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Background Transthyretin cardiac amyloidosis (ATTR) has been increasingly recognized in patients with degenerative aortic stenosis (AS). In some reports, the uptake of Tc-99m labeled bone radiotracers in cardiac amyloidosis has been documented. Tc-99m pyrophosphate (PYP) scintigraphy in the absence of evidence of a monoclonal gammopathy was diagnostic for transthyretin cardiac amyloidosis, providing a cost-effective and non-invasive technique with a specificity and positive predictive value of nearly 100%. We sought to determine the prevalence of ATTR as detected by the bone scan tracer among the patients with severe AS requiring surgical valve replacement. Methods We retrospectively analyzed clinical and echocardiographical data for 44 patients with severe AS requiring surgical valve replacement between Jan. 2009 and Dec. 2016. All eligible patients were offered Tc-99m PYP scintigraphy. Retention of Tc-99m PYP in the heart was assessed using both a semiquantitative visual score (range, 0 [no uptake] to 3 [uptake greater than bone]). Positive uptake was defined score 2 and 3. Results Myocardial deposition of Tc-99m PYP (Score 2–3) was identified in 4 of 44 patients (9%), all >70 years and 75% male. Patients with myocardial deposition of the tracer were older (78±8 years vs. 70±12 years), and had more mean interventricular septum thickness (18±3 mm vs. 14±5 mm). Both groups had at least ejection fraction and abnormal global longitudinal strain with no significant difference between groups. Pre-operative serum median NT-pro BNP level was similar between two groups, but post-operative improvement of NT-pro BNP was larger in non-deposition of the tracer group. During the post operative follow-up, survival was significantly worse if patients had amyloid deposition compared with no deposition subjects (25% vs. 7.5%). Conclusion Incidental transthyretin cardiac amyroidosis had a prevelance of 9% among patients undergoing surgical aortic valve replacement and was associated with a poor outcome. Funding Acknowledgement Type of funding source: None

Background Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome with multiple underlying causes. Transthyretin amyloidosis (ATTR) is an underdiagnosed cause of HFpEF. Extraosseous uptake, in particular, myocardial uptake, was observed in a number of ATTR patients examined with the bone scan tracers. Objectives We sought to determine the prevalence of ATTR as detected by the bone scan among the patients admitted due to HFpEF. Methods We screened all consecutive patients ≥60 years old admitted due to HFpEF (left ventricular ejection fraction ≥50%). All eligible patients were offered an echocardiogram and a bone scan (a 99mTc-DPD/MDP/HMDP scintigraphy). Echocardiographic and clinical variables were gathered in all the subjects. The intensity of the myocardial uptake was graded according to a visual scale ranging from 0 to 3 points, in which the absence of uptake was assigned a score of 0 points; uptake less than that of bone (referred to as the adjacent rib), 1 point; uptake similar to that of bone, 2 points; and uptake greater than that of bone, 3 points. The distribution of the uptake in myocardium was defined as focal uptake, diffuse uptake, uptake in a ventricular wall segment, diffuse ventricular uptake, or diffuse biventricular uptake. Results The study included 62 HFpEF patients (52% women, 73±9 years). The bone scintigraphic analysis revealed relatively intense myocardial uptake in 7 of 62 patients (11.2%). 7 patients had intense Tc-99m uptake (score of 2–3) in the cardiac region, showing deposition in both right and left ventricles in every case. Patients with amyloid deposition were older (78±6 vs. 70±12 years, p Conclusion ATTR is an underdiagnosed disease that accounts for a significant number (11.2%) of HFpEF cases. These findings create an opportunity for further investigation in the targeted therapy of patients with HFpEF.

