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Background Early recurrences of atrial arrhythmias (ERAAs) after ablation may require therapeutic intervention. The optimal medical therapy that prevents ERAAs requires clarification. This study aimed to compare the incidence of ERAAs between patients who received or did not receive bisoprolol transdermal patches (BTPs) at 3 months postablation. Methods This single‐center retrospective study enrolled 203 consecutive patients with paroxysmal atrial fibrillation (AF) who had undergone their first ablation, comprising 59 in the BTP group and 144 in the non‐BTP group. Follow‐up assessments were conducted monthly for 3 months. We evaluated the incidence of ERAAs. Results During the initial 1‐week observational period, the rate of ERAAs was lower in the BTP group (5.0%) than that in the non‐BTP group (18.8%) (P = .013). At 3 months postablation, the rate of ERAAs was lower in the BTP group (6.8%) than that in the non‐BTP group (25.7%) (P = .002). The cumulative freedom from ERAAs was significantly lower in the BTP group than in the non‐BTP group (log‐rank: P = .003). Administering BTPs was an independent factor that protected against ERAAs (odds ratio 0.181, [95% confidence interval 0.059‐0.559], P = .003). Conclusion BTPs may prevent ERAAs after ablation., The patients who were administered bisoprolol transdermal patches (BTPs) immediately after atrial fibrillation (AF) ablation showed significant reductions in the incidence of early recurrence of atrial arrhythmias (ERAAs) compared with the patients who were not administered BTPs. The efficacy of BTPs at preventing ERAAs was confirmed not only immediately after ablation, but also during the short period after AF ablation.

Recently, 4-dimensional computed tomography (4DCT) has become available for the preoperative planning of transcatheter aortic valve intervention.1 The 4DCT is reconstructed at 10% increments over the cardiac cycle, so that the 4DCT can evaluate not only the displacement of perivalvular structures but also the displacement of the myocardium.2 Most premature ventricular contractions (PVCs) arise from normal hearts. Further, it has been reported that PVCs arise from low-voltage areas and/or scar areas observed on voltage maps during electrophysiological studies, despite a structurally normal heart.3,4 Further, it has also been reported that a heterogeneous distribution of collagen within an infarct and the subendocardial layer is consistent with voltage mapping.5 From the above, we considered that an impaired myocardium would be displayed as having low dynamics on the 4DCT, whereas it would be displayed as a low-voltage or scar region on the voltage map. We herein describe our case, in which catheter ablation of PVCs was successfully performed, and a low-displacement area on the 4DCT corresponded to a low-voltage region on the voltage map.

A nanometric Rh overlayer formed on a metal foil substrate enables much higher turnover frequencies in NO reduction than the Rh nanoparticles used in conventional three-way catalysis. However, the thermal stability of the Rh overlayer structure needs to be improved for practical applications. In the present study, a Zr buffer layer inserted between the Rh overlayer and the foil substrate efficiently overcame the thermal deterioration at 900 °C for 25 h. A honeycomb catalyst consisting of a 7 nm-thick Rh overlayer, a 500 nm-thick Zr buffer layer and a 30 μm-thick Fe–Cr–Al metal (SUS) foil was prepared by pulsed arc-plasma deposition. After thermal ageing, the Rh/Zr/SUS demonstrated steep light-off characteristics in simulated NO–CO–C3H6–O2 reactions. In contrast, the neat catalyst without the buffer layer (Rh/SUS) was totally deactivated by the Al2O3 passivation layer that formed over the active Rh overlayer. The Zr buffer layer preserves the outermost surface of the Rh overlayer by blocking the interaction between the Rh and Al2O3 layers. Consequently, the Rh surface coverage of Rh/Zr/SUS exceeded 80% after thermal ageing at 900 °C, versus almost 0% for Rh/SUS.

In this paper, we provide new experimental data of the wave-induced steady forces (the added resistance, wave-induced steady lateral force, and yaw moment) acting on a full hull ship in regular waves, and we verify the validity of existing prediction methods for wave-induced steady forces by performing comparisons with results obtained experimentally. For the prediction methods, we consider the zero-speed three-dimensional panel method (3DPM) and the method based on formulas of the wave-induced steady forces that are expressed using the Kochin-function assuming a slender ship (strip theory-based Kochin-function method: SKFM). The results show that the calculation accuracy obtained using 3DPM and SKFM for added resistance and steady lateral force is acceptable for practical purposes although the accuracy is insufficient for the steady yaw moment. In order to confirm the applicability of both methods to the problem of maneuvering in waves, we predict the turning motions of the ship in irregular waves using the calculation results obtained by 3DPM and SKFM for the wave-induced steady forces, and we compare the turning motions with the free-running model test results. Both methods are useful for predicting turning motions in irregular waves.

Objectives Clostridium perfringens is a common anaerobic pathogen causing enteritis/enterocolitis and wound infections in humans. We analyzed clonal diversity and toxin gene prevalence in C. perfringens clinical isolates from humans in northern Japan. Methods Prevalence of nine toxin genes was analyzed for 585 C. perfringens isolates from patients collected for 20-month period between May 2019 and December 2020 by molecular methods. Sequence type (ST) based on multilocus sequence typing (Xiao's scheme) and alpha-toxin (PLC) sequence type were determined for a total of 124 isolates selected in the present study along with those in our previous study (2017–2018). Results Toxinotypes A (68.2%) was the most frequent, followed by F (31.6%), and G (0.2%), while additional toxin genes encoding binary enterotoxin (BEC/CPILE) and beta2 toxin were identified in one and six isolates, respectively. Among the 124 isolates with various toxin gene profiles, 62 STs including 53 novel types were identified, revealing the presence of six clonal complexes (CCs) consisting of 27 STs. Most of enterotoxin gene (cpe)-positive isolates belonged to CC36, CC41, and CC117. Based on 22 key amino acids in alpha toxin sequence, four PLC types (I-IV) including 21 subtypes were classified, and their relation to individual STs/CCs was clarified. Two isolates harboring bec/cpile belonged to different STs (ST95, ST131) and PLC types (If, IVb), indicating distribution of this toxin gene to distinct lineages. Conclusions The present study revealed the diversity in C. perfringens clones of human origin with various toxin gene profiles represented by ST/CC and PLC type.

