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Background: Fulminant myocarditis presentation (FMP) is a rare and severe presentation of myocarditis. The natural history of FMP and its clinical features associated with poor outcomes are incompletely understood because there is a lack of generalizable evidence. Methods: This multicenter retrospective cohort study included patients hospitalized with histologically proven myocarditis who underwent catecholamine or mechanical support from 235 cardiovascular training hospitals across Japan between April 2012 and March 2017. Clinical features and the prognostic predictors of death or heart transplantation within 90 days on the basis of clinical and pathologic findings were determined using the Kaplan-Meier method, log-rank test, and Cox regression analysis. Results: This study included 344 patients with histologically proven FMP (median age, 54 years; 40% female). The median follow-up was 600 days (interquartile range, 36 to 1599 days) and the cumulative risk of death or heart transplantation at 90 days was 29% (n=98). Results from multivariable Cox regression analysis showed that older age, nonsinus rhythm, low left ventricular wall motion ( Conclusions: The results from analyses of data from this multicenter registry demonstrated that patients with FMP are at a higher risk of death or heart transplantation in real-world settings. These observations inform which clinical and pathologic findings may be useful for prognostication in FMP. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000039763.

Abstract Renal denervation is a promising new non-pharmacological treatment for resistant hypertension. However, there is a lack of data from Asian patients. The REQUIRE trial investigated the blood pressure-lowering efficacy of renal denervation in treated patients with resistant hypertension from Japan and South Korea. Adults with resistant hypertension (seated office blood pressure ≥150/90 mmHg and 24-hour ambulatory systolic blood pressure ≥140 mmHg) with suitable renal artery anatomy were randomized to ultrasound renal denervation or a sham procedure. The primary endpoint was change from baseline in 24-hour ambulatory systolic blood pressure at 3 months. A total of 143 patients were included (72 renal denervation, 71 sham control). Reduction from baseline in 24-hour ambulatory systolic blood pressure at 3 months was not significantly different between the renal denervation (−6.6 mmHg) and sham control (−6.5 mmHg) groups (difference: −0.1, 95% confidence interval −5.5, 5.3; p = 0.971). Reductions from baseline in home and office systolic blood pressure (differences: –1.8 mmHg [p = 0.488] and −2.0 mmHg [p = 0.511], respectively), and medication load, did not differ significantly between the two groups. The procedure-/device-related major adverse events was not seen. This study did not show a significant difference in ambulatory blood pressure reductions between renal denervation and a sham procedure in treated patients with resistant hypertension. Although blood pressure reduction after renal denervation was similar to other sham-controlled studies, the sham group in this study showed much greater reduction. This unexpected blood pressure reduction in the sham control group highlights study design issues that will be addressed in a new trial. Clinical trial registration NCT02918305 (http://www.clinicaltrials.gov).

From the correlation between the blood flow dynamics and wall dynamics in the left ventriocle (LV) analyzed using echo-dynamography, the ejection mechanisms and role of the intra-ventricular vortex in the LV were elucidated in detail during the pre-ejection transitional period (pre-ETP), the very short period preceding LV ejection. The study included 10 healthy volunteers. Flow structure was analyzed using echo-dynamography, and LV wall dynamics were measured using both high-frame-rate two-dimensional echocardiography and a phase difference tracking method we developed. A large accelerated vortex occurred at the central basal area of the LV during this period. The main flow axis velocity line of the LV showed a linearly increasing pattern. The slope of the velocity pattern reflected the deformity of the flow route induced by LV contraction during the pre-ETP. The centrifugal force of the vortex at its junction with the main outflow created a stepwise increase of about 50% of the ejection velocity. Ejection of blood from the LV was accomplished by the extruding action of the ventricular wall and the centrifugal force of the accelerated vortex during this period. During ejection, acceralated outflow was considered to create a spiral flow in the aorta with help from the spherical structure of the Valsalva sinus.

A 79-year-old womam presented with severe aortic stenosis (AS) and aorto-iliac occlusive disease (AIOD). The distal end of her abdominal aorta was occluded with severe calcification. Simultaneous Y-grafting of the terminal abdominal aorta and transcatheter aortic valve implantation (TAVI) using the left limb of a Y-shaped artificial graft as an access route were planned. After proximal and distal anastomoses of the abdominal aorta and the right common iliac artery(CIA) using the Y-shaped artificial graft, TAVI was performed through the left limb of the artificial graft. The technique was similar to that used for transfemoral TAVI. Subsequently, the left limb of the graft was anastomosed to the left CIA. The patient's postoperative course was unremarkable, without heart failure or lower limb ischemia. This option serves as an effective access route for TAVI in patients with AIOD.

