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Indwelling urethral catheters (IUCs) are used to measure urine volume, keep patients on bed rest, or keep the groin area clean in patients with acute myocardial infarction (AMI). However, the association between IUC use and in-hospital urinary-related complications is unknown.This was a single-center retrospective analysis of 303 patients admitted to our hospital in 2018-2020 who had AMI without cardiogenic shock. An IUC was inserted in the emergency room upon initiation of invasive catheter treatment and removed as soon as possible. The primary outcome was in-hospital adverse urinary event (IHAUE), which consisted of in-hospital urinary tract infection and in-hospital gross hematuria.Of 303 patients, 243 patients (80.2 %) underwent IUC insertion. A lower proportion of patients with IUCs were male (72 % vs. 85 %, p = 0.044). A higher proportion had Killip classification 2 or 3 (13 % vs. 0 %, p = 0.003) or ST-elevation myocardial infarction (65 % vs. 32 %, p 0.001). IHAUEs occurred significantly more commonly in patients with IUCs than without IUCs (11 % vs. 2 %, p = 0.023). Kaplan-Meier analysis showed that IHAUEs occurred more frequently in patients with IUCs than patients without IUCs (log-rank test p = 0.033). Furthermore, IUC use longer than the median of 2 days was associated with a higher odds ratio (OR) for IHAUE when compared with those without IUC use (OR, 3.65; 95 % confidence interval, 1.28-10.4; p = 0.015). There were no significant differences in in-hospital mortality by IUC status.IUC use is associated with a higher risk of IHAUEs in patients with uncomplicated AMI. Routine IUC use might not be recommended.

Active cancer associates with increased cardiovascular and bleeding risks in patients with acute myocardial infarction (AMI). Recent chemotherapeutic agents have improved survival rate which enables to induce inactive status of cancer. However, whether cardiovascular and bleeding risks still exist in AMI patients with inactive cancer remains unknown.The current study is a retrospective cross-sectional study including 712 AMI patients receiving primary percutaneous coronary intervention (PCI) with drug-eluting stent between 2007 and 2017. Primary PCI in ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction subjects was defined as PCI performed within 48 and 72 hours of symptom onset, respectively. Cardiovascular (= all-cause death + non-fatal MI + stroke) and bleeding events were compared in AMI patients with and without inactive cancer.Inactive cancer was identified in 11.1% of study subjects. Patients with inactive cancer were older (P0.001) with atrial fibrillation (P0.001), chronic kidney disease (P0.001), anemia (P0.001) and a higher prevalence of Killip class IV (P0.001). Dual (82.3%Inactive cancer worsened clinical outcome, especially bleeding risks in AMI subjects, underscoring to further optimize their antithrombotic managements.

Background: Intravascular imaging has shown better response of coronary atheroma to statin-mediated lowering of low-density lipoprotein cholesterol in women. However, its detailed mechanism remains to be determined yet. Modifiability of coronary atheroma under lipid-lowering therapies is partly driven by lipidic plaque component. Given a smaller plaque volume in women, lipidic plaque features including their density may differ between sex. Therefore, the current study sought to characterize sex-related differences in the density of lipidic plaque. Methods: We analyzed 1429 coronary lesions (culprit/nonculprit lesions=825/604) in 758 coronary artery disease patients (men/women=608/150) from the REASSURE-NIRS multicenter registry (Revelation of Pathophysiological Phenotypes of Vulnerable Lipid-Rich Plaque on Near-Infrared Spectroscopy). Total atheroma volume at 4-mm segment, maximum 4-mm-lipid-core burden index, and lipid plaque density index (=maximum 4-mm-lipid-core burden index/total atheroma volume at 4-mm segment) on near-infrared spectroscopy/intravascular ultrasound imaging at culprit and nonculprit lesions were compared in men and women. Results: Statin and high-intensity statin were used in 72.4 ( P =0.81) and 22.9% ( P =0.32) of study subjects, respectively. Women exhibited a smaller adjusted total atheroma volume at 4-mm segment (culprit lesions: 50.3±0.4 versus 54.2±0.3mm 3 , P 3 , P P =0.11, nonculprit lesions: 288.8±26.7 versus 272.7±18.9, P =0.51). Furthermore, a greater adjusted lipid plaque density index was observed in women (culprit lesions: 18.2±0.9 versus 9.8±0.6, P P Conclusions: Women harbored greater condensed lipidic plaque features, accompanied by smaller atheroma volume. These observations indicate potentially better modifiable disease in women, which underscores the need to intensify their lipid-lowering therapies for further improving their outcomes. Registration: URL: https://www.clinicaltrials.gov/ ; Unique identifier: NCT04864171

Background Retiform hemangioendothelioma (RH) is a rare, intermediate-grade vascular tumor that often arises in the trunk and extremities. The clinical and radiological features of RH remain largely unknown. Case presentation A male patient in his 70s presented with shortness of breath on exertion, and computed tomography incidentally revealed a tumor in his right breast. Positron emission tomography (PET) revealed moderate 18F-fluorodeoxyglucose (FDG) uptake in the tumor. RH was observed in the resected specimens. Three months after surgery, the patient was free of local recurrence and distant metastasis. Conclusions RH was found in the male breast and was accompanied by FDG uptake on PET. PET may be useful in diagnosing RH. Although metastasis is rare in RH, local recurrence may occur, and careful follow-up is required.