50 μm-thick Fe−Cr−Al metal foils covered by 7 nm-thick Rh overlayers were prepared by pulsed arc-plasma (AP) and r.f. magnetron sputtering technique to compare their catalytic activities. As-prepared metal foil catalysts were wrapped into a honeycomb structure with a density of 900 cells per square inches and the stoichiometric NO−CO−C3H6−O2 reaction was performed at space velocity of 1.2 × 105 h−1. During temperature ramp at 10 °C min−1, honeycomb catalysts showed steep light-off of NO, CO, and C3H6 at above 200 °C and their conversions soon reached to almost 100%. Both catalysts exhibited high turnover frequencies close to or more than 50-fold greater compared with those for a reference Rh/ZrO2 powder-coated cordierite honeycomb prepared using a conventional slurry coating. When the temperature ramping was repeated, however, the catalytic activity was decreased to the different extent depending on the preparation procedure. Significant deactivation occurred only when prepared by sputtering, whereas the sample prepared by AP showed no signs of deactivation. The deactivation is associated with the formation of passivation layers consisting of Fe, Cr, and Al oxides, which covered the surface and decreased the surface concentration of Rh. The Rh overlayer formed by AP was found to be thermally stable because of the strong adhesion to the metal foil surface, compared to the sample prepared by sputtering.

This study investigated the thermal decomposition behaviors of platinum oxide (PtO2) nanoparticles deposited on polycrystalline TiO2 in different crystal phases. The dissociation of PtO2 to metallic platinum in air occurred at 400 °C on anatase TiO2 (Pt/TiO2-A), but required 650 °C or higher on rutile TiO2 (Pt/TiO2-R). The higher thermal stability of PtO2 on rutile TiO2 is caused by thermodynamic effect and rather than kinetic effect. In contrast to the thermodynamic prediction, metallic Pt (Pt0) on TiO2-R was reversibly oxidized to PtO2 (Pt4+) at 650 °C. This behavior was attributed to the coherent interface structure formed by strong interactions between PtO2 and rutile TiO2, as revealed by combined extended X-ray adsorption spectroscopy (EXAFS) and density functional theory (DFT) studies. At the optimized interface structure, between the (100) planes of α-PtO2 and rutile TiO2, the interface formation energy was −17.04 kJ mol–1 A–2 versus −9.84 kJ mol–1 A–2 in the anatase TiO2 model. The larger interfac...

Nanometric Rh overlayers were formed on Fe–Cr–Al stainless steel (SUS) foils by pulsed cathodic arc-plasma (AP) technique to investigate the thermal evolution of the structure and catalytic activity for stoichiometric NO–CO–C3H6–O2 reaction. As-prepared Rh overlayer catalysts (Rh/SUS) with 2000–8000 AP pulsing showed steep light-off of NO, CO and C3H6 at around 250 °C and their conversions soon reached to almost 100%. After thermal aging at 900 °C in H2O/air, however, the catalytic activity was decreased to the different extent depending on the number of AP pulsing. The most significant deactivation was observed for the smallest numbers of AP pulsing (2000), because Al in the foil was oxidized during the aging to form a passivation layer of α-Al2O3, which covered the surface of the foil and decreased the surface concentration of Rh. To overcome this deactivation, the Rh overlayer was formed by AP after preheating the foil at 1000 °C in air. This modified preparation process enables the deposition of Rh overlayer on the highly crystalline α-Al2O3 layer at the surface of the foil, which is found to be much more stable against thermal deactivation.

BACKGROUND Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed. METHODS We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period. RESULTS Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P < 0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093). CONCLUSIONS One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.

In Japan, most tularemia cases occur after contact with hares (hunting, cooking) and involve the glandular or ulceroglandular form. Here, we present a case of typhoidal tularemia in a 72-year-old Japanese male farmer who presented with fever, fatigue, and right lower abdominal pain. Computed tomography revealed intestinal wall thickening at the ascending colon, pleural effusion, and ascites. Following an initial diagnosis of bacterial enteric infection, his symptoms deteriorated after a week-long cephalosporin treatment course. The patient lived in an area endemic for scrub typhus; the antibiotic was changed to a tetracycline on suspicion of scrub typhus infection. His symptoms rapidly improved after initiation of minocycline treatment. Later, blood tests revealed marked increases in serological tests against Francisella tularensis exclusively, and the patient was diagnosed with typhoidal tularemia. Typhoidal tularemia may be characterized by any combination of general symptoms, but does not exhibit the local manifestations associated with other forms of tularemia. The patient, in this case, had no direct contact with hares or other wild animals and did not present with local manifestations of tularemia. Physicians should consider this disease, especially when tick-borne disease is suspected in the absence of local wounds, eschar, ulcers, or lymphadenopathy.

Background Cardiac resynchronization therapy (CRT) could be an effective therapy for patients suffering from severe heart failure (HF) despite optimal medical therapy. However, it has been reported that about 30% of patients receive ineffective results even if CRT has been performed. In a recent study, four-dimensional computed tomography (4DCT) was shown to be useful for pre-operative planning in transcatheter aortic valve intervention. The 4DCT is reconstructed with 10% increments over the cardiac cycle so that the displacement of the myocardium can be evaluated over time. From the above, we considered that the most delayed site where we would implant the left ventricular (LV) lead could be recognized by 4DCT. Case summary A 55-year-old man with a recurrent admission for HF indicated for CRT was referred to our hospital. In this patient, the 12-lead electrocardiogram (ECG) showed a relatively narrow QRS complex with a left bundle branch block pattern. An echocardiography demonstrated severe LV dysfunction. Although no dyssynchrony was detected, the LV lead was inserted into the most delayed site based on the 4DCT. Three-month later, the ejection fraction increased and the cardiothoracic ratio obviously shortened. Discussion We experienced a case in which we could evaluate the effective implantation site for the LV lead based on the 4DCT even though the effective site was not detected by echocardiography, and we could implant the LV lead at that effective site. The 4DCT may be useful for implanting LV leads in effective sites.