Complicated aortic arch plaques (CAP) and their progression are important for recurrent ischemic stroke (IS) and its prognosis. We investigated the effects and clinical benefits of rosuvastatin therapy on this pathophysiology. The purpose of this study was to investigate whether rosuvastatin prevention of aortic arch plaque progression improved the prognosis of IS patients.Ninety-seven consecutive acute cerebral embolism patients were retrospectively surveyed. All had transesophageal echocardiography (TEE) to assess the presence or absence of CAP, defined as aortic wall thickness ≥4 mm or plaque ulceration. Patients received conventional antithrombotic therapy as clinically indicated. All patients with CAP were recommended to receive 5 mg rosuvastatin/day, administered by their attending physicians; not all physicians followed this recommendation. Six-month follow-up TEEs were performed in patients with CAP who received rosuvastatin. Major adverse cerebrovascular events (MACEs) comprised recurrent IS and death.CAP was detected in 39 patients (40%), and MACEs in 15. Multivariate regression analysis showed that patients with CAP not taking rosuvastatin was an independent risk factor for MACEs (odds ratio = 18.044; 95% confidential interval = 2.089-155.846, p 0.01). When patients were divided into three groups: those with CAP taking rosuvastatin, those with CAP not taking rosuvastatin, and those without CAP, Kaplan-Meier analysis demonstrated that patients with CAP not taking rosuvastatin had significantly more MACEs than those in the other two groups (long-rank test; χRosuvastatin therapy prevented aortic arch plaque progression in IS patients with CAP, and may also have long-term clinical benefits.

A dissociated dislocation introduced by compression at room temperature in a Ag-15at.%Al alloy was studied comprehensively by the weak-beam method. In addition to the two Shockley partials of the dissociated dislocation, faint contrasts were observed near the Shockley partial with pure edge orientation. Contrast experiment was carried out on the faint contrast, and we conclude that this is evidence for the interaction between an edge-orientated Shockley partial moving under the action of an applied stress and vacancies at room temperature.

Background and purpose Many clinical trials have shown that 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) can significantly reduce coronary artery disease in both primary and secondary prevention. A recent study showed that aggressive lipid-lowering therapy with strong statins could achieve coronary artery plaque regression, as evaluated with gray-scale intravascular ultrasound (IVUS). However, it is unknown whether coronary plaque regression and stabilization are reinforced when eicosapentaenoic acid (EPA) is used with a strong statin. Methods and subjects We aim to assess patients with stable angina or acute coronary syndrome who had undergone successful percutaneous coronary intervention (PCI) with integrated backscatter IVUS (IB-IVUS) guidance. They will be randomly allocated to receive pitavastatin (4 mg), or pitavastatin (4 mg) plus EPA (1800 mg), and prospectively followed for 6–8 months. Results The primary endpoint will be changes in tissue characteristics in coronary plaques, evaluated by IB-IVUS, and secondary endpoints will include absolute changes in coronary plaque volume, serum lipid levels, and inflammatory markers. The safety profile will also be evaluated. Conclusions The combination therapy of EPA and pitavastatin for regression of coronary plaque evaluated by IB-IVUS (CHERRY) study will be the first multicenter study using IB-IVUS to investigate the effects of combination therapy with pitavastatin and EPA on coronary plaque volume and tissue characteristics.