BACKGROUND Acute myocardial infarction (AMI) patients with low body mass index (BMI) exhibit worse clinical outcomes than obese patients; however, to our knowledge, no prospective, nationwide study has assessed the effect of BMI on the clinical outcomes of AMI patients.Methods and Results:In this multi-center, prospective, nationwide Japanese trial, 2,373 AMI patients who underwent emergent percutaneous coronary intervention within 12 h of onset from the Japanese AMI Registry (JAMIR) were identified. Patients were divided into the following 4 groups based on their BMI at admission: Q1 group (BMI

Silicon and Strontium are key elements to explore the nucleosynthesis and chemical evolution of the Galaxy by measurements of very metal-poor stars. There are, however, only a few useful spectral lines of these elements in the optical range that are measurable for such low-metallicity stars. Here we report on abundances of these two elements determined from near-infrared high-resolution spectra obtained with the Subaru Telescope Infrared Doppler instrument (IRD). Si abundances are determined for as many as 26 Si lines for six very and extremely metal-poor stars (-4.0, Comment: 3 figures, 6 tables, PASJ, in press

Active M-type stars are known to often produce superflares on the surface. Radiation from stellar (super-)flares is important for the exoplanet habitability, but the mechanisms are not well understood. In this paper, we report simultaneous optical spectroscopic and photometric observations of a stellar superflare on an active M dwarf YZ CMi with the 3.8-m Seimei telescope and the $Transiting\, Exoplanet\, Survey\, Satellite$. The flare bolometric energy was $1.3^{+1.6}_{-0.6} \times 10^{34} \,\rm{erg}$ and H$\alpha$ energy was $3.0^{+0.1}_{-0.1} \times 10^{32} \,\rm{erg}$. The H$\alpha$ emission line profile showed red asymmetry throughout the flare with a duration of $4.6-5.1 \,\rm{hrs}$. The velocity of the red asymmetry was $\sim 200-500 \,\rm{km\,s^{-1}}$ and line width of H$\alpha$ was broadened up to $34 \pm 14$ $\r{A}$. The redshifted velocity and line width of H$\alpha$ line decayed more rapidly than the equivalent width, and their time evolutions are correlated with that of the white-light emission. This indicates a possibility that the white light, H$\alpha$ red asymmetry, and H$\alpha$ line broadening originate from nearly the same site, i.e., the dense chromospheric condensation region heated by non-thermal electrons. On the other hand, the flux ratio of the redshifted excess components to the central components is enhanced one hour after the flare onset. This may be due to the change of the main source of the red asymmetry to the post-flare loops in the later phase of the flare., Comment: 13 pages, 5 figures. Accepted for publication in The Astrophysical Journal

Background Acute myocardial infarction (AMI) infrequently occurs after acute stroke. The Heart‐brain team approach has a potential to appropriately manage this poststroke cardiovascular complication. However, clinical outcomes of AMI complicating acute stroke (AMI‐CAS) with the heart‐brain team approach have not been characterized. The current study investigated cardiovascular outcomes in patients with AMI‐CAS managed by a heart‐brain team. Methods and Results We retrospectively analyzed 2390 patients with AMI at our institute (January 1, 2007–September 30, 2020). AMI‐CAS was defined as the occurrence of AMI within 14 days after acute stroke. Major adverse cerebral/cardiovascular events (cardiac‐cause death, nonfatal myocardial infarction, and nonfatal stroke) and major bleeding events were compared in subjects with AMI‐CAS and those without acute stroke. AMI‐CAS was identified in 1.6% of the subjects. Most AMI‐CASs (37/39=94.9%) presented ischemic stroke. Median duration of AMI from the onset of acute stroke was 2 days. Patients with AMI‐CAS less frequently received primary percutaneous coronary intervention (43.6% versus 84.7%; P P P P P =0.009). These relationships still existed even after adjusting for clinical characteristics and medication use (major adverse cerebral/cardiovascular event: HR, 1.87 [95% CI, 1.02–3.42]; P =0.04; major bleeding: HR, 2.67 [95% CI, 1.03–6.93]; P =0.04). Conclusions Under the heart‐brain team approach, AMI‐CAS was still a challenging disease, reflected by less adoption of primary percutaneous coronary intervention and antithrombotic therapies, with substantially elevated cardiovascular and major bleeding risks. Our findings underscore the need for a further refined approach to mitigate their ischemic/bleeding risks.

Solar flares are often accompanied by filament/prominence eruptions (~10⁴ K and ~10¹⁰⁻¹¹ cm⁻³), sometimes leading to coronal mass ejections that directly affect the Earth’s environment. ‘Superflares’ are found on some active solar-type (G-type main-sequence) stars, but the filament eruption–coronal mass ejection association has not been established. Here we show that our optical spectroscopic observation of the young solar-type star EK Draconis reveals evidence for a stellar filament eruption associated with a superflare. This superflare emitted a radiated energy of 2.0 × 10³³ erg, and a blueshifted hydrogen absorption component with a high velocity of −510 km s⁻¹ was observed shortly afterwards. The temporal changes in the spectra strongly resemble those of solar filament eruptions. Comparing this eruption with solar filament eruptions in terms of the length scale and velocity strongly suggests that a stellar coronal mass ejection occurred. The erupted filament mass of 1.1 × 10¹⁸ g is ten times larger than those of the largest solar coronal mass ejections. The massive filament eruption and an associated coronal mass ejection provide the opportunity to evaluate how they affect the environment of young exoplanets/the young Earth6 and stellar mass/angular momentum evolution., 太陽型星のスーパーフレアから噴出する巨大フィラメントを初検出 --昔の、そして今の惑星環境や文明に与える脅威--. 京都大学プレスリリース. 2021-12-10.

Although a door-to-balloon (D2B) time ≤90 min is recognized as a key indicator of timely reperfusion for patients with ST-segment elevation myocardial infarction (STEMI), it is unclear whether regional disparities in the prognostic value of D2B remain in contemporary Japan.Methods and Results: We retrospectively analyzed 17,167 STEMI patients (mean [±SD] age 68±13 years, 77.6% male) undergoing primary percutaneous coronary intervention. With reference to the Japanese median population density of 1,147 people/kmThese data suggest that there is a substantial rural-urban gap in the prognostic significance of D2B time among STEMI patients, especially those with cardiogenic shock and a prolonged D2B time.