Background Roof-dependent atrial tachycardia (roof AT) sometimes occurs after pulmonary vein isolation (PVI) of atrial fibrillation (AF). This study aimed to investigate the relationship between the anatomy of the residual left atrial posterior wall and occurrence of roof AT. Methods A total of 265 patients with AF who underwent PVI were enrolled. After the PVI, induced or recurrent roof AT was confirmed by an entrainment maneuver or activation mapping using a three-dimensional (3D) mapping system. To identify the predictors of roof AT, the minimum distance between both PVI lines (d-PVI) was measured by a 3D mapping system and the anatomical parameters, including the left atrial (LA) diameter, left atrial volume index (LAVi), and shape of the left atrial roof, were analyzed by 3D computed tomography. Results Roof AT was documented in 11 (4.2%) of 265 patients. A multivariable analysis demonstrated that the d-PVI, Deep V shape of the LA roof, and LAVi were associated with roof AT occurrences (d-PVI: odds ratio: 0.72, confidence interval [CI]: 0.61–0.86, P < 0.001; Deep V shape: odds ratio: 0.19, CI: 0.04–0.82, P = 0.03; LAVi: odds ratio: 1.05, CI: 1.02–1.07, P = 0.001). A receiver-operating characteristic curve analysis yielded an optimal cut-off value of 15.5 mm and 55.7 mL/m2 for the d-PVI and LAVi, respectively. Conclusion The shorter d-PVI at the LA roof, greater LAVi, and Deep V shape were associated with the occurrence of a roof AT.

We herein report a case of disseminated Mycobacterium avium infection that involved both optic nerves, the conjunctiva, the right lower lung, and multiple skin lesions, including a thoracic nodule. The patient was a 65-year-old man without any significant medical history. The pathogen was detected in the patient's eye discharge, sputum, bronchial lavage fluid, and thoracic nodule. Anti-mycobacterial chemotherapy, including clarithromycin, rifampicin, and ethambutol, was administered, and the thoracic nodule was resected. An autoantibody to interferon-γ was detected in the patient's serum. Bilateral swelling of his optic nerves and facial dermatitis improved after initiating anti-mycobacterial chemotherapy.

Upper Limit of Vulnerability and the APD DynamicsIntroduction The restitution of the action potential duration (APD) is an important contributor to ventricular fibrillation (VF) initiation by a single critically timed ectopic beat. We hypothesized that a steep slope of the activation recovery interval restitution curve was related to the upper limit of vulnerability (ULV). Methods and Results Fifty-four consecutive patients with implantable cardioverter defibrillators (ICDs) implanted between April 2012 and July 2013 were included. At the implantation, pacing from the right ventricular (RV) coil to an indifferent electrode inserted in the ICD pocket was performed, and the unipolar electrograms from the RV coil were simultaneously recorded. We assessed the standard restitution by introducing extra-stimuli, while measuring the activation recovery interval (ARI). Our protocol for the vulnerability test consisted of delivering three 15 J shocks on the T-peak and within ±20 milliseconds of it. If VF was not induced by that procedure, a ULV of ≤15 J was defined. The relationship between the ULV and maximum slope of the restitution curve was analyzed. A restitution curve could finally be obtained in a total of 40 patients. The background characteristics were similar between the two groups. The maximum slope of the restitution curve was steeper in the ULV > 15 J group than ULV ≤ 15 J group (1.55 ± 0.45 vs. 0.91 ± 0.64, P 15 J from a ULV ≤ 15 J (sensitivity 61.5% and specificity 96.3%). Conclusion The maximum slope of the restitution curve was significantly related to the ULV. High defibrillation threshold patients could be detected by the ARI dynamics.

Background The precise location of truly active reentry circuits of typical atrial flutter (AFL) has not been well identified. The purpose of this study was to verify our hypothesis that the posterior block line is located along the posteromedial right atrium (PMRA) and the crista terminalis (CT) is the anterior pathway of AFL, with real-time intracardiac echo (ICE). Methods The entire right atrium (RA) three-dimensional activation and entrainment mapping were evaluated during AFL in 18 patients using CARTO sound. Results The CT was clearly visualized by ICE and the local electrograms along the CT were single potentials in all the patients. The CT was recognized as the truly active anterior pathway based on entrainment mapping in all patients. Double potentials were recorded along the PMRA. Entire RA entrainment mapping could be performed in 16 patients. The reentry circuits were separated into three passages. The first was around the tricuspid annulus (TA), the second the anterior superior vena cava (SVC; AFL waves passed between the anterior SVC and RA appendage), and the last the posterior SVC (between the posterior SVC and upper limit of the PMRA). All three of these passages were active in four, around the TA and anterior SVC in eight, around the TA and posterior SVC in three, and around only the anterior SVC in one patient. Conclusions The CT functions as the anterior pathway of typical AFL, and the posterior block line was located along the PMRA. Dual or triple circuits were recognized in the majority of AFL patients.