The effect of rosuvastatin was investigated on complicated aortic arch plaque (CAP) morphology and lipid profiles in acute cerebral embolism (CE) patients with normal low-density lipoprotein-cholesterol (LDL-c) levels. Transesophageal echocardiography (TEE) studies were performed in 56 consecutive CE patients with LDL-c less than 140 mg/dL who were not taking lipid-lowering agents at baseline. CAP observed by TEE was defined as the presence of greater than 4-mm diameter, ulcerated, or mobile aortic plaque. Patients were divided into those with CAP versus without CAP (group A, n=24, age 69±8 years) and without CAP (group B, n=32, age 62±10 years). Of the 24 group A patients, 18 received 5 mg/d of rosuvastatin for 6 months and had follow-up TEE studies. In Group A, the baseline values of high-density lipoprotein-cholesterol (HDL-c) and apolipoprotein A-1 (ApoA-1) were significantly lower than in Group B (44±15 versus 55±15 mg/dL, P=.0059; 103±19 versus 137±25 mg/dL, P=.0006, respectively) and age and serum high-sensitivity C-reactive protein concentration were significantly higher (69±8 vs. 62±10 years, P=.0080; 2.34±3.05 vs. 0.67±1.00 mg/dL, P=.0054, respectively). By multivariate logistic regression analysis, ApoA-1 was shown to be an independent predictor of CAP (odds ratio=.894, 95% confidence intervals .800-.996, P=.0483). In the 18 group A patients receiving rosuvastatin for 6 months, aortic arch plaque diameter and serum LDL-c were significantly decreased (5.8±2.2 to 5.1±2.1 mm, P=.0377; 110±23 to 81±23 mg/dL, P=.0008, respectively), whereas serum HDL-c and ApoA-1 concentrations were significantly increased (42±8 to 52±9 mg/dL, P=.0002; 109±22 to 135±15 mg/dL, P=.0002, respectively). Plaques were morphologically improved in 11 patients, unchanged in 6, and worsened in 1. These data suggest that rosuvastatin improves plaque morphology concomitant with improving lipid profiles in CE patients with normal LDL-c levels.

Albuminuria is an established risk factor for mortality and cardiovascular events in the general population. Albuminuria might be a marker of the various pathophysiologic changes, such as diffuse vascular injury and systemic inflammation, that arise in patients with chronic heart failure (CHF). However, the relation between albuminuria and CHF has not yet been fully elucidated. Therefore, the purpose of the present study was to assess the prevalence and prognostic significance of albuminuria in patients with CHF secondary to ischemic or idiopathic dilated cardiomyopathy. Of the 712 patients with CHF, 311 had normoalbuminuria, 304 had microalbuminuria, and 97 had macroalbuminuria. The patients with albuminuria had more cardiovascular co-morbidity and worse renal function than those with normoalbuminuria. A total of 152 cardiac events occurred during the follow-up period. Kaplan-Meier analysis demonstrated that patients with albuminuria had a greater incidence of cardiac events than those without albuminuria. Furthermore, albuminuria was significantly associated with an increased risk of cardiac events, even after adjustment for other prognostic variables. In conclusion, albuminuria is a powerful and independent predictor of adverse prognosis in patients with CHF and could be useful for risk stratification of patients with CHF.

Background There is a residual risk of coronary heart disease (CHD) despite intensive statin therapy for secondary prevention. The aim of this study was to investigate whether coronary plaque regression and stabilization are reinforced by the addition of eicosapentaenoic acid (EPA) to high-dose pitavastatin (PTV). Methods We enrolled 193 CHD patients who underwent percutaneous coronary intervention (PCI) in six hospitals. Patients were randomly allocated to the PTV group (PTV 4 mg/day, n = 96) or PTV/EPA group (PTV 4 mg/day and EPA 1800 mg/day, n = 97), and prospectively followed for 6–8 months. Coronary plaque volume and composition in nonstenting lesions were analyzed by integrated backscatter intravascular ultrasound (IB-IVUS). Results The PTV/EPA group showed a greater reduction in total atheroma volume compared to PTV group. IB-IVUS analyses revealed that lipid volume was significantly decreased during follow-up period in only PTV/EPA group. The efficacy of additional EPA therapy on lipid volume reduction was significantly higher in stable angina pectoris (SAP) patients compared to acute coronary syndrome patients. EPA/AA ratio was significantly improved in PTV/EPA group compared to PTV group. There was no significant difference in the incidence of major adverse cardiovascular events and side effects. Conclusions Combination EPA/PTV therapy significantly reduced coronary plaque volume compared to PTV therapy alone. Plaque stabilization was also reinforced by EPA/PTV therapy in particular SAP patients. The addition of EPA is a promising option to reduce residual CHD risk under intensive statin therapy.

SummaryUsing our “echo-dynamography”, blood flow structure and flow dynamics during ventricular systole were investigated in 10 normal volunteers. The velocity vector distribution demonstrated blood flow during ejection was laminar along the ventricular septum. The characteristic flow structure was observed in each cardiac phases, early, mid- and late systole and was generated depending on the wall dynamic events such as peristaltic squeezing, hinge-like movement of the mitral ring plane, bellows action of the ventricle and dimensional changes in the funnel shape of the basal part of the ventricle, which were disclosed macroscopically by using the new technology of high speed scanning echo-tomography and microscopically by the strain rate distribution measured by phase tracking method.The pump function was reflected on the changes in the flow structure represented by the flow axis line distribution and the acceleration along the flow axis line. The acceleration of the ejection had three modes, “A”, “B” and “C”, and generated by the wall dynamic events. “A” appeared from the apical to the outflow area along the main flow axis line, “B” along the anterior mitral leaflet and the branched flow axis line, and “C” generated by the high speed vortex behind the mitral valve. The magnitude of the acceleration was estimated quantitatively from the velocity gradient along the flow axis line. Macroscopic and microscopic asynchrony in the myocardial contraction and extension appeared systematically in the local part of the ventricular wall, which was helpful for making the flow structure and for performing the smooth pump function.

