に腹痛、下痢、血便、皮下出血を主訴に近隣病院の救急外来を受診され、感染性腸炎の診断で入院加療を受けた。入院時の血液検査でプロトロンビン時間 国際標準比(PT-INR)が 6.35と異常な延長を認めていた。退院後は当科外来へ通院再開したが、PT-INRの延長傾向が１ヶ月ほど続いた。今回、腹痛、下痢、血便、皮下出血が再発し当科外来を受診となった。血液検査にてPT-INR 4.14と延長を再度認めた。健康食品や嗜好品、生活習慣を含む生活歴を聴取したところ、1年前から初夏にレモン果皮を用いて飲用水を作成し頻回に飲んでいることが判明した。PT-INRが異常延長していた時期とレモン果皮が含まれる飲用水を常用していた時期が同じであったため、レモン果皮を用いた飲用水の常用によりPT-INRが異常延長し、出血傾向となったと考えられた。直ちにレモン果皮が含まれる水の飲用を中止させ、PT-INRは約1ヶ月のうちに治療域で安定した。以後PT-INRの異常延長および出血傾向は認められなくなった。We report a case of repeated bleeding tendencies due to regular use of lemon peel water. A 61-year-old woman underwent mitral valvuloplasty 11 and 4 years ago for mitral stenosis. She had recurrent paroxysmal atrial fibrillation and mild mitral stenosis after second surgery, and been administered with warfarin and amiodarone and continued outpatient treatment. One year ago, she visited the emergency department of a nearby hospital with chief complaints of abdominal pain, diarrhea, bloody stools, and subcutaneous bleeding, and she was hospitalized with a diagnosis of infectious enteritis. A blood test revealed the extremely elevated PT-INR value of 6.35. After she was discharged from the hospital, she returned to our outpatient clinic. The PT-INR prolongation trend had been continued for a month. This year, she visited our outpatient clinic because of recurrence of abdominal pain, diarrhea, bloody stools, and subcutaneous bleeding. A blood test showed the elevated PT-INR value of 4.14. Her social history was revealed that she had started to make water containing lemon peel and drunk it frequently in early summer for about one year. Since the time of extremely elevated PT-INR value and the time when she had started to drink the water with lemon peel frequently was the same, it was suspected that there was a causal relationship between them. After we stopped her from drinking the water with lemon peel immediately, the PT-INR value was normalized within in a month. Since then the extremely elevated PT-INR value has never been observed

Surgical treatment for secondary aortoesophageal fistula after prosthetic aortic replacement: A report of four cases.

Introduction:With the increase of thoracic aortic aneurysm surgery and thoracic endovascular aortic repair, secondary aortoesophageal fistula (AEF) has been reported. However, the treatment strategy for AEF remains controversial.Presentation of cases:Four patients who had undergone prosthetic aortic replacement for thoracic aortic aneurysm 4-36 months previously, were hospitalized with sepsis-like symptoms. They were diagnosed with aortic prosthetic graft infection after computed tomography revealed ectopic gas around the prosthesis. After that, esophagogastroduodenoscopy revealed an esophageal perforation, so we diagnosed AEF. They received medication and stepwise surgery; 1 patient was discharged, 2 remain hospitalized, and 1 died.Discussion:Some reports have suggested that combined surgery provides better outcomes for AEF. Infection may be controlled by esophagectomy and antibiotic treatment, so prosthesis replacement is not always necessary. However, we should note that infection between a prosthetic graft and the native aorta brings a danger of pseudoaneurysm of the anastomosis.With the increase of thoracic aortic aneurysm surgery and thoracic endovascular aortic repair, secondary aortoesophageal fistula (AEF) has been reported. However, the treatment strategy for AEF remains controversial.Four patients who had undergone prosthetic aortic replacement for thoracic aortic aneurysm 4-36 months previously, were hospitalized with sepsis-like symptoms. They were diagnosed with aortic prosthetic graft infection after computed tomography revealed ectopic gas around the prosthesis. After that, esophagogastroduodenoscopy revealed an esophageal perforation, so we diagnosed AEF. They received medication and stepwise surgery; 1 patient was discharged, 2 remain hospitalized, and 1 died.Some reports have suggested that combined surgery provides better outcomes for AEF. Infection may be controlled by esophagectomy and antibiotic treatment, so prosthesis replacement is not always necessary. However, we should note that infection between a prosthetic graft and the native aorta brings a danger of pseudoaneurysm of the anastomosis.Conclusion:Based on our experience we conclude that surgery performed stepwise along with infection control and general health improvement is a valid treatment strategy for secondary AEF after prosthetic aortic replacement

Early Detection of Abnormal Prion Protein in Genetic Human Prion Diseases Now Possible Using Real-Time QUIC Assay