Background Cardiac resynchronization therapy (CRT) improves the survival rates of patients with heart failure, but 30–40% of them do not respond to CRT, partially because of the position of the left ventricular (LV) lead. The relationship between the electrical and mechanical activation of the left ventricle is unknown. The aim of this study was to compare the electrical and mechanical dyssynchrony. Methods We inserted electrode catheters into the coronary sinus (CS) and venous branches of the CS during CRT implantations and constructed electroanatomical contact maps in 16 patients using the EnSite NavX™ system. Mechanical activation was evaluated by speckle-tracking echocardiography and the latest mechanical and electrical sites were compared. The degrees of the electrical and mechanical delays of the implanted LV lead were also compared. Results The electroanatomical maps revealed that the latest electrical sites were anterior in one, anterolateral in five, lateral in eight, and posterolateral in two. Echocardiographic imaging revealed that the latest mechanical sites were anteroseptal in two, anterior in four, lateral in five, posterior in two, and inferior in three. The latest electrical and mechanical sites matched in only three patients. The degree of the local mechanical delay for the LV lead was significantly larger in the responders than nonresponders, whereas the local electrical delay did not differ. Conclusion A discrepancy between the electrical and mechanical dyssynchrony might affect an adequate LV lead positioning.

Aims Cardiac resynchronization therapy (CRT) improves the clinical status of patients with congestive heart failure, although left ventricular epicardial pacing may increase transmural dispersion of repolarization (TDR). The aim of this study was to investigate the time-dependent effect of CRT on ventricular repolarization and ventricular arrhythmia at mid-term follow-up. Methods and results The study group consisted of 84 patients treated with CRT. Twelve-lead electrocardiogram was digitally recorded and Tpeak-to-Tend interval (Tp-e) was measured at baseline, 1 week, 1 month, and 3, 6, and 12 months after device implantation. We determined the time-dependent changes in Tp-e, ventricular tachycardia and ventricular fibrillation (VT/VF) during 12 months of follow-up, in both CRT responders and non-responders. Seventeen of 84 patients (20%) had VT/VF during first year. Six of those 17 patients (35%) experienced VT/VF within 1 month of implantation and diminished over time. Tp-e decreased significantly at 6 and 12 months after implantation compared with 1 week [108 ± 14 ms at 1 week vs. 97 ± 21 ms at 6 months (P = 0.03) and 95 ± 19 ms at 12 months (P = 0.01)]. Responders demonstrated a greater time-dependent reduction of Tp-e at 6 and 12 months of CRT and had a lower rate of VT/VF compared with non-responders (log-rank test, P = 0.004). Conclusion Transmural dispersion of repolarization and the number of patients with VT/VF decreased over time after CRT. Patients with reverse remodelling demonstrated a lower rate of VT/VF and a greater time-dependent reduction of TDR.

We report the case of a 13-year-old boy with bilateral osteochondritis dissecans in the lateral femoral trochlea of the knees. They were classified as grade 4 in the right knee and grade 1 in the left knee on the basis of the Nelson classification within 1 year after first consultation. In the right knee, the fragment was surgically fixed, but the left knee healed with conservative treatment. This case indicates the possibility that osteochondritis dissecans of the lateral femoral trochlea may develop bilaterally at different times and present at different stages. The case shows the importance of early diagnosis and appropriate treatment on the basis of the stage.

Left ventricular end-systolic volume (LVESV) changes at 6 months and clinical status are useful for assessing responses to cardiac resynchronization therapy (CRT). Regression of the LVESV following CRT has not been described beyond 6 months. This study aimed to assess the proportion, predictors, and clinical outcomes of responders whose LVESVs had regressed.We retrospectively analyzed 104 consecutive CRT patients. A responder was defined as a patient with a relative reduction in the LVESV ≥15% at 6 months after CRT. Fifty-six responders participated in this study. A transient responder was defined as a responder without a relative reduction in the LVESV ≥15% at 2 years after CRT or who died of cardiac events during the 24-month follow-up period.Of the 56 responders, 16 (29%) were transient responders. Multivariable logistic regression analysis showed that chronic atrial fibrillation (odds ratio [OR] = 19.2, 95% confidence interval [CI] [1.93, 190], P = 0.012) and amiodarone usage (OR = 60.9, 95% CI [4.18, 886], P = 0.003) were independent predictors of transient responses. Hospitalizations for heart failure were significantly higher among the transient responders than among the lasting responders during a mean follow-up period of 7.6 years (log-rank P0.001), and all-cause mortality tended to be higher among the transient responders (log-rank P = 0.093).One-third of the responders were transient responders at 2 years after CRT, and their long-term prognoses were poor. Careful attention should be paid to maintain the reduction in LVESV especially in patients with chronic AF.

Roof-dependent atrial tachycardia (roof AT) sometimes occurs after pulmonary vein isolation (PVI) of atrial fibrillation (AF). This study aimed to investigate the relationship between the anatomy of the residual left atrial posterior wall and occurrence of roof AT.A total of 265 patients with AF who underwent PVI were enrolled. After the PVI, induced or recurrent roof AT was confirmed by an entrainment maneuver or activation mapping using a three-dimensional (3D) mapping system. To identify the predictors of roof AT, the minimum distance between both PVI lines (d-PVI) was measured by a 3D mapping system and the anatomical parameters, including the left atrial (LA) diameter, left atrial volume index (LAVi), and shape of the left atrial roof, were analyzed by 3D computed tomography.Roof AT was documented in 11 (4.2%) of 265 patients. A multivariable analysis demonstrated that the d-PVI, Deep V shape of the LA roof, and LAVi were associated with roof AT occurrences (d-PVI: odds ratio: 0.72, confidence interval [CI]: 0.61-0.86, P0.001; Deep V shape: odds ratio: 0.19, CI: 0.04-0.82, P = 0.03; LAVi: odds ratio: 1.05, CI: 1.02-1.07, P = 0.001). A receiver-operating characteristic curve analysis yielded an optimal cut-off value of 15.5 mm and 55.7 mL/mThe shorter d-PVI at the LA roof, greater LAVi, and Deep V shape were associated with the occurrence of a roof AT.