Background Although the deformability of the left ventricular (LV) wall appears to be important in maintaining effective cardiac performance, this has not been debated by anyone, probably owing to the difficulties of the investigation. Objectives This study applies a new technology to demonstrate how the LV wall deforms so as to adjust for optimum cardiac performance. Subjects and methods Ten healthy volunteers were the subjects. Using echo-dynamography, an analysis at the “microscopic” (muscle fiber) level was done by measuring the myocardial axial strain rate (aSR), while the “macroscopic” (muscle layer) level contraction-relaxation/extension (C-R/E) properties of the LV wall were analyzed using high frame rate 2D echocardiography. Results Deformability of the LV was classified into three types depending on the non-uniformity of both the C-R/E properties and the aSR distribution. “Basic” deformation (macroscopic): The apical posterior wall (PW) thickness change was concentric and monophasic, whereas it was eccentric and biphasic in the basal part. This deformation was large in the PW, but small in the interventricular septum (IVS). The elongation of the mitral ring diameter and the downward movement of its posterior part were shown to be concomitant with the anterior extrusion of the PW. “Combined” deformation (macroscopic and microscopic): This was observed when the basic deformation was coupled with the spatial aSR distribution. Three patterns were observed: (a) peristaltic; (b) bellows-like; and (c) pouch-like. “Integrated” deformation: This was the time serial aSR distribution coupled with the combined deformation, illustrating the rotary pump-like function. The deformability of the LV assigned to the apical part the control of pressure and to the basal part, flow volume. The IVS and the PW exhibited independent behavior. Conclusions The non-uniformity of both the aSR distribution and the macroscopic C-R/E property were the basic determinants of LV deformation. The apical and basal deformability was shared in LV mechanical function.

Background: Complicated aortic arch plaque (CAP) detected by transesophageal echocardiography (TEE) provides prognostic information regarding cerebrovascular disease risk. Coexistence of peripheral atherosclerotic disease worsens the prognosis in ischemic stroke patients. Methods: We examined TEE, carotid artery intima-media thickness (CIMT, calculated from carotid echograms), and ankle-brachial index (ABI, calculated from ankle/brachial blood pressure ratios) in 100 consecutive cerebral embolism patients within 2 weeks of onset of symptoms. CAP was defined as atherosclerotic plaque (≥4mm) or presence of ulcerated plaque assessed by TEE. Patients were classified into those with CAP (n=36, Group A) or without CAP (n=64, Group B). Results: Comparing patients in the two groups, significantly higher values were seen in Group A for age (69±8 vs. 63±11 years, p Conclusions: For non-invasive evaluation of patients with acute cerebral embolism, the combination of both ABI and CIMT predicts CAP more strongly than either ABI or CIMT considered alone, with higher figures for sensitivity, specificity, and positive and negative predictive value.

Background: Complicated aortic arch plaque (CAP) is important in recurrent ischemic stroke (IS) and prognosis. Keying on the reduced occurrence of IS observed in the large-cohort JUPITER Study, the current investigation assessed clinical benefits and pathophysiology of statin therapy. Methods: Of 112 consecutive acute cerebral embolism patients, 97 gave informed consent for our retrospective survey and were analyzed. All had transesophageal echocardiography (TEE) to assess presence or absence of CAP, defined as aortic wall thickness >4mm or plaque ulceration. Also assessed were aortic stiffness parameter β (Aoβ) and aortic arch wall motion velocity (WMV) evaluated by tissue Doppler imaging. Patients received appropriate conventional antithrombotic therapy as clinically indicated, and in addition we recommended that all patients with CAP receive 5 mg rosuvastatin/day. Patients were divided into 3 groups: those with CAP taking rosuvastatin (Group A, n=26, 68±7 years), those with CAP not taking rosuvastatin (Group B, n=13, 71±9 years), and those without CAP (Group C; n=58, 62±12 years). Follow-up TEE was performed at 6 months in Group A. In these 3 groups recurrent stroke and death were defined as major adverse cerebrovascular events (MACE). Results: Study duration was 710±405 days. CAP was detected in 39 patients (40%), and MACE occurred in 15 (15%). Kaplan-Meier analysis demonstrated that Group B had significantly higher MACE compare to other 2 groups (long-rank test; X2=6.553, p Conclusions: Rosuvastatin therapy causes plaque regression and improved aortic arch stiffness in IS patients with CAP, and may also have long-term clinical benefits.

