Device Failure in Bicuspid Aortic Stenosis Following Transcatheter Aortic Valve Implantation

Recent studies showed the favorable outcomes of transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valve (BAV) stenosis. However, data on the rela-tion between BAV morphology and optimal transcatheter heart valve (THV) selection are limited. This study sought to evaluate the determinants of device performance in patients with BAV who underwent TAVI. Consecutive patients with BAV who under-went TAVI with the SAPIEN 3 from multicenters were evaluated. Outcomes were the incidence and predictors of device failure. Device failure was defined as peak aortic velocity > 3.0 m/s, mean pressure gradient > 20 mm Hg, moderate or severe paravalvular leakage and/or procedure mortality. A total of 187 patients with BAV were identified, aged 77 years, and 38.0% were women. A total of 37 patients (19.8%) were treated with 23-mm valve, 58 (31.0%) with 26-mm valve, and 92 (49.2%) with 29-mm valve. Predis -charge echocardiogram demonstrated 37 patients (19.8%) with device failure. BAV with excessive leaflet calcification plus calcified raphe (EC-BAV) (OR 16.7, 95% CI 1.99 to 39.6) and smaller THV (OR 4.41, 95% CI 1.43 to 13.6) were independently associated with increased risk of device failure. In addition, 4.0%, 5.1%, and 11.1% of device fail-ures were observed in patients without EC-BAV who underwent TAVI with 23-, 26-and 29-mm THV (p = 0.47), respectively, and 91.7%, 31.6% and 23.2% in those with EC-BAV, respectively (p < 0.001). In conclusion, EC-BAV morphology was the major deter-minant of a device failure after TAVI. Moreover, TAVI in patients with EC-BAV requir-ing small SAPIEN 3 could be challenging. Further data on device and treatment selection in patients with BAV are still warranted. (C) 2022 The Author(s). Published by Elsevier Inc.Peer reviewe

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

Neuroendocrine Carcinoma of the Bladder

The case was a 67-year-old male who visited our hospital with a major complaint of macroscopic hematuria. A bladder tumor was found. When a transurethral resection of the bladder tumor was performed, the histopathological diagnosis was neuroendocrine bladder cancer. After chemotherapy with cisplatin and etoposide a partial shrinkage of the tumor was observed; however, the patient expired 7 months after the first visit

Relation between Anemia and Vulnerable Coronary Plaque Components in Patients with Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis

The aim of the present study was to evaluate the plaque components and the predictors of thin-cap fibroatheroma (TCFA) in anemic patients with acute coronary syndrome using virtual histology-intravascular ultrasound (VH-IVUS). Anemia was defined according to criteria of the World Health Organization, (i.e. , hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) and we compared VH-IVUS findings between anemia group (171 patients, 260 lesions) and non-anemia group (569 patients, 881 lesions). Anemia group had greater % necrotic core (NC) volume (21% ± 9% vs 19% ± 9%, P = 0.001) compared with non-anemia group. Hemoglobin level correlated negatively with absolute NC volume (r = -0.235, P < 0.001) and %NC volume (r = -0.209, P < 0.001). Independent predictors of TCFA by multivariate analysis were diabetes mellitus (odds ratio [OR], 2.213; 95% confidence interval [CI], 1.403-3.612, P = 0.006), high-sensitivity C-reactive protein (OR, 1.143; 95% CI, 1.058-1.304, P = 0.012), microalbuminuria (albumin levels of 30 to 300 mg/g of creatinine) (OR, 2.124; 95% CI, 1.041-3.214, P = 0.018), and anemia (OR: 2.112; 95% CI 1.022-3.208, P = 0.028). VH-IVUS analysis demonstrates that anemia at the time of clinical presentation is associated with vulnerable plaque component in patients with acute coronary syndrome

Influence of farmland abandonment on the species composition of wetland ground beetles in Kushiro, Japan