A practical method for coupled oscillator design is elaborated. The topology analysis of a coupled oscillator, the ways of simulating its sensitivity, initializing its operation, and the oscillation frequency enhancement with nMOS phase couplers are presented. We have developed a write strategy system for DVD with a coupled oscillator using these techniques. In addition, we have also developed a low-power-oriented multiphase generator for mobile phones with our newly devised multiphase level shift system (M-LS). The M-LS has established superiority in its low power consumption because of no short current. Moreover, we have applied the method of output phase-accuracy improvement using a resistor ring to the M-LS. Two test chips are fabricated and the design method is validated. The first coupled oscillator has a resolution of 32 ps and a phase accuracy of -1.0 to 0.8 LSB at 490 MHz, corresponding to 16times DVD write speed. The second one consumes 1 mA and has a high phase accuracy of 0.5 LSB at 123 MHz.

We prepared partly crystalline polydiacetylenes (PDAs) by the solid-state polymerization of substituted benzyl 10,12-alkyldiynoates followed by the dissolution of the resulting polymers in refluxing 1,2-dichlorobenzene and subsequent reprecipitation. The obtained PDAs were soluble in organic solvents, such as chloroform and tetrahydrofuran, at room temperature. They showed thermochromism not only in the bulk and polymer matrices but also in solution. The UV–vis absorption spectrum of PDAs in solutions changed depending on the temperature along with a large hysteresis. The thermochromic properties were dependent on the structure of the PDAs, that is, the length of the alkyl side chains and also the structure of the substituent on the phenyl group. We have found that aggregates are formed in the solution when the temperature decreased on the basis of the NMR and dynamic light scattering measurement results.

Recent large clinical study demonstrated association of intermediate CD14++CD16+monocytes (IM) with cardiovascular events. We investigated the possible role of IM in pathophysiology of atrial fibrillation (AF). This case-control study included 30 AF patients (17 paroxysmal and 13 persistent AF

In order to detect flat-type dysplastic and cancerous lesions associated with longstanding ulcerative colitis, it is important to understand the minute findings detected by magnifying colonoscopy in active and quiescent stage of ulcerative colitis. The severity of mucosal findings by magnifying colonoscopy could be categorized as follows: polypoid mucosal tag which has severe ulceration and hemorrhage; coral-reef-like appearance which has coarse or nodular mucosa with ulcerations; minute defect of epithelia which has minute or shallow depressions surrounded by edematous mucosa; small yellowish spots which has minute whitish or yellowish coats; villi-like appearance which has shaggy appearance like small intestinal villi; and regularly arranged crypt opening which has round shaped and regularly arranged crypt.

We performed the systematic magnetization measurements in the temperature range down to 0.4 K for a 2:1 charge-transfer salt of a new donor molecule, ethyelendithiotetrathiafulvalenoquinone-1,3-dithiolemethide with FeBr4− ion that belongs to a π–d electron system. A novel resonant circuit method to sensitively detect the magnetization jump in the small hysteresis loop was introduced in the measurements. From the analysis of the transient oscillation signals in dM/dt, the ferromagnetic ordering was confirmed at TC=1.02±0.22 K.

The authors have been developing a new type of lightning location and monitoring system based on a technique of “VHF broadband digital interferometry". This paper summarizes this VHF broadband digital interferometer (DITF), together with new observations. As a first step of the development, the experimental system is installed and lightning observations are conducted. In these observations, imaging of lightning progression is obtainable in two- and/or three-dimensions. The effectiveness of our results has been confirmed by the comparisons with the results of previous studies and other observations. The evaluation of the system is discussed to improve its accuracy, and the advanced system is completed. At present, the advanced system has been completed and the first result is obtained. It is concluded that the function of the system works well, and the VHF broadband DITF for lightning monitoring is accomplished with high accuracy from the aspects of time and space resolutions.

The restitution of the action potential duration (APD) is an important contributor to ventricular fibrillation (VF) initiation by a single critically timed ectopic beat. We hypothesized that a steep slope of the activation recovery interval restitution curve was related to the upper limit of vulnerability (ULV).Fifty-four consecutive patients with implantable cardioverter defibrillators (ICDs) implanted between April 2012 and July 2013 were included. At the implantation, pacing from the right ventricular (RV) coil to an indifferent electrode inserted in the ICD pocket was performed, and the unipolar electrograms from the RV coil were simultaneously recorded. We assessed the standard restitution by introducing extra-stimuli, while measuring the activation recovery interval (ARI). Our protocol for the vulnerability test consisted of delivering three 15 J shocks on the T-peak and within ±20 milliseconds of it. If VF was not induced by that procedure, a ULV of ≤15 J was defined. The relationship between the ULV and maximum slope of the restitution curve was analyzed. A restitution curve could finally be obtained in a total of 40 patients. The background characteristics were similar between the two groups. The maximum slope of the restitution curve was steeper in the ULV15 J group than ULV ≤ 15 J group (1.55 ± 0.45 vs. 0.91 ± 0.64, P0.05). A maximum slope exceeding 1.0 was the optimal point for discriminating patients with a ULV15 J from a ULV ≤ 15 J (sensitivity 61.5% and specificity 96.3%).The maximum slope of the restitution curve was significantly related to the ULV. High defibrillation threshold patients could be detected by the ARI dynamics.

The precise location of truly active reentry circuits of typical atrial flutter (AFL) has not been well identified. The purpose of this study was to verify our hypothesis that the posterior block line is located along the posteromedial right atrium (PMRA) and the crista terminalis (CT) is the anterior pathway of AFL, with real-time intracardiac echo (ICE).The entire right atrium (RA) three-dimensional activation and entrainment mapping were evaluated during AFL in 18 patients using CARTO sound.The CT was clearly visualized by ICE and the local electrograms along the CT were single potentials in all the patients. The CT was recognized as the truly active anterior pathway based on entrainment mapping in all patients. Double potentials were recorded along the PMRA. Entire RA entrainment mapping could be performed in 16 patients. The reentry circuits were separated into three passages. The first was around the tricuspid annulus (TA), the second the anterior superior vena cava (SVC; AFL waves passed between the anterior SVC and RA appendage), and the last the posterior SVC (between the posterior SVC and upper limit of the PMRA). All three of these passages were active in four, around the TA and anterior SVC in eight, around the TA and posterior SVC in three, and around only the anterior SVC in one patient.The CT functions as the anterior pathway of typical AFL, and the posterior block line was located along the PMRA. Dual or triple circuits were recognized in the majority of AFL patients.