Poster: "EANM 17 / E-PW095 / Myocardial uptake of bone scintigraphic agents associated with cardiac amyloidosis in daily practice" by: "S. Fukuzawa, S. Okino, T. Uchiyama, N. Kuroiwa, Y. Iwata, M. Inagaki; Funabashi Municipal Medical Center, Chiba, JAPAN"

The growth of Cu nanostructures on the hydrogen-terminated Si(111) surface was studied by scanning tunnelling microscopy (STM). On the hydrogen-terminated Si(111) surface, small Cu nanostructures scatter mainly on the terraces and a few structures along the steps and domain boundaries at a deposition temperature of ∼310°C: the shape of the nanostructure is round or triangular, and the face is not clear. At ∼340°C, the Cu nanostructures form preferentially at steps and domain boundaries of the substrate: the shape is triangular with truncated corners and the nanostructures have some facets. The top face has an inclination angle of ∼6° and the side face has one of ∼35°. On the top face, mono-atomic steps can be seen ∼0.8 nm apart. From these results, it is concluded that the Cu nanostructure has a {554} facet on top and a {110} facet on the side. Copyright © 2003 John Wiley & Sons, Ltd.

Preparation, characterization and application of electro-conductive nano-powders of zinc oxide (ZnO) are reported. The aim of the present study is to clarify whether reflection or absorption of near infrared ray (NIR) is effective in the transparent conductive films of zinc oxide. It is shown that, in the case of powder coating films, the NIR is absorbed, while, in the case of physical vapour deposition (PVD) films, the NIR is simultaneously absorbed and reflected. These phenomena suggest any difference in relaxation mechanism of plasma oscillation of carrier electrons between different processes.

386 Xstrain 4d analysis is predictive of left ventricular remodeling after reperfusion therapy in patients with recent non-st-segment elevation myocardial infarction A.D’andrea1;L.Riegler1;E.Di Palma1; F. Martone1; R. Cocchie1; R. Padalino1; R. Calabro’1; PIO. Caso2; MG. Russo1; E. Bossone3 Chair of Cardiology Second University of Naples, Naples Italy, Italy; Vincenzo Monaldi Hospital, Naples, Italy; Policlinico San Donato, San Donato Milanese, Milan, Italy

This paper presents a technique for improving the resolution of complex bandpass /spl Delta//spl Sigma/ADCs which are used for wireless communication systems. Oversampling and noise-shaping are used to achieve high accuracy of a /spl Delta//spl Sigma/AD modulator. However when a multi-bit DAC is used inside a modulator, nonlinearities of the DAC are not noise-shaped and the SNR of the /spl Delta//spl Sigma/ADC degrades. For the conversion of complex intermediate frequency (IF) input signals, a complex bandpass /spl Delta//spl Sigma/AD modulator can provide superior performance to a pair of real bandpass /spl Delta//spl Sigma/AD modulators of the same order. This paper proposes a new noise-shaping algorithm-implemented by adding simple digital circuitry-to reduce the effects of nonlinearities in multi-bit DACs of complex bandpass /spl Delta//spl Sigma/AD modulators. We have performed simulation with MATLAB to verify the effectiveness of the algorithm, and the results show that the proposed algorithm can improve the SNR of a complex bandpass /spl Delta//spl Sigma/ADC with nonlinear internal multi-bit DACs.

IC packaging continues to grow in complexity. The trend to smaller packaging with higher pin counts requires PWB (printed wiring board) technology to keep pace. The current answer to this continuing trend of component micro sizing is the emerging Microvia Technology. At IBIDEN we have dedicated our resources to the study of the technology and process capability of Microvia PWBs. We have achieved this goal by analyzing photo and laser via forming, subtractive and additive patterning and various combinations of base materials that exhibit specific physical characteristics.

A case with multiple liver abscess accompanied by massive portal venous gas is reported. A 61-yr-old male was admitted because of left lower abdominal pain, fever, and diarrhea. Abdominal x-ray examination demonstrated multiple branching lucencies in the liver. Computed tomography revealed multiple liver abscesses and massive gas in the portal system as well as a thickened wall of the sigmoid colon. Enema study using contrast medium revealed a perforation of the sigmoid colon with diverticulitis. The outcome was favorable after sigmoid colectomy in addition to intensive treatment with antibiotics. Bacteroides fragilis, which produces gas (H2 and NH3) by fermentation, was isolated not only from the resected specimen but also from blood samples. Although the presence of portal venous gas is a sign of poor prognosis in patients with intestinal infectious diseases, the sensitive detection of hepatic portal venous gas by computed tomography and the appropriate treatment may improve the patient's prognosis.