Depopulation trends in many developed regions are resulting in an increase in areas of abandoned farmland, which could provide an alternative habitat for species endangered by past conversion of wetlands for agriculture. Additionally, various spatial and temporal factors (landscape structure, local habitat quality, and abandonment age) could influence species composition in abandoned farmland. In this study, we explored the spatio-temporal effects of land abandonment on the species composition of wetland ground beetles (Coleoptera: Carabidae) to examine whether abandoned farmland can contribute to conserve wetland species' habitats. We first compared ground beetle assemblages among four land uses (grassland, wetland, and newly and previously abandoned farmland) in the Kushiro region, eastern Hokkaido, Japan. We then examined the factors influencing differences in wetland species composition between abandoned farmland and wetland. We found that the composition of wetland species in abandoned farmland was more similar to that of wetland than that of grassland. Our results also showed that soil moisture in abandoned farmland was positively related to the land abandonment age and that differences in wetland species composition between abandoned farmland and wetland were negatively related to both soil moisture and surrounding wetland area. Our findings suggest that abandoned farmland can serve as an alternative habitat for wetland ground beetles. Maintaining a high level of soil moisture in abandoned farmland and conserving the surrounding wetland could be an effective strategy for restoring natural habitats for these species

重症大動脈弁狭窄症に併存する冠動脈狭窄の機能的評価、冠血流予備量比と瞬時血流予備量比の不一致症例の検討

熊本大

Seasonal variation in patch and landscape effects on forest bird communities in a lowland fragmented landscape

In fragmented temperate landscapes, species responses to patch and landscape structures are likely to vary across seasons. However, few studies have examined the dynamic effects on biodiversity across seasons. We examined the effects of patch attributes and connectivity and seasonal variation in the effects of these environmental variables on forest bird communities at woodland fragments surrounded by agricultural land across three seasons (breeding, dispersal, and wintering seasons). We surveyed birds in woodland remnants and examined the effects of patch area, woodland connectivity, woodland type, and three interaction terms between these environmental variables and season (patch area x season, connectivity x season, and woodland type x season) on forest bird communities. In the results, species richness, abundance and composition of forest bird communities were associated with patch attributes and connectivity, and some of these associations varied depending on the season. Specifically, there were significantly higher abundances of specialist birds in riparian woodlands compared to conifer woodlands during the breeding season, whereas this pattern was reversed during the winter. In addition, we found the negative effects of patch area during the dispersal and wintering seasons and the positive effect of connectivity during the dispersal season on generalist bird abundances. These results suggest that woodland patches with high conservation values differ among three seasons. The conservation planning for a fragmented landscape therefore needs to consider the role of patch attributes and connectivity during multiple seasons rather than just the breeding season

Assessing the landscape-dependent restoration potential of abandoned farmland using a hierarchical model of bird communities

While wetlands have been converted into farmlands, large amounts of farmlands are now being abandoned, and this novel habitat is expected to be inhabited by species which depend on wetlands. Here we examined the effects of habitat and landscape variables on the densities of wetland bird species in abandoned farmlands. We surveyed birds in abandoned farmlands with different patch area, habitat, and landscape variables in Kushiro district, eastern Hokkaido, northern Japan. We also surveyed birds in 15 ha of the remaining wetlands as a reference habitat. We used abundance-based hierarchical community models (HCMs) to estimate patch-level estimates of abundance of each species based on sampling plots data that only partially covered the studied patches. We observed 14 wetland species and analyzed them with HCMs. Abandoned farmland patch areas had significant positive effects on the densities of two species. Tree densities and shrub coverage exerted positive and negative effects on some species. Amounts of surrounding wetland/grassland had positive effects on many species. Ensemble of species-level models suggested that 24.7 and 10.6 ha of abandoned farmlands would be needed to harbor a comparable total abundance and species richness in 15-ha wetlands, respectively. These required amounts can be increased/decreased depending on the covariates. The use of HCMs allows us to predict species- and community-level responses under varied conditions based on incomplete sampling data. A quantity of 1.6 times larger areas of abandoned farmlands may be required to restore wetland bird communities in eastern Hokkaido