Thin films of Al–Ni–Co alloy were produced by vacuum deposition technique using a substrate material of amorphous carbon thin-foil. Attempts were made to obtain a homogeneous decagonal quasicrystalline film, where the preparation technique was based on the direct evaporation of pre-alloyed ingot of Al 72 Ni 15 Co 13 onto the heated substrates. In order to explore early stages of the decagonal film growth, the Al–Ni–Co films with different thicknesses ranging from 2 nm to 30 nm were deposited on either substrates heated at 500 °C or non-heated substrates. The film samples so obtained were examined mainly by atomic force microscopy in combination with transmission electron diffraction and imaging techniques. On the basis of these observations, deposition conditions necessary for the growth of decagonal phase in the resulting films as well as the growth mechanism of the decagonal film will be discussed.

Dissolution patterns essential for Al–Co–Cu and Al–Co–Ni decagonal quasicrystals (d-QCs) have been investigated in detail by chemical etching using a HF–HNO3–H2O solution followed by scanning electron microscopy (SEM) observations. The chemical etching of definite surface areas of the samples, which are either normal or parallel to the tenfold axes, using a solution with HF–HNO3–H2O (1 : 5 : 4 in volume ratio; 0°C; 5–10 min), produces a large number of microfacet pits of decagonal prismatic shape. In addition, the same etching test in combination with SEM observations was carried out on a deformed sample of the Al–Co–Ni d-QC, which had been subjected to concentrated mechanical stress at an elevated temperature of 850°C by means of the Vickers indentation technique. The morphological features of the resulting micropits and their possible origins are discussed on the basis of results obtained by SEM observations.

Dissolution patterns caused by anodic etching of an Al–Pd–Mn icosahedral quasicrystal and chemical etching of an Al–Cu–Co decagonal quasicrystal were examined by optical and electron microscopy as well as by atomic force microscopy. Appropriate etching treatments of these quasicrystals, i.e. the anodic etching of the Al–Pd–Mn quasicrystal in a solution of CH 3 OH–HNO 3 , and the chemical etching of the Al–Cu–Co quasicrystal in a solution of HF–HNO 3 –H 2 O resulted in occurrence of dissolution patterns composed of a number of well-facetted micropits (and hillocks for the Al–Cu–Co alloy as well) on low-indexed surfaces of the specimens. The morphological features of these etch-figures are discussed in relation to the internal structural symmetries.

To evaluate left atrial appendage (LAA) dysfunction using left atrial pulse-wave tissue Doppler imaging (PW-TDI) in acute cerebral embolism (ACE) patients with sinus rhythm (SR), transthoracic (TTE) and transesophageal echocardiograhy (TEE) were performed in 60 consecutive patients with SR without obvious left ventricular dysfunction within 2 weeks after ACE. Two groups were identified: LAA dysfunction [LAA emptying peak flow velocity (LAA-eV)

Faceted micropits obtained by electrochemical etching of a single quasicrystal of an Al-Pd-Mn icosahedral phase have been examined by optical and electron microscopy. Anodic etching of the flat surface of a fivefold plane in a solution composed of CH3OH and HNO3(3:1 in volume ratio) reveals a variety of icosahedrally faceted micropits which originated from pre-existing microvoids and etch pits of pentagonal pyramid shape due to the other origins, probably structural defects inside the specimen. As the dissolution progresses, the micropits make successive changes in their shapes, ending in pentagonal pyramids before they vanish.

The shapes of micro-pits formed in an Al-Pd-Mn icosahedral quasicrystal have been examined by alternating sequence of electrochemical etching and scanning electron microscopy (SEM) observations. Anodic etching was executed on fivefold and twofold surfaces of the single-quasicrystal. Prolonged anodic etching in a solution of CH 3 OH + HNO 3 (volume ratio 3 : 1) followed by SEM observations has revealed that two different types of micro-pits, i.e. pre-existing micro-voids and electrochemical etch-pits, develop into the same regular shape. The micro-pits develop into a pentagonal pyramid on the fivefold surface, and a flat-bottomed rhombic pyramid on the twofold surface. It is shown that these two polyhedral etch-figures correspond to two different sections of a regular rhombic triacontahedron.