Aims Left bundle branch block (LBBB) induces mechanical dyssynchrony, thereby compromising the coronary circulation in non-ischaemic cardiomyopathy. We sought to examine the effects of cardiac resynchronization therapy (CRT) on coronary flow dynamics and left ventricular (LV) function. Methods and results Twenty-two patients with non-ischaemic cardiomyopathy (New York Heart Association class, III or IV; LV ejection fraction, ≤35%; QRS duration, ≥130 ms) were enrolled. One week after implantation of the CRT device, coronary flow velocity and pressure in the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCx) were measured invasively, before and after inducing hyperemia by adenosine triphosphate administration, with two programming modes: sequential atrial and biventricular pacing (BiV) and atrial pacing in patients with LBBB or sequential atrial and right ventricular pacing in patients with complete atrioventricular block (Control). We assessed hyperemic microvascular resistance (HMR, mean distal pressure divided by hyperemic average peak velocity) and the relationship between the change in HMR and mid-term LV reverse remodelling. Hyperemic microvascular resistance was lower during BiV than during Control (LAD: 1.76 ± 0.47 vs. 1.54 ± 0.45, P < 0.001; LCx: 1.92 ± 0.42 vs. 1.73 ± 0.31, P = 0.003). The CRT-induced change in HMR of the LCx correlated with the percentage change in LV ejection fraction ( R = −0.598, P = 0.011) and LV end-systolic volume ( R = 0.609, P = 0.010) before and 6 months after CRT. Conclusion Cardiac resynchronization therapy improves coronary flow circulation by reducing microvascular resistance, which might be associated with LV reverse remodelling.

Iodoformgauze topical applications are often used to wound infections. We report a postoperative epidural abscess with delirium due to iodoformgauze topical application in an open wound. We had inserted an epidural catheter in 79-year-old man with an epidural abscess. After proper drainage, iodoformgauze was used to cover for the abscess. He suffered consciousness disturbance for 12 days postoperatively. Suspecting iodoform toxicity, we checked protein binding iodine (PBI) and total serum iodine. PBI was 14.5μg/dl and total serum iodine 152μg/dl. We stopped iodoformgauze use, and the man's consciousness cleared, indicating the importance of watching for side effects such as consciousness disturbance when using iodoformgauze.

The incidence of hemangioma is the highest of all benign liver tumors. Although subjective symptoms are rare, surgical treatment is considered only in symptomatic cases of giant tumors. We treated a 46-year-old male was admitted to our hospital with the rupture of a large cavernous hemangioma of the liver due to blunt abdominal trauma from a free-fall injury. Ultrasonography and computed tomography (CT) of the abdomen revealed intraabdominal bleeding in the left subphrenic space. Since the patient's vital signs were stable, we treated him conservatively. Subsequent enhanced CT, angiography, and MRI showed a ruptured hemangioma at the left lateral segment of the liver. Surgical intervention was conducted on hospital day 17. Pathological examination confirmed the ruptured cavernous hemangioma. Traumatic rupture of a hepatic cavernous hemangioma is surgery, the same as in spontaneous liver ruputure. In emergency cases, we consider it essential that careful diagnosis is vital using enhanced CT findings.

Severe pulmonary thromboembolism (PE) during pregnancy occurred in 2 young patients. One patient died from PE recurrence without placement of an inferior vena cava (IVC) filter, but the other survived with emergent filter placement before cesarean section. A 31-year-old woman presented with sudden dyspnea at 34 weeks of pregnancy. On examination, she was cyanotic and echocardiography revealed marked right heart dilatation and pulmonary hypertension. An emergent cesarean section was performed, but soon after the delivery, she fell into circulatory arrest. PE recurrence was suggested as cause, and t-PA was administered into the pulmonary artery. She was resuscitated but she died from another PE recurrence 4 days later. A 25-year-old woman, 35 weeks pregnant was admitted because of threatened abortion. She felt sudden dyspnea 3 days after admission and was diagnosed with severe PE by echocardiography and pulmonary catheterization. A Vena-Tech IVC filter™ was inserted at the suprarenal position to prevent PE relapse. Emergent cesarean section was then carried out uneventfully. Heparin and urokinase were administered postoperatively, and her pulmonary arterial pressure decreased. She was extubated 7 days later, and is now doing well 10 months later. Once severe PE has occurred, its relapse may be lethal. The IVC filter is effective in preventing recurrence. Even if the patient is young, emergent IVC filter placement to avoid fatal PE relapse is essential.

The object of this study was to determine the frequency and characteristics of altered paraumbilical vein in the hepatic parenchyma, developed from portal hypertension, using computed tomography (CT). Two hundred and ninety-two patients who presented with portal hypertension from 1986 to 1996 were studied retrospectively. The pathway of the dilated para-umbilical vein was demonstrated by contrast-enhanced CT. Thirty-one (11%) patients had a dilated para-umbilical vein arising from the left portal vein into the falciform ligament. In 24 (77%) of these patients, the para-umbilical vein followed the expected route, passing through the fissure of ligamentum teres hepatis. The remaining seven patients (23%) displayed the unusual pathway, with the vein arising from the left branch of the portal vein and passing into the hepatic parenchyma. In these seven patients, four had one collateral vein, and three patients had two collateral veins in the liver parenchyma. The dilated para-umbilical vein frequently passes through the hepatic parenchyma in patients with portal hypertension.

