Search

Aortic valve replacement is recommended for patients with "very severe" aortic stenosis (AS), irrespective of symptomatic manifestation. Nonetheless, the prognostic ramifications of "very severe" AS, as opposed to "severe" AS, subsequent to trans-catheter aortic valve implantation (TAVI) remain enigmatic. We enrolled consecutive patients who received TAVI at our institute between May 2015 and April 2021. We scrutinized the impact of baseline "very severe" AS upon 3-year all-cause death or heart failure hospitalization following TAVI, in comparison to "severe" AS. A total of 239 patients (84.8 ± 5.4 years old, 58 men) were included. Baseline "very severe" AS was observed in 65 (27 %) patients, who exhibited more advanced hypertrophy and higher B-type natriuretic peptide levels compared to those with "severe" AS (p < 0.05 for both). Baseline "very severe" AS was paradoxically associated with higher freedom from the primary endpoint following TAVI compared to those with "severe" AS (p = 0.01). The presence of baseline "very severe" AS was paradoxically associated with improved clinical outcomes subsequent to TAVI, in contrast to the cases of "severe" AS. [Display omitted] • Aortic valve replacement is recommended for patients with very severe aortic stenosis (AS), regardless of symptoms. • We investigated prognostic impact of very severe AS patients who underwent trans-catheter aortic valve implantation (TAVI). • Very severe AS was an independent good prognostic factor following TAVI. [ABSTRACT FROM AUTHOR]