When (111) wafers of Te-doped GaP were etched in H 2 SO 4 + H 2 O 2 + H 2 O (5 : 1 : 1 in volume ratio) at a temperature above 70°C for a period longer than 3.6 x 10 3 s, abnormal etch pits of asymmetric shape formed on the (111) P surface in minor density compared to those of normal triangular pits and spiral pits. From microscopic observation, the abnormal pit had an etch beak projecting from its apex. In order to clarify the origin of abnormal etch pits, structural defects in the wafers were examined by transmission electron microscopy after thinning. As a result, they were classified into several types such as dislocations, dislocation loops, precipitates and lineage defects composed of a dislocation bundle. As the lineage defects often take such a peculiar configuration as a zigzag pattern, we suppose that the abnormal etch pit with a beak would nucleate owing to preferential dissolution along the lineage defect.

The technique of chemical polishing or electropolishing of n-GaP to obtain a flat (111) surface has not fully been developed. We examined the anodic etching behavior of the (111) surface of Te-doped GaP in aqueous KOH solution at room temperature under normal indoor illumination. The (111) surface became smooth microscopically by etching at a voltage above 24 V in 0.1-0.5 kmol/m 3 KOH. In addition, we have also demonstrated a novel method for revealing lattice defects in the crystal by anodic etching under specified conditions.

Background Elevated aortic stiffness determined by transesophageal echocardiography (TEE), and presence of complicated aortic plaque provide prognostic information about cerebrovascular disease risk. Recently, pulse-wave tissue Doppler imaging (PW-TDI) has offered a new technique for assessing aortic wall stiffness. Methods The following aortic long-axis view TEE measurements were carried out in 103 consecutive acute ischemic stroke patients and 72 controls (stroke-free patients requiring TEE for conditions such as atrial fibrillation and valvular heart disease): (a) PW-TDI motion velocities measured as expansion peak velocity during systole (Vs) and contraction peak velocity during diastole (Vd); (b) aortic arch stiffness parameter β (Aoβ), defined as β = ln (systolic blood pressure/diastolic blood pressure)/([Dmax − Dmin]/Dmin), where ln is the natural logarithm, Dmax is maximum aortic lumen diameter, and Dmin is minimum aortic lumen diameter. The PW-TDI of Vs and Vd was compared with conventional vessel parameters brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI, calculated from blood pressure and PWV). Results Comparing acute ischemic stroke patients versus controls, Vs and Vd were significantly decreased (3.3 ± 1.6 vs. 3.9 ± 2.0 cm/sec, P

ObjectivesUsing newly developed ultrasonic technology, we attempted to disclose the characteristics of the left ventricular (LV) contraction–extension (C–E) property, which has an important relationship to LV function.MethodsStrain rate (SR) distribution within the posterior wall and interventricular septum was microscopically measured with a high accuracy of 821μm in spatial resolution by using the phase difference tracking method. The subjects were 10 healthy men (aged 30–50 years).ResultsThe time course of the SR distribution disclosed the characteristic C–E property, i.e. the contraction started from the apex and propagated toward the base on one hand, and from the epicardial side toward the endocardial side on the other hand. Therefore, the contraction of one area and the extension of another area simultaneously appeared through nearly the whole cardiac cycle, with the contracting part positively extending the latter part and vice versa. The time course of these propagations gave rise to the peristalsis and the bellows action of the LV wall, and both contributed to effective LV function.The LV contraction started coinciding in time with the P wave of the electrocardiogram, and the cardiac cycle was composed of 4 phases, including 2 types of transitional phase, as well as the ejection phase and slow filling phase. The sum of the measurement time duration of either the contraction or the extension process occupied nearly equal duration in normal conditions.ConclusionThe newly developed ultrasonic technology revealed that the SR distribution was important in evaluating the C–E property of the LV myocardium. The harmonious succession of the 4 cardiac phases newly identified seemed to be helpful in understanding the mechanism to keep long-lasting pump function of the LV.