4-Hydroxy-2-nonenal (HNE) is one of the major components of lipid peroxidation product and has been shown to react with proteins to form HNE-protein adducts. HNE-protein adducts are relatively stable and can be used as a marker of radical-mediated cellular damage. We report herein the immunohistochemical analysis of HNE-protein adducts in human alcoholic liver diseases using a specific monoclonal antibody HNEJ-2. Cytoplasm of hepatocytes and bile duct epithelia was positively stained for HNE-protein adducts, and the nucleus was negligibly stained. The immunohistochemical intensity of hepatocytes was classified into three groups: strong, moderate, and faint staining. Strong staining was found in 43% of alcoholic liver diseases and in 4% of viral liver diseases. Hepatocytes of alcoholic liver diseases contained a higher amount of HNE-protein adducts than those of viral liver diseases, and the difference was statistically significant (p = 0.005; chi2 test). Semiquantitative analysis of the histological intensities of HNE-protein adducts and iron indicated a significant positive correlation (p = 0.084; Spearman's rank correlation). The localization of HNE-protein adducts and iron in hepatocytes appeared to be identical. These data suggested the correlation between HNE-protein adducts and iron. Our results indicate that HNE-protein adducts, a marker of oxidative stress-induced damage, are increased in human alcoholic liver damage, and that hepatic siderosis may act on the production of free radicals.

Mapping of the antegrade fast pathway (A-FP) exact sites and antegrade slow pathway (A-SP) input locations has not been well described.In 56 patients with slow-fast atrioventricular nodal reentrant tachycardia (SF-AVNRT), pacing during sinus rhythm and entrainment pacing during SF-AVNRT were performed at various sites in the triangle of Koch and coronary sinus (CS) to identify the A-FP and A-SP inputs. User-defined three-dimensional electro-anatomical mapping of the stimulus-His potential (St-H) interval and anatomical location was performed. The A-FP input was defined as the site of the shortest St-H interval, and A-SP input as the site of the shortest St-H interval and with a postpacing-interval equal to the tachycardia cycle length. The locations of the A-FP and A-SP inputs were mapped as a ratio of the distance between the His bundle (HB) and CS orifice (CSO), and the HB-CSO axis was divided into three zones: superior-, mid-, and inferior septum. The distance between the A-SP and A-FP inputs was calculated using the distance from each input to the HB and HB-CSO axis.Only 30 patients were included in this study because the A-SP mapping failed in 26. The A-SP input was distributed to the superior septum in four, mid- or inferior septum in 25, and CS in one. An A-SP input which was located less than 10 mm from the A-FP input was observed in one of four patients with a superior septum A-SP.An A-SP input at the superior septum seemed to be a potential risk for atrioventricular nodal injury during ablation.

The aim of this study is to assess whether the risk or types of suicide change in Fukushima in the aftermath of a series of disaster, including earthquake, tsunami and nuclear accident in March 2011. The clinical records of all patients visited to the medical centre near the nuclear plant from 1 year before to 1 year after the disaster were reviewed (n = 981). Patients with non-fatal suicide attempt were divided into two categories depending on their method of suicide attempt. Standardised mortality ratios were calculated to adjust for changes in demographic profiles. The risk of non-fatal suicide attempts using high-mortality methods was significantly higher for 4 months, by three to four times after the series of disasters, and then decreased. There was no significant increase of non-fatal suicide attempts using low-mortality methods after the disaster. After such a disaster, immediate psychiatric support may be required because of the increased risk of non-fatal suicide attempts in the immediate aftermath.

Background The genus Chromobacterium consists of 7 recognized species. Among those, only C. violaceum, commonly found in the soil and water of tropical and subtropical regions, has been shown to cause human infection. Although human infection is rare, C. violaceum can cause life-threatening sepsis, with metastatic abscesses, most frequently infecting those who are young and healthy. Case presentation We recently identified a case of severe bacteremia caused by Chromobacterium haemolyticum infection in a healthy young patient following trauma and exposure to river water, in Japan. The patient developed necrotizing fasciitis that was successfully treated with a fasciotomy and intravenous ciprofloxacin and gentamicin. Conclusions C. haemolyticum should be considered in the differential diagnosis of skin lesions that progressively worsen after trauma involving exposure to river or lake water, even in temperate regions. Second, early blood cultures for the isolation and identification of the causative organism were important for initiating proper antimicrobial therapy.

Background: The upper lim it of vulnerability (UL V) closely correlates with the defibrillation threshold (OFT) . The aim of th is study was to establish the optimal protocol for using the UL V test to predict high OFT (>20 J) without inducing ventricular fibrillation (VF) . Methods and Results: The 10-J and 15-J ULV test with 3 coupling intervals (-20, 0, and +20ms to the peak of T-wave) and the OFT test were performed in 96 patients receiving implantable cardioverter defibrillator. ULV ::; 10J was confirmed in 47 (49%). ULV ::; 15J was confirmed in 70 (77%) of 91 patients (15-J ULV test could not be done in 5). The sensitivity and negative predictive value of both ULV > 1 OJ and> 15J for predicting high OFT were 100%. The specificity and positive predictive value of ULV > 15 J were higher than those for ULV > 1 OJ (85% vs. 55%, 43% vs. 22%, respectively). The rate of VF inducibility for confirming ULV ::; 15J was lower than that for ULV ::; 10J (23% vs. 51 %, P

Purpose: Early operative control of hemorrhage is the key to saving the lives of severe trauma patients. We investigated whether emergency room (ER) stay time (time from the ER to the operating room [OR]) is associated with trauma severity and unexpected trauma death (Trauma and Injury Severity Score [TRISS] method-based Probability of survival [Ps] ≥0.5 but died) of injured patients needing emergency trauma surgery. Methods: We performed a retrospective review of call trauma patients requiring emergency surgery and all patients with pelvic fractures requiring transcatheter arterial embolization at our hospital from January 2002 to December 2012. We analyzed the relationships among injury severity on ER admission (Injury Severity Score [ISS]; Revised Trauma Score (RTS); Ps; Shock Index (SI); American Society of Anesthesiologists Physical Status [ASA-PS]); mortality rate; unexpected trauma death rate; and ER stay time. Results: ER stay times were significantly shorter for patients with life-threating conditions (RTS

PURPOSE: Airway management of trauma patients during emergency surgeries can be very difficult and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings. METHODS: We performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, focusing on ESA. RESULTS: During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5 %) required emergency surgery. Four of these patients (0.72 %) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and 1 patient with penetrating neck trauma received open standard tracheostomy (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as "cannot ventilate, cannot intubate" (CVCI), and there were no complications associated with ESA. All cases had good outcomes. Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale >/=3) received ESA at a significantly higher rate than others (p = 0.015, odds ratio 14.1). CONCLUSION: One of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including providing ESA, to assure patient safety.