Identifying patients who can be spared nonbeneficial surgery is crucial, as pancreatic cancer surgery is highly invasive, with substantial negative effects on quality of life. The study objective was to investigate a useful indicator of patients who do not gain prognostic benefit from radical surgery after neoadjuvant therapy for resectable and borderline resectable pancreatic cancer. We compared factors among 609 patients with resectable or borderline resectable pancreatic cancer receiving neoadjuvant therapy during 2005–2019. Patients were divided into a poor-prognosis group (no surgery or postresection recurrence within a year) and a good-prognosis group (no recurrence or recurrence >1 year after resection). Patients who experience a recurrence within a year of resection (poor-prognosis group) did no better than patients who received neoadjuvant therapy and progressed but never made it to surgery. The value of carbohydrate antigen 19-9 after neoadjuvant therapy was the most significant indicator to predict the poor prognosis group and the elevation of carbohydrate antigen 19-9 (>200 U/mL) identified only poor prognosis group with high specificity of 96.6%. The overall survival of patients with more than 200 of carbohydrate antigen 19-9 after neoadjuvant therapy was significantly very poor and their 2-year survival rate was only 41.4%. A striking elevation of carbohydrate antigen 19-9 after neoadjuvant therapy for resectable or borderline resectable pancreatic cancer is a good indicator of poor prognosis. Patients with carbohydrate antigen 19-9 >200 U/mL after neoadjuvant therapy should not undergo radical surgery. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the temporal changes in body composition following esophagectomy in patients with esophageal cancer using bioelectrical impedance analysis and to assess the prognostic implications of these changes. Our study included 528 patients who underwent esophagectomy and preoperative body composition measurements between January 2013 and June 2020. Postoperative body composition was measured in 493 patients at discharge as follows: 184 at 1 month, 144 at 2 months, 143 at 3 months, 103 at 6 months, 58 at 9 months, and 78 at 12 months. Body weight (BW) continuously decreased until the 6 postoperative months (POMs), reaching −11.5% compared with preoperative levels. Subsequently, almost no change was observed at 12 POMs. Skeletal muscle mass (SMM) decreased until 3 POMs but gradually recovered after 3 POMs. Conversely, body fat mass (BFM) consistently decreased over time post-esophagectomy. The patients were categorized into moderate (>−10%) and severe (≤−10%) groups based on % BW, % SMM, and % BFM losses at 3 POMs. Severe SMM loss at 3 POMs correlated with reduced overall survival (OS) (3-year OS: 85.9% in moderate vs. 75.1% in severe, p = 0.035). BFM loss was associated with reduced recurrence-free survival (3-year RFS: 83.3% in moderate vs. 62.0% in severe, p = 0.011). Multivariate analysis identified pStages Ⅲ and Ⅳ, % SMM loss ≤ −10%, and % BFM loss ≤ −10% as independent factors for worse OS. Post-esophagectomy, distinct temporal changes in BW, SMM, and BFM are observed. Significant reductions in SMM and BFM 3 POMs indicate a poor long-term prognosis. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to compare the effectiveness of selective neck dissection (SND) and comprehensive neck dissection (CND) in patients with oral squamous cell carcinoma N1 (Level I). Randomized controlled trials and prospective and retrospective non-randomized clinical studies were selected and evaluated for the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. The statistical analysis was performed using Review Manager 5.4 software. We included one observational study. The analysis revealed no difference in survival rates (overall survival, disease-specific survival, and regional control) between SND and CND for oral squamous cell carcinoma N1 (level I) cases. In the included study, the risk of bias was high, total sample size was small, and certainty of evidence was rated as "very low.". This systematic review and analysis suggested no difference in effectiveness between SND and CND; however, a high certainty of evidence could not be determined. Such evidence needs to be established through future systematic reviews, including randomized controlled trials with larger sample sizes. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To explore the characteristics and management of dysphagia among older hospitalized patients with cardiovascular disease (CVD) in Japan and to clarify the impact of integrated dysphagia rehabilitation on oral intake, body mass index (BMI), and activities of daily living (ADL). Findings: Dysphagia is prevalent among older patients with CVD and significantly impacts their recovery. Integrated dysphagia rehabilitation can improve oral intake, BMI, and ADL independence. Message: Active integration of dysphagia management into cardiac care programs is crucial for enhancing the overall recovery and QOL in older patients with CVD. Purpose: This study assessed the characteristics, management, and outcomes of dysphagia rehabilitation in older patients with CVD in a super-aged society, highlighting the need for comprehensive management strategies in community hospital settings. It aimed to uncover valuable insights into the benefits of integrating dysphagia rehabilitation with cardiac care in patient management. Methods: We conducted a retrospective review of patients with CVD aged ≥ 65 years who were admitted to Niigata Minami Hospital between January 2019 and December 2021. We focused on patients requiring dysphagia rehabilitation and assessing the effects of these interventions on recovery. Results: The study included 732 participants with an average age of 86.0 ± 7.8 years, of whom 41.9% were male. Approximately 55.1% required dysphagia rehabilitation. Dysphagia rehabilitation significantly improved oral caloric intake and BMI in patients who underwent rehabilitation, and these improvements were comparable to those in patients who did not require dysphagia rehabilitation. Significant enhancement in the ADL of patients was observed at discharge. Patients who required dysphagia rehabilitation also had longer hospital stays and were more likely to be discharged to nursing facilities. Conclusion: Dysphagia is common in older patients with CVD, and dysphagia rehabilitation positively affects the maintenance of nutritional status and helps patients achieve ADL independence at discharge. This study highlights the importance of integrating dysphagia rehabilitation into ordinary cardiac rehabilitation programs for older patients with CVD to improve their QOL. [ABSTRACT FROM AUTHOR]