Background Although screening for coronary artery disease (CAD) using computed tomography coronary angiography in patients with stable chest pain has been reported to be beneficial, patients with chronic kidney disease (CKD) might have limited benefit due to complications of contrast agent nephropathy and decreased diagnostic accuracy as a result of coronary artery calcifications. Cardiac magnetic resonance (CMR) has emerged as a novel imaging modality for detecting coronary stenosis and high-risk coronary plaques without contrast media that is not affected by coronary artery calcification. However, the clinical use of this technology has not been robustly evaluated. Methods AQUAMARINE-CKD is an open parallel-group prospective multicenter randomized controlled trial of 524 patients with CKD at high risk for CAD estimated based on risk factor categories for a Japanese urban population (Suita score) recruited from 6 institutions. Participants will be randomized 1:1 to receive a CMR examination that includes non-contrast T1-weighted imaging and coronary magnetic angiography (CMR group) or standard examinations that include stress myocardial scintigraphy (control group). Randomization will be conducted using a web-based system. The primary outcome is a composite of cardiovascular events at 1 year after study examinations: all-cause death, death from CAD, nonfatal myocardial infarction, nonfatal ischemic stroke, and ischemia-driven unplanned coronary intervention (percutaneous coronary intervention or coronary bypass surgery). Discussion If the combination of T1-weighted imaging and coronary magnetic angiography contributes to the risk assessment of CAD in patients with CKD, this study will have major clinical implications for the management of patients with CKD at high risk for CAD. Trial registration Japan Registry of Clinical Trials (jRCT) 1,052,210,075. Registered on September 10, 2021.

Synthetic silicone rubbers are finding a broad spectrum of applications, yet there is a demand for developing greener silicone rubbers with processability, recyclability, and reversible tunability in their mechanical properties. Here, a recyclable photorheological silicone fluid (RPSF) is developed, which realizes completely reversible wavelength-selective liquid-rubber conversion upon photoirradiation, relying on the reversible photocycloaddition of coumarin upon alternating irradiation of light with wavelengths of 365 (UV

We present homogeneous abundance analysis of over 20 elements for 385 very metal-poor (VMP) stars based on the LAMOST survey and follow-up observations with the Subaru Telescope. It is the largest high-resolution VMP sample (including 363 new objects) studied by a single program, and the first attempt to accurately determine evolutionary stages for such a large sample based on Gaia parallaxes. The sample covers a wide metallicity range from [Fe/H]=-1.7 down to [Fe/H]=-4.3, including over 110 objects with [Fe/H] 0.7) is in the range of 20-30% for turn-off stars depending on the treatment of objects for which C abundance is not determined, which is much higher than that in giants (~8%). Twelve Mg-poor stars ([Mg/Fe] < 0.0) have been identified in a wide metallicity range from [Fe/H] =-3.8 through -1.7. Twelve Eu-rich stars ([Eu/Fe]> 1.0) have been discovered in -3.4, 66 pages, 28 figure, 8 tables, to appear in ApJ

Aims Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with substantial mortality, although there are limited data available on bleeding in this critical condition. This study sought to investigate the incidence and impact of major in-hospital bleeding on all-cause mortality in patients with AMICS who undergo percutaneous coronary intervention (PCI). Methods and results Between 2015 and 2017, a total of 3411 patients hospitalized within 24 h after symptom onset were prospectively enrolled in the Japan Acute Myocardial Infarction Registry (JAMIR) and followed up for a median of 293 (interquartile range, 22–375) days. AMICS developed in 335 (9.8%) patients (mean age, 71.3 ± 13.6 years). Overall, the rate of major in-hospital bleeding (Bleeding Academic Research Consortium types 3 and 5) and in-hospital mortality was 14.6% and 28.7%, respectively. The majority of major in-hospital bleeding (73.5%) occurred within 48 h after PCI. Compared to patients without major in-hospital bleeding, those with it had higher rates of renal failure, left main coronary artery culprit lesion, and intra-aortic balloon pump or extracorporeal membrane oxygenation support, and had longer door-to-device time. The cumulative incidence of 1-year all-cause mortality was significantly higher in the major bleeding group compared to the non-major bleeding group (63.8% vs. 25.5%; log-rank P Conclusions These findings of JAMIR indicate that major in-hospital bleeding is associated with all-cause mortality in patients with AMICS who undergo PCI.

Starspots and stellar flares are indicators of stellar magnetic activity.The magnetic energy stored around spots is thought to be the origin of flares, but the connection is not completely understood. To investigate the relation between spot locations deduced from the light curves and occurrence of flares therein, we perform starspot modeling for TESS light curves of three M-dwarf flare stars, AU Mic, YZ CMi, and EV Lac, using the code implemented in Paper I. The code enables to deduce multiple stellar/spot parameters by the adaptive parallel tempering algorithm efficiently. We found that flare occurrence frequency is not necessarily correlated with the rotation phases of the light curve for each star. The result of starspot modeling shows that either spot is always visible to the line of sight in all phases, and we suggest that this can be one of the reasons that there is no or less correlation between rotation phases and flare frequency. In addition, the amplitude and shape of the light curve for AU Mic and YZ CMi have varied in two years between different TESS Cycles. The result of starspot modeling suggests that this can be explained by the variations of spot size and latitude., Comment: 42 pages, 19 figures, 7 tables, accepted for publication in ApJ

Stellar coronal mass ejections (CMEs) have recently received much attention for their impacts on exoplanets and stellar evolution. Detecting prominence eruptions, the initial phase of CMEs, as the blueshifted excess component of Balmer lines is a technique to capture stellar CMEs. However, most of prominence eruptions identified thus far have been slow and less than the surface escape velocity. Therefore, whether these eruptions were developing into CMEs remained unknown. In this study, we conducted simultaneous optical photometric observations with Transiting Exoplanet Survey Satellite and optical spectroscopic observations with the 3.8 m Seimei Telescope for the RS CVn-type star V1355 Orionis that frequently produces large-scale superflares. We detected a superflare releasing 7.0 × 10³⁵ erg. In the early stage of this flare, a blueshifted excess component of Hα extending its velocity up to 760–1690 km s⁻¹ was observed and thought to originate from prominence eruptions. The velocity greatly exceeds the escape velocity (i.e., ∼350 km s⁻¹), which provides important evidence that stellar prominence eruptions can develop into CMEs. Furthermore, we found that the prominence is very massive (9.5 × 10¹⁸ g < M < 1.4 × 10²¹ g). These data will clarify whether such events follow existing theories and scaling laws on solar flares and CMEs even when the energy scale far exceeds solar cases., 史上最大質量の超高速恒星プロミネンス噴出 --せいめい望遠鏡が捉えた極限宇宙天気現象--. 京都大学プレスリリース. 2023-04-28., Superflare with Massive, High-Velocity Prominence Eruption. 京都大学プレスリリース. 2023-04-28.