In atrial fibrillation, it is known that hemodynamics vary according to the preceding R-R intervals. However, the informations of blood flow dynamics have not been available because of the methodological limitations. In this study, blood flow dynamics of atrial fibrillation were assessed using pulsed Doppler echocardiography. The subjects were 160 consecutive patients with atrial fibrillation and without left ventricular asynergy. Using a commercially-available pulsed Doppler instrument (Aloka SSD-910), blood flow patterns in the left ventricle were investigated from the apical long-axis view. The results were as follows: 1. In 22 of the 160 cases (14%), systolic blood flow in the central or apical region of the left ventricle directed towards the apex (termed "back flow"). 2. In the cardiac cycle with "back flow", the preceding R-R interval was shorter; whereas it was longer when "back flow" was absent (591 +/- 103 vs 817 +/- 179 msec, p less than 0.01). Moreover, when a long R-R interval (PPI) followed by a short R-R interval (PI) was observed (greater PPI/PI ratios), the next beat showed distinct "back flow". 3. Left ventricular ejection fraction decreased significantly in patients with "back flow" compared to those without it (42 +/- 15 vs 66 +/- 12%, p less than 0.01). 4. On left ventriculography, the motion of the base of the heart was preserved; however, with "back flow", the motion of the apical area was abnormal, extending towards the apex along the longitudinal axis. 5. Left ventricular ejection flow at the outflow tract disappeared in 13 of the 22 cases with "back flow" in cardiac cycles with short preceding R-R intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Pulse deficit in patients with atrial fibrillation is caused by the reduction of preload. The purpose of this study was to visualize the mechanism in view of blood flow dynamics using pulsed Doppler echocardiography. The subjects were 15 cases with atrial fibrillation and pulse deficit, and the results were as follows: 1. Simultaneous recordings of the carotid pulse wave (CPW) and blood flow at the left ventricular inflow tract indicated that, in nine of the total 15 cases, CPW disappeared from the cardiac cycle even with sufficient preceding RF in the other six cases (Group B). 2. In Group A, %RF correlated well with %CPW; however, there was poor correlation between them in Group B. Moreover, CPW was always greater than 26% if RF was greater than 50% of each mean value in Group A, but less than 25% in Group B, suggesting poor left ventricular ejection in the latter group. 3. The left ventricular ejection fraction (EF) and %fractional shortening (%FS) decreased significantly in Group B compared to those in Group A (EF; 59 +- 7 vs 41 +- 12%, p less than 0.01, %FS; 31 +- 5 vs 20 +- 6, p less than 0.01). These findings indicate that left ventricular contractility was significantly reduced in the cases with pulse deficit in Group B. 4. Systolic backward flow in the mid-ventricle caused by left ventricular asynchrony due to localized apical wall motion abnormalities was observed in all 15 cases. The heart rate during pulsed Doppler echocardiography was significantly increased in Group A as compared to that in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)