• Corpus callosotomy may be an effective treatment in selected individuals with refractory epileptic spasms. • Increased age at the time of corpus callosotomy is associated with worse spasm-free outcomes. • Structural aetiologies respond less favourably to corpus callosotomy alone for refractory epileptic spasms. • In some settings, corpus callosotomy may allow for electroencephalogram lateralization and further resective epilepsy surgery. We systematically reviewed the existing literature on the efficacy of corpus callosotomy (CC) in children and adults with refractory epileptic spasms (ES) and analyzed clinical determinants of seizure outcomes. The Preferred Report Items for Systematic Reviews and Meta-Analysis Guidelines (PRISMA) were followed. We systematically searched MEDLINE, EMBASE and Cochrane databases up to December 2023 for original research articles on using CC to treat refractory ES. The primary outcome measure was the proportion of study participants who achieved seizure freedom following initial CC at the last follow-up. Meta-regression using mixed-effects models was performed to obtain clinical determinants of seizure outcomes. A total of 12 studies were included (253 individuals). Initial complete total CC was most common (n = 218/253, 86%), followed by anterior CC (n = 29/253, 12%) and other forms of CC (i.e., anterior to posterior, posterior, staged total) (n = 6/253, 2%). The pooled proportion of patients achieving spasm freedom following CC was 0.31 (95% CI: 0.22, 0.42) (mean follow-up 47 months). Meta-regression showed that structural etiology and mean age at the time of CC were significant moderators of the pooled effect. For every 1% increase in the proportion of structural etiology, the proportion of spasm-free outcome was found to reduce by 0.45 (95% CI: -0.86, -0.03, p < 0.0001). In addition, increasing the mean age by 1 month led to a reduction in the proportion of spasms-free patients by 0.003 (95% CI: -0.005, -0.0006, p = 0.01). Sixty-two individuals (24%) from seven studies underwent further surgery for residual ES; 34 became spasm free (55%). Corpus callosotomy may be an effective treatment option in selected individuals with refractory epileptic spasms. Structural aetiologies and increased age at the time of corpus callosotomy are important clinical determinants. In some cases, CC may lead to further epilepsy surgery. [ABSTRACT FROM AUTHOR]

• Clustering of cases with abusive headd trauma in winters noted. • Electrograhic seizures were noted in 81 % cases who had cEEG. • Normal cEEG background predicted better neurological outcomes. • In-hospital mortality was 23 % in this cohort. Abusive Head Trauma (AHT) remains an important cause of acute seizures, morbidity, and mortality in children. We aimed to assess the clinical and electrographic seizure burden in children with AHT and to explore predictors of morbidity and mortality. We conducted a retrospective chart review of all children admitted with AHT who underwent continuous electroencephalographic monitoring (cEEG) between January 1st, 2015, and April 15th, 2021. Their clinical, EEG and imaging variables were extracted and summarized. A total of 31 children (17 female) were included. The median age was 3 months (IQR 1.75–5). Forty-five percent of cases presented in the winter season (p = 0.024). In 25 cases out of 31, cEEG detected electrographic seizures, with 6 of these children not manifesting clinical seizures. A shorter time to first recorded seizure during cEEG was a significant predictor of in-hospital mortality (p = 0.012) and the maximum 1-hour seizure count was higher in children with worse cerebral outcomes (p = 0.008). A normal EEG background activity during cEEG was associated with favorable neurological outcomes (p = 0.008). The hospital mortality rate was 23 %. Almost 20 % of children with AHT had seizures recognized exclusively by cEEG. Normal cEEG background activity predicted a better outcome, while a shorter time to the first recorded seizure was associated with a higher in-hospital mortality. Corroborating prior reports, we found a significant clustering of cases during the winter. These results could enhance AHT prevention strategies and case prognostication. [ABSTRACT FROM AUTHOR]

The TGF‐β superfamily plays a pivotal role in the regulation of adipogenesis, but little is known about the potential differential role of the three isoforms of TGF‐β, TGF‐β‐1~3. To further elucidate their role, two‐dimensionally (2D) and three‐dimensionally (3D) cultured 3T3‐L1 mouse preadipocytes were subjected to the following analyses: (a) qPCR analysis of adipogenesis‐related factors and major extracellular matrix protein (2D and /or 3D), (b) lipid staining by Oil Red O (2D) or BODIPY (3D), (c) Seahorse cellular metabolic measurement (2D), and (d) size and stiffness measurements of 3D 3T3‐L1 spheroids. In the 2D cultured 3T3‐L1 cells, mRNA expression levels of adipogenesis‐related genes and Oil Red O lipid staining intensity were significantly increased by adipogenesis and they were substantially decreased following treatment with 0.1 nm TGF‐β isoforms, with TGF‐β2 having the greater effects. Consistent with these results, treatment with TGF‐β2 resulted in suppression of mitochondrial and glycolytic functions in 2D cultured 3T3‐L1 cells. However, the inhibitory effect of TGF‐β on adipogenesis decreased under 3D spheroid culture conditions and TGF‐β isoforms did not affect adipogenesis‐induced (a) enlargement and downsizing of 3T3‐L1 spheroids, (b) increase in BODIPY lipid staining intensity, and (c) up‐regulation of the mRNA expression of adipogenesis‐related genes. The findings presented herein suggest that the three TGF‐β isoforms have different suppressive effects on adipogenesis‐related cellular properties of 2D cultured 3T3‐L1 cells and that their effects decrease under 3D spheroid culture conditions. [ABSTRACT FROM AUTHOR]