Calcified nodule (CN) is an eruptive calcified mass causing acute coronary syndrome (ACS). Since coronary calcification is associated with an elevated cardiac event's risk, ACS attributable to CN may exhibit worse clinical outcome following percutaneous coronary intervention (PCI).We retrospectively analyzed 657 ACS patients receiving PCI with newer-generation drug-eluting stent (DES) implantation under intravascular ultrasound (IVUS) guidance. CN was defined as (1) protruding calcification with its irregular surface and (2) the presence of calcification at adjacent proximal and distal segments. The primary endpoint was a composite of major adverse cardiac event [MACE = cardiac death + ACS recurrence + target lesion revascularization (TLR)].CN was identified in 5.3% (=35/657) of the study subjects. CN patients were more likely to have coronary risk factors including hypertension (p = 0.005), chronic kidney disease (p 0.001), maintenance hemodialysis (p 0.001) and a history of PCI (p 0.001). During the observational period (median = 1304 days), CN was associated with an increased risk of MACE (HR = 7.68, 95%CI = 4.61-12.80, p 0.001), ACS recurrence (HR = 12.32, 95%CI = 6.05-25.11, p 0.001) and TLR (HR = 10.48, 95%CI = 5.80-18.94, p 0.001). These cardiac risks related to CN were consistently observed by Cox proportional hazards model (MACE: p 0.001, ACS recurrence: p 0.001, TLR: p 0.001) and a propensity score-matched cohort analysis (MACE: p = 0.002, ACS recurrence: p = 0.01, TLR: p = 0.005). Of note, over 80% of TLR at the CN lesion was driven by its re-appearance within the implanted DES.ACS patients attributable to CN have an increased risk of ACS recurrence and TLR, mainly driven by the continuous growth and protrusion of the calcified mass.

Designing stimuli-responsive polymers derived from reversibly cleavable main chains provides a strategy for fabricating smart materials with responsive properties and functions upon desired stimuli. Herein, we report the synthesis of reversibly photocleavable pseudo-ladder polymers (PPLPs). These polymers consist of stiff ladder and reversibly cleavable hexaarylbiimidazole (HABI) backbone linkages to enable molecular weight control of PPLPs upon photoirradiation. Moreover, the concept has been successfully extended to the synthesis of amphiphilic graft copolymers with PPLP main chains and poly(ethylene oxide) side chains. Self-assembly of these graft copolymers in H2O afforded spherical micelles with ca. 100–200 nm in diameter, and interestingly, the size of these micelles doubled upon photoirradiation.

The distal radial approach (DRA) is a novel catheter cannulation technique to access the distal radial artery for coronary angiography (CAG). It is associated with less occurrence of puncture site occlusion than the conventional transradial approach. However, cannulation failure occasionally occurs due to difficulty in puncturing the smaller distal radial artery. Nitroglycerin is expected to improve the rate of successful DRA via its vasodilative and vasospasm-preventive effects.The DRA in CAG using transdermal NitroGlycerin patch (DRANG) study is a single-center, double-arm, parallel-assignment, double-blinded, randomized, controlled trial. Eligible patients with angina pectoris who are scheduled to receive CAG via DRA at the National Cerebral and Cardiovascular Center will be enrolled and allocated to the nitroglycerin group (n = 46) or the no-treatment group (n = 46). The nitroglycerin group will receive a transdermal nitroglycerin patch pre-integrated with a covering material that completely conceals the patch on their upper arm on the puncture side. The no-treatment group will receive only the covering material. Applications are performed 2-8 h before puncture while the patient wears an eye mask. Physicians who are blinded to the allocation and have similar experience with DRA puncture will perform DRA using the Seldinger technique with a 22-gauge needle. The primary outcome is the rate of successful palpation-guided distal radial artery cannulation with the first puncture. The secondary outcomes are the rate of successful distal radial artery cannulation, number of punctures, procedure time, use of ultrasound guidance, diameter of the distal radial artery and changes before and after patch application, and occurrence of arterial vasospasm, occlusion, or hypotension.This study will allow us to determine the impact of a transdermal nitroglycerin patch on the rate of successful DRA and validate its effectiveness as a DRA pretreatment.jRCTs051210128.

The purpose of this study was to investigate the occurrence rate and predictors of photodynamic therapy (PDT) induced acute exudative maculopathy (PAEM). This retrospective study included 39 eyes of 39 patients (32 males and 7 females), who were treated with initial PDT. PAEM was defined as an increase in central retinal thickness (CRT) of 10% or more measured by OCT on day 3 after PDT compared with baseline. Sixteen of 39 eyes (41%) were classified in the PAEM+ group. CRT and central choroidal thickness (CCT) were significantly increased at 3 days in the PAEM+ group and significantly decreased at 1 month after PDT in the PAEM- group. In a multiple comparison, neovascular age-related macular degeneration (nAMD) had a significantly higher incidence of PAEM compared to polypoidal choroidal vasculopathy (PCV) and central serous chorioretinopathy (CSC). The incidence of PAEM was lower in PCV and CSC, and higher in nAMD. BCVA at 1 month was significantly worse in the PAEM group, which may be related to visual prognosis after PDT. Since both CRT and CCT decrease at 1 month, the detection of PAEM needs to be assessed a few days after PDT.

