Impact of Mild Paravalvular Regurgitation on Long- Term Clinical Outcomes After Transcatheter Aortic Valve Implantation

The impact of mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) remains controversial. We evaluated the impact of mild PVR after TAVI on long-term clinical outcomes. We included patients who underwent TAVI for severe symptomatic aortic stenosis between December 2008 and June 2019 at 2 interna-tional centers and compared all-cause death between the group with mild PVR (group 1) and the group with none or trace PVR (group 2). PVR was categorized using a 3-class grading scheme, and patients with PVR >= moderate and those who were lost to follow-up were excluded. This retrospective analysis included 1,404 patients (mean age 81.7 +/- 6.5 years, 58.0% women). Three hundred fifty eight patients (25.5%) were classified into group 1 and 1,046 patients (74.5%) into group 2. At baseline, group 1 was older and had a lower body mass index, worse co-morbidities, and more severe aortic stenosis. To account for these differences, propensity score matching was performed, resulting in 332 matched pairs. Within these matched groups, during a mean follow-up of 3.2 years, group 1 had a significantly lower survival rate at 5 years (group 1: 62.0% vs group 2: 68.0%, log-rank p = 0.029, hazard ratio: 1.41 [95% confidence interval: 1.04 to 1.91]). In the matched cohort, patients with mild PVR had a significant 1.4-fold increased risk of mortality at 5 years after TAVI compared with those with none or trace PVR. Further studies with more patients are needed to evaluate the impact of longer-term outcomes.(c) 2022 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) (Am J Cardiol 2023;191:14-22)Peer reviewe

Microcirculatory and Metabolic Responses during Voluntary Cycle Ergometer Exercise with a Whole-Body Neuromuscular Electrical Stimulation Device

Vigorous exercise increases blood viscosity and may pose a risk of cardiovascular events in patients with cardiovascular diseases. We recently reported that single-use of novel whole-body neuromuscular electrical stimulation (WB-NMES) can be safely applied in healthy subjects without adversely affecting blood fluidity. We performed a crossover study to explore the effectiveness and safety of a hybrid exercise with ergo-bicycle and WB-NMES; 15 healthy volunteers, aged 23–41 years, participated in this study. No arrhythmias were detected during the hybrid exercise and 20 min recovery, and although blood fluidity was transiently exacerbated immediately after both the exercise programs, in vivo parameters in the sublingual and nailfold microcirculation remained unchanged. There was a significant decrease in blood glucose and increase in lactic acid levels immediately after both exercise programs. Even with the same workload as the cycle ergometer exercise, the oxygen intake during the hybrid exercise remained higher than that during the cycle ergometer exercise alone (p < 0.05, r = 0.79, power = 0.81). Both the hybrid and voluntary cycle ergometer exercises transiently exacerbated blood fluidity ex vivo; however, microvascular flow was not adversely affected in vivo

Microcirculatory and Metabolic Responses during Voluntary Cycle Ergometer Exercise with a Whole-Body Neuromuscular Electrical Stimulation Device

Vigorous exercise increases blood viscosity and may pose a risk of cardiovascular events in patients with cardiovascular diseases. We recently reported that single-use of novel whole-body neuromuscular electrical stimulation (WB-NMES) can be safely applied in healthy subjects without adversely affecting blood fluidity. We performed a crossover study to explore the effectiveness and safety of a hybrid exercise with ergo-bicycle and WB-NMES; 15 healthy volunteers, aged 23–41 years, participated in this study. No arrhythmias were detected during the hybrid exercise and 20 min recovery, and although blood fluidity was transiently exacerbated immediately after both the exercise programs, in vivo parameters in the sublingual and nailfold microcirculation remained unchanged. There was a significant decrease in blood glucose and increase in lactic acid levels immediately after both exercise programs. Even with the same workload as the cycle ergometer exercise, the oxygen intake during the hybrid exercise remained higher than that during the cycle ergometer exercise alone (p < 0.05, r = 0.79, power = 0.81). Both the hybrid and voluntary cycle ergometer exercises transiently exacerbated blood fluidity ex vivo; however, microvascular flow was not adversely affected in vivo

Jejunal heterotopic pancreas containing high-grade pancreatic intraepithelial neoplasia (PanIN-3): case report and literature review

　We here report a rare surgical case of heterotopic pancreas in the jejunum that contained high-grade pancreatic intraepithelial neoplasm (PanIN-3). When a sixty-fouryear old man had a surgery for transverse colon cancer in our hospital, a subserosal mass was coincidentally found in the jejunum and was resected for pathological determination. The mass was Heinrich type-I heterotopic pancreas that contained irregular dilation of pancreatic ducts with moderate to severe atypia, so-called PanIN-3. It is reported that heterotopic pancreas can be found at approximately 0.5% of laparotomy, mostly without specific preoperative symptoms. Most of its pathological characteristics are benign, whereas, there are a few reports of its malignant cases. PanIN-containing heterotopic pancreas is very rare in the literature. However, its malignant alteration is thought to arise through PanIN or intraductal papillary mucinous neoplasm (IPMN) as the carcinogenesis of orthotopic pancreas

Assessment of urine partial oxygen pressure to predict postoperative acute kidney injury in major surgical patients

　Urine partial oxygen pressure (PuO2) was monitored in postoperative intensive care unit (ICU) patients to verify if an earlier diagnosis of acute kidney injury (AKI) is possible. Fifty-nine patients who were admitted to the ICU after surgery for at least 48 hours at Kawasaki Medical Center between January 2019 and June 2020 were assessed for AKI using the Kidney Disease: Improving Global Outcome (KDIGO) criteria. The AKI group had 15 patients while the non-AKI group had 44 cases. The PuO2 of each group showed no significant difference. Arterial partial oxygen pressure (PaO2) was measured concurrently with PuO2. When the ratio of PuO2 to PaO2 (PuO2 / PaO2) from each group was compared, the AKI group had a significantly higher ratio just 2 hours after admission to the ICU. Reduced oxygen consumption in the renal medulla may be a possible cause of AKI in those patients. Thus, measuring the PuO2 / PaO2 ratio in postoperative patients 2 hours after ICU admission could be useful to predict AKI earlier than is currently done