Left ventricular relaxation property was evaluated by pulsed Doppler echocardiography. The indices obtained from Doppler signals within the left ventricle (LV) during the isovolumic relaxation period (IRF) were compared with the hemodynamic parameters obtained from cardiac catheterization studies. Subjects of this study were four patients with hypertrophic cardiomyopathy, four with hypertensive heart disease, three with angina pectoris, and seven normal subjects. All of them had no wall motion abnormalities and their ejection fractions were more than 0.60. The three indices of IRF were the time interval from the start of IRF to the time immediately before the rapid filling flow (isovolumic relaxation time; IRT), the time interval from the start to the peak (acceleration time; AcT), and the slope from the start to the peak (acceleration rate; AcR). The peak pressure (peak P) was measured at the same time. The positive and negative deflections of the first derivative of left ventricular (LV) pressure (+dp/dt and -dp/dt) and the time constant of LV pressure fall (time constant T) were calculated from LV pressure using a micromanometer-tipped angiocatheter. The end-diastolic volume index (EDVI), end-systolic volume index (ESVI), and ejection fraction (EF) were calculated from the LV angiogram. There were no significant correlations between the three IRF indices (IRT, AcT and AcR) and the hemodynamic parameters (peak P, EDVI, +dp/dt and -dp/dt). However, the time constant T, which is a good index of LV relaxation property and which is relatively free from afterload and preload, correlated well with IRT (r = 0.75, p less than 0.001), AcT (r = 0.60, p less than 0.01), and AcR (r = -0.66, p less than 0.01). It was concluded that the indices obtained from the blood flow patterns of the left ventricle during isovolumic relaxation were useful for estimating left ventricular relaxation property non-invasively and quantitatively.

Activity increase of the cytosolic isozyme of thymidine kinase (TK) in resected specimens of lung tumor patients would be a useful marker for tumor malignancy and prognosis. In 24 resected cases of malignant lung tumors, the whole enzyme extracts of the tumorous part of the specimens showed that the activities of TK, thymidylate synthetase, and ribonucleotide reductase increased at an average of 469 (P less than 0.001), 208 (not significant), and 193% (P less than 0.02) of the corresponding enzymes in the tumor-uninvolved lung parts, respectively. Two TK isozymes, cytosolic and mitochondrial TKs, were separated better by means of p-aminophenyl 3'-TMP:CH-Sepharose gel affinity column chromatography for precise quantitation of the activity than by polyacrylamide disc gel electrophoresis. These separated isozymes from the tumorous part of the specimens were characteristically very similar to the isozymes of cytosolic and mitochondrial fractions of the xenograft (CPX-101) of human lung tumor transplanted in athymic nude mice, respectively. The cytosolic isozyme activity isolated by this method from the tumorous part was remarkably higher and more varied than that of the tumor-uninvolved part, while that of the mitochondrial isozyme was lower and less agitated. The tumor doubling time showed a good inverse correlation to the activity of the cytosolic isozyme of TK when compared logarithmically (r = -0.798, P less than 0.01). Poorly differentiated tumors exhibited significantly higher activities of the TK cytosolic isozyme than did well-to-moderately differentiated tumors (766.0 +/- 379.1 and 308.1 +/- 119.5 pmol/mg of protein/h, mean +/- SE, respectively), a phenomenon also seen in the activities of the tumors with versus without recurrences within 12 mo after resection (803.6 +/- 278.7 and 124.1 +/- 42.1 pmol/mg of protein/h, respectively). The levels of these relationships using the cytosolic TK activity provided a clearer indication of prognosis and the state of the malignancy than those using the whole extract TK activity.

There is no noninvasive index to assess the left ventricular relaxation property during the isovolumic relaxation period except for the isovolumic relaxation time, which is derived from M-mode echocardiography or phonocardiography. The intracardiac blood flow can now be precisely observed using pulsed Doppler echocardiography. We evaluated the left ventricular relaxation property and studied the effect of age on the relaxation property using this method. Cardiac catheterization and pulsed Doppler echocardiography were performed for 27 patients with various heart diseases, none of whom had wall motion abnormalities on left ventriculography, to determine the relationships between invasive and noninvasive parameters. The effects of age were examined in 25 normal healthy persons ranging in age from 26 to 69 years. In all cases, the intracardiac blood flow during the isovolumic relaxation period (isovolumic relaxation flow) as obtained by pulsed Doppler echocardiography was laminar, and directed from the base toward the apex of the left ventricle. The duration of this flow (the time interval from the beginning to the end of this flow; IRT), the acceleration time (the time interval from the beginning to the peak velocity; ACT) and the acceleration rate (the slope of the beginning to the peak velocity; AcR) were measured, and IRT, ln AcT (natural logarithm of AcT) and ln AcR (natural logarithm of AcR) were compared with the parameters obtained by cardiac catheterization. The time constant T of the fall in left ventricular pressure during the isovolumic relaxation period, which was proposed as an index of the left ventricular relaxation property, correlated well with IRT (r = 0.82, p less than 0.001), ln AcT (r = 0.69, p less than 0.001) and ln AcR (r = -0.77, p less than 0.001), but there were no significant correlations with maximum blood pressure, left ventricular ejection fraction, maximal positive dp/dt or the left ventricular end-diastolic volume index. Age and these three Doppler indexes in normal healthy persons correlated significantly as follows; IRT (r = 0.80, p less than 0.001), ln AcT (r = 0.60, p less than 0.001) and ln AcR (r = -0.61, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