High rate deposition of Al (99.999% in purity) from dual sources of W-baskets was carried out onto NaCI crystals which were cleaved in air and heated at temperatures of 523 to 643 K in an ordinary high vacuum (2 x 10 -3 Pa). From a transmission electron microscopic observation, it was found that when deposited in thickness of 80 to 200 nm at a substrate temperature of 623 K the films grew continuously with island structure in (100) orientation. Moreover, (100) flat single-crystal films thicker than 200 nm often developed without containing islands and they usually included numerous dislocations. Most dislocations were come out from the films during heating to a high temperature above 873 K in the electron microscope.

An icosahedral Al 70 Pd 20 Mn 10 quasicrystal was etched under several etching conditions with solutions composed of HF and H2O plus HCl and/or HNO 3 . The formation of etch pits was examined closely by scanning electron microscopy and replica electron microscopy. When etched for 5 s at 293 K with the etchants of different compositions, the faceted pits were often observed except for a few exceptions. All those pits revealed the similar shape of pentagonal dodecahedron where the pentagonal faces were curved slightly near their corners and edges. By etching for 5 s with a solution of HF+HCl+H 2 O (1:3:5 in volume ratio), the average size of the pits decreased from 4.5 to 2.5 μm with an increase of etching temperature from 273 to 333 K, and the pentagonal faces tended to be flattened above 313 K. The pentagonal faces near the corners and edges of the pits became more curved and the average size remained unchanged (∼4.5 μm) with increasing etching time in the range of I and 20 s at a temperature of 293 K. By comparing the surfaces before and after etching at the same areas, it was concluded that the faceted pits originated from irregular small holes which pre-existed on the polished surface.

Simultaneous evaporation of Al (99.999% in purity) from dual sources of W baskets was carried out onto a surface of NaCl crystal cleaved in an ordinary high vacuum (10 -3 Pa), and the crystallinity of the deposited film was examined through a transmission electron microscope (TEM). The substrate temperature varied in the range from room temperature to 523 K during the preparation of Al films of thickness 100 nm. On the other hand, the deposition thickness was changed from 20 to 130 nm at a substrate temperature of 473 K. A continuous single-crystal film with the (111) plane of thickness more than 70 nm was obtained on a substrate heated to 473 K.

It was recently found that the electrochemical dissolution of an n-GaP (111) surface proceeded selectively or uniformly in an aqueous KOH solution, depending on an anodic high-voltage above ten volts. In the present study we report the formation of whiskers at dislocation sites of the n-GaP (111) surface that remain undissolved at an anodic voltage of 16 V in the 0.5 kmol·m−3 KOH solution.

Summary Background The existence as well as the exact genesis of left ventricular suction during rapid filling phase have been controversial. In the present study, we aimed at resolution of this problem using noninvasive and sophisticated ultrasonic methods. The clinical meaning was also documented. Methods Ten healthy male volunteers were examined by 2D echocardiography and echo-dynamography which enables us to obtain detailed instantaneous data of blood flow and wall motion simultaneously from the wide range of the left ventricle. The correlation of blood flow and wall motion was also studied. Results Rapid ventricular filling was divided into 2 phases which had different physiology. The early half (early rapid filling: ERF) showed the effect which was alike drawing a piston. This was proved by the shape of the velocity of inflow and the basal muscle contraction which actively assisted extension of the relaxed apical and central parts of the left ventricle, giving the negative pressure which causes the ventricular suction. The later half (late rapid filling: LRF) showed the turning of the fundamental flow and the squeezed basal part just like the sphincter in addition to the expansion of the apical and central portions of the left ventricle, and all of these cooperatively augmented the suction effect. Conclusion Ventricular suction does exist to help ventricular filling. Simultaneous appearance of the contraction in the basal part and the relaxation or extension in the apical part during the post-ejection transitional period was made to occur the suction in the LV. And it can be said that the suction appeared in the late stage of systole as the one of the serial systolic phenomena.

We observed melt-growth process of Bi and Sn thin films by in-situ transmission electron microscopy. After preparing the films with some specified orientations from bulk single crystals of Bi (99.9 and 99.9999 %) and Sn (99.999 %), we partially melted and regrew them by cooling at a nearly constant rate in an electron microscope. In the Bi films, a growing solid-liquid interface was observed to be concave toward melt more frequently than faceted. The movement of the curved interface was sensitive to small fluctuations of the falling temperature, while the faceted interface was insensitive. During the melt growth various crystal defects were introduced, and their density depends on the orientation, purity of films and the cooling condition. In the Sn films, a growing interface was always curved. The defects formed were confined to lineage defects, of which formation was not influenced by the cooling rate but by the film orientation.

