Successful Management of a Rare Case of Stent Fracture and Subsequent Migration of the Fractured Stent Segment Into the Ascending Aorta in In-Stent Restenotic Lesions of a Saphenous Vein Graft

Stent fracture is a complication following implantation of drug eluting stents and is recognized as one of the risk factors for in-stent restenosis. We present the first case of successfully managing a stent fracture and subsequent migration of the fractured stent into the ascending aorta that occurred during repeat revascularization for in-stent restenosis of an ostium of saphenous vein graft after implantation of a zotarolimus-eluting stent. Although the fractured stent segment had migrated into the ascending aorta with a pulled balloon catheter, it was successfully repositioned in the saphenous vein graft using an inflated balloon catheter. Then, the fractured stent segment was successfully connected to the residual segment of the zotarolimus-eluting stent by covering it with an additional sirolimuseluting stent

Late Stent Thrombosis After Drug-Eluting Stent Implantation: A Rare Case of Accelerated Neo-Atherosclerosis and Early Manifestation of Neointimal Rupture

An 80-year old woman suffered from sudden onset of chest pain and dyspnea, and visited the emergency room. She received stent implantation with a biolimus A9-eluting stent (Nobori® 3.0×24 mm) at a the mid-portion of the left anterior descending artery 5 months prior to admission. The emergency 5-month follow-up angiogram was performed under the impression of late stent thrombosis. The follow-up angiogram showed subtotal occlusion at the mid-portion of the left anterior descending artery, which was the same segment of previous stent implantation 5 months ago. Immediately after thrombus aspiration with the thrombus aspiration catheter, the optical coherence tomography showed layered appearance of neointimal hyperplasia and neointimal rupture within the previously stented segment. Thus, neointimal rupture within accelerated growth of neointimal tissue was observed within a relatively shorter period (i.e., about 5 months) after stent implantation

Impact of left atrial appendage closure on cardiac functional and structural remodeling: A difference-in-difference analysis of propensity score matched samples

Background: Although the safety and efficacy of left atrial (LA) appendage (LAA) closure (LAAC) in nonvalvular atrial fibrillation (NVAF) patients have been well documented in randomized controlled trials and real-world experience, there are limited data in the literature about the impact of LAAC on cardiac remodeling. The aim of the study was to examine the impact of LAAC on cardiac functional and structural remodeling in NVAF patients. Methods: Between March 2014 and November 2016, 47 NVAF patients who underwent LAAC were included in this study (LAAC group). A control group (non-LAAC group) was formed from 141 NVAF patients without LAAC using propensity score matching. The difference-in-difference analysis was used to evaluate the difference in cardiac remodeling between the two groups at baseline and follow-up evaluations. Results: The LAAC group had a larger increase in LA dimension, volume and volume index than the non-LAAC group (+3.9 mm, p = 0.001; +9.7 mL, p = 0.006 and +5.9 mL/m2, p = 0.011, respectively). Besides, a significant increase in E and E/e’ ratio was also observed in the LAAC group (+14.6 cm/s, p = 0.002 and +2.3, p = 0.028, respectively). Compared with the non-LAAC group, left ventricular (LV) ejection fraction and fractional shortening decreased in LAAC patients, but were statistically insignificant (–3.5%, p = 0.109 and –2.0%, p = 0.167, respectively). Conclusions: There were significant increases in LA size and LV filling pressure among NVAF patients after LAAC. These impacts of LAAC on cardiac functional and structural remodeling may have some clinical implications that need to be addressed in future studies

Synthesis and properties of electrically conductive poly N-methyl phenothiazine sulfide.