In this paper, we describe a clinicopathological study of primary hepatocellular carcinoma (HCC) associated with alcoholic liver disease without hepatitis virus infection. In 180 HCC patients who were admitted to Asahikawa Medical College Hospital from 1987 to 1995, 10 patients (6%) had HCC associated with pure alcoholic liver disease (Al-HCC) whereas the HCC in 165 patients was associated with chronic viral liver diseases, in 2 with primary biliary cirrhosis, in 1 each with coexistence of the hepatitis C virus infection and hemochromatosis, and in 2 with cirrhosis of unknown origin. In the Al-HCC group, all patients were male. The diagnosis of HCC was obtained at the age of 54 to 67 years old, and the duration of ethanol intake was 33 to 40 years. Four cases had a history of temperance. As an underlying liver disease, liver fibrosis was found in three cases and liver cirrhosis in seven cases. HCC was diagnosed histologically in all cases. Serum α-fetoprotein and PIVKA-II were positive in patients with advanced HCC. In cases with small HCC, the tumor was resected surgically in three cases and percutaneous ethanol injection was performed in two cases. In four cases with small HCC, the patients were alive without tumor recurrence during the observation period. In advanced HCC, transcatheter arterial chemolipiodolization was performed. In the analysis of genetic polymorphism of ALDH 2, all Al-HCC had ALDH 2 1 /2 1 .

A case of primary biliary cirrhosis (PBC) associated with idiopathic thrombocytopenic purpura (ITP) is reported. The patient is a 59-year-old man. When he was 49 years old, he was diagnosed with ITP and received steroid therapy that successfully increased platelet numbers. However, the steroid therapy failed to normalize the elevated gamma-glutamyl transpeptidase. Ten years after this episode, he suffered from general itching and malaise and exhibited a gradual increase of serum biliary enzyme levels. Immunologically, IgM was increased and anti-mitochondrial antibody was positive. Histological findings of liver needle biopsy showed chronic non-suppurative destructive cholangitis, confirming the diagnosis of PBC. To date, very few PBC cases associated with ITP have been reported. Our case is the second one in Japan. PBC and ITP in our patient seemed to develop simultaneously, but the effect of steroid therapy on the two conditions was different. This result suggests that the autoimmune process may have been different in PBC and ITP in the present patient.

A 71-year-old man was admitted to our emergency center complaining of severe pain and cyanosis in both legs. No arterial pulses were palpable in either foot, and emergency aortography revealed thromboembolism of the right knee and left common iliac artery. Thromboembolectomy via a Fogarty catheterTM was performed on both sides and cyanosis disappeared, but swelling developed in the lower leg and pulsation in the right foot was weak even after embolectomy. Angiography 30 days later revealed a peroneal arteriovenous (AV) fistula on the right side. Transarterial embolization (TAE) with a MDC coilTM was performed, and the swelling resolved and the pulsation in the right foot improved soon after the TAE. Peroneal AV fistula is an unusual complication of Fogarty catheterTM embolectomy, often detected only after postoperative follow-up angiography. We emphasize the importance of angiography following embolectomy and the effectiveness of TAE in treating AV fistula.

転移抑制遺伝子のひとつであるnm23-H1遺伝子産物の発現は肝癌細胞の転移能に逆相関することを明らかにしたが, その機序を検索するにあたり施行したノーザンブロットとウエスタンブロットに相反する結果が認められた. しかし, PCR-SSCP, サザンブロットおよびマイクロサテライト解析を加えて検索することにより, nm23-H1遺伝子産物の発現は肝癌細胞においては主に転写後に制御されるという結論を得た. このように遺伝子産物の発現機序の解明には複数の電気泳動法による検索とそれらの結果を総合して解析することが重要であると考えられた.

The aim of this study was to investigate the effects of milrinone (MLN) on lung water and hemodynamics in dogs with oleic acid induced lung edema. Extravascular lung water volume (EVLWV) was measured as an index of lung water using a themo/sodium double indicator method. After baseline measurements, 0.08ml/kg of oleic acid was injected into the caval vein. Twelve mongrel dogs were divided into the following two groups; MLN group and control group (C). In the MLN group, 100μg/kg of MLN was administrated by bolus injection followed by infusion at 1.0μg/kg min. The same volume of saline was infused in to the C group. Values were again obtained at 30, 60 120, and 180 minutes after the start of MLN. EVLWV was significantly increased by oleic acid and was significantly reduced in the MLN group compared to the C group. Hypoxemia was improved by MLN. Pulmonary vascular resistance in the MLN group was significantly lower than that in the C group.

Development of Wireless EEG system is described. Realtime impedance monitoring and active electrodes are introduced in order to reduce noise from impedance changes caused due to body motion, and to prevent noise from power line interference, respectively. EEG ASICs are developed for the system. The complete system has a low noise (60nV/√Hz) and is packaged in a compact enclosure (38mm × 38mm × 16mm). The system is evaluated against different types of artefacts and possible applications with the system are discussed.

The patient was a 67-year-old man who showed right massive haemothorax after being run over by a low-speed vehicle. In the ambulance, his Glasgow Coma Scale score was 15/15 (eyes: 4; verbal: 5; motor: 6) and he was able to speak. However, he went into cardiopulmonary arrest during transportation. On admission to our hospital 40 min after arrest, right massive haemothorax was detected. The …

In this paper, we present a miniaturized (