The interaction between local myocardial motion and blood flow dynamics should be assessed to evaluate left ventricular pump function.The contour map of the absolute value of blood flow velocity in the left ventricle (LV) was drawn. The ridgeline of the contour was defined as the "flow axis line". LV wall motion was assessed by the tracing endocardial border in consecutive B-mode images and by myocardial tissue velocity distribution obtained by the optical flow method.The location of the main flow axis line was affected by the local myocardial movement in the short axis direction. The flow axis line method is superior to the previous investigations on two-dimensional blood flow analysis because it considered three-dimensional blood flow.The flow axis line represents not only intracardiac blood flow structure but also its interaction with the cardiac wall motion.

Circulatory maintenance with a left ventricular assist device (LVAD) alone during cardiac arrest until heart transplantation has been evaluated. To assess the effect on the autonomic nervous system, the sympathetic neurogram was analyzed by power spectrum and coherence function. LVAD were inserted between the left atrium and the descending aorta in seven adult mongrel dogs and ventricular fibrillation was induced electrically. Renal sympathetic nerve activity (RSNA) was detected by bipolar electrodes attached to the left renal sympathetic nerve. Values of squared coherence between the arterial pulse wave and RSNA were calculated. Under the condition of circulatory maintenance with only LVAD, coherence at the cardiac rhythm frequency was decreased, and coherence at the LVAD pumping rhythm frequency was increased. These results indicate that the arterial pulse wave observed during maintenance of the circulation with only LVAD contributed to the sympathetic neurogram.

La dissolution de la surface (111) de monocristaux de cuivre a ete etudiee en fonction de la concentration en agent oxydant (NH 4 ) 2 S 2 O 8 et en agent complexant NH 4 OH dans la solution de Young (NH 4 ) 2 S 2 O 8 -NH 4 OH-NH 4 Br lors d'une attaque d'une duree de 10s a la temperature de 280K.

We report a case of angiosarcoma of the right atrium presenting superior vena cava syndrome. The patient was a 61-year-old man. Echocardiography, CT and MRI revealed a tumor arising in the anterior wall of the right atrium. The tumor was hen-egg sized and unresectable because of the invasion of the pericardium, the right ventricular wall and the superior vena cava. An open biopsy and left brachiocephalic vein-right atrium bypass grafting were performed. The pathological diagnosis was angiosarcoma. The patient agreed to chemotherapy with docetaxel, which is known to be often effective against angiosarcoma of the scalp or face. After 5 courses of docetaxel administration (30 mg/m2 on day 1, 8 and 15 followed by 14 days. rest as one course), echocardiography and CT showed a remarkable tumor reduction, which was evaluated as a partial response. The chemotherapy was suspended for 8 months because of neutropenia and general fatigue as side effects of docetaxel. The administration of docetaxel was resumed and 4 courses were performed. The tumor, however, became resistant to docetaxel and formed metastatic involvements in the liver. Following treatments with paclitaxel, IL-2 and CPT-11 were ineffective for the primary tumor and liver metastases. He died of cardiac tamponade caused by massive hemorrhage into the pericardiac space from the tumor surface. He had long-term survival 31 months after the diagnosis. An effective treatment for cardiac angiosarcoma has not yet been established. Chemotherapy with docetaxel should be considered in the treatment of patients with cardiac angiosarcoma.

The case of a 57-year-old man, who had a brother suddenly died at 62 years of age, admitted to other hospital with palpitation. Because his Holter ECG showed non-sustained ventricular tachycardia, and ultrasound cardiography showed left ventricular hypertrophy with normal cardiac function, he was introduced to our hospital for further cardiac examination of hypertrophic cardiomyopathy. Although his coronary angiography showed no organic stenosis, and his magnetic resonance imaging demonstrated asymmetrical septal hypertrophy and delayed enhancement on inferolateral wall of left ventricle compatible with hypertrophic cardiomyopathy, his biopsied tissue from cardiac muscle revealed cardiac Fabry disease. He received enzyme replacement therapy after implantation of implantable cardioverter defibrillator (ICD) for primary prevention. After 7 months from implantation, he had an appropriate ICD therapy for sustained ventricular tachycardia. Primary prevention of ICD implantation for patients with Fabry disease has not been established, while some cases of cardiac Fabry disease show fatal ventricular tachyarrhythmia in their lives. Primary prevention of ICD could be a considerable therapeutic option in some patients with cardiac Fabry disease, especially who demonstrated a family history of sudden death or ventricular tachyarrhythmias.