Background: The prognostic significance of urinary N-acetyl-β-D-glucosamidase in acute heart failure has not been fully elucidated. Accordingly, this study investigated whether urinary N-acetyl-β-D-glucosamidase could be associated with subsequent adverse events in acute heart failure patients. Methods: We studied 708 consecutive acute heart failure patients who had accessible N-acetyl-β-D-glucosamidase data on admission from the National Cerebral and Cardiovascular Center Acute Decompensated Heart Failure registry. We assessed the relationship between the admission N-acetyl-β-D-glucosamidase level and the combined endpoint of all-cause death and worsening heart failure. Worsening heart failure was defined as worsening symptoms and signs of heart failure requiring intensification of intravenous therapy such as diuretics, vasodilators and inotropes or initiation of mechanical support after stabilisation with initial treatment during hospitalisation, or readmission due to heart failure after discharge. Results: During a median follow-up period of 763 (interquartile range 431–1028) days, higher urinary N-acetyl-β-D-glucosamidase was significantly related to increased events of all-cause death and worsening heart failure. In addition, patients with higher urinary N-acetyl-β-D-glucosamidase and lower estimated glomerular filtration rate on admission had the worst clinical outcomes. In multivariable Cox regression, urinary N-acetyl-β-D-glucosamidase on admission was independently associated with adverse events (hazard ratio 1.19, 95% confidence interval 1.04–1.35) even after adjustment by covariates including the baseline estimated glomerular filtration rate. Conclusions: Higher urinary N-acetyl-β-D-glucosamidase level on admission was independently associated with worse clinical outcomes. Our findings indicate the potential value of assessing urinary N-acetyl-β-D-glucosamidase on admission for further risk stratification in patients with acute heart failure.

Background:Acid-base balance can change as a result of pulmonary oedema and low tissue perfusion in acute heart failure patients. However, its long-term prognostic significance remains to be clarified.Methods:We prospectively examined a cohort of 472 consecutive acute heart failure patients who underwent arterial blood gas analysis on admission between January 2013 and May 2016. Acidaemia, alkalaemia and normal range of base excess were defined as pH 7.42 and −2 to 2 mEq/L, respectively. The primary outcome was all-cause death.Results:During a median follow-up period of 714 days, 101 patients died. Although there was no difference in mortality among patients with acidaemia, normal pH and alkalaemia (p = 0.92), patients with high base excess had the highest mortality compared with others. Multivariable Cox proportional hazard models revealed that high base excess was an independent determinant of mortality (hazard ratio 1.83, 95% confidence interval 1.08–3.13 (high versus normal base excess), hazard ratio 0.81, 95% confidence interval 0.47–1.41 (low versus normal base excess)), even after adjustment for significant prognostic covariates. Furthermore, regarding mortality stratified by base excess and carbon dioxide partial pressure (pCO2), patients with high base excess (>2.1 mEq/L) and high pCO2 (>40 mmHg) had the highest mortality compared with others.Conclusions:High base excess, but not low base excess, on admission was associated with long-term mortality in acute heart failure patients, indicating the importance of evaluating acid-base balance on admission by base excess for stratifying the risk of mortality in patients with acute heart failure.

To address many uncertainties in the acute care of patients with acute myocardial infarction (AMI) in proportion to increasing age, we underwent the nationwide current survey consisted of 11,676 patients with AMI based on the database of the Japanese Acute Myocardial Infarction Registry between January 2011 and December 2013 to figure out how difference of clinical profiles and outcomes between coronary revascularization and conservative treatments for AMI. Clinical profiles in a total of 763 patients with AMI with conservative treatments (7% of all) were characterized as more elderly women (median age, 71 yeas vs. 68 years, p

Purpose To describe the immunohistochemical profile in a case with focal nodular gliosis (FNG) of the retina. Methods A 56-year-old female patient presented with vitreoretinal tractional syndrome with FNG of the retina. After resection of the retinal tumor tissue during the 25-G pars plana vitrectomy, immunohistochemistry using anti-epidermal growth factor receptor (EGFR), p-53, Ki67, glial fibrillary acid protein (GFAP), CD34, and vascular endothelial growth factor antibodies was performed in the excised tissue of the FNG of the retina. Results Histopathological analysis of the tumor led to a diagnosis of FNG of the retina. Spindle cells of the tumor exhibited strong positive staining for glial fibrillary acid protein, and there was local staining for CD34 in the endothelial cells in the blood vessels. The epidermal growth factor receptor and vascular endothelial growth factor immunoreactivity were strongly observed in the endothelial cells. Conclusion This study demonstrated epidermal growth factor receptor expression in eyes with FNG of the retina. Oncogenic epidermal growth factor receptor might trigger and amplify the expression and function of endothelial vascular endothelial growth factor.

Recovery of copper was attempted from municipal waste incineration ashes using acid extraction and electrodeposition by a flow-through type electrolysis cell (FE). Efficient extraction of copper from the incineration ash was obtained using 0.5 mol L-1 sulfuric acid, i.e., copper extraction rate: 78% from bottom ash and 88% from fly ash. The copper in the 10-fold diluted extractant injected into the FE was quantitatively adsorbed by applying -0.4 V and was quantitatively desorbed by eluting with nitric acid.

Lipid-rich plaque is an important substrate that causes future coronary events. However, the clinical implications of underlying plaque characteristics in coronary lesions after newer-generation drug-eluting stent (DES) implantation remain unknown.The current study analyzed 445 target lesions after newer-generation DES implantation in 416 patients with coronary artery disease (CAD) (chronic coronary syndrome/acute coronary syndrome = 264/181) from the REASSURE-NIRS multicentre registry. Near-infrared spectroscopy (NIRS) imaging was used to evaluate maximum lipid core burden index after stent implantation in target lesions (residual maxLCBIMedian residual maxLCBIResidual maxLCBI

Previous studies have reported that acute myocardial infarction (AMI) related to left anterior descending (LAD) lesion is associated with worse outcomes than left circumflex artery (LCX) or right coronary artery (RCA) lesions. However, it is unknown whether those relationships are still present in the contemporary era of primary percutaneous coronary intervention (PCI), using newer generation drug-eluting stents and potent antiplatelet agents.Methods and Results:This study is a sub-analysis of the Japan AMI Registry (JAMIR), a multicenter, prospective registry enrolling 3,411 AMI patients between December 2015 and May 2017. Among them, 2,780 patients undergoing primary PCI for only a culprit vessel were included and stratified based on infarction-related artery type (LAD, LCX, and RCA). The primary outcome was 1-year cardiovascular death. The overall incidence of cardiovascular death was 3.4%. Patients with LAD infarction had highest incidence of cardiovascular death compared to patients with LCX and RCA infarction (4.8%, 1.3%, and 2.4%, respectively); however, landmark analysis showed that culprit vessel had no significant effect on cardiovascular death if a patient survived 30 days after primary PCI. LAD lesion infarction was an independent risk factor for cardiovascular death in adjusted Cox regression analysis.The present sub-analysis of the JAMIR demonstrated that LAD infarction is still associated with worse outcomes, especially during the first 30 days, even in the contemporary era of PCI.