Introduction: The definitive diagnosis of genetic prion diseases (gPrD) requires pathological confirmation. To date, diagnosis has relied upon the finding of the biomarkers 14-3-3 protein and total tau (t-tau) protein in the cerebrospinal fluid (CSF), but many researchers have reported that these markers are not sufficiently elevated in gPrD, especially in Gerstmann-Sträussler-Scheinker syndrome (GSS). We recently developed a new in vitro amplification technology, designated "real-time quaking-induced conversion (RT-QUIC)", to detect the abnormal form of prion protein in CSF from sporadic Creutzfeldt-Jakob disease (sCJD) patients. In the present study, we aimed to investigate the presence of biomarkers and evaluate RT-QUIC assay in patients with gPrD, as the utility of RT-QUIC as a diagnostic tool in gPrD has yet to be determined. Method/Principal Findings: 56 CSF samples were obtained from gPrD patients, including 20 cases of GSS with P102L mutation, 12 cases of fatal familial insomnia (FFI; D178N), and 24 cases of genetic CJD (gCJD), comprising 22 cases with E200K mutation and 2 with V203I mutation. We subjected all CSF samples to RT-QUIC assay, analyzed 14-3-3 protein by Western blotting, and measured t-tau protein using an ELISA kit. The detection sensitivities of RT-QUIC were as follows: GSS (78%), FFI (100%), gCJD E200K (87%), and gCJD V203I (100%). On the other hand the detection sensitivities of biomarkers were considerably lower: GSS (11%), FFI (0%), gCJD E200K (73%), and gCJD V203I (67%). Thus, RT-QUIC had a much higher detection sensitivity compared with testing for biomarkers, especially in patients with GSS and FFI. Conclusion/Significance: RT-QUIC assay is more sensitive than testing for biomarkers in gPrD patients. RT-QUIC method would thus be useful as a diagnostic tool when the patient or the patient\u27s family does not agree to genetic testing, or to confirm the diagnosis in the presence of a positive result for genetic testing

キョウブ ダイドウミャク ジンコウ ケッカン チカン ジュツゴ ニ カッケツ トケツ オ キタシタ サイシュジュツ ショウレイ ノ セイセキ

【緒言】胸部大動脈疾患に対する人工血管置換術後に、喀血・吐血を来して再手術を要した症例の背景、予後を報告する。【症例】当院で2012年1月から2020年12月までに、喀血・吐血を主訴に胸部大動脈手術を行った24例中、人工血管置換術後の19例（喀血11、吐血8）を対象とした。【結果】年齢中央値73歳（49 - 88歳）、男性12例、女性7例、17例は緊急で手術を行った。初回手術からの間隔は中央値435日（55 - 1883日）であり、初回手術は上行置換1例、下行置換7例、弓部置換11例であった。手術適応は人工血管感染11例、仮性動脈瘤7例、急性大動脈解離1例であった。感染症例の内、9例に大動脈食道瘻を認めた。今回手術は、下行置換6例、胸腹部置換1例、弓部置換3例、ステントグラフト8例、自己弁温存基部置換術１例であった。全体の在院死亡は6例（32%）、生存者の術後滞在期間の中央値は101日であった。大動脈食道瘻を来した症例のうち6例は、2期的に食道抜去も施行し、その在院死亡は33%であった。一方、食道抜去を施行しなかった3例の在院死亡は67%であった。感染の有無で2群に分け検討したところ、在院死亡に統計学的有意差は認めなかった（p=0.147）。Kaplan-Meier法による全体の3年生存率は22.8%と不良であり、感染を認めた群では2年生存率9%と極めて不良であった。【結論】胸部人工血管置換後に喀血・吐血を来した症例の中でも、人工血管感染を生じた症例の予後は極めて不良であった。特に大動脈食道瘻を認めた場合は、食道抜去が必要であると考えられる。Introduction:We report the conditions and outcomes of patients suffering thoracic aortic disease, who developed hematemesis and hemoptysis and required reoperation.Patients: From January 2012 to December 2020, 19 patients (11 hemoptysis, 8 hematemesis) who had previous thoracic aortic surgery required reoperation with the main complaint of hemoptysis and hematemesis. Results:The median age was 71.5 years; there were 7 females, and 17 urgent cases. The median interval since the previous surgery was 435 days (55 to 1883 days), and the previous surgeries were 1 ascending aorta replacement, 7 descending aorta replacements, and 11 total arch replacements. The indications for reoperation were infection in 11 cases, pseudoaneurysm in 7 cases, and acute aortic dissection in 1 case. Aortoesophageal fistula was found in 9 of the infected cases. The surgical actions were 6 descending aorta replacements, 1 thoracoabdominal aorta replacement, 3 total arch replacements, 8 stent grafts, and 1 valve-sparing root reconstruction. Only one patient, who suffered aortic rupture due to dissection, died within 30 days. Six of the cases with aortoesophageal fistula also underwent esophagectomy in the second phase. There were 6 in-hospital mortality cases (32%), and the median length of stay after surgery for survivors was 101 days. The patients were divided into two groups according to the presence of infection, but the difference in-hospital mortality (infection (-): 13%, (+): 45%, p = 0.147) was not statistically significant. The 3-year survival rate by the Kaplan-Meier method was 23% overall, but the 2-year survival rates were 9% in the infected group and 53% in the non-infected group (Log-rank p= 0.167). Conclusion:Among the patients developing hemoptysis and hematemesis after previous thoracic aortic surgery, the cases of graft infection had extremely poor prognosis. Especially when aortoesophageal fistula is found, it is necessary to consider esophagectomy immediately

Vascular smooth muscle RhoA counteracts abdominal aortic aneurysm formation by modulating MAP4K4 activity

Whether a small GTPase RhoA plays a role in the pathology of abdominal aortic aneurysm (AAA) has not been determined. We show here that RhoA expression is reduced in human AAA lesions, compared with normal areas. Furthermore, incidence of AAA formation is increased in vascular smooth muscle cell (VSMC)-specific RhoA conditional knockout (cKO) mice. The contractility of the aortic rings and VSMCs from RhoA cKO mice is reduced, and expression of genes related to the VSMC contractility is attenuated by loss of RhoA. RhoA depletion activates the mitogen-activated protein (MAP) kinase signaling, including MAP4K4, in the aorta and VSMCs. Inhibition of MAP4K4 activity by DMX-5804 decreases AAA formation. Set, a binding protein to active RhoA, functions as an activator of MAP4K4 by sequestering PP2A, an inhibitor of MAP4K4, in the absence of RhoA. In conclusion, RhoA counteracts AAA formation through inhibition of MAP4K4 in cooperation with Set