We have already reported that, in atrial fibrillation (Af) "back flow" in the left ventricular (LV) central or apical area may occur in the cardiac cycle with a short preceding R-R interval, especially in cases with impaired LV pump function. This abnormal flow was considered to be caused by LV asynchrony. Analysis of LV wall motion abnormalities, however, is a less established procedure. The purpose of the present study was to clarify the relationship between LV blood flow dynamics and LV wall motion using pulsed Doppler echocardiography and left ventriculography. The results were as follows: 1. In seven of 15 cases "back flow" was observed in the LV central or apical area. 2. On left ventriculography in the seven cases, the apical area showed a backward movement in a longitudinal direction in the cardiac cycle with a short preceding R-R interval. 3. The % shortening of the long-axis dimension was significantly decreased in the seven cases with back flow, and three of them had negative values. 4. Ejection fractions (EF) of both the apical and basal halves were significantly decreased in cases with back flow, and the difference in the ejection rate of the apical and basal halves tended to decrease in cases with back flow. 5. LVEF was also significantly decreased in the cases with back flow. These results indicate that left ventricular "back flow" observed in Af is caused by the LV asynchrony due to localized wall motion abnormalities in the apical area.

Cardiac function at the time of ventricular premature contractions (VPC) is influenced by the coupling interval or the site of those origin. Clinical and experimental studies of the effects of VPC on intracardiac pressure dynamics have been performed; however, little is known about left ventricular blood flow dynamics. This study was attempted to determine the characteristics of blood flow dynamics in respect to the site of origin of VPC using pulsed Doppler echocardiography. The subjects consisted of 18 cases with VPC but without apparent organic heart disease. Seven cases had VPCs with a left bundle branch block pattern suggesting possible origin in the right ventricle. The other 11 cases had VPCs with a right bundle branch block pattern indicating the left ventricular origin. With the probe in the apical position, the blood flow patterns of the left ventricular outflow, central and inflow tracts were examined. The results were as follows; 1. Except for one case with shortened coupling interval, all six cases with VPCs originated from the right ventricle showed preservation of left ventricular ejection flow. 2. In two of the three cases with VPC which originated from the left ventricle and with left axis deviation, systolic flow in the left ventricular central area showed "back flow" to the apex. Ejection flow at the outflow tract was markedly diminished or disappeared in all three cases. 3. In all eight cases with VPC which originated from the left ventricle and with right axis deviation, ejection flow was slightly disturbed both in the left ventricular outflow and in the central area. 4. Ejection flow volume assessed by velocity integral indicated similar dynamics as did the ejection flow velocity. 5. In left ventriculography, asynchrony due to dyskinetic motion of the anteroapical wall was observed at the times of VPCs with left axis deviation. In conclusion, the patterns of left ventricular ejection flow dynamics depend on the site of origin of VPCs. This disturbed flow is more apparent in VPCs originating from the left ventricle compared to the right ventricle. This is especially true in cases with left axis deviation, in which VPCs arise from the posterior site of the left ventricle.