The chemical abundances of very metal-poor stars provide important constraints on the nucleosynthesis of the first generation of stars and early chemical evolution of the Galaxy. We have obtained high-resolution spectra with the Subaru Telescope for candidates of very metal-poor stars selected with a large survey of Galactic stars carried out with LAMOST. In this series of papers, we report on the elemental abundances of about 400 very metal-poor stars and discuss the kinematics of the sample obtained by combining the radial velocities measured in this study and recent astrometry obtained with Gaia. This paper provides an overview of our survey and follow-up program, and reports radial velocities for the whole sample. We identify seven double-lined spectroscopic binaries from our high-resolution spectra, for which radial velocities of the components are reported. We discuss the frequency of such relatively short-period binaries at very low metallicity., Comment: 24 pages, 9 figures, 5 tables, to appear in ApJ

We present our spectroscopic observations of V455 Andromedae during the 2007 superoutburst. Our observations cover this superoutburst from around the optical peak of the outburst to the post-superoutburst stage. During the early superhump phase, the emission lines of Balmer series, He I, He II, Bowen blend, and C IV / N IV blend were detected. He II 4686 line exhibited a double-peaked emission profile, where Balmer emission lines were single-peaked, which is unexpected from its high inclination. In the ordinary superhump phase, Balmer series transitioned to double-peaked emission profiles, and high-ionization lines were significantly weakened. These transitions of the line profiles should be related to the structural transformation of the accretion disk, as expected between the early and ordinary superhump transition in the thermal-tidal instability model. The Doppler map of H$\alpha$ during the early superhump phase exhibits a compact blob centered at the primary white dwarf. In analogy to SW Sex-type cataclysmic variables, this feature could emerge from the disk wind and/or the mass accretion column onto the magnetized white dwarf. The Doppler map of He II 4686 \AA~ is dominated by the ring-like structure and imposed two flaring regions with the velocity of $\sim$300 km/s, which is too slow for a Keplerian accretion disk. The phase of the flaring regions was coincident with the inner spiral arm structure identified during the early superhump phase. Our disk wind model with the enhanced emission from the inner arm structure successfully reproduced the observed properties of He II 4686 \AA. Therefore, V455 And is the first case in dwarf nova outbursts that the presence of the disk wind is inferred from an optical spectrum., Comment: 19 pages, 11 figures, 3 tables, accepted for publication in PASJ

Background: Acute coronary syndrome (ACS) due to an unprotected left main coronary artery (LMCA) lesion is a critical condition, but there are limited data available on in-hospital outcomes of percutaneous coronary intervention (PCI). Methods and Results: The Japan Acute Myocardial Infarction Registry is a nationwide, real-world database. The clinical data on 13,548 ACS patients hospitalized between January 2011 and December 2013 were retrospectively collected from 10 representative regional ACS registry groups. We compared the 404 patients (3.0%) with LMCA ACS with the remaining 13,144 patients with non-LMCA ACS. The LMCA group was characterized by older age, lower rate of ST-segment elevation myocardial infarction, and higher rate of advanced Killip class. In-hospital mortality was significantly higher in patients with LMCA ACS than in those with non-LMCA ACS (23.3% vs. 5.5%, respectively; P

Backgrounds: The formation of intrastent thrombus is a PCI-related complication in subjects with ACS, which infrequently causes acute stent thrombosis. Given that lipid-rich plaque, a substrate for ACS, activates inflammation inducing prothrombotic state, the degree of lipidic plaque materials may associate with intrastent thrombus formation. Methods: Culprit lesions in 70 ACS subjects (=STEMI/NSTEMI/uAP=28/27/15) receiving newer-generation DES implantation were evaluated by both near-infrared spectroscopy (NIRS) and optical coherence tomography (OCT) imaging. NIRS-derived 4-mm maximum lipid-core-burden index (maxLCBI 4mm ) at culprit lesion was measured prior to PCI. OCT-derived intrastent thrombus-burden index (ITBI) after stent implantation were calculated as follows: [Σ(every 1-mm cross sectional thrombus-arc score: 1=1-90°,2=91-180°,3=181-270°,4=271-360°)/analyzed length]x(averaged longitudinal length). ITBI was compared between subjects with maxLCBI 4mm Result: The averaged maxLCBI 4mm was 525±236, and dual-antiplatelet therapy with aspirin and clopidogrel, and aspirin and prasugrel was used in 43 and 56%, respectively. On OCT imaging analysis, maxLCBI 4mm was significantly associated with ITBI (r=0.55, p 4mm as an independent predictor of higher ITBI even after adjusting MSA, stent malapposition and other clinical characteristics (Table). Conclusions: The presence of lipid-rich plaque was associated with intrastent thrombus formation in the setting of ACS. Our findings suggest the potential importance to modulate activated prothrombotic cascade by using more potent antiplatelet agent in ACS patients exhibiting lipid-rich plaques.

Introduction: Coronary subclavian steal syndrome (CSSS) is coronary steal phenomenon due to subclavian artery stenosis (SAS) in patients with a history of CABG using internal mammary artery (IMA). While CSSS could cause acute coronary syndrome (ACS), its frequency, clinical characteristics and cardiovascular outcomes remain unknown. Methods: The current study was a retrospective multi-center analysis of 142 ACS patients who previously received CABG from January 2007 to October 2020. CSSS was defined as myocardial ischemia due to SAS. Clinical characteristics and cardiovascular events (=cardiac-cause death + myocardial infarction + stroke) were compared in subjects with and without CSSS. Results: CSSS was identified in 7.0% (=10/142) of study subjects. Of these, 1, 6 and 3 CSSS cases had SAS at right, left and both subclavian arteries, respectively. The averaged pressure gradient at SAS site was 31±13mmHg. ACS subjects attributable to CSSS were more likely to exhibit NSTEMI (90% vs. 52%, p=0.02), a history of hemodialysis (40% vs. 14%, p=0.03) and peripheral artery disease (70% vs. 20%, p Conclusions: A substantially elevated cardiovascular risk was observed in ACS patients attributable to CSSS. This finding suggests clinical needs to meticulously evaluate SAS before and after CABG using IMA.