Poly-phenothiazine sulfide (PPS) and poly N-methyl phenothiazine sulfide(PMPS) were synthesized by sulfuration directly from sulfur dichloride. The polymers are solution processable, transparent, electrically conductive, and photosensitive. When Iodine-doped, conductivity of the polymers increased to as high as 10\sp{-2}mho/cm. Results from EPR spectroscopic studies revealed that the nature of the charge carrier was a radical cation present along the polymer chain produced by electron-transfer between the polymers and the dopant. During the electrochemical doping of the polymers, changes in color from yellow to dark-blue were reproducible. The environmental stabilities of doped polymers and the quality of optical contrast between undoped polymer film and doped film implied the potential use of these polymers in electrochromic devices. Cyclicvoltammetric studies and In situ spectroscopic studies during electrochemical doping revealed that polymers were oxidized stepwise through radical cations (first step) to dications (second step). These studies revealed that the first oxidation step followed first order kinetics and its rate constants increased at higher applied potentials. The activation energies of this first oxidation at 0.8V were 16Kcal mole\sp{-1} and 13.6Kcal mole\sp{-1} for PMPS and PPS, respectively. The second oxidation step followed zero order kinetics. The rate constant of the second step in PMPS was 0.0532 M\sp{-1} min\sp{-1} at room temperature and at 1.9V. When PMPS was utilized as a photosensitizer in a photovoltaic cell in the presence of Cr(III) or Fe(III), the open-circuit voltage and the closed-circuit current density increased remarkably. PMPS is the first polymer to exhibit such a significant magnitude of photovoltage and photocurrent without applying an external electrical field. Under illumination, the photocell produced the open-circuit voltage as high as 0.65V and closed-circuit current density of 0.27mA/cm\sp2. This improvement in the efficiency of the photocell was achieved by constructing a Totally-Illuminated-Thin-Layered (TITL) type cell and using a polymer modified metal electrode.Ph.D.Applied SciencesElectromagneticsMaterials sciencePolymer chemistryPure SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128198/2/8813024.pd

Association of Low Muscle Mass and Isokinetic Strength with Metabolic Syndrome

Background and objectives Sarcopenia and metabolic syndrome (MetS) increase incidence with age. This study evaluated the prevalence of MetS in middle-age to elderly men according to knee and grip strength and muscle mass. Methods Data from 256 males aged 40–69 years were analyzed. The impedance method was used to assess appendicular skeletal muscle mass (ASM). Muscle strength was measured grip strength with a dynamometer and 60°/s knee strength with isokinetic machine. Strength and muscle mass were divided into quartiles, and logistic regression analyses were performed. Results Absolute strength was not significantly prevalent in MetS, but MetS prevalence was significantly higher in participants with lower relative strength and muscle mass values (p<0.05). The group with the lowest relative ASM showed a 3.604-fold increase in MetS prevalence compared to highest ASM. Lowest relative knee extension strength group increased by 3.308 (95% CI 1.201–8.064) and relative knee flexion strength increased by 2.390 (95% CI 1.006–5.560) in MetS prevalence compared to the highest strength group. Lowest muscle mass and extension strength group increased by 6.8-fold com-pared to the highest muscle mass and strength group. Conclusions Relative values of strength and muscle mass divided by body weight were significantly associated with MetS. Therefore, having high muscle strength and muscle mass along with low body weight will prevent MetS

Serial Changes of Neointimal Tissue after Everolimus-Eluting Stent Implantation in Porcine Coronary Artery: An Optical Coherence Tomography Analysis

Purposes. The serial changes in neointimal tissues were compared between everolimus-eluting stent (EES) and bare-metal stent (BMS) in the porcine coronary artery using optical coherence tomography (OCT). Methods. Serial (1, 3, and 6 month follow-up after stent implantation) OCT examinations were performed in 15 swine with 15 BMS- and 15 EES-treated lesions in porcine coronary arteries. Results. In BMS-implanted lesions, neointimal volume decreased from 7.3 mm3 to 6.9 mm3 and 6.4 mm3 at 1, 3, and 6 months follow-up without statistical significance (P=0.369). At the time points of 1, 3, and 6 months, neointimal tissue appearance was mainly a homogeneous pattern (80.0%, 93.3%, and 100%, resp.), while the other pattern was layered. In contrast, in EES-implanted lesions, neointimal volume significantly increased from 4.8 mm3 to 9.8 mm3 between 1 and 3 months but significantly decreased to 8.6 mm3 between 3 and 6 months (P<0.001). Between 1 and 3 months, the layered pattern of neointimal tissue increased from 26.7% to 66.7% but decreased to 20.0% between 3 and 6 months. Conclusions. EES had a biphasic pattern of neointimal amounts that correlated with changes in neointimal morphology