The timing of intervention to treat lymphedema differs among facilities. Understanding differences in the prevalence and severity of lymphedema following different surgical procedures for lymphadenectomy could promote early intervention to treat lymphedema. There is currently little evidence to support the notion that inguino-pelvic lymphadenectomy is associated with greater morbidity than inguinal lymphadenectomy, although it is believed that the difference in the extent of surgery results in a difference in the severity of lymphedema. In this study, we compared volume percentage change between inguinal lymphadenectomy and inguino-pelvic lymphadenectomy in patients with skin cancer of the lower extremity. A total of 29 patients with skin cancer of a lower extremity who underwent lymphadenectomy were classified into an inguinal lymphadenectomy group and an inguino-pelvic lymphadenectomy group. The increase in the volume of the affected side compared with that of the unaffected side in the whole lower extremity, thigh, and lower leg was calculated on volume-rendered computed tomography images. The mean volume percentage increase in the inguinal lymphadenectomy group and the inguino-pelvic lymphadenectomy group was, respectively, 6.72% and 11.18% in the whole lower extremity and 7.30% and 2.55% in the lower leg, showing no statistically significant differences. In contrast, the mean volume percentage increase in the respective groups was 7.03% and 19.78% in the thigh, showing a statistically significant difference (p = 0.0275 < 0.05). The findings of this study indicate that the leg volume of the whole lower extremity may not have worse outcomes in inguino-pelvic lymphadenectomy compared with inguinal lymphadenectomy. [ABSTRACT FROM AUTHOR]

Lymphatic vessels support wound recovery and absorb excess fluid. Blepharoplasty involves excess tissue excision, and this study investigated the relationship between lymph vessel density in excised tissue and the postoperative course. Forty eyelids from 21 patients with blepharoptosis who underwent blepharoplasty were included. Each resected excess tissue sample was divided into 4 parts by 3 parasagittal cuts—medial, central, and lateral. The area percentages occupied by lymphatic vessels and elastic fibers in the inner tissue between skin and muscle, exposed by these cuts, were determined histologically. The wound-healing process was assessed at 2 weeks and 1, 3, and 6 months postoperatively, using a visual analog scale (VAS) to estimate edema and the Vancouver Scar Scale (VSS) for scar assessment. With increasing age, the area percentage of lymphatic vessels declined significantly (r = −0.581, p < 0.001), while an increase in solar elastosis was observed. The percentage of lymphatic vessels was highest on the medial side of the eyelid (p < 0.05), where their relative distribution to the "shallow layer" close to the skin was also the highest (p < 0.01). Independent of age, the VSS values at 2 weeks and 1 month postoperatively were significantly lower in patients with a higher area percentage of lymphatic vessels (2 weeks: p < 0.05; 1 month: p < 0.01). In patients undergoing blepharoplasty, the percentage of lymphatic vessels in the upper eyelid tissue decreased with advancing age. Higher proportions of lymphatic vessels were associated with improved wound-healing outcomes. [ABSTRACT FROM AUTHOR]