The residual risk of atherosclerotic cardiovascular disease (ASCVD) in patients with diabetes on statin therapy warrants identification of other pro-atherogenic drivers. Lipoprotein(a) [Lp(a)] promotes the formation of necrotic cores within vessel walls. Given that patients with diabetes have an Lp(a)-associated ASCVD risk, Lp(a) might lead to plaque vulnerability in patients with diabetes on statin therapy.We analyzed target lesions that underwent PCI in 312 patients with coronary artery disease (CAD) on statin treatment from the REASSURE-NIRS registry (NCT04864171). Maximum 4-mm lipid-core-burden index (maxLCBIHigh-intensity statin use (p = 0.49) and on-treatment low-density lipoprotein cholesterol (LDL-C) (p = 0.32) and Lp(a) levels (p = 0.09) were comparable between patients with and without diabetes. Lp(a) levels were significantly associated with maxLCBIA significant relationship between Lp(a) and maxLCBI

Introduction AMI infrequently but concomitantly occurs after stroke events. Current guideline recommends primary PCI with DAPT in the setting of AMI. However, this approach is not necessarily applicable in AMI subjects following acute/subacute stroke events due to its bleeding risk. Clinical management and outcomes of these AMI subjects following remains uncertain. Purpose To characterize management and clinical outcomes in patients with AMI following acute/subacute stroke events (=post-stroke AMI). Methods The current study retrospectively analyzed 2041 AMI patients hospitalized at our institute from 2007 to 2018. Post-stroke AMI was defined as its occurrence within 14 days after ischemic/hemorrhagic stroke. The use of reperfusion and anti-thrombotic therapies, and the occurrence of major adverse cardiovascular events (=CV death, non-fatal MI and non-fatal stroke) and major bleeding events (BARC type 3 or 5) were compared in post-stroke and non-post-stroke AMI patients. Results Post-stroke AMI was identified in 1.1% of entire subjects (=23/2041). Of these, 65% of them (=15/23) had AMI within 3 days from the onset of stoke event. Over 60% of them was due to cardioembolic stroke, followed by hemorrhagic (9%), atherothrombotic ones (8%) and other causes (22%). Post-stroke AMI patients were more likely to exhibit Af (p=0.02) and a history of hemodialysis (p=0.009), and have a lower BMI (p=0.04) and hemoglobin level (p=0.02). They were less likely to receive emergent coronary angiography, and primary PCI was conducted in only 65% of post-stroke AMI patients (Table). Furthermore, they more frequently received thrombectomy (p=0.04) alone rather than stent implantation (p=0.002) (Table). With regard to anti-thrombotic therapy, the proportion of DAPT use was significantly lower in post-stroke AMI subjects (52 vs. 89%, p=0.0001), and 17% of them did not receive any anti-thrombotic agents. Of note, only 48% (p=0.04) and 43% (p=0.0001) of post-stroke AMI patients were treated with other established medical therapies including β-blocker and statin, respectively. During the observational period (median = 2.9 years), post-stroke AMI was associated with a greater likelihood experiencing major adverse cardiovascular events (log-rank p Conclusions In our real-world data, the adoption of guideline-recommended reperfusion and anti-thrombotic therapies were considerably low in AMI subjects following acute/subacute stroke events. Given their elevated risk of cardiovascular and bleeding events, it is required to establish better therapeutic management for mitigating their thrombotic/bleeding risks. Funding Acknowledgement Type of funding sources: None. Table 1Figure 1

Introduction Current ESC guideline recommends achieving LDL-C Methods The REASSURE-NIRS registry is an on-going multi-center registry to enroll CAD subjects receiving PCI under the guidance of near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS: DualProTM, Nipro, Tokyo, Japan) imaging. Culprit lesions in 557 CAD patients who already received a statin were evaluated by NIRS/IVUS. Maximum 4-mm-lipid-core burden-index (maxLCBI4mm) and plaque calcification grade at culprit sites were measured. Calcification grade at each 1-mm cross-sectional image was defined as follows: calcium arc 0° = 0, 0–90° = 1, 90–180° = 2, 180–270° = 3, 270–360° = 4. MaxLCBI4mm and the averaged calcification grade were compared in diabetic and non-diabetic subjects stratified according to on-treatment LDL-C level, respectively. Result The proportion of diabetic (n=293, HbA1c; 6.9±0.9%) and non-diabetic patients (n=264) with on-treatment LDL-C Conclusion Achieving LDL-C Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Background Lipid-rich plaque is an important substrate causing acute coronary events. Near-infrared spectroscopy (NIRS) imaging has been shown to visualize lipidic coronary plaque at non-culprit site associated with future coronary events. Given that histopathological studies reported that the unstable plaque underlying the implanted drug-eluting stent (DES) could cause neoatherosclerosis formation, we hypothesized that NIRS-based evaluation of lipidic plaque burden behind the implanted DES may clinically predict the occurrence of stent failure in patients with CAD receiving PCI. Purpose We aimed to investigate the relationship of stent-related events' risk with lipidic plaque materials behind the implanted DES imaged by NIRS/intravascular ultrasound (NIRS/IVUS) imaging. Methods The REASSURE-NIRS registry is an on-going multi-center registry to enroll CAD subjects receiving NIRS/IVUS-guided PCI. In this registry data, 406 lesions in 379 CAD subjects (ACS/non-ACS=150/229) receiving new-generation DES were analyzed. Minimum stent area (MSA) after PCI and maximum lipid-core-burden index in any 4mm-segment within the implanted stents (in-stent maxLCBI4mm) were measured. A 3-year lesion-oriented composite outcome [LOCO: culprit lesion-related MI + ischemia-driven target lesion revascularization (ID-TLR)] was compared in subjects stratified according to the tertile of in-stent maxLCBI4mm. Results The mean value of in-stent maxLCBI4mm was 221, and 17% of lesions exhibited in-stent maxLCBI4mm >400. Patients with a greater in-stent maxLCBI4mm were more likely to exhibit a higher LDL-C level (p=0.026) with a longer stent length (p Conclusion The amount of underlying lipidic materials at culprit lesions receiving new-generation DES implantation did not necessarily predict future stent-related events. Clinical significance of maxLCBI4mm behind the implanted DES may be different from that at naïve non-culprit plaques. Funding Acknowledgement Type of funding sources: None. Background and lesion characteristicsKaplan-Meier analysis for LOCO

The development of solventless system for modulating properties of network materials is imperative for the next generation sustainable technology. Utilization of photostimulation is important owing to its spatial and temporal locality, yet designing photoresponsive network materials exhibiting repeatable and dramatic change in their properties remains a challenge. Here, the authors report a photocleavable regenerative network (PRN) linked with photoresponsive hexaarylbiimidazoles (HABIs) synthesized from narrow dispersity star‐shaped poly(dimethylsiloxane)s (PDMSs) having 2,4,5‐triphenylimidazole end groups. The use of urea anion as a catalyst for ring opening polymerization (ROP) of cyclic siloxane initiated from silanols enables control of molecular weight and dispersity. The rheological measurements for the synthesized PRNs exhibit drastic changes in storage and loss moduli (G′ and G″) upon photoirradiation in the solid state (G′ > G″). This photocontrolled change in viscoelasticity with retaining solidity enables application of PRNs as a remotely‐controlled photo‐melt adhesive and photo‐scissible string. The developed PRNs will enable a wide variety of applications such as industrially important next‐generation sustainable adhesive, sealant, and reversibly‐deformable 3D printing materials with their spatially and temporally local manipulability, solventless handleability, and excellent reversibility., Photocleavable regenerative networks (PRNs) are synthesized from structurally precise star‐shaped poly(dimethyl siloxane) precursors to realize a solventless spatially and temporally local dramatic change in mechanical properties. The photocontrolled dynamic change in viscoelasticity in the solid state enables application of PRNs as solventless remotely‐controlled photo‐melt adhesive and photo‐scissible string.

The Laser Interferometer Gravitational-wave Observatory Scientific Collaboration and Virgo Collaboration (LVC) sent out 56 gravitational-wave (GW) notices during the third observing run (O3). Japanese collaboration for Gravitational wave ElectroMagnetic follow-up (J-GEM) performed optical and near-infrared observations to identify and observe an electromagnetic (EM) counterpart. We constructed web-based system which enabled us to obtain and share information of candidate host galaxies for the counterpart, and status of our observations. Candidate host galaxies were selected from the GLADE catalog with a weight based on the three-dimensional GW localization map provided by LVC. We conducted galaxy-targeted and wide-field blind surveys, real-time data analysis, and visual inspection of observed galaxies. We performed galaxy-targeted follow-ups to 23 GW events during O3, and the maximum probability covered by our observations reached to 9.8%. Among them, we successfully started observations for 10 GW events within 0.5 days after the detection. This result demonstrates that our follow-up observation has a potential to constrain EM radiation models for a merger of binary neutron stars at a distance of up to $\sim$100~Mpc with a probability area of $\leq$ 500~deg$^2$., 25 pages, 10 figures, 3 tables, published at https://academic.oup.com/ptep/article/2021/5/05A104/6122445

Background The ideal mortality prediction model (MPM) for acute heart failure (AHF) patients would have sufficient and stable predictive ability for long-term as well as short-term mortality. However, published MPMs for AHF predominantly predict short-term mortality up to 90 days, and their prognostic performance for long-term mortality remains unclear. Methods and Results: We analyzed 609 AHF patients in a prospective registry from January 2013 to May 2016. We compared the prognostic performance for long-term mortality among 8 systematically identified MPMs for AHF that predict short-term mortality up to 90 days from admission. The PROTECT 7-day model showed the highest c-index for long-term as well as short-term mortality among the studied MPMs. Sensitivity analyses revealed serum albumin and total cholesterol to be the most important variables, as dropping these variables resulted in a significant decline in c-index, when compared with other variables specific to the PROTECT 7-day model. Furthermore, significant improvements in c-index and net reclassification were observed when serum albumin or serum albumin plus total cholesterol was added to the studied MPMs, other than the PROTECT 7-day model. Conclusions The PROTECT 7-day model demonstrated the highest predictive performance for long-term as well as short-term mortality in AHF patients among the published MPMs. Our findings indicate the importance of accounting for nutritional status such as serum albumin and total cholesterol in AHF patients when developing a MPM.

BACKGROUND: Vulnerable plaque features including lipidic plaque have been shown to affect fractional flow reserve (FFR). Given that formation and propagation of lipid plaque is accompanied by endothelial dysfunction which impairs vascular tone, the degree of lipidic burden may affect vasoreactivity during hyperemia, potentially leading to reduced FFR. Our aim is to elucidate the relationship of the extent of lipidic plaque burden with coronary physiological vasoreactivity measure. METHODS: We analyzed 89 subjects requeuing PCI due to angiographically intermediate coronary stenosis with FFR ≤0.80. Near-infrared spectroscopy (NIRS) and intravascular ultrasound were used to evaluate lipid-core burden index (LCBI) and atheroma volume at both target lesion (maxLCBI(4mm); maximum value of LCBI within any 4 mm segments) and entire target vessel (LCBI(vessel): LCBI within entire vessel). In addition to FFR, delta-FFR was measured by difference of distal coronary artery pressure/aortic pressure (Pd/Pa) between baseline and hyperemic state. RESULTS: The averaged FFR and delta-FFR was 0.74 (0.69–0.77), and 0.17±0.05, respectively. On target lesion-based analysis, maxLCBI(4mm) was negatively correlated to FFR (ρ=−0.213, P=0.040), and it was positively correlated to delta-FFR (ρ=0.313, P=0.002). Furthermore, target vessel-based analysis demonstrated similar relationship of LCBI(vessel) with FFR (ρ=−0.302, P=0.003) and delta-FFR (ρ=0.369, P