The risk factors for residual liver recurrence after resection of colorectal cancer liver metastases were analyzed separately for synchronous and metachronous metastases. This retrospective study included 236 patients (139 with synchronous and 97 with metachronous lesions) who underwent initial surgery for colorectal cancer liver metastases from April 2010 to December 2021 at the Fujita Health University Hospital. We performed univariate and multivariate analyses of risk factors for recurrence based on clinical background. Univariate analysis of synchronous liver metastases identified three risk factors: positive lymph nodes (p = 0.018, HR = 2.067), ≥3 liver metastases (p < 0.001, HR = 2.382), and use of adjuvant chemotherapy (p = 0.013, HR = 0.560). Multivariate analysis identified the same three factors. For metachronous liver metastases, univariate and multivariate analysis identified ≥3 liver metastases as a risk factor (p = 0.002, HR = 2.988); however, use of adjuvant chemotherapy after hepatic resection was not associated with a lower risk of recurrence for metachronous lesions. Inverse probability of treatment weighting analysis of patients with these lesions with or without adjuvant chemotherapy after primary resection showed that patients with metachronous liver metastases who did not receive this treatment had fewer recurrences when adjuvant therapy was administered after subsequent liver resection, although the difference was not significant. Patients who received adjuvant chemotherapy after hepatic resection had less recurrence but less benefit from this treatment. Risk factors for liver recurrence after resection of synchronous liver metastases were positive lymph nodes, ≥3 liver metastases, and no postoperative adjuvant chemotherapy. Adjuvant chemotherapy is recommended after hepatic resection of synchronous liver metastases. [ABSTRACT FROM AUTHOR]

This study investigated the use of deep learning-generated virtual positron emission tomography (PET)-like gated single-photon emission tomography (SPECT VP) for assessing myocardial strain, overcoming limitations of conventional SPECT. SPECT-to-PET translation models for short-axis, horizontal, and vertical long-axis planes were trained using image pairs from the same patients in stress (720 image pairs from 18 patients) and resting states (920 image pairs from 23 patients). Patients without ejection-fraction changes during SPECT and PET were selected for training. We independently analyzed circumferential strains from short-axis-gated SPECT, PET, and model-generated SPECT VP images using a feature-tracking algorithm. Longitudinal strains were similarly measured from horizontal and vertical long-axis images. Intraclass correlation coefficients (ICCs) were calculated with two-way random single-measure SPECT and SPECT VP (PET). ICCs (95% confidence intervals) were defined as excellent (≥ 0.75), good (0.60–0.74), moderate (0.40–0.59), or poor (≤ 0.39). Moderate ICCs were observed for SPECT-derived stressed circumferential strains (0.56 [0.41–0.69]). Excellent ICCs were observed for SPECT VP -derived stressed circumferential strains (0.78 [0.68–0.85]). Excellent ICCs of stressed longitudinal strains from horizontal and vertical long axes, derived from SPECT and SPECT VP , were observed (0.83 [0.73–0.90], 0.91 [0.85–0.94]). Deep-learning SPECT-to-PET transformation improves circumferential strain measurement accuracy using standard-gated SPECT. Furthermore, the possibility of applying longitudinal strain measurements via both PET and SPECT VP was demonstrated. This study provides preliminary evidence that SPECT VP obtained from standard-gated SPECT with postprocessing potentially adds clinical value through PET-equivalent myocardial strain analysis without increasing the patient burden. [ABSTRACT FROM AUTHOR]

[Display omitted] IL-33 is a type 2 inflammatory cytokine that is elevated in the esophageal epithelium of eosinophilic esophagitis (EoE) subjects. We previously developed a mouse model of EoE dependent on constitutive overexpression of IL-33 from the esophageal epithelium (EoE33). Our objective was to develop an inducible, IL-33–dependent model of EoE and examine induction of EoE-associated pathology. We utilized a tetracycline-inducible system to express IL-33 in the esophagus by generating 2 transgenic mice. The first (iSophagus) expresses a reverse tetracycline transactivator from the esophageal epithelium. The second (TRE33) features a tetracycline response element driving expression of IL-33. When crossed, these mice generate an inducible model of EoE (iEoE33). Mice were administered doxycycline-infused chow for up to 2 weeks. Cytokines were assessed by ELISA or bead-based multiplex analysis. T cells were assessed by flow cytometry. Pathology was assessed by histology and immunohistochemistry for IL-33, eosinophil peroxidase, CD4, and Ki-67. iEoE33 was treated with steroids and crossed with IL-13−/− mice. Doxycycline-treated iEoE33 mice demonstrated expression of IL-33 in the esophageal epithelium, and esophageal pathology including eosinophilia, CD4+ cell infiltrate, basal zone hyperplasia, and dilated intercellular spaces. These findings became pronounced on day 7 of induction, were accompanied by weight loss and esophageal thickening, and were steroid responsive and IL-13 dependent. Inducible IL-33 expression in the esophageal epithelium elicited features pathognomonic of EoE. iEoE33 enables investigation of EoE disease mechanisms as well as initiation, progression, and resolution. [ABSTRACT FROM AUTHOR]

To compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization in patients with congenital heart disease. Retrospective observational study. A single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually. Patients younger than 15 years who underwent cardiac catheterization under general anesthesia between March 1, 2021, and December 31, 2022. Exclusion criteria were general anesthesia maintained with other than remimazolam or sevoflurane, receipt of remifentanil, American Society of Anesthesiologists score 4 or 5, emergency procedures, and no direct arterial pressure measurement. General anesthesia was maintained with remimazolam or sevoflurane. A total of 309 patients were analyzed, including 28 in the remimazolam group and 281 in the sevoflurane group. Propensity score matching adjusted for confounding factors resulted in 28 patients in each arm, with no apparent differences in background factors. Hypotension was defined as a time-averaged area > 1, in which systolic arterial pressure fell below 80% of the baseline from the start of anesthesia to the end of procedure. The significance level was set at P <.05. The incidence of hypotension was 39.3% in the remimazolam arm and 46.4% in the sevoflurane arm, with no significant difference (P =.79), although the ratio of the median systolic arterial pressure to the baseline value was significantly higher in the remimazolam arm (91.4 ± 15.2% vs 83.2 ± 11.4% in the sevoflurane arm; P =.03). Remimazolam was not associated with a lower incidence of hypotension compared to sevoflurane during pediatric cardiac catheterization for congenital heart disease while maintaining significantly higher blood pressure overall. [ABSTRACT FROM AUTHOR]

This study investigated the long-term outcomes of physiological and anatomical repair for corrected transposition of the great arteries and double-outlet right ventricle with discordant atrioventricular connection. This single-center retrospective study included 146 patients who underwent biventricular repair of corrected transposition of the great arteries or double-outlet right ventricle with discordant atrioventricular connections from 1972 to 2023. Survival rate, freedom from reoperation, New York Heart Association (NYHA) Functional Classification, and incidence of systemic ventricular dysfunction in the long-term were compared between physiological repair (PR) and anatomical repair (AR) groups. The PR group consisted of 55 patients, with median age at repair of 10.3 years. Thirty-one patients underwent conventional Rastelli procedure, and 24 patients underwent atrial and/or ventricular septal defect closure. The AR group consisted of 91 patients, with median age at repair of 5.8 years. Seventy-two patients underwent atrial switch plus Rastelli procedure and 19 patients underwent atrial plus arterial switch operation. The 30-year survival was 63.5% in the PR group and 72.3% in the AR group (P =.448). The 30-year freedom from reoperation was 71.9% in the PR group and 62.2% in the AR group (P =.220). There was a significant difference in the incidence of systemic ventricular dysfunction between the groups (87.5% in the PR group and 35.3% in the AR group, P <.001) and in the NYHA classification of long-term survivors (mean NYHA class of 1.9 in the PR group and 1.5 in the AR group, P =.009). The systemic ventricular function and general status in the long-term were significantly better in AR patients, suggesting the potential advantage of AR. [ABSTRACT FROM AUTHOR]

To validate the Japanese below-the-knee (J-BTK) chronic total occlusion (CTO) score for the prediction of successful guidewire crossing (S-GC) in angiographic evaluation. A prospective, multicenter, nonrandomized study examined 751 consecutive BTK CTOs in 497 patients treated with endovascular therapy in 16 Japanese medical centers from April 2021 to March 2022. The cohort was classified into 2 groups: an S-GC group and a failed guidewire crossing group. The J-BTK CTO score, which assigned one point to "Blunt type at the proximal entry point," one point to "Calcification at the proximal entry point," one point to "Reference vessel diameter <2.0 mm," one point to "CTO length ≥200 mm," and two points to "No outflow of the target vessel," was used to categorize BTK CTOs into 4 grades with varying probabilities of S-GC: grade A (J-BTK CTO score of 0 and 1), grade B (score of 2 and 3), grade C (score of 4 and 5), and grade D (score of 6). Rates of S-GC in each grade (grades A, B, C, and D) were 97.5%, 89.1%, 62.5%, and 27.3%, respectively. The area under the receiver-operating characteristic curve for S-GC was 0.8304. Although the previous J-BTK CTO study enrolled only de novo lesions, both de novo and restenotic lesions were evaluated in this study. De novo lesions have a lower chance of S-GC (odds ratio: 0.24, 95% confidence interval: 0.09-0.67) in the multivariate analysis, and the area under the receiver-operating characteristic curve of the modified J-BTK CTO score, which additionally assigned two points to "De novo lesion," was 0.846. The modified J-BTK CTO score showed an appropriate calibration (Hosmer-Lemeshow P =.957). The J-BTK CTO score and the modified J-BTK CTO score predict the probability of an S-GC of BTK CTOs and stratify the difficulty of endovascular therapy for BTK CTOs in angiographic evaluation. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) using a self-expandable valve (SEV) promotes better hemodynamics compared with a balloon-expandable valve (BEV) in a small aortic annulus (SAA). The authors sought to compare hemodynamic properties and clinical outcomes between the latest-generation BEV and SEV after TAVR for SAA. We retrospectively analyzed 1,227 patients undergoing TAVR for aortic stenosis with SAA, defined as an annulus area ≤430 mm2, using the BEV (SAPIEN3 Ultra RESILIA, Edwards Lifesciences) and SEV (Evolut FX, Medtronic). The impact of valve design on severe prosthesis–patient mismatch, aortic valve mean pressure gradient ≥20 mm Hg, paravalvular leakage (PVL) ≥ mild, new permanent pacemaker implantation (PMI), and modified VARC-3 device success at discharge was evaluated using logistic regression and propensity score analysis. Of 1,227 patients, 798 (65.0%) underwent TAVR with BEV implantation. TAVR using BEV had a relatively higher rate of severe prosthesis–patient mismatch (OR: 1.74; 95% CI: 0.54-5.62) and significantly higher incidence of mean pressure gradient ≥20 mm Hg (OR: 2.05; 95% CI: 0.91-4.62) than that using SEV. By contrast, the BEV showed significantly lower incidence of PVL ≥ mild (OR: 0.19; 95% CI: 0.14-0.26), and new PMI (OR: 0.53; 95% CI: 0.33-0.86). The rate of device success was comparable between the BEV and the SEV. These results were confirmed by propensity score analysis. In TAVR for SAA, SEV demonstrated better hemodynamics than the latest BEV, whereas the latest BEV had lower incidences of PVL ≥ mild and new PMI than the SEV. [Display omitted] [ABSTRACT FROM AUTHOR]

A survey of the kinorhynch fauna in the Oki Islands revealed six species of kinorhynchs in three families and four genera. Among these, one species in the genus Echinoderes was described as a new species, Echinoderes okiensis sp. nov., based on the following characteristics: presence of middorsal acicular spines on segments 4–8; ventrolateral tubes on segment 2; lateroventral tubes on segment 5; lateroventral acicular spines on segments 6–9; midlateral tubes on segment 10; type-1 glandular cell outlets present middorsally on segments 1–3, 5, and 7, two middorsally on segments 10 and 11, one pair paradorsally on segments 4, 6, 8, and 9, sublaterally on segment 1, and ventromedially on segments 2–10; type-2 glandular cell outlets absent; tergal extension narrowing abruptly into long acicular tips, constituting 5–7% of trunk length; males with three pairs of penile spines, the middle pair being very short; females with papillae in ventrolateral position on segment 7 and ventromedial position on segment 8, as well as with lateral terminal accessory spines. This species was also found to inhabit off Iejima Island in Okinawa, more than 1000 km away from the Oki Islands. Phylogenetic analysis based on 18S and 28S rDNA sequences suggested that this species is closely related to Echinoderes aureus Adrianov et al., 2002 in the family Echinoderidae. These two species, along with the Echinoderes dujardinii species group, the Echinoderes spinifurca species group, Echinoderes truncates Higgins, 1983, and Cephalorhyncha , compose one of the two major clades detected in Echinoderidae. [ABSTRACT FROM AUTHOR]